tag:blogger.com,1999:blog-82001105501520246292024-02-20T17:13:36.503-05:00Hoodie DaysDan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.comBlogger97125tag:blogger.com,1999:blog-8200110550152024629.post-42699318386890907882016-10-30T09:38:00.000-04:002020-02-18T11:01:20.018-05:00How a Therapist Might Differ from Friends or Family I suppose that this next section could be attributed its own import or could be grouped with the them of "core rules," about which I have previously written. At this moment, I wish to afford it its own accord for no real reason other than not, at this time, interesting myself in the subject or theme previously mentioned.<br />
It is worth speaking about the difference between the station of the therapist and of friend or confidant. It is useful to have close characters whose opinion is trusted and whose advice sets future paths and current hearts more true. Were this enough for an outside element to not be needed, such factors and close friendship-based or familial relationships would prove enough for most people. Indeed, for some, this is true. Somehow, some lucky or clever people find a group of friend or are born into a circle of kin who so enrich them that someone like me is unneeded. I do think that this is not altogether normal (perhaps better said: usual), though I do have my own envy when I meet such a person.<br />
Allow me to put the question more plainly: What is it that requires a profession like mine to exist? What can I offer that a mother, father, sibling, or friend cannot? Why is it that these people cannot practice this ideal? Is this a thing that they can learn? Is it the core of "good therapy"? I hope to answer these questions and any others that enter my head during this scratching.<br />
I posit that the main difference between the two stations is willingness. Frequently, a family member or a friend will only go so far in digging down on a topic (possibly due to self-preservation, personal guilt (especially if that topic is perceived as having something to do with them), or even disinterest, depending on the definition/foundation of that relationship). A therapist's willingness can be based on any number of things, including worry or concern, monetary gain (their paycheck), academic curiosity, or even banking on the fact that they are the therapist and are therefore allowed to be more nosy than the normal person.<br />
It is important to note that the training of the therapist increases the usefulness of this willingness. Sure, parents can be just as willing to help their children, but do they have the specific psychotherapeutic experience that can make a deeper delve truly worthwhile (or even possible)? Therapists are trained (to some degree or another) to engage a client in such a way that encourages change or insight. A parent might, through sheer connection or willingness to discuss, pursue a problem right up to the door or portal of a good interpretation, but they most likely do not have the prowess to interpret (or perhaps their station disallows such a transaction). Does a friend understand the nuances of Freud, the clarity of Rogers, or the direct ideas of Ellis?<br />
We as therapists must be willing to engage a client in such a way that anything that is thrown at us is fair game. We have to be able to not say "no" to any request for insight or skill-building. Others stop; we do not. We want clients to reach resolution and following their paths to an end that requires mere analysis or concludes treatment. We follow them with a smile and encouragement. We are also the people who take hold of the shovel when the client is tired and dig deeper, hoping to retrieve more. Our title gives us the permission to do this.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-56798103912791534082016-08-24T21:45:00.000-04:002020-02-18T09:36:49.272-05:00Honesty and the Therapeutic Alliance I believe that I have written before on the subject of therapeutic relationship and its central nature in any therapeutic endeavor. Today, I am going to write about the crossover between therapeutic alliance and honesty.<br />
Honesty in therapy is, I think, a different topic. When I write about it, I am not necessarily writing about bluntness. Instead, I would rather discuss the use of honesty and its use/misuses right now. Honesty, I think, comes up very much when a clinician is asked questions. We are told/educated to be wary of questions. I don't disagree that some caution should be shown; I guess my main problem here is when you have an honest response, but it might be detrimental to therapy. Frequently, instead of answering the question, we choose to process it to hell and hope that the client forgets that he'she has a question. Heinz Kohut remarked at one point in his life that it is impolite not to answer a question.<br />
Not answering a question can inhibit a relationship because it can lead to an assumption of dishonesty, backfiring the processing response. Answering a question, even after some processing, can lead to a negative response, as well. A clinician does have to be careful, but to lie shows infidelity, to some degree, to the client. Processing out the reaction after the answer can very much strengthen the relationship.<br />
I guess one of the main things that I am trying to say here is that there is a direct relationship between honesty and the relationship. When one is strengthened (relationship), the other can grow. At the same time, the more one is honest, the stronger the relationship may grow. There is a balancing act that takes place here . . . one that is very essential to future work. If one is too honest (or blunt, I guess) too soon, he risks, in a real way, the suffering of the relationship. I guess that this is the clinical implication of bluntness. This might happen when a therapist is burnt out or when their empathy, for whatever reason, is low during a session. The phrase that pops up in my own head some days is: "Well, let me tell you what is going on here." This is the language of interpretation. The difficulty with this is knowing when <u>not</u> to "give the truth." We must, obviously, be as intelligent as possible about when we us such means.<br />
As previously mentioned, a counselor must be honest with his or her client, especially when answering questions. Malingering must be remembered as things that take away from the amount of data processing space between the two members. If an honest answer leads to some problem, as mentioned, it is appropriate to process the disconnect. It is very important here to remember that apologizing should only be used when a real misdemeanor has been committed. It should not be the go-to response. What does frequent apologizing do but attempt to push the relationship backwards in time with the unsaid understanding that that is bullshit. An apology, or a string of them, can only function as a weak "coping mechanism" for the relationship. Apologies aside, processing out the issue forward the meta-curriculum of honesty for the relationship. I have already been in situations where I have committed some unknown social slight, which led to a good lesson for me about cultural matters. Such a lesson could not have been learned without process willingnessDan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-9122111833454920192016-06-06T17:10:00.000-04:002020-02-17T21:35:09.464-05:00Core Rules of Therapy I have been thinking about the topic of core rules for therapy for some time. Perhaps better said: I have been thinking about core rules for how I do therapy for some time. There are definitely some principles that I think are at the very center of how I practice. What I hope to do is start an on-going group of entries that will serve to illustrate this idea.<br />
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<ol>
<li><b>Silence.</b> It is my understanding - both viewing my own experience and what I see from others - that clinicians always want to talk. For the beginning therapist, silence is scary, as it might show weakness or perhaps give the client and therapist a chance to think a problem through to an un-therapeutic end. Silence, when done correctly, can increase rapport between parties, because it allows the client to take charge of their own thoughts in an environment that might seem under the control of another party: the therapist. It also give the therapist, possibly, time to think. Some beginning therapists equate silence with incompetence; they end up saying something half thought-out than a thought of real worth. As we are in a profession that holds intent of action in the highest regard, does it not make sense to be able to think properly about a response that is appropriate, rather than electing to engage in a random jump of (il)logic?</li>
<li><b>Not everything is about you. </b>This can be meant in a couple of ways: 1) We can mean that the actions of the client have much less to do with us than we might think and 2) we might mean that we are in service to others in a session - not ourselves. Being myself, both of these sub-topics took some time for me to really internalize (if I even have) and I still need to remind myself of these lessons regularly. Let us go into the meaning behind the words. I will attempt the first hurdle. It is simple to be overreactive and hyper-vigilant in the beginning of our careers. We are attempting, I hope, in this time, to build up a bedrock of skills and techniques that will allow us to forge ourselves into the therapists who we wish to become. This leaves us open and vulnerable to others. As therapists, there are almost no peoples more important in opinion to us as our clients. Were a client to say: "You are a bad therapist," it would crush us. Whether that is a wholly helpful reaction or not is not my goal here. This bedrock that we have created has been cracked, allowing more doubt to leak in that is normal. Am I doing my job well? Is this the correct line of work for me? These are logical questions that we ask ourselves in this situation (well . . . as logical as the reaction as a whole can be). We fall into a classic blunder that we ask our clients not to enter: mind-reading. We attempt to exorcise thoughts from our clients' heads through mind-voodoo - that is, without actually asking. Were we to ask, a good conversation might result about the match between client and therapist or the events that transpired that pushed our client to say such a thing. Allow me to get away from the previous example and posit another: A client and therapist have a good session (in the therapist's estimation). The client does not present at his/her next session. The therapist might go back over the mental notes that he wrote to point to a reason. He might find no reason. Either way, the clinician is allowing an unknown to control his behavior, possibly impeding him from acting in therapeutically advisable manners to following clients. When the therapist asks the client over the phone about the situation, he learns that the client had a family emergency. A situation that, in reality had nothing to do with the clinician, had everything to do with him in his own mind. This shows real weakness or deficit or [insert non-offensive term here] that that clinician must analyze. The reason: Such a circumstance occurs frequently. The answer: address it, if possible, and if not, let it go. This, of course, comes from time and possibly outside therapy. This writer does want to mention that a pitfall occurs here for some people. I myself flirt with it from time to time, but not much (which will lead nicely into my second sub-topic in a moment). We must ensure that we do not trip into a lack of caring as an overreaction response to the too-much-caring that we previously felt. As previously mentioned in this work, moderation is normally the best option. It is of highest priority, when working with a client, to consider them. When I use the word "consider" here, I mean that we must consider all parts of them, including their words, body language, look that day . . . everything. To really consider someone requires one to see past themselves. I would like to say that I do not mean that the therapist should block himself off, but rather use his or her whole self as an antenna for the use of the client. </li>
</ol>
Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-14588336793327665962016-06-02T16:20:00.000-04:002016-10-28T16:21:02.945-04:00Compartmentalization (cont'd) and "Value Armor" After thinking a little more about compartmentalization, I can see one real advantage to it: it might lead to long-term resilience against clinician-side traumatic shock. If we can seal part of ourselves away from view (from both the damage done to use by a client's story and our own ideas about it), we might be more able to heal after a particularly deep shock. I am somewhat unconvinced though . . . As I tell my clients, were we extremely comfortable with ourselves, most of these traumas would bounce off of our "value armor" - that is, the natural defense anyone has who knows who they are, what they believe in, and what makes them a person. It is extremely difficult to penetrate such armor, but not impossible; even the most comfortable-with-himself/-herself person still requires patches and upgrades to their armor. Life provides us with many experiences that test our armor and it is our job to continually ensure that it can stand up to most outside incursions. Many people perform such maintenance on their own, while others require the help of a professional to repair their chinks. For these who can self-repair, only major dents need outside help in the form of a psychotherapist.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-60129169677409696002016-05-31T16:11:00.000-04:002016-10-28T16:12:46.582-04:00Compartmentalization In my continued attempt to question all things about therapy that I have learned (which is something that I think everyone in their chosen field really should do; such action brings innovation), I will now discuss the topic of compartmentalization - something all, if not most, therapists are told to engage in. The question for this entry is: Is engaging in compartmentalization beneficial to the relationship?<br />
Budding therapists are told that compartmentalization is key in therapy, as thoughts about one's own life might obstruct the work occurring in the session. Is this true? I'm not entirely convinced one way or the other. As with many such fundamental principles, we must take a look at why the "rule " was at first imposed. I see two ways of looking at this: 1) the Freudian method and 2) the everyman graduate school method. I must preface this specific talk with the warning that I am not a Freudian analyst nor a ghost mind-reader. Therefore I have not the training or the "skill" to claim what I will do. Nevertheless, I will still engage in such palaver, as this is my work and I'd like to see if/how my thoughts change the future. I'm thinking that Freud thought that any interference from the therapist is/was bad (hence his arcs into counter-transference). He wanted the client to be able to open up in any way they see fit in order to get to their own solution, rather than a solution that the therapist thinks is appropriate. This led to the stereotype of analysts' taciturn natures in therapy. I do give Freud much credit here because he is still one of the main forces behind a clinician looking into his/her own countertransference to engage their deep-seeded motivations. Unfortunately, in our effort to ensure that no countertransference exists, many therapists still do engage in a fear-oriented therapy that is more about them in the end than the client. The other way to look at this problem might be to engage it from a more modern and educational approach: How are current therapists taught (or not) to compartmentalize? I will only speak for myself in this section and what was explained to me in my own Master's-level training. As far as I can remember, we, as aspiring clinicians, were taught that whatever didn't begin in therapy room was to stay outside that room. I'm thinking that this might have been so stressed to future clinicians in order to assure that our own issues do not impede the work being done in session. Otherwise stated: We, as beginners, need to assure that the session is for the client, not for the clinician. This is a good point, but I do wonder how far this mantra should be taken.<br />
Now that I have explained some of the origins of this idea as I see it, the next step is to figure out what the helpful and the harmful aspects of compartmentalization actually are. Furthermore, who does it help or hinder to engage in such action? As with most "fundamental" issues such as this one, there is some give and take either way. I think that the positives (or helpful factors) in compartmentalization really do exist more for the young, or budding, therapist than for the elder, more experienced, one.<br />
It is, to some extent, a learned skill to block out personal issues in life. A therapist must be able to do this while in session - or a therapist must be able to disengage from therapy completely. This is where I think a critical argument one way or the other must be had. The former forces a therapist to cut off pieces of himself - not quite the "genuine person" that Rogers spoke of. On the other hand, to not cut some of it out might lead to the session being more about the clinician than the client. This can be useful if the meta-curriculum of that session is one where such a role reversal provides helpful insight to the client. This, alas, is a more senior technique and one that I'm not ready for yet. To be able to disengage from therapy completely is a luxury that many clinicians do not have, leading, possibly, to burnout or resentments of the job. There is much healing to be done in taking some time off to process such compartments created and figure out whether they are really needed anymore.<br />
As previously mentioned, I do laud Freud in his idea that researching one's own countertransference is very important. It can make a clinician better at his/her job. I do worry that compartmentalization takes us away from some of our more primal parts, leading to less data from which the therapist might work. I think that there is some merit to allowing some of the walls to drop and to permit the client's message to bounce around in some of the dark corners of the self. Sure, this might bring to the surface some very complex issues for the clinician and it is here that the clinician might start the compartmentalization process - understanding that they need to throw light upon that inner conflict at some other point. To an extent, leaving these compartments up might actually lead to stagnation in the self, in the client, and in the practice in general.<br />
As mentioned, if a client's pain resonates personally for the clinician, it is his/her job to undergo some kind of supervision or therapy to gain insight into that issue. This leads to personal growth, bringing things that were in the unconscious to the conscious to be played with and changed before allowing it to be re-submerged into the unconscious. We put that thought back in its place to change some of the other issues around it and to achieve wide-spread health. We also put that thought back into the unconscious because we can't hold it in the conscious for very long and doing so provides us with some measure of anxiety, as we add more to our plate than what we might be used to. Putting these barriers up might actually lead to a lack of means to more productive advancement.<br />
One main reason why a therapist exists is as a sounding board for the client's thoughts. I always visualize this in my mind as a literal board on which clients throw their concerns. It seems to me that compartmentalizing actually decreases the surface area of this board, allowing for more good material to pass a clinician by. As mentioned, we put ourselves out there to feel with the client. In order for this mutual feeling to occur, there must be much to fasten onto, whether that is the lighter or darker parts of ourselves. I think that it is sometimes the darker parts of ourselves that resonate the most with clients. If we don't allow ourselves to be open with clients, then there is really minimal space for the therapeutic relationship to thrive and heal. I can see how a teaching program might push compartmentalization in that, were they to teach the radical openness that I am quasi-advocating for, a fresh student might take the lesson too far and over-share or not temper their sharing with experience or reason (the former of which they have minimal or none).<br />
This brings me to talk a little about openness in therapy. It seems to me that there is a culture of lack of openness. It could have something to do with the ideas previously mentioned or more cultural/societal fears of liability and judgment that might come of self-disclosure. We must always temper such fears with the assessment of our clients' wellbeing.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-21560506687516460152016-05-16T21:50:00.000-04:002016-10-27T21:52:15.888-04:00Client Responsibilities A very good book idea might be one where I outline not the process of therapy, but rather the responsibilities and right of the therapee. Expectations of therapy would be vital. I would talk about stages of therapy, but constantly re-inform the reader that they must ask their therapist questions. Asking questions to and of the therapist is a client's best tool. It allows a client to shield themselves from counter-transference; it allows a client to gain more understanding of themselves - something crucial in practice; it allows the client to increase their knowledge of the clinician in such a way to increase the bond between these two disparate points.<br />
I think that a client must be told that his/her self is the most powerful force in the therapeutic alliance. A clinician receives and reflects only; that is, a good clinician receives or reflects with very minimal else. The clinician and the client do work together; the clinician does not do work in spite of the client. This is called psychoeducation and is not true therapy.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-7719283087953551752016-04-18T21:38:00.000-04:002016-10-27T21:39:01.028-04:00Appropriate Emotional Investment It is important for a clinician to be emotionally interested, but not emotionally invested in his or her clients. There is an important distinction here that must be mentioned in order to further the point. A clinician who is emotionally invested in clients ties a string to clients' development, taking themselves along for a ride, which depends upon someone else's motivation. This, of course, brings up many issues regarding boundaries between clinician and client. A clinician does not want to be at the mercy of the client; this might cause ripples to be felt throughout that therapist's whole practice. The opposite end is where the emotionally cut-off clinician practices - a place that does not necessarily engender good therapy and creates (possible on purpose on some level) no emotional connection or attachment with the clinician. This, just like the opposite end, can lead to echoes into other therapy sessions. So what does the middle look like? And why am I so afraid of the extremes? And how have I seen myself going into either extreme?<br />
Betwixt these two extremes, a clinician finds the land of emotional interest without emotional investment or dependence. This is a space where the clinician is comfortable with being present and appropriately emotional/empathetic with the client without allowing his or her personal life to bleed through into the session (non-therapeutically). To some degree, I think that it takes time to find this balance.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-14335734902086361022016-04-15T21:19:00.000-04:002016-10-27T21:25:02.361-04:00Arguing Against Progress There are many things that I am afraid of - one of the more curricular ones is the quasi-inevitable heath-death of this field. Sarcasm and hyperbole aside, the lack of forward development in the field is of huge concern. What does a lack of change really mean? It means that the answers have been found and/or no one cares anymore. A good parallel is language: language develops until another is created from its ruin or something better or more efficient takes its place. I do worry about this because I don't see as many people asking the important questions in the field and engaging in deep introspection and supervision, in order to develop themselves. This baffles and hurts me. Without each member of our field asking questions that further themselves and the field as a whole, we will stagnate and possibly start to see what we have already accomplished as enough. This would surely be the death of the field. As our culture, society, and clientele change, so must we. One could say that culture, society, and clientele will always be changing, so the field will as well. The added component here must be pride. Man is full of pride (and laziness) in his work, wanting the effect to stop when homeostasis is reached. It is important to never feel lazy in this fight. To some degree, there should always be someone who is the nay-sayer or the devil's advocate; someone who is ready to push the envelope, point out the weaknesses, or instill doubt. One could almost say that we are not looking for a Unified Theory (as this would surely mean the end of the field), but rather the continued dialogue and struggle to find that within ourselves that helps another - and surely each of us can contribute something (a lesson, perhaps) that is wholly our own, wholly subjective.<br />
To argue is to seek continued survival; to find perfection is to encourage death. This is odd, in that one could think that I am purposefully undermining a perfect theory - but that is the exact problem: there is no perfect theory! We each must continually question how we practice in order to be better ourselves.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-71463848949620620242016-04-15T13:49:00.000-04:002016-10-21T13:49:44.650-04:00Teaching Theories and Basic Skills I still have some major internal conflict on the topic of teaching theories to therapists. I'm still unsure of whether it is a good idea or not. I think that the main counseling skills of true active listening, empathy, reactive choices (interpretations, reflections, minimal urges, etc.), and appropriate self-disclosure. Of course, some of these skills come easier to some student of the field versus others. This should be monitored, as we do not want to continue teaching the expert. I'm starting to think that some mastery of these skills should be shown before moving on to deeper theories of the field. To put this whole paragraph a different way: While theoretical orientation is of high impact, it should not be taught before the basic elements of the craft are honed in the budding clinician.<br />
Theories are all well and good (and I will get to these parts in a moment), but they do not fulfill the needs of the therapeutic dyad that the basic counseling skills do in full. A therapist without active listening is deaf; a therapist without empathy is cold and uncaring; a therapist without correct reactions is ineffective; and a therapist without a personal and semi-transparent identity is not a true person, but a cheap mask. No amount of theoretical knowledge will help that therapist - he or she is not a researcher, an occupation where warmth, though encouraged, is not vital. Simply being intelligent in theory might increase the positive content of the message, but as every good therapist knows, how a message is conveyed is not of secondary importance.<br />
While it might seem as if I am bashing theories, allow me to be the first to quash this idea. Theories provide us with important information about what might be going on behind the eyes of a client. They also inform us as to what reaction might be appropriate for the clinician and the client. It must also be said that the basic counseling skills can be learned, and even monitored, by anyone, without the necessary education that therapists undergo. The layman is, of course, capable of reading any text that a budding or expert therapist might, but I would say (hesitantly) that the layman is not able to understand the implications of the text without the same education. This is, to some small degree, what separates the therapist from the natural-born thinker.<br />
It would be very difficult to measure the ability of trainees in the basic counseling skills. Observers would need to be use, in order to grade trainees in real interactions with clients. Pen-and-paper exams would be useless here. This would further push the impact of professors and instructors in their job as gatekeeper for the field. Were they to observe a student who shows no aptitude in these basic skills, they would need to take action for the sake of their university's program and, more importantly, to keep the bar set high for incoming professional therapists.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-7829577770499773722016-03-19T13:11:00.000-04:002016-10-21T13:12:04.610-04:00Answers Sometimes I have to laugh at my own ego. I think that I have the answer to other people's problems - that somehow the books I read have an answer to their troubles. Sure, that information can give some insight into the general, the objective, the well-known, but can anything written in these tomes get to the core of the person? Said otherwise: Might the presentation of a book help a client through their concern? This has, of course, occurred; how else would bibliotherapy be seen as a viable sub-theme of psychotherapy? Of course, people have also found inspiration in books. But inspiration is much different than true insight. Insight requires the addition of a second person who shares goals, but does not share eyes. In this way, therapy is more about communication and undersanding that it is the knowledge gleaned in a classroom. Such knowledge is a frame while listening and understanding is the beautiful painting housed within. Which is the real art? Which took more effort and understanding? That is a difficult question - one that causes science and art to become at odds. I do not, at this time, endeavor to belittle either in favor of the other. Instead, should not the pairing be celebrated?Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-91927906969730639382016-03-07T16:54:00.000-05:002016-10-13T16:54:30.853-04:00What is the Highest Ideal? I do wonder . . . what do we want for our clients? Many therapists might say peace; many might say stability; others could say health. Some therapists push their clients toward that ever-elusive Maslowian self-actualization. I do wonder whether that might be a too-lofty goal. Of course, I'm not saying that self-actualization is not a relevant goal worth seeking. What I am trying to critique is the probability of a client, or even anyone, to reach this goal. Even Maslow commented on the low probability of this end. For the everyman, then, what is the end goal? It can't be a self-actualization. Why not happiness? Is that not enough?<br />
Most people, I would say, want a sense of happiness. What this means for them depends very mcuh ont heir personality, so I will not break happiness down into component parts. Is it wise for a therpaist to ask a client if they are happy? For many clients, the answer is most likely yes; I do, though, want to push some hesitation on the budding therapist to think about their client before asking, as happiness itself might be an unattainable ideal to them.<br />
A good example of this might be a client in current crisis or one with significant traumatic background. That client, most likely, is not interested in developing themselves in that manner, but rather is looking for an alleviation of their current negative symptoms. Asking an idealistic question (for that is what a query about happiness is), can be almost a slap in the face. A client might think that the clinician is not listening to them.<br />
Viktor Frankl, in an article or book (I can't remember which), mentioned that happiness is not the most proper ideal that man can aspire to. The interesting thing to me is not that he talks about meaningfulness being a more proper ideal, but rather that he mentioned happiness altogether. I'm wondering whether he would think that meaning lays on the path to happiness or vice versa. Differently said: Does having purpose bring one happiness or does happiness generally cause one to gain purpose? Did Frankl think, perhaps, that happiness is off the table because meaningfulness is a logical step to be gained first - and perhaps can only organically arise through the search for and attainment of purpose? Are there truly happy people who do not have purpose in their lives?Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-57621348328483021702016-02-26T16:38:00.000-05:002016-10-10T16:38:43.971-04:00Truth in Therapy I have, perhaps, discussed this topic before, but I think that it is of almost paramount importance. Today's topic is about the correctness of talking about truth with a client. I bring this topic up, at least at first, because, when interpreting, or even reflecting, a client's words/self, some reflections or interpretations, while true, can also be somewhat damaging to a client. The question here is one of the pragmatism or idealism: Does a therapist spare the client some anxiety (possibly undue) and reflect a different topic back to a client; or does the clinician instead tell the whole truth to the client, because, perhaps, it is his or her job to uncover what is hidden, even if the process of uncovering the treasure beneath is somewhat sullied?<br />
There are arguments for, and against, each topic here, which I hope to detail presently. There are also moderate approaches to each that are important to mention that might be more digestible for those more interested in that type of thing. A third, and possibly the last remark that I will make today on this subject, has more to do with the type of therapist that would choose each and answer to this question. The difficult part of this (and indeed all of these writings), is that these are opinions, penned by a man-boy who knows little to nothing on the subject yet.<br />
So, I guess the first question here has mainly to do with the truth. Why would the truth be beneficial for a client? This is a deeper question than what might be seen at first. Truth unto itself sheds all pretense at flippancy, sarcasm, charm, wit, and lie. It is without any type of cover. Such as it is, the truth can either "set you free" or very much mire one under a burden of personal guilt or responsibility. The therapist very much needs to understand the client and the situation. Perhaps that is more for another section . . . There are definitely those therapists who see themselves as truth-bringers - people who are there to say what needs to be said and damn the rest. there is some respect to be granted to these individuals, yet some appropriate caution to be taken, as well. The caution is relatively self-explanatory. The clinician who brings up the truth lays the client bare before himself/herself. He takes minimal responsibility, then, for the resulting actions. Telling the truth should lead to increased normal anxiety in a client. Anxiety is a flag to anyone that change must occur. Heightened anxiety is unstable and uncomfortable, pushing a client to make some kind of change in his or her life to vent some of that feeling away. It is a good idea for this change to be discussed in therapy (and, really, what good therapist wouldn't explore this?), though sometimes it isn't for purely administrative and physical reasons. It is here when the clinician's responsibility ends to some degree. Actually making a positive change is available to most clients and should be acted on. Some clients choose, though, to make negative changes, frequently self-harm, other-harm, homicide, or suicide. These are concepts that any good clinician is afraid of. Many therapists are afraid, I think that a good truth-related statement will be taken the wrong way and lead to those negative results. I think that the key here is to follow up that statements with something, especially if it could be a statement that shakes the core of the client. Such a follow-up could be anything, depending very much on how that clinician operates normally. Personally, I would suggest processing out the truth statement.<br />
I believe that I have delineated (though not amazingly well) the positives and negatives of using truth in a session. The next question to answer is: How do I integrate this into my practice? This is a good question and one whose answer must be enacted with tact. Obviously, having a practice where one "spits the truth" will be one with fierce opponents as well as very loyal clientele. While controversy is not always horrible, I think that most clinicians would oppose such a practice, even for the sheer stress level. So how does the average clinician add naked truths into their practice? This is a difficult question. I think that a lot of the question as to how honest and how often to be so honest depends very much on the quality of the relationship. In grad school, we are told that the relationship is an amazingly important thing. Why? We leverage much against it. There are very few relationships in someone's life that require the type of thought that the relationship between the therapist and the client requires. We ask clients to bear their soul; we ask clients to talk to uninhabited chairs; we tell clients their way of thinking about a problem in unintelligent. What is the fuel for this change? The relationship! Without such a bedrock of trust, there would be no reason for the client to engage in these farces. How does one include stark honesty and truth into the relationship? One has to build the relationship and hope that that connection is enough to continue after the trauma of truth. There's much more to this, but perhaps I will save it for another entry.<br />
I read a very good book that I would recommend to any therapist called <i>The Schopenhauer Cure</i> by Irvin Yalom. One of the many qualities of this text that I admire is its characters. Sure, it has a good therapist or two, but it also has a philosopher therapist. This is the type of therapist that can give out only truth. A true "non-philosopher therapist cannot act as such (and be considered a "normal" therapist). One thing that makes a good therapist is the ability to explain and be softer in their words. To a degree, this whole discussion is somewhat moot, as a therapist deals with much subjective truth, but must be able to communicate it in a way that is understandable and easier to swallow than either subjective or existential truths being forced on someone. So, perhaps better said, therapy is all about truth anyway. The therapist needs to communicate the truth effectively, though soft enough that it doesn't send the client into some kind of existential funk.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-29828904105616522852016-01-17T15:39:00.000-05:002016-10-10T15:40:04.254-04:00The Evolution of Psychotherapy I've been researching CBT a lot recently. I'm seeing more and more that it is a good hook into a client. For many clients, running into insight-based therapy is a bit too much too early. CBT, in this case, can be good. I'm reading Judith Beck's seminal work on CBT, which I am finding to be very accessible and am learning quite a lot. I like how she talks about the core beliefs, especially.<br />
Anyway, I had a thought relatively recently that confuses me a bit. We see knowledge, to some degree, as a river. The beginning of this river yields less complete ideas. Over time, these ideas become more refined, more "correct." We learn to take the critique on original knowledge as new knowledge. This new knowledge is then critiqued and seen as innovation and the "better way to go about it." I have left the river metaphor behind, but I think that I have illustrated my thought satisfactorily. Taking this idea to my field's end, one could say that the culmination, at this point in time, of the field's knowledge is indeed cognitive behavior therapy. Would it not, then, make sense to study this practice and use it?<br />
The answer, as usual, is neither yes or no. It is a mixture. Obviously, using some CBT is quite advantageous. As mentioned over and over in this text, it quite depends on the client (as well as the clinician). It is relatively easy to learn and is easily used.<br />
There are obvious nos to the debate as well - many of which I have already elaborated upon and feel no need to repeat. I do think that the previous thought of evoluation of psychotherapy as one river is perhapse incorrect - or ther emight be a different visualization needed. I like to use the word evolution because I do think that it is a good way to describe it. Just like in evolution, there are offshoots to a central line (and then more offshoots . . . and then more). Allow me to illustrate:<br />
<br />
The River Concept<br />
<br />
Psychoanalysis -> Behaviorism -> Humanistic/Existential -> CBT<br />
<br />
The Evolution Concept*<br />
REBT -><br />
Behaviorism -> <br />
CBT -> DBT -><br />
Psychoanalysis -> Existential -><br />
Humanistic -><br />
Gestalt -><br />
<br />
I'm not quite of the mind to go into a whole account of the evolution of the field. I will say, though, that even the evolution concept, as seen by Darwin, might not be 100% accurate. The main addition (and change) that must be made here is that each theory not only creates off shoots, it also comes back into the center an affects the whole (or core) of aggregate theory. I think that this core could be described as common factors in that it is very basic and relatively agreed upon that most clinicians should practice in this way, at least minimally.<br />
With this in mind, as well as my previous point of every theory in turn re-affecting the core approach to therapy, one might come to the conclusion that there are still more therapies to be imagined. CBT takes an odd place in the model (it is definitely an offshoot theory, in my opinion) as it comes not mainly from the core theory, but more from a behavioristic approach.<br />
<br />
*We must understand (because it is illustrated so horribly here) that there are arrows pointing off from each theory (e.g. behaviorism, CBT, existential, etc.) to show that there is further change to be done within each area.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-34265787422875534102016-01-09T13:22:00.000-05:002016-10-10T13:23:32.402-04:00Pulling Back That Curtain How much should a clinician tell a client about their care? Is it worth it (for the client) to lete them in on some of the behind-the-curtain goings-on of their counseling treatment? This is a difficult question and, like most of my queries, has no straight answer. It depends much on the client and if the clinician has chained himself or herself to an orientation.<br />
I'm trying to figure out if intelligent - that is, naturally more cognitively gifted - clients would benefit from such action. I can see it a couple of different ways. I can very easily see that opening up to clients can short-circuit the practice. Seeing where the clinician is coming from and revealing our "tricks" for what they are can cheapen the experience. It can make a clinician seem like some kind of scientist, charlatan, or mystic, depending on how they practice and the client's perspective. Taking a client further down the road without explaining the process might push the client further than needed at that moment. Showing the client the process, on the other hand, might also help them further along.<br />
Some theories, like CBT, to a certain degree, are less mystified and more operationalized. For a very intelligent client, the steps can be learned (and, in that theory, they are even taught). So, in this this theory, such a practice of foresight and explanation is good. But in general . . . are there positive? There could be! A client could be self-healing. We all dream of (or fear) that client that can help themselves. I would say that such a "clinical intervention" is less rote technique and more psychoeduction (which is less taxing on the clinician and also less satisfying to me, for some reason).<br />
I must say . . . rolling back the curtain could lead to two negative business practices. First, the client could go nowhere in therapy and quite; they could also drum up bad reviews. The other negative side - and I find this to be morally, ethically, and personally reprehensible - is that increasing the speed of a client's recovery decreases the business from that client. I don't like thinking that way, but, alas, I did. May Science have mercy on my soul. I will say, though, that increased client recovery can lead to better reviews and better business down the line.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-74231864014394798532016-01-02T10:22:00.000-05:002016-10-07T10:22:21.172-04:00Action in Therapy I have come to the conclusion that action in therapy is scary to me. I would much rather not be responsible for other people's actions, which I am most logically not. But, were I to suggest a course of action and then were that to lead to some negative action, I would most assuredly feel badly. This has pushed me to take a very inactive approach to therapy of late. With this, I have been feeling very ineffective. That, though is important: How effective am I being in the therapy room? Effectiveness can be measured in many ways, but I think that one very important way to measure its opposite - ineffectiveness - is to check the activity of the therapist.<br />
I have been sequestering myself to a type of therapy involving minimal reflections, interpretations, or advice-giving. I am still of the opinion that advice is pretty much shit, but it must sometimes be given, depending on the client at hand. Unfortunately, some clients need to be told what to do. Perhaps a reason why I was scared (which is the correct word) to really do things is because I was afraid of being responsible for others' care and wellbeing. I was scared that a stray word from me could push a client to some kind of excessive negative behavior. While this is a possibility, of curse, it is a bit extreme. I was also afraid that an imperfect person should not be able/is not suitable to guide a client in self-development.<br />
I can't say that my outlook has changed much, but, at least at this point, I am trying to rectify the symptoms by learning more skills-based therapies to help to decrease the immediate suffering of the client.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-79142189908319575162015-12-22T16:53:00.000-05:002016-10-10T13:27:30.671-04:00Theoretical Orientation Research I would like to take a little time to write some about a research project I would like to undergo. This research has to do with the selection of a theoretical orientation. The aim of the research is to find out whether there is any statistical relationship between personality type and theoretical orientation. I would like to add in a questionnaire about when field clinicians think they chose their orientation and whether they have experienced any changes in their orientations throughout their careers.<br />
The tools to be used here are manifold. There is a good theoretical orientation sorter out there that I have use in the past call Selective Theory Sorter - Revised. It is from a book by the name of <i>Developing Your Theoretical Orientation in Counseling and Psychotherapy</i>. This tool asks the user questions and grades their reactions, in the end giving them a numerical output for twelve well-known theories for further research.<br />
The next tool is a shortened version of the Myers-Briggs test call the Myers-Briggs Preference Sorter. This tool is much shorter than the Myers-Briggs and can be taken in about ten minutes, rather than the multiple-hour exam that is the normal evaluation.<br />
The third part to this study would be a questionnaire for both current students and professionals. This questionnaire, which I hope to elaborate on later, has demographic questions as well as questions about their current place of work/study and their own ideas about theoretical orientation.<br />
There are some limitations of these tools that must be mentioned. The first is that both of the non-questionnaire tools are short. I have less confidence in the Myers-Briggs Sorter than I do the other, as the former as a long and much more version. The theories sorter is mildly concerning, as the book in which the sorter finds itself has other ways to find one's clinical orientation.<br />
I would like to more succinctly detail the reason for this study. I am testing the relationship between personality and theoretical orientation. I am not wanting subject to take only the Myers-Briggs test or the orientation sorter, as, independently, these tests mean nothing. Were I to just give out the Sorter, I would only be gather information on this population's theoretical preference (which are not necessarily generalizable). On the other hand, giving out the personality test would at least give some kind of viewpoint as to common personalities of budding and established therapists. Doing both hopefully will connect not just personality type to therapy (which has already been done), but rather personality type to a specific theory. This might aid in decreasing search time for budding counselors or at least some possible borders for research after mastering basic counseling techniques.<br />
As far as questionnaire questions are concerned, here are some:<br />
<br />
<ul>
<li>Name</li>
<li>Credential/License information</li>
<li>Number of years in the field</li>
<li>Level of schooling achieved</li>
<li>Current theoretical orientation</li>
<li>Previous theoretical orientations</li>
<li>Is your current TO based in your current area of work?</li>
<li>Current area/type of work?</li>
<li>Do you ind TO important in your work?</li>
<li>Did you start out practicing a certain method/theory and go on to change your desired theory (1), alter how you practiced the first method/theory (2), or add additional skills/techniques/theories to become more "eclectic" (3)?</li>
<li>Did your clinical educational program adopt a theoretical orientation that was then taught to all students? - or - Was your education more generalist, in that you were presented with multiple theories and then recommended to choose one?</li>
</ul>
Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-47373770876484339342015-12-21T11:55:00.000-05:002016-10-06T11:56:17.769-04:00Counselor Versus Therapist I have written before about the difference between counseling and therapy/psychotherapy. A similar question is What is the difference between a counselor and a therapist? While I think that one is still more developed (or higher) than the other - specifically that being a therapist is higher than a counselor - my reasoning for the difference between the two are different. I don't know if my new reasoning is correct - perhaps that is why I am writing all this down. My thought has to do with level of training and how a clinician practices. Could it be that a therapist is an experienced counselor (perhaps of a couple of years) who has created their own, or implemented an existing theoretical orientation that increases the effectiveness of therapy.<br />
I have raged against the need for implementation of theoretical orientation in the past. I still don't think that theoretical orientations are the most important things in therapy, but they do have their place. It is important here to discuss when to implement a theoretical orientation and to what degree. A counselor should stay a counselor for a significant time, studying theories of course, but primarily practicing the basic skills of counseling that provide a positive bedrock off of which to build a theoretical orientation. Echoing what I have said in previous entries, my opinion on this subject is that every clinician should review much relevant literature and then create their own orientation that works for them. The "when" is a difficult question here. When does a counselor graduate to therapist? Who graduates them? How does the counselor know that he or she is ready?<br />
These are amazingly challenging questions, for sure. I am not sure that there are absolute answers to these, but I will still give it a shot. A counselor, as said, should be constantly researching different theories and techniques. Perhaps the moment when a counselor becomes a therapist is when he or she becomes so comfortable with the base counseling skills that he or she hits a ceiling in practice or that they feel stuck where they are. At this point, the logical response is to change something. Sometimes, the change is to review the basic counseling techniques (like Rogerian/client-centered therapy or motivational interviewing, if one bends that way). Sometimes, the change is to add more: in this case, we would add theoretical techniques more strongly into therapy.<br />
Such a graduation comes about in different time periods. Different clinicians take different amount of times to do things. This does not necessarily mean that one clinician is better than another, because he or she takes less/more time to learn things; I think the opposite might be the case, as frequently the clinician who pushes the learning process learns less.<br />
It is important for the budding therapist to gain supervision when creating and implementing his/her own therapy. In my opinion, a serious therapist should show proof of their learning through writing or reading texts. Just because a therapist thinks that something is a good idea doesn't mean that it is. Generally, if a clinician finds something in the literature, especially seminal literature, normally that is OK to use right out of the bag.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-14614204546329272602015-12-16T17:56:00.000-05:002016-10-02T17:56:46.745-04:00What Is the Role of a Therapist? Why go to therapy? What do you hope to achieve? Why can't we just do therapy by ourselves? What function does the therapist serve? Why can't a person just talk themselves into a better state? Why can't they talk to their mother, friend, or a stranger and be in a better state? What about a real therapeutic encounter helps people? Again: What is the role of the therapist?<br />
To some degree, I see the therapist as a "nudger." In a perfect therapeutic situation, the therapist's job is to course correct with the client, identifying negative behaviors, thoughts, and expressions with the client and discussing more positive behavior. Instead of giving advice, the clinician is tasked with taking information given, evaluating it with the client, and coming to a good conclusion as to its validity and place in the client's life.<br />
The therapist provides outside perspective. That is one of the main reasons to go to therapy. As such, a therapist must ensure that he or she is very unbiased. While we have previously thought that children are tabula rasa, in this case, it is the therapist who must shut off his or her previous actions and become a reflective surface, on which the client might see the person they are and make corrections needed.<br />
I think that I have said this before, but part of the significance of the therapeutic encounter is the setting in which it occurs. Just as the therapist must be ultimately objectively subjective, the space in which therapy finds itself should allow for minimal distractions or means for negative transference. Some decoration, or course, is needed, but not so much that the client thinks that he or she is impeding on someone else's territory. That said, I don't think it horrible for the clinician to provide some kind of backsplash on which a client might throw their personal dirt. That is having some objects in the room(s) that create conversation might push deeper understanding on both sides.<br />
A note that I would like to make is to say that therapists do not say what is correct and what is incorrect. That decision is fully on the client's shoulders. It is the clinician's role to help the client to figure out what is correct and incorrect of them. Of course there is an objective right and wrong and the hope is that a client's subjective right and wrong are similar. When the two are strikingly dissimilar, coordination between the two parties must occur, sometimes requiring a more directive or psychoeducational session on norms of right and wrong, consequences on actions, or a very MI-based discussion on ideas behind these thoughts.<br />
Were someone to say that a therapist is a guide, I would not wholly disagree with them, but rather ask them to qualify the parameters of the word. That is a therapist is a guide to a person's inner self, not a guide to the outside world. That latter work is the work of a skill-builder specialist. A therapist's bread and butter are a person's inner-most ideas, motivations, feelings, and thoughts. Frequently, a person's own self gets in the way of their path forward and it is the therapist's job to help a client to figure out the possible paths and then their choices. They are not a guide in that the therapist does not do much (if anything) for or to preempt the client.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-2695381462057536392015-12-15T17:22:00.000-05:002016-10-02T17:25:21.008-04:00Some Clinician Responsibilities I've been thinking a lot recently about why therapy works (or doesn't) and what each individual's role is in therapy. I've also been thinking about how to ensure that individual knows what their role is and how to address the situation in the moment.<br />
A good therapy session requires a good therapeutic relationship. This almost goes without saying, but I think that it continues to be a statement that must be reiterated from time to time for personal clarification. I don't want to go into this subject, as I have talked about it earlier. I do think that both sides have certain roles that need to be present and acted-out for the session to be called a success. Upon writing this, I am thinking that the last sentence was somewhat directive. I do not want to continue that thread, as all I am saying is that there are certain things to do and certain things not to do in therapy on both sides. I guess the first thing to say here is that each side has certain roles to fulfill that will increase the chances of a good therapeutic effect.<br />
So what are these rules, roles, or obligations? I would like to start to talk about this topic on the side of the clinician, as that is where I am currently. What are the clinician's responsibilities? I ask the question because I am looking around me and seeing multiple avenues of practice. Some of these avenues are directive, others are not so directive. It is my view that a clinician is not necessarily a teacher. A clinician is more a guide. As such, a clinician is not present to instruct the client on what to do, but is rather there to help sift through all probably options with the client and create an atmosphere in which a client can come to their own conclusion as to their course of action. It is not the place of the clinician to add new knowledge to a client (normally), because I think that many clients already have an over-abundance of information, which can lead to their anxiety or depression.<br />
It must be said that sometimes teaching must occur. Some clients do not have a set of skills or an understanding of their situation that is helpful. In this case, it is more the how of the teaching that is the key to the situation, rather than the why. Giving a client options is a very good way for them to learn positive skills. Better said: Giving a client a buffet of choices will lead to hearty discussion about the positives and negatives of each option, why the client chose a certain option, the evaluation of that option with the help of the clinician, and a creation of a plan to implement that skill, if desired.<br />
The client gains much when a therapist does not choose their path for them. They learn the skill of decision-making and some self-confidence. Understand that a client will want to engage in a path/plan that they have created themselves. It means more to them (hopefully), thus making them adhere to it more than if it were created by the clinician. When a client creates some path, it is the therapist's job to help the client to ensure that the path is going to a positive place, that the end result is a therapeutic one. A path, being made out of stones or objects of some kind, should be examined by both members. Each stepping stone is another sub-goal or experience that must be processed by both members. It is the client's place to attempt to process; it is the clinician's place to encourage such processing and, if it deviates from a positive path, to attempt to correct it. The therapist does not exist to create and maintain this; such a thing is more in the realm of the client<br />
Some clients do not know how therapy should work, so it must be the role of the clinician to guide them.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-51581159411668183002015-11-10T22:35:00.000-05:002016-10-02T11:36:24.750-04:00The First Interview Let's talk a little about the start of the interview and the client working relationship. How does a good therapeutic relationship start? First impressions being what they are, I think that it is important to come up with a way to greet clients that is relatively standardized, because this will allow the clinician to be comfortable in that setting, hopefully transferring that state of ease onto the client. It might be important to note that different clinicians are going to proceed through the first session differently. Also, where a clinician practices might make the decision for the clinician, as to how that first session operates. Let us start with the greeting.<br />
The very first contact with the client can be a crucial make or break point. I think that an appropriate greeting involves a warm smile, a healthy handshake, and an introduction involving identity. While I am not partial to the smile, I think that it does calm the client and gives them a positive first image to be remembered later on. The handshake very much depends on the client: some clients are touch-averse. Frequently the clinician can gain this information from the assessment, which can happen over the phone or from a previous appointment. The introduction should probably entail name and any degree-related formality (Dr. and such). I'm not sure that there should be too much talking about self at this point because there could be a walk back to the office or a "settling in" period that separates the greeting from the formal introduction.<br />
There is much more to do in the first interview, obviously, than the greeting. The next step would be the "setting in" period. After that is the introduction phase, which is a complicated phase, full of sub-phases that I hope to talk about shortly. After the introduction, depending on the reason for therapy and the setting, first-session questions should be asked in order to gain a baseline understanding of the client. I hope to go over some of these questions here. I also wish to explain the end of the first interview and what should be discussed then. This includes possible avenues of therapy going forward, talks about the frequency of care, the length of each session, the length of treatment in general, etc. I realize now that I forgot to talk about discussion points in the introduction. The introduction is the time to talk about payment/insurance, clinician degrees/certifications/licenses, specialties, and any relevant experience of the clinician. Client concerns with therapy can be dealt with here or could be discussed in the baseline questions. I think that there are more questions in that section that I have forgotten, so I will hope to explain them further later.<br />
The greeting having been covered already, what does one do during the "settling in" phase? Normally some small talk may occur here. This is a good time for the therapist to introduce the space, asking whether the configuration is good for the client and, if not, how the pattern of chairs, desks, and tables might be more agreeable. This is also the time to get any water or tea that the client or clinician would want. This stage is very much the "hemming and hawing" between stage. After the settling in in comes the formal personal and professional introductions.<br />
I think it is important to note that the introduction is not only a space for the clinician to "awe" the client with his or her credentials, but also to ask some important questions about the client. Introductions, as such, should be mutually presented. This time is the chance for the clinician to inform the client about the clinician's work experience, including some history on where and how long the therapist has worked. This may bring up some points of similarity between the two parties, possibly strengthening their bond from the beginning. It is also the clinician's job to expound on the proficiencies and deficits of the clinician's practice. What do I and what don't I do well? This talk might include the therapist's orientation to clinical work and their expectations of the client (and themselves). As previously mentioned, insurance information and payment should also be discussed early on (rather than later on in the session. I would like to mention that session rules should also be discussed. Perhaps these are the same as client/therapist expectations or perhaps not. Obviously any special degrees, certifications, and licenses should be quickly introduced for the edification of the client.<br />
Between introductions and baseline questions, there might be a good opportunity to ask clients about their previous counseling experiences, including quantity and quality of treatment. This is important because the clinician can know what worked and did not work with the client. He or she can also know what not to do or how not to act - possibly just as important as the prior point.<br />
There are other questions that must also be asked in the first interview, including more assessment-based questions, these include:<br />
<br />
<ol>
<li>Full name/nicknames</li>
<li>Address, phone number</li>
<li>Employment/job/occupation + feelings about it</li>
<li>Family growing up + feelings about them</li>
<li>Family now + feelings about them</li>
<li>Religious background (what type/denomination)</li>
<li>Psychiatric symptoms</li>
<li>SI/HI</li>
<li>Why are you here? </li>
</ol>
<br />
Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-8246273081092309952015-11-06T11:37:00.000-05:002016-09-26T22:30:32.705-04:00The Basic Counseling Skills A word of caution: No good therapist exists who does not have basic counseling skills. Why do I bring this up? I realize that I have recently been focusing overmuch on the higher-level therapy skills, having not really strengthened my core skill set yet. I guess what I want to illuminate here are the skills that a therapist needs to be successful, were any kind of orientation stripped away. It is on this foundation that a good practice can be built. What are these elementary skills?<br />
<br />
<ol>
<li>Listening skills</li>
<li>Empathy</li>
<li>Positive regard</li>
<li>Appropriate silence</li>
<li>The "go on" skill</li>
<li>Unpacking</li>
<li>Appropriate self-care</li>
<li>Introduction</li>
<li>Gaining feedback</li>
<li>Balance self versus clinician</li>
</ol>
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I'm going to comment on these ten items. I think that they are a good beginning, but are also nowhere near what any good therapist needs to be successful and helpful.</div>
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The first three items are very Rogerian. It is my belief that Rogers was a good practitioner of basic counseling skills. Listening - specifically active listening - is a much-needed skill because it pushes the clinician not only to really hear what the client is saying, but to react in an appropriate way. Both of these skills allow the client to feel comfortable telling a stranger some of their darkest truths. Listening should start from day one in order to accustom the client to that level of deep interpersonal acknowledgment. This skill is difficult because it takes a high level of composure and compartmentalization on the part of the counselor to ensure that such listening can occur. Because every counselor is still a person with his or her own hopes, dreams, thoughts, beliefs, motivations, prejudices, loathes, etc, we must all ensure that our outside (or inside) stuff does not preclude us from this most basic and important of techniques. </div>
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Now let us talk bout empathy. I find myself with much internal conflict about this, specifically as to the ability to develop it versus being born with it. The reason I waiver has both to do with my own personal level of empathy and neurological science behind empathy and personality. I think, for myself, that I have a certain amount of empathy inherent in me, but that there could be more (but who couldn't say that?). It is better in this business to have more empathy, as it is the main connection of caring between the client and the clinician, though too much may lead to a difficulty in engaging in appropriately high-level self-care. The other argument, to get back on track, is saying that brain structure decides empathy. To take it to an extreme, those diagnosed with anti-social personality disorder are said to have no empathy. Taking it a step further, we can say that to this population, empathy cannot be taught; perhaps put differently, empathy cannot be "bought into," meaning that it might be taught and understood academically or mechanically, but cannot be truly believed in by that person. So what does all this mean for the therapist? Empathy is something that, at best might be taught and developed in someone that has the seed for it. Empathy, being one of these core criteria for a counselor, is something that a good counselor MUST have. </div>
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This next subject is one that I don't quite agree with Rogers on. Rogers touted unconditional positive regard. This seems very difficult and tiresome to me, as, like empathy, it almost seems to be something one must be born with. I also think that unconditional positive regard is almost a lie to the self and unrealistic in practice. I will talk about the latter first. Unconditional positive regard is not something that exists naturally in the world. It seems to me that everyone has an internal list of things that, if violated, would break this type of positive regard. Also, we need to make sure that we are reality testing here with our clients . . . Now that I am thinking about it, I guess that there really is a difference between unconditional positive regard for the client and unconditional positive regard for the client's actions and choices. The latter does not deserve such regard, whereas the former is difficult, but perhaps possible. The reason I changed my mind is that a client will not work with a therapist who thinks that he or she is a scumbag or a dumbass. I guess this one is both an interpersonal issue as well as one that could effect the clinician's case conceptualization. </div>
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Appropriate silence can be a difficult topic. I think that it can be every new counselor's instinct to fill in the conversation completely. A problem here is that frequently such dialogue is inane chatter, which only serves to confuse the client and tire the clinician. Sometimes clients must sit with a problem and think about it, while in the presence of a therapist. In these moments, it is not therapeutic to tell the client an answer or a philosophy. Rather, allowing them to piece out a problem might be exactly what they need in that moment. Silence is also a guard measure taken against over-functioning. Of course, there are some clients who disallow silence, so for those cases a clinician must be able to act in the opposite way in order to be effective.<br />
The next skill is a difficult one to make sound genuine for me. Frequently clients stop their dialogue, looking for something. From my own time in therapy, I would say that clients stop in order to ensure that the clinician is still with them, that they are not sounding crazy or stupid, that they started to hit on a topic that they would rather not talk about, or that they are looking for more encouragement to continue (for whatever reason). it is in this case that the clinician employs this skill to "allow" the client to continue. The therapist needs to give some kind of verbal or non-verbal cue to the client. Sometimes, a simple nod of the head will do. Frequently, a vocalization is fine (such as "mhm" or "hmm" or such). Now and then something like "yeah, "yup," "I hear you," or some such can be used. I think that this skills is quite dramaticized and romanticized in movies and books, to the point that the clinician says something like, "Talk/Say more about that," or, "Tell me more." For the reason that these terms are used so frequently in major media, I myself feel awkward in using such lines. Still, they might be useful.<br />
This next skill is a pretty advanced one for this list, but is one that requires a lot of work on the part of the therapist. I think that "unpacking" can lead to a clinician getting to know themselves better as a therapist, to a point that they might be able to learn their own theoretical orientation. Anyway, unpacking is the ability to break apart what a person is saying into different parts, consisting of narrative, problems, thoughts, feelings, complexes, etc (or the lack of any of these attributes), in order to highlight the important aspect to a client that can be explored during therapy. As previously mentioned, what a clinician chooses to unpack - or perhaps better put - what a clinician chooses to discuss after unpacking is a good indicator of that clinician's end "theoretical orientation." Unpacking is important because a clinician can gain much information from one sentence. At this time, I do not have a great example of such a sentence. While unpacking, a clinician can make connections and hypotheses that will allow them to continue a conversation if it starts to stall later on in therapy. My level of unpacking at this point is still somewhat basic, meaning that it takes me longer to do it and that it is difficult for me to do it in my head - meaning that I frequently have to be writing things down. This can get in the way of truly active listening and engaging with the client, but it is a positive for good and accurate case conceptualization. This is a skill that must be continually used and perfected if the clinician has a hope of being a master therapist in the future.<br />
Good self-care is essential to any therapist. Not engaging in proper self-care leaves one open to "psychic viruses" such as sarcasm in the office, compassion fatigue, a grand case of the fuck-its, and depression or anxiety. Good self-care can take the form of pretty much anything - being as changing as the subjective person.<br />
The next two skills frequently occur at the beginning (for the first) and at the end (for the second) of the relationship. The first is the introduction. I have elaborated on this portion many times, especially when discussing the documentation that occurs at the beginning. I will most liley be updating that section soon. This has more to do with how one acts at the beginning of a clinical relationship and at the start of all sessions. Confidence is key here, as it starts the relationship off on good footing and allows the client to see the clinician as someone who might actually help them. It is important in the first introduction to talk about fees, credentials, past history in psychotherapy, experience, orientation, and any paperwork that must be completed. It is important to ask for questions and concerns throughout, as airing these might allow for good discussion topics and make the client as comfortable as possible. That work - comfort - is very much something that is highly important in the first session. I think that making the client as comfortable as possible can only echo well throughout the rest of therapy. Every session also has some kind of introduction, which can change very much based on the clinician and their therapeutic approach. A clinician could create a set agenda or start out with a general question, such as "So, what's going on?" or "What would you like to talk about?" I guess comfort is just as important to the clinician, but in a different sense. The clinician is supposed to be relatively comfortable in the chair, so the introduction is just as much for him or her as it is for the client to ensure that there is a good fit or match between the two parties.<br />
This next one seems to, again, be an issue that is frequently regulated based upon theoretical orientation. This is unfortunate, as feedback is good for both parties and very good for future discussion and planning. Oddly, I think that most theories could easily accept the feedback rule and integrate it into themselves. Bringing the conversation back to the present with a feedback question is very existential-focused. I think that a behaviorist can get behind this question as well in their constant search for feedback and numbers-based results. Feedback allows the client to give their thoughts on the conduct of each party as well as the discussion and give good insight for the clinician as to what is important in current therapy to them and figure out what they are getting from therapy. Clinicians are on the receiving end of this and use the feedback to alter their own case conceptualization and change now they are engaging in therapy with the client. I'm not sure that it must be a rule as to when the feedback question is asked. I can see wisdom in sometimes asking the question during the middle of the session, especially to check whether an intervention has landed, though I would say that ending the session with the question might be a good idea to write good notes and track milestones in the client's treatment.<br />
The last point that I will mention here is a sometimes difficult balance that any counselor has to make between showing self and not showing self in session. This can be better said. Many counselors have to deal with this question: How much of myself do I show in session versus showing a more generic therapist self? This is a very good question that can easily affect how a clinician behaves in session. Some therapists have an innate ability to add themselves genuinely into the conversation. They can highlight their own behaviors subtly and model what a healthy individual might act like. Some clinicians use the role of clinician as a foundation or base to act in a way that they find appropriate. I can't say that one is necessarily better than the other, though I do think that there should be a balance because clients can tell when a clinician is hiding things and/or not being up-front with their feelings. </div>
Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-10096182292504272612015-11-05T11:24:00.000-05:002016-09-26T11:25:14.665-04:00Some Criticism of MI, CCT, and Existential Psychotherapy It seems to me that a reflective statement (a la motivational interviewing) is inherently revealing of the orientation of the clinician who states it. A complex reflection - one that is not just a rephrasing of the client's own words - adds to the client's statement by switching words out and adding in a small interpretation. This interpretation can vary wildly between therapists. Some will talk about the client's thoughts; some, their motivations; others their core values and meaning in life.<br />
It bothers me that some people call motivational interviewing their "theoretical orientation," because, as I have written previously, it is not one; it is more a technique. The reflection that MI uses really shows the underlying theories that the clinician holds dear to them. I do think that we should not discount MI, though, because it does operationalize how to actively listen to clients and is, in my opinion more of an offshoot of client-centered therapy than anything.<br />
In this light, I guess it would be difficult to call even client-centered therapy a complete psychotherapy, because its practitioners mainly use only one technique (active listening). When only one techniques is used, it seems to me that theory is pretty much technique-less and is more an avenue for a theory than a theory unto itself. In the same way, I guess that many people would point the finger at existential therapy and say that it is only theory and has minimal technique (I would like to say that CCT is a good personality theory, but in the realm of therapy, falls somewhat short because much of the theory falls flat when used in session; hence the minimal technique). My rebuttal here is that existential therapy's technique is both very present and invisible. It is present in being present-focused, critical, and always thoughtful. It is willing and able to explore all the subjects that the client would like to understand. It is invisible in that the technique is so parallel to the theory that it is often difficult to understand that it exists, especially apart from other theories. I also like to view it as a pair of eyeglasses that one forgets he or she is wearing but one that constantly informs his choice of phrase and approach to an issue brought up.<br />
Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-21645451029530492062015-11-03T11:51:00.000-05:002016-09-23T16:55:07.619-04:00When Is Therapy Finished? What is the end result of therapy? I really struggle with this question. I think that different therapists with different orientations would, surely, have wildly different answers. Allow me to map this out so that I might better describe the issue later on. There would be a difference between what a directive and non-directive therapist would say. There would be a difference between what a therapist and a client would say. There would be a difference between what an insight and a more behaviorist clinician would say. Different venues would have different goals here. Diagnoses would entail different approaches and result in varied goals. A psychologist, a psychiatrist, and a therapist would describe different goals. A practitioner from the past would detail a different result from a therapist from more recent times. Similarly, a client from years ago and a client now would surely expect an end to therapy at different times.<br />
I think I will start this short essay with answering these questions/topics and, if I remember, go into my own ideas as to the result of therapy and knowing when therapist is "done."<br />
A directive therapist versus a non-directive therapist is the first topic I brought up. The locus of control for a true directive therapist would obviously be with that therapist, so the burden of result would be more with the clinician. Now, it must be said that most clinicians are not summarily directive, so this might be a moot point. A non-directive clinician, on an opposite note, will, at their core, leave the client to find the end of therapy. I think that the question here still stands: What is the end result for these two types of psychotherapy? Perhaps this is a confusing question. A better one could be: When does therapy end? or How does one know that therapy should be concluded? Referring back to the example of directive versus non-directive, I think that a directive clinician will halt therapy (if they think that a discharge is positive) when all goals on a treatment plan have been dealt with. This clinician is one that is doing more of the "executive functioning" of the dyad. On the other side of the equation is the non-directive therapist. When is therapy done in that situation? This is a much more difficult question. A client who is ready to release himself or herself from that type of therapy is one who has the skills, confidence, and reason to do it. Either that, or he'she just stops coming to therapy (which, while here being a jab at non-directionalism, is very true of most therapy types).<br />
What about a each person in the relationship? When would a clinician be able to say that a client is ready to leave therapy and when would a client know that they are done with it? I think that the first question is much easier to answer than the second, as I can speak through the lens of orientation or general counseling theory, while the latter has only a lens of personality or subjectivity. I would like to get into theoretical orientation later, if I remember, so I think that at this time I can speak from a more general viewpoint. In general, a counselor knows that a client is ready to leave if he'she shows a marked decrease in distress in their lives and can deal with situations in such a way that leads to minimal discomfort and no psychiatric disorders. As mentioned, it is difficult to adhere to an idea of an individual client (and his/her ideal self post-therapy) because each client is very different. To some degree, I think that the end result that a client is looking for is probably very similar to the generic counselor in his comparison. Frequently, in my short-lived experience, clients tend to disengage from therapy before their therapist intends. Barring bad match-ups and negative dialogue, clients seem to frequently want more instant gratification therapy; that is, clients want tools to help them decrease their stress immediately with minimal insight. In my opinion, it takes a special client who really wants to look deeply into themselves and reveal (as well as sometimes combat) what is there. These clients are looking for self-development and understanding and frequently only leave therapy when they have found that. Some want to undergo very intense therapy and frequently require little of the therapist outside a gentle nudge or permission/validation to continue their talk, needing more of a safe space to discuss themselves with themselves.<br />
Going on with this subject in a slightly different manner, an insight therapist and a more new-age symptoms-based therapist would have very different ideas as to what constitutes a "recovered" or "cured" client. I think that an insight- or depth-based therapist looks for a client, to some degree, to self-assess their own condition. This is in contrast to the more behavioral therapist who operates based on scaling and other more quantitative measures. It must be said that the former clinician will most likely have their client for longer than the latter therapist.<br />
It is important to look at where the client is being helped. If the client is at a clinic attached to a hospital, I think that the former scaling rules used would very much inform when a client is discharged or when they choose to leave treatment. Depending on the topic of treatment, a "cured" client is most likely one who shows minimal to no behaviors that plagued them before and pushed them to enter some kind of treatment to begin with. In a private-practice setting, it is possible that the client stays very long in that setting - which depends much on the client's identified concern(s) and/or the orientation or plan of the therapist. There are, of course, many different venues for therapy to occur, and each one has myriad different variables to take into account when this essay's question presents itself.<br />
I think that the next section is probably both the most interest academically, as well as the easiest one to talk about. Because this part has to do with diagnoses, there is an already set framework upon which to work, specifically symptoms and diagnostic criteria of the DSM 5. This section is easy because we are looking at set criteria. If these criteria dissipate, then we can easily make the case that the client should be discharged. Again, in my opinion, it is always good to check-in with the client to ascertain their viewpoint on the subject. Many venues, such as progressive private practices, might not diagnose or use diagnoses at all, so this venue cannot use symptoms, as such, as a criterion to discharge or recognize a client as able to leave treatment.<br />
Let us look at differences between what a psychologist, a psychiatrist, and a therapist would deem an appropriate as an end to therapy. I must preface this by saying that I am talking through my own lens and cannot completely see nor understand the intricacies of the other jobs (nor, indeed, all of them in my chosen field). A psychologist, in my opinion, uses many numerical measures. They might scale, as previously discussed, in order to ascertain whether a client is finished with therapy. There are many psychologists who act more like therapists and I would understand them more through the lens of a therapist. A psychiatrist, especially a more new-world one who is more interested in medication than true therapy, might see a reduction in certain symptoms as a basis for an end of therapy and a proclamation of a cured client. An unfortunate issue here has to do with the many medications from many psychiatrists being taken for a lifetime instead of being tapered off (when possible) and replaced with a strengths-based talk therapy regime. I believe that I already have revealed my own thoughts about how I see counselors acting in this frame and will ask the reader to refer back to those words rather than repeat them.<br />
The last two points have to do with the past: How would psychotherapists from the past know when/if a client is done with therapy? and How would a client from the past know this? I will answer this in one paragraph as a I think that the latter question is very dependent on the former. It is my opinion that many clients in the further-flung past (early 1900s) held their therapists in such high esteem that their therapist was the one to end the relationship, frequently whether or not the client agreed. In Freudian terms, a client was in denial when resisting treatment, something he saw as a great step forward in treatment, as it signaled that the client was avoiding the clinician due to issues being uncovered that were uncomfortable and, therefore, important. These therapists (and I am speaking specifically of analysts) frequently kept clients for years, so an end to therapy was very infrequent for them.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-6166160664934737972015-10-07T10:48:00.000-04:002016-09-23T10:48:52.907-04:00Buy-In From Client and Therapist When a therapist and a client take on a problem, both parties experience buy-in. I am not sure that this is a term in the vernacular of the field yet, but it should be. Both parties experience varying levels of this state, which to define it, might sound something like: "The idea that a person will get something out of the experience that will benefit them in the long-/short-run . . ." I'm sure there is more to it than that, but that is just off the cuff, as it were.<br />
As stated, the level of buy-in varies and depends very much on many different factors. Just a few are the client-clinician match, pre-conceived notions of therapy and its uses/structure, how the experience starts, and similarities or differences in communication styles. A client can come into therapy wanting to use the session(s) to complete good work that will change something in his or her life. Similarly, yet completely opposite, a client might enter therapy without their consent. A clinician can have the same bipolar situation going on, one day entering a session with relish and an attitude of "stick-to-it-ness," but show a very different side of themselves later.<br />
This entry is not about the on-going buy-in of clinician or client, but rather the resolution felt by either party at the end of a span. I did not know the correct word to use, so "span" it is. By this word, I mean to signify the end of a certain issue, whether that be a problem going on in a client's life or the end of therapy with that particular client. Obviously, a client gets resolution during therapy; that is what successful therapy is all about. I would like to look at the theme of resolution at the end of a span on the part of the therapist. Does the therapist need resolution as well? What does therapist resolution mean and look like?<br />
These are very difficult questions. I would say, even at this early point in my career, that a therapist's resolution is fleeting and transparent when in existence at all. Frequently, the client leaves therapy or moves on to a new subject before therapist resolution can occur. Does this not weigh on the therapist? Does this not decrease future general buy-in for the therapist in the same and different clients? Possibly. Probably. I would say that true resolution - getting past the phenomenological idea that resolution looks different for ever single person, which is true but unhelpful when writing about it - is the knowledge that something was gained by the client due to the time that was spend in the company of the therapist. This is what <u>should</u> be - and I use that word sardonically.<br />
I think that a therapist frequently wants to get into many issues that a client deems unworthy or not as important as another at a given time. This, I think, can plague the therapist with a case of the "I wish"es, "I should have"es, or give him or her a general sense of not being challenged or stretched in their practice. These are issues that can bring a therapist to his or her knees without good supervision or the help of a therapist's therapist.<br />
Allow me to talk about these ailments and their specific impacts on the therapist. The first "ailment" is a case of the "I wish"es. Perhaps better said, it is the case of the "If only"s or the "I wish I had"s. When a certain span ends, it is rather simple for a counselor to wonder whether something more should have been done (to be honest, this is the same as the "should"s) to seek a better or different conclusion. The therapist thinks that they did not do a very good job, or could have been better. This can lead to a long-term case of second-guessing, especially when the end to the span was not good for the client and/or ended badly for the therapist.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0tag:blogger.com,1999:blog-8200110550152024629.post-58408173343596496042015-09-29T10:14:00.000-04:002016-09-23T10:14:13.399-04:00Honesty in Therapy Therapists must ask themselves an important question very early on in their practice: How honest do I want to be with my clients? Honesty can be either an important building block in the relationship between therapist and client or a stumbling block that sends the duo into disarray. I think that there are positives and negatives to honesty in therapy. I would like to talk about the advantages and disadvantages for each side, the long-term and short-term outlooks of each, and what it says about the clinician to use stark truth and/or white lies.<br />
I will talk about white lies first. Are they every appropriate? Sure, depending on the state of the client, a white lie might be a good bet. Just like with a client, though, white lies can be slippery slopes, increasing the chance of this "intervention" in the future, especially if the lie is never found out. A good question to ask here is When is it appropriate to use this? The therapist must always keep in mind that a white lie might be found out and that consequences could ensue. So, the lie should be as white as possible, be explainable by the therapist, and, taking those two into account, should not be so hurtful that they fundamentally injure the relationship. If the issue at hand is life or death (it could be a trauma case, a client with SI or HI, etc.) and a very small white lie can help that person to endure their situation and possibly survive until they, or someone else, can ensure their safety, then the answer is a non-idealistic and pragmatic "yes." I think that white lies have to be monitored closely because, just like normal lies, they can multiply quickly if one is trying to cover them up, and they can be detrimental to any relationship, as mentioned. In the end, after giving this some due thought, I think that lies in general should be avoided - after all, it is the place of the therapist to screen behavior and call clients on maladaptive thoughts, emotions, and beliefs.<br />
When it comes to honesty, there are, of course, times when the therapist must care to soften a blow and use more of an opaque honest (versus a clear honesty). I do think, though, that honesty really is the way to go. As previously mentioned, a crucial effect of honesty is trust. Without trust, a client would get nothing from therapy. I don't want to belabor that point as I think that it is relatively self-evident. I do think that one good topic for discussion is <u>how</u> to go about being honest. A good velvet-wrapped brick approach seems appropriate here. I think that this is a good metaphor because being honest can be pretty traumatic and blunt. Wrapping it in velvet (a.k.a. saying it in a way that is softer than merely blurting out the truth) can go a long way. No client wants their therapist to tell them the honest truth outright that they are absolutely wrong, absolutely screwed if they continue their current actions, etc. No one wants to hear that. What good therapy allows us to do is to hear the client, their reasons for saying their piece, and then discuss their choices. A declaration of incorrectness can be just as hurtful to a therapeutic relationship as a found-out lie could be.<br />
Is one theory more honest than another? I'm not certain that this is a particularly fair question and is not one that I am prepared to answer. I think that it is less the theory and more the therapist that is the final answer to the question.Dan Rhodeshttp://www.blogger.com/profile/02021827657725394408noreply@blogger.com0