To a Better Approach to Finding a Therapist

     I am starting to think that the current model of psychotherapy initiation and execution is flawed and inefficient.  The current mode for client intake goes something like this:

1. Client searches internet/newspaper or asks advice from friends/family about a practice they know and trust.
1. If they search the internet exclusively, they forego knowledge of therapy jargon and choose based on the marketing skill and beauty of the site.  
2. Client calls therapist and hopefully asks some probing questions about means of therapy and history of the therapist.
3. Client agrees (or disagrees) with therapist, shows up (or doesn't), and is counseled. 
4. Client leaves therapy in relief of symptoms/presenting problem (could take time) or leaves therapy frustrated and upset that they lost money (or sanity).

     I think what irks me the most here is that the client dos not have the means to make an intelligent and educated choice about the therapist.  If a therapist works for Ralph, my friend's brother's boss, how do I know that the therapist will help me?  Word-of-mouth is inaccurate.  Looking over internet websites, while more accurate, is prone to folly when it comes to word choice, money spent, and therapist countenance.  It seems like there are too many factors with which a therapist could accidentally hang himself.

     There is a much better way to advertise counseling correctly/accurately.  It starts with understanding who the client is.  Steps three and four above describe the counseling process and any reaction afterward.  Any negative remark about therapy would be avoided if proper screening occurs at the front end.  I think there should be some kind of questionnaire that the client is required to take that shows what type of therapy might work best for him.  Therapists speak of "meeting the client where they are" - something that, I think, extends far beyond what questions to ask.  Certain clients might do better with a behaviorist while others could gain relief with an emotion-focused practitioner.  If such an exam could be constructed, it would be simple to match clients of a certain temperament to a counselor that would best fit them.

     There are two complications that come to mind here.  Other than the overhaul of the system (which no one likes).  The first is insurance and the second is accreditation.  I think that insurance companies would subsidize only the top nth percent of the therapists who provide care, based on the democratic process of choosing the ones who practice must.  This means that those practicing CBT would land insurance money while analysts wouldn't (this, of course, assumes that CBT would be matched to more people while psychoanalysis wouldn't)!  This would ensure that more therapists would train as CBT practitioners (and that schools would only teach CBT) and that fringe clients would have a mismatch when seeking treatment.  

     Accreditation here refers to the process through which a therapist gains the right to practice a certain orientation.  More schools would open up (probably called institutes, offering certificates) and more specialized training would be received.  

     I talked on December 24th, 2012 about abstract versus concrete practice.  I rather think that such a topic also has relevance here.  How constrictive would a therapist be in his practice?  Could they use techniques from other schools?  How is such a thing maintained?  Would therapists be required to amass further training in the future?

     This prompts yet another issue that would be the backlash to such a stunt.  If we made it normal to test clients on their "therapeutic temperament," would we not also require this of therapists?  If a prospective therapist is interested in such a study, would it not behoove him to take such a test to find out which speciality is best for him?  I am unsure of this.  To take it further, if a current student of existential psychotherapy takes the exam in the middle of his education and receives back an answer of behaviorism, would he then be required to change tracks or relocate his education?

     A huge part of this discussion is choice.  I think I put it on ice for awhile with this.  Should clients have the right to choose their therapists as they see fit?  Yes! Even if it doesn't help them?  Yes!  That's the beauty of choice.

Subjectivism and Objectivism

     When I talk to myself (which I think is very healthy), I keep catching myself being amazingly subjective.  Instead of saying something like, "The world is a beautiful and wondrous place," I say, "To me/For me the world is a beautiful and wondrous place."  I think that the distinction between the two is cavernous.  The first depicts a world as a truth inevitable.  There is right and wrong in this kind of world.  If, to fit the example, one would disagree with the notion that the world is indeed beautiful and wondrous, he or she would be incorrect without possibility of revision.  But all should ask themselves, is a sunny day beautiful?  To me, rainy and overcast days are beautiful.  So obviously total objectivism is not valid in this world.  At the other end of the spectrum, total subjectivism can't be correct either.  If we think of "correctness" as a morally acceptable (which opens up a whole bunch of cans of worms, but I'll take it here as an assumption), then those with antisocial personality disorder, who think stealing and killing are OK, are also correct (or at least not wrong).  Are their motivations really OK?  No.  Obviously either extreme end of the spectrum is a bit much.  Like most things, living or working somewhere in the middle is better . . .  it provides a level of comfort, adaptability, and safety that most people thrive on.

The Correctness of Psychotherapeutic Theories

     By trying to disprove previous theories of psychotherapy when there is documented proof that improvement has been made, are we really trying to help create better theories or just disprove old ones for abstract reasons?  I think that if there is documented proof of improvement, then something about the therapeutic relationship has helped them (if we assume that outside factors and time healing are not - or at least minimally-contributing factors).  Perhaps it is the case that psychoanalytic theory is wrong, but, again, something was going right.  Maybe it had nothing to do with the client's drives or motivations, but just the fact that someone is listening in a nonjudgemental fashion could be more of a common therapeutic factor.  So, by that logic, Freud did not have it all wrong (perhaps, even, psychoanalytic theory is 100% correct!).  He started everything that we do - sitting with clients, listening, etc.  He was the foundation.  Therefore, he was right, to a degree.

More on Religion (and Some About Science)

     Unfortunately this entry is going to be about religion again.  I still have some issues with it.  A doctrine built around a faith structure - a good idea?  I don't think so anymore than I did the last time I talked about it.  But is it a bad idea?  No.  At least, not when correctly philosophized.  What is religion more than rules about official conduct and beliefs about phenomena yet unexplained?  So, by that logic, is not science a religion?  It talks of proper behavior or etiquette - a certain level of sophistication and civility in this scientific age - as well as explanation of the unexplained - for instance, why does anything with a positive charge attract that with a negative?  I don't know . . .  They don't know, but we will give them names and observe them still.

     This brings me to to two points.  First, science is the obvious next step of religion.  And second, if science is indeed a religion, it is most likely not a good idea to listen to everything said.  If, by the stream of thought anchored from the first point, religion has spawned science and science is yet another religion unto itself, why are scientists not worshipping Reason and Logic?  Most likely in order to further themselves from formal religion and because practice, experimentation, and invention are they new praying, confessing, and sacrifice (and the former disallow the same attitude as the latter).  But, more to the point, I think that it used to be the case (and well still might be) that clergymen were the most educated men of their time.  This practically made them the scientists of their time (if such thought was not prohibited to begin with).  No, they did not experiment, for this was not their means/practice, but they observed, taught, and explained.  They did all they could with the resources they had.  Most likely it is true that most Renaissance thinkers were religious.  Many (thought not all, and the number is decreasing steadily) of our current scientists practice even while believing in more "old world" religions.  As technology progressed, and the fruits were received, it seems to me that the change in god figures only makes sense.  We could actually see changes and reasons for being through this new mode of understanding.  To a degree, just like the Greek/Roman gods are no more worshipped as they once were, technology and science are the new gods a la mode.  Old religions were in existence to explain the unexplained.  We now have "better" answers through this new apparatus.  The swift changeover from superstition to hypothesis is only logical.

     Could it be the case that science, like religious indoctrination, can lead to the closing of minds as much to the opening of them?  Yes!  Do we believe in the supernatural anymore? No, because it's not logical - even though there is plenty in the outside world that we don't understand.  It is very true that science has made the world/universe smaller; it has taken away some of its majesty through computation and through educated conjecture.  Science re-invents itself frequently as theories are proven to be false.  This means that everything we know is either a lie or an estimation (like modern physics).  Call me cynical, but it almost seems that creating astrophysics is akin to creating Demeter - another variant to explain another phenomena.

     Does this mean that science or any religion is bunk?  Absolutely not!  Far be it from me to take away someone else's meaning in life.  Should we all become Luddites?  Should we all throw away our science because we are afraid of what is to come?  No.  Indeed progress is very important.  Do progress and religion share every meal? . . . Maybe.  Very probably.  I think that we are only as un-evolved as our understanding of ourselves and our universe.  Science tells us a great deal about he latter, but the former?  Only we can know ourselves.  Only by really understanding who we are in this moment and understanding where we want to be in the future will we be free of all shackles of formal re-education.  A healthy dollop of personal understanding with a grain religion is, for me, perfect.  Goes down smooth, without worry of worry, cynicism, or self-hate.  The next question to answer is:  Who am I?  Were it that I could answer that question to its conclusion.  Unfortunately, I lack the cerebral skills and linguistic development that would allow an answer that is coherent and pleasing to read. 

The Most Important Letter in Psychotherapy

     I remember sitting in one of my classes early this year and hearing my professor begin many of his interventions with "Gee."  As in: "Gee, I wonder why you're feeling that way, " or, "Gee, do you maybe think that Sandra feels differently than you?" This brought me to the conclusion that G is the most important letter in the alphabet in psychotherapy.

A Continuum of Psychotherapeutic Theories

     One of my professors, William Casile, showed our Group Therapy class a really interesting graphic depicting different psychotherapeutic theories on an x and y plane.  I am going to present it quickly and take it a step further.  The x axis portrays the continuum of objective versus subjective theories.  Said another way, this axis shows the theories' views on reality.  Is reality a construct of the individual (subjective) or is there a distinct and cohesive reality that everyone is part of (objective)?  The y axis's continuum attempts to discern between an empirically-based theory and an experiential/growth-related non-empirical theory.  The former is capable of experiment or correlation, while the latter is less data-oriented and therefore less able to be quantified for a journal or publication.

     Where empirical methods and subjective methods cross, existentialism and psychoanalysis result.  Should existentialism be here?  I don't like, first of all, that existentialism is organized with psychoanalysis.  More importantly, it is hard for me to believe that existential psychotherapy is easier to research than Rogers' common factors (as Yalom's book on group psychotherapy can attest).  That being said, I think that Casile, being an existentialist himself, knows better than I on this one.  This area's title is Rationalism.  This could possibly be because these two orientations are the deepest, most roots-based approaches.  But rational?  The use of psychoanalytic metaphor is one of the less rational approaches I know (not necessarily saying it's false - metaphor can be a powerful thing).

     Humanism is the convergence of experiential and subjective.  Humanism is all about the client.  But not only.  Humanism is also all about the therapist.  While growth and personal reality are important in the client's life, I think that it is just as important to the therapist.  I think that the best and perhaps most vocal of experiential proponents was Carl Whitaker who always wanted the client to act as his therapist.  I think that everything in the Humanism category is also more feelings-based than its polar opposite, Empiricism.  Experiential models are inherently more about affect anyway.  

     Empiricism is more the polar opposite of Humanism.  It does not dwell on emotions, but rather on behaviors or cognitions.  Both behaviorism and cognitive-behavioral therapy are testaments to that.  They are both the most empirical theories to date.  They also espouse a relationship that is one of teacher and student.  The client is actually being taught how to cope better or become more active in their own lives.  This teaching underscores the "correctness of reality" that its place on the x axis denotes.

     I can't say that I know much about the last category.  My program does not intensely teach the more collectivist theories (outside systems-based family approaches).  I honestly don't think that systems theories should be in this model at all.  It seems to me that systems and multicultural competencies are better used as a z axis.  What to call such as axis?  At this point, I do not know.  Perhaps later I will find a phrase that rolls off the tongue eloquently enough to sit somewhere beside such an educational model.

More Thoughts on a Unified Theory

     Upon further thought about some kind of Unified Theory, I have realized a major flaw in the logic of the primary idea.  To create some kind of non-varied theory, that would, in essence, require 1) an agreement among professionals and 2) a change from theory to process/fact.  The latter point is distressing because we would be changing a theoretical construct (something that can be further developed or altered) and change it into a globally-accepted idea.  If something is accepted by everyone to such a degree, it becomes de facto fact.
     People are not the same!  Sure, some theories have shown empirically better results than other, but those results are most likely pulling mostly within two standard deviations of the mean.  There are always outliers.  To use such a Unified Theory would leave these individuals out in the cold and would staunch further development by professionals.  Sure, there would be fringe development, but such action would be seen as para-science by professionals and would include only minor numbers, decreasing its academic potency.
     This is not to say that a therapist-based theory is not worthwhile to cultivate (keeping in mind that it would not function for all clients).  Instead, I think that it is of great import for any therapist to understand their own core methodology with room to alter for fringe cases.