Answers

     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?

What 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?
     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.
     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.
     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?

Truth 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?
     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.
     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.
     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.
     I read a very good book that I would recommend to any therapist called The Schopenhauer Cure 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.

The 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.
     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?
     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.
     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:

The River Concept

Psychoanalysis -> Behaviorism -> Humanistic/Existential -> CBT

The Evolution Concept*
                                                          REBT ->
                               Behaviorism ->
                                                          CBT -> DBT ->
Psychoanalysis ->                            Existential ->
                               Humanistic ->
                                                         Gestalt ->

     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.
     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.

*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.

Pulling 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.
     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.
     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).
     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.

Action 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.
     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.
     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.

Theoretical 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.
     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 Developing Your Theoretical Orientation in Counseling and Psychotherapy. 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.
     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.
     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.
     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.
     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.
     As far as questionnaire questions are concerned, here are some:

• Name
• Credential/License information
• Number of years in the field
• Level of schooling achieved
• Current theoretical orientation
• Previous theoretical orientations
• Is your current TO based in your current area of work?
• Current area/type of work?
• Do you ind TO important in your work?
• 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)?
• 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?