Thursday, January 24, 2013

Normalcy or Being Abnormal in Therapy

     We keep on acting as if people are not normal.  I have already discussed normality and universality - two terms that halfway disprove total uniqueness (and adding "normal" back into the equation) - so I won't go into them.
     Should counselors be trying to change someone's personality?  Should an individual seek that sort of permanent alteration?  I'm unsure.  While actions show normality and universality, thoughts trend more into the realm of the unique (most likely because actions are bordered by physics, whereas imagination is infinite depending on the mind).  This being the case, that one does not translate into the other 100% of the time, should we try to construct further barriers to true unique thought by instituting outside action?
     An example is probably in order.  Sometimes I get skittish around people.  To a degree, it may be due to genes and a possibility of depression in my ongoing family and lack of sociability when I was a child.  This feeling might be detrimental to the counseling environment.  Perhaps a mood swing takes me in the middle of a session.  What then?  Should I not seek to reverse this trend and create inside of myself a feeling of calm and self assurance?  Would this not provide an inhospitable environment for mood swings?
     The answer:  perhaps.  But what would I be giving up were I to undergo such a change?  Would I lose part of myself?  Again:  perhaps.  This is a tangential thought adhering itself to the main purpose of this idea.  I don't know how to change myself in this manner.  What I want to figure out is how to live with my behavior and thoughts and feelings.  Generalizing this more:  How does a therapist advise on their presenting behavior?  Do we ask them to stop it?  Mask it?  Let it out?  Obviously this depends on the behavior and should be assessed on an individual-by-individual basis, but still . . .
     I think it comes down to this:  Good advice to a client (for me) might sound something like this:  "I hear what you're saying and really what comes to mind is the topic of acceptable consequences.  Are you willing to be responsible for your behavior?  If you are, then perhaps it is 1) not too severe and 2) worth the energy put into it.  If you are not, then perhaps we can look into some techniques that will allow you to act a little differently in certain situations."
     The counselor must also assess the behavior for himself also.  If the client enjoys killing people and is totally OK with the repercussions, the statement above is defunct.  We must stick to our ethical guidelines.  Personality disorders and irrational thought have the ability to destroy such a statement of consquences.

Monday, January 14, 2013

Universality Versus Normalizing

     Some of my classmates (and even some of my professors) confuse the terms universality and normalizing.  Both of these are terms that have to do with the understanding of one's problem or issue as normal.  They differ only in context, but it is this difference that makes them unique.
     Universality is an idea that promotes an understanding of one's problematic behavior through the idea that:  others have suffered in the same way, or similarly, in the past; are suffering in such a way in the present; and will most likely continue to suffer like they have in the future.  This promotes the feeling and idea that they are not alone and that others have either been "cured" or have learned to solve their problem/cope with it in a way that they can live a happy life.  This is one of Yalom's group theory therapeutic factors and makes a lot of sense when the immediate group can support the therapist or show their own similar behaviors/strategies on their own.
     Normalizing is more of an intrapersonal topic.  Instead of highlighting extrinsic factors, it describes the idea that the behavior itself is normal.  All behavior is normal.  Any mental illness is a product of all experiences of the past.  This means that the psychotic is normal because he or she is just performing the actions that make sense to them given what has happened in the past/what happens to them every day.  Carl Whitaker is very well known for accepting clients' behaviors as normal.
     While similar in intent, these concepts are dissimilar in context.  It is important not to mix them up because they are attributed to two different thinkers.

Tuesday, January 1, 2013

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.