Thursday, December 25, 2014

Is Showing Emotion Appropriate?

     If we were to split up the practitioners of psychotherapy into to distinct groups, I think that one criterion that splits them might have to do with the relationship the therapist has with emotion. Better said: Will the facilitator allow himself or herself to feel with/due to the client? Feeling takes real energy from the practitioner that can manifest later or can crop up outside the relationship. It could also be a subjective marker for the client. Does feeling help the therapy process? Perhaps feeling leads to ethical dilemmas. Many of those sound, negative but assuredly there is much that is positive here.
     As far as different theories are concerned, I think that we can all agree that fundamentalist clinicians, if such a thing were to exist, would come down on one side of this argument. More humanistic practitioners would describe the importance of being in the  moment with the client, experiencing what they are experiencing to some degree. More cognitive therapists, by nature, would eschew such tactics and really heavily on the thought process of the client. Both the nature of the therapy and role of the clinician as expert would not really allow the therapist the space to identify the clients/their own emotional circumstances.
     Were the therapist to allow himself or herself to feel, would there be any negative side effects in the session? Sure, emotions can be distracting. The clinician must not only track and pursue the emotions of the client, but must also keep a tight hold on his or her own feelings. These could cloud the counselor's judgement, disallowing good therapy to occur. It is very possible that, based on a clinician's own past, an intervention could fail. Feeling also takes up energy that the therapist could use thinking, filling out paperwork, or relaxing.
     The client must e taken into account as well. Does he or she respect the emotional spectrum? Is there a previous diagnosis that precludes accessing emotional data? Just as the style of therapy should match the therapist, of course that same style should match the client. There are some who either militantly do not wish to access their emotions, or are so cognitive that emotions play little part in their lives. With these clients, showing what the therapist feels would be uncomfortable and, for them, almost bordering on inappropriate.
     Feeling emotions is one thing, but showing them is altogether different. While the argument for or against showing emotions is not over, I'd like to cover this. Some clients would like the therapist to show some kind of emotion - this could vary from a slight pinching in the eyes  in empathetic pain, to openly weeping.  Personally, I would say that the former is better than the latter. There are some clients that might take advantage of the therapist of the latter emotional persuasion. Covering up emotions can also take up important time and energy that could be used for other things.
     Opinion time: I am an advocate of the therapist feeling in session. There are some definite negative possibilities to the equation there, though. A therapist can choose to act on the feelings, engaging in either predatory, maleficent, or sexual acts with the client. This probably isn't the best option. Some other negatives are listed above. Emotional therapists can also use their feelings as tools. They can deduce, though their own state, what the clients if feeling. They can also attempt to use this superpower to try to predict behavior.

Thursday, December 18, 2014

REBT as Technique, not Therapy or The Disadvantage of Logic in Therapy

     I think a lot about the elegance of certain psychotherapeutic theories. One that comes up quite a bit is Rational Emotive Behavior Therapy (REBT). Certainly it is a very elegant theory. The way Ellis connects thoughts, beliefs, and feelings through the use of logic is a great technique. It is the logic part that we must discuss.
     Ellis was a very logical guy. He used that innate logic, coupled with a review of some philosophy, to create REBT. This is all well and good, but we must ask ourselves whether a theory based strictly upon logic is good. Most of our clients are "stuck." Their "logic processes" are malfunctioning and they need someone to help these processors get up and running again. It seems to me that logicking a client to death might be somewhat counterproductive.
     As we know, Ellis simplifies REBT through the use of the alphabet. "A" means activating event or antecedent, representing an event that has occurred that "sets off" the following behaviors. "B" means irrational/illogical belief - we'll come back to this. "C" is an emotional consequence that is normally negative (and thus the reason someone is coming to therapy). Ellis said that many people that outside situations or actions (A) affect them, created their distress (C). What they failed to grasp is the ever elusive B. The person's illogical belief, their interpretation, of A led to their disturbance. He would dispute (D) their thought pattern until they saw the light.
     Disputing, in my view, can only go so far. This is especially true when the disputer talks from a standpoint of expertise. This tends to sound high and might to many clients, which can undermine any helpful tendencies of therapy. I think that it might be better to work with the client and that disputing a claim rather than discussing it is probably an incorrect approach.
     I know I wrote that a theory based strictly upon logic probably isn't all that great. I would like to explain this. A lot of other theory is very metaphor-based, meaning that, to some degree, it is constructed with a good amount of wiggle room and space for project and interpretation. It leaves room for interpretation. REBT does not. It espouses an idea of total correctness. Is it correct? In its limited scope, yes. But there is much more to psychotherapy, "stuckness," and a client than the relationship between beliefs, feelings, and thoughts.
     I think that REBT is better categorized not as a psychotherapeutic discipline, but rather as an effective group of techniques whose goal is to use psychoeducational techniques to help clients with their understanding of basic relationships between beliefs, feelings, and thoughts.

Saturday, December 6, 2014

Interplay between Thoughts, Emotions, and Beliefs

     I think that it's about time to struggle through the trinity of experience explainers.  This trinity, is, of course, thoughts, feelings, and beliefs.  To some degree, I think that behaviors should be thought of as part of that system, but behaviors don't explain, they are the explanations.  Better said: behaviors are the end result of feelings, beliefs, or thoughts - they are the effect to thoughts', feelings', and beliefs' cause.  I think that there is very little that can be described as "pure behavior."  One could cite reaction as pure behavior, but something started or informed such action - some previous thought, deep feeling, or belief.  The experience explainers are precursors to all behavior as action cannot occur without thought or due to some deeply-rooted feeling or belief.
     So what is the difference between these three states?  Where do they come from?  How are they linked?  How/why are they so easily misunderstood or mislabeled?  First, I'll try to define each one.  1) Thoughts:  Thoughts are reason in electrical form.  A true thought is complete, meaning that its very reason for existing is known.  It exists in order to explain, or help explain, something.  A thought is refined.  Thoughts are created when problems are introduced  and a reasoning chain is used to overcome it.  Logic can be used to develop a thought, but there are indeed many that are formed without its consent.
     2) Feelings:  Feeling are  much more primal than thoughts.  The previously-mentioned reactions have more to do with feelings than they do with thoughts.  Just as thoughts are refined through some kind of process, feelings most often aren't, or, perhaps, can't be.  To think through a feeling strips it of its raw, primal nature, and transforms it, by definition, into a thought.  In this way, we can say that feelings are precursors to thoughts.  Whereas thoughts are a very cerebral ornament, feelings are less so.  I very much hesitate to say that they are reptilian, as I do not know for sure if reptiles or similarly "un-evolved" animals have the capacity for higher-order feelings.  Feelings can be based on the old adage of "mad, sad, bad, glad."  Most feelings can be added to one of these headings.  Feelings are created when an experience upsets or supports previously-held beliefs.
     3) Beliefs:  I think that beliefs are some of the most interesting constructs we know about.  Beliefs are thoughts without evidence.  One believes something only when a thought is impossible because reasoning cannot adequately occur.  One must take a belief on faith.  I don't really mean the same faith as religion, but a similar one that requires adherence without proof.  Beliefs are inherently illogical.  Logicality is the domain of thought.  Violating a belief normally causes a negative feeling.
     REBT would tell us that when we experience something less than savory, a belief is called into question, leaving us with a bitter feeling.  It is only through complete and logical thought that the healing process can occur.  I think that this makes sense, but that the CBTers are speaking to their boathouse on this one.  OF COURSE thought would be the end result for a cognitive therapist.  Emotion-focused theorists think that the examination of feelings (rather than the interplay under REBT) are the true path to understanding the self.  Beliefs, it seems to me, are the jurisdiction of none (at least in the sense of this post).
     I think that beliefs have no part in therapy or in everyday life.  Beliefs are abstract, not thought through, and due to a lack of evidence, can really get a client into trouble.  To some degree, I think that it is a therapist's job to help a client explore their beliefs and discard those that are so illogical that thought is not permitted and feelings run rampant.

Sunday, November 30, 2014

Nature or Nuture in Becoming a Therapist

     I'm struggling with the selection process for a good therapist - that is, selecting who could become a good therapist.  Is this identity nature-based or could it be more driven by outside factors?  That is - is the deep temperament of a therapist inborn or is it something that can be molded or taught?  Of course when it comes to the satisfactory counselor, techniques and special inquiries can be instructed, but I'm more referring to the master therapist and researcher.
     If we were talking about a genetic predisposition to the field, we would almost be able to track such career choices through a family genogram.  All, or at least some/most, of the family member would exhibit behavior that would lead them along a similar professional line.
     To be sure, such a project would be very unwieldy.  We must take into account the fact that children are susceptible to lessons, modeling, and behavior perhaps more than others.  Trying to separate the unadulterated behaviors from the learned ones would be quite impossible; the only route otherwise would involve either constant self-journaling or an as yet undiscovered technology along the lines of mind reading.
     Such an endeavor is only possible through the subtle art of twin, adoption, or orphan studies.  The main issue here is that our tabula rasa is not blank for long.  From the first experience on this plane, a mind is most likely significantly altered.  So it would seem that the study would have to begin almost on day one.  No outside stimuli at all.  This would lead, of course, to extreme legal penalties based on the current moral viewpoint on infant experimentation and deprivation.
     As figuring this problem out through the pathway of nature would either be impossible or, at least, controversial, we would then have to funnel our energies through some type of nurture studies.  The question here would be:  Can we CREATE a master therapist?  The final result, were it a success, would have to be repeatable.  This involves some type of formula or quasi-formula of actions.  This view is pretty Skinnerian.
     I find that the selection process between two points tends more to be explained better through some combination of those two points, rather than an extreme on either end.  It is very likely that a certain person has the core, rough characteristics that would yield a good master therapist.  That being said, that person would need proper instruction (or some kind of outside motivation - positive or negative) in order to harness the ability afforded him through his genes.  Just as clay can be formed into beautiful pottery by hands yet cloth or bubbles cannot.
     The next step here would be to identify those traits that create a master therapist.  The next stop thereafter would involve finding hereditary lines with those traits.  An important note here is to understand that not everyone in that line would go into the field.  There are many other very satisfactory professions (e.g. intelligence services, customer services, etc.) for those who naturally show the qualities of Rogers.  After these steps, the big jump would be to create a curriculum that would yield near-perfect master therapist candidates.  Not an easy job.
     The end answer is simple.  But first, what is the question?  It is not, with nature and nurture combined, one of creating a master therapist.  An end result of this process almost assures us of this.  The question anew is: Can we create master therapists from ANYONE?  to this, my simple answer is a simple no.

Tuesday, November 11, 2014

Should a Therapist Have a Theoretical Orientation?

December 12th, 2012

     Is it good to have a working model from which one directly pulls during therapy or is it better to have none and work from scratch with each client?  As with most extremes, working in the middle seems more appropriate.  Both extremes have their distinct advantages and disadvantages.
     Working from a model provides the clinician with a sound foundation, off of which he can issue thoughts and attempt techniques.  These ideas have been milled down to their finer points and through practice, the practitioner makes them his own.  Strictly working from a certain viewpoint can be very inefficient, through.  If a client presents with depressive characteristics due to ideas an "inner language/dialogue" with himself, an analyst cannot move from home territory to talk about such communication.
     On the other extreme, one without orientation can be dynamic and compelling.  He can feel free to flit around the various models and use what seems appropriate at the time.  A problem may arise when he is asked why he is taking route A instead of route B.  Is he doing it because he thinks that B is grounded in better evidence-based research or that he feels more comfortable with it?  Maybe.  But it seems to me that such abstract knowledge disallows depth of insight into one (or more) particular categories of therapy.  If the therapist knows a little about a lot, will he ever know a great deal about something more specific?
     And so I think that a home base with much knowledge of other areas may be the best way to go.


October 4th, 2014

     I find it unsettling when people ask me what my "theoretical orientation" is.  It's a dumb question.  Why does it matter?  What box does a such a term put me in?  Why can't I partake of many things?  I have this image in my head that ACA or APA conventions or conferences are a little like gang hangouts.  I picture a ballroom where analysts are in one corner with their cigars and conservative cravats; humanists are in another corner hugging each other and softly whispering, "I hear you."  CBTers  and true behaviorists in a third corner are re-programming passersby only to wash this behavior extinguish rapidly.  I know that such a thing doesn't really happen, but part of me would really like if it were the case.
     That all being said, if I had to pick a psychotherapeutic backer, it would be something very phenomenological and human potential-based.  Authors that come to mind are Husserl and Heidegger for phenomenology and Rogers and Perls for human potential.  I choose these not only because they closely follow my own thoughts and observations on human behavior, but also because they give me the freedom to supplement their incompleteness with other styles' techniques.  I think it is very OK to harness the power of REBT when speaking of a client's fear of public speaking.  I just don't think that REBT is a very good starting point in understanding the client.
     My opinion tends toward the view of decreasing the limits on self.  I find so many theories inherently limiting.  CBTers can only use CBT.  Behaviorists will only use behaviorism.  Analysts with their analysis.  Choosing a theory, while it seems to be almost compulsory anymore, is not a good idea.


November 11th, 2014

     We must ask ourselves why we ask the question of someone's foundation theory.  Is it for our benefit or is it for the benefit of the client?  From a strictly professional point of view, the answer would most definitely involve the client more than the practitioner (perhaps substituting should for would would make that sentence a little more powerful).  But how does this benefit the client?  Yes, different techniques will be used and the therapist will approach the client from a specific standpoint, but if we look at each therapeutic theory, they are all interconnected, meaning that each is just another reframe of the former.  There is much in various theories that blurs the lines between different, if not opposing, theories.  For instance, irrational beliefs in REBT are so ingrained into the client's psyche that they most likely could be aggregated and be called the unconscious, a more Freudian term.
     If we assume this, then we all seem to be coming at theory from different points, yet all are hitting something that bears fruit.  So this can't be for the client, because no matter where we come from, we'll most likely be able to affect them positively.  It must be for us.  What use do we have for this designation?  It seems somewhat idiotic to eschew one way of thinking for another due only to a particular school of thought's doctrine.  Thinkers are supposed to take in voices from all sides of the equation, digest them, and allow some of the good ones to permeate their thought process.  This will give them new avenues of thought.  It seems that without new blood, some theories will stagnate and die out.
     So why do we do this odd exclusion and choice warfare?  Aren't we supposed to be empathetic and understanding professionals?  It could be, just like in any other business where multiple people are involved, that there must be an us-vs.-them designation.  While I think that this is natural (as it seems to be a human reaction to happiness or strife or lack thereof), to an extent I would think that clinicians would have the understanding nature that would allow them to not engage in such behavior.
     This point would be moot if it were not for the fact that there is much distress in the (at least beginner) clinical community as to which general psychological philosophy to choose.  This can stunt us or retrain us to think differently about other theories or practitioners.

Sunday, August 24, 2014

The Similarity of Man, or, The Ego of Man

May 23rd, 2014

     There are only a few types of people in the world.  I know that we like to think that everyone is a unique individual with wholly different plumbing than anyone else.  This is true and untrue.  It is true int hat, biologically, there is almost infinite variability in man.  There will most certainly never be two men with the exact same neuron organization pattern in existence.  It is untrue in that the general behavioral consequences have many less probabilistic reactions (mostly due to learned/simulated responses seen in the past demonstrating what is proper or possible, and due to the natural lack of response reactions to any given stimulus).  While biology may yield a human who has never before set foot upon the earth, many people will have the same reactions to specific stimuli.  When stimuli are viewed back-to-back, it is, of course, less likely that the individuals will continue behaving similarly.  But these are broad categories under which some people may be catalogued.  I will not administer titles to these groups at this time; such categorization is tricky due to the common man's need to be individualistic.  Were I to create such broad groups (and other theorists have done so in the past), they would lead to different types of interventions that would be used to pursue betterment.  I must be clear in saying that these titles would not label the client, but instead would only describe behavior (much like diagnosis should do).


June 24th, 2014

     I'm wondering if we romanticize the human personality too much.  We continually marvel at the complexity of our own brains, but are they really so intrigue-worthy?  We revel in our own superiority due to our increased intelligence.  I think that there are equal parts stupidity and ingenuity where the human collective is concerned.  Sure, we've created books and harnessed electricity, but we've done so many things that warrant repugnance.  We've created so many wonders fit for gods, yet we still lack basic self-control and morality.
     I don't want to go too far off track here.  We see ourselves as superior to all due to our inventions.  Douglas Adams said it best when he wrote:  "For instance, on the planet Earth, man had always assumed that he was more intelligent than dolphins because he had achieved so much - the wheel, New York, wars and so on - whilst all the dolphins had ever done was much about in the water having a good time.  But conversely, the dolphins believed that they were far more intelligent than man - for precisely the same reasons."
     I think that the turning point in our superiority in intelligence occurred when we became conscious of our consciousness.  Somehow this imbued us with a sense of supremacy so vast that the behavior study of humans became very different from the study of any other animal.  We have shown, though, that the needs, habit, tendencies, etc. of man are similar to the "lower" animals.  Primates close to us, like chimpanzees and gorillas, exhibit behavior that is so close to ours, such as grouping and communication.  Verbal language, something uniquely human (another engineering marvel of ours), isn't just ours.  Well, it isn't our insofar that not only we can learn it.  We can teach other beings communication (parrots (though meaning behind the words might not be understood) and gorillas), so can we teach them to feel?  To think?  I believe that primates have already answered that for us.
     Complexity in behavior deals pretty heavily with brain plasticity and neuroscience as well as previous education and experience (nature versus nurture at its finest).  I can't help but equate this to the biological variance inherent in DNA.  Just like we see people who resemble others (including, sometimes, that other's behavior as well) we experience different behavior-styles in people.  If these groups can be given names and whose elements can be catalogued, doesn't it then seem as if personality variance is finite?  We act as if it is not.
     I think that it can follow that certain measures can then be taken for certain personality types.  This can help when people are seeking treatment.  If all this is correct, and I have no reason to think that it is, then human personality is not as infinite as idealists once thought.  In fact, it is the finiteness of personality that allow us to treat it.  Were the human mind a constantly changing and uniquely independent variable, it is somewhat reasonable to think that only the deepest of psychotherapies could work.  Perhaps that is the crux of some of the deeper psychotherapies' arguments.

Tuesday, August 12, 2014

Change vs. Persistence

     What is the correct methodology behind psychotherapy?  Namely, should clients be encouraged to change or to persist in their behavior?  Both points have their advantages and disadvantages.  Also:  what is the metric through which the two sides are measured?  Health (whatever that means)?  Decreased distress after the treatment?  Increased feelings of "at-oneness"?  Are both points correct but should be used for different populations?  Why is it at all relevant or important to current discourse?
     Change is a scary thing.  The familiar has a certain amount of safety.  Safety, as any introductory course in psychology would note, is one of the core needs of humans, after basic physiological requirements.  When the familiar is disrupted, as it most likely will be in vigorous therapy, one feels as if the bottom has been dropped out them.  Skills must be re-learned, relationships re-crafted.  All other non-physical needs (again referring back to Maslow) are secondary, meaning that such things as love and family, education, or exercise are obscured by the re-prioritization that occurs when a change is made.
     The argument can be made (and should be made) that any change that a client incurs is of their own making.  A client must accept change.  I think that the subject of conscious and sub- or un-conscious comes into play here.  A client, after having been force-fed a treatment, even a necessary one by a practitioner, might deny it consciously, but their subconscious may be have soaking in the teaching, allowing the chain reaction to start whereas the client's front mind is not yet willing to grasp it.  
     A change has the ability to bring a client to a more beneficial place.  A change in behavior may allow the client to attract less unwanted attention to him/herself when on an outing.  Such slight behavioral changes could be both positive and relatively simple to implement.  Changes in thoughts and feelings are much more difficult to access and implement because the operate at the core of our being.  When it comes down to it, we are walking bundles of thoughts and feelings, spewing out behaviors.  
     Changes can also be hazardous to our health.  When change occurs too quickly and dramatically, it is foreseeable and understandable that these individuals with an especially weak grounding or constitution might turn to self-harm or inhibitors as a way to cope.  We experience unwillingness to change from clients in the form of words and actions in the office.  We can lose points with our clients by forcing change that they are not ready for or by promoting too much change to the thirsty client that they cannot handle.
     Persistence is something else entirely.  I see persistence occurring in two ways:  First, persistence may occur through lack of encouragement to change.  In effect, this position emphasizes only the strengths that a client owns, while not looking at the deficits in the client's character.  I think that a client might also go along the path of persistence by choosing to change the world instead of themselves.  This is a difficult course of action, but that which is frequently taken by many organizations vying for the inclusion of certain non-behavioral, biologically-based mental disorders (autism, intellectual disability, lefthandedness (heh)).
     We must ask ourselves if persistence is enough.  Change shows that a client has learned a new way of thinking/feeling/behaving through an observable alteration.  Persistence is the opposite.  At best, a client would learn more about themselves and endeavor to piss of others as little as possible.  The gold standard for results in psychotherapy is change.  The metric is change.  Persistence has a lot to live up to.
     I think that persistence could be seen by many people as "persistence of intrinsic directive" versus an extrinsic imperative set onto the client.  The latter here is change.  Of course, in this interpretation, persistence takes on the identity of more fundamental humanism while change adopts the mantras similar to structured psychoeducational methods.
     In general, I think that it is difficult to advocate for a persistence model of psychotherapy when compared to a change model.  In this circumstance, I must add that I am specifically referring to behavioral issues, not biological ones.  Society needs to learn to work with these people, not against them.  I do wonder if there is any middle ground between the two.  To a pretty high degree, I think that the Wellness Model fits the bill nicely.
     I think that two main methods of persistence are normalizing and universality - both cooling techniques.  Normalizing is the act of telling a client that their actions/behaviors/thoughts/feelings are normal and representative of their bracket.  Universality is more helping the client understand that others have behaved/suffered as the client has behaved/suffered and have walked away from it.  While these two techniques are viable and useful, they are not unto themselves total means of therapy.
     One thing that goes along with change that might incur the most resentment is the tendency for either side of the relationship to want to "fix" the other.  Here, an additional point about change must be written.  Change must come intrinsically.  The therapist can only do so much; more is over-working of and over-functioning for the client.  This is not useful to either party.  

Thursday, June 19, 2014

The Role of Diagnosis

     Why does diagnosis exist?  I think that a "diagnosis talk" should exist with clients who receive one from a clinical professional.  There is an obvious stigma in most cultures against people with such titles.  Perhaps as a clinical community, we can subtly change the message of diagnosis from one of hindrance and abnormality to one of medical jargon and record-keeping.
     I really think that a diagnosis would be better suited as a description/shorthand for some behaviors that help professionals understand the client.  Rather than saying, "You are a schizophrenic," or, "You have schizophrenia," why not say, "Schizophrenia is the best name one can give your behaviors?"  The former message gives a title and with it and with it an assumption of status.  The latter is more of an agreement between professionals as to what behaviors a client exhibits.  This should not be a label!

The Role of Therapist

     The role of therapist is a highly contested one.  At is inception, therapists were distant and interpretive, disallowing deep relationships (a la Freud).  The second movement was, in my opinion, less of a psychotherapeutic discipline as it was an experimental psychology doctrine.  But the behavioral method eventually rose to a direct client-based state.  Oddly, though the movement was in direct opposition to Freud's views on psychopathology, sex drives, and the unconscious, behaviorism shares the distance that Freud believed in.
     I think that Adlerian individual psychology was the bridge between the second and the third movements.  It seems to me that Adler was really trying to be a warm being in the client's life.  This could partially be due to the fact that he dealt quite often with children (as they were his main population).  Individual psychology may have even started the idea that the relationship between therapist and client is crucial.
     But, of course, Rogers's client-centered therapy is what it took for the therapist to be seen not as savior or expert (Freud) or caring doctor (Adler), but as a facilitator or helper.  It is this title that so interests me.  Other theorists have changed Rogers's view on the role of therapist slightly.
     Both Beck and Ellis of CBT fame espoused to be more structured and educator-based in their theories.  They acted in the role of expert.  They were teaching concepts for future use.  I think, to be honest, that this approach to therapist role has more to do with the type of theory that it is (teaching techniques for the future) rather than any specific plan they concocted.
     The more I practice, the more I find myself in the situation of psychoeducational technique use.  This could be due to the fact that most of my clients were in the drug and alcohol realm and that life skills teaching is a must in rehabilitation.  Due to this, I think that the role of therapist as educator and expert is important, but perhaps could be turned down so as not to discourage clients fro seeking further help.
     Changing the name of the role from teacher to tutor might reflect my views on the subject a little better.  A teacher can (and often does) talk down to a student from their high peak of knowledge.  A tutor, on the other hand, can teach and instruct, but also can have the ability to provide empathy.  A tutor works with a student, not in spite of him/her.  It is this collaboration that allows the real work to happen.  Just as a tutor can help a student with their research, a tutor approach can help a client conduct research into themselves and their behaviors.

Saturday, June 14, 2014

Intellectual Suicide

     Today, children, we are going to talk about suicide.  People commit suicide for a multitude of reasons, the major one possibly being the inability to cope with some stressor and the additional point of lack of support around them.  They figure that this inner-outer conflict is less preferable to death.  Then, depending on their belief system, they would have to cope with some after-life punishment.  This, if thought through, would imply that such never-ending punishment would be preferable to their current torment.  Some belief systems, if they can be called that, assume that there is a never-ending nothingness waiting to greet us on the other side.
     Suicide is the final action.  Nothing is more subjectively/personally last than this.  But for some people, suicide is scary.  The thought of "taking oneself out" is unpleasant, dissuading one from engaging in the action.  Honestly, the unpleasant thought could deal with the aforementioned afterlife consequences, the process, or the thought of possible failure.  Either way, such rash action is unpleasant.  This is why I think that people commit a more mundane, but no less effective, form of suicide.
     This form of suicide shares at least one aspect with "death suicide."  Both inhibit a future.  This other form of suicide is the tendency of an individual, when met with a fork in the road, to take the easiest path in order to prevent possible failure in the future: that is, to stagnate and make no decision.  But why would one engage in this type of suicide, this future or intellectual suicide?  Perhaps they are afraid of taking the harder road and failing.  Perhaps they are inundated with expectation or policy.  Maybe they are burnt out.  Either way, they are not engaging themselves on the path of highest self-betterment due to a fear of something.
     A lot more can be written on the subject as far as tools are concerned.  Last thought:  suicide, at any level, is about giving up.  There is no hope anymore.  Perhaps there is some learned helplessness here.  Either way, exploring hope with clients is probably one of the main tasks here.

Tuesday, May 6, 2014

"Breaking" a Client

     I've been thinking a lot about new theories and such.  To a degree, just like a choir director or horse trainer must break the choir members' voices or the horse of its behaviors, it seems to me that a therapist must break a client.  What does this mean?  I almost think that one could view catharsis in any form as the behavioral affect of such breaking.  Freud sought catharsis as the key healing factor in his work.  Today we know to pursue the client further than mere cathartic reaction.
     I really don't like the term breaking, though.  It's much too rough and lacks a certain finesse and cold vocabulary that is used nowadays.  Until I think of a better term, it will do.  To break someone, the therapist must only pursue the client's "programming" down to the most basic ciphers.  This requires a lot of uncovering of bad programming.  Some good examples of bad programming came from Ellis's musts and shoulds.  Once these are dealt with, a deeper understanding of the client can be gleaned.
     I think that it could almost be said that a client isn't necessarily looking for the counselor to fix them.  Instead, what they came to find (sometimes with the help of the counselor) is that they want to be understood.  As said, this deeper understanding of the positive aspects of the core person can only be accessed after their negative behaviors are cast aside.  Once their natural beneficence is free and observed, to a degree I think that it is the counselor's job to assist that person in building themselves back up.

Sunday, May 4, 2014

Were I a Professor...

March 29th, 2014

     I can't say that I know what it's like being a professor, but I do have some experience teaching in a university setting as a teaching assistant.  With this, I can give my thoughts on what a class and syllabus would look like with me as the the instructor.  Obviously the class structure and make-up would differ depending on the size and background of the class.  I'm just going to boil this down to simple ideas.  All rules apply to the students as well as myself.

1.  Cell phones will be on off or vibrate; computers off.
2.  There is a difference between thinking and feeling; during any remark, I expect everyone to use the correct word to illustrate their point. 
3.  Swearing is allowed - just not in any one person's direction.
4.  Everything deserves to be discussed.
5.  Any opinion can be cited as long as it is understood that any other person then has the air time to shoot it down.
6.  10% of your grade will be open for participation points.  It is up to the student to show me their motivation and interest in the class.  Part of these participation points include completing the daily work and attempting extra work.
7.  We will read the seminal texts in the theories, or at least excerpts therefrom.
8.  Any presentations will be graded on both the information inside, as well as how it is given.  The what is important, but the how is also.
9.  I will only look at my watch when I am talking.
10.  Coming to class is not a requirement.  That being said, that 10% of your grade discussed earlier is easier to award when you are present.  If you do come to class, I expect you to listen and take notes.  If you spoil the class time for someone else, I will as you to leave.
11.  My expectations of you are high; I therefore expect you to do the work and understand the material.  This class was not created for you to memorize.  We are not in high school anymore.  We are here to learn and be competent in a subject.


April 3rd, 2014

12.  I expect to know everyone's name in a reasonable amount of time.  Really the only way that this will occur is by participating.  If I realize that I don't know your name, I'll call on you.
13.  "I don't know" is a fair answer, though not always a respectable one.
14.  If you star to monopolize class time, I will ask you to wrap it up.
15.  If you need to speak with me outside office hours, please contact me via my provided email address/phone number with ample time to return your request.
16.  When group presentations occur, I will put aside time scheduled by the student/group to get my review.  I would like all students to attend, though not necessarily all at the same time.  
17.  Using the word "like" incorrectly multiple times will result in me, like, not listening to you.


April 4th, 2014

18.  Only one person will be talking a time in class.  We will have respect for whoever is speaking.
19.  Any papers written will use a certain format (MLA, APA, Chicago).  I want to ensure that students have some contact with a scholarly format for future use.
20.  I do not want to fail anyone.  That being said, if you don't put in the time, thought, and effort into the study, your grade will reflect that lack of motivation.
21.  I would like to give everyone as much time as needed to discuss every single point in class.  Unfortunately, we probably won't quite have time for all of them.


May 4th, 2014

22.  There are minimal exceptions for justifiable late papers and assignments.  Out-of-order printers and lost books will not count.
23.  At the end of every paper, you will complete a mini-assignment.  This assignment is to answer the prompt:  "Tell me something profound about psychology that you have learned.  Explain why it is profound and why it matters."
24.  There is such a thing as a stupid question.  A stupid question is one asked in ignorance of required reading.
25.  Food is allowed, but crinkly containers (like chip bags) are not.  They interrupt the presenter or instruction . . . and you don't need the carbs anyway.

Friday, April 4, 2014

Religion and Psychology: The Ministry as a First Attempt at Psychotherapy

March 12th, 2014  

     Could it be that the first psychotherapy was religion?  I'm thinking about writing a paper on the subject.  Here are some pertinent points and questions to this end.

  1. How are religion and psychotherapy linked?
  2. Are there any sources out there that can shed light on this? (counseling ministries)
  3. Religion satisfies all existential concerns: meaninglessness, isolation, freedom, death.
  4. Could eastern religions (specifically Confucianism) be a more constructivist religious psychotherapy?
  5. What places does philosophy take in this?
  6. Read more Yalom, Freud, philosophy, and religious texts.
  7. Is religion open to autonomous thought? Or is it more a rule book?  Are there therapies out there that are rule books? (12 step)
  8. How are psychotherapy and religion not linked?
  9. Is there still space in the world for such practice?
  10. Religion and psychotherapy timelines.  How did people deal with their problems before Freud?
  11. Is there any correlation between increase in church attendance/participation and struggles (economic, moral, etc.)?
  12. Definitions of religion and psychotherapy (and philosophy).
  13. Was philosophy/can philosophy be used as a psychotherapeutic theory?
  14. Is philosophy a more scientific/secular religion?
  15. Which existed first: religion or philosophy? Are they the same? Are they two sides of the same coin?
  16. Is religion without a conventional therapeutic theory a viable practice?
  17. Are clergy taught therapeutic ideals? Would clergy be better at their jobs if they knew more therapy?
  18. What situations could be better/worse with therapy or religion?
  19. Do different Abrahamic religions parallel to different types of psychotherapy?
  20. What is a clergy member's training process?
  21. Religion could be called a first attempt at explanation.  To a degree, a first attempt at science.  Perhaps ministry, the instruction and use of certain techniques based on religious tenets, could be described as a first psychotherapy.
  22. What were/are ministry's goals?
  23. What were Freud's reasons to create a systematic psychotherapeutic theory?
  24. Who were the Freuds, Ellises, and Rogerses of ministry?
  25. Is there literature about ministerial traditions as applied to confession, paster/paritioner relationships, etc.?
  26. Are there ethics documents like the ACA/APA have for the ministry?
  27. Can ministry still be an alternative to psychotherapy? Are there any studies that suggest it is better or worse?
  28. Could a modern therapist use religion as a therapeutic technique?
  29. Are there any good examples of clergymen who were good therapists or therapists who were devoutly religious?
  30. What does all this mean for the modern therapist? Why should we care?
  31. Rogers, at one point, went (or planned to go) to seminary.  Could we say that his genuineness, unconditional positive regard, and empathy came from a religious state of mind?
  32. What venues or side tracks would not be shared between the two?  Career/vocational counseling, research, pastoral care
  33. Could a minister counsel anybody (even the non-religious)? Could a therapist do the same?
  34. Should there be courses in counseling education about religions or religious therapy techniques?
  35. Do some research into Christian apologetics, Christian existentialism, and Christian existential apologetics.
  36. Take a look at literature that is critical of Yalom's critique of religion.  This could show the beginning of research direction and what has already been covered by others.
  37. There is an evolution from religion to psychotherapy.  Remember: Ministers are helpers, just like psychotherapists.  This means, to a degree, that there is something after psychotherapy, some higher evolution thereafter.
  38. An assumption that must be made is that man created religion.  Whether a God or gods exist is not germane here.  Man created a hierarchy of places/beings/actions that have consequences.  Religion was man's first imperfect way to define the world.  One of the biggest things the enlightened man must deal with his own mortality.  Before questions about starts and beginner physics, one must deal with the beginnings of endings.  As beginnings can be proven through record or memory, it is only endings that have no real means of record.
  39. Just as a square is a rectangle, but a rectangle is not a square, ministry could be a type of therapy, but therapy itself is not a religion.  A minister can use therapeutic techniques and provide some kind of counseling, but a counselor cannot necessarily do the same. 

April 3rd, 2014

40.  Why was psychotherapy created?  What were Freud's thoughts on religion?
41.  Research more into christian counseling, its applications, licensure programs, etc.


April 4th, 2014

42.  Understand that psychotherapy in general is metaphor and technique.  Very basically, it allows the self to understand and be more aware of itself, decreasing symptoms.  There is minimal scientific evidence that psychoanalytic theory or psychodynamics is scientifically accurate or presentable.  But it still works!
43.  Just as every invention is base on the client (and therefore should be malleable/adaptable to that end), I think that religion as a technique would have to follow the same basic rule.  Perhaps this is where religion and therapy broke off historically.  Religion could not keep changing for every person specifically while a budding concept, psychotherapy, could, and easily did.
44.  A good title for an article might be, "The Historical Role of the Ministry in Psychotherapy."
45.  Couldn't the idyllic image of a counselor as calm and patient come originally from the transfer over from the ministry?
46.  I think that therapists on both sides of the religion debate need to examine their own motives for argument.  On the one side, those against religion speak from personal opinion, seeking, to some degree, to "convert" people to their side.  The other side, those who are religious themselves, should take just as much care not to let their personal beliefs poison the interviews.  Each side must eschew such thoughts and attempt to do what is good for the client.  Perhaps a discussion about religion would be beneficial.  We are, at least, not in the business of bringing clients to shed their belief system.  Judgement is not our game.
47.  While religion might be a coping mechanism, I don't think that ministry is the same.  Again:  Freud's analysis of coping mechanisms is psychoanalysis, just as the application of religion is ministry.
48.  Find "official" and unbiased/biased definitions of religion and ministry.
49.  What can both fields (ministry and psychotherapy) learn from one another?
50.  With the New Science anti-religious movement, it seems that a lot of the debate for or against religion is done.  While who won the debate is somewhat up for grabs, a place for religion seems to be more and more scarce.
51.  What caused a split off between ministry and psychotherapy?  Is it a relevant psychotherapy anymore?  Could ministry be a flawed psychotherapy teaching its "clients" sub-par coping strategies?
52.  What research is out there promoting religion as positive?  As negative?
53.  Should we respect religion as a valid way of life?  Should it be a way of life?  Is it too much/too little?
54.  What are the positive effects of religion versus the positive effects of psychotherapy?  Are there negatives for both?  Anecdotes?

Saturday, March 22, 2014

Persona Theory

August 5th, 2013

     Persona psychotherapy came about when I thought about what shaped me.  I think that we an all agree that other people are huge shapers of what we think.  Moreover, they don't just change what comes to mind, such as our political leanings or speech patterns, but also the very fabric of who we are.
     This theory is obviously very nurture (as opposed to nature) based.  While I think that nature has its place in the argument, I believe that nurture is a greater force to be reckoned with.  Genetics can be micro-manipulated by the self in certain ways (weight gain, resistances, etc.).  But nurture is where the real lifelong change comes into play.  Whether or not we believe it, communication has both report and command components.  These sometimes subtle variations in behavior can signal life-long observable changes in an individual, especially if they are repeated for years.
     It's all about the people.  When we think who were the most important figures in our lives, we have to think in a broad scope or spectrum.  Obviously our parents were huge in our lives, but it's more than that.  We should be including co-workers, friends, media figures (actors, characters (in books and TV/movies), etc.) and societal norms.  All of these are "personas."  They all have the effect on us of proclaiming what is right, decent, or ideal (and very often what is wrong, indecent, and flawed) in our nature and in society.  I think that everyone's ideal is different.  For men, the ideal man could be younger Arnold Schwarzenegger or Clint Eastwood or perhaps some new charismatic media persona.
     As mentioned, cultural and over-arching time-sensitive norms are important here as well.  A persona consists of both of these.  A man is made up of many things, including the time period in which he or she lives.  A good example is Freud.  Though at this point in the future we scowl at the very name and poo poo his accomplishments and his at-that-time genuinely novel ideas, his ideas were celebrated because they were acceptable at that time.  The odd thing about the current age (especially as compared to pre-printing press days) is that we can choose to change ourselves based on past idea and persona due to the proliferation of media on the internet and in books.


August 10th, 2013

     One of my points in a previous entry was to ensure that I write about similarities and differences between this budding one and current psychotherapies.  I don't think that I will spend a separate entry detailing such things.  These will most likely be introduced piece-meal-style throughout this writing.
     As mentioned, persona psychotherapy is all about people.  There is a postmodernist feel here because our ideas about people (and how we integrate this figure into our own behaviors) is based, more or less, in our culture and upbringing.
     While these other figures or personas are important, we must understand the reason that we are integrating their behaviors into our own.  We saw or experience something in their actions that we aspire to.  Perhaps a behavior was expressed, like self-confidence, that brought about a date or pay raise.  We, on the outside, would see this behavior and attempt to mirror it on our own.  WE do this because we see a deficit of such behavior in our heretofore collected bag of expressions.
     But what is the goal here?  The goal is to gain all the correct behaviors so that any problem can be surmounted.  Similar to Maslow's theory, we are striving for a self-actualized persona.  I don't think, though, that self-enhancement by way of integration ever stops.  Just because one finds that most problems are solve with his or her current behaviors, there is always much more out there to react to.  I'd really rather call this unattainable (or shortly-attainable) goal the ideal self after Rogers.
     Akin to the idea that one see usable behaviors and integrates them into self, just like building a house from many bricks, it seems that the selection of behaviors has also to do with the matching of behaviors from someone who presents himself or herself as similar to that ideal self image.  I think that this might be one way that negative behaviors are integrated.
     As mentioned in a previous entry, a whole generation (or two) of America saw Clint Eastwood (his characters, really) as an ideal image of what it is/was to be a man.  In their attempt to adapt his "positive" mannerisms, such as his deep, scratchy voice or confident, yet haughty glare, they might adapt a characteristic stubbornness that goes with Eastwood's characters.  Another possibility, other than accidentally sweeping up an unwanted behavior, is that the unwanted mannerism was a stepping stone to, or building block of, the wanted behavior.  In order to attain the desired manliness of Clint Eastwood, a level of stubbornness must be attained.


October 25th, 2013

     Going back to my ideas on persona theory, I think that many of our anxieties in life occur when we don't have the necessary skills to deal with them.  Also, our affliction with the other characters in our lives is important.  I have already discussed that we mirror successful behavior (or unsuccessful behavior) from people we look up to.  But what if the relationship with that person degrades?  What does that mean for our current behaviors?
     Most people would choose to either A) continue their behavior because it is successful to them, or B) discontinue its use due to its negative association with that individual.  Their new stance on that person has changed their skill set.
     I think that every person in our lives occupies three levels (or more) in our mind.  The first is the real level.  This level is an accurate, relatively non-subjective view of this character.  The real level, especially if this person has recently become a "skill-setter," can take place in the past, before the skill has been absorbed.  Best said, the real level is a past-verified view of a person that is relatively well-believed across a sample.
     The next level is the ideal level.  This level denotes the rosy-eyed view of the individual.  At this level, one normally starts adopting behaviors and testing them out before absorbing them completely into themselves.
     The last level is the fall level.  This level occurs normally after the individual engages in some kind of behavior that brings their identity into question.  Oddly, the action could be anything - that's why people become stuck so often.
     These levels are important, because they really do note the level of favor and the chance in mood toward them when actions change.  It's a big drop from ideal to fall.  We do a lot of intra-personal work in building people up in our mind to get them to the level of ideal.  The fall consists not only of the general lack of favor and its disparity as compared to the ideal level, but in the acknowledgement of the need for the deconstruction of that foundation.  This is a painful process.
     It's important to remember that people aren't just searching for these new skills and to become unstuck, they are also looking for help to learn to re-trust.  Counselors are tasked with re-teaching, or perhaps better said, re-allowing clients to trust appropriate people.


October 29th, 2013

     There has to be someone who doesn't fit this theory, right?  Someone must exist who hasn't been "imprinted," right?  I'm not so sure.  The more I think about it, the more I come to believe that common man, who has developed in the company of others, can't have progressed without the guidance of those coming before.  When we hear of such untainted individuals, they are the wild man and woman of antiquity.
     Using the word untainted pushes me to talk about Ellis.  I remember that he talks a lot about younger individuals adopting the behaviors and rules of their parents.  He was a real advocate of a person identifying "correct" behaviors for themselves.  I don't disagree with his motivations, that is, to rid the self of inaccurate or outright incorrect thoughts and behaviors that are based on the teachings or examples of parents.  I agree with him that people have to learn to choose and expel behaviors based on their utility.


March 15, 2014

     I've come to the conclusion that this Personal Theory has a lot of influence from social-learning theory, but that it also has elements of a bunch of other theories.
     Let's talk about conflict for a second.  If a child or even an adult experience two viable yet opposed viewpoints, how does he or she choose which one to follow?  This is the heart of decision-making.  The subject must first review all biopsychosocial rules that they follow.  They would have to ask: "Would my parents agree with this?"; "Is this illegal?"; "Would my socioeconomic status decrease or increase due to this decision?"; et cetera.  I think that people then try out the behavior.  I would hope that the attempt at each would start on a small scale, but maturity and self-control might take a role in that specific instance.  After these testing results are yielding positive effects, the practice increases in intensity possibly being integrated into main parts of life.  The last step to that integration would be to add it into the personality schema.
     I'm trying to re-understand the levels that I wrote about prior to this.  I delineated three levels: Reality, Ideal, and Fall.  I think that it is hard to quantify these.  Better said, creating a hierarchal view of which one of these levels (or which a figure of significance may be on) is difficult.  Which one is better?  I think that each have their own positives and negatives.  Let's review them.
     Reality: Positive - Knowing a figure totally and understanding the real connotations and situation is an invaluable skill to have.
     Reality: Negative - If this real, "objective" view of this person is locked - and taking into account that that figure is under our expectations - there is a certain depression that might come from this failure.
     Ideal: Positive - If an ideal figure embraces characteristics that are positive and constructive, the follower would then aspire to these ideals and learn to adopt them.
     Ideal: Negative - I think that it is possible for subjects to adopt negative behaviors from a positive ideal figure.  If this figure was honored to the point of worship, then the negative behaviors shown would have just as much of an ability to be integrated as the positive ones.
     Fall: Positive - I think that the Fall is a part of the process.  One definite positive to this is coming to the realization that the figure has faults (and, even deeper, that the subject has faults) and that there is a learning process in life.  The identification of negative behaviors is also a positive learning experience.
     Fall: Negative - The change from Ideal to Fall can be a huge one . . . I think that this might lead a person to a minor depressive episode, depending on how glorified the figure was in the subject's mind.
     Let me try to tackle the non-hierarchal nature of this now.  At an earlier age, I think (and this is a gross generalization) that we tend to idealize both easily and often.  Children tend to be impressed with others easily.  So, it follows that the ideal level is the first.
     It is almost inevitable that we see through the ideal figures in our lives.  A good general example is our parents.  When it comes to gender-stereotyped behavior, boys idealize their fathers and girls idealize their mothers.  When a child reaches adolescence and the lines between parent-leader and parent-helper start to blur, the Fall level is reached.  There is some doubt as to some/all adopted characteristics from that person.  Much introspection is done and then, hopefully, a youth comes to create their own ideas about their actions.
     For me, a big fall (other than the normal parental one) came in the form of Carl Rogers.  In my education, Rogers was always portrayed as the ideal counselor and theorist.  I exalted him above all others.  Then two things happened.  1) My continuing education propelled me on to other interesting areas in psychotherapy and 2) I found out that he was an alcoholic.  For whatever reason, his me-created facade of constant angel-like calmness was gone.  Quickly his words meant less and less.
     The next step, after a figure has reached the apex of the Ideal and the trough of the Fall, is to become real in the eyes of the subject.  I think it is at this point when both faults and positive qualities can be weighed more objectively.


March 17th, 2014

     The adoption of behaviors and assimilation into the self is what I have commented on so far in this theory.  I think that the original intent here was to understand my own use of other personas in my daily life.  That last sentences begs an example.  If I need to motivate a group of people, my mind immediately shifts to a guy I once knew named Bill who had this ability.  I try to mimic his way of speaking and acting and this seems to help me in this particular situation.  After this channelling is over, I try to grade the result.  If it is a positive one, I attempt to integrate some of the mannerisms into my own behavior set, rather than having to refer back to the character.  This has the advantage of personalizing the behavior, possibly making it more organic.


March 22nd, 2014

     As previously mentioned, sometimes people impersonate important figures in their lives.  I'm going to free associate with this and try to figure out a why and a when to this phenomenon.
     In my opinion, I think that impersonation might tend to happen with youths.  When I say youths, I do not necessarily mean children, but rather a state of being that denotes an immaturity in the functioning environment.  For example, a newly-promoted executive might impersonate his or her supervisor in order to act more professionally and integrate himself/herself into the job.
     I guess that impersonation is a phenomenon that occurs during the Ideal level.  The figure's significance to the subject at this level is so large that the adoption of specific behaviors is possible.  Impersonation does occur in the reality stage as well, but the subject's own personality is more dominant, allowing for the integration of behaviors, rather than pure adoption into a behavior system.
     So what happens when there are behaviors that conflict with one another?  Which one does the subject adopt and then integrate?  I think that this could be a main source of anxiety.  We might hear a client say, 'What do/should I do?"  It could be that two figures of similar level and dissimilar behavior are on trial in the subject's mind.
     Perhaps, on the developmental side of things, a therapist who is engaged with this type of counseling is charged with helping the client with any conflicts between figures, but also to help the client through a Fall.  This latter point includes both a Fall that occurs through the client's own thought process and one that a counselor might start.  I think that some clients hold their parents at the Ideal level a bit too long or a bit too high, increasing the likelihood that differentiation would not occur.  In this situation, very sensitive confrontational techniques could be used.  This is to say that a counselor should not slam the idea home.  Instead just a word or two of challenge might cause the client to think about the issue in a different manner.

Tuesday, March 18, 2014

My Rules of Counseling (or Things to Remember in Therapy)

January 12th, 2014

1.  Everyone has strengths.  Remember to ask after, and support, their strengths.
2.  Projection is huge.  Remember that people come to counseling to talk about themselves and their own problems.  Search for any meaning behind their words for they are only talking from their own frame of reference.
3.  Don't be rude; always listen and react kindly (though sometimes being firm is OK too).
4.  Resistance is not inherently negative; in fact, it can show that a client has a firm grounding in a belief structure.  No resistance ever either means 1) that you are the best therapist ever or 2) that the client has no personal belief/thought system.  Also: resistance is a call for some process counseling.
5.  When in doubt, go back to process. This is a good way to increase rapport and possibly go to other topics. Process should not always be a last-ditch intervention.
6.  One of the most important things to understand for most interventions is that they should be what the client needs.  Countertransference is fine (it actually normally isn't), but to sate it during every compulsion will not benefit the client.
7.  Physical touch can be a huge factor in therapy for good or for ill. Boundaries being what they are, a quick hand on hand action, handshake, etc. can show support on a different level than normal talk therapy.
8.  Modern therapy is fixated on the present. To a certain extent, that is good. But we cannot disregard the past.  Situations and relationships may be informed very heavily by past ones. The past is rich with background information and clues to current behavior.


March 18th, 2014

9.  Don't underestimate the value of time in therapy.  If a technique of subject-matter does not work or is not yielding good discussion, it is perfectly alright to come back to it in a session or two.  Half of the time, the conversation will make the client think more during non-session times, anyway.
10.  Nothing happens within a vacuum.  Decisions are never made due to one variable only.  Always search outside the immediate circumstance for more information.
11.  Clinical distance is one of the most difficult things to implement and keep throughout the process.  That being said, it is there for a reason and will help with termination and difficult confronting.
12.  Understand the resources around your practice for continuing care and referral.

Thursday, February 13, 2014

Realms of Therapeutic Issues

     It is becoming clearer and clearer to me that a respectable counselor does not just query a client about the problem at hand.  Sure, a client may come in with a presenting concern, but is that issue their true problem?  I think that a lot of counselors would find this doubtful.  Exploring a client's whole self is of utmost importance.  What I would like to understand are all the realms of self that a counselor would and should cover.  I guess a first step in this understanding is to attempt a creation of a list of these "realms." Here we go:

  • Childhood
  • Family
  • Current relationships (romantic)
  • Work
  • Friends/Other influencers
  • Strengths/Weaknesses
  • Fears
  • Current life events/issues
  • Long term event/issues
  • Exercise/Diet
  • Financial Issues
  • Values

Monday, January 27, 2014

Steps in Therapy (Under Constant Revision)

December 4th, 2012

Steps in Therapy --> to be revised!!

  1. Question:  What are you looking to gain from therapy?
  2. Joining - Try to create a sense of "us" with client so that they feel more comfortable and are more willing to disclose
  3. RESPECTFUL model - This will give a therapist a great look at the client's situation and their part in it
  4. Bronfenbrenner's Ecological Theory Model - I think that this is somewhat similar to the RESPECTFUL model in that it shows off the environment around the client
New Step 1:  Talk about confidentiality, roles, and meeting for communicating outside the sessions (as well as Duty to Warn and other limitations on confidentiality)
New Step 1:  Introduce self.  This is amazingly important due to the fact that any first introduction paves the road for future communication.  It teaches them not only more about the therapist, but also gives them a mini lesson in how to communicate.
Last Step (per session):  Document what happened in the session


December 6th, 2012

Steps in Therapy
  1. Introduce self
  2. Discuss payment
  3. Discuss confidentiality et al.
  4. Ask why they are here and what they hope to accomplish
  5. Joining
  6. Systems models (RESPECTFUL, wellness, Bronfenbrennarian/Ecological)

January 9th, 2013

     About a month ago, I wrote a more succinct progression of steps when beginning psychotherapy.  To look at some details on these steps, consider the explanations in the first log.  After seeing an abbreviate session in one of my classes, I was told - and later saw the logic in the statement - that a priority in therapy is to understand the client.  I believe that my steps attempt that, but that they lack that word choice.  I think that step six's intent is to understand the greater context of the individual.  But we also need to understand the individual.  So, rather than just ask questions and seek information about his/her environment, seeking information about the person is integral.
     I also think that step five should not be a step in and of itself, but rather the title "joining" hould consist of multiple steps/phases.  I'm not exactly sure what these should be at this time.  I think that the steps should be revised to look like this:

Steps in Therapy
  1. Introduce self
  2. Discuss payment
  3. Discuss ethical considerations in therapy
  4. Ask purpose of visit and prospective achievements
  5. Discuss number of appointments and method of therapy
  6. Rogerian interviewing to understand client
  7. Systems models

January 10th, 2013

     Because I am in my program's ethics course right now, I am sure that some of my future writings will introduce concepts taught or thought up in class.  This is one such entry.  I've been attempting to create steps in the beginning of a successful psychotherapy and I think I've thought of a new step one.  The first step, before formally introducing oneself with credentials and so forth after sitting down in the chairs, would be to give the client pertinent sign-able documents.  These papers would include confidentiality rules and regulations as it pertains to the ACA (or whatever ethical organization is important).  So the steps now are:
  1. Disperse and collect paperwork pertaining to ethical and legal issues
  2. Introduce self and explain relevant education and licenses
  3. Discuss payment
  4. Discuss ethical considerations in therapy
  5. Ask purpose of visit and prospective therapeutic achievement
  6. Discuss number of appointments and method of therapy
  7. Commence therapy starting with Rogerian interviewing to understand client
  8. Systems models
  9. Remember to console client with universality (if applicable)

January 14th, 2013

     Going off of my previous steps in counseling, I have come to realize more steps and a change in the overall model.  The steps to add include 1) an explanation of counseling, 2) an assertion of more to come, 3) a discussion on client-centered variables in counseling, and 4) the agenda for the first meeting.  Let me elaborate a bit more on each one.
     The first idea stems from misunderstandings in what counseling is and what it entails.  Clients think that counseling is a "quick fix," one that takes a session or two and . . . done!  Instead, it takes work and the ability to change.  This is important for both a resistant client and a client who has been forced into therapy.  Better said, if they don't want to change, therapy will do nothing for them.  
     The second idea is both a phrase meant for comfort and a business practice.  It is very important, first of all, to ensure that a client does not despair in his or her first meeting with the therapist.  The first session is an information-gathering one and can therefore, due to lack of therapeutic merit, be very disconcerting to the client.  To avoid this feeling, it is important to make sure the client realizes that more therapy will commence when information is gathered.
     The third item here is about clients.  A lot depends on the client:  willingness (as previously mentioned), attitude, skills, etc.  Honestly, I jumped the gun on the first point.  Change should have been in this paragraph.
     The last item is talking about the agenda for the first meeting.  This is designed to make sure that the client knows what's in store for the session.  This can alleviate anxiety and the possible feelign of being jipped.
     Moving on, I think that putting these steps into "steps" might be a bad idea.  I think to set these into such a format might give them some kind of permanence as a list.  Rather, I think that they are better used as suggestions or points of discussion.  Also . . . I don't want to hampered by so many formal steps.
     I think that some of these points of discussion could be cleared up in a pre-therapy discussion or a pre-therapy paperwork.  Information about ethical and legal issues could be disseminated this way, but should be followed up.  Payment can be easily outlined via paper and may cause the therapist to avoid such a sensitive matter.
     It is possible that some of the other information can be explained via paper, as well.  Information regarding agenda for the first meeting, self information about education, and number of appointments can be presented in a document also, but should be followed-up as well.  
     Let me try to portray this new model again with all the other information:

Pre-therapy documents
  • Ethical paperwork
  • Payment information
  • First meeting agenda
  • Short biography including schooling and license(s)
  • Policy for number of appointments
  • Short description about method
Points of discussion
  • Follow-ups
    • Ethics paperwork
    • Payment information
    • Method description
    • First meeting agenda
  • Self introduction
  • Purpose of visit and prospective goals
Beginning of therapy
  • Rogerian interviewing and systems models
    • these are used in order to understand the client from their point of view and in their context
     It is probably important to cite on-going techniques of merit in therapy also . . .  At this time, I will forego this, but will put it in my agenda for future writings.


January 28th, 2013

     More points of discussion to add.  They are:

  • themes and values in life/family
  • developmental thought process location
  • introduction of self outside of therapy
     The first point is very much an existential/psychodynamic one (and systems, obviously).  It mentions the important or underlying points in an individual's life.  Through asking the client about their own thoughts about family, life, etc., the therapist might glean at least a small amount of information about the client without their own resistances coming forth.
     The second point is from something I learned from one of my professors.  He talked about thought across the lifespan.  In particular, three of conventional thought (going from moral thought).  The first stage is pre-conventional thought.  It is a stage when a person is mainly concerned with the self.  From a Freudian personality component theoretical model the pre-conventional thought stage is closely related to the id.  The second stage in the model is conventional thought.  In this stage, closely related to the superego, the person harnesses externally-based thought.  While this is an attractive notion, it means that the client thinks of himself/herself in terms of other people's opinion.  This can be potentially harmful.  The third step is post-conventional thought.  It represents the integration of abstract thought into life.  Abstract thought allows the client to form unique ideas and identify both pre-conventional and conventional thought.  This stage is most closely related to the Freudian ego.
     The third point is critical if the therapist might have contact with the client.  If the therapist lives in a small town, the probability of seeing any number of previous or current clients is higher than living in a large city.  It is important to determine means of introduction, complete with proper salutation (Mr., Dr., etc.).  Since multiple relationships are not healthy for the client-therapist relationship, knowing how to act in these situations is important.
     With this line of thought comes obvious paperwork designed to pry information from the client.  I think at least one good piece to have is information about family and friends.  Let's recap the process:

Pre-therapy documents
  • Ethical paperwork
  • Payment information
  • First meeting agenda
  • Short biography including schooling and license(s)
  • Policy for number of appointments
  • Short description about method
  • Family/friend information (w/ addresses, contact information, etc.)
Points of discussion
  • Follow-ups
    • Ethics paperwork
    • Payment information
    • Method description
    • First meeting agenda
  • Beginning of therapy
    • Rogerian interviewing
    • Systems models
    • Depth themes
    • Lifespan thought process model

January 27th, 2014

Pre-therapy documents
  • Ethical paperwork (consents/confidentiality)
  • Payment information (include insurance information)
  • First meeting agenda (include demographic and basic information)
  • Short biography including schooling and credentials
  • Introductory policy as far as number of visits
  • Method description
  • Family systems information
First Session Points of Discussion
  • Brief repeat of:
    • Ethics paperwork
    • Payment information
    • Method description
    • First meeting agenda
    • Self
    • Questions
  • Goals of Therapy
  • Reasons for entering therapy (what is client's definition of wellness?)
  • Mental Status Exam
  • Ask about room structure/formation
  • Previous therapy experience
  • Medication?
  • Post-counseling dual relationships