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.  

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