Monday, April 20, 2015

How Not to Run Out of Things to Say

     Another name for a therapist is counselor. A counselor learns counseling. In counseling, there are many different styles that, when matched to the appropriate clinician/client relationship, can yield positive responses. I think that we sometimes forget that there is more to therapy than these theories. In fact, no new counselor is trained in any theory, really. We forget that counseling itself has its own questions to be asked and is a support that any clinician of any theoretical orientation can fall back on when their theory is not working.
     One of my own faults has to do with "seizing up" when I realize that I don't know were to go during a session. Frequently, I find myself running out of things to say which puts both parties in the uncomfortable situation of awkward silence and can undermine the relationship as a whole. I think that there are important questions that need to be answered: These could be:

  • What are you looking to get out of counseling?
  • Why did you choose therapy?
  • Do you have any supports in your life?
  • What are some advantages/disadvantages of that situation?
  • How are you feeling about that now?
  • What are some changes you can make to meet your goals?
  • How did that affect you?
  • What is your biggest concern?
  • What changes between then and now?
  • What's that like for you?

In-Session Paperwork

     Therapists talk a lot about having an idea about where they should be going with therapy. We should know why we are questioning the client as we are. Random questions should not be discouraged, but should be minimized so as not to confuse the client (or ourselves, for that matter). To some degree, we want the client to see where we're going; we want the client to be able to understand the topic enough to foresee where the conversation is headed.
     Therapists need to be able to have their end idea in mind and ask questions in order to sustain, or to throw out, their hypothesis. 99% of the hypotheses will be incorrect and that's OK. Even incorrect hypotheses give one at least two pieces of information: 1) They allow a clinician to rule out that idea and 2) they allow more information to be gathered that could lead to the genesis of a new hypothesis. Of course, there are some phrases said by clients that require a specific response at that time, even if it is not a question or a statement that lends itself to the hypothesis.
     It can be easy for a clinician to become fixed on a certain hypothesis. This could happen in any number of ways, I suppose, but two come to mind at present. The first is that the clinician believes that their hypothesis is the only correct explanation for the behavior that exists. This means that whatever signals the client sends are discarded by the clinician and the client saying, "THAT'S NOT IT AT ALL!" might be seen only as denial. The second type of hypothesis fixation is when any outside comments are not taken into account and will not dissuade the clinician in finding out if this hypothesis is correct.
     A good note sheet could look something like this:

|     Client's Name                                                                                      Working Hypothesis         
|     Date                                                                                                     New Hypothesis                
| -------------------------------------------------------------------------------------------------------------------------
|     Topic:                                                                      Intervention:                                                  
|     Information:                                                                                                                                   

Working With the Client in All Ways

     I have been rather stupid in the recent past. I have talked a lot about meeting the client where he/she is, yet I threw out the importance of theories such as CBT to the theoretical framework of a practicing therapist. Thoughts are a part of the person. A therapist cannot just deal with emotions, behaviors, and beliefs. Even if this works 99% of the time (which it wouldn't) a therapist is failing clients due to a faulty knowledge base.
     I must say that I am rather disappointed in myself for denying such an important are of knowledge. I will say that I am no CBTer. I still don't see it as an end-all, be-all type of therapy . . . but it does have some merit.