Wednesday, August 12, 2015

How Do We Help a Client?

     Is it the place of the therapist to help the client solve their problems in session or is it the clinician's duty to bring up so many questions in the client's life that they must choose to answer them or go insane?
     As with all dyadic arguments, each side has both advantages and disadvantages inherent in their methods as well as outside their application. We must take into account here that I am speaking, of course, in generalities, as the quite phenomenological part of me disdains such gross thought. We must also take into account here that there are some schools of psychotherapeutic thought that deal mainly with the issue of solving problems with/for the client. CBT, frequently, does this, while some therapies, such as solution-focused therapies to it exclusively.
     I think that it is frequent that clients want the therapist to come to a conclusion for them. Many therapists do this, giving out advice and educating a client on what to do. It must be said here that explaining how to do something is quite different than describing what to do. The latter burdens the therapist with deciding the issue, one way or the other. I think that it is quite clear that it should be the client's decision to make a change. But, seeing the issue from the outside, how much does the clinician push? Psychoanalysts would say that little to no guidance is best. DBT practitioners would say the opposite, possibly.
     So is it the therapist's place to say, "You are having an issue with ________."? To some degree, I think that that burden lays only on the shoulders of the client. To be forced or coerced will not lead to a positive prognosis and says little about the future good of the therapeutic relationship. When a client looks back on their goals and treatment plans, might it not be best if the concerns tackled were theirs? Obviously here I predicate the argument on these clients being intelligent enough to be able to perform such a cognitive task.
     So, so far, without answering, or even alluding to an answer to the central question and reason for this entry, I have masterfully come to the conclusion that clients would be able (when at all possible) to determine their own problems. How much prodding by a therapist in one direction is appropriate here? As previously mentioned, voicing personal opinions on a client's hidden presenting concern may not be the most skillful one. As all clinicians are taught in school, it is fine to (indeed preferred to) operate under a hypothesis, even if that hypothesis is in direct violation of the client's own presenting issue. This is where the expert role of the clinician may come into play.
     An analyst will frequently refer back to his/her hypothesis, even if thrown out by the client. He or she will still see a kernel of truth in it (due to their own training and past experience) that the client may refute brazenly. A client-centered therapist might approach things differently, taking their assertions as gospel, or at least remaining mum about the continued hypothesis. The clinician's theoretical orientation is the main sway in this argument.
     When it comes to actively solving a problem with the client, what are the gains and harms? A huge gain is that a clinician can supervise the problem-solving process, deterring a client from violence (to self and/or others) or other negative outcomes. A harm that comes with that has much to do with the finite knowledge and experience of the clinician. It is possible that a clinician could steer the client down a wrong path, leading  to one of the not-so-positive outcomes aforementioned. A positive may be the efficiency with which the clinician can fulfill the client's needs in therapy. A subsequent advantage here would be the speed which a session can get on to the new - possibly more important - topic or the clinician can schedule a client in more dire need of therapy. A big negative could be that problem-solving methods do not necessarily yield information about personal history or motivation that might reveal the true nature of the concern or the true concern itself. Another negative is that the client may leave treatment, thinking  that his or her work is done, without reaching into himself or herself for another important topic.
     What about the second approach? Is it more effective for a clinician to deny the topic of helping a client to solve his or her problem and instead search for the deeper meaning behind their plight or plea? Frequently, a client comes in with a certain problem: this could be anything from pain in their head to an existential angst about death. A therapist can choose - in the sense of the first approach - to find the reason for the pain (which might be very dynamic of them, depending on how they go about it and how deep they endeavor to delve) and/or talk about different, normally cognitive or behavioral methods that could help the client in the short run. A therapist of the insight persuasion might do this, but also bring to light some other issues that the client is having. To put it another way, the clinician does not see the presenting problem as such, rather sees this concern as an avenue to the real, or just other deeper, issues that the client is facing.
     One strategy that this therapist might use is to identify so many issues that the client shows distress with, that there builds up in said client a certain level of anxiety. This is a critical point that can show the difference between the seasoned and the amateur therapist. The immature therapist may stop too soon in this process, allowing too little anxiety to show in the client, before working with the client on some of the problems. The immature counselor may also go too far, not identifying the client's anxiety and working with the client to increase their own intrinsic motivation for change. This could lead to many more violent concerns, such as self-injurious behavior, suicide, or an outward explosion onto others.
     The seasoned therapist, quite on the other hand, will allow the client to feel his or her anxiety, reinforcing their own strengths - particularly their strength for changing themselves. This will allow the client to come to an intrinsic change much quicker that will last longer specifically because it came (in the client's mind - which is what matters here) from the client. I think that the seasoned therapist in general (obviously) has more techniques and skills built up that will allow the therapist to operate in a way that is best for the client.
     So the end question is: which approach is better? Perhaps the better question is: Which approach is more skillful? I think that the answer here would have to be the latter choice. But this is not to say that the former is not all bad. Rather, this is to say that the former is just an immature expression of the latter. The skillful therapist will test out how to gain experience enough to move to the next level in their own practice.

No comments:

Post a Comment