Friday, August 7, 2015

Is It Too Much to Ask a Client for a Fundamental Change?

     As with any theory, there are pros and cons. The same occurs with psychoeducational psychotherapy. I think that a main con that is difficult to see as otherwise with this modality is its use of convincing. I'm using the word here to denote the need for teaching rote skills to a client. Obviously, for a client to really take these lessons, they must be convinced that the material is worth enacting. True, some clients won't need this, but some do.
     It is this convincing that quickly leads to a certain type of (hopefully positive) indoctrination. This, frankly, scares me a little and is the main topic of this entry. I think that there has to be a certain level of buy-in to any psychotherapeutic meeting. This goes along quite intimately with Rogers's views on the strength of the therapeutic relationship being the most important factor in positive change in the client. Aside from this, thought: Are we not asking our clients to change/adapt a new philsophy, lifestyle, or state of mind? Is this not a lot to ask of anyone?
     If we were to really think how groundbreakingly catastrophic this could be to someone, would we do it? Sure, we start small, making/facilitating minor changes, hoping that the client sees the light and starts advocating for themselves in their personal lives. We need to be very careful in how we go about this process. Push too much and, yes, we might lose a client; but think about the significant impact that this could have on their lives!
     Take, for instance, a client who is having a relationship issue. This clients is unsure of his spouse's/significant other's reactions and his/her own proper reactions. If the therapist deigns it worthy, she might go deeper to find some history of spousal abuse in the parents that is replaying itself out in the client's current life. While the client's behavior is assuredly maladaptive, changing the behavior is tricky. The behaviorist would ask the client to simply practice new skills. He or she would assume that the old behavior would extinguish itself in time and the new behavior, if properly maintained, would take its place. The humanistic practitioner would work with the client, avoiding conflict and setting up scaffolding to prepare the client for positive change. The CBTer would dispute negative cognitions when heard in order to activate the client's "logic function" and give them an "aha!" moment. The depth-based practitioner might look at the client's own past, motivations, resentments, etc. All of the clinicians are looking for some "in" that will allow them (or allow them to help the client) to make some kind of quasi-philosophical change in his or her life.
     Such a change is huge! It can cause the client's whole life (in their subjective experience) to fall to tatters. It is, then, the therapist's job to help the client to rebuild their worldview (again, only if such a reaction were to occur . . .  with very existential clients/clinicians, the probability of this occurring is a tad higher). Frequently what is required here is the adoption, by the client, of a new lifestyle. THIS is one of the most important and most difficult steps in therapy. Identifying the problem is relatively simple. Encouraging the client to see that issue is the problem that is somewhat harder. but to convince them to change their general outlook?. . . very very difficult. To even take it one step further: changing their outlook in a manner that does not require them to re-examine every single aspect of their lives . . . this can be very difficult. I must warn that the issues that I am discussing here are not skills-based ones. These are more depths-based ones, such as trauma, race-issues, religion-issues, and communication problems.
     This last part of really convincing the client that what they are doing is wrong/unskillful/maladaptive can be difficult. It frequently takes many sessions for this to occur. Some clients never quite get it. It is important here not to get too frustrated. Sometimes all a therapist can do is to help the client see a glimmer of who/what they could be and hope that they change themselves when they are in themselves during the week. I think that many clinicians get very frustrated with clients not listening to them. They reframe, redirect, and coach, hoping against hope that their words, methods, and strategies stick. But is it the strategy or the relationship that is the grounds for change?

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