Tuesday, September 29, 2015

Honesty in Therapy

     Therapists must ask themselves an important question very early on in their practice: How honest do I want to be with my clients? Honesty can be either an important building block in the relationship between therapist and client or a stumbling block that sends the duo into disarray. I think that there are positives and negatives to honesty in therapy. I would like to talk about the advantages and disadvantages for each side, the long-term and short-term outlooks of each, and what it says about the clinician to use stark truth and/or white lies.
     I will talk about white lies first. Are they every appropriate? Sure, depending on the state of the client, a white lie might be a good bet. Just like with a client, though, white lies can be slippery slopes, increasing the chance of this "intervention" in the future, especially if the lie is never found out. A good question to ask here is When is it appropriate to use this? The therapist must always keep in mind that a white lie might be found out and that consequences could ensue. So, the lie should be as white as possible, be explainable by the therapist, and, taking those two into account, should not be so hurtful that they fundamentally injure the relationship. If the issue at hand is life or death (it could be a trauma case, a client with SI or HI, etc.) and a very small white lie can help that person to endure their situation and possibly survive until they, or someone else, can ensure their safety, then the answer is a non-idealistic and pragmatic "yes." I think that white lies have to be monitored closely because, just like normal lies, they can multiply quickly if one is trying to cover them up, and they can be detrimental to any relationship, as mentioned. In the end, after giving this some due thought, I think that lies in general should be avoided - after all, it is the place of the therapist to screen behavior and call clients on maladaptive thoughts, emotions, and beliefs.
     When it comes to honesty, there are, of course, times when the therapist must care to soften a blow and use more of an opaque honest (versus a clear honesty). I do think, though, that honesty really is the way to go. As previously mentioned, a crucial effect of honesty is trust. Without trust, a client would get nothing from therapy. I don't want to belabor that point as I think that it is relatively self-evident. I do think that one good topic for discussion is how to go about being honest.  A good velvet-wrapped brick approach seems appropriate here. I think that this is a good metaphor because being honest can be pretty traumatic and blunt. Wrapping it in velvet (a.k.a. saying it in a way that is softer than merely blurting out the truth) can go a long way. No client wants their therapist to tell them the honest truth outright that they are absolutely wrong, absolutely screwed if they continue their current actions, etc. No one wants to hear that. What good therapy allows us to do is to hear the client, their reasons for saying their piece, and then discuss their choices. A declaration of incorrectness can be just as hurtful to a therapeutic relationship as a found-out lie could be.
     Is one theory more honest than another? I'm not certain that this is a particularly fair question and is not one that I am prepared to answer. I think that it is less the theory and more the therapist that is the final answer to the question.

Thursday, September 17, 2015

Client: Know Thyself?

     Some theories look at the deep-seated issues in any specific person. We call these theories "depth" or "insight" psychotherapies. These theories attempt to crystallize, in some manner appropriate to that theory, what makes a person tick, where it came from, why it exists, and perhaps even how to change this for the future (this last point is one that I hope to remember to bring up at the end of this small essay). 
     The main issue I would like to understand in this writing is whether people are meant to know their deepest, darkest motivations, desires, and dramas. I think that both sides to the debate have credible viewpoints. Going along with this question are some important sub-questions that I hope to discuss more. They include these: Does fully knowing one's self open the door to over-reviewing the self and becoming neurotic? Are people simple creatures without the needed neurological tools to cope with such deep understanding? Are there certain groups of people out there who can and should explore the dark recesses of the mind and soul?
     Depth therapies require the client to enter into a type of contract with themselves. This contract states that he or she will be open and willing to plumb their own depths, no matter what they find there. To be willing to do this is a big deal because it shows that the client wants to get to know themselves better. So let's get down to it.
     Is it good or bad for a person to truly know themselves? Allow me to start by saying that we all hide things from ourselves. We hide negative reactions, unsavory opinions about people or ideals, and sometimes our own impulses in a given direction. The Freudian unconscious is a good method of illustrating this point, but one that comes much more naturally to me is that of a bubble bath or a dark barrel full of water. Our negative, and, to be honest, sometimes even positive attributes are pushed below the surface to a place that is invisible from where we normally operate. One must ask himself: Do we do this for a reason? Is the reason a good and adaptive one? I guess another good metaphor for the place we stash our deepest motivations could be an unlit and dank basement. Such a basement is frequently neglected, has some major disrepair, and smells awful. We can bring down a flashlight, but that flashlight only illuminates a small spot on a wall, a corner, a floor. A therapist can help by adding a second flashlight to the search. It is only with true self-analysis (for lack of a better phrase) that we can turn on a gas lamp or install an electrical system to see it all at once. 
     I like this last metaphor best, I think, because a basement has movement that can be heard, felt, and feared from the upper floors. Our lamps/flashlights can hit a corner and show, perhaps for a second, the movement of some small and skittering something before it crawls out of view to be swallowed by the darkness, which it finds more comfortable, assuredly. Sometimes, a therapist and his or her client can shine their lights on one of these creepy-crawlies and blind it long enough to examine it. Doing this can be (and is) uncomfortable for the client and the creature will scurry away in time. 
     I have definitely gotten off track, but I really like that metaphor and will continue to use it. The main point still stands and is amazingly difficult to answer. To some degree I think that it comes down to what a person has on their figurative/psychic tool belt that will allow them to cope with any shocks that they might incure in the process. It is pretty easy to understand how much the fundamental pillows on which a person has founded their meaning in life can be put at risk, damaged, or even toppled because they have dared to gaze into their own eyes. If this person has the education or natural grit that allows for quick positive reaction and repair, then they might come out of this encounter unscathed. Everyone will have scars showing their ordeal. 
     But can a person be driven insane because of their peek into themselves? Probably not. I think that someone can be shaken to their core, as described above, but, especially with the help of a qualified therapist to help them, they should be able to recover from any and all shocks and be a stronger person in the end. We must also take into consideration the fact that one doesn't only find negatives in their basements, but also bright spots including memories, unknown strengths, and other sources of positivity. I think that much of this is found when reacting to a negative critter, but some of it can be uncovered when free associating strictly or not. 

Monday, September 14, 2015

The First Three Movements in Psychotherapy and Their Places in History

     Does psychotherapy change with the fashion of the day? It seems to me that it might. We can look back at Freudian analysis and see that Freud himself was a product of his time (a time of sexual repression in Victorian Europe) and the citizens of the culture took it on (perhaps, at first for the novelty of the idea). If we look throughout history and the development of such theories, I think that we can map the changes with the changes in culture. The movements in psychotherapy are good ways to look at the movements' effects on culture and the culture's effect on therapy. I will also be taking into account the chicken or egg factor with each movement.
     The first movement in psychotherapy was, of course, Freudian analysis. As mentioned, the people of this time repressed their own sexuality. Freud's theory was, to some extent, an essay not only on sexual repression, but also on general repression and other concurrent psychological concerns. Repressing one's own innate sexuality as well as bad memories (through the "stiff upper lip" doctrine, especially) led to the fame of this theory. One reason, possibly, that this is considered the first movement in psychotherapy is that it is the first time that therapy was named such and operationalized as such. The novelty of therapy was high at this point and critique of it came some time after its inception. This critique originated from within and without. Two of Freud's own proteges broke off to create their successful theories. These include Jung and Adler (there were, of course, many others, including Freud himself). Jung's theory especially seems to have taken advantage of a certain mysticism inherent in those days, concurrent with similar study of mysterious phenomena in science and medicine.
     Freud's popularity started to wane as the scientific nature of his theory was questioned. The second wave of therapies started. This wave included the other end of the spectrum from Freudian and Jungian analysis: behaviorism. It ames sense to see this as a direct result of Freud's work. Skinner himself eschewed  the quasi-mystical nature of Freud's theories for the purely visible and quantifiable nature of a more behaviorist agenda. Science, at this time, was gaining a more consistent quantified requirement. It follows that psychotherapy, still performed mainly by doctors and/or psychiatrists (with the addition of psychologists) would try to mirror such changes.
     The pendulum seems to have swung back, as it does, toward a less quantifiable realm to admit the third movement in psychotherapy: humanistic/existential theories. To some degree, I think we can see that this movement or wave, upon examining the positive and negative factors of the first two, tried to expel some of the very negative portions (namely, the psychosexual fixation of Freud and the strict and neutral stance of behaviorism) and celebrate the positive ones (such as, in Freud's theory, the use of the unconscious, general developmental theory, and patience and feeling in talking to the client and, as in a Skinnerian model, a shorter therapeutic session need and a certain "go with what works" feel), in order to gain some ground and create a more viable and user-friendly theory. I am not sure of this, but i would say that with the modernization of education - which is to say the quasi-requirement of it in today's college society - that many more people were opened up to "high-order" anxieties such as existential depression, anxiety, guilt, and terror. Perhaps there is a less interested viewpoint on the more patient-related or medical model (the "talk down to" model). I think that both of these points really do create the need for a theory that both takes existential crises into account and works with, rather than above, a client.

Saturday, September 12, 2015

Is All Psychotherapy Depth Psychotherapy?

     To a degree, all psychotherapy is depth psychotherapy. I say this to mean that every therapy is going at least slightly beneath the surface in order to bring to the client's attention that there is something going on that is affecting their behavior negatively. What the therapist is looking out depends on their orientation, but all at least go beneath the surface a little.
     We can, though say that some are deeper than others. Some theories, such as pure existential theory is 100% depth-oriented. There are, of course, advantages and disadvantages to this. I believe that I have talked about this earlier and do not wish to rehash that topic. What I would like to talk about is a non-depth-oriented theory here. It is funny to me when therapists guffaw in the face of depth-based therapy.
     It seems to me that going beneath the surface to thoughts is good, but not enough. It almost seems lazy. One can infer much from thoughts and belongs in a deeper therapy than CBT because the therapist is inferring much from the thoughts (it also goes to show how difficult it is to be a raw CBT user). It behooves the client to get to know themselves on a deeper level. Only at this point, in my opinion, is it possible to truly identify normal or maladaptive behaviors and then change them in the moment.
     I must say that there are therpies that do not go beneath the surface. I personally would not call these psycho-therapies anyway. These include (but are not limited to) behaviorist therapies and neurological/medical therapies. Neither of these care to go beneath the surface or engage in a meaningful relationship with the client.

Thursday, September 10, 2015

Creating a Unique Psychotherapy

     There is some wisdom to the teaching assertion that counseling/therapy students should have a theoretical orientation. I think of all the theories out there, especially the well-known and most authored ones, and do agree that it can be difficult and often intimidating to try to research and incorporate some or many of them into a coherent practice. I imagine all these theories as dark boxes lined up in rows and columns on the floor of a large, non-descript, vacuous room. A student must open boxes, peruse (in the true meaning of the word) their contents, and then move on to another, always trying to find a perfect match. He or she might feel some large stress due to the search and need for personal identification with/through the theory.
     Now, I must admit that this is mostly auto-biographical (as if anyone thought any differently). It is probable that many students do not have the drive, patience, or tenacity that I do in finding different theories and techniques and attempting to integrate them into my own practice. I do feel a sense of need to create something for myself . . . something that is mine exclusively. I've always had this urge. I think I've written this before, but it seems to me that every clinician should have their own theory. For many, perhaps most, this means that they make combination theories: theories that add whole sections of different psychotherapies together to create a chimera or hybrid theory. I'm thinking that this could work when the particular cogs in the created theory (cogs are the specific techniques or the general orientation of the theory) really do work with and for one another.
     For some reason for me, such a combination theory is unattractive. It still has too many restrictions that exist in the component parts. It is best, for me, to create something from scratch that I can believe in and that seems to be useful in session. So it seems to me that a good clinician really does base psychotherapy off of themselves; after all, when we take a look at the progenitors of different psychotherapeutic means, can we not see a glimmer of themselves in their output?
     I don't know . . . the more I talk about creating a theory from scratch, the more I think about not only how difficult such a thing would be, but also that I have already been influenced by so many established ways of thinking.

Wednesday, September 9, 2015


     There are many pseudo-therapies out there. These are psychotherapeutic techniques that seem to masquerade as theories, but are in fact, not. The list includes such modern staples as motivational interviewing and cognitive-behavior therapy. It is important to note why those, in my opinion, are not theories/therapies unto themselves, but are, rather, techniques only.
     Each one of these methods has one thing in common: they do not go far enough. It's not necessarily that they don't go deep enough, for I don't want to make this an issue of depth versus non-depth therapies; I think that this merely has more to do with the fact that motivational interviewing and CBT seem to me to be natural segues to other therapies. Talking about thoughts is all well and good, but where did they come from? What is their impact on the client and others?
     Now that I am thinking about it . . . yes, the problem is really that these two methods don't go deep enough. It seems irresponsible to me to stop early when there is most likely much going on in the client's life that needs examination.

Thursday, September 3, 2015

The Simplicity of the Person

     The more I think about it, the more I am convinced that people are simple AND deep. People can be both. People are simple in that they (we) all have pretty basic motivations that push our actions and thoughts. Even our more advanced, seemingly mysterious, behaviors often have common origins.
     I am not trying to belittle the "mystery of our existence" or anything. I am of the rather conventional opinion that each man makes his own meaning in life. That in and of itself is somewhat mystical. Rather, I think, when it comes to therapy, people share more concerns than differ in them. I think I am painting in somewhat broad strokes here (because, as we all know, if we get down to the minutia of motivation and will, there are myriad reasons as to why we act the way we do), but it seems to me that this might be a good way to start out.
     What I am hoping does not happen is an increase in a feeling of futility in writing on this subject because people are "simple." I think that even mentioning it shows that certain cogs are spinning to this tune. Out of self-preservation, it seems to me that stopping this train of thought holds great merit. But is that just lying to myself? Should I be pursuing this further?
     Were I to really believe this, it would be a somewhat bold and fantastic claim. It would signal my belief that this is the correct and only logical or true and to quasi-scientific/philosophical inquiry into the subject. It would signal that I am correct where so many others just as, and much more, talented than myself have failed. That is some kind of hubris. With that conclusion, I think that I must say that the belief is wrong. I say this for two reasons (other than the aforementioned). One: I need this line of inquiry. It keeps me questioning and developing in the craft of psychotherapy. It keeps my mind limber. Two: I don't think that there is any one answer to the question of "What is the best form of therapy?" or "What is the only form of therapy?". Such an end result, in my opinion cannot exist. To create such a balm would end therapy. We could then program a computer to do therapy. Because of the dynamic, intra- and inter-psychic forces between a therapist and client, depending on the therapist and client, it cannot exist. Personality is just as diverse as all the hues we can, and cannot discern. So, two personalities working close with one another increases those hues even more.