Tuesday, December 22, 2015

Theoretical Orientation Research

     I would like to take a little time to write some about a research project I would like to undergo. This research has to do with the selection of a theoretical orientation. The aim of the research is to find out whether there is any statistical relationship between personality type and theoretical orientation. I would like to add in a questionnaire about when field clinicians think they chose their orientation and whether they have experienced any changes in their orientations throughout their careers.
     The tools to be used here are manifold. There is a good theoretical orientation sorter out there that I have use in the past call Selective Theory Sorter - Revised. It is from a book by the name of Developing Your Theoretical Orientation in Counseling and Psychotherapy. This tool asks the user questions and grades their reactions, in the end giving them a numerical output for twelve well-known theories for further research.
     The next tool is a shortened version of the Myers-Briggs test call the Myers-Briggs Preference Sorter. This tool is much shorter than the Myers-Briggs and can be taken in about ten minutes, rather than the multiple-hour exam that is the normal evaluation.
     The third part to this study would be a questionnaire for both current students and professionals. This questionnaire, which I hope to elaborate on later, has demographic questions as well as questions about their current place of work/study and their own ideas about theoretical orientation.
     There are some limitations of these tools that must be mentioned. The first is that both of the non-questionnaire tools are short. I have less confidence in the Myers-Briggs Sorter than I do the other, as the former as a long and much more version. The theories sorter is mildly concerning, as the book in which the sorter finds itself has other ways to find one's clinical orientation.
     I would like to more succinctly detail the reason for this study. I am testing the relationship between personality and theoretical orientation. I am not wanting subject to take only the Myers-Briggs test or the orientation sorter, as, independently, these tests mean nothing. Were I to just give out the Sorter, I would only be gather information on this population's theoretical preference (which are not necessarily generalizable). On the other hand, giving out the personality test would at least give some kind of viewpoint as to common personalities of budding and established therapists. Doing both hopefully will connect not just personality type to therapy (which has already been done), but rather personality type to a specific theory. This might aid in decreasing search time for budding counselors or at least some possible borders for research after mastering basic counseling techniques.
     As far as questionnaire questions are concerned, here are some:

  • Name
  • Credential/License information
  • Number of years in the field
  • Level of schooling achieved
  • Current theoretical orientation
  • Previous theoretical orientations
  • Is your current TO based in your current area of work?
  • Current area/type of work?
  • Do you ind TO important in your work?
  • Did you start out practicing  a certain method/theory and go on to change your desired theory (1), alter how you practiced the first method/theory (2), or add additional skills/techniques/theories to become more "eclectic" (3)?
  • Did your clinical educational program adopt a theoretical orientation that was then taught to all students? - or - Was your education more generalist, in that you were presented with multiple theories and then recommended to choose one?

Monday, December 21, 2015

Counselor Versus Therapist

     I have written before about the difference between counseling and therapy/psychotherapy. A similar question is What is the difference between a counselor and a therapist? While I think that one is still more developed (or higher) than the other - specifically that being a therapist is higher than a counselor - my reasoning for the difference between the two are different. I don't know if my new reasoning is correct - perhaps that is why I am writing all this down. My thought has to do with level of training and how a clinician practices. Could it be that a therapist is an experienced counselor (perhaps of a couple of years) who has created their own, or implemented an existing theoretical orientation that increases the effectiveness of therapy.
     I have raged against the need for implementation of theoretical orientation in the past. I still don't think that theoretical orientations are the most important things in therapy, but they do have their place. It is important here to discuss when to implement a theoretical orientation and to what degree. A counselor should stay a counselor for a significant time, studying theories of course, but primarily practicing the basic skills of counseling that provide a positive bedrock off of which to build a theoretical orientation. Echoing what I have said in previous entries, my opinion on this subject is that every clinician should review much relevant literature and then create their own orientation that works for them. The "when" is a difficult question here. When does a counselor graduate to therapist? Who graduates them? How does the counselor know that he or she is ready?
     These are amazingly challenging questions, for sure. I am not sure that there are absolute answers to these, but I will still give it a shot. A counselor, as said, should be constantly researching different theories and techniques. Perhaps the moment when a counselor becomes a therapist is when he or she becomes so comfortable with the base counseling skills that he or she hits a ceiling in practice or that they feel stuck where they are. At this point, the logical response is to change something. Sometimes, the change is to review the basic counseling techniques (like Rogerian/client-centered therapy or motivational interviewing, if one bends that way). Sometimes, the change is to add more: in this case, we would add theoretical techniques more strongly into therapy.
     Such a graduation comes about in different time periods. Different clinicians take different amount of times to do things. This does not necessarily mean that one clinician is better than another, because he or she takes less/more time to learn things; I think the opposite might be the case, as frequently the clinician who pushes the learning process learns less.
     It is important for the budding therapist to gain supervision when creating and implementing his/her own therapy. In my opinion, a serious therapist should show proof of their learning through writing or reading texts. Just because a therapist thinks that something is a good idea doesn't mean that it is. Generally, if a clinician finds something in the literature, especially seminal literature, normally that is OK to use right out of the bag.

Wednesday, December 16, 2015

What Is the Role of a Therapist?

     Why go to therapy? What do you hope to achieve? Why can't we just do therapy by ourselves? What function does the therapist serve? Why can't a person just talk themselves into a better state? Why can't they talk to their mother, friend, or a stranger and be in a better state? What about a real therapeutic encounter helps people? Again: What is the role of the therapist?
     To some degree, I see the therapist as a "nudger." In a perfect therapeutic situation, the therapist's job is to course correct with the client, identifying  negative behaviors, thoughts, and expressions with the client and discussing more positive behavior. Instead of giving advice, the clinician is tasked with taking information given, evaluating it with the client, and coming to a good conclusion as to its validity and place in the client's life.
     The therapist provides outside perspective. That is one of the main reasons to go to therapy. As such, a therapist must ensure that he or she is very unbiased. While we have previously thought that children are tabula rasa, in this case, it is the therapist who must shut off his or her previous actions and become a reflective surface, on which the client might see the person they are and make corrections needed.
     I think that I have said this before, but part of the significance of the therapeutic encounter is the setting in which it occurs. Just as the therapist must be ultimately objectively subjective, the space in which therapy finds itself should allow for minimal distractions or means for negative transference. Some decoration, or course, is needed, but not so much that the client thinks that he or she is impeding on someone else's territory. That said, I don't think it horrible for the clinician to provide some kind of backsplash on which a client might throw their personal dirt. That is having some objects in the room(s) that create conversation might push deeper understanding on both sides.
     A note that I would like to make is to say that therapists do not say what is correct and what is incorrect. That decision is fully on the client's shoulders. It is the clinician's role to help the client to figure out what is correct and incorrect of them. Of course there is an objective right and wrong and the hope is that a client's subjective right and wrong are similar. When the two are strikingly dissimilar, coordination between the two parties must occur, sometimes requiring a more directive or psychoeducational session on norms of right and wrong, consequences on actions, or a very MI-based discussion on ideas behind these thoughts.
     Were someone to say that a therapist is a guide, I would not wholly disagree with them, but rather ask them to qualify the parameters of the word. That is a therapist is a guide to a person's inner self, not a guide to the outside world. That latter work is the work of a skill-builder specialist. A therapist's bread and butter are a person's inner-most ideas, motivations, feelings, and thoughts. Frequently, a person's own self gets in the way of their path forward and it is the therapist's job to help a client to figure out the possible paths and then their choices. They are not a guide in that the therapist does not do much (if anything) for or to preempt the client.

Tuesday, December 15, 2015

Some Clinician Responsibilities

     I've been thinking a lot recently about why therapy works (or doesn't) and what each individual's role is in therapy. I've also been thinking about how to ensure that individual knows what their role is and how to address the situation in the moment.
     A good therapy session requires a good therapeutic relationship. This almost goes without saying, but I think that it continues to be a statement that must be reiterated from time to time for personal clarification. I don't want to go into this subject, as I have talked about it earlier. I do think that both sides have certain roles that need to be present and acted-out for the session to be called a success. Upon writing this, I am thinking that the last sentence was somewhat directive. I do not want to continue that thread, as all I am saying is that there are certain things to do and certain things not to do in therapy on both sides. I guess the first thing to say here is that each side has certain roles to fulfill that will increase the chances of a good therapeutic effect.
     So what are these rules, roles, or obligations? I would like to start to talk about this topic on the side of the clinician, as that is where I am currently. What are the clinician's responsibilities? I ask the question because I am looking around me and seeing multiple avenues of practice. Some of these avenues are directive, others are not so directive. It is my view that a clinician is not necessarily a teacher. A clinician is more a guide. As such, a clinician is not present to instruct the client on what to do, but is rather there to help sift through all probably options with the client and create an atmosphere in which a client can come to their own conclusion as to their course of action. It is not the place of the clinician to add new knowledge to a client (normally), because I think that many clients already have an over-abundance of information, which can lead to their anxiety or depression.
     It must be said that sometimes teaching must occur. Some clients do not have a set of skills or an understanding of their situation that is helpful. In this case, it is more the how of the teaching that is the key to the situation, rather than the why. Giving a client options is a very good way for them to learn positive skills. Better said: Giving a client a buffet of choices will lead to hearty discussion about the positives and negatives of each option, why the client chose a certain option, the evaluation of that option with the help of the clinician, and a creation of a plan to implement that skill, if desired.
     The client gains much when a therapist does not choose their path for them. They learn the skill of decision-making and some self-confidence. Understand that a client will want to engage in a path/plan that they have created themselves. It means more to them (hopefully), thus making them adhere to it more than if it were created by the clinician. When a client creates some path, it is the therapist's job to help the client to ensure that the path is going to a positive place, that the end result is a therapeutic one. A path, being made out of stones or objects of some kind, should be examined by both members. Each stepping stone is another sub-goal or experience that must be processed by both members. It is the client's place to attempt to process; it is the clinician's place to encourage such processing and, if it deviates from a positive path, to attempt to correct it. The therapist does not exist to create and maintain this; such a thing is more in the realm of the client
     Some clients do not know how therapy should work, so it must be the role of the clinician to guide them.