Sunday, October 30, 2016

How a Therapist Might Differ from Friends or Family

     I suppose that this next section could be attributed its own import or could be grouped with the them of "core rules," about which I have previously written. At this moment, I wish to afford it its own accord for no real reason other than not, at this time, interesting myself in the subject or theme previously mentioned.
     It is worth speaking about the difference between the station of the therapist and of friend or confidant. It is useful to have close characters whose opinion is trusted and whose advice sets future paths and current hearts more true. Were this enough for an outside element to not be needed, such factors and close friendship-based or familial relationships would prove enough for most people. Indeed, for some, this is true. Somehow, some lucky or clever people find a group of friend or are born into a circle of kin who so enrich them that someone like me is unneeded. I do think that this is not altogether normal (perhaps better said: usual), though I do have my own envy when I meet such a person.
     Allow me to put the question more plainly: What is it that requires a profession like mine to exist? What can I offer that a mother, father, sibling, or friend cannot? Why is it that these people cannot practice this ideal? Is this a thing that they can learn? Is it the core of "good therapy"? I hope to answer these questions and any others that enter my head during this scratching.
     I posit that the main difference between the two stations is willingness. Frequently, a family member or a friend will only go so far in digging down on a topic (possibly due to self-preservation, personal guilt (especially if that topic is perceived as having something to do with them), or even disinterest, depending on the definition/foundation of that relationship). A therapist's willingness can be based on any number of things, including worry or concern, monetary gain (their paycheck), academic curiosity, or even banking on the fact that they are the therapist and are therefore allowed to be more nosy than the normal person.
     It is important to note that the training of the therapist increases the usefulness of this willingness. Sure, parents can be just as willing to help their children, but do they have the specific psychotherapeutic experience that can make a deeper delve truly worthwhile (or even possible)? Therapists are trained (to some degree or another) to engage a client in such a way that encourages change or insight. A parent might, through sheer connection or willingness to discuss, pursue a problem right up to the door or portal of a good interpretation, but they most likely do not have the prowess to interpret (or perhaps their station disallows such a transaction). Does a friend understand the nuances of Freud, the clarity of Rogers, or the direct ideas of Ellis?
     We as therapists must be willing to engage a client in such a way that anything that is thrown at us is fair game. We have to be able to not say "no" to any request for insight or skill-building. Others stop; we do not. We want clients to reach resolution and following their paths to an end that requires mere analysis or concludes treatment. We follow them with a smile and encouragement. We are also the people who take hold of the shovel when the client is tired and dig deeper, hoping to retrieve more. Our title gives us the permission to do this.

Wednesday, August 24, 2016

Honesty and the Therapeutic Alliance

     I believe that I have written before on the subject of therapeutic relationship and its central nature in any therapeutic endeavor. Today, I am going to write about the crossover between therapeutic alliance and honesty.
     Honesty in therapy is, I think, a different topic. When I write about it, I am not necessarily writing about bluntness. Instead, I would rather discuss the use of honesty and its use/misuses right now. Honesty, I think, comes up very much when a clinician is asked questions. We are told/educated to be wary of questions. I don't disagree that some caution should be shown; I guess my main problem here is when you have an honest response, but it might be detrimental to therapy. Frequently, instead of answering the question, we choose to process it to hell and hope that the client forgets that he'she has a question. Heinz Kohut remarked at one point in his life that it is impolite not to answer a question.
     Not answering a question can inhibit a relationship because it can lead to an assumption of dishonesty, backfiring the processing response. Answering a question, even after some processing, can lead to a negative response, as well. A clinician does have to be careful, but to lie shows infidelity, to some degree, to the client. Processing out the reaction after the answer can very much strengthen the relationship.
     I guess one of the main things that I am trying to say here is that there is a direct relationship between honesty and the relationship. When one is strengthened (relationship), the other can grow. At the same time, the more one is honest, the stronger the relationship  may grow. There is a balancing act that takes place here . . . one that is very essential to future work. If one is too honest (or blunt, I guess) too soon, he risks, in a real way, the suffering of the relationship. I guess that this is the clinical implication of bluntness. This might happen when a therapist is burnt out or when their empathy, for whatever reason, is low during a session. The phrase that pops up in my own head some days is: "Well, let me tell you what is going on here." This is the language of interpretation. The difficulty with this is knowing when not to "give the truth." We must, obviously, be as intelligent as possible about when we us such means.
     As previously mentioned, a counselor must be honest with his or her client, especially when answering questions. Malingering must be remembered as things that take away from the amount of data processing space between the two members. If an honest answer leads to some problem, as mentioned, it is appropriate to process the disconnect. It is very important here to remember that apologizing should only be used when a real misdemeanor has been committed. It should not be the go-to response. What does frequent apologizing  do but attempt to push the relationship backwards in time with the unsaid understanding that that is bullshit. An apology, or a string of them, can only function as a weak "coping mechanism" for the relationship. Apologies aside, processing out the issue forward the meta-curriculum of honesty for the relationship. I have already been in situations where I have committed some unknown social slight, which led to a good lesson for me about cultural matters. Such a lesson could not have been learned without process willingness

Monday, June 6, 2016

Core Rules of Therapy

     I have been thinking about the topic of core rules for therapy for some time. Perhaps better said: I have been thinking about core rules for how I do therapy for some time. There are definitely some principles that I think are at the very center of how I practice. What I hope to do is start an on-going group of entries that will serve to illustrate this idea.

  1. Silence. It is my understanding - both viewing my own experience and what I see from others - that clinicians always want to talk. For the beginning therapist, silence is scary, as it might show weakness or perhaps give the client and therapist a chance to think a problem through to an un-therapeutic end. Silence, when done correctly, can increase rapport between parties, because it allows the client to take charge of their own thoughts in an environment that might seem under the control of another party: the therapist. It also give the therapist, possibly, time to think. Some beginning therapists equate silence with incompetence; they end up saying something half thought-out than a thought of real worth. As we are in a profession that holds intent of action in the highest regard, does it not make sense to be able to think properly about a response that is appropriate, rather than electing to engage in a random jump of (il)logic?
  2. Not everything is about you. This can be meant in a couple of ways: 1) We can mean that the actions of the client have much less to do with us than we might think and 2) we might mean that we are in service to others in a session - not ourselves. Being myself, both of these sub-topics took some time for me to really internalize (if I even have) and I still need to remind myself of these lessons regularly. Let us go into the meaning behind the words. I will attempt the first hurdle. It is simple to be overreactive and hyper-vigilant in the beginning of our careers. We are attempting, I hope, in this time, to build up a bedrock of skills and techniques that will allow us to forge ourselves into the therapists who we wish to become. This leaves us open and vulnerable to others. As therapists, there are almost no peoples more important in opinion to us as our clients. Were a client to say: "You are a bad therapist," it would crush us. Whether that is a wholly helpful reaction or not is not my goal here. This bedrock that we have created has been cracked, allowing more doubt to leak in that is normal. Am I doing my job well? Is this the correct line of work for me? These are logical questions that we ask ourselves in this situation (well . . . as logical as the reaction as a whole can be). We fall into a classic blunder that we ask our clients not to enter: mind-reading. We attempt to exorcise thoughts from our clients' heads through mind-voodoo - that is, without actually asking. Were we to ask, a good conversation might result about the match between client and therapist or the events that transpired that pushed our client to say such a thing. Allow me to get away from the previous example and posit another: A client and therapist have a good session (in the therapist's estimation). The client does not present at his/her next session. The therapist might go back over the mental notes that he wrote to point to a reason. He might find no reason. Either way, the clinician is allowing an unknown to control his behavior, possibly impeding him from acting in therapeutically advisable  manners to following clients. When the therapist asks the client over the phone about the situation, he learns that the client had a family emergency. A situation that, in reality had nothing to do with the clinician, had everything to do with him in his own mind. This shows real weakness or deficit or [insert non-offensive term here] that that clinician must analyze. The reason: Such a circumstance occurs frequently. The answer: address it, if possible, and if not, let it go. This, of course, comes from time and possibly outside therapy. This writer does want to mention that a pitfall occurs here for some people. I myself flirt with it from time to time, but not much (which will lead nicely into my second sub-topic in a moment). We must ensure that we do not trip into a lack of caring as an overreaction response to the too-much-caring that we previously felt. As previously mentioned in this work, moderation is normally the best option. It is of highest priority, when working with a client, to consider them. When I use the word "consider" here, I mean that we must consider all parts of them, including their words, body language, look that day . . . everything. To really consider someone requires one to see past themselves. I would like to say that I do not mean that the therapist should block himself off, but rather use his or her whole self as an antenna for the use of the client. 

Thursday, June 2, 2016

Compartmentalization (cont'd) and "Value Armor"

     After thinking a little more about compartmentalization, I can see one real advantage to it: it might lead to long-term resilience against clinician-side traumatic shock. If we can seal part of ourselves away from view (from both the damage done to use by a client's story and our own ideas about it), we might be more able to heal after a particularly deep shock. I am somewhat unconvinced though . . . As I tell my clients, were we extremely comfortable with ourselves, most of these traumas would bounce off of our "value armor" - that is, the natural defense anyone has who knows who they are, what they believe in, and what makes them a person. It is extremely difficult to penetrate such armor, but not impossible; even the most comfortable-with-himself/-herself person still requires patches and upgrades to their armor. Life provides us with many experiences that test our armor and it is our job to continually ensure that it can stand up to most outside incursions. Many people perform such maintenance  on their own, while others require the help of a professional to repair their chinks. For these who can self-repair, only major dents need outside help in the form of a psychotherapist.

Tuesday, May 31, 2016


     In my continued attempt to question all things about therapy that I have learned (which is something that I think everyone in their chosen field really should do; such action brings innovation), I will now discuss the topic of compartmentalization - something all, if not most, therapists are told to engage in. The question for this entry is: Is engaging in compartmentalization beneficial to the relationship?
     Budding therapists are told that compartmentalization is key in therapy, as thoughts about one's own life might obstruct the work occurring in the session. Is this true? I'm not entirely convinced one way or the other. As with many such fundamental principles, we must take a look at why the "rule " was at first imposed. I see two ways of looking at this: 1) the Freudian method and 2) the everyman graduate school method. I must preface  this specific talk with the warning that I am not a Freudian analyst nor a ghost mind-reader. Therefore I have not the training or the "skill" to claim what I will do. Nevertheless, I will still engage in such palaver, as this is my work and I'd like to see if/how my thoughts change the future. I'm thinking that Freud thought that any interference from the therapist is/was bad (hence his arcs into counter-transference). He wanted the client to be able to open up in any way they see fit in order to get to their own solution, rather than a solution that the therapist thinks is appropriate. This led to the stereotype of analysts' taciturn natures in therapy. I do give Freud much credit here because he is still one of the main forces behind a clinician looking into his/her own countertransference to engage their deep-seeded motivations. Unfortunately, in our effort to ensure that no countertransference exists, many therapists still do engage in a fear-oriented therapy that is more about them in the end than the client. The other way to look at this problem might be to engage it from a more modern and educational approach: How are current therapists taught (or not) to compartmentalize? I will only speak for myself in this section and what was explained to me in my own Master's-level training. As far as I can remember, we, as aspiring clinicians, were taught that whatever didn't begin in therapy room was to stay outside that room. I'm thinking that this might have been so stressed to future clinicians in order to assure that our own issues do not impede the work being done in session. Otherwise stated: We, as beginners, need to assure that the session is for the client, not for the clinician. This is a good point, but I do wonder how far this mantra should be taken.
     Now that I have explained some of the origins of this idea as I see it, the next step is to figure out what the helpful and the harmful aspects of compartmentalization actually are. Furthermore, who does it help or hinder to engage in such action? As with most "fundamental" issues such as this one, there is some give and take either way. I think that the positives (or helpful factors) in  compartmentalization really do exist more for the young, or budding, therapist than for the elder, more experienced, one.
     It is, to some extent, a learned skill to block out personal issues in life. A therapist must be able to do this while in session - or a therapist must be able to disengage from therapy completely. This is where I think a critical argument one way or the other must be had. The former forces a therapist to cut off pieces of himself - not quite the "genuine person" that Rogers spoke of. On the other hand, to not cut some of it out might lead to the session being more about the clinician than the client. This can be useful if the meta-curriculum of that session is one where such a role reversal provides helpful insight to the client. This, alas, is a more senior technique and one that I'm not ready for yet. To be able to disengage from therapy completely is a luxury that many clinicians do not have, leading, possibly, to burnout or resentments of the job. There is much healing to be done in taking some time off to process such compartments created and figure out whether they are really needed anymore.
     As previously mentioned, I do laud Freud in his idea that researching one's own countertransference is very important. It can make a clinician better at his/her job. I do worry that compartmentalization takes us away from some of our more primal parts, leading to less data from which the therapist might work. I think that there is some merit to allowing some of the walls to drop and to permit the client's message to bounce around in some of the dark corners of the self. Sure, this might bring to the surface some very complex issues for the clinician and it is here that the clinician might start the compartmentalization process - understanding that they need to throw light upon that inner conflict at some other point. To an extent, leaving these compartments up might actually lead to stagnation in the self, in the client, and in the practice in general.
     As mentioned, if a client's pain resonates personally for the clinician, it is his/her job to undergo some kind of supervision or therapy to gain insight into that issue. This leads to personal growth, bringing things that were in the unconscious to the conscious to be played with and changed before allowing it to be re-submerged into the unconscious. We put that thought back in its place to change some of the other issues around it and to achieve wide-spread health. We also put that thought back into the unconscious because we can't hold it in the conscious for very long and doing so provides us with some measure of anxiety, as we add more to our plate than what we might be used to. Putting these barriers up might actually lead to a lack of means to more productive advancement.
     One main reason why a therapist exists is as a sounding board for the client's thoughts. I always visualize this in my mind as a literal board on which clients throw their concerns. It seems to me that compartmentalizing actually decreases the surface area of this board, allowing for more good material to pass a clinician by. As mentioned, we put ourselves out there to feel with the client. In order for this mutual feeling to occur, there must be much to fasten onto, whether that is the lighter or darker parts of ourselves. I think that it is sometimes the darker parts of ourselves that resonate the most with clients. If we don't allow ourselves to be open with clients, then there is really minimal space for the therapeutic relationship to thrive and heal. I can see how a teaching program might push compartmentalization in that, were they to teach the radical openness that I am quasi-advocating for, a fresh student might take the lesson too far and over-share or not temper their sharing with experience or reason (the former of which they have minimal or none).
     This brings me to talk a little about openness in therapy. It seems to me that there is a culture of lack of openness. It could have something to do with the ideas previously mentioned or more cultural/societal fears of liability and judgment that might come of self-disclosure. We must always temper such fears with the assessment of our clients' wellbeing.

Monday, May 16, 2016

Client Responsibilities

     A very good book idea might be one where I outline not the process of therapy, but rather the responsibilities and right of the therapee. Expectations of therapy would be vital. I would talk about stages of therapy, but constantly re-inform the reader  that they must ask their therapist questions. Asking questions to and of the therapist is a client's best tool. It allows a client to shield themselves from counter-transference; it allows a client to gain more understanding of themselves - something crucial in practice; it allows the client to increase their knowledge of the clinician in such a way to increase the bond between these two disparate points.
     I think that a client must be told that his/her self is the most powerful force in the therapeutic alliance. A clinician receives and reflects only; that is, a good clinician receives or reflects with very minimal else. The clinician and the client do work together; the clinician does not do work in spite of the client. This is called psychoeducation and is not true therapy.

Monday, April 18, 2016

Appropriate Emotional Investment

     It is important for a clinician to be emotionally interested, but not emotionally invested in his or her clients. There is an important distinction here that must be mentioned in order to further the point. A clinician who is emotionally invested in clients ties a string to clients' development, taking themselves along for a ride, which depends upon someone else's motivation. This, of course, brings up many issues regarding boundaries between clinician and client. A clinician does not want to be at the mercy of the client; this might cause ripples to be felt throughout that therapist's whole practice. The opposite end is where the emotionally cut-off clinician practices - a place that does not necessarily engender good therapy and creates (possible on purpose on some level) no emotional connection or attachment with the clinician. This, just like the opposite end, can lead to echoes into other therapy sessions. So what does the middle look like? And why am I so afraid of the extremes? And how have I seen myself going into either extreme?
     Betwixt these two extremes, a clinician finds the land of emotional interest without emotional investment or dependence. This is a space where the clinician is comfortable with being present and appropriately emotional/empathetic with the client without allowing his or her personal life to bleed through into the session (non-therapeutically). To some degree, I think that it takes time to find this balance.

Friday, April 15, 2016

Arguing Against Progress

     There are many things that I am afraid of - one of the more curricular ones is the quasi-inevitable heath-death of this field. Sarcasm and hyperbole aside, the lack of forward development in the field is of huge concern. What does a lack of change really mean? It means that the answers have been found and/or no one cares anymore. A good parallel is language: language develops until another is created from its ruin or something better or more efficient takes its place. I do worry about this because I don't see as many people asking the important questions in the field and engaging in deep introspection and supervision, in order to develop themselves. This baffles and hurts me. Without each member of our field asking questions that further themselves and the field as a whole, we will stagnate and possibly start to see what we have already accomplished as enough. This would surely be the death of the field. As our culture, society, and clientele change, so must we. One could say that culture, society, and clientele will always be changing, so the field will as well. The added component here must be pride. Man is full of pride (and laziness) in his work, wanting the effect to stop when homeostasis is reached. It is important to never feel lazy in this fight. To some degree, there should always be someone who is the nay-sayer or the devil's advocate; someone who is ready to push the envelope, point out the weaknesses, or instill doubt. One could almost say that we are not looking for a Unified Theory (as this would surely mean the end of the field), but rather the continued dialogue and struggle to find that within ourselves that helps another - and surely each of us can contribute something (a lesson, perhaps) that is wholly our own, wholly subjective.
     To argue is to seek continued survival; to find perfection is to encourage death. This is odd, in that one could think that I am purposefully undermining a perfect theory - but that is the exact problem: there is no perfect theory! We each must continually question how we practice in order to be better ourselves.

Teaching Theories and Basic Skills

     I still have some major internal conflict on the topic of teaching theories to therapists. I'm still unsure of whether it is a good idea or not. I think that the main counseling skills of true active listening, empathy, reactive choices (interpretations, reflections, minimal urges, etc.), and appropriate self-disclosure. Of course, some of these skills come easier to some student of the field versus others. This should be monitored, as we do not want to continue teaching the expert. I'm starting to think that some mastery of these skills should be shown before moving on to deeper theories of the field. To put this whole paragraph a different way: While theoretical orientation is of high impact, it should not be taught before the basic elements of the craft are honed in the budding clinician.
     Theories are all well and good (and I will get to these parts in a moment), but they do not fulfill the needs of the therapeutic dyad that the basic counseling skills do in full. A therapist without active listening is deaf; a therapist without empathy is cold and uncaring; a therapist without correct reactions is ineffective; and a therapist without a personal and semi-transparent identity is not a true person, but a cheap mask. No amount of theoretical knowledge will help that therapist - he or she is not a researcher, an occupation where warmth, though encouraged, is not vital. Simply being intelligent in theory might increase the positive content of the message, but as every good therapist knows, how a message is conveyed is not of secondary importance.
     While it might seem as if I am bashing theories, allow me to be the first to quash this idea. Theories provide us with important information about what might be going on behind the eyes of a client. They also inform us as to what reaction might be appropriate for the clinician and the client. It must also be said that the basic counseling skills can be learned, and even monitored, by anyone, without the necessary education that therapists undergo. The layman is, of course, capable of reading any text that a budding or expert therapist might, but I would say (hesitantly) that the layman is not able to understand the implications of the text without the same education. This is, to some small degree, what separates the therapist from the natural-born thinker.
     It would be very difficult to measure the ability of trainees in the basic counseling skills. Observers would need to be use, in order to grade trainees in real interactions with clients. Pen-and-paper exams would be useless here. This would further push the impact of professors and instructors in their job as gatekeeper for the field. Were they to observe a student who shows no aptitude in these basic skills, they would need to take action for the sake of their university's program and, more importantly, to keep the bar set high for incoming professional therapists.

Saturday, March 19, 2016


     Sometimes I have to laugh at my own ego. I think that I have the answer to other people's problems - that somehow the books I read have an answer to their troubles. Sure, that information can give some insight into the general, the objective, the well-known, but can anything written in these tomes get to the core of the person? Said otherwise: Might the presentation of a book help a client through their concern? This has, of course, occurred; how else would bibliotherapy be seen as a viable sub-theme of psychotherapy? Of course, people have also found inspiration in books. But inspiration is much different than true insight. Insight requires the addition of a second person who shares goals, but does not share eyes. In this way, therapy is more about communication and undersanding that it is the knowledge gleaned in a classroom. Such knowledge is a frame while listening and understanding is the beautiful painting housed within. Which is the real art? Which took more effort and understanding? That is a difficult question - one that causes science and art to become at odds. I do not, at this time, endeavor to belittle either in favor of the other. Instead, should not the pairing be celebrated?

Monday, March 7, 2016

What is the Highest Ideal?

     I do wonder . . . what do we want for our clients? Many therapists might say peace; many might say stability; others could say health. Some therapists push their clients toward that ever-elusive Maslowian self-actualization. I do wonder whether that might be a too-lofty goal. Of course, I'm not saying that self-actualization is not a relevant goal worth seeking. What I am trying to critique is the probability of a client, or even anyone, to reach this goal. Even Maslow commented on the low probability of this end. For the everyman, then, what is the end goal? It can't be a self-actualization. Why not happiness? Is that not enough?
     Most people, I would say, want a sense of happiness. What this means for them depends very mcuh ont heir personality, so I will not break happiness down into component parts. Is it wise for a therpaist to ask a client if they are happy? For many clients, the answer is most likely yes; I do, though, want to push some hesitation on the budding therapist to think about their client before asking, as happiness itself might be an unattainable ideal to them.
     A good example of this might be a client in current crisis or one with significant traumatic background. That client, most likely, is not interested in developing themselves in that manner, but rather is looking for an alleviation of their current negative symptoms. Asking an idealistic question (for that is what a query about happiness is), can be almost a slap in the face. A client might think that the clinician is not listening to them.
     Viktor Frankl, in an article or book (I can't remember which), mentioned that happiness is not the most proper ideal that man can aspire to. The interesting thing to me is not that he talks about meaningfulness being a more proper ideal, but rather that he mentioned happiness altogether. I'm wondering whether he would think that meaning lays on the path to happiness or vice versa. Differently said: Does having purpose bring one happiness or does happiness generally cause one to gain purpose? Did Frankl think, perhaps, that happiness is off the table because meaningfulness is a logical step to be gained first - and perhaps can only organically arise through the search for and attainment of purpose? Are there truly happy people who do not have purpose in their lives?

Friday, February 26, 2016

Truth in Therapy

     I have, perhaps, discussed this topic before, but I think that it is of almost paramount importance. Today's topic is about the correctness of talking about truth with a client. I bring this topic up, at least at first, because, when interpreting, or even reflecting, a client's words/self, some reflections or interpretations, while true, can also be somewhat damaging to a client. The question here is one of the pragmatism or idealism: Does a therapist spare the client some anxiety (possibly undue) and reflect a different topic back to a client; or does the clinician instead tell the whole truth to the client, because, perhaps, it is his or her job to uncover what is hidden, even if the process of uncovering the treasure beneath is somewhat sullied?
     There are arguments for, and against, each topic here, which I hope to detail presently. There are also moderate approaches to each that are important to mention that might be more digestible for those more interested in that type of thing. A third, and possibly the last remark that I will make today on this subject, has more to do with the type of therapist that would choose each and answer to this question. The difficult part of this (and indeed all of these writings), is that these are opinions, penned by a man-boy who knows little to nothing on the subject yet.
     So, I guess the first question here has mainly to do with the truth. Why would the truth be beneficial for a client? This is a deeper question than what might be seen at first. Truth unto itself sheds all pretense at flippancy, sarcasm, charm, wit, and lie. It is without any type of cover. Such as it is, the truth can either "set you free" or very much mire one under a burden of personal guilt or responsibility. The therapist very much needs to understand the client and the situation. Perhaps that is more for another section . . . There are definitely those therapists who see themselves as truth-bringers - people who are there to say what needs to be said and damn the rest. there is some respect to be granted to these individuals, yet some appropriate caution to be taken, as well. The caution is relatively self-explanatory. The clinician who brings up the truth lays the client bare before himself/herself. He takes minimal responsibility, then, for the resulting actions. Telling the truth should lead to increased normal anxiety in a client. Anxiety is a flag to anyone that change must occur. Heightened anxiety is unstable and uncomfortable, pushing a client to make some kind of change in his or her life to vent some of that feeling away. It is a good idea for this change to be discussed in therapy (and, really, what good therapist wouldn't explore this?), though sometimes it isn't for purely administrative and physical reasons. It is here when the clinician's responsibility ends to some degree. Actually making a positive change is available to most clients and should be acted on. Some clients choose, though, to make negative changes, frequently self-harm, other-harm, homicide, or suicide. These are concepts that any good clinician is afraid of. Many therapists are afraid, I think that a good truth-related statement will be taken the wrong way and lead to those negative results. I think that the key here is to follow up that statements with something, especially if it could be a statement that shakes the core of the client. Such a follow-up could be anything, depending very much on how that clinician operates normally. Personally, I would suggest processing out the truth statement.
     I believe that I have delineated (though not amazingly well) the positives and negatives of using truth in a session. The next question to answer is: How do I integrate this into my practice? This is a good question and one whose answer must be enacted with tact. Obviously, having a practice where one "spits the truth" will be one with fierce opponents as well as very loyal clientele. While controversy is not always horrible, I think that most clinicians would oppose such a practice, even for the sheer stress level. So how does the average clinician add naked truths into their practice? This is a difficult question. I think that a lot of the question as to how honest and how often to be so honest depends very much on the quality of the relationship. In grad school, we are told that the relationship is an amazingly important thing. Why? We leverage much against it. There are very few relationships in someone's life that require the type of thought that the relationship between the therapist and the client requires. We ask clients to bear their soul; we ask clients to talk to uninhabited chairs; we tell clients their way of thinking about a problem in unintelligent. What is the fuel for this change? The relationship! Without such a bedrock of trust, there would be no reason for the client to engage in these farces. How does one include stark honesty and truth into the relationship? One has to build the relationship and hope that that connection is enough to continue after the trauma of truth. There's much more to this, but perhaps I will save it for another entry.
     I read a very good book that I would recommend to any therapist called The Schopenhauer Cure by Irvin Yalom. One of the many qualities of this text that I admire is its characters. Sure, it has a good therapist or two, but it also has a philosopher therapist. This is the type of therapist that can give out only truth. A true "non-philosopher therapist cannot act as such (and be considered a "normal" therapist). One thing that makes a good therapist is the ability to explain and be softer in their words. To a degree, this whole discussion is somewhat moot, as a therapist deals with much subjective truth, but must be able to communicate it in a way that is understandable and easier to swallow than either subjective or existential truths being forced on someone. So, perhaps better said, therapy is all about truth anyway. The therapist needs to communicate the truth effectively, though soft enough that it doesn't send the client into some kind of existential funk.

Sunday, January 17, 2016

The Evolution of Psychotherapy

     I've been researching CBT a lot recently. I'm seeing more and more that it is a good hook into a client. For many clients, running into insight-based therapy is a bit too much too early. CBT, in this case, can be good. I'm reading Judith Beck's seminal work on CBT, which I am finding to be very accessible and am learning quite a lot. I like how she talks about the core beliefs, especially.
     Anyway, I had a thought relatively recently that confuses me a bit. We see knowledge, to some degree, as a river. The beginning of this river yields less complete ideas. Over time, these ideas become more refined, more "correct." We learn to take the critique on original knowledge as new knowledge. This new knowledge is then critiqued and seen as innovation and the "better way to go about it." I have left the river metaphor behind, but I think that I have illustrated my thought satisfactorily. Taking this idea to my field's end, one could say that the culmination, at this point in time, of the field's knowledge is indeed cognitive behavior therapy. Would it not, then, make sense to study this practice and use it?
     The answer, as usual, is neither yes or no. It is a mixture. Obviously, using some CBT is quite advantageous. As mentioned over and over in this text, it quite depends on the client (as well as the clinician). It is relatively easy to learn and is easily used.
     There are obvious nos to the debate as well - many of which I have already elaborated upon and feel no need to repeat. I do think that the previous thought of evoluation of psychotherapy as one river is perhapse incorrect - or ther emight be a different visualization needed. I like to use the word evolution because I do think that it is a good way to describe it. Just like in evolution, there are offshoots to a central line (and then more offshoots . . . and then more). Allow me to illustrate:

The River Concept

Psychoanalysis -> Behaviorism -> Humanistic/Existential -> CBT

The Evolution Concept*
                                                          REBT ->
                               Behaviorism ->
                                                          CBT -> DBT ->
Psychoanalysis ->                            Existential ->
                               Humanistic ->
                                                         Gestalt ->

     I'm not quite of the mind to go into a whole account of the evolution of the field. I will say, though, that even the evolution concept, as seen by Darwin, might not be 100% accurate. The main addition (and change) that must be made here is that each theory not only creates off shoots, it also comes back into the center an affects the whole (or core) of aggregate theory. I think that this core could be described as common factors in that it is very basic and relatively agreed upon that most clinicians should practice in this way, at least minimally.
     With this in mind, as well as my previous point of every theory in turn re-affecting the core approach to therapy, one might come to the conclusion that there are still more therapies to be imagined. CBT takes an odd place in the model (it is definitely an offshoot theory, in my opinion) as it comes not mainly from the core theory, but more from a behavioristic approach.

*We must understand (because it is illustrated so horribly here) that there are arrows pointing off from each theory (e.g. behaviorism, CBT, existential, etc.) to show that there is further change to be done within each area.

Saturday, January 9, 2016

Pulling Back That Curtain

     How much should a clinician tell a client about their care? Is it worth it (for the client) to lete them in on some of the behind-the-curtain goings-on of their counseling treatment? This is a difficult question and, like most of my queries, has no straight answer. It depends much on the client and if the clinician has chained himself or herself to an orientation.
     I'm trying to figure out if intelligent - that is, naturally more cognitively gifted - clients would benefit from such action. I can see it a couple of different ways. I can very easily see that opening up to clients can short-circuit the practice. Seeing where the clinician is coming from and revealing our "tricks" for what they are can cheapen the experience. It can make a clinician seem like some kind of scientist, charlatan, or mystic, depending on how they practice and the client's perspective. Taking a client further down the road without explaining the process might push the client further than needed at that moment. Showing the client the process, on the other hand, might also help them further along.
     Some theories, like CBT, to a certain degree, are less mystified and more operationalized. For a very intelligent client, the steps can be learned (and, in that theory, they are even taught). So, in this this theory, such a practice of foresight and explanation is good. But in general . . . are there positive? There could be! A client could be self-healing. We all dream of (or fear) that client that can help themselves. I would say that such a "clinical intervention" is less rote technique and more psychoeduction (which is less taxing on the clinician and also less satisfying to me, for some reason).
     I must say . . . rolling back the curtain could lead to two negative business practices. First, the client could go nowhere in therapy and quite; they could also drum up bad reviews. The other negative side - and I find this to be morally, ethically, and personally reprehensible - is that increasing the speed of a client's recovery decreases the business from that client. I don't like thinking that way, but, alas, I did. May Science have mercy on my soul. I will say, though, that increased client recovery can lead to better reviews and better business down the line.

Saturday, January 2, 2016

Action in Therapy

     I have come to the conclusion that action in therapy is scary to me. I would much rather not be responsible for other people's actions, which I am most logically not. But, were I to suggest a course of action and then were that to lead to some negative action, I would most assuredly feel badly. This has pushed me to take a very inactive approach to therapy of late. With this, I have been feeling very ineffective. That, though is important: How effective am I being in the therapy room? Effectiveness can be measured in many ways, but I think that one very important way to measure its opposite - ineffectiveness - is to check the activity of the therapist.
     I have been sequestering myself to a type of therapy involving minimal reflections, interpretations, or advice-giving. I am still of the opinion that advice is pretty much shit, but it must sometimes be given, depending on the client at hand. Unfortunately, some clients need to be told what to do. Perhaps a reason why I was scared (which is the correct word) to really do things is because I was afraid of being responsible for others' care and wellbeing. I was scared that a stray word from me could push a client to some kind of excessive negative behavior. While this is a possibility, of curse, it is a bit extreme. I was also afraid that an imperfect person should not be able/is not suitable to guide a client in self-development.
     I can't say that my outlook has changed much, but, at least at this point, I am trying to rectify the symptoms by learning more skills-based therapies to help to decrease the immediate suffering of the client.