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.

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.

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.