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.