Nature or Nuture in Becoming a Therapist

     I'm struggling with the selection process for a good therapist - that is, selecting who could become a good therapist.  Is this identity nature-based or could it be more driven by outside factors?  That is - is the deep temperament of a therapist inborn or is it something that can be molded or taught?  Of course when it comes to the satisfactory counselor, techniques and special inquiries can be instructed, but I'm more referring to the master therapist and researcher.
     If we were talking about a genetic predisposition to the field, we would almost be able to track such career choices through a family genogram.  All, or at least some/most, of the family member would exhibit behavior that would lead them along a similar professional line.
     To be sure, such a project would be very unwieldy.  We must take into account the fact that children are susceptible to lessons, modeling, and behavior perhaps more than others.  Trying to separate the unadulterated behaviors from the learned ones would be quite impossible; the only route otherwise would involve either constant self-journaling or an as yet undiscovered technology along the lines of mind reading.
     Such an endeavor is only possible through the subtle art of twin, adoption, or orphan studies.  The main issue here is that our tabula rasa is not blank for long.  From the first experience on this plane, a mind is most likely significantly altered.  So it would seem that the study would have to begin almost on day one.  No outside stimuli at all.  This would lead, of course, to extreme legal penalties based on the current moral viewpoint on infant experimentation and deprivation.
     As figuring this problem out through the pathway of nature would either be impossible or, at least, controversial, we would then have to funnel our energies through some type of nurture studies.  The question here would be:  Can we CREATE a master therapist?  The final result, were it a success, would have to be repeatable.  This involves some type of formula or quasi-formula of actions.  This view is pretty Skinnerian.
     I find that the selection process between two points tends more to be explained better through some combination of those two points, rather than an extreme on either end.  It is very likely that a certain person has the core, rough characteristics that would yield a good master therapist.  That being said, that person would need proper instruction (or some kind of outside motivation - positive or negative) in order to harness the ability afforded him through his genes.  Just as clay can be formed into beautiful pottery by hands yet cloth or bubbles cannot.
     The next step here would be to identify those traits that create a master therapist.  The next stop thereafter would involve finding hereditary lines with those traits.  An important note here is to understand that not everyone in that line would go into the field.  There are many other very satisfactory professions (e.g. intelligence services, customer services, etc.) for those who naturally show the qualities of Rogers.  After these steps, the big jump would be to create a curriculum that would yield near-perfect master therapist candidates.  Not an easy job.
     The end answer is simple.  But first, what is the question?  It is not, with nature and nurture combined, one of creating a master therapist.  An end result of this process almost assures us of this.  The question anew is: Can we create master therapists from ANYONE?  to this, my simple answer is a simple no.

Should a Therapist Have a Theoretical Orientation?

December 12th, 2012

     Is it good to have a working model from which one directly pulls during therapy or is it better to have none and work from scratch with each client?  As with most extremes, working in the middle seems more appropriate.  Both extremes have their distinct advantages and disadvantages.
     Working from a model provides the clinician with a sound foundation, off of which he can issue thoughts and attempt techniques.  These ideas have been milled down to their finer points and through practice, the practitioner makes them his own.  Strictly working from a certain viewpoint can be very inefficient, through.  If a client presents with depressive characteristics due to ideas an "inner language/dialogue" with himself, an analyst cannot move from home territory to talk about such communication.
     On the other extreme, one without orientation can be dynamic and compelling.  He can feel free to flit around the various models and use what seems appropriate at the time.  A problem may arise when he is asked why he is taking route A instead of route B.  Is he doing it because he thinks that B is grounded in better evidence-based research or that he feels more comfortable with it?  Maybe.  But it seems to me that such abstract knowledge disallows depth of insight into one (or more) particular categories of therapy.  If the therapist knows a little about a lot, will he ever know a great deal about something more specific?
     And so I think that a home base with much knowledge of other areas may be the best way to go.

_________________________________________________________________________________

October 4th, 2014

     I find it unsettling when people ask me what my "theoretical orientation" is.  It's a dumb question.  Why does it matter?  What box does a such a term put me in?  Why can't I partake of many things?  I have this image in my head that ACA or APA conventions or conferences are a little like gang hangouts.  I picture a ballroom where analysts are in one corner with their cigars and conservative cravats; humanists are in another corner hugging each other and softly whispering, "I hear you."  CBTers  and true behaviorists in a third corner are re-programming passersby only to wash this behavior extinguish rapidly.  I know that such a thing doesn't really happen, but part of me would really like if it were the case.
     That all being said, if I had to pick a psychotherapeutic backer, it would be something very phenomenological and human potential-based.  Authors that come to mind are Husserl and Heidegger for phenomenology and Rogers and Perls for human potential.  I choose these not only because they closely follow my own thoughts and observations on human behavior, but also because they give me the freedom to supplement their incompleteness with other styles' techniques.  I think it is very OK to harness the power of REBT when speaking of a client's fear of public speaking.  I just don't think that REBT is a very good starting point in understanding the client.
     My opinion tends toward the view of decreasing the limits on self.  I find so many theories inherently limiting.  CBTers can only use CBT.  Behaviorists will only use behaviorism.  Analysts with their analysis.  Choosing a theory, while it seems to be almost compulsory anymore, is not a good idea.

_________________________________________________________________________________

November 11th, 2014

     We must ask ourselves why we ask the question of someone's foundation theory.  Is it for our benefit or is it for the benefit of the client?  From a strictly professional point of view, the answer would most definitely involve the client more than the practitioner (perhaps substituting should for would would make that sentence a little more powerful).  But how does this benefit the client?  Yes, different techniques will be used and the therapist will approach the client from a specific standpoint, but if we look at each therapeutic theory, they are all interconnected, meaning that each is just another reframe of the former.  There is much in various theories that blurs the lines between different, if not opposing, theories.  For instance, irrational beliefs in REBT are so ingrained into the client's psyche that they most likely could be aggregated and be called the unconscious, a more Freudian term.
     If we assume this, then we all seem to be coming at theory from different points, yet all are hitting something that bears fruit.  So this can't be for the client, because no matter where we come from, we'll most likely be able to affect them positively.  It must be for us.  What use do we have for this designation?  It seems somewhat idiotic to eschew one way of thinking for another due only to a particular school of thought's doctrine.  Thinkers are supposed to take in voices from all sides of the equation, digest them, and allow some of the good ones to permeate their thought process.  This will give them new avenues of thought.  It seems that without new blood, some theories will stagnate and die out.
     So why do we do this odd exclusion and choice warfare?  Aren't we supposed to be empathetic and understanding professionals?  It could be, just like in any other business where multiple people are involved, that there must be an us-vs.-them designation.  While I think that this is natural (as it seems to be a human reaction to happiness or strife or lack thereof), to an extent I would think that clinicians would have the understanding nature that would allow them to not engage in such behavior.
     This point would be moot if it were not for the fact that there is much distress in the (at least beginner) clinical community as to which general psychological philosophy to choose.  This can stunt us or retrain us to think differently about other theories or practitioners.

The Similarity of Man, or, The Ego of Man

May 23rd, 2014

     There are only a few types of people in the world.  I know that we like to think that everyone is a unique individual with wholly different plumbing than anyone else.  This is true and untrue.  It is true int hat, biologically, there is almost infinite variability in man.  There will most certainly never be two men with the exact same neuron organization pattern in existence.  It is untrue in that the general behavioral consequences have many less probabilistic reactions (mostly due to learned/simulated responses seen in the past demonstrating what is proper or possible, and due to the natural lack of response reactions to any given stimulus).  While biology may yield a human who has never before set foot upon the earth, many people will have the same reactions to specific stimuli.  When stimuli are viewed back-to-back, it is, of course, less likely that the individuals will continue behaving similarly.  But these are broad categories under which some people may be catalogued.  I will not administer titles to these groups at this time; such categorization is tricky due to the common man's need to be individualistic.  Were I to create such broad groups (and other theorists have done so in the past), they would lead to different types of interventions that would be used to pursue betterment.  I must be clear in saying that these titles would not label the client, but instead would only describe behavior (much like diagnosis should do).

_________________________________________________________________________________

June 24th, 2014

     I'm wondering if we romanticize the human personality too much.  We continually marvel at the complexity of our own brains, but are they really so intrigue-worthy?  We revel in our own superiority due to our increased intelligence.  I think that there are equal parts stupidity and ingenuity where the human collective is concerned.  Sure, we've created books and harnessed electricity, but we've done so many things that warrant repugnance.  We've created so many wonders fit for gods, yet we still lack basic self-control and morality.
     I don't want to go too far off track here.  We see ourselves as superior to all due to our inventions.  Douglas Adams said it best when he wrote:  "For instance, on the planet Earth, man had always assumed that he was more intelligent than dolphins because he had achieved so much - the wheel, New York, wars and so on - whilst all the dolphins had ever done was much about in the water having a good time.  But conversely, the dolphins believed that they were far more intelligent than man - for precisely the same reasons."
     I think that the turning point in our superiority in intelligence occurred when we became conscious of our consciousness.  Somehow this imbued us with a sense of supremacy so vast that the behavior study of humans became very different from the study of any other animal.  We have shown, though, that the needs, habit, tendencies, etc. of man are similar to the "lower" animals.  Primates close to us, like chimpanzees and gorillas, exhibit behavior that is so close to ours, such as grouping and communication.  Verbal language, something uniquely human (another engineering marvel of ours), isn't just ours.  Well, it isn't our insofar that not only we can learn it.  We can teach other beings communication (parrots (though meaning behind the words might not be understood) and gorillas), so can we teach them to feel?  To think?  I believe that primates have already answered that for us.
     Complexity in behavior deals pretty heavily with brain plasticity and neuroscience as well as previous education and experience (nature versus nurture at its finest).  I can't help but equate this to the biological variance inherent in DNA.  Just like we see people who resemble others (including, sometimes, that other's behavior as well) we experience different behavior-styles in people.  If these groups can be given names and whose elements can be catalogued, doesn't it then seem as if personality variance is finite?  We act as if it is not.
     I think that it can follow that certain measures can then be taken for certain personality types.  This can help when people are seeking treatment.  If all this is correct, and I have no reason to think that it is, then human personality is not as infinite as idealists once thought.  In fact, it is the finiteness of personality that allow us to treat it.  Were the human mind a constantly changing and uniquely independent variable, it is somewhat reasonable to think that only the deepest of psychotherapies could work.  Perhaps that is the crux of some of the deeper psychotherapies' arguments.
 

Change vs. Persistence

     What is the correct methodology behind psychotherapy?  Namely, should clients be encouraged to change or to persist in their behavior?  Both points have their advantages and disadvantages.  Also:  what is the metric through which the two sides are measured?  Health (whatever that means)?  Decreased distress after the treatment?  Increased feelings of "at-oneness"?  Are both points correct but should be used for different populations?  Why is it at all relevant or important to current discourse?

     Change is a scary thing.  The familiar has a certain amount of safety.  Safety, as any introductory course in psychology would note, is one of the core needs of humans, after basic physiological requirements.  When the familiar is disrupted, as it most likely will be in vigorous therapy, one feels as if the bottom has been dropped out them.  Skills must be re-learned, relationships re-crafted.  All other non-physical needs (again referring back to Maslow) are secondary, meaning that such things as love and family, education, or exercise are obscured by the re-prioritization that occurs when a change is made.

     The argument can be made (and should be made) that any change that a client incurs is of their own making.  A client must accept change.  I think that the subject of conscious and sub- or un-conscious comes into play here.  A client, after having been force-fed a treatment, even a necessary one by a practitioner, might deny it consciously, but their subconscious may be have soaking in the teaching, allowing the chain reaction to start whereas the client's front mind is not yet willing to grasp it.  

     A change has the ability to bring a client to a more beneficial place.  A change in behavior may allow the client to attract less unwanted attention to him/herself when on an outing.  Such slight behavioral changes could be both positive and relatively simple to implement.  Changes in thoughts and feelings are much more difficult to access and implement because the operate at the core of our being.  When it comes down to it, we are walking bundles of thoughts and feelings, spewing out behaviors.  

     Changes can also be hazardous to our health.  When change occurs too quickly and dramatically, it is foreseeable and understandable that these individuals with an especially weak grounding or constitution might turn to self-harm or inhibitors as a way to cope.  We experience unwillingness to change from clients in the form of words and actions in the office.  We can lose points with our clients by forcing change that they are not ready for or by promoting too much change to the thirsty client that they cannot handle.

     Persistence is something else entirely.  I see persistence occurring in two ways:  First, persistence may occur through lack of encouragement to change.  In effect, this position emphasizes only the strengths that a client owns, while not looking at the deficits in the client's character.  I think that a client might also go along the path of persistence by choosing to change the world instead of themselves.  This is a difficult course of action, but that which is frequently taken by many organizations vying for the inclusion of certain non-behavioral, biologically-based mental disorders (autism, intellectual disability, lefthandedness (heh)).

     We must ask ourselves if persistence is enough.  Change shows that a client has learned a new way of thinking/feeling/behaving through an observable alteration.  Persistence is the opposite.  At best, a client would learn more about themselves and endeavor to piss of others as little as possible.  The gold standard for results in psychotherapy is change.  The metric is change.  Persistence has a lot to live up to.

     I think that persistence could be seen by many people as "persistence of intrinsic directive" versus an extrinsic imperative set onto the client.  The latter here is change.  Of course, in this interpretation, persistence takes on the identity of more fundamental humanism while change adopts the mantras similar to structured psychoeducational methods.

     In general, I think that it is difficult to advocate for a persistence model of psychotherapy when compared to a change model.  In this circumstance, I must add that I am specifically referring to behavioral issues, not biological ones.  Society needs to learn to work with these people, not against them.  I do wonder if there is any middle ground between the two.  To a pretty high degree, I think that the Wellness Model fits the bill nicely.

     I think that two main methods of persistence are normalizing and universality - both cooling techniques.  Normalizing is the act of telling a client that their actions/behaviors/thoughts/feelings are normal and representative of their bracket.  Universality is more helping the client understand that others have behaved/suffered as the client has behaved/suffered and have walked away from it.  While these two techniques are viable and useful, they are not unto themselves total means of therapy.
     One thing that goes along with change that might incur the most resentment is the tendency for either side of the relationship to want to "fix" the other.  Here, an additional point about change must be written.  Change must come intrinsically.  The therapist can only do so much; more is over-working of and over-functioning for the client.  This is not useful to either party.  

The Role of Diagnosis

     Why does diagnosis exist?  I think that a "diagnosis talk" should exist with clients who receive one from a clinical professional.  There is an obvious stigma in most cultures against people with such titles.  Perhaps as a clinical community, we can subtly change the message of diagnosis from one of hindrance and abnormality to one of medical jargon and record-keeping.
     I really think that a diagnosis would be better suited as a description/shorthand for some behaviors that help professionals understand the client.  Rather than saying, "You are a schizophrenic," or, "You have schizophrenia," why not say, "Schizophrenia is the best name one can give your behaviors?"  The former message gives a title and with it and with it an assumption of status.  The latter is more of an agreement between professionals as to what behaviors a client exhibits.  This should not be a label!

The Role of Therapist

     The role of therapist is a highly contested one.  At is inception, therapists were distant and interpretive, disallowing deep relationships (a la Freud).  The second movement was, in my opinion, less of a psychotherapeutic discipline as it was an experimental psychology doctrine.  But the behavioral method eventually rose to a direct client-based state.  Oddly, though the movement was in direct opposition to Freud's views on psychopathology, sex drives, and the unconscious, behaviorism shares the distance that Freud believed in.
     I think that Adlerian individual psychology was the bridge between the second and the third movements.  It seems to me that Adler was really trying to be a warm being in the client's life.  This could partially be due to the fact that he dealt quite often with children (as they were his main population).  Individual psychology may have even started the idea that the relationship between therapist and client is crucial.
     But, of course, Rogers's client-centered therapy is what it took for the therapist to be seen not as savior or expert (Freud) or caring doctor (Adler), but as a facilitator or helper.  It is this title that so interests me.  Other theorists have changed Rogers's view on the role of therapist slightly.
     Both Beck and Ellis of CBT fame espoused to be more structured and educator-based in their theories.  They acted in the role of expert.  They were teaching concepts for future use.  I think, to be honest, that this approach to therapist role has more to do with the type of theory that it is (teaching techniques for the future) rather than any specific plan they concocted.
     The more I practice, the more I find myself in the situation of psychoeducational technique use.  This could be due to the fact that most of my clients were in the drug and alcohol realm and that life skills teaching is a must in rehabilitation.  Due to this, I think that the role of therapist as educator and expert is important, but perhaps could be turned down so as not to discourage clients fro seeking further help.
     Changing the name of the role from teacher to tutor might reflect my views on the subject a little better.  A teacher can (and often does) talk down to a student from their high peak of knowledge.  A tutor, on the other hand, can teach and instruct, but also can have the ability to provide empathy.  A tutor works with a student, not in spite of him/her.  It is this collaboration that allows the real work to happen.  Just as a tutor can help a student with their research, a tutor approach can help a client conduct research into themselves and their behaviors.

Intellectual Suicide

     Today, children, we are going to talk about suicide.  People commit suicide for a multitude of reasons, the major one possibly being the inability to cope with some stressor and the additional point of lack of support around them.  They figure that this inner-outer conflict is less preferable to death.  Then, depending on their belief system, they would have to cope with some after-life punishment.  This, if thought through, would imply that such never-ending punishment would be preferable to their current torment.  Some belief systems, if they can be called that, assume that there is a never-ending nothingness waiting to greet us on the other side.
     Suicide is the final action.  Nothing is more subjectively/personally last than this.  But for some people, suicide is scary.  The thought of "taking oneself out" is unpleasant, dissuading one from engaging in the action.  Honestly, the unpleasant thought could deal with the aforementioned afterlife consequences, the process, or the thought of possible failure.  Either way, such rash action is unpleasant.  This is why I think that people commit a more mundane, but no less effective, form of suicide.
     This form of suicide shares at least one aspect with "death suicide."  Both inhibit a future.  This other form of suicide is the tendency of an individual, when met with a fork in the road, to take the easiest path in order to prevent possible failure in the future: that is, to stagnate and make no decision.  But why would one engage in this type of suicide, this future or intellectual suicide?  Perhaps they are afraid of taking the harder road and failing.  Perhaps they are inundated with expectation or policy.  Maybe they are burnt out.  Either way, they are not engaging themselves on the path of highest self-betterment due to a fear of something.
     A lot more can be written on the subject as far as tools are concerned.  Last thought:  suicide, at any level, is about giving up.  There is no hope anymore.  Perhaps there is some learned helplessness here.  Either way, exploring hope with clients is probably one of the main tasks here.