Not everyone is suited, in my opinion, for success in talk therapy. One of the essential elements of successful talk therapy, perhaps the single most essential element and the single most important factor in determining therapeutic success, is the establishment of a strong therapeutic relationship. This is something that the therapist is responsible for fostering, and it is also something that the client must be capable of entering into. If a client is not so capable, or is capable only in significantly limited ways, the likelihood of successful therapy is reduced.
If a client is not especially capable of developing insight, or reflective self awareness, the likelihood of success is reduced. If a client is not particularly given to introspection; is deeply and powerfully invested in a particular world view; is committed to having to be right; or only wants to be told what to do, the success of talk therapy, at least as I practice it, is less likely.
Perhaps such people would be better served in seeking help through another of the modalities available, such as the ones mentioned in Part 1 of this post. Nothing wrong with that. And it might save disappointment if the best suited modality is entered into, instead of believing that only talk therapy can help.
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Tuesday, June 7, 2011
Proper Limitations of Talk Therapy, Part 1
It seems to me that over the last 25 years or so, with the onslaught of the managed care invasion of psychotherapy, one of the results has been a widening expectation of what talk therapy can do for people. It has come to be seen as a remedy for everything from front line crisis intervention aimed at perhaps saving people's lives (or preventing them from taking their lives), to rehabilitating people from the destructive effects of chemical addiction, sexual addiction, process addictions, work addiction and more, to providing solace and skills for dealing with grief, to healing the effects of trauma, to re-educating people who have problems controlling their anger, to providing a cure for domestic violence, to managing any number of socially frowned upon "aberrant" behaviors, to
teaching couples how to be in relationship in mutually satisfying ways, to keeping people with very serious mental illnesses from completely ruining their lives. Etc.
This is surely not an exhaustive list, but one that I hope helps to give an idea of the breadth of the expectations that have grown up around talk therapy.
Other kinds of therapies have grown out of talk therapy, because some of the inherent limitations of talk therapy have been recognized. We have the somatic (body inclusive/body centered) therapies which are aimed, often, at helping people resolve the effects of trauma; we have shamanic "therapies"; we have group therapies and psycho-educational "therapies"; we have movement and music and art therapies; we have "intuitive" therapies; we have the energy psychologies; we have all manner of body-mind therapies, including hypnotherapy, EFT, EMDR, and others.
Then there is always pastoral counseling; or talking to a priest; or making confession; or visiting a curandera.
I'd like to make an argument for the proper limitations of talk therapy as a healing modality. I don't think it's suited to the treatment of every kind of personal or relational distress, even though there seems to be at least something of this expectation now in the culture at large. For example, it's not at all uncommon - it is in fact the norm - for mental health agencies, and even for private treatment centers, to load up therapists with impossibly brutal case loads, expecting that somehow, some magic will occur that will allow these therapists to properly "treat" inordinate numbers of clients, presumably based on the assumption that talk therapy is a magical process whereby people are readily, easily, and probably painlessly "cured" of what ails them. The public, largely I believe because of the obscenely profit driven agendas of the gargantuan insurance monopolies, has come to believe this nonsense too.
mdavid-lpcc.com
teaching couples how to be in relationship in mutually satisfying ways, to keeping people with very serious mental illnesses from completely ruining their lives. Etc.
This is surely not an exhaustive list, but one that I hope helps to give an idea of the breadth of the expectations that have grown up around talk therapy.
Other kinds of therapies have grown out of talk therapy, because some of the inherent limitations of talk therapy have been recognized. We have the somatic (body inclusive/body centered) therapies which are aimed, often, at helping people resolve the effects of trauma; we have shamanic "therapies"; we have group therapies and psycho-educational "therapies"; we have movement and music and art therapies; we have "intuitive" therapies; we have the energy psychologies; we have all manner of body-mind therapies, including hypnotherapy, EFT, EMDR, and others.
Then there is always pastoral counseling; or talking to a priest; or making confession; or visiting a curandera.
I'd like to make an argument for the proper limitations of talk therapy as a healing modality. I don't think it's suited to the treatment of every kind of personal or relational distress, even though there seems to be at least something of this expectation now in the culture at large. For example, it's not at all uncommon - it is in fact the norm - for mental health agencies, and even for private treatment centers, to load up therapists with impossibly brutal case loads, expecting that somehow, some magic will occur that will allow these therapists to properly "treat" inordinate numbers of clients, presumably based on the assumption that talk therapy is a magical process whereby people are readily, easily, and probably painlessly "cured" of what ails them. The public, largely I believe because of the obscenely profit driven agendas of the gargantuan insurance monopolies, has come to believe this nonsense too.
mdavid-lpcc.com
Sunday, June 5, 2011
My Ideal Client
When you first are about to finish your masters program, the one that will lay the foundation for you to practice counseling, or therapy, I think there is a tendency to think that you can help everyone and anyone. There is, naturally, a combination of enthusiasm, hope, naivete, and maybe even confidence that conspire to support this illusion. I was fortunate enough at that time to have a supervisor who told me straight out that that would not be the case. Even so, it took some years of experience in the trenches, and of personal development, for me to understand really what he meant. I think I have a pretty good idea now.
One hopefully learns more about one's own limitations, one's real skills, one's personal preferences and needs; about the real nature of a variety of dysfunctional behaviors and conditions, about the importance of client motivation in making any meaningful changes at all - and let's remember always, that psychotherapy is about making meaningful changes, and not about maintaining a status quo.
My professional experience suggests that making changes isn't something that most people look forward to, or embrace enthusiastically, or even understand the need for. If I could tell clients that I could and would help them to remain exactly the same as they are, and still experience whatever benefits they think they're after, I'd have the busiest practice on the planet. A waiting list years long. People ready and willing to pay any fee I cared to charge. You see the point.
Of course (I say "of course", but I don't actually believe it's obvious, or readily understandable), this is never the case. I underline "never". So the older I get,
and the more experience I have, the more I sometimes feel that I perhaps ought to publish a list of criteria, of pre-requisites, or qualities that my ideal client will be able to meet, or will possess. This will avoid encouraging people who really don't want to make any personal changes, people who want someone else to change but not themselves, people who seemingly lack even the most basic insights or understandings about themselves or about their circumstances, from looking to therapy for help. Why encourage what is extremely unlikely? Why offer promise where there is virtually none?
So here's a list; a work in progress. I'm writing this as much to see what I'll come up with as to be of service to others. I admit my selfishness and my simple curiosity. Here goes:
A certain degree of humilty
A certain degree of willingness to explore
A certain curiosity about oneself, about people, about life
A certain recognition, even if vague, of the possibility of healing
Something less than a phobic avoidance of the likelihood of having to change
An ability to see oneself, even if only partially, as no better than anyone else
A certain awareness, perhaps, of the essential structural reality of relationship
A value system that includes concern for people beyond oneself and beyond one's
narrow circle
Ideally, at least a sense of the possibility of a Reality, a Truth, a Meaning, beyond one's small self serving agenda in life
At least a budding awareness of the importance of including one's feelings in one's life, as well as one's ideas
Some degree of capacity for and disposition toward the truth
This is enough for a start, I think. And of course, this is only my bias. Give me a call if you can relate.
mdavid-lpcc.com
One hopefully learns more about one's own limitations, one's real skills, one's personal preferences and needs; about the real nature of a variety of dysfunctional behaviors and conditions, about the importance of client motivation in making any meaningful changes at all - and let's remember always, that psychotherapy is about making meaningful changes, and not about maintaining a status quo.
My professional experience suggests that making changes isn't something that most people look forward to, or embrace enthusiastically, or even understand the need for. If I could tell clients that I could and would help them to remain exactly the same as they are, and still experience whatever benefits they think they're after, I'd have the busiest practice on the planet. A waiting list years long. People ready and willing to pay any fee I cared to charge. You see the point.
Of course (I say "of course", but I don't actually believe it's obvious, or readily understandable), this is never the case. I underline "never". So the older I get,
and the more experience I have, the more I sometimes feel that I perhaps ought to publish a list of criteria, of pre-requisites, or qualities that my ideal client will be able to meet, or will possess. This will avoid encouraging people who really don't want to make any personal changes, people who want someone else to change but not themselves, people who seemingly lack even the most basic insights or understandings about themselves or about their circumstances, from looking to therapy for help. Why encourage what is extremely unlikely? Why offer promise where there is virtually none?
So here's a list; a work in progress. I'm writing this as much to see what I'll come up with as to be of service to others. I admit my selfishness and my simple curiosity. Here goes:
A certain degree of humilty
A certain degree of willingness to explore
A certain curiosity about oneself, about people, about life
A certain recognition, even if vague, of the possibility of healing
Something less than a phobic avoidance of the likelihood of having to change
An ability to see oneself, even if only partially, as no better than anyone else
A certain awareness, perhaps, of the essential structural reality of relationship
A value system that includes concern for people beyond oneself and beyond one's
narrow circle
Ideally, at least a sense of the possibility of a Reality, a Truth, a Meaning, beyond one's small self serving agenda in life
At least a budding awareness of the importance of including one's feelings in one's life, as well as one's ideas
Some degree of capacity for and disposition toward the truth
This is enough for a start, I think. And of course, this is only my bias. Give me a call if you can relate.
mdavid-lpcc.com
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