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Therapy yes, but which kind?

March 14, 2013

My journey as a therapist started out with an undergrad degree in psychology. There, the therapy of choice, er, forget choice; the only therapy taught, was person-centered therapy a la Carl Rogers. Rogerian therapy teaches empathetic listening, active listening, unconditional positive regard, reflection and perhaps reframing. I couldn’t stand it.

I argued with the professor, who by the way, studied directly with Carl Rogers, that if a person came in with a problem, why not offer them a solution? That was apparently sacrilege and so my entry to counseling began with me getting cuffed upside the head (metaphorically) until this approach was drilled into me. Heck, I couldn’t pass the course without practicing and demonstrating the concepts. I was now whole-heartedly Rogerian.

My first job in a helping profession however, was as a childcare worker in a group home for severely developmentally delayed, disordered and/or brain damaged youths, within a large children’s mental health centre. The treatment was strictly behavioral. Forget Rogerian. A Rogerian approach was antithetical to the behavioral approach. Dwelling on or giving attention to the comments, ramblings or inappropriate behavior of this client group was seen as inadvertently reinforcing the very behavior that was problematic. The new mantra was withhold attention from undesirable behavior and teach or reinforce desirable behavior. I felt like I was being cuffed upside the head again until this new approach was drilled into me. I abandoned Rogerian and adopted behavioral.

Interested in the role that the social worker had in that group home, I noticed she didn’t work behaviorally and she got to work with the entire family. I was intrigued and decided to expand my education by taking a Masters degree in social work. Little did I know how I would be cuffed upside the head yet again.

Social work theory and intervention is all about “the person in context”, based upon systems theory. After two years in a rigidly behavioral unit, I had to shift my thinking from linear to thinking about statements like the whole is greater than the sum of its parts and homeostatic mechanisms and thinking in triangles. Here, the shortest distance between two relationships, was anything but a straight line. Behavior was always seen in a larger context of  other social transactions. This was a cuffing upside the head like no other, but I embraced it.

In my practice placement I provided family therapy just like the social worker was doing that prompted my foray into social work. I had arrived. However, the style of intervention of the agency in which I was embedded was strategic therapy. Oh it was systemic in theory, but strategic in type. I loved it.

After a brief stint in a child protection agency where it felt like theory didn’t matter, I finally got back to the children’s mental health centre where I started out, but now as a social worker in the adolescent program. There, they practiced systemic based family therapy. We worked in teams with practitioners from a multiple of disciplines and the family therapy was always conducted in front of the one-way mirror with the team watching. The team leader could actually call in to the therapist during the session via a telephone intercom to interject or redirect as per the thinking of the unseen team. This was magnificent – if not intimidating to start.

With my first family in front of me and the team behind me, I began my interview. Within moments, the intercom rang and I was redirected in terms of my line of enquiry and person whom I was addressing. I was quickly thrown off my game and the intercom rang incessantly keeping me on a track I had no idea of which was heading.

Impressively and despite several awful similar experiences I wasn’t fired. Finally, 2 months into my employment, my supervisor and I come to understand the problem. In this agency, everyone practiced structural family therapy, whereas I was trained in strategic family therapy. Same underlying theory of human behavior, but remarkably different approaches to facilitating change. This was yet another cuffing upside the head.

During my 4 years employ at this children’s mental health centre, I was exposed to medication training, physical intervention, psychodynamic theory for individual psychotherapy, group therapy training, Milan family therapy and out of interest, I undertook to educate myself about feminist critiques of individual, marital and family therapy. Needless-to-say, I took so many shots to the head in terms of exposure to different therapeutic theories and school of intervention that I thought my head would fall off. Oh yeah, we were also trained in psychiatric diagnosis.

Since my time at that children’s mental health centre, I have since immersed myself in a number of other theoretical orientations and approaches to intervention. I continue to read the social science literature and embrace change, the result of ongoing continuing education.

Eventually I learned some larger truths about understanding human behavior and facilitating change. There are a myriad of ways to understand human behavior and a myriad of approaches to intervention and particular interventions may be better suited to particular problems.  

For any particular issue in front of me at this stage of my practice, I do like to consider the issue from multiple theoretical perspectives and then consider what would provide the greatest relief from distress in the shortest amount of time. This is the concept of parsimony. As per the Merriam-Webster’s dictionary: economy in the use of means to an end.

I take the view that the only reason anyone ever sees a therapist/counselor is because they are in distress and the only goal of anyone in distress is relief – the sooner the better. Given my opinion that therapy is also a grudge spend, I believe that people would much rather preserve their funds for spending anywhere else but on me and therapy. So, parsimony. Facilitate relief as expeditiously as possible.

I am accountable for my actions in therapy. Ask me why I said whatever to whomever and I will likely be able to articulate an underlying theory and explanation for my actions based on a therapeutic approach.

I never say I am eclectic. I worry that that is the buzzword of the therapist unable to articulate their training, theoretical orientation, clinical hypothesis and rationale for intervention.

So, therapy yes, but which kind? Really? It depends on one’s training.

Gary Direnfeld, MSW, RSW

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  1. rbox63 permalink

    I just graduated with a master degree in clinical psychology. I’m work at a youth residential facility as a therapist conducting individual and family therapy. I feel lost to the type of therapy I should be providing in my sessions. Help!

  2. Likely best to address that in supervision with your manager.

    However, many residential facility workers provide kind of a problem solving approach or reality testing approach with youths. “What are you thinking? How would that work” What would happen if…?” What other solutions might you come up with? What might happen next… and after that?” the objective is to help the youth think before taking action…

  3. DrRAH permalink

    This is interesting. I was trained in psychodynamically, Sullivan, Fromm-Reichmann and…Rogers, existentialists, also. The key element was the humanism, growth and healing through the relational engagement. I have tried to “perform” other methods, I think, I was terrible and I know, miserable in the end.

    In the end, for me and perhaps many, we must do what resonates personally. My experience is performances are just that. Healing and growth comes from relational contact. The other elements, behaviorism, TA whatever. I don’t necessarily use”tools” except myself as an instrument….

  4. I agree that we must do what resonates with us personally. That is part of being authentic. I also believe that in being authentic there is the kind of relational contact you speak of, regardless of the therapeutic modality. I think it is a misguided stereotype that those who practice behaviorally or in other modalities might not have relational skills. Indeed I think relational contact and skills and sincerity are key components to the efficacy of any therapeutic modality.

    It still remains, that the therapy one gets is primarily the outcome of who you see and the training of that person.

  5. This was very helpful to me. I am just starting my class on Social Work Processes. I am in an extremely accelerated program (5 week modules) and our professor told us she can only give us a “small taste” of each theory.

    There have been entire books written on each theory, so there is an inherent fear that I am going to miss out on some good info in this program. So I am looking outside my textbook for more viewpoints.

    I think that my training so far has probably been Rogerian. It is hard to tell though, because my book touches on all of the theories scattered throughout. According to my book, you don’t want to be too passive but you don’t want to solve the problems for them either. Letting them work things out on their own is good for their sense of confidence and it shows you respect them.

    But at the same time, they are not paying you to sit there silently and listen. They could do that with their dog, for free.

    “…a passive approach to practice is essentially inconsistent with the value of self determination and respect for individual dignity,” (Compton, p 88).

    The book doesn’t really describe what it means by” passive.” There is a lot of vague passages like that one. Some of the time it is clear as mud. I think that this article really clarified things for me though.

  6. I am guessing you are referring to the Compton and Galloway book – Social work Processes… At least that was the book I had to read…. in 1984.

    Pleased that my article put a bit of perspective on things for you. Let it all wash over you and in time as you are exposed to a number of different theories, you will come to better appreciate the vast array of approaches and lines of thinking available!

    Welcome to the field of social work.

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