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Examining Therapy

September 22, 2017

Therapy is a funny thing.

Although the history of psychotherapy can be traced earlier, it was Sigmund Freud’s “talking cure” that created the template for today’s psychotherapy.

That template is built on assumptions such as the standard 50 minute session and letting people “free associate”. In Freud’s time, the person actually laid down on a couch with the psychotherapist sitting in a chair just behind and out of the person’s field of vision. If the therapist said anything it was to reflect back some of what was heard or to offer an interpretation. In the context of Freudian therapy, the therapist was the expert.

Years later, Carl Rogers developed what he came to call in the latter part of his career as “person-centered therapy”. This moved the therapist from behind the couch to a face to face position with the person served. As a former minister, for Rogers, having a connection with the person was important to his style of practice. Without going into the underlying theory, important in his approach was seeing the person as expert rather than the therapist. The therapist was there to provide unconditional positive regard (UPR), empathy and to reflect back positively what was heard from the client. In this context, the therapeutic relationship was seen as pivotal for facilitating wellness.

There have been many other remarkable and notable therapists before and since. However, common to virtually all psycho-therapeutic approaches is the 50-minute hour, empathy and letting the client take the lead.

The thinking or theory held by many psychotherapists given the history of psychotherapy, is that if they create a “safe place”, typically thought of as free from judgment where the person is allowed to speak freely, the person will come to trust the therapist and then after however many session it takes, reveal either directly or indirectly events that have shaped their lives, but they were either out of touch with or felt shameful about.

It is in finally revealing those past events that provides relief. The other thinking is that “timing” is involved. The traditional therapist believes that past issues can or should only be revealed when the client is ready.

Here’s the thing…

People seeking help for emotional or interpersonal distress typically haven’t read or are familiar with the history of psychotherapy. As such, it is only through attendance over time do they learn to be a client. However, depending on the time and the discomfort of the issues, many people drop out of therapy not having attained the relief or resolution sought. To add, if the service is private pay, the persons served can develop an even greater sense of dissatisfaction, not having obtained a desired result for time or money spent. This leads to treatment failure and an experience that leaves the person reluctant to try therapy again.

I have never taken to a traditional view of psychotherapy. From sitting in my original counseling class in undergrad psychology with a remarkable woman who trained with Carl Rogers, to present, I have always held the view, that while the therapist is not the expert on the life of the client, the therapist can hold expertise and knowledge to be used directly in the service of the client. As such, it not only behooves the therapist to be knowledgeable on therapeutic approaches, but also social science research, understanding those issues that give rise to emotional, cognitive and behavioral issues as well as those conditions that promote healing and wellness.

From this perspective and approach, the therapist is very active in the therapeutic process, asking direct questions regarding one’s background and life experiences. “Safety” in this context is derived from the therapist’s comfort in and non-judgmental listening to the content brought forth by the client’s disclosure of material from direct questions.

By asking direct questions and with a good knowledge of social science research as well as biological factors underlying behavior and issues related to mental health or illness, the therapist can more forthrightly uncover those issues that may relate to current matters of distress.

Whereas many therapists, including myself rely upon the genogram (pictorial representation of one’s family history or family tree) , the more traditional therapist build their genogram over time, based on content delivered session after session. In my approach, I seek to build the genogram within the extended first meeting, that first meeting scheduled for 3 hours.

By creating a more elaborate genogram in one sitting, within the first session and with knowledge of social science research, the therapist is then able to sooner provide connections between life events and current circumstances rather than relying on the passage of time and for the person to eventually come to their own deconstruction-reconstruction of factors contributory to their issues. It also helps the therapist rule in or out issues that may be historical and/or biological and thus lends itself to more efficient treatment.

Guidance, information and treatment recommendations may flow from the single encounter, sufficient to meeting the person’s needs.

If necessary, a follow-up meeting is set to support the use of strategies or increased knowledge or information provided to the person. Follow-up meetings may also serve for examining hypotheses that may have also been generated at the meeting and then tested between appointments.

With this approach if a follow up meeting is set, it usually is some 4 or more weeks into the future. This allows feedback or guidance provided in the first meeting to percolate with the person and to provide time to practice, adjust, explore or implement any of the strategies provided. As in the first meeting, 3 hour chunks of time are always provided yet only the time used is actually billed to the person. With this approach, the meeting concludes more when it makes sense rather than arbitrarily having run out of time. This lowers concern for the person that they will run out of time before addressing issues and also lowers concern for losing momentum not having addressed issues of concern from one meeting to the next.

There is nothing to say this approach is better or worse than any other approach, but to say it is different. It isn’t helpful to all persons, but in my experience the persons I serve typically express satisfaction.

My bottom line in writing this blog is to bring to therapists’ attention that just as we seek to have people examine their lives, we too who provide therapeutic services, must examine our beliefs and approaches too. That is the nature of reflective practice.

I am Gary Direnfeld and I am a social worker. Check out all my services and then call me if you need help with a personal issue, mental health concern, child behavior or relationship, divorce or separation issue or even help growing your practice. I am available in person and by Skype.

Gary Direnfeld, MSW, RSW

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Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas and Georgina Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America. He consults to mental health professionals as well as to mediators and collaborative law professionals about good practice as well as building their practice.

One Comment
  1. daveyone1 permalink

    Reblogged this on World4Justice : NOW! Lobby Forum..

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