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This Cross Training Enables Better Treatment

November 6, 2019

In terms of my training, I remember having difficulty shifting my thinking from my behavioral training to family therapy training and psychodynamic training. I even had to integrate some medical and psychiatric training as it pertains to behavior. These different approaches to therapy don’t always point in the same direction.

Behavior therapy is based on linear thinking. A behavior is the result of the stimulus preceding or reinforcement following.

Family therapy is based on systemic thinking. With systemic thinking an event or issue in one part of the system (family) has influence in other parts.

Psychodynamic theories is all about what is inside our head – how we have internalized our view of our-self and place in the world.

It helps to also have the medical and psychiatric training on issues that can influence behavior as many medical conditions can manifest in behavioral and psychiatric symptoms.

For instance, child tantrums:

From a behavioral perspective we may wonder what preceded… is the child hungry; was the child frustrated. If we change the conditions leading up, we change the behavior. Or, we can punish innapropriate behavior and reward appropriate behavior.

From a systemic perspective that same child may throw a tantrum when the parents start fighting. The tantrum distracts the parents from their fight causing their fight to stop. From this perspective, there is a positive function to the child’s behavior. It restores peace (homeostasis) to the family.

From a psychodynamic perspective we would wonder of the child has internalized a poor sense of self and is acting out the pain of issues within the self.

From a medical perspective, this could be a child with a medical condition, unable to express their pain, but now manifesting as a tantrum.

There is tremendous benefit to cross training. Typically how one is trained is how one assesses. The problem is, if you assess behavior from one perspective but the problem is the result of another, you then wind up applying the wrong intervention.

With cross training, we can assess from multiple perspectives simultaneously. With that we hope to arrive at a more appropriate understanding of what drives the problematic behavior and thus apply a more appropriate intervention.

I have seen many folks in my practice whose issues appear psychiatric, but where there is an underlying medical condition. When I suspect an underlying physical issue, I refer to the physician before considering psychotherapy.

Learning and integrating various theories and forms of practice takes considerable time.

Indeed, it is a lifelong process which I enjoy.

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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 video conferencing.

Gary Direnfeld, MSW, RSW for counseling and support – to build your successful practice


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, former 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 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.

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