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Why aren’t people in need seeking psychotherapy? That’s the question that resonated in a recent California conference and that’s the question that got me thinking about my own psychotherapy practice.
I often hear recently referred clients state that they liked their previous shrink but that all the therapist did was listen, “ I can get sympathy and understanding from my wife, why should I have to pay someone for it,’’ was a comment that I heard from more than one disgruntled client.
As a university professor involved in teaching psychology students the trade, I partially understand the problem. Recent research analyzing the results of multiple studies has debunked the notion that any specific form of psychotherapy is better than any other. What seems to make more of a difference in determining outcome are qualities of the therapist, in particular, empathy, genuineness and alliance building. My advice to students; “be care what you read in the Journals!”
Although the current rage is all process, or the therapeutic relationship, when I was in graduate school it was all technique. Get the phobic to approach the feared object through the technique of exposure, build the shy person’s repertoire with social skills training, or help the angry client restructure his or her irrational assumptions. In all this early focus on technique, not a care was given in the research literature to the kind of relationship you needed to develop with the client to make this happen or even the words and images that might facilitate success. Although his approach was unrealistically simplistic, but accepted for many years.
Now, the tables have turned and students are being taught to minimize technique and focus exclusively on the relationship. The hallmark of the therapeutic relationship seems to be active listening and reflective empathy. But, in my opinion, this singular focus on the relationship will also come to a bitter end.
In my view, clients seek expertise; either in the form of increased understanding, a new direction or tools to change their problematic behavior. In short, they need techniques. However, the techniques need a facilitating contextual relationship with the client to make them effective. Technique and process are intertwined; one without the other is plain silly.
I also feel that more psychotherapists are reluctant to provide direct help in solving client problems?
Strange thing to say, let me explain.
Clinical psychology, and its prodigy, cognitive behavioural therapy (CBT) have their theoretical foundations firmly planted in America. Political values such as independence and individual determination are intertwined into the terms and concepts of CBT; terms such as self-efficacy, self-monitoring, self-control -all of which speak to these democratic notions of individual liberty and volition.
Our earliest ventures as a profession into psychologically-based psychotherapies- the so-called client centered therapy- stressed the importance of letting the client direct the therapy content. Even now, CBT textbooks cite the collaborative process of collective problem-solving. Well, if that’s all we offer- putting two equal heads together in some collaborative venture- we’re charging too much!
In order to provide real help to clients, we need to give them something tangible and that means having the therapist take a direction and provide something that the client does not currently have. That means utilizing our differential status and not fearing that such differences will lead to authoritarian abuses. Experts in human relationships and problem-solving can also be empathetic and understanding. But people come to us for help, not to meet with some peer, to generate ideas they could have thought of on their own.
We don’t mean to but there are demeaning barriers:
Another common reason for not seeking help from a psychologist involves some demeaning aspects of therapy. We don’t mean to do it, but our training taught us to discriminate among problems especially for research purposes. What began as clarification has now generalized to rampant application of diagnostic labels applied to all manner of problems in living. Regrettably, most of the psychiatric labels areare prejorative in nature. Rarely, have I met a client who is happy to be labeled as a borderline or bipolar and if they are, I’m suspicious.
But even without formal labels, many of our theories of why problems happen- psychopathology –( note already the distasteful word) highlight client irrationality as an underlying cause. So the depressed woman feeling rejected by friends and lovers is confirming a long-held schema that she is in fact unlovable. Correct or not, accepting both the problem and potentially her own formative role in creating the problem, is an unpleasant hurdle for many clients.
Perhaps, it’s only me or perhaps it is my current practice where I see professional athletes or business executives struggling with workplace challenges, but for most of my clients, I’m not sure that I could do any better in their circumstances. In fact, for the athletes, I’m obviously not even in their league. I think that my “there but for the grace of God” attitude might make it easier for clients to seek help. In my opinion, some life situations are just plain difficult for anybody, and sometimes in those situations psychology can help.
So there’s my recipe for getting and retaining more clients; provide practical help in a supportive relationship focused on solving life problems without labels or theories of causality that blame.