Towards More Honest Ways to Teach Counseling Theories

I’d like to think that if therapists like me who have been farting around with psychotherapy for twenty years or so, might be able to improve the way counseling theory is taught in graduate school. Ideally, I would like to support the development of theory that address social ills. I have found myself feeling this way when I think of all the different misconceptions that I have endeavored in over the years. Now that I have established my niche and am advocating for new movements and theories that make most sense to me, I am finding myself wanting to help budding therapists learn how to conduct the art of psychotherapy in ways that help solve pressing issues, not just apply a scientifically proven technique or pass a test.

I think psychotherapy has made a break through to some extent that doesn’t get talked about. More and more theory is being constructed that help therapists solve problems rather than exhibiting panacea proclamations. I consider panacea theory to be what I was taught in graduate school: in its most postmodern form it includes narrative and solution focused therapies. Panacea theory was often remiss to really address social ills as they exists in agencies and on the ground. I think the onset of what I would call problem-centered approaches began with movements like DBT and Motivational Interviewing.

 

Problem-Focused Therapy instead of Panacea Therapy:

And I think if we look at what works about the problem-focused therapies that already exist, we can learn a lot about not only about how to solve real social problems, but also how to create theoretical elements that actually help teach other therapists in ways that enhance their art of psychotherapy.

While it is clearly arguable that Evidence Based Practice represents the move in the problem-focused direction, I think that that movement is missing the genuine insight about what works in the art of psychotherapy. This may be due in part to our past of panacea proclamations mixed with big ego and money making desire of theorists that genuinely corrupt the movement towards health. But the idea that a movement must bear scientific proof and create fidelity measures that are imposed on the practitioner oversteps the utility of a theoretical model/movement. Perhaps, I have just seen fidelity measures fail to filter down too often to really understand their genius. However, it seems to me that this runs the risk of leaving community mental health in a state of being constantly and inappropriately experimented on by workers who are taught to listen to an organization or a science more to than their true self and their humanity.

To put it simply, I am only arguing the problem-centered theoretical movement needs to know when to teach and when to leave the psychotherapist alone. I think a good movement needs to create jargon that gets taught and understood in a way that defines and understands the problem and proposes direction for solution.  It needs to be a set of information that once known, enables creative and spontaneous technique to flow from within the practitioner’s character and towards the local circumstance that the individual is dealing with.

In my mind, fidelity focused techniques that are applied may fail to pay regard to both the therapist’s persona and the unique cultural entity that is a participant and the social context that surrounds them. I don’t see this being understood by everyone who follows fidelity techniques and I feel that there are times this can distort real authentic connection. As Evidence Based Practice exists now, many therapists can walk away from an encounter having applied the best practice technique feeling satisfied that they have done their job, without having any idea about how and whether it works; and the blame for failure once science becomes involved, ends up all on the participant, not the therapeutic movement.  It is the reverse of what reality is and it encourages practitioners to burn out.

 

Material that Inspires Spontaneous Techniques verses Scientific Notions:

Consider instead what Marsha Linehan has done in redefining elements of complex trauma and proposing solutions that enable the therapists to be themselves and complement each other in structured ways. This does not mean DBT is always going to be perfectly conveyed to the recipient.  There is plenty of space for there to be Damn Bad Therapy going on by personalities who are not good fits or by a failure to truly validate a subject, but in my mind the material does not claim to have control over this.

Speaking for myself, I have worked up an internalized sense of my own definition of “psychosis” along with complimentary solutions. I have done this based on my own experience in running groups for “psychosis” over eight years.  In doing this I have found that new ways to focus on treatment have started spilling out into my personal work in individual sessions. In doing this I find myself driven to use spontaneous techniques with a clear rationale for how and why they may be helpful to the individuals I work with. If they miss, I try again. I believe that with any kind of redefinition internalized that different people can make different kinds of techniques and interventions. Techniques need not be studied and applied, they need to flow out of authentic moments. And material needs to be created that inspires one to do this.

The more group leaders do what I have done, reconstruct the problem and accompany it with directions toward solutions, the more they will be able to focus on the cultural art of psychotherapy. Original techniques may come up naturally in the creative and spontaneous moment and will be more likely to work. The more that a student studies or is forced to utilize someone else’s technique, trying to apply them in a scientific manner, the more frustration and burnout and bad therapy is likely to result.

 

Supporting Counseling Theories that Address the Real Social Ills:

I am not arguing that the time spent studying panacea therapy is an entire waste of time: it has clearly been utilized in the eclectic approaches in DBT, MI, and the approaches I am developing towards work with “psychosis!”  But still, I think a lot could be done in the teaching of it so that misconceptions do not become institutionalized in a learner’s head.  Thinking that you must scientifically replicate a Minuchin or a Fritz Pearls is a misconception that I was taught on several occasions. Perhaps if I had continued in school, I may have learned this is not a valid contention. But I also think studying yourself as a person is also extremely important in addition to studying a theoretical model. And constantly questioning and reflecting on the errors of what you are doing is likewise necessary, even when they fit the standard of care, is extremely important

But, I’d also like to argue that right now there are major vacuums existing with for which problem-focused theories are desperately needed. Clearly, I feel “psychosis” is one of them, but so too is there a vacuum for OCD: both are highly neglected due to the western worlds institutionalized past. Of course, there are many other problems that could be addressed like psychopathology and socio-pathology if our society was not so influenced by concentration camp businesses like the prison, pharmacological, mental health, and drug war industries. Ultimately, these are some the issues that Counseling Theory most desperately needs to address.

Author: Tim Dreby

I am an award-winning author and practicing psychotherapist

4 thoughts on “Towards More Honest Ways to Teach Counseling Theories”

  1. Yes! Graduate programs can (and probably should) continue to teach students about the many modalities of therapy that are out there, and how various clinicians have adapted, adjusted, or combined these modalities to suit their personality/style and the populations they are working with. This is all useful information: about what techniques and perspectives have been helpful to clients and reinforcing that there is a wide range of ways to engage in therapy and room for creativity and making it your own.

    Too often it seems grad schools encourage their students to learn about a few modalities, and then choose one to explore in more depth and work at ‘perfecting’ the described strategies. This discourages the individual creativity and curiosity that could be most helpful in their growth as therapists. Organizations and supervisors that new therapists train under also tend to over focus on getting the trainee to take on the modality, techniques, and style of the supervisors.

    The therapeutic relationship is undeniably important, but these relationships become less authentic and genuine as therapists are taught to force-fit themselves into other people’s expectations of the “right” or “best” way to do therapy.

    Organizations, supervisors, and professors insisting on overly rigid method of therapy is often well-intended and many times influenced by external restrictions (e.g. what will insurance agree to cover). But I think it is often motivated by fear- on the part of trainers and trainees alike. More structure feels safer which is understandably alluring. But with that sense of safety (from familiar techniques, step-by-step treatment manuals, regular measures of symptom outcomes) we are trading our own willingness to be vulnerable.

    It is more vulnerable sitting with a client without already-scripted solutions, acknowledging not having the answer(s) and being willing to explore and learn together. And when our own self doubt and discomfort arises, not retreating into manuals and structured techniques and instead embracing the discomfort as a chance to experience a tiny piece of the client’s experience.

    That willingness to be vulnerable, to be authentic and true to yourself as a therapist helps both therapist and client grow individually and has great potential for a trusting, genuine therapeutic relationship. And more generally, humans improving their understanding and acceptance of themselves increases their capacity to understand and accept others– the more we do this inside and outside a therapy room, the better.

    Liked by 1 person

    1. Hi Stacy,

      I really appreciate your comments, as they are exactly the type of things I think about when I work. I love what I do and am not burned out in the least because I strive to be authentic and vulnerable in spontaneous manners.

      The problem I sometimes encounter is that people who have different beliefs about how or whether a person can heal sometimes attack or exploit the vulnerability that gets expressed and may call it bad boundaries and work to politically take it out even if it is working for the people who are receiving the therapy. This has happened to me on a few occasions.

      I can certainly hear that some people may not feel comfortable with vulnerability and that it has to be artfully used in order to be powerful, but it is very difficult when people who are afraid of it and perhaps are jealous of it vie to politically attack it. This sometimes causes me grief when working on teams; however, sometimes teams can be good too.

      I just wish it was taught more and less attacked.

      I have noticed that schools often push people to fully understand a school more than they encourage someone to fully understand themselves. It’s kind of a pity.

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      1. Yeah, it’s definitely not as simple as therapists not being willing to be vulnerable or it not being taught in grad schools and training programs; it’s often actively discouraged and targeted.

        I’ve noticed the ‘poor boundaries’ response between therapists as well — it almost always shuts down important conversations and elicits shame, guilt, and fear in therapists to be vulnerable even with their peers. Counterproductive across most situations, and especially when treatment is helping!

        Being vulnerable and authentic won’t always go as intended. We’ll make mistakes, misread situations, miscommunicate, and so on but I hate when these circumstances are used as evidence that the vulnerability is too risky/unpredictable. Not only are mistakes unavoidable and can help us learn and improve as therapists over time, the process of responding to them and sorting them out with a client can be invaluable.

        On a somewhat related note, I recently finished reading your book, and was repeatedly struck by the vulnerability and authenticity in your writing. I can only imagine it took a ton of courage to put your experiences out into the world. And I like hearing you talk about fighting to bring that authenticity into your clinical work (including struggling against the larger system and the conflicts it can bring with colleagues/management). It’s your openness in sharing all aspects of your experience (including the most painful parts, times of self doubt, and experiences of regret) that make the stories complete (and thereby most believable, relatable, and understandable). To take out the pieces that are hardest to show the world would remove the impact. It’s inspiring to read!

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      2. Hi Stacy:

        Your points sound like many conversations I’ve had in defending myself. I believe being authentic and vulnerable helps us know when we are right and wrong in our work and that is something I definitely want to know and conversation about. Otherwise, with artificial boundaries we may walk around thinking we are helping and never know whether we are helping or even hurting.

        Thank you so much for the compliment on the book it means the most to me. I’d love it if you wrote a review on Amazon if you have time.

        Thank you again,

        Tim

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