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.