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I
prefer to view my professional role as that of a "life coach"
rather than the traditional view of doctor and patient. I do not like the
medical model because it focuses so much on giving a pathological label to
what is being treated. I use a learning and systems model. My
client's problems and struggles are not due to abnormal psychopathology,
but are normal reactions to living in this stressful, complex, changing
and sometime contradictory world. I
want to understand each of my client's issues and struggles in the context
of their real lives rather than in reference to a theoretical model that
focuses on pathology.
We are guided and limited by
our learning. People don't usually
receive formal education and training about human behavior, handling
feelings, listening and communicating with others, or the various ways of
productively resolving conflict. We initially learn how to get along with
others, how to relate to the opposite sex, how to handle anger and
conflict and other problems by what we were taught, experienced and
observed in our family as we were growing up.
The learning broadens as we observe and learn from others outside
our family, but it is always limited and incomplete. If a person is lucky
and is raised in a healthy, well-balanced, high functioning family, the
person learns effective skills for living in a harmonious environment. If
a person is unlucky and is raised in a broken or dysfunctional family, the
person will likely either learn to be similarly dysfunctional or will
learn how not to handle things. Knowing what doesn't work and what not to
do is useful, but not as useful as knowing what does work. Even a person
raised in a high functioning environment does not necessarily have the skills to
function effectively in a hostile dysfunctional environment. Humans are
too complex and there are so many different ways of being, relating,
believing and doing things that we cannot learn it all. By far, the vast
majority of people who come to me for help have not learned how to
effectively deal with or make sense of and understand the issues and
dynamics causing their problems.
I always strive to understand
my clients from the perspective of their life, based on who they are,
their values and the unique pressures and stresses they experience.
Basically my task as a therapist is to accurately understand what the
person wants, what is interfering or preventing the person (or couple)
from accomplishing it themselves, what they need to do differently in
order to achieve or resolve it, and to coach and guide them in their
efforts.
There are 5 interrelated
dimensions that I use to help me understand my clients and the situations
and issues they want help with.
- Cognitive.
I
want to know how the person understands, makes sense of or interprets
the problem or event. People generally feel and behave in a way that
is consistent with the way they are thinking, believing and
anticipating. The more accurate and clear a person is in his/here
understanding the more appropriate and effective the person is able to
be.
- Affective.
How does the person feel? What does the person do with their feelings?
How does the person use their feelings? How aware and skilful is the
person with his/her feelings? What feelings are difficult for the
person? How does the person react to and handle someone else's
feelings.
- Behavior.
What do they actually do behaviorally? What skills do they have for
handling the event, and what might they need to learn? What impact
does their behavior have on others? How deliberate and conscious is
their behavior, and how automatic and unconscious is it.
- Social.
I want to understand the social context of the event or problem. The
climate of the social/family system, the pressures and supports.
- Biochemical.
I keep this in mind because I do not want to make the mistake of
thinking everything is psychological and overlook the possibility of
an underlying medical problem or drug and alcohol abuse.
There are only a few general
reasons people seek counseling and psychotherapy.
- Discomfort.
The person is significantly bothered by something, is experiencing
significant discomfort and wants relief or help to overcome it.
Typical examples include grief, depression, anxieties, guilt, worry,
anger, or bother about a habit or behavior of their own or a behavior
of someone else.
- Dysfunction.
The person is having difficulties in their life as a result of a
dysfunction, limited ability or simply lack of learning. They have
become aware of it and want help overcoming it, or accepting it and
living more effectively with it.
- Growth.
There are those who are not having any particular difficulties in
their life but value learning and growth.
They want to broaden their awareness and/or get another
perspective on something.
- Requirement.
Some people are forced or pressured to receive treatment. The pressure
could come from their family, employer, the legal system, etc. or
therapy might be required in order to be eligible for something else.
- Desperate.
The person or couple has been having difficulties for a long
time and has avoided getting help from a therapist. Things have gotten
so bad and there is a realization that things are about to get even
worse, they seek therapy as a desperate last resort.
When there is dysfunction or
discomfort one or more of the following concepts will usually be out of
balance, lacking or inappropriately applied.
- Awareness
and Seeing Clearly. If
something is occurring and we have no awareness of it, we can't do
anything about it. We are not in control of it, and it might be in
control of us. Once we become consciously aware of it, we can than
start to do something about it. Of
course the awareness should be clear and comprehensive. The more
clearly we see others, the situation, and ourselves, the more
effective we can be.
- Direct.
In the general American culture, being direct with others and with
self usually helps the communication be more effective by improving
the clarity of the message. Hinting is too subtle and is easily
dismissed, and the message could be missed altogether.
- Honest.
Lying usually eventually makes things worse. Don't say it is
"ok" when it is not ok. Don't tell the other person you
would like to, and you would if you could but you can't, when the
truth is you don't want to.
- Respectful.
Be direct and honest with others with tact and respect. Don't
be a jerk by being direct and honest without tact and respect, which
comes across as blunt, demanding or insensitive and may trigger
resistance or resentment. Be
respectful to others and to yourself. Be just as respectful of
your own needs, wants, beliefs and values as you are of others.
- Responsibility.
Be clear of what you are responsible for, as well as the limits of
your responsibility. What are the other person's responsibility and
the boundaries of their responsibility? What about shared
responsibility. People have a lot more trouble and difficulties when
they don't accept responsibility for their choices and behavior or for
the consequences of their choices and actions.
- Acceptance.
There are some things that bother us that we can do something
about, and there are things we cannot do anything about. It makes no
sense to get stuck on and waste time and energy on something we cannot
do anything about.
Some therapists have a basic
assumption that people (especially clients) are weak and fragile and need
to be protected from upset and pain, or that clients are so limited,
incapable and powerless that they need to be saved and rescued. I think
such assumptions are insulting and disrespectful. I assume that people are
generally capable, adaptable and durable. We may not currently know how to
do something, but we might be able to learn. We don't have to avoid
something because it is uncomfortable, frightening or upsetting, we can
tolerate and handle a lot. Upset and pain is a part of life and we need to
be able to face and effectively handle upsetting and painful events and
feelings when necessary. We also don't have to make ourselves powerless or
helpless and just tolerate and endure painful or upsetting things when
we could do something to make things better. I want my clients to see
themselves and others clearly and accurately. We should be aware of our
weaknesses and limitation and our abilities, strengths and
capabilities.
Some therapists believe that
they know what is best for their clients, and tend to impose their own
values and agenda on their clients. I do not believe that there is one
best set of values or one best way of life. My values and beliefs work for
me, but they may not work for someone else. I do not have any need or
desire to impose my beliefs or values on others, especially in my
professional life. If I
accept someone as a client, I will respect his or her values and belief
systems. I stay oriented and
relevant to what my clients want from therapy. During the first or second
meeting we will identify the goals of treatment. Once the goals have been
achieved therapy will end.
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