11. Why Some Therapy Models Help and Others Don’t
During my 40-plus years as a psychotherapist, my clients have shared information with me about their previous years of therapy. They often arrive at our initial session with a diagnosis given to them when they first sought help. They feel hopeless and frightened that the label they were given defines them and will affect the rest of their life. In addition, they are typically taking one or more psychotropic medications. I offer my clients an understanding that they have been trying to deal with their issues in a manner that has not aided them in making their desired life changes or creating the opportunities they want in life.
I assure them: There are other ways.
Most mental health intervention primarily identifies what’s wrong with people, giving them a diagnosis and prescribing drugs. At one of the mental health clinics where I worked as a therapist, I tried to talk to the CEO about my concerns with this methodology. I informed him that I had difficulty working with clients taking medications for two main reasons:
Their symptoms were masked by the medications; thus, their feelings were not fully available to work with in therapy.
When people are medicated, they often don’t have the necessary motivation for change.
The CEO told me he recognized I did good work as a therapist, but that we had to keep the focus on prescribing the medications, and to do that, our clients were required to be in counseling. There was not much support for change in that system.
Change takes effort and commitment
According to one of my great teachers, Ernest Holmes: “Change is simple, but not easy.” Getting ourselves to do something different can be a huge challenge, yet when we do, the changes we need to make are often very simple.
We have gotten it all wrong in this field of “mental health.” We have been chunking up (the Neuro-Linguistic Programming term for categorizing). In other words, we take all the symptoms a person presents with and try to put them in a category, creating a psychiatric diagnosis. The purpose of diagnosing someone is simply for government grants or billing insurance. It, unfortunately, becomes the person’s label and identity from that point forward AND how others think of them.
I do not find diagnosing useful for helping people resolve their problems. Having worked in many different mental health centers, I’ve had the opportunity to thoroughly understand how the system is organized and operates. So much is driven by the pursuit of funding (the tail wagging the dog). It is more useful to chunk down (the Neuro-Linguistic Programming term for determining the underlying qualities of their experience in behavioral terms.)
There is a tendency to try to get rid of feelings, to mask them with medications, or do other things to get feelings to go away. In my opinion, that does not contribute to helping people find deep resolution and become their full potential. We can’t keep doing more of the same and expect different results. That is the definition of insanity. It is ultimately useful to do something different, which involves learning to work with our feelings and help them bring to us what they have wanted for us. This helps us gain the deepest experience of what the feeling response has wanted for us, allowing us to have choices in our responses and be our complete and authentic selves.
I have worked in many mental health clinics and was tasked with doing intake sessions with my clients. Prior to their first session, the perspective client spent hours filling out paperwork, reporting their problems and symptoms. In the session, I had to ask a lengthy list of questions about their problems and where they came from, in order to be able to meet the requirements of funding sources and to assign a diagnosis. It was difficult for me to then do therapy with this client, having given them the impression that the information about their past problems was useful, where this actually sends people back into the experience of their difficulties. It does not contribute to helping people resolve their issues nor help them feel better about themselves.
In the therapy that I do, when people first call to schedule an appointment with me, I ask them to be thinking of what they hope to get from therapy; what they want to have be different and better in their life. I utilize this “solution-focused” approach, which focuses minimally on what’s wrong and primarily on defining goals and helping people access their inner resources to reach their desired outcomes. Clients are often prepared for the “problem-focused” model and come to their first appointment prepared to report everything wrong with them. People have shared with me their relief with not needing to have to “rehash their problems”, but spend time in focusing on and creating what they desire in their life.
As the professional, it is my job to help people coming to me to resolve problems and move toward reaching their goals. I take my job seriously and notice the results of my communication and interventions: Where am I sending people’s brains and thus their experience? My goal in therapy sessions is to help my clients access their inner resources to resolve their problems, reach their goals, AND to leave feeling better than when they came in for the session.