Carl Rogers Pumps his Fist

Interesting article in the New York Times Magazine this past Sunday by Laurie Abraham: Can This Marriage be Saved? Abraham followed a couples therapy group for one year, and provides an insider view on both the interactions between the participants, and the therapist's thought process. I liked the thoughts and personality of the therapist very much -- she's well-educated, but at her best when she lets her instincts guide her and her quirky personality shine through. I find the same approach works for me, but I haven't had her years of experience to prove that it's safe (and more effective) to go that way. Reading about experienced clinicians at work is often helpful.

There are a few interesting segués in the article, and I wanted to call out one regarding what the literature has to say on the nature of an effective therapeutic relationship:

Investigators have repeatedly tried to single out specific "therapeutic factors" that can distinguish good therapy from bad, and the only unequivocal winner is what's termed a "positive therapeutic alliance," meaning the client feels that the therapist exhibits qualities like empathy and support.

Jay Efran, a psychologist and emeritus professor at Temple University who surveyed the last 25 years worth of trends in therapy in an ambitious recent article (...) has another idea about what makes for an estimable therapist. He suggests that therapy boils down to a facility for conversation and therefore is a creative and contingent act that does not lend itself to formulas. "The profession has gotten itself into a bind," he told me recently, "because it wants to be seen as a science and it wants to collect money and it has made this category mistake of thinking it provides treatments for diseases and not just conversation or community or human contact or offering new slants on life."

In school, I've had the point in the first paragraph drilled into me so many times I can't count. It's one of the foundations of the humanistic approach that Carl Rogers, a founding father of modern psychology, first defined. And it feels right on to me. (Note that there is a silly, 40-year-old myth related to this which holds that therapists are simply trained to either a) say back to you what you've said to them, or b) gush vague, unexamined supportive statements. Neither is true of a good therapist, regardless of his or her theoretical background.)

The second point seems to me simply to take point number one a giant step further. It may be stated just a little too loosely for my taste, but the gist, again, feels right to me. And while I can hear my more scientifically-oriented friends in the field (and the HMOs, and their panels of well-paid MDs) groaning loudly in the background as I type this, there is a boat-load of truth in this quote.

Thinkulous readers know that I'm a big fan of what science can tell us about our minds, emotions, and behavioral patterns. Neurological breakthroughs in the last 20 years have taken our understanding giant steps forward. Social scientists blaze wide swaths of fascinating new information, cutting through the vast forest of ignorance about our inner workings. I adore reading this stuff, and I try to integrate it into how I approach the field.

At the same time, I've always believed that science, art and mystery are not only highly compatible (in this and any field) but are actually three parts of one whole. What I know, and what I've yet to know that I know, flow together indistinguishably and create my unique approach to clients and clinical situations -- the art. Heck, they create me. And while I adore what science can add to that picture, there isn't an argument in the universe that will convince me that science is any more important than mystery, intuition and subjectivity. We're talking about the mind, about emotions, about self-hood. If it isn't subjective, we are, by definition, off track. How could we possibly quantify why certain people are healing to be around?

One well-recognized marker of mental health is flexible thinking. Practitioners spend a lot of time fostering in our clients a balance of healthy empiricism and risk-tolerant acceptance of the unknown. If the field of psychology doesn't admit pretty soon that the dynamics of pscyhological healing are at least somewhat unquantifiable -- while also unmistakable -- are we then practicing what we preach?

Albert Ellis: Great and Controversial

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The great Albert Ellis died on Tuesday. He made a huge contribution to the field of psyhology -- and outraged professionals and lay-people around the world.

He was one of the founders of what eventually became cognitive behavioral therapy. He believed our past is important, but doesn't affect us as much as we affect ourselves through our unconscious thought patterns.

The Boston Herald (which I usually avoid) ran a pretty good summary of his life here.

During my year-long Theories of Psychology course at grad school, we watched a film in which one (brave) woman underwent one session each with three giants of the field: Carl Rogers, Fritz Perls, and Ellis. My classmates were utterly turned off by Ellis' blunt, no-nonsense style, and the professor did a lot of eye-rolling and winking. I was the only one who said, "I don't think I'd want to work with this guy long-term, but if I could get six sessions with him, I bet I would be a happier man."

I'm definitely not a pure CBT therapist (too many great approaches out there to lean on just one), and Ellis' personal style is not for most people. But the field is tremendously more effective because of his work. And hey, Ellis was a "Take Me or Leave Me" kind of guy, and frankly, that's kind of refreshing in a psychotherapist -- or anyone.

The Tao of Therapy

Things are progressing well at the camp I work at for kids with Asperger's Syndrome. (See previous posts, and this one will make more sense.) Once again, I've learned that the relationship can do most of the work of healing.

Many years ago, Carl Rogers astutely and repeatedly insisted that people basically will heal themselves when they are in the context of a healthy therapeutic relationship. Subsequent research has strongly supported this; the school of therapy used affects the outcome far less than the qualities of the professional in the relationship (as perceived by the client).

During the first week or so of camp, I was, Thinkers will remember, a little distressed by all the obscene language, digusting references and endless physical wrestling. (Not that we wanted to outlaw all of this behavior. A little of it in teenage boys is to be expected.) Today, incidents of that kind are less frequent, and eager participation is up noticeably. Some of this probably flows from kids getting used to the new people they were suddenly supposed to hang out with five hours a day for six weeks in a row. Also, one of the prime instigators was going through a medication change and might now have settled in with his new prescriptions.

But I think that the biggest factor of all was simply time -- spent in a group that is framed around fun, creative activities and mutual respect. We counselors work quite hard to respond to the campers in a positive way, looking for the campers' strengths in any situation, no matter what they do, or, for that matter, don't do.

They have seemed to begin to understand that we mean it. They're so used to being ostracized for their different behavior (unusual tone of voice, pedantic speech patterns, obsessions with one particular interest, physical awkwardness -- all visible in many teens, butfar more so in most Aspies). Perhaps they were simply pre-empting our expected criticism with negative behavior, to maintain a sense of control of the social situation, a sense that is rare for them. They come to us already bruised, and perhaps if we continue to handle them with care, they'll flourish even more. Time will tell.

I experienced a similar curve at my internship at the college counseling center this year. I charged out of the gate determined to make a difference in my clients' lives -- in a brief 10 sessions at most. By half-way through the year, I realized that, while I was having a positive effect a reasonable amount of the time, I was putting out way too much effort. When I relaxed and trusted the intelligence and instincts of the person sitting across from me -- and, most of all, the process of the relationship -- clients actually improved more quickly and effectively. And *they* were the ones, appropriately, who did the work, although I might instigate it here and there, or keep it on track.

It's certainly not the same thing as laying back. In some ways, I'm more tuned in more of the time using this approach. But it's a relaxed alertness. I love this discovery (even the second time around), because it means that I don't have to do anything other than what comes naturally to me in order to be helpful. I listen, I reflect or comment or react, I give respect, I am honest and genuine. And they see that, feel that -- and start acting the same way, especially toward themselves. And that, of course, is when the improvements really start, and are most likely to last.