Assumptions underlying therapy
When someone comes to me I admit to making some assumptions, including:
- the person has a “problem(s)”
- these problem(s) cause discomfort or pain, health problems, diminished achievements, relationship difficulties, loneliness or alienation
- to date, the person has not been able to solve their problem(s)
- therefore, whatever approach the person has used it has not been effective (so don’t use the same methods)
- the person does want relief from their pain but may not want to spend the time and effort to look for the cause and rectify it
- the person may not be totally honest but may not consciously know this
- the person’s expectations in some way or another may by unrealistic
- the person will bring with them their prejudices about how and when they will manifest the problem(s)
- the person will bring their “baggage” that perhaps must be discovered in order to help them understand the “baggage”. I will assume that the person may not know about this “baggage” or may not willingly reveal it.
- the person have resources as well as deficiencies even though the person may not appreciate this.
The task of therapy
“Mental Illness” falls broadly into two groups: firstly, “brain diseases” including melancholic depression, bipolar disorders, schizophrenia, Alzheimer’s and dementia and Parkinson’s disease and, secondly, problems of the human condition which are the problems of development and its failures, relationships and the problems of living and dying, Of course, the two groups can and often co-exist. It should be kept in mind that there are degrees of all of these characteristics that can range from very mild to very severe. At all levels of severity some effect can be created in the quality of life and performance.
Existential perspectives of the “Rolls Royce” of psychotherapy
The psych-bio-social approach to psychotherapy has been the accepted approach for decades and longer. Although it is totally correct, it is deficient in missing the existential perspective that refers the need for “meaning” in mental wellbeing. This is not new, as Victor Frankl wrote Man’s Search for Meaning nigh on five decades ago. In this book Frankl describes his observation of the role of “meaning” in the context of Holocaust survivors in World War II.
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One might combine “spiritual needs” with “meaning”, “identity” and “purpose” as factors all necessary to achieve emotional wellbeing.
My fundamental belief is that the best therapy has four “legs”, being:
- medical: usually a medication to rectify chemical “imbalances”
- psychological: includes all the “talking” therapies
- lifestyle: addresses the need to have a balanced life fulfilling all of life’s needs, and
- spiritual: not just organised religion, but addressing the need for personal identity, direction, purpose and meaning.
I will not compromise on this belief and omit any one factor for whatever reason, including patient preference.
I also say “beware the mono-therapist”, being the therapist who has the one tool and uses this one tool on all. There is no “one size fits all” in therapy. I will therefore apply whatever method I think best suits each circumstance and this method proves ineffective I will try something else. This is sometimes called “eclectic” therapy.
I undertake to expand continually my “tool kit”. I insist on the right to help select the treatment method after I know the nature of the problem. I will not accept instructions like “I want you to hypnotise me to stop me eating, to be more intelligent” etc.
My therapy will include humor. To be able to laugh at oneself is therapeutic.
Honesty, diligence and empathy are prerequisites of a good therapist.
I retain the right to be human, to be tired, to be bored but commit to always listen - like it or not.
I insist that the “treatment” is a team effort with the sufferer committing to work as hard as me at pursuing change. I do not believe I can make anyone change; rather, I help others to change themselves. Coaches can only shout encouragement from the sidelines; they can’t go onto the playing field.
I only keep my relationship at the one level: professional and therapeutic.
I keep in mind my own qualities - good and bad.
I will always need to know thoroughly the individual I am trying to help. I need to know not just the symptom but where and when that symptom might have started and how the individual came to be the person they now are.
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If I determine that there are several parts to a problem that contribute to the cause, I would prefer to address them all. I do not want something else to come back “to bite me”. Therefore, I will be “impatient” to make progress, as time is too valuable to waste. Most sufferers have wasted time enough already.
I will not agree with what I truly believe to be incorrect, but I will always listen.
I will be direct and honest in responding at the risk of the patient’s disapproval, but I will not be brutal with the honesty.
I will always understand legitimate suffering, but eventual transcendence of this suffering is my goal for the sufferer.
We all like to know “why?” Insight is fine and necessary to plan the treatment, but insight alone may give temporary relief - but never cure.
There will always be a provisional treatment plan but it must be flexible to meet the needs of the day even though this may cause delays. This then makes the treatment longer.
How long will therapy take? Sometimes a session or two, more often a few sessions more than this, and sometimes quite a few sessions and sometimes a very long time. It all depends on what turns up when he starts digging around for the cause and whether the sufferer wants symptom relief or cure of the cause.
But I believe enough is enough. There is no “perfection”, so why keep seeking it?
If your request for help is conditional on the help being done “your way”, no-one can help you. If you want relief but you can’t or won’t be told “what to do” or won’t “stop what you’re doing” or you “won’t take tablets” (or learn relaxation or do more exercise or eat a better diet), then don’t waste your money and the therapist’s time by seeking their help because you obviously know better.
If your “request” for help is to impress, satisfy or distract someone else, I recommend that you do not waste time and money on this endeavour.
If your “request” for help is to prove something to yourself or anyone else (such as “I have tried everything and nothing works”), then think again, for maybe the only one “fooled” is yourself.