ACA Blog

May 28, 2013

What’s Missing Here?

     Counseling is a powerful treatment for most ‘mental’ conditions: depression, neurosis, anxiety, addictions, defiant personalities, bipolar disorders, schizophrenia, psychosis—in fact most dysfunctional conditions the DSM IV identifies. It has often been shown to more effective than drug treatment. But how can it be more effective than drugs? The big factor missing in drug treatment, which is the very power and unique gift of counseling is the relationship between the client and the counselor. The conditions listed above can all be understood and diagnosed as dysfunctions in interaction with others—dysfunctions in responding to another person—defects in relating to other individual. So it makes sense that changing a person’s relationship problems would be difficult unless a relationship is a part of the treatment. The counseling treatment is the treatment of an individual by creating new relationship—a new, unique dyad—the client/counselor relationship—through which change in the way one relates to others can change.  

      It has often been noted that many radically different theories of counseling are effective. This suggests that it is the client’s experience of his or her interactions with the counselor that actually brings about the changes—no matter what the counselor or client may be conceptualizing and talking about.

     Many ‘theories of counseling’ come from obvious observations: change a person’s way of thinking and you will change their feelings and behavior; change a person’s way of feeling and their thinking and behavior will change; change a person’s way of acting and their thinking and feeling will change. It’s not ‘rocket science’ as they say. But what is the healing factor? Clearly the relationship that develops during the ‘talking’ is a major factor. So to call counseling ‘talk therapy’ is so discounting and demeaning of the power of what is really happening—perhaps like calling psychiatrists ‘drug dealers.’

     Descartes was blind to the 900 lb gorilla when he said ‘Cogito ergo sum’—‘I think therefore I am’—he hypnotized us to the fact that there is no ‘I’ without a ‘you’ and language itself assumes at least 2 distinct entities. Most of western science—especially psychology--has focused exclusively on the ‘I’ while ignoring the role of the ‘you’ which informs that ‘I’ and gives it its existence. But we cannot ignore the earth when we try to explain the behavior of the moon.

    Unfortunately, I feel that many recent developments in psychotherapy—new diagnosis criteria, focus on biological or neurological aspects of the client, reliance on an individual’s response to paper and pencil stimuli, etc.-- are moving more away from the true power of counseling and ignoring the true power we as counselors are offering our clients. Always remember that the brain, the body, the emotions, thinking, behavior all respond to the requirements an individual puts on them as they interact with others. A runner’s muscles get stronger and faster in response to what he or she demands of them.

    How often have you heard that ‘empathy’ is a critical factor in counseling? It’s true because empathy basically is a description of the counselor providing a relationship within which a client can change because they feel affirmed and safe and empowered—that is, the experience their power and ability to change. They then can go ahead and make the changes they want.

    If it is the interaction between the client and the counselor that is the critical healing dimension in counseling, WHY DO ALL DIAGNOSTIC INSTRUMENTS FOCUS EXCLUSIVELY ON THE CLIENT AND DO NOT INCLUDE THE COUNSELOR?

    Whether it be a standardized test or some depression or anxiety scale or DSM-IV list of diagnostic criteria, they only gather information about one element in the dyad of the relationship and that usually is isolated from the counseling process itself. Considerations of the counselor’s personal reactions are usually ignored in diagnosis and treatment programs. I believe that one of the most important sources of information in identifying the source of the problem or problems a client is dealing with is my own personal response to that client—emotionally, intellectually and with my behavior. When I first meet a client, my response often directs my attention to pinpoint exactly how the client is discounting their own abilities or choices—their own power. My first experience of a client even gives specific clues as to how to help the client change.

     I may not be able to articulate it immediately but I can sense it. If I am in touch enough with my own self, I can often glean important information from the way I respond to a new client. And in my response, I should be able to detect why my client is having problems! Again, I may not be able to clearly articulate what I am sensing but much ‘nonverbal’ information is contained in the way my body and emotions respond.

     Note, also, that the way I respond, especially unconsciously, determines to a large extent the way the client will subsequently respond to me. This, I believe, is that element of the process that gives the counselor the advantage over every other kind of treatment for many dysfunctions clients are experiencing. Certainly it is easier to tell a person to ‘take 2 pills twice a day’ that it is to work with them to relate to me in a new way. But the healing is in the relating because that basically is the source of most mental issue dysfunctions.

    At one major university I worked at, the psychiatric department used as a kind of ‘differential diagnosis’ of a borderline personality clinicians were arguing with each other about a particular subject. The way they responded to the client was a much stronger predictor than any ‘list of characteristics’ listed in the DSM-IV. Ego States in Transactional Analysis are identifiable as observable behaviors. One of Berne’s main criteria for identifying which Ego State a person was manifesting in a particular transaction is the way you and others respond to that person—which ego states that person ‘hooked’ in others. In Joines and James book, Personality Adaptations, the counselor’s own sense is an important part of both the diagnosis and treatment plan. 

    When I write notes about diagnosis, treatment goals, treatment progress, etc., I include my own responses as an important dimension. I keep them for my own private use but they are critical for both diagnosing and planning. I would suggest that you try this: Include your own changes in your response to the client as part of the treatment goals. Then as treatment progresses in a log describe your own changes in the progress of an individual client in as much detail as you do for the client and see if that does not give you valuable information as your treatment plan is pursued. (For your own development, it is also helpful at the end of the day, to reflect on your own experiences throughout the day.)

  Counseling heals because of the relationship between the client and counselor and the responses of both must be included in all aspects of the process. It gives an opportunity for both the client and the counselor to learn and grow if they take advantage of it.
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Ray McKinnis is a counselor with a special interest in 'spirituality beyond religion' and veterans 'beyond PTSD'.

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