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Monday, August 15, 2011

Removing the Fixings: Examining The Issues

     When I started my therapy career, if a family came in with a lot of emotion and upset, I would find myself disengaging because I couldn't immediately see a solution to their myriad of issues they were bringing to the table. It made me feel sick, powerless, fearful, and reluctant to see the clients who needed me the most because I couldn't figure out how to treat their dysfunction. One of the challenges of family therapy is having to listen to so many different people and formulate treatment from all their stuff that works for everybody, and some of my families are very vitriolic. In supervision, I came to realize I was practicing a slight form of dissociation when these families would come in that rendered me unhelpful. I felt the need to either better control the session with less talking time and more structured time, or to interrupt and redirect, or to just sit and glance up at the clock, hoping they would finish tirading soon so I could actually do some therapy. I felt embarrassed that I didn't have quick answers for them, and impatient if they didn't "get better" soon enough. I chalked all this up to not being the best therapist for the job, which sent me deeper into my disengagement. It didn't help that I was told to focus specifically on Solution Focused strategies with all my clients, no matter what, so I felt forced to stay in a little box of communication and try to remember all the catch phrases and questions I was "supposed" to ask instead of communicating naturally.

Over time, I have learned a few things. I'm excited because today I navigated a session that could have been uncomfortable because of its deep emotionalism and the family member's difficulties communicating with each other. But in the last 2 and a half years, some things are finally clicking for me. Many of my ideas are based on Solution Focused and Motivational Interviewing concepts, with an odd hybrid of Psychodynamic and Attachment Theories thrown in, so you will see those theories demonstrated in what I have learned. I know more experienced therapists than myself have said these things, and said them better, but here is the way I have it worked them in my brain.

1. Treat all issues with genuine curiosity instead of trying to find a solution right away. Spend more time analyzing and less time intervening. What I have found this accomplishes is that interventions rise to mind based on analysis that I might never have come up with otherwise.

2. Treat all interventions as experiments, and all analysis as a hypothesis. This one I borrowed from our wise Solution-Focused gurus, but now I am actually doing is a lot more than I used to. Maybe I am right, or maybe I am wrong. Lets see, shall we? "What if we tried...could that help? What do you think?"

3. Reserve the right to be WRONG. I can be wrong a whole lot more than I can be right, and how I see a family when I first assess them may be totally different than I see them 6 months later. I routinely change my analysis. I used to feel bad about this, like I wasn't a good enough assessor, but now I am learning that most of it is based on the information I have been given, not on my skills. I am bound to get something right eventually, and its usually sooner than later as long as I keep communicating my hypotheses to the family and let them correct me or modify my understanding as needed.

4. Let the problem be a big problem. A problem neither needs minimization or exaggeration. It is usually exactly as big as the family thinks it is and they know better than me. While I normalize a lot, especially about what to expect from teenagers, who are apparently the most obtuse creatures on the planet, I also respect the level of distress the issues facing the family are causing for its members. I am also learning I don't have to resolve their problems in the session in which those issues are uncovered. I can respect their problems and let them leave with the family without being an ineffective therapist. Rather, its a recognition of the seriousness of their situation that they had to come and see a person like me in the first place. Their problems are big problems, or they wouldn't be here. I am learning to be okay with complex problems which aren't fixed in one or two sessions.

5. My most important job is to care for 50 minutes. People may not remember how I analyzed their problems or my interventions, but they will remember that I care. I am striving to be an excellent therapist, but what matters to be an adequate therapist is simply that I know about their lives and show them compassion and love. I am also learning how to share with them emotionally, and then let their feelings go until the next time. It has taken some mental work, but I am learning to put my emotional response to their emotional displays away until they are needed again. Sometimes residual responses remain is particularly troubling, but most of the time I can pick up and put back on my mantle as needed. This is going to continue to take some work on my part.

What about you? What lessons have you learned in treatment, or in your job, which someone may have told you about but didn't start clicking until you were practicing for a while?


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