THE PHILOSOPHY AND PRACTICE OF PSYCHOTHERAPY

Despite nearly a thousand distinct forms of therapy, no single model of treatment has emerged as sufficiently compelling to become the chosen model of care. There is scant agreement on how best to understand human nature and the development of personality, what constitutes the origin of symptom formation, why the role of the therapist differs markedly between theories, or how best to determine the most appropriate course of treatment for a specific condition or injury. Consider such pervasive health disorders as psychosis, addiction or depression; for each, we have no common ground on etiology, course of illness, or method of treatment. I find it helpful, therefore, to keep some basic tenets and truisms in mind: ON HUMAN NATURE 1. WE ARE SOCIAL BEINGS o This fact is central to our survival and inherently defines our human nature. o Because one cannot define their existence outside of others belongingess is the fundamental purpose of human nature. Problems are by-products of social interaction and our relationships. In this regard all problems are relational, as is their resolution or cure (Adler). o Intimacy and the striving for meaningful purpose is at the core of all human interaction. o Conflict and cooperation are continuous by-products, with conflict resulting in tension when unresolved. Often, they lead to power-struggles remedied through force or punishment through passive-aggressive acts like failure, depression, or illness. o Our needs are universal. “What we all need” -- courtesy of Mark Tyrrell: - feel safe and secure day to day - give and receive attention - have a sense of some control and influence over events in life - feel stretched and stimulated by life to avoid boredom - have fun sometimes and feel life is enjoyable - feel intimate with at least one other human being - feel connected to and part of a wider community - be able to have privacy and time to privately reflect - have a sense of status, a recognizable and appreciated role in life - have a sense of competence and achievement - a sense of meaning about life and what we do o Emotions are universal as well. The behavior, the extent of the mood and the triggers may differ, but the feeling is universal. Anger, is anger, is anger.13 2. BELIEVING IS SEEING There is an old idiom which states that “Believing is seeing”. In truth, the opposite has more bearing, that “Seeing is believing”; we interpret events and then feel and act accordingly, continuously reaffirming our self-concept and our convictions about others and the world around us.  Action is a combination of behavior, emotion and will. It is not random but purposive, consistent with and representative of the inner goals and beliefs of the individual. In this regard, we can view each action as a representative snap-shot or microcosm of the individual’s world-view, the context within which the individual defines their interaction with others and their beingness in the world.  Behaviors and emotions create responses in others, which, in turn reaffirm the individual’s subjective experience of self in social interactions. This feedback loop maintains a continuum to perception, thereby preserving consistency of the manner in which one operates within the world. In a fundamental way, one behaves in a manner that elicits responses in others which reaffirm one’s beliefs about their beingness and subjective experience of the world.  While behavior and emotion is driven by belief, insight is not always a sufficient or necessary prerequisite for change. One may act differently and evidence change in their belief system even if they do not understand the purpose of the action or its intent. Arguably, insight is beneficial as it encourages change to remain anchored as well as to become more generalized in its effect: o When one thinks differently, one behaves differently o When one behaves differently, one thinks differently  The therapy session is the primary venue for experimentation and the practice of new ways of thinking, feeling and behaving. It is a medium through which to experience trust, intimacy and acceptance.  Casework supervision is the most instructive venue for clinical training. It provides actual situations around which to discuss clinical premise and methods in practice. Is a transformational process that involves the Supervisor, Counselor and Client in a change relationship similar to the therapy process: it encourages insight and self-introspection; problem identification, prioritization and solution determination; the confrontation of one’s own convictions and prejudices; and the opportunity to assume personal risk in exchange for self-discovery and maturational growth.  Lastly, a word about theory. In order to become expert as a clinician, one needs to operate from a theoretical framework. While counseling can still be effective without it, there remains a need for a more comprehensive foundation if one is to fully understanding 1) the development of personality; 2) the origination and role of symptoms; 3) the change process and what constitutes personal and