Psychotherapy Networker is singing my song about wisdom

“Even if all interested parties only want symptom relief, ignoring the cultivation of wisdom may still be a problem. Focusing exclusively on empirically supported techniques runs the risk of failing to develop the primary instrument of treatment—us. Even as much of the therapy literature, modeled after double-blind pharmaceutical research, has tried to eliminate the therapist as a variable, metanalyses like those of Bruce Wampold and others keep showing that we can’t take ourselves out of the equation. Again and again, we learn how much the therapeutic relationship matters.”

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Is it time for psychiatry to lose its monopoly?

There was a fascinating May 11 New York Times article that should be of interest to those of us who work in the mental health field. The article was written by Allen Frances, MD, who was chairman of the task force that produced DSM-4, which is widely known as the bible of mental health disorders. Dr. Frances has concluded that it is time for psychiatrists to lose their century long monopoly on defining mental illness. Dr Frances wrote this:

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Wow. This would indeed produce a revolution in mental health care if it were to happen.

When I was in my Masters program in 1988, the professor often quipped that the course was about insurance companies, and the insurance companies were about the Diagnostic and Statistical Manual of Mental Health Disorders. Our job was to learn how to get paid properly by insurance companies and to do that we needed to understand the language they spoke. Seemed cynical, but true at the time. The professor had an existential bent by the way and we always knew he believed the system was arbitrary and ridiculous, but it was the system in which we were forced to work.

I had another professor of child psychotherapy who argued that the child section of the DSM should have about seven broad categories instead of the dozens of diagnoses that were included in DSM-3 at the time. That also seemed to make a lot of sense to me.

Then, I went to a Scott Miller workshop and heard for the first time that there was essentially no way to effectively select a specific treatment model that would produce any better results than any other model or technique, based solely on the psychiatric diagnosis assigned. In other words, the diagnosis does not matter as much as we like to think it does.

I took these factors to heart when I synthesized the Interpersonal Wisdom approach. But I have a more radical idea that even this brave physician who is sure to take a lot of heat from his colleagues, would find hard to fathom.

All treatment is about relationship and resilience. What is the capacity of the human being in front of us to withstand environmental or physiological attacks on his best functioning? How can we be in relationship with that human being in such a way that we can help that person be his/her best self? Sure, we provide a lot of information and engage in a whole bunch of behaviors to try to help, but essentially what we are doing is containing, loving, and encouraging. Uh, Oh, I let my hippie alter ego out again. Oh, well.

I admire Dr. Frances for his courageous stance, and believe a change such as he is suggesting would turn the mental health field upside down – in a good way. But there is a deeper paradigm shift already occurring out here in the talk therapy community that contains even more possibilities for human flourishing.

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The psychotherapist

It is time that we ask the hard questions about who we are and what we do.  Health care reform is upon us.  Change is here.  How do we want to be known?  This is from my paper, Interpersonal Wisdom, the capacities and characteristics of the best talk therapists:

Let it Flow, The Philosophy of Becoming (1996).

“Whitaker the man and the teacher will continue to flow into the story of
our knowledge about human beings. His life, his thought, and his rapport
with human suffering will continue to be appreciated by new generations of
family therapists. As they grow tired of the endless models, new
approaches, and super techniques, in the end, they will yearn to find human
beings and their qualities in the real world and not in the microscope.
Whitaker’s legacy will be revealed even by those who kept their distance
during his lifetime, labeling him as “bizarre” and “irrational.” Carl was
a pioneer in family therapy, a giant, who did not allow himself to be
seduced into creating a myth around his personality. He died without any
official disciples, but he trained a multitude of therapists around the
world, sometimes unbeknownst to them, with the power of integrity and
coherence. He taught us more about life than about techniques. He taught
us about the search for ourselves and our own spiritual essence, through
the experience of suffering and solitude.

More soon…

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Continuously Maneuvering

One of the hallmarks of interpersonal wisdom is what I call continuously maneuvering within the evolving (therapeutic) relationship.  Scholars talk about this capacity as part of emotional or social intelligence.  I think some people are born with the ability to do this while others have to learn the capacity.  Simply put, this capacity is the ability to discern and know what your client needs in the moment and being courageous and creative enough to provide it.  But the trick is in the knowing.  And to know is to see.

Change agents that have this capacity are deeply attuned to their clients on a moment by moment basis and they have high intuition.  When we speak about intuition we often think about the emotional “felt sense”.  I like to think about intuition as a learned means of knowing that has been finely tuned over years of interpersonal practice.  Sometimes folks that have this skill are interpersonal extroverts who thrive in person to person energy exchanges.  Others may be observers who grew up feeling like outsiders in their relational communities and thus developed a strong capacity to see and know.  Others may be from family situations where there was conflict or interpersonal tension and as a result of that experience they learned how to anticipate response patterns in order to protect themselves.  There are many ways that people hone this capacity, which may be one of the most important that change agents possess.

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When a prospective client asks…..

How do we know family therapy works with any type of presenting problem? I would try to answer honestly this way based on the available research.

1.  We know that people who receive psychotherapy tend to be better off than people that do not and the statistical difference is significant.

2. There is no evidence to suggest that any particular model or approach, or any therapist type or school of thinking produces results that are superior to any other.  There is evidence to suggest that therapists matter and that therapeutic relationships matter (most clients seem to get this better than we do).  Since we in MFT are relationship specialists we believe that we do a pretty good job at offering the types of therapeutic relationships that a lot of clients need, but we don’t yet know if we are any better than anyone else.  That research has not been done.

3. The decision to use family therapy seems to have to do with client preference.

4. If you are seeking couples therapy you should be aware that most therapists and many family therapists have received little training in that modality.

5. There is some research that has attempted to show that certain models of family therapy are effective with certain presenting problems.  I find that research suspect and believe, based on later studies that when unique therapist factors are controlled the differences between approaches disappear.  The truth is that all models are effective when they match what clients are seeking in a therapeutic style.

5. Hence, my style is thus………..

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What is Interpersonal Wisdom?

Interpersonal Wisdom is a term I am using to describe the ways of being in coaching or talk therapy that bring about the best results regardless of the specific theoretical orientation or preferred working model of the talk therapist.  The best guides get good results because of who they are and the way they apply their interpersonal talents.  This is fertile ground in the helping community that builds on previous work and consequently the ideas below are evolving.

Interpersonally wise therapists are experienced as authentic without being perceived as trying to be authentic.  They believe that being is more important than doing, and that character is more important than competence.

Interpersonally wise therapists are comfortable with relational complexity and know how to continuously maneuver within the evolving therapeutic relationship.

Interpersonally wise therapists use self-disclosure to improve the therapeutic alliance.

Interpersonally wise therapists are able to offer accurate intra or extra relational interpretations that hit the mark and make their client (s) feel understood.

Interpersonally wise therapists apparently take risks earlier in the process and are not people-pleasers, thus often resulting in lower client satisfaction ratings in early treatment.

Interpersonally wise therapists create positive energy that summons the extratherapeutic factors that are largely responsible for bringing about change.

Interpersonally wise therapists are able to express honest disclosure without alienating their clients. Their authenticity and strength of character enable them to be bold.  When their directness does create tension they are able to repair the alliance and generate an even more productive working relationship.

Interpersonally wise therapists are capable of artful continuous relational assessment.

Interpersonally wise therapists create a safe environment for exploration of emotional issues by being laid back AND direct and by being in charge but not controlling.

Interpersonally wise therapists are open to new experience and are highly curious.

Interpersonally wise therapists appreciate the concept of therapeutic containment.

Interpersonally wise therapists are perceived to have high integrity because while they are flexible as to implementing their approach they are seen as consistent with regard to their own personal narrative and their expressed values.

Interpersonally wise therapists have an advanced sense of timing, especially when relaying sensitive information or when challenging clients.

Interpersonally wise therapists believe that positive and negative energy can be transmitted between human beings and they make a choice to transmit the positive.

Interpersonally wise therapists embody the relational quality known as “approachable authority”.  They own their own strength but do not take themselves too seriously.

In summary interpersonally wise therapists are non-conventional, congruent, curious and bold. They are realistic optimists with high character that convey genuine caring for their clients and seem to intuitively understand how to offer the right amount of active listening, direction AND containment simultaneously.  They have faith in the universe, which allows for client agency and activation of the extra-therapeutic factors that lead to change.  They have high tolerance for relational complexity and excellent anxiety management ability in ambiguous and stressful conditions.  They solicit ongoing feedback from clients and alter their approach continuously based on that feedback, but they do not come across as squishy or people pleasing.  They are adept at reading people and adjusting their approach based on the full range of interpersonal cues coming from clients.  They are expert at repairing therapeutic relationships after inevitable working alliance disruptions.  Most importantly, they have the ability to like a lot of different people because they have a deep appreciation for the humanity beneath the presentation.

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Hello world!

Please take a look at my interpersonal wisdom page, which reflects my thinking about virulent change agent factors.

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