While the understanding of the psyche interested the human race from the dawn of civilization, the end of 19th century is considered to be the beginning of psychology as a scientific field in the west, with Wilhelm Wundt often cited as its father (Kinderman et al., 2011). With the contribution from scholars and therapists such as Sigmund Freud and Carl Rogers (Kinderman et al., 2011; Rogers, 1985), who emphasized the importance of qualitative research, the seemingly paradoxical marriage of the highly improvisational aspect of talk therapy together with its deep reliance on empirical data nowadays is perceived as a matter of fact.
Within the myriad of today’s therapeutic approaches, some more grounded in research than others, and all of them competing for the attention of therapists and clients alike, it is an art to make wise choices as a psychotherapist in discerning which modality and to which extent to use with specific clients. If one chooses to follow an utterly client-based approach without relying on any theory, it might potentially lead to no positive outcomes, or potentially even harmful results.
In their couples’ therapy training, doctors John and Julie Gottman (2017) start by discussing what might happen when therapists rely just on their intuition and common sense when conducting therapy. One example they give is that of a popular couples’ therapy method used the sixties in which expressing anger by the partners was encouraged, with the help of hitting each other with foam bats, that were later patented and sold to the clients by the therapists. Even though the idea of expressing repressed anger can sound like potentially a helpful thing, the results turned to be unproductive and even harmful for the couples involved in that sort of therapy.
The Gottmans add, that even when looking at evidence-based psychotherapies, it is not enough to follow what seems to have some scientific validity to it, but that counselors should strive to be as effective as possible in helping their clients:
These so-called evidence-based small-effect treatments just don’t so much to help our clients. The American Psychological Association may have given them their seal of approval, but that certification is small consolation to our everyday clients, who are still ailing after therapy. This average effect size of half a standard deviation would still leave many couples very, very unhappy. (Gottman & Gottman, 2018, p. xii)
On the other hand, if a therapist chooses to follow a therapeutic model too strictly, they might fall into the trap of missing what the client needs and losing sight of a critical assessment of the client’s progress. Therefore, as therapists progress on their career path, they first accumulate knowledge until it reaches a critical mass, and then start the process of un-learning; When the therapist possesses a great deal of knowledge and experience, a process of deep integration and letting go of dogmas and rigid thinking starts to occur (Bernard, 2014).
Throughout my training as a therapist, I have seen live and recorded work by therapists who use the same modality, as if they were using completely different theoretical models. Therefore, even though every theory influences the treatment plan, plan revision, and application of the plan, I believe that the unique interpretation of the theory by each specific therapist is equally important. What complicates things even more, is that for a therapist to be truly helpful, some scholars consider that at least some level of eclectic approach by using a pool of different modalities is needed (Hansen, 2006).
So how would a counselor draw from a specific theory in order to create and implement a treatment plan? In my work, it starts with an assessment. For example, when I work with families, the first therapy session, even though therapeutic in nature, holds the goal of assessing of what happens within the family, what brings them in, and what would they like to achieve. I do not shy away from goals and believe that clear goals can and should be a path to successful therapy. The clearer the goals are, and the more motivated the clients are, the more efficient the progress of therapy will be.
In forming a treatment plan, in the first session, I ask the family members very specific questions, that give me information that will help me understand how to be most helpful to the clients according to the primary family therapy modalities that I use: Bowenian, strategic, structural and solution-focused (Weeks, 2004). I draw a structural map of the relations between the family members, and a genogram that gives me a condensed visual representation of all the family members in three generations, the relationships between them, and relevant demographic information. I then ask questions that directly affect the course of therapy and are the main component of the treatment plan. Here are a few examples of the questions I ask:
What is the problem that brings you into therapy?
What do you think causes this problem?
What have you tried to do to solve this problem?
What are the family’s goals for treatment?
What is the family members’ motivation to change? Scale 1-10 (1=no motivation, 10=ready to do anything)
Once we have clear goals, we can start the therapeutic work, guided by these goals and the family therapy modalities and interventions I use. It is vital for me to check with the clients what worked and what did not during the week between the sessions. This can affect the course of my future work with the family, and it can also lead to revising the goals and the treatment plan.
Sasha Raskin, MA, is an international #1 bestselling co-author , the founder and CEO of Go New , a transformational education program, a life, and business coach and a psychotherapist in Boulder, CO. He is working on a P.h.D in Counseling Education and Supervision and is an adjunct faculty at the Contemplative Counseling master’s program at Naropa University, from which he also graduated. Sasha has been in the mental health field for more than 10 years, worked with youth at risk, recovery, mental health hospitals, and coached individuals, couples, families, startups, and groups. He has created mindfulness stress reduction and music therapy programs within different organizations. Whether it’s in person or via phone/video calls, Sasha uses cutting-edge, research-based techniques to help his clients around the world to thrive.
As a coach Sasha Raskin provides individual and group coaching in Boulder, Colorado, and worldwide via video and phone calls, drawing from over ten years of experience. His services include: life coaching, business coaching, career coaching, ADD / ADHD coaching, leadership coaching, and executive coaching. Schedule your free 20-minute coaching phone consultation with Sasha Raskin
As a counselor in Boulder, CO, Sasha provides individual counseling in Boulder, CO , family therapy in Boulder, CO, and couples therapy in Boulder, CO, marriage counseling in Boulder, Colorado, and couples intensives / couples retreats, drawing from over ten years of clinical experience. Schedule your free 20-minute psychotherapy phone consultation with Sasha Raskin
References
Bernard, J. M., Goodyear, R. K. (2014). Fundamentals of Clinical Supervision. [VitalSource]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781269650731/
Gottman, J. M., & Gottman, J. S. (2018). The science of couples and family therapy: Behind the scenes at the love lab. New York: W.W Norton & Company.
Gottman, J & Gottman J. S. (2017). Level 1 clinical training: Gottman method couples therapy. The Gottman Institute, Inc.
Hansen, J. T. (2006). Counseling theories within a postmodernist epistemology: New roles for theories in counseling practice. Journal of Counseling and Development: JCD, 84(3), 291-297.
Kinderman, P., Scoyoc, S. van, Vassalos, A., & Roycroft, P. (2011). Research methods in Counselling Psychology: What would Wilhelm Wundt think? Counselling Psychology Review, 26(4), 3–8. Retrieved from http://search.ebscohost.com.libproxy.edmc.edu/login.aspx?direct=true&db=pbh&AN=67495220&site=ehost-live
Rogers, C. (1985). Toward a more human science of the person. Journal of Humanistic Psychology, 25(4), 7–24
Weeks, G. (2004). Handbook of Family Therapy. [VitalSource]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780203490419/