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I work as a clinical social worker in an outpatient mental health clinic. I do psychotherapy with people in an office. My sessions are about 30 to 45 minutes for each person I see. We sit and talk about the person’s problems during this time and how to work on those problems. I do the same thing that a psychologist does when “practicing” psychotherapy instead of doing research. I see people who are 18-years-old or older with a diagnosed mental illness. Most of my clients are poor. I am posting here because I cannot seem to find colleagues to talk to who would know what I was talking about with the issues I am internally facing. If anyone on this website is a fellow psychotherapist, I would greatly appreciate replies to my message below. Replies from other people are welcome too. So long as you are reasonable. Unfortunately, many of my coworkers are not. My issues are complicated and so I may write a lot. Please, understand that I only do so because I think that the nature of my issues here are complex.
I believe in the idea that, in theory, we can know the best paths to human flourishing (“eudaimonia” if you will). However, I think that we currently have an infantile understanding of human flourishing. I cannot emphasize that point enough from what I know about psychology, neuroscience, philosophy, sociology, anthropology, psychopharmacology, etc. We are making strides in our understanding of human beings. However, those are strides compared to a long history of very poor understanding of what it means to be human. I agree with Sam Harris that it is clearly important that we must prevent the worst possible suffering for everyone if that was to happen. So, yes, I admit that there are things that are inherently bad, such as suffering (from my perspective as a human, which is the only perspective I can occupy. Suffering might not be inherently bad if I was a being other than a human). However, trying to help people to decrease suffering and increase well-being is very, very tricky business. I really think we “jumped the gun” when it came to inventing such a thing as clinical psychology with practicing “clinicians” (psychiatrists, psychologists, clinical social workers, etc). We should have known more about the human condition before claiming that we had a real science of humanity and that we knew enough to apply it to helping people with their mental suffering. When it comes to physical problems, such as a broken hand, we clearly seem to know a lot more. I am not a dualist, but I think that the mind is VERY complex. So, I will, for a lack of better terminology, use terms like “mental” and “physical” even though I do not think that the mind is supernatural or nonphysical. The mind is still different from a hand that is much easier to scan as I write this. Please forgive me if that is confusing.
The history of psychotherapy begins with Freud. He had… a very bad understanding of human beings. However, even if we began with more current knowledge, we would still be starting too soon. This leads to my main issues below:
I have been thinking about how, in my profession, we use normative assumptions in deciding what is “mentally healthy”. By working as psychotherapists, we are making an assumption that we know something about the good life or at least what would take someone away from the good life (a good life?). The Diagnostic and Statistical Manual of Mental Disorders (DSM) itself does that. On top of or separate from the DSM are treatment approaches. Examples are cognitive, behavioral, psychodynamic, humanistic, mindfulness-based, multimodal, emotion-focused, interpersonal, eclectic, etc approaches to psychotherapy. All of those make normative assumptions about flourishing or at least how to get rid of barriers to flourishing as well. Yet, as therapists, we are simultaneously encouraged to be “value-free”... to not “impose” our values on others, working within the value-system of a client. This, of course, is not true. There are value assumptions behind psychotherapy. As psychotherapists, we push our values on others by intervening in the first place, even if someone asks for our help. The question is, what values do we impose? What values should we impose? Some impose a rehashed version of Buddhism (e.g. “dialectical behavior therapy, mindfulness-based cognitive therapy, metacognitive therapy”). Some impose drug-induced happiness (pharmacotherapy). Some use the religion of the client (eclictic, strengths-based, spiritual therapy, etc.). Some don’t talk about religion with the client even if the client wants to, encouraging the client to talk to a priest or other religious “authority”. I wonder, though… what is the most ethical, sensible approach? We don’t know much about what the good life really is. We also don’t know much about what barriers to flourishing would be. I’ll present some more specific examples of what I mean below.
I don’t know if happiness that is drug induced or based on self-deception is necessarily bad, for instance. Most people who are NOT depressed and especially those who are optimistic engage in self-deception, according to research. Most depressed people make more accurate predictions about themselves… Perhaps a bit of self-deception and irrationality can be helpful in some way? Perhaps only in certain contexts? Here’s another example, the placebo effect. People can experience a decrease in symptoms that are transient, such as depressive symptoms, anxiety symptoms, symptoms of irritable bowel syndrome, in a way that they cannot from a broken hand (except for, perhaps, the pain from the broken hand). If I give you a pill or perhaps even do a sort of “ritual” with you in psychotherapy (exposure therapy, relaxation techniques, cognitive restructuring, etc.) and you expect it to work, it can work even if the ingredients of the supposed treatment are “inert”. Is it unethical to administer placebos if people who are normatively deemed mentally healthy deceive themselves much of the time anyway through positive bias toward themselves that is unwarranted? Is feeling good all that there really is to the good life? As opposed to, say, understanding reality, virtue AND feeling good? Perhaps only some understanding of reality is necessary, but too much is not necessary and even harmful in a way that is always bad for humans?
I wonder if, due to a current lack of knowledge about the heights of human flourishing, as a therapist, should I be more eclectic in my approach? Should I focus on many (even contradictory in different cases) different approaches mainly in the service of vaguely helping people feel good and reducing harm? There are ethics behind that, though not necessarily a relativism. More of a multiculturalism, cosmopolitanism, pragmatism and intellectual honesty about what I actually may currently know about the human condition. Feeling good seems to be better than suffering. It is perhaps better even if it involves some deception. I believe in the saying “Do no harm”. Perhaps encouraging some people to think more truthfully and to not focus on religious lies is actually wrong if it means that person would never be as happy as they would otherwise. Perhaps I should only focus on not encouraging religious fanatics, but otherwise sometimes I should actually use religion in therapy if it would help someone, considering everything I have said. Imagine if someone is a Christian client who is dying and suffering from depression, everything else I tried did not seem to work and that person has identified that belief in a god has been the most helpful thing. Even if it is a false belief, it may not actually be harmful to believe in a god in such a context. However, if I had a client who was a suicide bomber (never ran into that scenario), then I could refuse to treat the client. Actually, there is the duty to warn, so depending on what that person told me, I would actually get in trouble for not calling the police:) Perhaps I should, OUTSIDE of the therapy office, encourage the ideas you would find in this website instead of within therapy?
Does this all make sense? I think it does. Any thoughts about these issues I present? Different ways of thinking about them? I am grappling with what kinds of pictures of human flourishing to push in psychotherapy and what kinds of barriers those forms of flourishing I should focus on. I think that the picture of flourishing that I push in psychotherapy is different from the kind I would push outside of my role as a psychotherapist. Does that make sense? Then again, the lines between personal, professional and political are blurry… perhaps I should not use religion in psychotherapy, discourage false beliefs or at least not focus on them as part of interventions for the religious (even if they could help someone feel good and might seem benign in a given context)... because doing so is just encouraging more insanity in society at large. At the same time, society is not my client in the therapy office. One person is my client and I am told to focus on what is best for that person. However, what is best for that person can be intertwined with what is best for society. Again, I am always pushing societal norms on that person anyway… Is the best approach to not perform psychotherapy until we know more? Could it even be bad to try that because then people would get a similar service from priests or “alternative medicine” practitioners? Is psychotherapy like a form of harm reduction (since it has already been introduced and it’s hard to turn back now), considering the human drive for ritual, hope, strange beliefs, shaman-like figures? Am I like a less harmful version of a shaman?
I know that I wrote a lot and I mixed together many different issues in this post. Anyone in my field would hopefully understand, considering the enormous complexity of human behavior. I would appreciate feedback from psychotherapists. I also would appreciate feedback from people who have an understanding of psychology, particularly clinical psychology, but may not currently work in the field. An understanding of philosophy could be helpful too, since there are philosophical assumptions underlying any science. Please, help me out with my philosophical difficulties. I’ve considered changing my career because of them (which might be hard to do, considering my expenses and student loan debt already in place).
I think what you’ve said makes perfect sense. Then again, I’m not a psychologist, so maybe I don’t know what perfect sense is. But I do think the ends justify the means. If happiness is the end objective, and if believing in God leads to happiness, then believing in God makes sense. At some level, even if we’re not aware of it, we all “believe in” something for which there is no objective evidence, even if it’s something like “life is good.”
I’m reminded of something Jack London wrote about the “Truth of Life” and the “White Logic,” one of my favorite passages in literature:
There seem to be various orders of truth in this world. Some sorts of truth are truer than others. Some sorts of truth are lies, and these sorts are the very ones that have the greatest use-value to life that desires to realize and live. At once, O untraveled reader, you see how lunatic and blasphemous is the realm I am trying to describe to you in the language of John Barleycorn’s tribe. It is not the language of your tribe, all of whose members resolutely shun the roads that lead to death and tread only the roads that lead to life. For there are roads and roads, and of truth there are orders and orders. But have patience. At least, through what seems no more than verbal yammerings, you may, perchance, glimpse faint far vistas of other lands and tribes.
Alcohol tells truth, but its truth is not normal. What is normal is healthful. What is healthful tends toward life. Normal truth is a different order, and a lesser order, of truth. Take a dray horse. Through all the vicissitudes of its life, from first to last, somehow, in unguessably dim ways, it must believe that life is good; that the drudgery in harness is good; that death, no matter how blind-instinctively apprehended, is a dread giant; that life is beneficient and worth-while; that, in the end, with fading life, it will not be knocked about and beaten and urged beyond its sprained and spavined best; that old age, even, is decent, dignified, and valuable, though old age means a ribby scarecrow in a hawker’s cart, stumbling a step to every blow, stumbling dizzily on through merciless servitude and slow disintegration to the end—the end, the apportionment of its parts (of its subtle flesh, its pink and springy bone, its juices and ferments, and all the sensateness that informed it), to the chicken farm, the hide-house, the glue-rendering works, and the bone-meal fertilizer factory. To the last stumble of its stumbling end this dray horse must abide by the mandates of the lesser truth that is the truth of life and that makes life possible to persist.
This dray horse, like all other horses, like all other animals including man, is life-blinded and sense-struck. It will live, no matter what the price. The game of life is good, though all of live may be hurt, and though all lives lose the game in the end. This is the order of truth that obtains, not for the universe, but for the live things in it if they for a little space will endure ere they pass. This order of truth, no matter how erroneious it may be, is the sane and normal order of truth, the rational order of truth that life must believe in order to live.
to man, alone among the animals, has been given the awful privilege of reason. Man, with his brain, can penetrate the intoxicating show of things and look upon a universe brazen with indifference toward him and his dreams. He can do this, but it is not well for him to do it. To live, and live abundantly, to sting with life, to be alive (which is to be what he is), it is good that man be life-blinded and sense-struck. What is good is true. And this is the order of truth, lesser though it be, that man must know and guide his actions by, with unswerving certitude that it is absolute truth and that in the universe no other order of truth can obtain. It is good that man should accept at face value the cheats of sense and snares of flesh, and through the fogs of sentiency pursue the lures and lies of passion. It is good that he shall see neither shadows nor futilities, nor be appalled by his lusts and rapacities.
And man does this. Countless men have glimpsed that other and truer order of truth and recoiled from it. Countless men have passed through the long sickness and lived to tell of it and deliberately to forget it to the end of their days. They lived. They realized life, for life is what they were. They did right.
And now comes John Barleycorn with the curse he lays upon the imaginative man who is lusty with life and desire to live. John Barleycorn sends his White Logic, the argent messenger of truth beyond truth, the antithesis of life, cruel and bleak as interstellar space, pulseless and frozen as absolute zero, dazzling with the frost of irrefragable logic and unforgettable fact. John Barleycorn will not let the dreamer dream, the liver live. He destroys birth and death, and dissipates to mist the paradox of being, until his victim cries out, as in “The City of Dreadful Night”: “Our life’s a cheat, our death a black abyss.” And the feet of the victim of such dreadful intimacy take hold of the way of death.
(From John Barleycorn: Memoirs of an Alcoholic.)
London blamed the White Logic on alcohol, but if he had lived in today’s world he probably would have been diagnosed with depression. The point is, there is no objective evidence that life (the state of being alive) is any better or worse than the state of being dead. Reason can just as easily lead to one conclusion as the other. So if a little self-deception helps a person arrive at the Truth of Life instead of the White Logic (and isn’t that what they’re paying you for?) then I say: go with the self-deception.
I’ve been told this is an arrogant point of view, basically the idea that “It’s true, God doesn’t exist, but some people—not me, of course—may be better off believing in Him anyway.” But I don’t think it’s arrogant at all. Far more arrogant in my opinion is the idea that “I know what’s best for everyone else and you shouldn’t believe in God because He doesn’t exist.”
If feeling good is the end desired in psychotherapy, then why not just administer heroin to the client in the office or tell the client to use heroin on his/her own time?
Also, if it is arrogant to tell a client that there is no god (which I wouldn’t bother doing), then isn’t it also arrogant, in the same sense, to tell a client that the FBI is not following him to the library and watching him while he fills out his SSI paperwork (if he is experiencing paranoid delusions)?
-Dave
Note: Everyone else, PLEASE respond to my original post without making this a thread in response to antisocialdarwinist’s response. I’m really looking for a range of answers to what I originally posted. Thanks in advance.
If feeling good is the end desired in psychotherapy, then why not just administer heroin to the client in the office or tell the client to use heroin on his/her own time?
Well, are you interested in your client’s long-term happiness or only his short-term happiness? If the latter, then I’d say heroin would be a good choice.
DEL - 10 September 2011 05:01 PM
Also, if it is arrogant to tell a client that there is no god (which I wouldn’t bother doing), then isn’t it also arrogant, in the same sense, to tell a client that the FBI is not following him to the library and watching him while he fills out his SSI paperwork (if he is experiencing paranoid delusions)?
Is your client happier believing the FBI is following him than not? If so (I’d be surprised if this was the case), then yes, it would be arrogant to tell him they aren’t.
Is your five-year-old happier believing in Santa Clause than not? Same argument.
“Well, are you interested in your client’s long-term happiness or only his short-term happiness? If the latter, then I’d say heroin would be a good choice.”
And:
“Is your client happier believing the FBI is following him than not? If so (I’d be surprised if this was the case), then yes, it would be arrogant to tell him they aren’t.
Is your five-year-old happier believing in Santa Clause than not? Same argument.”
So you are a hedonist? There is nothing more important than feeling good? Is that the only important thing in life?
“Well, are you interested in your client’s long-term happiness or only his short-term happiness? If the latter, then I’d say heroin would be a good choice.”
And:
“Is your client happier believing the FBI is following him than not? If so (I’d be surprised if this was the case), then yes, it would be arrogant to tell him they aren’t.
Is your five-year-old happier believing in Santa Clause than not? Same argument.”
So you are a hedonist? There is nothing more important than feeling good? Is that the only important thing in life?
-Dave
I’m assuming that your client’s happiness is your objective. Did I misunderstand that?
It depends on who you ask… that is where knowledge of psychotherapy and clinical psychology can be useful.
For instance: in cognitive-behavior therapy, the actual goal is symptom reduction. This is achieved through helping someone to think both simultaneously 1) More accurately and 2) In a more self-helping way (as opposed to self-defeating).
Most psychotherapies are focused on symptom reduction. However, an example I could use for contrast is Acceptance and Commitment Therapy, where the goal is “psychological flexibility”. So, symptoms may even continue, but increasing psychological flexibility involves living a rich, full and meaningful life (not necessarily a happy one) while effectively reducing the impact and influence of painful thoughts and feelings (could also call these symptoms).
The DSM has implicit assumptions about what normal behavior is and what people should ideally act like. That is what I meant when I mentioned normative assumptions. Homosexuality was once listed as a mental disorder in the DSM. That would probably be one of the best examples of how social norms can easily dictate what we consider “mental disorder”. It was later taken out. Now, there is a debate over the disorder Gender Identity Disorder. That disorder involves feeling like you are a female if you are a male and vice versa. The treatment often can involve sexual reassignment surgery (after a year of psychotherapy in New York State to try making sure someone is stable enough to handle such a drastic change).
Can you see what I mean now? Perhaps what I wrote above could be summed up by saying that part of my issue is in deciding what the goal of psychotherapy should be. The DSM claims to just describe mental disorders. However, there are still assumptions involved even in the act of categorizing clusters of behavior, emotion and thought patterns, labeling them as disorders. There is an underlying assumption in doing that that you understand what ordered behavior, emotion and thought patterns looks like. What I am trying to say is… do we actually have a clear picture of that? I feel like I’m repeating myself and it may be helpful to re-read my original post, but your assumption that feeling good is the goal might actually serve to anecdotally support a point here. It may be the case that feeling good, hedonism essentially, is what a therapist should want to help people increase. Whether or not feeling good in the long term is the goal is another question. It possibly good be. However, why is that important? You or I could die tomorrow or in the next few minutes. So, feeling good in the short term could be a valid focus. Perhaps that could be judged based on probability. If you are already actively dying, then giving you heroin could be a perfectly valid intervention. Indeed, we give people in hospice care morphine… basically the same thing. I have known psychiatrists who are more likely to give Xanax to people who are dying or who don’t have much longer to live. Anyway, yeah, feeling good in the long term could be a decent goal for therapy. However, then one must ask if certain false beliefs will really lead to feeling good in the long term. That becomes an empirical question. It appears that many people actually do better in the long term if they have a self-serving bias. Even if those people are fooling themselves. However, this could still work. Indeed, pessimists can often have more accurate thinking, but they may not perform as well as those who are more biased. If the goal is also functioning well in the world, which would generally probably help you to feel better in the long term (so that would still be the primary goal for those likely to be around for a while), then having some biased thinking might actually HELP with that.
If the goal is helping people to feel good, then yes, I agree that encouraging a belief in god in someone who finds that belief to make them happy could be important. Failing to do so would actually get in the way of that goal. You would want to use whatever tools possible to reach that goal. Also, it may not always be important to intervene with schizophrenics if they aren’t harming anyone else or themselves through their delusions. The issue of paranoid delusions is a bad example… generally people don’t find those pleasant. It is possible to have pleasant delusions or hallucinations and if the person isn’t hurting anyone it may not make sense to intervene. However, if the person feels good, but cannot take care of him/herself, then this can affect society. If the person took a drug that helped to get rid of the pleasant delusions, this could help the person to potentially work, draining society for money less. This might take away from that person’s pleasure, but add to the overall pleasure of those in society. I see clients forced into treatment regularly. People mandated by drug court, probation, parole, child protective services, family court, assisted outpatient treatment orders, etc. These people do not always have goals for treatment, they just come in. What message should I be sending to them? What values should I be working from in that case? That raises the issues of what the ideal kind of life should look like again…
I suppose this raises a couple of points that have been on my mind. I have not seen a decent argument against the idea that feeling good could be part of human flourishing. I also have not seen a decent argument that, in certain contexts, false beliefs might be helpful. Owen Flanagan, in response to the fact that psychological research shows that positive illusions are helpful for people as they’re happier believing them.
Check out this video of Owen Flanagan discussing the issue and notice his response. Fast forward to 4:00. He simply says “We can get past this”. He doesn’t explain WHY we even should or WHY what is true matters in a hedonistic framework. Perhaps it does for him personally, but perhaps he just likes learning about things. Perhaps the pleasure centers of Owen Flanagan’s brain light up when he learns new things. Perhaps he is a know-it-all, a knowledge addict. Not everyone wants to be. Should I be encouraging clients to think more accurately AND to feel good. Or should I be focusing on just feeling good. I guess those questions come up there. I could easily be missing something.
I’m asking you. But it sounds like you don’t really know. If that’s the case, then how can you expect to answer the question of whether promoting belief in God and other self-deceptions are going to achieve your objective?
DEL - 10 September 2011 06:14 PM
Perhaps what I wrote above could be summed up by saying that part of my issue is in deciding what the goal of psychotherapy should be.
I think this is a separate question than the question of how to achieve whatever goal is decided on. From that standpoint, it’s premature to be asking whether you should be promoting belief in God. It depends on the objective!
For whatever it’s worth, here’s my take on what the goal of psychotherapy should be: whoever is paying for the therapy should decide. If the client or his insurance is paying, then the client should decide. If the client doesn’t know or is incapable of making that kind of decision, then the first objective of the therapy should be to get the client lucid enough to where he can make that decision and then help him figure out what he wants from the therapy.
If the state is paying, then this taxpayer thinks the objective should be to maximize the benefit (or at least minimize the cost) to society of the client. In cases where it’s possible, that means making him a productive, taxpaying member of society. In cases where it’s not, maybe something akin to hospice care would be the least costly way to deal with him. Note that the client’s happiness is irrelevant unless it helps achieve the objective of minimizing-cost-maximizing-benefit. In extreme cases, it might even be that the best way to achieve this objective would be to turn the client away or even persuade him to commit suicide. Are you allowed to do that?
But that’s just my opinion on what the objective should be. It’s a purely subjective objective. As any objective is.
“I’m asking you. But it sounds like you don’t really know. If that’s the case, then how can you expect to answer the question of whether promoting belief in God and other self-deceptions are going to achieve your objective?”
And:
“I think this is a separate question than the question of how to achieve whatever goal is decided on. From that standpoint, it’s premature to be asking whether you should be promoting belief in God. It depends on the objective!”
And:
“For whatever it’s worth, here’s my take on what the goal of psychotherapy should be: whoever is paying for the therapy should decide. If the client or his insurance is paying, then the client should decide. If the client doesn’t know or is incapable of making that kind of decision, then the first objective of the therapy should be to get the client lucid enough to where he can make that decision and then help him figure out what he wants from the therapy.
If the state is paying, then this taxpayer thinks the objective should be to maximize the benefit (or at least minimize the cost) to society of the client. In cases where it’s possible, that means making him a productive, taxpaying member of society. In cases where it’s not, maybe something akin to hospice care would be the least costly way to deal with him. Note that the client’s happiness is irrelevant unless it helps achieve the objective of minimizing-cost-maximizing-benefit. In extreme cases, it might even be that the best way to achieve this objective would be to turn the client away or even persuade him to commit suicide. Are you allowed to do that?
But that’s just my opinion on what the objective should be. It’s a purely subjective objective. As any objective is.”
Hmm. Seeing these responses above, I’m reminded of how Sam Harris talked about the difficulty of the term “well being”. He compared it to the difficulty of the term “health”. Just because health is hard to define doesn’t mean that anything goes. You wouldn’t go to a doctor and tell him exactly how to treat you. You would go and hear the doc’s advice. You pay the doc, he tells you what would be healthy for you and you either listen or you don’t. He doesn’t have to tell you what you want to hear just because you are paying. Because we’re dealing with the mind, people assume that it must be different. However, well being could be similar. There appear to be really bad depths of human suffering that are possible. It appears that certain beliefs would be more likely to lead to a higher level of suffering. It seems that the therapist and client should agree on the goals. Not because the client defines the objectives, but because when dealing with people and trying to change their minds you need to find common ground to start with. You need to have rapport and trust. Otherwise, the person won’t listen to you. That doesn’t mean you have to agree with everything the client says. In health, there is the issue of public health on top of individual health. Both are interrelated. It seems like, over the long run, in terms of the greatest well being for everyone, encouraging true beliefs would make the most sense. For instance, more bad situations can probably be prevented by everyone having more of a focus on what is true than if everyone is focusing on fantasies. Perhaps just not talking about religion would be the best approach. I guess I have generally over the years been able to not speak much about religion with clients and still help them. Many of them don’t really expect to talk about it much with me. While spirituality might help some people feel good, there isn’t reason to think it is necessary for anyone… Also, cognitive therapy alone, without a behavioral component, helps a lot of people and the primary focus is on thinking accurately as well as in a way that is self-helping (not self-defeating). You can do both.
I should also mention that I think the goal of therapy should include something cognitive behavior therapy doesn’t usually include. I think that therapy should increase one’s empathy for others and one’s compassion. Generally, I think that therapy promotes selfishness, which is good for the client, but bad for society. Therapy generally needlessly promotes a kind of egoism. However, if one is to live in the world, one must focus on how to best live with others. Being more compassionate can be helpful in this regard. I think therapy should focus more on everyone’s well being. Not just that of the client.
Welcome Dave. I’m not a psychotherapist, but I’m not totally unfamiliar with psychology. In reading your OP, I would say first of all, that I agree an eclectic approach is the most objective, if for no other reason than it keeps one open to all the disciplines or the best of each, rather than having a sort of tunnel vision due to bias to a particular one. Secondly, with regard to religion, I wouldn’t feed that delusion, except for casual references, unless it was imperative that not dealing with it might result in some harm. Of course, schizophrenics will usually have deep associations with it, right? Thirdly, I would think the focus of the therapy would be not so much to attain maximum levels of happiness, but maximum awareness and coping mechanisms that allow maximum functioning. Lastly, which is worse, waiting for the development of optimum treatment modalities, or none at all, or regression and neglect, like turning them out of state hospitals and pouring them into the streets a la Reagan and cutting funding for services and pouring them out into the streets a la Tea Party?
If feeling good is the end desired in psychotherapy, then why not just administer heroin to the client in the office or tell the client to use heroin on his/her own time?
If you’re a psychotherapist, you must know that a constant use of opiates would not in itself result in blissful happiness for the duration of a person’s life.
What viable alternatives do people have to feeling good? You sound as though you’re ignoring certain human realities. For instance, if our feel-good chemical production systems fail in some way, we end up feeling other than good. You put a religious-sounding slant to it with your word choice. Hedonistic? You’ve got to be kidding. We need to feel good just to function in the world.
Hmm. Seeing these responses above, I’m reminded of how Sam Harris talked about the difficulty of the term “well being”. He compared it to the difficulty of the term “health”. Just because health is hard to define doesn’t mean that anything goes. You wouldn’t go to a doctor and tell him exactly how to treat you. You would go and hear the doc’s advice. You pay the doc, he tells you what would be healthy for you and you either listen or you don’t. He doesn’t have to tell you what you want to hear just because you are paying. Because we’re dealing with the mind, people assume that it must be different. However, well being could be similar.
You misunderstood what I said. I didn’t say the client should decide on the method of treatment. I said he should decide on the goal of the treatment. There’s a big difference. If you went to the doctor with a broken arm, is there any doubt about your goal? You’d want your broken arm fixed! That’s what I mean by:
Antisocialdarwinist - 10 September 2011 07:46 PM
For whatever it’s worth, here’s my take on what the goal of psychotherapy should be: whoever is paying for the therapy should decide. If the client or his insurance is paying, then the client should decide.
If the client (assuming he’s paying) said, “I want to be happy,” would you overrule him and say, “Sorry, I’m going to make you a productive member of society, instead?” Wouldn’t that be like telling the doctor, “I want you to fix my broken arm” and the doctor overruling you with, “Sorry, I’m going to remove your tonsils, instead?”
Now, you wouldn’t tell the doctor how to fix your broken arm any more than your clients tell you how to make them happy (if that’s what they want from you). But that’s different than specifying the goal of the treatment or therapy.
Am I missing something here? This seems like a no-brainer: goal versus method. Client chooses goal, then you choose method.
What do you see as the range of goals clients might choose? Happiness? Productive member of society? (Those seem synonymous to me, but there are probably lots of people who disagree.) What others?
Welcome Dave. I’m not a psychotherapist, but I’m not totally unfamiliar with psychology. In reading your OP, I would say first of all, that I agree an eclectic approach is the most objective, if for no other reason than it keeps one open to all the disciplines or the best of each, rather than having a sort of tunnel vision due to bias to a particular one. Secondly, with regard to religion, I wouldn’t feed that delusion, except for casual references, unless it was imperative that not dealing with it might result in some harm. Of course, schizophrenics will usually have deep associations with it, right? Thirdly, I would think the focus of the therapy would be not so much to attain maximum levels of happiness, but maximum awareness and coping mechanisms that allow maximum functioning. Lastly, which is worse, waiting for the development of optimum treatment modalities, or none at all, or regression and neglect, like turning them out of state hospitals and pouring them into the streets a la Reagan and cutting funding for services and pouring them out into the streets a la Tea Party?
Answerer,
I like your reply. It’s seems sensible. Until we know more an eclectic approach could make the most sense. Your idea of how truth could come into the picture seems reasonable too. Not too rigid. Also, yes, psychotherapy is more about reducing suffering, harm reduction, than about increasing happiness. So one doesn’t necessarily need a very clear picture of flourishing to work on that. Though one might need a clear picture of flourishing to work on that. I think it’s still a possibility and that was one of my concerns. Your last comment makes sense too. I think that we cannot undo what is already in place now. Yeah, the church would be filling the role of psychotherapists if they didn’t exist and that would be a problem. It seems to be an improvement. Thanks a lot for the thoughtful reply. It’s helpful to see someone write this who is outside of my situation. The next thing I study will be multimodal psychotherapy with a focus on cognitive behavior therapy primarily.
If feeling good is the end desired in psychotherapy, then why not just administer heroin to the client in the office or tell the client to use heroin on his/her own time?
If you’re a psychotherapist, you must know that a constant use of opiates would not in itself result in blissful happiness for the duration of a person’s life.
What viable alternatives do people have to feeling good? You sound as though you’re ignoring certain human realities. For instance, if our feel-good chemical production systems fail in some way, we end up feeling other than good. You put a religious-sounding slant to it with your word choice. Hedonistic? You’ve got to be kidding. We need to feel good just to function in the world.
Nonverbal, I take your point regarding opiates. I was more throwing something out there to see Antisocialdarwinists response. It was a socratic question and I was going to make a similar point. However, considering that our lives are finite and we can never know the time of our death, that changes things when it comes to a long term focus. It can actually make sense to not take a long term focus, I think. However, as I said, if you know that you are probably going to be around for a long time (no major illnesses, family history of longevity, you are young, etc.), you should probably focus on long term happiness.
Your second paragraph above is one I take more issue with. Finding meaning is a viable alternative. Even if you are unhappy, you can find meaning, purpose in things. You can have a sense of direction that drives you in life. Indeed, happiness without meaning is often short-lasting, this is why Logotherapy developed. Victor Frankl was in a concentration camp and if he was focusing on just being happy, he probably would not have gotten through it. He instead focused on helping other prisoners and being a sort of “doctor” with the tools he had to help people in the camp. Regardless of that, one of the most evidence based treatments there is, Behavioral Activation for depression, involves having people behave in certain ways REGARDLESS of how they feel. People can certainly function without being happy. The point of behavioral activation is that your feelings and thoughts can follow if you act in a certain way. It is often very effective. What perpetuates depression can often be an obsession with being happy and asking why you are feeling unhappy, instead of getting out of your head and doing something that is important to you. So, meaning in that case can go along with behavioral activation. It can give you a sense of direction when you have few prospects of feeling happy so that eventually happiness might arise. However, not just happiness, but a sense of “mastery”. Mastery is measured in cognitive behavior therapy seprately from pleasure because it is widely recognized as equally important. Mastery involves a sense of efficacy while moving in the direction of a goal that involves challenges. Paradoxically, it often seems that when people try to control their moods, their moods don’t work the way they want them to. A sense of meaning can help to ground you when there is little prospect that your moods will change and you have stopped moving in life. If you have gotten “stuck”, so to speak, finding your sense of purpose can help you get unstuck. Then, happiness might follow. This is where a longer-term focus in therapy can be more useful because you can help a client to develop more lasting happiness and independence if you help that person to identify what is important to him/her in life that can give a more reliable sense of direction than just trying to be happy more of the time. Does this make sense? One problem is that many people find “god” to give them a sense of direction. It doesn’t have to be a transcendent sense of purpose. However, some people may not have much else that does. Those are the cases that are tough for me as I’m not sure what to do. Say the person is depressed and isolated without finding much reason to leave their home other than to go to appointments. The person has no job. The person has few if any friends. The person doesn’t exercise. If that person seems to think that god is the only motivator, my issue in that case would be, should I focus on helping the person develop another sense of purpose or use what the person already relates to? Generally, it can be much better to work with what people already know as a therapist because they are more likely to work with you and listen to you. It’s just part of working with people. It’s different from a debate between a theist and an atheist. You know? You can lose a person easily and that person might not come back… that person might just kill him/herself if he/she doesn’t come back. So the stakes can be high with depression. Any thoughts, Nonverbal?
Hmm. Seeing these responses above, I’m reminded of how Sam Harris talked about the difficulty of the term “well being”. He compared it to the difficulty of the term “health”. Just because health is hard to define doesn’t mean that anything goes. You wouldn’t go to a doctor and tell him exactly how to treat you. You would go and hear the doc’s advice. You pay the doc, he tells you what would be healthy for you and you either listen or you don’t. He doesn’t have to tell you what you want to hear just because you are paying. Because we’re dealing with the mind, people assume that it must be different. However, well being could be similar.
You misunderstood what I said. I didn’t say the client should decide on the method of treatment. I said he should decide on the goal of the treatment. There’s a big difference. If you went to the doctor with a broken arm, is there any doubt about your goal? You’d want your broken arm fixed! That’s what I mean by:
Antisocialdarwinist - 10 September 2011 07:46 PM
For whatever it’s worth, here’s my take on what the goal of psychotherapy should be: whoever is paying for the therapy should decide. If the client or his insurance is paying, then the client should decide.
If the client (assuming he’s paying) said, “I want to be happy,” would you overrule him and say, “Sorry, I’m going to make you a productive member of society, instead?” Wouldn’t that be like telling the doctor, “I want you to fix my broken arm” and the doctor overruling you with, “Sorry, I’m going to remove your tonsils, instead?”
Now, you wouldn’t tell the doctor how to fix your broken arm any more than your clients tell you how to make them happy (if that’s what they want from you). But that’s different than specifying the goal of the treatment or therapy.
Am I missing something here? This seems like a no-brainer: goal versus method. Client chooses goal, then you choose method.
What do you see as the range of goals clients might choose? Happiness? Productive member of society? (Those seem synonymous to me, but there are probably lots of people who disagree.) What others?
Antisocialdarwinist,
My response to what you wrote is actually contained in my response to Nonverbal.
All of your words point to the struggle it can be to attain and maintain feelings of good cheer. We agree completely about everything even if our words may not mesh.
I appreciate your OP request for opinions from professionals in the fields surrounding psychotherapy. I’m not such a person, and feel reluctant to say much of anything about a field I’m ignorant about. I respect your apparent self-honesty and concern for your patients. The most I can do is to pick at your word choices or suggest a different tone, etc., which I’ll be happy to continue to do.
Also, if you’re looking for an excuse to leave your field, look to your own reaction to the work you do. Does it make you feel the way challenging work can make a person feel, or has your work become tedious and/or risky? Do you have another field in mind? If so, how does that field make you feel? If you were to leave your field, would you feel terribly guilty? Is it possible to know how you would feel if you were to leave your field, or would it be more or less a wild guess?
I had to chuckle when I read your thread because you are internally debating the same issues that I did when I was seeking a therapist. I was a psych minor in college and I was familiar with the many approaches to psychotherapy, ranging from Client Centered to Behaviorist to Jungian to Logotherapy to Existentialist and even more. Did I want to ROLF? Maybe a feminist approach?
In my youth, when I was big into Sartre and Camus, I managed to find an Existential therapist, which wasn’t easy. Week after week, we brooded about my ultimate values and I concluded that I was going to take a an Episcurean/Stoic approach to life, which sounds contradictory, but really isn’t. I taped a copy of Bertrand Russell’s “A Freeman’s Worship” to my mirror, then lived as “authentically” as possible.
Eventually Existentialism led to Buddhism and I decided a cognitive therapist would be best for me. This therapist and I explored my habits of faulty thinking
.
Next, I fell into woo, as the atheists on this site like to call it. I became a Perennial Philosophy, Comparative Religion enthusiast and switched to a Jungian-leaning therapist, who if had written a book about the important of spirituality in therapy….sort of like Scott Peck.
Please understand, I didn’t see these guys for years and years….my visits were episodic and I only saw each one for only a few months. But each was helpful to me, even though the Existentialist was a bit of a brooder and we both sighed a lot during our sessions.
In regard to your problem, my own view is that the relationship between patient and therapist should be creative, dynamic and individualized and, therefore, ethical questions such as you describe must remain fluid. There are all sorts of factors to consider in regards to each client and a predetermined “flourishing formula” or theoretical assumption is unjust. Some people will flourish if some form of belief system remains intact…or better yet…helped to be seen from a mature perspective, but other people will be liberated when freed from the religious shackles that bind them.
In addition to that, there is the decision involved in putting morality on a timeline continuum rather than locating it in the current circumstances. A philosophical stance that might make someone flourish at time A may be detrimental to them…and others… at time Z. Again, no easy answers, but that is because each individual is a result of a unique combination of biological, social, experiential and environmental influences.
The best we can hope to do is struggle to be as wise, perceptive, good willed, and flexible in our interactions with others as possible. Yes, this is exhausting. If its any consolation, I am grateful to the three therapists who tried their best to advise me and I do think they all helped me “flourish” to some degree. “Flourishing” is a process, don’t you think? Very different from “flushing”.
I think you are probably an excellent and committed therapist, but you may burn-out in ten years. Try yoga.
All of your words point to the struggle it can be to attain and maintain feelings of good cheer. We agree completely about everything even if our words may not mesh.
I appreciate your OP request for opinions from professionals in the fields surrounding psychotherapy. I’m not such a person, and feel reluctant to say much of anything about a field I’m ignorant about. I respect your apparent self-honesty and concern for your patients. The most I can do is to pick at your word choices or suggest a different tone, etc., which I’ll be happy to continue to do.
Also, if you’re looking for an excuse to leave your field, look to your own reaction to the work you do. Does it make you feel the way challenging work can make a person feel, or has your work become tedious and/or risky? Do you have another field in mind? If so, how does that field make you feel? If you were to leave your field, would you feel terribly guilty? Is it possible to know how you would feel if you were to leave your field, or would it be more or less a wild guess?
Nonverbal,
No they don’t. The evidence actually points to the idea that feelings of good cheer seem to be only part of the picture. I explicitly talked about other issues involved in helping people to change. Here’s a concrete example… having kids. The evidence suggests that having kids actually makes you less happy. However, people seem to deceive themselves when asked directly about having kids after they already had them. At the same time, people seem to find meaning in having children. This is NOT the same as happiness or feeilngs of good cheer. They gain a sense of efficacy instilling their values in the child. They have a sense of purpose in that the child is always giving them directions to go in to help the child. They gain a sense of their own values when trying to instill them in the child. They also gain a sense of self-worth by being there for a child who needs them. This does not require happiness. The social psychologist Roy Baumeister wrote a book called Meanings of Life, which I highly recommend. In it, he defines meaning. Happiness is actually one way people can find meaning. Pursuing happiness. However, they can also find meaning in work, romantic/intimate relationships, children, religion etc. He defines four needs for meaning: Purpose, Value (Justification), Efficacy and Self-Worth. He is one of the few people I have seen who tried to define what meaning is and how it works. He considers meaning a necessary but not sufficient condition for happiness. Also, if you read Owen Flanagan’s The Bodhisattva’s Brain: Buddhism Naturalized, he talks at length about the difference between flourishing (Eudaimonia) and happiness. He talks about how happiness could be linked to Eudaimonia. Interestingly, Flanagan describes himself as a “Platonic Hedonist”. He focuses on what is “true, good and beautiful” in life. Again though, happiness is not the end all in the case of platonic hedonism. When we focus on what is true, this does not always bring happiness in the moment. There is more to life than just happiness. Flanagan has some decent writing about that. Happiness seems to be a big part of the picture and it would be silly to claim that it wasn’t. I am just saying that it is not so self-evident that everything is secondary to happiness. I thought I did a good job of illustrating how. If you saw the struggles that my clients go through and how many of them want happiness, but just can’t seem to find it, you might see what I mean in a concrete sense. Happiness is one part of the picture, but it seems that as I discuss this it is helping me to see the value of my work. Meaning can and perhaps often should be the primary focus and happiness could actually be secondary in many cases. Meaning is more stable than happiness. You can have a vision of where you ideally want your life to be without happiness. I would argue that that ideal should not be to be happy as much as possible. Happiness is more something that pops up. It arises. You don’t control it. You can control your behavior though and what meaningful paths you take in life. The primary focus should perhaps be on one of those meaningful paths, not something fleeting like happiness. Many of my clients, by taking a narrow focus in life, lose their sense of meaning, but they want happiness. They focus on happiness exclusively and take a very self-centered approach to life, getting lost in their heads. They take pills to try and control their moods as if they can be happy all the time. That kind of an approach doesn’t work. You could try claiming that finding meaning could just be a way of tricking yourself into a mind state that is more conducive to happiness. Maybe. However, it actually seems far-fetched. I think that finding meaning is just a separate issue from finding happiness. Mastery, which I mentioned above, is one example of probably efficacy. I actually modify things to focus on not just mastery, but also purpose, values and self-worth with clients.
This is all actually helping me to decide to stay in my field of choice. I just try to be critical of myself and what I do with my time, as you can see:) Thanks.
All of your words point to the struggle it can be to attain and maintain feelings of good cheer. We agree completely about everything even if our words may not mesh. . . .
Nonverbal,
No they don’t. The evidence actually points to the idea that feelings of good cheer seem to be only part of the picture. I explicitly talked about. . . .
Then that part of the picture is what I’m referring to—the part that produces chemicals that assist in motivating us to get out of bed each morning even when nothing is scheduled. Certain of those feel-good chemicals need to be with us all day long, even if we’re in a prison camp. Unless some sort of balance is able to be maintained, suicide becomes a viable option.
DEL: No they don’t. The evidence actually points to the idea that feelings of good cheer seem to be only part of the picture. I explicitly talked about other issues involved in helping people to change. Here’s a concrete example… having kids. The evidence suggests that having kids actually makes you less happy. However, people seem to deceive themselves when asked directly about having kids after they already had them. At the same time, people seem to find meaning in having children. This is NOT the same as happiness or feeilngs of good cheer. They gain a sense of efficacy instilling their values in the child. They have a sense of purpose in that the child is always giving them directions to go in to help the child. They gain a sense of their own values when trying to instill them in the child. They also gain a sense of self-worth by being there for a child who needs them. This does not require happiness. The social psychologist Roy Baumeister wrote a book called Meanings of Life, which I highly recommend. In it, he defines meaning. Happiness is actually one way people can find meaning. Pursuing happiness. However, they can also find meaning in work, romantic/intimate relationships, children, religion etc. He defines four needs for meaning: Purpose, Value (Justification), Efficacy and Self-Worth. He is one of the few people I have seen who tried to define what meaning is and how it works. He considers meaning a necessary but not sufficient condition for happiness. Also, if you read Owen Flanagan’s The Bodhisattva’s Brain: Buddhism Naturalized, he talks at length about the difference between flourishing (Eudaimonia) and happiness. He talks about how happiness could be linked to Eudaimonia. Interestingly, Flanagan describes himself as a “Platonic Hedonist”. He focuses on what is “true, good and beautiful” in life. Again though, happiness is not the end all in the case of platonic hedonism. When we focus on what is true, this does not always bring happiness in the moment. There is more to life than just happiness. Flanagan has some decent writing about that. Happiness seems to be a big part of the picture and it would be silly to claim that it wasn’t. I am just saying that it is not so self-evident that everything is secondary to happiness. I thought I did a good job of illustrating how. If you saw the struggles that my clients go through and how many of them want happiness, but just can’t seem to find it, you might see what I mean in a concrete sense. Happiness is one part of the picture, but it seems that as I discuss this it is helping me to see the value of my work. Meaning can and perhaps often should be the primary focus and happiness could actually be secondary in many cases. Meaning is more stable than happiness. You can have a vision of where you ideally want your life to be without happiness. I would argue that that ideal should not be to be happy as much as possible. Happiness is more something that pops up. It arises. You don’t control it. You can control your behavior though and what meaningful paths you take in life. The primary focus should perhaps be on one of those meaningful paths, not something fleeting like happiness. Many of my clients, by taking a narrow focus in life, lose their sense of meaning, but they want happiness. They focus on happiness exclusively and take a very self-centered approach to life, getting lost in their heads. They take pills to try and control their moods as if they can be happy all the time. That kind of an approach doesn’t work. You could try claiming that finding meaning could just be a way of tricking yourself into a mind state that is more conducive to happiness. Maybe. However, it actually seems far-fetched. I think that finding meaning is just a separate issue from finding happiness. Mastery, which I mentioned above, is one example of probably efficacy. I actually modify things to focus on not just mastery, but also purpose, values and self-worth with clients.
This is all actually helping me to decide to stay in my field of choice. I just try to be critical of myself and what I do with my time, as you can see:) Thanks.
I have decided I want you to be my fourth psychologist. We can discuss my theist-wannabeism and the existential anguish which still plagues me despite the efforts of the first psychologist to convince me I have to adapt to it. I’d also like to lose weight and re-spark my sex life. I shall prepare by reading Viktor Frank’s “Man Search for Meaning” Where do you live? Can I stay for about a month in your guest room? Do you use a sliding fee scale?
Seriously, you sure do sound like an enlightened therapist. Good luck to you.
I had to chuckle when I read your thread because you are internally debating the same issues that I did when I was seeking a therapist. I was a psych minor in college and I was familiar with the many approaches to psychotherapy, ranging from Client Centered to Behaviorist to Jungian to Logotherapy to Existentialist and even more. Did I want to ROLF? Maybe a feminist approach?
In my youth, when I was big into Sartre and Camus, I managed to find an Existential therapist, which wasn’t easy. Week after week, we brooded about my ultimate values and I concluded that I was going to take a an Episcurean/Stoic approach to life, which sounds contradictory, but really isn’t. I taped a copy of Bertrand Russell’s “A Freeman’s Worship” to my mirror, then lived as “authentically” as possible.
Eventually Existentialism led to Buddhism and I decided a cognitive therapist would be best for me. This therapist and I explored my habits of faulty thinking
.
Next, I fell into woo, as the atheists on this site like to call it. I became a Perennial Philosophy, Comparative Religion enthusiast and switched to a Jungian-leaning therapist, who if had written a book about the important of spirituality in therapy….sort of like Scott Peck.
Please understand, I didn’t see these guys for years and years….my visits were episodic and I only saw each one for only a few months. But each was helpful to me, even though the Existentialist was a bit of a brooder and we both sighed a lot during our sessions.
In regard to your problem, my own view is that the relationship between patient and therapist should be creative, dynamic and individualized and, therefore, ethical questions such as you describe must remain fluid. There are all sorts of factors to consider in regards to each client and a predetermined “flourishing formula” or theoretical assumption is unjust. Some people will flourish if some form of belief system remains intact…or better yet…helped to be seen from a mature perspective, but other people will be liberated when freed from the religious shackles that bind them.
In addition to that, there is the decision involved in putting morality on a timeline continuum rather than locating it in the current circumstances. A philosophical stance that might make someone flourish at time A may be detrimental to them…and others… at time Z. Again, no easy answers, but that is because each individual is a result of a unique combination of biological, social, experiential and environmental influences.
The best we can hope to do is struggle to be as wise, perceptive, good willed, and flexible in our interactions with others as possible. Yes, this is exhausting. If its any consolation, I am grateful to the three therapists who tried their best to advise me and I do think they all helped me “flourish” to some degree. “Flourishing” is a process, don’t you think? Very different from “flushing”.
I think you are probably an excellent and committed therapist, but you may burn-out in ten years. Try yoga.
Saralynn,
I think you can be too flexible though. Sometimes you can enable a client who is not changing by not pushing them or by continuing to see the client even when you know they are stagnating. You definitely have to be flexible, otherwise you will surely lose clients. I have before due to that. However, I have also gone along with bullshit for many sessions with an “illusion of work” (an illusion of change). What I have read of therapies that are very relativistic is invariably pathetic. Post-modernism is in vogue now and I embarrassingly had my woo woo stage getting immersed in it. It involves basically throwing the baby out with the bath water because a science of human nature is not perfect. Wow there are gaps in our knowledge, that doesn’t mean we have a duty to fill the gaps with all manner of nonsense. Constructivist psychotherapy is an example of a therapy that is a bit too flexible. Another therapy that I appreciate in some ways but am somewhat wary about is called multimodal psychotherapy. The person who invented it, Arnold Lazarus, is no doubt a psychologist that I respect.
I am about to read the rest of his book on that therapy and I think it has some decent ideas, but in some ways it could become too relativistic. It could also become dishonest in that the practitioner could be working with assumptions that the practitioner doesn’t admit to him/herself. What I take from it thus far that is useful is the idea of using a general understanding of social learning theory to drive the way you help clients. On top of that, you use an acronym called BASIC ID as a shorthand way of assessing and conceptualizing a client’s case. It stands for Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal, Drugs (“biological”). It’s drugs instead of biological so that it sounds better:) But the idea is that it adds to Cognitive Behavior Therapy in terms of assessing and using other “modalities” mentioned in the BASIC ID acronym. You use different methods though, not theories. The theory is social learning theory. You also use whatever is most evidence based in terms of techniques. The idea is that people are highly complex creatures and so you should use whatever techniques might work and individualize things as much as possible until we know more about what makes humans tick. Some people might relate to imagery more than verbalizations in their heads. Also, in multimodal therapy, you look at the relationship between the therapist and the client. You look at expectation. If the client expects a Freudian, can you mold yourself to what they want or do they need a different therapist? It’s a very interesting approach.
I think that some therapists use religion too much in therapy, which is scary stuff. It’s a trend that is getting out of hand. At the same time, if a client is religious and that is how the client conceptualizes his world, then you may have to work from there. You need to build rapport and start where someone is at or you will lose the person. If you encourage a religious person to be more reasonable while also using some of their irrational beliefs in the process, maybe later that person will reject the faith. I generally think it would be best if I leave out talk about religion unless it seems warranted in certain contexts. Some concrete examples of those contexts have already been discussed in this thread. *sigh* It’s much more difficult than it might seem if you actually care about doing the right thing and being honest as a therapist. I think that reading “new atheist” and naturalist literature makes me forget that, in the context of psychotherapy, the game is very different. It’s not a debate between Sam Harris and a Christian apologist. It’s a person asking for help who is suffering and another person offering to help that person suffer less. In that context, you need to respect someone’s beliefs. You have to work from that person’s unique phenomenology, that person’s BASIC ID. People don’t change right away. If you don’t, respect that person’s beliefs, the person will sense it and you will lose the client. While a utilitarian might say that it is better for certain clients to be lost, from a rule utilitarian perspective, it would probably be bad for a therapist to think that way. It’s important for a therapist to be very empathic and compassionate. If you view some clients as expendable, then you sacrifice this mindset. I guess there are perfect answers here… There are so many books on therapy, but very few that focus on how a therapist who has a dedication to reason (rather than alternative medicine, the unconscious, “spirituality”, etc) might best serve clients. Cognitive Behavior Therapy is one. However, it’s starting to be polluted by post-modernism and an enchanting but probably naive view of Buddhism. Hmm, I guess I’m regaining my sense of a center in terms of how to approach psychotherapy while not throwing reason out the window or engaging in magical/supernatural thinking.
What you wrote was helpful.
Thanks for the compliment. I’m always developing and I learn a lot from the people I try to help. I think it makes me a better person for sure. I learn so much about what it means to be human by seeing people’s struggles. Many therapists burn out in 10 years:) I have a front-row seat to human suffering.
-Dave
EDIT: I should have said “I guess there are NO perfect answers here” above… Sorry - Dave Also, if cognitive behavior therapy is a therapy dedicated to reason, then there are plenty of books about therapy dedicated to reason as there are plenty of books about CBT… hehe. My bad. - Dave
DEL: No they don’t. The evidence actually points to the idea that feelings of good cheer seem to be only part of the picture. I explicitly talked about other issues involved in helping people to change. Here’s a concrete example… having kids. The evidence suggests that having kids actually makes you less happy. However, people seem to deceive themselves when asked directly about having kids after they already had them. At the same time, people seem to find meaning in having children. This is NOT the same as happiness or feeilngs of good cheer. They gain a sense of efficacy instilling their values in the child. They have a sense of purpose in that the child is always giving them directions to go in to help the child. They gain a sense of their own values when trying to instill them in the child. They also gain a sense of self-worth by being there for a child who needs them. This does not require happiness. The social psychologist Roy Baumeister wrote a book called Meanings of Life, which I highly recommend. In it, he defines meaning. Happiness is actually one way people can find meaning. Pursuing happiness. However, they can also find meaning in work, romantic/intimate relationships, children, religion etc. He defines four needs for meaning: Purpose, Value (Justification), Efficacy and Self-Worth. He is one of the few people I have seen who tried to define what meaning is and how it works. He considers meaning a necessary but not sufficient condition for happiness. Also, if you read Owen Flanagan’s The Bodhisattva’s Brain: Buddhism Naturalized, he talks at length about the difference between flourishing (Eudaimonia) and happiness. He talks about how happiness could be linked to Eudaimonia. Interestingly, Flanagan describes himself as a “Platonic Hedonist”. He focuses on what is “true, good and beautiful” in life. Again though, happiness is not the end all in the case of platonic hedonism. When we focus on what is true, this does not always bring happiness in the moment. There is more to life than just happiness. Flanagan has some decent writing about that. Happiness seems to be a big part of the picture and it would be silly to claim that it wasn’t. I am just saying that it is not so self-evident that everything is secondary to happiness. I thought I did a good job of illustrating how. If you saw the struggles that my clients go through and how many of them want happiness, but just can’t seem to find it, you might see what I mean in a concrete sense. Happiness is one part of the picture, but it seems that as I discuss this it is helping me to see the value of my work. Meaning can and perhaps often should be the primary focus and happiness could actually be secondary in many cases. Meaning is more stable than happiness. You can have a vision of where you ideally want your life to be without happiness. I would argue that that ideal should not be to be happy as much as possible. Happiness is more something that pops up. It arises. You don’t control it. You can control your behavior though and what meaningful paths you take in life. The primary focus should perhaps be on one of those meaningful paths, not something fleeting like happiness. Many of my clients, by taking a narrow focus in life, lose their sense of meaning, but they want happiness. They focus on happiness exclusively and take a very self-centered approach to life, getting lost in their heads. They take pills to try and control their moods as if they can be happy all the time. That kind of an approach doesn’t work. You could try claiming that finding meaning could just be a way of tricking yourself into a mind state that is more conducive to happiness. Maybe. However, it actually seems far-fetched. I think that finding meaning is just a separate issue from finding happiness. Mastery, which I mentioned above, is one example of probably efficacy. I actually modify things to focus on not just mastery, but also purpose, values and self-worth with clients.
This is all actually helping me to decide to stay in my field of choice. I just try to be critical of myself and what I do with my time, as you can see:) Thanks.
I have decided I want you to be my fourth psychologist. We can discuss my theist-wannabeism and the existential anguish which still plagues me despite the efforts of the first psychologist to convince me I have to adapt to it. I’d also like to lose weight and re-spark my sex life. I shall prepare by reading Viktor Frank’s “Man Search for Meaning” Where do you live? Can I stay for about a month in your guest room? Do you use a sliding fee scale?
Seriously, you sure do sound like an enlightened therapist. Good luck to you.
Saralynn,
LOL. I actually would not recommend Victor Frankl’s work. He has a book called “The Unconscious God” which is less popular. I own a copy. It’s out of print. It’s written for clinicians rather than the general public and in it, he reveals that he thinks everyone unconsciously cares about god on some level. I found it ridiculous. I mean, if you sift through some of his BS, Man’s Search For Meaning could be a decent read. However, while it’s not a self-help book, I would recommend Roy Baumeister’s book The Meanings of Life over Frankl’s work. Baumeister takes a far more critical approach. He is more detailed in his approach as well. He’s more academically rigorous. Frankl was religious and assumed that you need a transcendent sense of meaning. However, Baumeister makes a decent case that you don’t. He makes a decent case for the idea that a transcendent meaning is a myth. He writes about what people tend to find meaning in and how to conceptualize meaning itself. He also doesn’t make claims like the ones listed here: http://www.logotherapyinstitute.org/About_Logotherapy.html “Life has meaning under all circumstances, even the most miserable ones.” That one gets me… Baumeister points out that people literally seem to LOSE meaning when they go through enough excruciating pain. Pain is like a meaning killer. This is why torture breaks people down and they’ll sometimes say anything to get you to stop. Their higher sense of meaning are gone with enough pain involved. This is why I think euthanasia is the only compassionate response if someone who has no prospect of feeling better is going through a lot of debilitating pain. However, I do not wish to debate euthanasia, it was just a passing remark. “Our main motivation for living is our will to find meaning in life.” Again. That is highly doubtful. It seems to be highly important for most people, but that is a dogmatic, rigid claim without empirical support. Anyway, I have issues with logotherapy. I think that you can use the idea of finding meaning without logotherapy. I think a lot of therapists just aren’t creative enough and they don’t seem to think outside the box enough. Logotherapy is available, so they use that if they are interested in existentialist issues and meaning.
All of your words point to the struggle it can be to attain and maintain feelings of good cheer. We agree completely about everything even if our words may not mesh. . . .
Nonverbal,
No they don’t. The evidence actually points to the idea that feelings of good cheer seem to be only part of the picture. I explicitly talked about. . . .
Then that part of the picture is what I’m referring to—the part that produces chemicals that assist in motivating us to get out of bed each morning even when nothing is scheduled. Certain of those feel-good chemicals need to be with us all day long, even if we’re in a prison camp. Unless some sort of balance is able to be maintained, suicide becomes a viable option.
Nonverbal,
There are serious issues with the trend in talking about “chemical imbalances” in depression or any other mental illness. I could honestly write a lot about it. I would rather avoid that because I’ll be on this computer all day. Let me think of some links to give you to check out. Here’s one that relates to depression because the logic of the “disease of the brain” model of addiction is the same basic idea as that used for depression: http://www.npr.org/blogs/13.7/2011/09/09/140307282/addiction-is-not-a-disease-of-the-brain?sc=fb&cc=fp Just read it yesterday, so it came to mind. I also recommend reading The Bodhisattva’s Brain: Buddhism Naturalized by Owen Flanagan if you haven’t already. The section on using brain scans to measure whether Buddhists are more happy or to determine whether someone is flourishing (eudaimon) is very helpful. He mentions how you cannot look at behavior by looking at the brain. You cannot see how someone exists in the world. Depression is more than just a brain state. It is about patterns of behavior and patterns of thinking. It’s also about interpersonal patterns. There are various issues that maintain depression. There is no evidence whatsoever that a chemical imbalance is the CAUSE. Drugs might help. However, they rarely are the main cure. They also don’t help much in the long term compared to psychotherapy. The most effective psychotherapies work on changing one’s behavior, their interpersonal relations and their cognitions (their reasoning). Looking at brain chemicals and measuring pleasure levels just doesn’t cut it. There are many risk factors for suicide that don’t have to do with pleasure levels. I guess we’ll have to agree to disagree as we’ve already presented our cases. Thanks.
There are serious issues with the trend in talking about “chemical imbalances” in depression or any other mental illness. . . .
I’m not trying to divert from your OP question, but I noticed several nuances of yours that were bothersome, and I picked two.
As I’m sure you know, cognitivists have argued with behaviorists for many decades. They’ve finally melded somewhat into cognitive-behavioral, but it’s fun to revisit old arguments anyway, isn’t it? Notice that I’ve mentioned nothing whatsoever about what a human needs to do in order to maintain mentally healthy balances and long life. My point was small, but you saw it as some sort of disagreement with your highly fluid and nicely organized explanations about life, pursuits and meaning. My point remains that unless some group of chemicals arrives at the right locations and at the right moments, suicide looms, or perhaps worse.
I think you can be too flexible though. Sometimes you can enable a client who is not changing by not pushing them or by continuing to see the client even when you know they are stagnating. You definitely have to be flexible, otherwise you will surely lose clients. I have before due to that. However, I have also gone along with bullshit for many sessions with an “illusion of work” (an illusion of change). What I have read of therapies that are very relativistic is invariably pathetic. Post-modernism is in vogue now and I embarrassingly had my woo woo stage getting immersed in it. It involves basically throwing the baby out with the bath water because a science of human nature is not perfect. Wow there are gaps in our knowledge, that doesn’t mean we have a duty to fill the gaps with all manner of nonsense. Constructivist psychotherapy is an example of a therapy that is a bit too flexible. Another therapy that I appreciate in some ways but am somewhat wary about is called multimodal psychotherapy. The person who invented it, Arnold Lazarus, is no doubt a psychologist that I respect.
I don’t think I meant relativistic when I used the term “flexible”. I was thinking more along the lines of forming a living dynamic relationship with a patient rather than approaching them as an object to be fixed according to a set of preconceived instructions. However, I do recognize that this is idealistic and there are more practical considerations. I tutor children in their homes and if I told parents what i truly thought about their child rearing practices, I’d lose a lot of clients. I never criticize directly, but subtly try to steer the moms and dads in the right direction in a supportive manner. Most parents want to be good parents and I build on that. It’s vitally important to refrain from judging them, which is fairly easy for me because I usually see the the best in people.
I used to informally work with the mentally ill and it is certainly a challenging enterprise. It’s a long story, but suffice to say I did it for many years until I burned out….very badly, I might add. From my own experience. I think what patients need the most is to be seen as human beings and not disorders. Even when people were severely disturbed, I always tried to connect with the sane person inside them who was grappling with their myriad disabling symptoms.
In terms of approaches, I found, by far, the best strategy was to help them focus on their “will”, which is, if you think about it, the only thing they are able to control. (even if it is illusory) I stressed that thoughts can contribute to symptoms and sometimes ARE the symptoms, and that the patients had to learn to accept or reject them using their reason. “Is my dead mother really talking to me on TV or is that a symptom of my illness?” “Am I really going to have a heart attack or are those sensations caused by anxiety?” I was inspired in this approach by that book “A Beautiful Mind” about John Nash, the brilliant mathematician who went crazy and learned to live with his illness by using his reason. Also, insights learned thruough “Recovery, International” were extremely helpful.
