I meant what I said, I'm just not sure I said what I meant

[callunav]

I'm feeling self-conscious about the first part of my last entry, worrying that it makes it sound like I sit there with clients telling them what to do or...I don't know what. The kind of thing I'm talking about is like this:

Imagine, if you will, that I am seeing a woman who has recently extricated herself from an abusive boyfriend, worrying about her adolescent son who is now acting out.*


--

A (hypothetical) reflective Rogerian/Humanistic interaction:

Her: He's just so confused and angry, and it's all my fault.

Me: You're feeling responsible because you're the one who left the relationship and took him with you.

Her: Yes! I hate that he didn't even have any choice in it, but what was I supposed to do?

Me: You feel like he blames you for upheaval in his life, and he didn't want to leave?

Her: He does. He says so. He shouts at me all the time. He says he--his father--never did anything to him. What am I supposed to do?

Me: Are you wondering if you did the right thing?

Her: I--No... I mean, I know his father never hit him or anything, but he was constantly putting him down and stuff. It wasn't a good environment for him. I know I had to make the decision for him. I mean, I'm his mother and he's my kid. Honestly, I kind of wonder if he hasn't really been angry for a long time, and now it's just coming out.

Me: Angry because of how his father treated him, you mean?

Her: Yeah.

---

What actually happened:

Her: He's just so confused and angry, and it's all my fault.

Me: Whose fault?

Her: Mine!

Me: Whose fault?

Her: ...his father's...?

Me: That's how it looks to me. What do you think?

---

The humanistic approach often looks kind of stupid in writing, but it serves a lot of purposes. It lets the client tell me if I'm understanding her right. It makes her feel heard/seen/witnessed/understood. It lets her express her feelings as much as she needs to. And it lets her work her own way around - with a gentle assist - to seeing that maybe she's putting the blame in the wrong place. If she reaches that conclusion mostly on her own, she's more likely to believe it.

The more...I'll say, in this case, that was a cognitive approach...is helpful in that it not only draws attention to the problem in how she's thinking about the situation, it also addresses it directly and more clearly, and possibly most importantly, it establishes clearly that she does have some (really normal, really understandable) distortions in how she perceives responsibility and fault, which will help with identifying things like that in the future, and eventually, hopefully, her challenging them for herself. So, cognitive =/= bad. However, if I'd been a little more humanistic in my approach, it might have been even better.

(Another example of this kind of thing which still makes me grin is the kid who described an anger management fail, saying, "I kind of threw a chair a little." I said, "You kind of threw a chair a little?" She said, "Yeah." I said, "You threw a chair." She said, "...yeah." On that one, I have no regrets.)



* Not the actual scenario. Client confidentiality etc..

Comments

[redbird]

Those both seem reasonable to me, as a client.

In my only experience of therapy as an adult, the therapist did, if not tell me what to do, at least make suggestions. Though I think at least once that was in response to my asking her for help/techniques for dealing with a problem. (This was a relatively short course of therapy, including her teaching me a couple of CBT techniques. And thank you for this post, because in commenting on it I have been reminded that I do have those techniques, and they might come in handy right now.)

[callunav]

You're welcome!

And, yes, skill-building is a great thing. I do it a lot with DBT distress-tolerance skills, and hope to be able to move on to emotional regulation and effectiveness skills. (I'm not a hardcore DBT therapist, but I have trained in it, and there's a lot of good stuff in there.) I use the behavioral part of CBT less than the cognitive part, but they both can be verrry important.

And I think suggestions are very useful when the client is either asking for them or noticeably stuck.

ETA: Although even then, it's often worth while asking what they'd suggest to themselves before I suggest anything. A lot of the time, it turns out that even people who feel very stuck do actually have the internal resources they need.

[julian]

This sparked thoughts of mine I kept meaning to put in my LJ weeks ago, so:

The Rogerian cant of reflective listening bugs the shit out of me in writing, but, it is clear that the counseling mainstream thinks it works, and I should at least get used to doing it.

Also, *when* I am not staring at it in writing, but instead the active observer (in say, a therapeutic triad), it actually *does* work, and not just because the faux client is being kind to the faux therapist.

Now, it is clearly not the *only* thing that works, god knows, but that doesn't mean I shouldn't get a grounding in IT, and in how not to sound like an idjit while doing it, before (and/or while) doing other things too.

But it's a relief to have a mild demonstration of where it can go, from people who aren't invested in filling us full of Rogerian Goodness at all times.

[callunav]

It really does make one feel like an idiot - worse, a condescending idiot - in writing, doesn't it? But you're right - even in roleplays, it's possible to feel how it works, and - well, all I can say is that I have never yet had a client tell me, "For God's sake, stop fking telling me that you hear me and parroting back what I said, and say something useful already."* Which seems like the most natural response in the world, when I look at it written out.

I do think it's possible to go too far in the Rogerian model, crossing the line into uselessness, and I actually think Carl Rogers sometimes did, at least going by the video of him working. But the line is a lot further out than I would have thought.

ETA: * I mean, give me a few more years and I may have this experience too, but.