Development of a personal therapeutic theory based on client responsibility

¶ … Personal Theory

As a therapist, my basic approach is to view the person in therapy as taking responsibility for his or her own life and problems. I believe that all human beings have a basis of good, and that it is my job as a therapist to help my patients find this seed of good inside themselves, however small. In order to do this however, I cannot try to force the process by attempting to force my view of human nature into the therapy session. Instead, it is my job to unconditionally accept my clients and their views as a basis for future therapy towards healing.

As such, I need to accept that all my clients come to therapy with a certain past, containing events that they will not necessarily want to share. In this, I believe that it is important to help clients understand that their therapy is their own responsibility. This is also an important part of acceptance. Human existence is filled with difficulty, flaws, and depression. These things are helpful clues towards the subconscious processes that will eventually help me to help my clients take responsibility for their lives.

Problem Identification

My goals for meetings with clients include first forming a friendly and open relationship with them by everyday conversational dialogue. I will ask the client leading questions regarding his or her life, goals and ideals, as well as deeper questions relating to how he or she feels about life and existence in general. The focus throughout the conversation will be complete and unconditional acceptance of the client and his or her views.

To identify the problem, I will listen carefully for clues in the responses of the client. This will then provide material for further conversation and the possibility of excavating possible hidden and more subconscious issues that the client might be struggling with. I will then use the issues raised during the conversation to plan my intervention in further sessions. It is important that the client plays an active role in these decisions. The closure of each session will then be a focus on dialogue regarding the specific issues raised during the session, and planning for future sessions. I will encourage the client to make suggestions for the therapy, and explain my premise for the therapy. The client should also feel sufficiently confident to criticize any of my approaches, upon which I will make modifications accordingly. The premise is to let the client not only take responsibility for his or her life, but also for the course of the therapy.

In terms of outcome assessment, I will use a combination of my own observations and the client's feelings to determine whether to terminate therapy. Of course it is possible that the client might feel he or she is ready to terminate when my estimation is that this is not the case. In such a case I would suggest a trial period and keep regular contact with the client.

Key Concepts and Therapeutic Approach

In my therapeutic practice, I specifically draw from four therapeutic theories in order to integrate my own approach. These include the Psychoanalytic, Person-Centered, Existential, and Gestalt Therapies. Each theory has valuable aspects upon which I draw to form an integrated approach to be of optimal help to my clients.

In psychoanalysis, I am not a very big adherent to Freud's analytic theory in terms of human sexuality. Indeed, his tendency to see sexuality as the basis of all human behavior appears somewhat narrow, particularly in the complexities of the mind. Furthermore, I cannot reconcile myself with the idea that all women envy men for their sexual organs, or that all boys want their mothers as lovers. What I do gain from this is however that the therapist can never approach a case from a basis of a single viewpoint. Instead, the whole of human experience - both psychological and physical - and furthermore the way in which these interact to form the particular individual of each particular case. The point of therapy is not to impose generalized theories upon individual cases, but to use relevant aspects in order to reach the core of each individual problem.

My problem with Freudian psychoanalysis is then basically that the sexual aspect encompasses everything. Sexuality is part of humanity, but does not dictate the whole of human life and behavior. Furthermore, I find the idea of the id, ego, and superego as delineated by Freud somewhat simplistic. I am more in agreement with Carl Jung, who places greater emphasis on the subconscious and its impact upon human behavior, including sexuality. While Psychoanalysis is therefore a good starting point for a therapeutic approach, my personal approach is to use it as a springboard for further ideas.

The theory that I feel most comfortable with is Person-Centered therapy. Its simplicity and focus on the client are the elements that make me most comfortable with this theory, and I therefore also use it to the greatest degree in my approach. In my view, Person-Centered therapy, in my view is most relevant to therapy and the theory of humanity today. Particularly, I am attracted by the fact that therapy is the responsibility of the client rather than the therapist, and also the fact that the therapist builds an open and honest relationship with the client. I like the idea that the therapist is an instrument in the pathway towards healing, rather than the "oracle" from which the client is somehow to receive healing like a holy grail. In person-centered therapy, the focus is on a more equal relationship between the client and the therapist.

In terminology, I also like the idea of "clients" rather than "patients," although this is not imperative for me. In particular, I feel that the point is to let the patient or client decide for him- or herself which terminology and method is most comfortable on the way towards healing.

A more important point is the emphasis on attitude. Whereas Freudian therapy strikes me as somewhat biased, particularly against the female paradigm, I feel that the positive and open attitude of the person-centered therapist is much more conducive to honesty. Honesty is for me at the basis of an effective therapist-client relationship.

In Gestalt therapy, the most important element for me is dialogue, which combines well with the attitude aspect of the person-centered paradigm. Effective dialogue is based on a positive and honest attitude.

Finally, the main element of existential therapy that I use in my integrated approach is its honesty regarding the human condition. While some of its aspects are decidedly negative, particularly in terms of the meaninglessness of a life that ends in a mysterious death, I do find that this very negativity provides a valuable balance and honesty from which to view the condition of the patient.

In integrating the above four theories, I will then use person-centered therapy as my point of departure, and combine it with what I view as the most important aspects of the other three. In starting my session with a client, I would therefore begin by a simple conversation. I approach such a session as forming a new friendship, and try to connect with the client on a personal level. I will determine what is interesting about the client, and what is important to him or her. During this session, I will then listen carefully for clues regarding issues that the client would like to address during future sessions. I will end the session by explaining to the client what I have observed, and asking whether they agree or disagree.

While the above is basically a client-centered approach, I will integrate the idea of the subconscious in psychoanalysis, the dialogue of gestalt therapy - particularly at the end of the session - and the basic honesty of existentialism. In this, I will focus upon accepting the person in an all-inclusive and honest manner in order to promote honesty from the client during the sessions as well.

In terms of informed consent, I will explain my basic approach to the client only at the end of the first session in order to encourage spontaneity during the session. I believe that therapy will be most effective only if I can encourage my clients to spontaneous during our initial conversation. At the end of the session I will inform the client of my intention for future sessions. I will also encourage further dialogue relating to what the client believes should be the focus of further therapy.

Therapeutic Goals

As mentioned above, my main focus is person centered, and therefore a large amount of therapeutic responsibility will be that of the client. As therapist, I will however not completely relinquish responsibility for the therapeutic process, and I therefore believe that goal determination should be a collaborative process between myself and the client.

At the end of each session, the goals for future sessions will be determined, while those from previous sessions will be evaluated and revised, if necessary. The client will have a large amount of control, in that he or she has to be in complete agreement with the goals in order for therapy to continue effectively. The client will also have complete freedom to change or add to the goals as necessary.

Goal determination in my approach is a very good way to help the client assume responsibility for therapy and eventual healing. In order to facilitate goal directed behavior, I will then help the client by strategies such as naming and writing down goals for use in everyday life. Together, we will determine goals to reach outside of therapy. These do not necessarily relate to therapeutic goals. The ideal is to help the client become aware of the necessity of setting and reaching goals; in effect, to help him or her form the habit of reaching goals.

Central Techniques and Methods

My techniques and methods are based upon the client centered approach, while using gestalt dialogue for problem diagnosis and goal setting. Rather than setting myself apart from the client as therapist, it will be my goal to create for the client a basis of friendship from which to approach and solve problems. It will therefore not be a basis of therapy for its own sake, but rather of an honest relationship to use as a springboard for problem solving and goal oriented behavior.

Conversational techniques are used to determine the way forward for further therapy. The client is given full power to determine the course of therapy throughout each session. The therapeutic process is therefore determined by the client. The relationship is also collaborative, however, and as therapist I provide the client with input on how I believe the therapeutic goals can best be achieved. This is however not done in an authoritarian way and the client is at all times welcome to provide criticism and suggest modifications to my input.

Because the client is the one with the specific problems to be treated, I believe that the client knows, either consciously or subconsciously, the best way to deal with these problems. As a therapist, it is therefore my goal to help him or her arrive at such solutions.

Resistance

Of course it is also possible that my clients will come to therapy with considerable resistance. This is a significant problem that has to be eliminated at the beginning of therapy. Resistance opposes the benefit of therapy, and could result from a variety of sources. One major source of resistance could be the fact that the client does not believe that he or she needs help, and was entered into therapy by a concerned family or friend.

In order to understand resistance, I will therefore attempt to determine from the client its source. If the source is an influencing person, I will schedule a therapy session with the persons involved and encourage dialogue to resolve the resistance. This might take one or several sessions. If there is no person involved in the resistance, I will attempt to understand it via dialogue with the client. Further dialogue will then be used to resolve such resistance for therapy to continue. During such conversations, an attempt will be made to project an attitude of acceptance towards and empathy with the client.

Conclusion

Clients come to me for assistance with issues in their lives. I attempt to show them complete acceptance; whatever their situation and however terrible their world view. By accepting how they feel, I believe I create for them a safe situation in which to share their feelings regarding the world, life, and how they experience these.

While I believe that the client-centered approach is most relevant for the 21st century, I also believe that other therapeutic approaches have great value to offer. In order to help my clients find the good in themselves in order to live effective and happy lives, I therefore follow an integrated approach that include elements of psychoanalysis, gestalt therapy, and existential therapy. In this way, I am able to use the best of what therapy has to offer and impart it to my clients for their benefit.

I believe that therapy today can be revolutionary in a way that was never possible before. Clients can benefit from the best that therapists have to offer. The first step in this is taking responsibility and seeking help. Resistance is directly opposed to taking responsibility for healing. The first steps towards healing are then to remove such resistance. At the end of therapy, the client-centered approach provides a basis of friendship that can help the client beyond the therapy sessions themselves.