ACA Blog

As clinicians we undoubtedly do everything we can to help our clients. Many times this help comes in the form of “traditional” talk therapy and related interventions but there are times when behavioral interventions alone will not do the job. There are times when level of anxiety, depression (the most common reasons many enter treatment) reach a level that a client will need to be assessed for either short or long term medical interventions.

We counselors have an almost impossible challenge: on the one hand, if we come to a counseling session with a particular diagnosis or theory or plan, we are likely to be blind to what does not fit that diagnosis or plan; on the other hand, if we come completely ‘open’ we are likely to miss patterns that give clues to understanding our client’s problems.

I am not one that ever wanted to be classified as a psychometrician though I did study school psychology and have done my share of testing. It’s funny though that in so many of the psychometric protocols they use the term “normative range” to define behavior that was normal, abhorrent, adjusted, maladjusted, average etc. I remember those days and just had a thought. In light of today’s social and political climate, the back stabbing, back biting, viciousness, endless lies and innuendo compounded by years of “reality” tv shows and the glorification of people who you would never want to live in your neighborhood (planet?) that perhaps we need to take another look at these instruments to make sure that they in fact reflect society standards. I imagined a few scenarios and wanted to share one of them.

After a few sessions, a client I’ll call “Paul” looks at me with tears in his eyes and says, “I wish I had known this years before. I can help myself if I learn to watch my mind—it’s so simple that it’s almost silly, but what a difference it makes for me.”

We counselors have an almost impossible challenge: we have to facilitate a client into more functional and satisfying behavior patterns within a system that strokes dysfunctional behavior. From the very first, clients come to us (or are sent to us) because they are (or someone else is) dissatisfied with some aspect of their functioning—this very act is a process in which dysfunctional behavior results in lots of attention—lots of strokes. We as counselors are challenged to help them develop other behaviors which are more functional in getting strokes, all the time giving them attention because they have a problem. People don’t come to us because they are happy or successful or satisfied with their relationships or job or life in general—those sources of strokes that make individuals ‘winners’.

It was going to be a tough case. During intake, the client had been particularly resistant to any sort of disclosure. To be honest, given his tight-lipped demeanor, I was not really sure why he sought therapy. His unwillingness to do more than moan and just sit there expressionless, near-catatonic, dead to the world, made me believe something was not as it seemed and there were deeper issues at play.

Many of you reading this are likely doing so just to find out what the heck I am talking about. I would guess that the majority of you have never heard of many of the words in my title. You may feel a bit lost, confused and possibly frustrated; I assure you that this was by design so that I could illustrate my point.

Two pioneers of positive psychology are psychologists Martin Seligman from the University of Pennsylvania and Mihaly Csikszentmihalyi from Claremont Graduate University. They began to communicate their definition of positive psychology around 1998. From their view, since World War II, psychology had become a science largely about healing mental disorders. It concentrated on repairing damage within a disease model of human functioning. In contrast, the aim of positive psychology is to begin to catalyze a change in the focus of psychology from preoccupation only with repairing the worse things in life to also building positive qualities. Their prediction is that positive psychology in this century will allow psychologists to understand and build those factors that allow individuals, families, and communities to flourish, not just endure and survive. As a side effect of studying positive human traits, science will learn how to buffer against and better prevent mental, as well as some physical, illnesses. For the purpose of this blog entry, I will quickly review the concept of well-being theory that is proposed by positive psychology which can be used as another useful tool for the counselor’s toolbox.

I was called in to meet with the psychiatrist with one of my clients the other day and we were discussing her symptomology. I had done the assessment on this client, and because Medicaid wants a diagnosis pretty much minute one, I had given her the diagnosis of major depressive disorder. First off, let me say that I did so because I think it was the least restrictive one I could have given her. Secondly, I could probably write an entire blog about my feelings about Medicaid and the way it runs, but that is a battle for another day. Anyway, when I got into the room with the psychiatrist and all three of us started talking, it was very clear that the client exhibited much more bipolar II symptomology rather than atypical depression. What I had considered as triggers for bad behaviors were indeed triggers, but they were more than likely triggers for her manic episodes. It was important to make the right distinction because medication choice relies heavily on whether or not she is depressed versus bipolar. So, I was incredibly thankful that the psychiatrist had caught the things I missed.

Last week I blogged about how the DSM axis II so-called personality disorders could be understood as the most negative aspects of those personality adaptations which we all learn in the first few years of life in order to survive this strange, new world. I find them fascinating and extremely useful. Research indicates they are real. But their real benefit comes from the fact that they can be used to rapidly diagnose a client and develop a precise treatment plan. Rapidly means 3 to 5 minutes after meeting a client, a counselor can pretty well know what issues a client is dealing with that keeps that client from making the changes they need to make to resolve their problems.