After finishing my last blog in which I discussed how the metaphor we choose to guide our ethical thinking affects how we decide what to do, I was struck with an epiphany. Much became clear. Maybe I’m just a little slow and others already realized it, but I’m using the opportunity of this blog to think through some of the implications of this insight.
In the business of changing individuals, people seem to choose one of 3 main models used to guide their process and choice of techniques.
The first model, which is not used much anymore in counseling at least, uses a kind of legal model. It assumes that there are certain laws that are required to be followed and if you don’t follow them, you will get punished. And by being punished you will decide to change your behavior. In the 60’s and 70’s this was a prevalent attitude toward criminals—if the punishment is severe enough, your will change your behavior. It was also the assumption of many encounter groups of the 60’s and of boot camps for correcting behavior—especially that of defiant youth. It was also a popular way to deal with alcoholics. It still is advocated as a way of ‘breaking the will’ of kids and youth in some faith communities. Note that this is not behavioral modification because its only tool is punishment, not rewards. If I speed and get caught, I get a ticket; if I don’t speed, I don’t get anything. As the prison recidivism rate shows, this does not work—and in fact some evidence indicates it makes things even worse.
However, there are two other distinct models used in counseling and the one I chose largely guides the processes and contents of my counseling.
The most prevalent model assumed in my graduate school (and, I believe, by most counselors) could be compared to the refurbishing of an old, perhaps historic, house. Using this model, the counselor develops a picture of what the house (client) could be to make it beautiful, functional, efficient, etc. When a counselor says they take a holistic approach to counseling including
thinking/feeling/behavior/spiritual/body, they are describing their picture--what their goal will be.
In order to achieve this ideal, the present condition of the house must be carefully studied. The diagnosis from the DSM and most diagnostic tests are ways of identifying what is wrong with the house and needs attention. A thorough intake includes gathering information about every important system in that house—plumbing, electrical, roof, paint, structure, etc. That way all the problems that must be dealt with can be identified. A client I once had told me that a psychiatrist told him he had 6 things wrong with him; I cringed.
Furthermore, different techniques have been developed to correct different problems of different systems that might be found. I have seen intake forms that are 10 pages long that take more than an hour to administer and diagnostic tests that are several hundred questions long (like the MMPI). Intakes are often done by individuals who are different from the counselor who will be treating the client—like the mechanical inspector of a house who is not usually the person who fixes any issues found.
Handbooks have been written with scripts which a counselor can follow for dealing with simple problems. For more involved problems, the counselor must be trained to deal with that particular difficulty, say the plumbing or electrical system, or needs to refer the client to another counselor who has the skills.
Throughout the entire refurbishing process, the counselor continues to explore all aspects of the client’s life that might affect the total outcome and the more a counselor learns about the house, the more effective he or she can be. Open-ended questions are better than closed ended questions; as new issues arise, it is important to explore them because they may have an effect on the refurbishing project. More than once I’ve heard a supervisor advise, “That would be a good issue to explore.” By doing so the process keeps moving toward the ideal and the counselor can put in the notes, ‘progress is being made’. Although the ideal can never be achieved, as anyone who has refurbished an old house knows, after enough progress has been made, the work ceases for a time.
Another entirely different model has been gaining more popularity recently. This model considers the counseling encounter as a dialogue—a communication model. The client “speaks”; the counselor listens, discerns the meaning of what is communicated and responds appropriately. From this process of speaking, listening, responding, change emerges. Some call it a ‘listening’ cure, the counselor being a kind of witness to the life of the client because the critical element is for the counselor to listen to everything the client is communicating each time he or she “speaks”—with their mouth, their face, their body, their subconscious, etc. If the person is coming in for counseling, usually more than one “person” can be “heard” speaking. The counselor must be sensitive to hear all of them as they present themselves and to respond congruently to as many as he or she can. Milton Erickson was the champion at this communicating on several levels with the client. Transactional Analysis (TA) and some “strength-based” counseling also offer ways of doing that. The assumption is that every individual wants to be healthy and integrated physically and mentally however sometimes dysfunctional forces keep them from living the way they want to. By decreasing the stress from such barriers, this unique client (or should I say ‘these clients’) can naturally actualize their own unique potentials.
One of the most important preparations for using this ‘listening cure’ is the clearing of myself from any preconceptions which might prevent me being sensitive to what the client is saying. But many of the courses in graduate school (e.g., multicultural awareness or developmental theories or preferred counseling techniques), many research papers (how the brain of extroverts differ from introverts) and most diagnostic tests were actually counter-productive—they set me up to be prejudiced. The purpose of these courses seems to be to “make me aware” of this aspect (e.g., because of Hispanic culture) or that possibility (because of the way morals develop) but basically they tended to cloud my mind and keep me from being fully present with this client in front of me at this time and in this place. When the person in front of me has darker skin or is wearing a cross or is a male wearing a dress, all of that my educated ‘awareness” can only interfere with my ability to hear what this particular individual is telling me. Understanding is primarily an act of detecting the impact the client wants to make on me as he or she responds to me. But if I already have studied the ‘Asian culture’, my sensitivity to this Asian-looking individual has already been compromised.
Each individual is unique and each counseling event is unique. The next time I see this ‘same’ individual, they are, in many ways, different and so am I and a new dialogue is created. Who we are is affected by the circumstances we are in and who we are with.
A couple of personal experiences will describe what I mean:
My IQ ranges anywhere from 60 to 140. When I was taking introduction to psychology 101 in college, a doctoral candidate invited students to take part in a research project he was conducting. Part of that research involved giving an adult intelligence test which included 10 math word problems. He was to read the question and time how long it took (up to 10 seconds) to answer. They were straight-forward questions like ‘If you bought 4 five cent stamps and 3 one cent stamps and 2 ten cent stamps and gave the clerk three quarters, what change would you get back?’ I would give the answer immediately after he finished reading the question, before he had a chance to start his watch. This was a skill I developed in high school working at a drive in restaurant when the customer would order, say, 2 hamburgers, fries and a small coke. I would write the total cost on the bill immediately. Unfortunately this grad student after 9 of these problems said something about how fast I was doing them because he was not get able to get the ‘time to solve’ required by the test. But his remark ignited all sorts of strong feelings in me so that when he read the 10th problem, I had no idea what he was saying and after 10 seconds, I had no answer but I was feeling terrible! My IQ dropped precipitously.
Another example: I really like the Meyers-Briggs Personality Inventory as a way of understanding how people interact with each other in certain contexts. When I took it at work, I came out to be a clear ESTJ; but when I took it in my faith community, I came out a strong INFP. In both contexts I was choosing what would be most appropriate. In a dialogue, each individual is shaped by the other person and it is a matter of choice. I choose to change the MB characteristics to act more appropriately in different situations.
Given this model of counseling, the first encounter I have with a client is critical. When I go into the waiting room and greet him or her, I have already begun my ‘intake’—that is, I have begun to create the dialogue of that counseling session. By carefully being aware of everything about how the client is responding to me, my intake should be fairly complete by the time we sit down together in the office. If the client presents with conflicting messages, the intake might take longer as I establish a dialogue with all of the ‘persons’ presenting themselves through this individual (think, for example, ‘ego states’ in TA or ‘strengths’ in strength-based counseling). There is no intake form to fill out—the only information needed is their name and contact information. Note that this information is their social identity—information needed to locate them in society.
One of the key differences between the two counseling models is the role of decision or choice. The first model assumes that a situation progresses, getting better and better—a higher GAF score. In a dialogue on the other hand, each transaction is an action chosen by the individual. This model assumes we decide to act one way or another. ‘Making progress’ or ‘exploring topics’ really don’t make much sense. I as a counselor chose responses which I think will help my client experience their own power so that they can make more appropriate decisions to think and act and feel. And how much time does an actual decision take?
I hope this brief sketch gives you an idea of the power that this epiphany has had on me and that you can identify which model you as a counselor assumes or which one guides the organization you work.
Since I find this second model more powerful for bringing about change more quickly, I wish my graduate program would have included courses in communication—specifically, communication in a dialogue. Some suggested couses would be: how to be completely present to another person; how to observe and communicate on several levels; how to read faces as Paul Ekman has taught us; how my unique personality affects different personalities differently; how different responses might bring about different effects; or even simply TA. More about communication and much less on content would have made me more effective as a counselor.
Ray McKinnis is a counselor with a special interest in 'spirituality beyond religion' and veterans 'beyond PTSD' with a website at counselingandcoachingforlife.com.