Fairly often someone writes to me asking about how to gather information to determine what the structure of the problem is, and what intervention to use. “How can I decide what to do when, and which method to use?” This is a very important basic question, and I want to offer a few thoughts in response to it, and some alternate ways of thinking about it.
When you have a number of different interventions that work for different problems — and not for others — it is important to make sure that the solution is appropriate to the problem. In contrast, many therapists still use a “one-size-fits-all” method, so they don’t have to gather information at all; they simply launch their one intervention and hope that it works.
For instance, Gestalt Therapy — which I was deeply involved with for about ten years back in the 1960’s and 1970’s — always involves fully experiencing and identifying with different aspects of a conflict in the present moment. That works pretty well for grief, in which the client feels separated from the lost person, because in the two-chair process they can fully experience reengaging with the special feelings they had with the lost person. But Gestalt has no impact on a phobia, because the client is already fully experiencing the terror in the present — the solution offered by Gestalt is the same as the problem.
Now let’s take a look at the presupposition in the word “the” in “the problem” — that there is only one problem. Some limited problems have a structure that can be resolved with a single intervention, and this is true of most phobias and many simple habits or responses. A problem like a phobia that occurs only occasionally in a limited set of contexts will usually have a simpler structure and will be easier to resolve. A problem that occurs in a wide range of contexts is more likely to result from a combination of factors, or from a key element of someone’s functioning, such as decisions, motivation, the way they organize time, or a part of their identity.
Sometimes a single inappropriate structure may have many different problematic results, so when you change that structure, a number of seemingly unrelated problems resolve simultaneously. Changing someone’s personal timeline often does that. For instance, a timeline that is stretched out in space, so that images of tomorrow and yesterday are always a block away, will cause someone to disregard past mistakes and future consequences, and pay more attention to the immediate present. This will tend to have a large number of consequences, including strong motivation toward pleasure in the present, vulnerability to temptation, and a poor ability to hold a job or stay with a task that is not pleasant in itself, but which promises future rewards. With a more compressed timeline, those images of tomorrow and yesterday will be closer and larger (and often brighter and more colorful) so they will have much more impact on present decisions and motivation.
But most people don’t have one problem, they have several, and some have quite a lot of them. What may seem to be a single problem may have many different separate aspects or elements, and each of them usually requires a different method to resolve.
For instance, in PTSD, there is usually what I call the “phobic core,” a memory of a terrifying life-threatening experience, often a “frozen” momentary image that appears in “flashbacks” in response to sensory triggers. But usually PTSD also includes other aspects — guilt, shame, grief, regret, anxiety, hypervigilance, violence, etc., and the client often experiences them as a single tangled mess. My online video streaming program, The PTSD Training, demonstrates how to tease these different aspects apart and work with each of them separately, so that each one can be worked with using an appropriate method. (The introductory discount for ordering this program—with no risk money back guarantee—is available through January 31.) My other online streaming video program, entitled Releasing PTSD, demonstrates how to do this in working with an Iraq vet over 4 sessions totaling 9 hours.
When I’m teaching a particular pattern or intervention, I don’t have to gather any information; I simply ask for someone who has the kind of problem that the intervention is designed to work with. I ask for someone who is grieving, or has a phobia, or has difficulty making decisions. Occasionally the volunteer has a different experience of the words I use — for instance, they have anxiety, rather than a phobia — but usually there is a good match, and what they have is appropriate for the intervention I want to demonstrate.
This suggests a possible alternate way to work with a client, particularly for a beginning therapist, or someone who has only a few methods available to them. Rather than beginning with a general inquiry about what problem(s) they would like to resolve, or what outcome(s) they would like to achieve, and then gathering more detailed information, you could try a different approach.
You could make a mental list of the different methods that you know, and what problems they resolve, and then do the same thing I do in a training — ask your client if they have a problem for which you have a dependable solution. “Do you have a phobia? Are you troubled by grieving over a loss? Do you have anger or resentment that interferes with your life? Do you have anxiety in certain contexts? Are you ever troubled by regret?”
When the client answers “Yes” to one of your questions, you can proceed to offer them a method that is appropriate, with a high probability of success. Rather than risk getting lost in endless information-gathering and possibly getting “over your head” trying to solve problems for which you are not well prepared, you can offer them a sort of smorgasbord of what you know how to do dependably.
This approach is particularly useful with a client who is in a major muddle, and doesn’t have much idea of what they need. Your list of problems may include one that they hadn’t thought of, or that they assumed was not something that can be solved, so they wouldn’t think of asking for it. If a client doesn’t realize a phobia can be cured in one session, they won’t ask for it.
There are a number of advantages to this approach. You can be more confident of being useful to a client, knowing that you can deliver results rapidly when working with the kinds of problems you know how to solve. When the client gets results quickly, that delivers value, and builds rapport and the likelihood that they will return to get resolution for other difficulties. In the process of solving one problem, others may emerge, and you may get information about other aspects of the person that is useful in making other changes.
However, this approach would not be as appropriate with a client who already has a pretty well-formed description of their problem or outcome, because they might feel that you are ignoring that, so it’s important to maintain rapport, or use a different approach with them.
Yet another way to work is to become fluent in several fundamental processes that often underlie so many problems, such as decisions, motivation, timelines, and identity. Then when a new client comes in, you can listen respectfully to how they describe their problem, and if you know how to resolve it, proceed to do so. But this would only be a sort of preamble to saying, “I have found that if I investigate certain fundamental skills that everyone has and needs, I can be of more use to you more quickly in helping you with the specific problems that you are concerned with,” and then gather information about how they make decisions, how they motivate themselves, how they represent the flow of time, or how they think of themselves, and offer any useful changes you can identify that would be useful. (There is an introductory chapter on each of the first three topics in Heart of the Mind,and a whole book about the fourth, Transforming Your Self.
Making changes in any one of these four basic processes may even solve the problem that brought them to you, or it may resolve other issues that they may not have recognized, or which may not have been in the forefront of their experience. At the very least it will be interesting, and offer important clues about what else might be useful or not useful to explore further.
To summarize, you can gather information about the presenting problem or outcome, you can offer a sort of smorgasbord of different specific changes for the client to choose from, or you can investigate some very basic processes that are likely to be useful for every client. And you can always combine these different approaches, or move smoothly from one to another as the session unfolds, making it less likely that you will ever get stuck in any one of them.
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