Monday, June 17, 2013

Counseling: Sunlight on Water

Myths about what happens in counseling abound, and are sadly inaccurate.  Like many processes, counseling loses its essence when reduced to individual steps in an attempt to convey its mechanics.  I don't read minds, although I am good at asking people in many different ways to read their own.  I don't tell clients what to do.  I don't "fix" people.  I don't give advice.  I don't provide absolution.  I don't give false hope.  I don't analyze people like they are a science project.  I don't play games.  I don't give you a label and send you on your way.  I don't tell clients what they want to hear, and sometimes I tell them things they very much do not want to hear, but I try to do it when they are ready to at least try.  More often and even better, clients end up telling themselves, I just provide the space.

My professional identity is founded on the notion that I am something akin to a purveyor of opportunity. When clients come for counseling, I see that as an opportunity (and a privilege for all involved). Some people do not have access to the opportunity that therapy provides, for example it is beyond their financial range perhaps or maybe they are simply not interested in it. However, when a person seizes the opportunity, I provide them with more. The client may not know where to go, or rather, they do not believe they know. I do not show him or her the path, I reflect many paths and illuminate different things. I do this by using the information he or she provides and the knowledge we develop together; the client chooses the avenue we explore. I envision therapy as being sunlight on water. Not the sun itself or the water but the interaction of the two. The sunlight warms the water, illuminates it, reflects upon it but remains stable while the water moves and flows. I also believe that therapy is more about growth or promoting growth than anything else. This frame helps respect the process of therapy and the work a client does.

The second layer of my professional foundation is the concept that therapy is most effective when there is a convergence of person, place, and time. I call this the "Confluence Theory of Counseling". This incorporates a person’s willingness to change, which stage of change he or she may be in, the therapeutic match between client and counselor, and a client’s life events and external factors among other things. I believe that growth can happen when these factors are misaligned but it is most effective when they meet. Given my clinical experience working with involuntary clients, I would say that sometimes the convergence takes place after a therapeutic relationship is established.

This layer of foundation is also mixed with my belief that everyone can grow. While everyone can grow, not everyone takes/can take advantage of the opportunity to grow. The reason a person might not grow at a certain time is because he or she has not experienced an overlap of factors yet. In addition to the belief that everyone can grow, I firmly believe that everyone deserves an opportunity to work toward mental health and growth. Inviting clients to grow by offering them an opportunity to share in a safe space is my short definition of counseling.  One of the other core beliefs I have regarding counseling is that mental health and mental illness are not dichotomous with each other.  It is entirely possible not to have a diagnosable  "mental illness" and still have poor mental health.  Conversely, it is completely possible to have a diagnosed "mental illness" and have impeccable mental health.  Just as physical health is comprised of a more global, general wellness, so is mental health.  The failure to recognize this distinction is one of the most limiting and harmful misconceptions about counseling and mental health.  

The two pieces of my foundation were distilled from reflection and experience. It was my work with sex offenders that prompted me to think about the necessity of a convergence of person, place, and time. Some of them take to therapy well, utilize it as much as they can and make an effort to grow. Conversely, some are cognizant of the fact that they need to change their lives and one way of doing that is through treatment but they resist it. It might be that they are in the right place geographically/physically (a treatment facility) and the right time developmentally but there is a personal reason that is keeping them from fully engaging. For individuals still imprisoned, they might be in the right place personally but the space and time are not conducive to growth. There are multiple possible combinations, and I have seen many of them.

I have found that almost everything that people come to counseling for, and one of the largest controllable factors that stops people from seeking counseling, is fear. Fear of failure, fear of exposure, fear of betrayal, fear of relationships, fear of confirmation (aka fear of rejection). The fear of confirmation is a more accurate descriptor of why rejection is painful, I think. When we are rejected, it confirms all of the insecurities and negative perceptions we hold about ourselves. A rejection confirms that we are stupid, unattractive, not good enough, damaged, unequal, inferior, a terrible person...crazy, weak etc.  One of the really nice things about counseling is that a person gets to explore these concepts and decide which ones are actually worth paying attention to.

It is important to note that while I strongly believe everyone can benefit from counseling, sometimes that benefit comes at an initially painful and challenging price that some people cannot move past.  In short, sometimes people feel worse in counseling before they start to feel better.  As a client typically has full decision making power over continuing in counseling, sometimes they stop before coming to the other side of distress.  We have psychological defenses for reasons.  If they are not examined carefully, with respect to the protection they provide, harm is possible.  To undergird the removal or restructuring of the defenses is an integral part of what a counselor does in session.  These concerns are also a large part of why Counseling Psychology has a code of ethics, and a central ethical duty of Psychologists is gatekeeping.

It can be intimidating and uncomfortable for many people to recognize the responsibility and power they have over their functioning. Many people fail to make this distinction regarding counseling. Counseling is not for the benefit of the therapist. Sometimes in an effort to "best" the therapist, some people manage to outwit themselves in counseling, not realizing that by being guarded and indirect they are only impeding their own progress. Someone with a cracked tooth would be ill-advised to visit the dentist and provide inaccurate information about their situation. A lack of openness with their dentist would likely result in a lower quality of care, and a lower quality of life as a result. It is no different with counseling. The most effective way of sabotaging the positive effects of counseling is by not engaging openly, or by being a less genuine form of oneself. Therapists don't "fix" people, a) because someone seeking counseling is not "broken", ever, and b) it's the client who makes or breaks the growth process.  Counselors attend to the client's empowerment, and their willingness to make changes.  Ethically, if someone seeks counseling but remains resistant to the process, a frank, and often powerful, discussion about reconsidering counseling at a different time in life should happen.

One of the most integral realizations from my professional life that has impacted my conceptualization of counseling is what function a therapist serves. Each practitioner has their own style, and theoretical orientation.  However, it has been my experience that people working in mental health are frequently labeled “helping professionals.” This is problematic for me in many ways, although I appreciate that the label is not meant to be, and is instead supposed to be representative of something positive. In my professional perspective, I am not a helper. Helper implies that someone is unable to do something and that he or she must have assistance. It also means that there is something fundamentally wrong that must be rectified; a helper helps the person fix him or herself. I also feel that “helper” debases the therapeutic relationship, i.e. it does not respect the profound nature of people connecting in such a way. For me it is a partnership and there is tremendous work, most of which is done by the client. To say that it is “helping” discounts that perspective. I am also not a guide necessarily, it is not my journey although I am a part of it. How could I guide someone on their path? It is not about me guiding them, it is about opportunity.

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