Essential for healing to occur
By David H. Kerr July 23, 2015
Instincts plus a balanced Caring Relationship developed with your client, may far out way what is learned by the traditional assessment, diagnosis and rote application of recommended counseling techniques. This is the belief of Psychiatrist Allen Frances who wrote the essay published in the July 7, 2015 issue of the “Psychiatric Times” – see Addendum below. I would agree with Frances but how you apply what you have learned to develop a natural conversation and relationship is “the art of healing.”
There’s no training that can overshadow the power of caring and the subsequent healthy and healing relationship that is established between counselor and client. Common sense? Sure but let’s not forget to use it! What we learn by life experiences and from books and formal training must be absorbed and communicated in a most natural way as if you are talking to your brother. If you apply “common sense” then your relationship will be guided and focused and “healing” rather than intimate or detrimental or pontificating. Every counselor must understand that “healing” comes from the heart, not the books or the libido.
Dr. Allen Francis concludes that "the major focus of the fact of therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship; they hurt when they distract from it."…
Francis goes on to say that "The paradox is that the therapists are increasingly schooled in specific techniques to the detriment of learning how to heal. The reason is clear; it is easy to manualize technique, hard to teach great healing."
Fanny Marell, an experienced Swedish social worker, licensed psychotherapist and friend of Francis, shares her input; "many therapists worry so much about assessing symptoms, performing techniques, and filling out forms that they miss the wonderful vibrancy of a strong therapeutic relationship."
Marell goes on to say that "If we focus only on troubles and diagnostics, we lose the advantage of capitalizing on the personal strengths and resources. Therapy without conversations about strengths and hopes is not real therapy."
Dr. Francis concludes his meeting with the following: “Thanks Ms. Marell, for terrific advice. Some of the best natural therapists I have known have been ruined by psychotherapy training, becoming so preoccupied learning and implementing technique that they lost the healing warmth of their personalities.”
I think that public funding and regulatory bodies should understand the truth expressed by Dr. Francis and Ms. Marell. Talking and listening to your client is informative and essential. However, without establishing a relationship with your client and expressing the healing warmth and human caring of your personality we may miss the basic ingredient of the healing process. Those effective psychiatrists and counselors whom I have known, understand that a caring relationship with their clients is essential for healing to occur.
My next blog is entitled: “An alternative to a degree as a measure of caring and competence”
The Magical Healing Power of Caring and Hope in Psychotherapy July 07, 2015 | Couch in Crisis, Psychotherapy By Allen Frances, MD
“Allen J. Frances (born 1942 in Thessaloniki, Greece) is an American psychiatrist best known for chairing the task force that produced the fourth revision of Diagnostic and Statistical Manual (DSM-IV) and for his critique of the current version,DSM-5. He warns that the expanding boundary of psychiatry is causing a diagnostic inflation that is swallowing up normality and that the over-treatment of the "worried well" is distracting attention from the core mission of treating the more severely ill. In 2013, Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests.”
There are 3 consistent research findings that should make a world of difference to therapists and to the people they treat.
1. Psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first
2. A good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used
3. There is a very high placebo response rate for all sorts of milder psychiatric and medical problems
This is partly a “time effect: People come for help at particularly bad times in their lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological —the body often actually responds to placebo just as it would respond to active medication (/basics/psychopharmacology)..
These 3 findings add up to one crucial conclusion—the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship; they hurt when they distract from it.
The paradox is that therapists are increasingly schooled in specific techniques to the detriment of learning how to heal. The reason is clear—it is easy to manualize technique, hard to teach great healing.
I have, therefore, asked a great healer, Fanny Marell, a Swedish social worker and licensed psychotherapist, to share some of her secrets.
1Ms Marell writes: Many therapists worry so much about assessing symptoms, performing techniques, and filling out forms that they miss the wonderful vibrancy of a strong therapeutic relationship.
Thinking I can help someone just by asking about concerns, troubles, and symptoms is like thinking that I can drive a car solely by looking in the rearview mirror. Dreams (/basics/dreaming), hopes, and abilities are seen out of the front window of the car and help us together to navigate the road ahead. Where are we going? Which roads will you choose and why? It surely will not be the same roads I would take. We are different; we have to find your own best direction.
If we focus only on troubles and diagnosis, we lose the advantage of capitalizing on the person’s strengths and resources. If I am to help someone overcome symptoms, change behaviors, and climb out of difficult situations, I need to emphasize also all the positives he brings to the situation. Therapy without conversations about strengths and hopes is not real therapy.
And often most important: Does the patient have a sense of humor? Laugh together! Be human. No one wants a perfect therapist. It is neither credible nor human.
Symptom checklists and diagnoses play a role but give me no understanding of how this person/patient understands his world and her troubles.
And don’t drown in manuals, missing the person while applying the technique.
People come to me discouraged and overwhelmed, their hopes and dreams abandoned. Early in our time together, I ask many detailed questions about how they would like life to change. What would you do during the day? Where would you live? What would your relationship to your family be like? What would you do in your spare time? What kind of social circle would you have? By getting detailed descriptions I get concrete goals (e.g. I want to go to school, I want to argue less with my parents, spend more time with friends).
Almost always, working with the family is useful; sometimes it is absolutely necessary. What would be a good life for your child? How would it affect you?
Sometimes dreams are big, perhaps even too extravagant; sometimes they are small and and perhaps too cautious. But dreams always become more realistic and realizable when they are expressed. Sharing a dream and making it a treatment goal helps the person make a bigger investment in the treatment and to take more responsibility for it. He becomes the driver and the therapist may sit in the back seat.
Because my first conversation is not just about symptoms and troubles, we start off on a basis of realistic hope and avoid a negative spiral dominated by troubles. Problems have to be faced, but from a position of strength, not despair and helplessness.
Having a rounded view of the person's problems and strengths enriches the therapeutic contact and creates a strong alliance.
Thanks, Ms. Marell, for terrific advice. Some of the best natural therapists I have known have been ruined by psychotherapy training, becoming so preoccupied learning and implementing technique that they lost the healing warmth of their personalities.
Therapy should always be an exciting adventure, an intense meeting of hearts and minds. You can't learn to be an effective therapist by reading a manual and applying it mechanically.
I would tell therapists I supervised never to apply what we discussed to their next session with the patient, lest they always be a week behind. Therapy should be informed by technique, but not stultified by it.