Design thinking principles & the therapeutic alliance

There is something about being a designer that is aspirational. We hope and dream for something better, to create something that makes impact and leads to change. We create out of raw materials, with the resources at hand. We build. We research and identify patterns. We solve problems. There has been a lot of attention towards social innovation, a novel solution to a social problem that is more effective, efficient, sustainable, or just than current solutions. While this is a human-centered approach that I am passionate about and will also cover, the emphasis is primarily on larger groups. What I am concerned about in this series is matters of the heart, mental and emotional health and well-being that starts on a deeply individual level.

We are meaning seeking creatures. Many seek therapy looking for answers on how to live, but first therapy addresses the why questions. Why do we live? Why do we do the things that we do? In therapy, great emotional work is demanded from the practitioner. Therapists come from many schools of thought and integrate various techniques in their practice to work with patients to make change happen. While there are many forms of therapy, such as CBT, family systems therapy or EMDR therapy, (see therapy list) the aim of therapy is to help the patient cure him or herself. Looking at it another way, the patients are the change agents, and ultimately are the ones responsible for re-creating their thoughts, their attitudes and their lives. In both design and therapy, there must be a willingness to empathize and get messy, to enter into chaos so as to bring order.

I’ll give a very brief overview of psychotherapy which is talk therapy, and the design thinking process as we lay a foundation to explore the synthesis of both in greater depth. For more information, there are great resources for design thinking over at IDEO U, Standford’s d-school and Hasso-Plattner Institute. For more information on psychotherapy, Goodtherapy is a good place to start, as well as Irvin Yalom, a contemporary psychiatrist and educator who has written extensively about existential psychotherapy.

Design Thinking

Design thinking stems from a mindset of empathy, collaboration and experimentation. It is a problem solving approach focused on creating experiences to address people’s needs. Here are four design principles laid out by Christoph Meinel and Larry Leifer, of the Hasso-Plattner-Institut-Stanford Design Thinking Program.

The design process is by no means linear, but it does follow these 5 general phases: 1) empathize with and engage customer needs, how they think and feel, 2) define the challenge and opportunities, 3) ideate and brainstorm based on insights gained, 4) prototype to think through and answer questions, 5) test out your hypothesis and get feedback. As you progress, the process narrows until you reach a solution and are ready to execute. Meaningful and innovative design happens at the intersection of desirability (making people’s lives better), feasibility (achievable) and viability (able to work successfully). Looking at IDEO U, I think their 4 phases of design thinking would translate well to the therapeutic realm.

Therapeutic Alliance

The therapeutic alliance, also known as the therapeutic relationship, helping alliance or the working alliance, refers to the relationship between a healthcare professional and a client (or patient). It is the means by which a therapist and a client hope to engage with each other, build trust and effect beneficial change in the client. Carl Rogers (1902–1987) was a humanistic psychologist who believed that for a person to achieve self-actualization they must be in a state of congruence. He pioneered Person Centered Therapy, based on his theory that each person has the capacity and desire for personal growth and change. A patient needs an environment that provides them with genuineness (openness and self-disclosure), acceptance (being seen with unconditional positive regard), and empathy (being listened to and understood). Rogers believed that we can all achieve our goals, wishes and desires in life.

Irvin Yalom affirms that the capacity to tolerate uncertainty is a prerequisite for the therapy profession. (design connection: see the ambiguity design principle in the first diagram) The temptation to achieve certainty through a certain ideology or therapeutic system only serves to block the uncertain and often spontaneous encounter that is vital for effective therapy. This encounter insists that as the therapist enters into the life of the patient, the therapist would be affected and perhaps even changed by their therapeutic encounter. Patients can sense genuine care and compassion — it is the person of the therapist that most impacts a therapeutic relationship. In both therapy and design, how much we care matters.

Finally, I love what interior architect Ilse Crawford has to say about design. “Design is not just a visual thing. It’s a thought process. It’s a skill. Ultimately, design is a tool to enhance our humanity. It’s a frame for life.” What are the particular ways in which we frame our lives? How can design impact our emotional lives, our lens through which we view our worlds?

*note: I used an image of a Holi Festival symbolically, as this festival of colors celebrates the triumph of good over evil, and is for many a festive day to meet others, play and laugh, forget and forgive, and repair broken relationships. I also wanted to represent the joyful blend of design and therapy in this mixture of colors.