This past week I had some realizations about being a therapist and what might be needed for me to become more grounded in my approach. I wonder if it is what I probably should have done when I started. I wonder if it is how all therapists should start.

One day while reading a book on Borderline Personality disorder to better help a client, I was struck by my desire for deep meaningful work in a setting that is not necessarily set up for that, encouraging that, discussing that. So I did some journaling at work about my process of integration. I have grown more mature over the past couple years in how I see theories and my work overall. Working somewhere that doesn’t match my theoretical orientation does not have to be impossible. I just have to be creative in integrating them. I must work within a more medical, short term, problem solving model. This is not even completely against my own desires. I like problem solving and CBT and medical model approaches are not ALL bad. I think this limits one’s ability to operate in the world. But are those approaches enough when dealing with people’s lives? No, not even close.

So how do I integrate what might seem like competing theories? Well I have ideas about this. I guess I’ve had ideas about this for awhile but they always sort of stay ideas and I kind of try and keep them all in mind when I’m working with people. But I am starting to see, or at least wonder at this point, that this is part of my global issue in being the therapist I am, or have been.

A Container

Historically, I have not liked being pinned down. This can be applied anywhere in my life. Pick an area, and I’ve probably created processes where I avoid being trapped or overly committed. I have wanted to trust my own process of being with clients. I like being outside the box, not just doing what others tell me to do. I like to explore clients based on what is being said right there. I sort of work in a freestyle mode. This is not to say there is no theory involved — that would be naive. But when it comes to therapeutic practice, I have not immersed myself fully in one approach. I am going to get into the theories I favor in just a bit, but before I do that I want to address this idea of a container.

I’ve been listening to lots of Richard Rohr’s talks on YouTube during my lunch breaks. Rohr is a Roman Catholic Contemplative Psychologist. He isn’t an actual psychologist but I think he is a natural one, one that doesn’t need a degree. Anyway, one of his major developments is a Jungian idea of the first and second halves of life. Rohr discusses the first half as internalizing the containers within which we live. Usually these would be set out by the adults in our lives. When they are not, it causes problems which he addresses but I’m not going to get into that right now. The point of containers are to steep one’s self in values and ways of living that follow a sense of morality and almost “how to”ness. But the second half of life is to break away from that — not discarding it but growing from it’s confines. One can only really grow into the second half of life if they internalized a well structured container.

We see this idea in many areas of learning. Students must learn the basics and do as the teacher says until they internalize that well enough that they can now go off on their own and develop their own style. I believe much of my life has been “sort of” building containers. I never stay in any of them long enough to really internalize them as second nature. I’m not going to be black and white here because I don’t think I’ve not done this at all, but I can see where I have not done so enough when it comes to practicing psychotherapy. I’ve always wanted to go straight to my own style. Finding my way through the dark, so that it was fresh. I still like this idea. But I think I am coming around to the idea that I at least need to make what I find more explicit. I need to develop my own approach in writing, constructing my favorite theories and ways of being with clients, more formally. Not just kept in my head. I will say that I’ve learned a great skill in trusting what I read and think and how that will show itself when sitting with clients. But I’m seeing that I need to really develop a more specific approach. I’ve not called myself ecclectic, but really that is what I am. And really if that’s what I want to be, then I need to develop what that looks like more formally so that I have a container.

What I am realizing is that being more freestyle and processing things as they come sometimes leaves me and the client lost in the dark with no road map. Maybe “no road map” is too extreme because I still attempt to use them as the road map, even if it is in that moment. But I can also see that having a container to get inside at times would help my therapy with clients. Sometimes I think it needs to come back to some kind of focus or re-focus when we are lost. Especially in my current work where I must not get too far away from CBT. But I want to infuse CBT processing with more meaning-oriented and depth sensibilities, and if I want to do that, I need to actually develop this explicitly on paper. I have fought this idea for years. I think I’m afraid of the work. I like to just go with the flow. It’s what keeps me from formal education. I don’t like containers. I don’t like being pinned down. And at the same time I’ve learned enough about myself to know that I need them to feel safe and secure as well. I’m a 6 on the Enneagram and we tend to find security in these kinds of containers.

I like to do many things backwards and in my own way. So I have developed the ability to work in the dark for many years. I don’t stay strictly to analytic ideas, or structure my work around CBT worksheets, or only work with existential themes. I work with people through a variety of theories via my intuition. I also work with people atheoretically. I just talk until we find patterns or conflict or something that gives us a “handle.” I wouldn’t trade these ways of working for anything, but I can see that I skipped to what mature, seasoned therapists can do. I’ve wanted to be a great therapist without doing the necessary. I’ve been grasping toward Possibility and haven’t steeped myself in Necessity (Kierkegaard). I’m not going to get into the personal here, but it has been my own personal life that has calmed me and forced me to face Necessity. Now it is carrying over into my work and to be honest, it is kind of exciting. Totally backwards, but oh well.

Now I want to get into the theories that I jump around to because I see such power in all of them. I’m not really sure there is any theory I wouldn’t like to some degree and see its use. Nobody studies theories for years to produce no truth whatsoever. Everything has something to offer.

I’m going to list them and speak to what interests me about them briefly.

Existential/Humanistic
This governs my work. It is not a technical theory but a philosophical one. I appreciate the lens it provides. I value seeing people as whole people, not parts by which to be reduced. Why? Because that reduction can be invalidating to one’s whole sense of themselves. I care about humanistic values because honoring the person and accepting the person in front of me is necessary for them to grow. I think Carl Rogers’ work is more profound than people give him credit for. It isn’t philosophically rigorous but it is experientially powerful. The idea of accepting one’s self fully, even within the pathology one finds one’s self, is the most powerful shift that can happen in therapy if you ask me. I also really appreciate the acknowledgment of what all humans must confront that existential psychology provides. Our lives are always up against existence and sometimes up against more specific themes within that. Working through those and acknowledging that is also powerful. To honor the human being by exploring the fullness of human life, is to value it. It is this value that produces the acceptance of Rogers and the greater focus of existential care. Even within this lens and theory, I vary on my focus and what seems important. Sometimes I think just focusing on acceptance is most important and then other times I think existential analysis is important. I think those can be competing at times. They are still unique paradigms in themselves.

Psychodynamic
It was this theory that helped produce the greatest healing in my own life. It is what got me into this work before I even knew that is what helped me. Yes, this has a lot to do with working through childhood stuff, but it’s more complex and beautiful than that. It’s also about more than childhood. It’s understanding transference — a word that describes how the way we make sense of our experiences becomes our psychological life, the way we make sense of things. There are internal dynamics at play and the power of the unconscious. There are unseen ways we cope and process. At least they are “unreflected upon” (Stolorow). I don’t believe in the unconscious the way Freud developed it, but I still think Freud was a genius who in many ways worked with no container but developed one as he moved through the dark with his patients. Jung’s development of the collective unconscious and archetypes helps us to understand that there is a lot going on in the psyche of the human being. It has been impossible to work with couples and people in relatioship problems and not see unconsious patters driving them in paradoxical directions. I feel strongly that this cannot be ignored in therapy if one is to truly confront themselves.

Family Systems
I received my Masters degree in Marriage and Family Therapy from Saybrook University, a school of humanistic psychology. I had no real plan or interest in Marriage and Family work but this was the most clinical program they had in the Masters department. I am now very glad that this was my education because the systems element has proven to be a powerful element to my work, not only with individuals, couples, and families, but also in my understanding and analysing others systems like work, politics, etc. I love systems issues and trying to figure out the dynamics contributing to its conflict and struggle. There are always feedback loops between individuals and between individuals and the group. Each participant impacts others which impacts the whole. It can get complicated and can be anlysed through different systems theories. But it is the ongoing dynamics between people that interest me. When I work with couples I call it a dance and we spend time trying to understand the dances they are in which bring about the opposite of what they want. It isn’t about the content but the process. The interactional dynamics. And this is often when psychdynamics are at play as well.

Buddhist Psychology
Again, this lens helped me greatly in my own journey. I find it very helpful to neutralize tension and give one some space from emotional overwhelm. It has practices such as mindfulness that can be very beneficial when a person struggles to find grounding. Here is a long spiritual tradition, rich with confronting existence. It has a lot to say that is very psychological and would be stupid not to pull from it at times with clients.

Theology
I do not use this. I grew up with this in my home and have been on a personal journey regarding it. I don’t know if it will ever find its way into my therapeutic work, other than how it impacts me as a person. But I think aspects of it run through many western psychological theories. I hate the over-used concept of a “higher power.” It makes me want to seriously throw up when I hear it. But there is an element at times, when working with people, that this reality seems to present itself. We are not fully in control of our lives. People struggle to accept this. Some can. It’s not ludicrous to wonder if someone else is involved. I think this can be an elment of therapy for many people. It has its own way of analysis and transformation and one would have to be very explicit about that if one were to call upon its analytic mechanisms.

Cognitive Behavioral Therapy
This is a very reductionistic therapy and pretty much goes against the other approaches to the core. But when not used as a core lens and approach, it can be beneficial. For some people, simple psychoeducation around thoughts and feelings and the idea that we can change some thoughts or behaviors with freeing results can be helpful. To me it is more about understanding perspective. It’s also understanding routine and ritual and how being-in-the-world is very behavioral. We can sometimes be too focused on hours of insight when some basic behavior change can also bring about freedom and insight after the fact. It is a piece and what I call the common sense layer.

Grab bag: focusing-oriented psychotherapy (use this often to help clients get at experience), gestalt (really like this theory and sort of use it practically in session), solution-focused, narrative, feminist, attachment theory (psychodynamic), and probably some others I am forgetting.

Conclusion
I wrote a paper in graduate school integrating some of these theories. But I believe that I need to develop a more explicitly integrated theory so that I can find grounding at times. When I look for grounding, my mind runs around to all these theories to see which one might help. This isn’t always conscious in session of course. Sometimes it is.

I have never before wanted to do this but I think it is what has caused me frustration in my work. I think when therapists build good rapport and work with clients within some kind of container they are more successful then good rapport alone. Although sometimes I dont’ believe that. Depends on the client. Some people aren’t looking for deep work and just need space to talk with another. That’s it. But even if that’s the case, I want to have that written formally into my own personal theory. I want to develop main points to help me structure. I want to take the essence of all these theories to almost create my own, incorporating as much of what I see when I work with people and incorporating as much of human life in its wholeness. Obviously I will make choices and leave out other elements of human life that other theories address but trying to make room for everything is in some ways what I’ve been doing and has left me with no container.

We’ll see how it goes.