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Turn, Turn, Turn

By Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

As a general rule: Therapy can and should help people develop strong interpersonal relationships, in part so that their relationship with their therapist doesn’t replace …

4 Comments to
Turn, Turn, Turn

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  • What are your thoughts about ‘directive’ verses ‘non-directive’ approaches?

    (I guess I will find this out when I read the book, but this gives you an opportunity to answer this question, which may be helpful for other readers – that’s my excuse!)

  • Hi Adam,
    Thanks for the good question! No excuses necessary.
    Since I’ve already been “accused” of being goal oriented (guilty as charged), my main therapy motto is “Use what works.” Or, slightly modified, “Use what’s been proven to work.”
    Both directive approaches (such as cognitive behavioral therapy, reality therapy, and so on), and non-directive approaches (such as humanistic,client centered therapy and so on ) can be effective. Therapists should make their decisions about what approaches and techniques to use primarily based on what’s been proven to work and with what works with a particular patient and diagnosis (which can vary over the course of therapy).
    Basically, you must tailor the therapy to the patient at all times. For example, a new patient might be feeling raw and sensitive and your approach with him/her will be different than it will be a couple of months into therapy as he/she progresses. Your choices should help engage the patient and propel him or her forward.
    Also important: a therapist must take into consideration his or her own skills and experience with a particular technique. A therapist gains skill with a technique by studying/reading about it and using it over and over again in clinical settings under supervision.
    Students might find that a particular technique or overall approach appeals to them in the classroom, but once they become immersed in their internships they often find other approaches are more accessible and effective. One of my mantras: “Theory is not a substitute for practice.”
    I know I answered your question in perhaps a broader manner than perhaps warranted, but I hope it will be helpful.

  • The great family therapist and systems thinker Jay Haley went right at this issue in his amazing essay “Why Not Long Therapy?” in BRIEF THERAPY: MYTHS, METHODS AND METAPHORS, edited by Zeig and Gilligan.

    http://www.mhweb.org/mustread/articles5.htm#b

    To call this a provocative essay is to call the Grand Canyon a pleasant little crack in the earth.

    @Adam? I don’t know if there was EVER a more directive therapist than Jay Haley.

    To wit:

    “Of the many ways to set a fee, the most obvious is to charge for the cure of a symptom rather than the number of hours sitting in the presence of the client. Each problem can have a designated fee. There is a precedent for this in medicine, where a surgeon charges by an action, in contrast to a pediatrician, who charges by the hour or any portion thereof as an office visit.

    In the field of therapy there are also precedents. Masters and Johnson charge a flat fee for sexual problems, with consultation for a period of time afterward. Milton Erickson was known to say to parents who brought in a problem child, “I’ll send you a bill when he is over the problem.”

    Enjoy!

  • Thank you both. It is a big subject area.

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