Client Centered in a Psychodynamic World

[IHrtHealthPsych]

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I'm not sure if I am entering this thread in the right place, but I want to ask opinions from others who are largely client-centered or Rogerian in their orientation. I identify this way clinically, and I'm currently completing my master's practicum (hoping to go to PhD). My site supervisor seems very client-centered as well (we both integrate CBT in addition), but my seminar instructor at my school is clearly a psychodynamic and family-systems oriented psychologist. I just presented a case in class where I received all of this advice about exploring the client's relationship with her mother, father, etc., etc., and it irritated me because the client has not brought forth those issues to discuss. My instructor just jumped ahead to all of this nonsense that has nothing to do with our current therapy. The client has another focus, and I respect that. I hope I'm not being too vague.

Is it hard for anyone else to practice in a truly client-centered way, with supervision that is psychodynamic? Granted, it's not my direct supervisor (Thankfully!). I have very strong personal reasons for not practicing psychodynamically or from a systems approach--namely because I think it narrows the focus of the therapy, especially for individuals whose lives have excluded family for specific reasons (even through death, etc.) or whose reason for seeking therapy are not relational (i.e., trauma).

Thoughts?? Anyone else relate?? Validation?!

 

[KillerDiller]

I'm not primarily client-centered, but I can still relate. My approach is behavioral in nature, but my supervisor one year was psychodynamic. We maintained a good working relationship, but often conceptualized problems very differently. And, yes, it sometimes felt strange to be asked to discuss clients' childhoods when their concerns were more immediate.

My advice is to take what you can from it and not worry too much about it. This person is not your clinical supervisor, so will he/she even need you to follow-up on these questions? Also, realize that this issue isn't confined to psychodynamic treatment. I think once psychologists choose a perspective, they tend to filter everything through it and frame their questions accordingly.

 

[roubs]

Is your seminar instructor going to insist that you stop focusing on what the client wants and spend significant session time drawing out as much as you can about the client's parents and childhood? If not, nod your head and smile and think about how what they are saying can be incorporated into schema focused therapy if you ever get there.

If they do insist, sounds like you can rely on your site supervisor for cover.

Once during case presentation at my site I got berated for using "that DSM language" by a psychodynamic clinician because I said the client was "hallucinating" I just did this later:

 

[nitemagi]

I've tended to appreciate supervision that goes against my instincts. Like others here I take it with a grain of salt, but I've found it useful to conceptualize a patient multiple different ways. Make the theory fit the data, not the other way around. Moreso, while it's valuable to stay with a patient in the moment, go where they want to go, I buy into listening with the third ear, and recognizing they do not always know where they need to go. That's part of the reason they come to you for help. Not that exploration of childhood issues should be crammed down anyone's throat, but I wouldn't dismiss it as useless either.

Our own resistance to learning is itself an opportunity to learn.

 

[Neuropsych2be]

Our own resistance to learning is itself an opportunity to learn.

I *like* that statement!!!!!!!!!!!!

 

[IHrtHealthPsych]

recognizing they do not always know where they need to go. That's part of the reason they come to you for help.

Our own resistance to learning is itself an opportunity to learn.

This is quite a psychodynamic way of looking at it, though, don't you think?! That way of seeing clients and unconscious processes of learning is not how I approach my work or my life. Being person-centered is by definition about allowing the client to explore based on what they bring to the session, and by going with your instinct as a therapist and person in the world. I don't buy the therapist-as-expert or "challenge the unconscious resistance" paradigms, that's my point.

 

[IHrtHealthPsych]

My advice is to take what you can from it and not worry too much about it. This person is not your clinical supervisor, so will he/she even need you to follow-up on these questions? Also, realize that this issue isn't confined to psychodynamic treatment. I think once psychologists choose a perspective, they tend to filter everything through it and frame their questions accordingly.

That makes sense. I just wish it had been more useful. Sigh...

Is your seminar instructor going to insist that you stop focusing on what the client wants and spend significant session time drawing out as much as you can about the client's parents and childhood? If not, nod your head and smile and think about how what they are saying can be incorporated into schema focused therapy if you ever get there.

If they do insist, sounds like you can rely on your site supervisor for cover.

It probably doesn't matter much, although the seminar instructor issues the grades (but based on the site supervisor's evaluation). My supervisor's license is on the line. I may have hinted at this, but this agency is pretty adamant against taking a systems-oriented approach, which is based on the population (I'll be broad and vague to protect my identity--trauma work), and this is why my supervisor is not psychodynamic, and probably why she chose to take me on. I did tell the instructor that. He understood. But it would be great to have some guidance from a similar orientation.

It must be hard to be oriented a certain way but to oversee such a variety of sites. Eclectic, schmeclectic. That particular presentation was a conceptualization/presentation, nothing more.

 

[nitemagi]

This is quite a psychodynamic way of looking at it, though, don't you think?! That way of seeing clients and unconscious processes of learning is not how I approach my work or my life. Being person-centered is by definition about allowing the client to explore based on what they bring to the session, and by going with your instinct as a therapist and person in the world. I don't buy the therapist-as-expert or "challenge the unconscious resistance" paradigms, that's my point.

Going where the patient wants to go could be argued to be a psychodynamic approach, just more self-psychology than ego-psychology.

Regardless of buying into a psychodynamic model, though, it's valuable to think outside of where the patient wants to go in the moment to come up with alternative strategies. CBT conceptualizes a patient and offers techniques that the patient doesn't know, and guides them into areas they may avoid going.

My point though was that one can gain from psychodynamic supervision without practicing a psychodynamic technique, in that conceptualizing a patient multiple ways helps to see alternative perspectives and approaches, rather than doing the same thing over and over. If nothing else it gives you flexibility in your own thinking, which I believe is a valuable tool as a therapist.

 

[aequitasveritas]

This is quite a psychodynamic way of looking at it, though, don't you think?! That way of seeing clients and unconscious processes of learning is not how I approach my work or my life. Being person-centered is by definition about allowing the client to explore based on what they bring to the session, and by going with your instinct as a therapist and person in the world. I don't buy the therapist-as-expert or "challenge the unconscious resistance" paradigms, that's my point.

I guess you have either no concept of defense mechanisms or no regard for them?

 

[2012PhD]

Going where the patient wants to go could be argued to be a psychodynamic approach, just more self-psychology than ego-psychology.

Regardless of buying into a psychodynamic model, though, it's valuable to think outside of where the patient wants to go in the moment to come up with alternative strategies. CBT conceptualizes a patient and offers techniques that the patient doesn't know, and guides them into areas they may avoid going.

My point though was that one can gain from psychodynamic supervision without practicing a psychodynamic technique, in that conceptualizing a patient multiple ways helps to see alternative perspectives and approaches, rather than doing the same thing over and over. If nothing else it gives you flexibility in your own thinking, which I believe is a valuable tool as a therapist.

+1

I have gained enormously from psychodynamic supervision even though i am more CBT/integrative. Even though you may not agree with all the concepts, it has taught me how to be more patient, exploratory, and curious without jumping into problem solving or gratifying patient needs. Any good therapist will go where the patient wants to go, but also keep an eye out for what the patient is avoiding, ashamed of revealing, or minimizing etc. This approach is not unique to dyanmic therapists. CBT and DBT therapists use it all the time. If you are going to be genuine with patients, you also have to bring up some important things they have been avoiding or don't want to talk about.

 

[IHrtHealthPsych]

I guess you have either no concept of defense mechanisms or no regard for them?

What now? What are those?

🙄

 

[aventurine]

I actually appreciated having supervisors and instructors of diverse orientations during my training. Even if you have a valid reason for not using an intervention that may be suggested to you, and I think it's appropriate to discuss this with your supervisor or instructor, it's helpful to consider what may be going on from different perspectives, especially when you are relatively early in your training. I agree, it's important to have some flexibility in your thinking.

 

[aequitasveritas]

What now? What are those?

🙄

You may be able to insert an eye roll, but this is a serious question. Being able to listen for, and interpret conflict in a patient is incredibly important regardless of orientation. Analysis of conflict is not....not client centered; it is serving the client's best interest in fact. You may want to read "Psychodynamic psychotherapy: learning to listen from multiple perspectives" by Frederikson.

Rogers never meant for his work to turn into what it has become. Indeed he even lamented over the "client centered" movement, which was originally meant to steer more toward what we would recognize as todays psychodynamic model...away from the classical 1 person psychoanalytic model (which is rarely used in most institutes these days anyway).

 

[ela]

Veritas (slash NORRIS)

Agreed.

Just read/went to an excellent talk by Robert Stolorow, one of the key figures in the intersubjective (or as he prefers now, "phenomenological collectivist") mode of analysis. Highly recommended vision of analysis that is field-centered rather than either analyst or client centered.