How to manage difft perspectives in psychotherapy

[priorities2]

Hello, I'm a nursing student hoping to become a PMHNP in the future. I'm also currently in therapy and the experience of being on the patient side made me realize a challenge I might face in my future practice. I'd love to hear your opinion on my observation =)

So, I was seeing a really smart LMFT who was helping me a lot with some family/behavioral issues. He, along with a family studies course I took at my school, suggested that it's important for me to pay attention to my relationships within my family of origin in order to make sure I'm not projecting those problems onto other relationships. He, and this course, emphasized the generational pattern of abuse and other family problems, and how breaking the cycle means in part paying attention and not ignoring/neglecting relationships within the family of origin. From a family systems perspective, I imagine these statements aren't too controversial. However, when I went to see a psychiatrist (a pretty anti-overmedication/psychotherapy-oriented one), she suggested that "if talking to my close family member about difficult issues doesn't get me anywhere, maybe I should just stop doing it."

Now, the specifics of this event aren't what's important, but rather the clear contradiction between what my LMFT told me and what my psychiatrist told me. Both of them were really educated, successful and upstanding therapists. Yet, they had completely different advice. In the field of psychology, what does a provider make of these contradictions? Is it possible to stay well-informed on all developments in all perspectives (cognitive-behavioral, biological, family systems, narrative, etc...) and to even know when your advice is contradictory to that of another perspective? Should you be obligated to inform the patient/client about the different perspectives out there before proceeding with therapy? Meh, maybe it's not such a big deal, I just didn't know what to make of it. Any thoughts are appreciated!

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[roubs]

One of our faculty has an atheoretical maxim called

"Well, how's that working out for you?"

A conceptualization, from any perspective, should be a working hypothesis. It may fix some problems and not others, aspects of the guidance that flows from it may not work well with all people/situations. This isn't to bash any theory of the idea that our work should come from theory, it's to acknowledge that all of these frameworks have strengths and limitations.

So I guess my point is, "Well, how's that working out for you?" can be applied to identifying a plan of action and modifying one.

 

[Psychadelic2012]

One of our faculty has an atheoretical maxim called

"Well, how's that working out for you?"

Atheoretical? Sounds like Glasser to me.

 

[roubs]

Atheoretical? Sounds like Glasser to me.

Nothing is truly atheoretical, right? He wasn't big into Glasser, but wouldn't be surprised if he nabbed that idea from him. It is a very present focused question, but I think it can also lead people to explore how they arrived at a particular point.

 

[Doctor Eliza]

Atheoretical? Sounds like Glasser to me.

Also sounds like Dr. Phil.

 

[roubs]

Also sounds like Dr. Phil.

Much longer and more complex than "Get Real"

 

[MBellows]

Much longer and more complex than "Get Real"

Don't you mean "Geeet Reeel?"

 

[KillerDiller]

One of our faculty has an atheoretical maxim called

"Well, how's that working out for you?"

Hey, that's my line .

 

[erg923]

Atheoretical? Sounds like Glasser to me.

I do warn my student about the dangers of over conceptualization and over reliance on theoretically driven approaches to treatment.

 

[Therapist4Chnge]

It is important to keep the various provider roles well defined. If there are multiple professions involved that have overlapping areas of competency, then they need to decide who is covering what. For example....the counselor may address interpersonal/therapy stuff, the prescriber handles the meds management, the social worker/case manager addresses access to resources and coordination of services, etc. Too many cooks in the kitchen rarely ends well.

 

[LivingOffLoans]

Is it possible to stay well-informed on all developments in all perspectives (cognitive-behavioral, biological, family systems, narrative, etc...) and to even know when your advice is contradictory to that of another perspective?

Stay informed, yes. Be an expert, no. Someone who knows a little bit about everything is an expert at nothing. There is so much information out there that, no matter how 'smart' you are, it is incredibly difficult to be well-informed on all the perspectives (beyond a general intermediate level of knowledge) that each working professional would possess (e.g. psychiatrist, neuropsych assessor, counselor, etc...). It is hard enough to be well-versed in multiple theoretical approaches as a therapist (behavioral, psychodynamic, group process). I suspect this is why we have different job titles and training requirements, nevermind areas of expertise.

Should you be obligated to inform the patient/client about the different perspectives out there before proceeding with therapy?

Perhaps. But what is more important, I think, is to not mislead the patient into thinking that this treatment you are providing is the only treatment for them. Someone who has a super-obsessive personality structure and trust issues, for example, I would not want to encourage their pathological tendencies by voluntarily offering up information on all the hundreds of different treatment options. I would want to establish trust with them, display confidence in what I'm doing, etc... which is probably more likely to get them on board and begin improving in some symptom areas. Of course, anytime a clinician and a client suspect that the treatment seems to be failing, and it is not simply a matter of 'resistance', then you should absolutely assist the client in making an informed decision about how to proceed and offer them your future service if they need it.

 

[Pragma]

You should absolutely be obligated to explain the evidence behind the approach you are using and the evidence behind other approaches out there (especially if they are more effective). This is part of informed consent and we should all strive to help our clients make educated decisions about their care. For example, it would be pretty unethical to treat an OCD client with psychoanalysis, not tell them there's not a shred of evidence for it (and even can be contraindicated), and not tell them that ERP is the gold-standard treatment.

You definitely need your clients to be aware of your approach to treating their problems and what the standards of care are. I would argue that you should also, as psycscientisit mentions, make them aware of other approaches that are out there. They need to be able to make an informed decision about whether they want to work with you or seek a different type of treatment, particularly if you are using an approach with litte/no evidence behind it.