All therapists have the common experience of sitting in a first session intake with a distraught client and learn that they have tried therapy three, four, five, half a dozen or more times before for the same issue. Some therapists might look askance at the client, and start asking themselves, “What about this client has made it so hard for others to help them?” That is the wrong way to look. It doesn’t usually occur that the reason this client has not found relief is that their prior therapists didn’t know how to fix what was wrong. You see, clients are in pain and their pain makes them very persistent in their search for relief. They will abide being viewed as a walking pathology but will not tell their therapists about the toxic effect that is having, or the fact that the therapy really isn’t working. They are on our turf and they know it, and even the boldest will keep it to themselves. They will simply cancel their appointment one day and stop coming in.
So what is going wrong? I didn’t really understand it until I studied and became certified in something called Rapid Resolution Therapy. RRT clinicians are taught to pay very close attention to the connection that is forming from the very first moments. We are taught to speak with our intended effect always uppermost in our mind. If we can’t help the client, we make it plain it’s due to our lack of skill and not some defect in them. We don’t put it on them or make it about them. But happily, most of the time we can help, usually within the first few sessions.
My purpose here is not to explain the technical side of how this is done, but rather to show what’s usually going on and contrast it to what I consider a qualitatively better experience. Not long ago, I watched a tape of a therapist of another stripe working with an Iraqi war vet with severe PTSD. She had been with him for a whole year of sessions and yet he was still flooding, having nightmares, unable to work, drinking episodically to manage intense distress, mired in deep shame about his condition and the effect it was having on his marriage. She was trying her best in a conjoint session to improve the connection between the vet and his frustrated, scared spouse. The discussion that ensued among mental health professionals in the room assumed this man was unfixable and that he would have to live with his condition forever. That at best, a stronger relationship with his partner could possibly buffer the devastating effects of PTSD and marriage counseling would aim at helping them manage it together. However beneficial a good marriage might be, I saw right there with the technologies on hand to address some of the more difficult conditions, many of us therapists have lost hope in our own craft. They continue to meet with clients, as this therapist had, under the cloud of knowing they have little to offer for the problem at hand and think they are doing well with at least offering “support” or redirecting goals to a different target of care. But that crucial shift is seldom directly disclosed.
I stopped to consider what a curious thing this is that might only be happening in our field. If a dentist couldn’t fix a tooth or a mechanic couldn’t repair a car system, they would say so in the work-up phase, and either refer to a more qualified colleague or break the bad news without delay. The wouldn’t go tinkering with a different system.
There is a basic dishonesty going on in mental health. I can’t say for sure why it occurs. My guess is it occurs unintentionally because of a confluence of complex causes that exist in our field, among them shame for not having an answer, the need to be needed, sharp ideological divisions, and of course, the need to keep money coming in. I couldn’t help but wonder what effect meeting under this cloud would have on both therapist and client through time.
I imagine it like this:
This vet would continue to come in for his weekly supportive meeting with his individual therapist. He would be looked upon as an especially problematic (read hopeless) case and everyone right out to the receptionist at the front desk would view him that way. He would be strongly recommended to go on regular doses of prescribed medication and warned he must stay on his regimen. He would pay his copays and assemble and submit the documentation necessary to stay on disability, which would now be incentivized and protected because it’s his only means of income. He might be funneled into a support group with other vets who’ve come to see themselves as broken and be encouraged to sit with them once a week and talk about it–the misery of living with horrific symptoms and just struggling to stay alive. This is the current state of the art, with few exceptions. I’m thinking if I’m that vet I’d go anywhere, to the ends of the earth if necessary to escape this fate, and that I would avoid like the plague anyone who would see me that way or recommend that dance card as my primary treatment plan. I’d want to start fresh with someone who believed I could get well.
I’ve been trained in a way that is more effective than most and looks at clients as people who can get well. I’m aware as I write this we in the RRT community haven’t done a good job of getting the word out. We have to do better. We have to let those with broadcast abilities know that we’ve left behind our traditional training and the dead ends it leads to, and that we do therapy in a much different way, from a much different orientation.
We don’t just care, we actually repair.