I love this. The idea that it has to come from the present, from the here and now with the patient, not prefabricated- that reminds me of Bion and his laconic psychoanalytic paper, Notes on Memory and Desire.
What a wonderful article! I agree with many of the points author of the article, and would like to add:
1. There are differences in the skills and approaches that are appropriate for a mental health system that is working the the way it *should* be, and those that are needed to provide the best care we can in the broken system we have. Reliance on acronym therapies might not be what we’d want in an ‘ideal’ health system, but it may be the best (only) option I have for the client sitting in front of me today.
2. Acronym therapies can help with quick documentation and communication in the same way as diagnoses can. Both disgnoses and acronym therapies are flawed and incomplete - but do provide a helpful shorthand when there isn’t the time if mental energy to read through pages of notes. If I am referred client who has previously had CBT vs one who has previously had EMDR - I have a better idea of what questions to ask them about their previous treatment experiences during intake.
3. While a the ‘dodo’ theory is valid for a lot general depression/anxiety presentations - some mental health conditions do seem to respond better to targeted evidence based therapies, such as ERP for OCD.
4. The ability to successfully and safely apply an eclectic approach to therapy takes an incredibly amount of skill, insight, experience, intellectual humility and awareness of personal biases and fears. So many of the horror stories from our profession come from therapists who rely on their ‘intuition’ alone to make clinical decisions. We need intuition + theory + empirical evidence + client feedback + quality supervision + humility and self awareness.
5. I work with a lot of clients with cognitive impairments, and strongly believe we need to be wary of assuming ‘talking to achieve insight’ is the best therapeutic approach for all clients. Certain clients, particularly those with difficulties with verbal processing, working memory, and abstraction, may do better with worksheets and more structured, concrete delivery models. Historically, clients with high verbal and interoceptive abilities have been the ones who sought out (and could afford) therapy - that doesn't mean that particular cognitive profile is the 'default'.
When I went to therapy a few years ago, I announced I needed (quoting myself from memory) "not just some CBT, I need some real Freud shit, like really digging into my past and stuff!"
I don't think we actually did "some real Freud shit", but I got MUCH better therapy than the useless CBT I'd been sent to years before this (with a therapist who said she didn't really know psychosis but I should do the CBT for job stress - as if being stressed at work could be treated independently from dealing with psycho-schizo-something.)
I love this. The idea that it has to come from the present, from the here and now with the patient, not prefabricated- that reminds me of Bion and his laconic psychoanalytic paper, Notes on Memory and Desire.
Nice piece thanks.
What a wonderful article! I agree with many of the points author of the article, and would like to add:
1. There are differences in the skills and approaches that are appropriate for a mental health system that is working the the way it *should* be, and those that are needed to provide the best care we can in the broken system we have. Reliance on acronym therapies might not be what we’d want in an ‘ideal’ health system, but it may be the best (only) option I have for the client sitting in front of me today.
2. Acronym therapies can help with quick documentation and communication in the same way as diagnoses can. Both disgnoses and acronym therapies are flawed and incomplete - but do provide a helpful shorthand when there isn’t the time if mental energy to read through pages of notes. If I am referred client who has previously had CBT vs one who has previously had EMDR - I have a better idea of what questions to ask them about their previous treatment experiences during intake.
3. While a the ‘dodo’ theory is valid for a lot general depression/anxiety presentations - some mental health conditions do seem to respond better to targeted evidence based therapies, such as ERP for OCD.
4. The ability to successfully and safely apply an eclectic approach to therapy takes an incredibly amount of skill, insight, experience, intellectual humility and awareness of personal biases and fears. So many of the horror stories from our profession come from therapists who rely on their ‘intuition’ alone to make clinical decisions. We need intuition + theory + empirical evidence + client feedback + quality supervision + humility and self awareness.
5. I work with a lot of clients with cognitive impairments, and strongly believe we need to be wary of assuming ‘talking to achieve insight’ is the best therapeutic approach for all clients. Certain clients, particularly those with difficulties with verbal processing, working memory, and abstraction, may do better with worksheets and more structured, concrete delivery models. Historically, clients with high verbal and interoceptive abilities have been the ones who sought out (and could afford) therapy - that doesn't mean that particular cognitive profile is the 'default'.
When I went to therapy a few years ago, I announced I needed (quoting myself from memory) "not just some CBT, I need some real Freud shit, like really digging into my past and stuff!"
I don't think we actually did "some real Freud shit", but I got MUCH better therapy than the useless CBT I'd been sent to years before this (with a therapist who said she didn't really know psychosis but I should do the CBT for job stress - as if being stressed at work could be treated independently from dealing with psycho-schizo-something.)