Is Your Therapist Living in Another Century? ~ David Silverman

Via David Silvermanon Aug 17, 2013

Freud

Consider a solution-focused therapy instead of one that emphasizes talking about the problem.

When Freud began seeing patients in the nineteenth century, his approach was basically to help the client uncover unconscious childhood memories that would “unlock” and “cure” such disorders as anxiety or depression.

So many therapists still practice some form of this technique. They encourage their clients to “talk about the problem,” in the hopes of finding a reason for the clients disorder buried in childhood experience.

The Freudian, or psychodynamic, therapists draw comparisons with repetitious dysfunctional behaviors that appear from childhood. For these therapists—and yours may be like this—they talk and talk about the client’s childhood and talk and talk about the client’s “problem.”

This can and does go on for years.

During the 20th century, many theorists devised alternative methods to practicing therapy that could be conducted more briefly and without discussing in great depths, over and over, the problem and everything that happened in the client’s childhood.

Solution-Focused Therapy was developed by Steven DeShazer and Milton Ericson, among others. This theory posited that instead of talking about the problem each session, why not talk about the solution?

These therapists believed in brief therapy with as few as 10 sessions at a much lower cost, because there was no reason to talk “about the problem” all the time. If fact, they theorized that the client was better off not going over and over their problems and trying to link everything back to the client’s childhood.

These new approaches feel that a more appropriate method would involve “talking about the solution” to the client’s dysfunctional behavior. They try to find the client’s strengths—say, coping mechanisms that already are somewhat functional—and help the client use them as part of a solution.

Solution-focused therapists use their time with the client to uncover the client’s own resources in solving the problems they present with. They ask their clients about exceptions—times when the client does not experience their disorder. The idea behind these types of questions is that no problem occurs all the time.

In other words, no one is depressed every minute of the day.

When such a resource is discovered in session, the client is encouraged by the therapist to “do more” of it. In the same way, these therapists, called “post-modern,” try to find out about the client’s past successes. This method steers these clients into thinking about successes, bolstering their confidence about solving their own issues.

These solution-focused therapists help the client imagine a future in which their problems no longer exist. They might ask the client some version of what they call “the miracle question”—if they were to fall asleep tonight and wake up tomorrow to find all their problems were gone, how would they know this had occurred? How would they behave differently from how they behave today?

The idea of these types of questions is to have the client think about a future in which they are “better,” and to get them thinking about what such a future might look like and how they might be behaving differently to support the change.

Empowering the clients in this way turns out to be a powerful and effective tools for the clients in solving their problems. The notion that the therapist and client solve problems together is very much part of this type of therapy.

Ultimately, when therapy is over, the client will be the one dealing with his issues by himself.

The client is considered the “expert,” and the therapist works with him or her to solve problems that the client chooses. The therapist knows his work is done when the problems are over, not after delving into the unconscious and deconstructing the problem as part of the client’s childhood.

What if your therapist is still trying to “uncover unconscious childhood influences” and still talks about your problem the way therapists did a hundred years ago? What if doesn’t seem to be working?

Therapists are taught alternate theoretical orientations, and if one isn’t working after a reasonable period, the therapist is ethically bound to try something different or refer the client to another therapist.

If talking about the problem isn’t working for you in therapy, you might consider asking your therapist to try a solution-focused approach or refer you to a therapist who uses such an approach routinely and is proficient in using it.

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Asst. Ed.: Linda Jockers/Ed: Sara Crolick

About David Silverman

David Silverman studied Psychology at Stanford University, graduating with Departmental Honors.  He spent years writing for newspapers, television and film. He is a Licensed Marriage and Family Therapist practicing in Los Angeles, California.

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8 Responses to “Is Your Therapist Living in Another Century? ~ David Silverman”

  1. Muks says:

    I would prefer a mix of both approaches. On the one hand it has helped me to see what happened in my life to get out of denial and to really feel angry and sad about childhood experiences. Once these feelings are over I feel more healed, if you know what I mean. After a rant with someone I trust a few weeks ago about my parents treating me in a very unfair way, I ended up feeling very calm and relaxed for the whole week after. When I think about exactly that unfair experience now, I can see it from a distance without all the negative feelings. In the same time I try to think about things that I can do better. I read literature that gives me hope and that is positive. It helps as well, as I can see my options and do not feel as helpless as I used to.

    • David Silverman says:

      I actually am quite eclectic. I'm a humanist I like CBT narrative behavioral analysis and family systems. I just wrote the article this way to drive home the point.
      David Silverman

  2. Mild

    I completely understand the need to be hears and validated. In my therapy I’m

    Actually eclectic and use a person centered approach in addition to solution focus. Therapists have to consider the client first.

    I listen without judgement. For some clients CBT (Cognitive Behavioral Therapy) may work best in addition. I just feel strongly that the solution should a major part of what’s talked about in session.

  3. Margaret says:

    Hey David!
    Great article. So succinct. I didn't know you could express yourself and our field so well. Didn't know you went to Standford either. This is a great reminder to us therapists as well to stay positive and follow the client's lead.
    Margaret Medhus, LMFT

  4. Margaret

    Thanks for the kind words. I have seen too many therapists who have embraced old school psychodynamic methods without considering research done in the late 20th century. I believe psychotherapy is both an art form and a science bit I still respond best to methods that are evidence-based.

  5. miq strawn says:

    This sounds to me like a more personal, one on one approach, to behaviorism. Practical and succinct, I love it, everything that modern psychology stands for is trembling! Good job Dave,

  6. This is very different from behaviorism. This approach is very concerned with the client’s input and in collaborating with them. The client is the exert and together we uncover personal coping methods.

    Thanks for the comment.

  7. Bill says:

    Wasted a lot of time with my first therapist in NY decades ago (which, granted, was another century), unaware that I could have been with someone who'd actually try assist me in finding solutions.

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