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Tuesday 22 March 2011

Are You a Surgeon or a Barber?

When I was trained as a clinician, there was an unspoken assumption about mental health practice.  People would come to therapy in a time of distress, they would receive an intervention, the problem would go away, and the problem would stay solved for the rest of their lives.   

It seems to be the nature of unspoken assumptions that stating them plainly and consciously makes them look a bit silly.

The surgeon model of therapy is based on the idea of a limited-term intervention, following which the problem (and contact with the client) is over.  It is the implicit standard for therapy practice. 
But few other forms of healthcare use this model.  No family physician believes that if she solves a patient’s problem she will never see them again.  No masseur imagines that a person will remain loose and relaxed four months after the last massage.  Even the most skilled barber will not render future haircuts unnecessary.  Not even psychopharmacologists believe that most patients will retain the benefits of a drug they no longer take. 

It is a remarkable feat of therapy that we can train our clients in new skills and new understandings, say our goodbyes, and the clients can go on using what we have provided for a lifetime. 

But life is difficult.  Just when we think we have our problems figured out, they take on new shapes and come at us again.  As we age we encounter new challenges and new psychological territory.  We can all achieve stability, but the idea that we can maintain absolute steadiness all our lives is a delusion that is best discarded.

With some clients we may be more of a barber than a surgeon.  They come to see us, we work on a problem, they say goodbye, and a few months or years later they return, perhaps with a new problem or perhaps with a new wrinkle on an old one.  If none of our clients seem to manage for long without us, we should probably examine our practice; perhaps we are unintentionally fostering dependence.  But if none return, this may have more to do with our halitosis than our effectiveness.

When I opened my private practice I somehow imagined that clients would leave never to return and that, if they did come back, it would be a sign of my failure.  Since then I have realized that some of my clients will see me as “their” therapist, just as they have a chiropodist and a physiotherapist, and that they will call me up when they get into sticky territory.  So while I still like to think of myself as a surgeon, I have come to embrace my barber practice as well.  

If you're a clinician, it's worth taking a few minutes to consider your own surgeon-to-barber ratio.  How do you see yourself?  And has this changed (or evolved) since you started out?

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