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Tuesday, 26 June 2012

Process: Negative Direction or Positive Direction?

Ask clients what they want out of therapy, and initially they often have difficulty nailing it down. “I don’t know.  Feel better?” They may have come to therapy because their discomfort has simply become too great. “I’m in pain and not coping well, so I’ll go to a therapist.”

What we need is some sense of the path out of the pain. What does the client really want? A reduction of 50% on their Beck Depression Inventory score is a nicely operationalized definition of “less pain,” but pain is what they don’t want, not what they do want.

Stand in a large field next to a live grenade. You want to get away, and it doesn’t much matter which of the 360 degrees available to you is the direction you take.

In therapy it matters, because there are other grenades in the field.

At the start of therapy I’ll often ask clients to create a list of all the things in their lives they don’t like. This is a bit risky, because it can imply that we are going to deal with all 183 problems.  In fact, this would never work.

But every one of those problems is a direction marker. Turn and face that problem straight on. Then look behind you, over your shoulder. Opposite the problem lies a possible goal. We can mention these to the client and see how they react.

  • You are completely out of shape? Perhaps fitness is a goal.
  • You hate your marriage? Maybe enhancing it is the goal. Or leaving it. (The client may not know which, pointing to exploration and decision-making as a possible goal for therapy.)
  • You are in the wrong career? Perhaps exploring new options is the goal.
  • You have no sense of meaning and purpose in your life? Then cultivating meaning and purpose may be the goal.

The negative direction can lead us to a positive direction. But it is only once we have at least an initial positive heading that we can get started. The goals may change as we go. “Maybe I don’t want to save this marriage after all.” Fine. But we need at least one goal anyway.

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