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John Simon September 8th, 2004 03:14 AM

Too Much Change?
Mr. Lankton,

Would Erickson have ever thought that a person can change too quickly? The reason that I am bring up the question is that change over a longer period of time might allow for reflection on different alternatives while "sponteneous" change might not. How can we help a client change at a pace that limits dangenous behavior?

I think that outlining a similiar scenario to one of my recent cases might refine my question. Suppose that a client came to therapy because he was no longer interested in sex. However, he thought that eventually he might like to get married and have a family someday and would like to work on the problem. During the second session, a metaphor appears to have helped the client see his situation in a different light. The following week, he comes to therapy and states that he had unprotected sex with 10 women that week and he really enjoyed himself.

Now, in a sense, his problem is solved. However, he is now engaged in dangerous behavior, and I did not have time to discuss the downsides of this behavior before he acted on it. I know that I cannot possibly think of every scenario, and that the client has to take responsibility for his actions. However, I have a nagging feeling that if change had occurred in a more moderate pace, these issues would have come out in therapy before they were acted upon in the real world.

Stephen Lankton September 8th, 2004 03:04 PM

And then there is assuming too much responsibility...
Change is not a one shot adjustment in most cases. Nor is it necessary that a person gets it perfect on the first try. There are a number of reasons why the result so far is what you have stated. These include:
1) Over-expression of the urge due to previous suppression/repression and this would account for an array of, or variety, of different expressions and motives for so doing. These can be anything such as: images on how to be a man, self-image based on peer competition, a desire to get back at a parent, modeling after a promiscuous father, a substituted manner of getting a mother who nurtures, etc.
2) Acting out with apparent permission of the therapist’s intervention and this can come from accidental, purposeful, or unconscious motives of the therapist.

Both of these may have been prevented by avoiding interventions simply aimed at the removal of a symptom instead in favor of and intervention based on the whole-person assessment. This comment is not meant to be personally directed to you – but in fact, this sort of outcome is a great example of why therapy should be restricted to licensed therapists with graduate degrees in the mental health fields – as it shows how well-meaning interventions aimed at symptom removal can overlook greater issues.

This case perhaps indicates that his previous avoidance is, in part, due to not associating the wisdom in his Adult judgment during matters of sexual behavior. The next part of therapy needs to help him do so.

Now all that said, HE CHOSE how to use his body and you could not make that happen and should not be blaming yourself. You should not assume responsibility for his choices. The fact that he didn’t tell you he wanted to have sex with 2 women a night sounds deceitful in a fashion that hurt your own sense of confidence in therapy. I would share that with him.

John Simon September 11th, 2004 02:18 PM

....and then there is novice behavior
Mr. Lankton,

Thanks for your input. As a new therapist who just finished his masters degree in May, I still find it challenging to focus on tatics in therapy while keeping in mind the overall therapeutic context. To borrow from Gestalt Therapy, in this case, the figure was symptom reduction and the ground was a number of child-like behaviors, from the client, that were presented as clues in therapy that the post therapy behavior might occur. However, I only noticed them in hindsight.

To be honest, this is the first time I have felt really responsible for my client's actions so I guess it got amplified in my mind. My thought was I might have suggested that the client "go slow." He might not have listened but at least I would have covered your Point #1 in therapy. I agree that ultimately his behavior is his responsibility.

Do you do trainings on assessment? My program was cognitive/behavioral and I felt it had some major shortcomings regarding whole person assessment. In fact, I have found the strictly cognitive model taught in my program, a la Ellis, to be inappropriate for me because it is largely a "one size fits all model" that does not seem very respectful to the client. The Erickson conference in San Francisco last December, piqued my interest in a new way of therapy (new at least to me). I am now in the process of trying to figue out the best way to learn this type of therapy while feeling like I am soemtimes trying to take a drink from a fire hose.

Stephen Lankton September 12th, 2004 02:01 PM

That's an excellent reply. I know just what you mean, too. Actually, I do workshops on assessment from time to time. I don't have any right now at conferences that are scheduled. However, my PHX 5-day workshops always have a healthy amount of assessment throughout. It is in fact, the point of the workhops: designing interventions from the assessment. Although, the interventions in the 5-day are heavily weighted toward those that can be delivered within metaphors or various types. The workshops beginning next spring are being re-worded and the organization will be modified. I'm planning on making one of them a weekend workshop on assessment and induction. I don't know if people will come in from out of state for a 2-day workshop...but I'll guess I'll find out.

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