Problem Solving and the Dance of Therapy

Getting sucked into problem solving is a danger all therapists face. Clients, about whom you care, are troubled and upset because of issues they are dealing with. These clients ask you for help. “What should I do here?” they say. “Isn’t he wrong about that?” or even “You know me better than anyone, what should I do?” It is so very tempting to try and help them solve the problem by giving solutions and “guidance” with recommended actions. Most therapists are pretty good at problem solving (especially if the problem is not their own!!) and they truly want to be helpful to their clients. But this is not good therapy. It is not my job as a therapist to discover the solution that would make my clients life work better, nor is it my responsibility to “suggest” various courses of action to them. My job is to listen, care, and reflect back to them what I am hearing and what I experience when I listen to them. It is their job to decide what risks they will or won’t take and what paths they will or will not follow. I can help them reality test the options, but I cannot choose a course of action for them. In therapy, we often speculate about a variety of options and do a cost-benefit ratio assessment of the possibilities. I tell my clients on a regular basis, that they can choose whatever path they wish. “ Our job is to help you figure out what it costs to make this choice, and what it costs not to make this choice. Once you know the cost and the expected payoff, you are in a better position to make a good choice, whatever that may be.” “But, I tell them, it is your choice to make and you have to be responsible for making it. It is not my call.” The outcomes will not be mine to experience, either for good or ill, they are the clients’ and they alone need to make the choice.

When a problem presents itself in therapy a wonderful opportunity becomes available, as long as the therapist does not get seduced into trying to solve the problem. The opportunity is to stand back and observe the patterns the client uses in trying to solve the problem. This is especially helpful if there are two or more clients involved in the session. The dynamics of their interaction, their processing and awareness skills are of grave importance to the therapist. What I do, and would encourage any of you who are trying to become therapists to learn to do, is watch and listen for the rhythms of the dance. The interactive process used by clients when they are upset and angry is illustrative, to say the least. What is displayed says a lot about their developmental history, and their skills for handling stress, and vulnerability, as well as anger or fear. We have all learned in our childhood how we are supposed to behave under duress, or in times of high agitation. These behaviors are conditioned within us by the models our parents and teachers have set for us and by the reinforcements that were used to help us “behave” in appropriate ways.

What is useful to the clinician in a therapy session is, that under stress, the client regresses to what we call primitive coping skills as their cognitive process is reduced or over -saturated by the amount of pressure they experience. What the client models for the therapist is an accurate reading from the book of their youth. If the therapist maintains enough emotional distance to observe what is demonstrated for them, and does not feel “responsible” for controlling the outcome, then the therapist can use the information to reflect to the client what their primitive defenses are and teach the client to process whether or not these coping strategies and behaviors from childhood are still cost effective. The client can decide if this is still the way in which they wish to behave. This can be especially constructive if the stress occurs within a relationship.

In the following example you can see how this comes into play. I learned when I was a child who lived in a dangerous, emotionally volatile childhood home, to never let anyone see that I was upset. I learned to deflect almost everything with humor and never under any circumstances get out of control. As a result I never get drunk, never do drugs and always keep myself aware of my surroundings so that I can spot danger. My early warning radar for threat assessment is typical of many who have survived childhood trauma. I can go into a room full of strangers and “feel” who among them is dangerous, who is angry, who is happy, who is “safe” and who is not. One of the advantages of developing these skills is that I can “hide in plain sight.” This is a real asset for me in doing therapy, because I almost never get swept up in the emotional flooding and chaos of my clients, no matter what and how they are dealing with an issue. This is not to say that I don’t care, I do. But, my skill set allows me to numb my own reactions in order to be sensitive to the emotional status of others. I can think and process in the midst of chaotic emotional venting. I am not emotionally vested with ownership when my client is mired in panic or distress, so I can stay calm and anchor them. Often, what I do in the immediate moment is to calm them down with guided imagery, instructions to breathe deeply or reality test, with feedback about their physical space. I assure them with, “You are safe, you are with me, nothing can hurt you here, no one is here now but the two of us. You need to listen to my voice and breath with me when I tell you, inhale, hold it while I count slowly to three, then exhale, listen to my voice and follow my breathing,”……… etc. This process will calm the client and then, we have an opportunity, we can discuss the visibility of the patterns in their lives that have resulted in these outbreaks.

Many of the clients with whom I work are in relationships that represent opportunities to re-enact the coping experiences and patterns of their childhood training. If you were the “hero” child you will be the one who automatically and reflexively sticks his/her neck out to take charge and solve the problem. If you were the “invisible” child, you will have to learn to be passive avoidant or passive aggressive, so you can try to control outcomes without visibility or visible responsibility. If you were the family “clown” your job will be to take any serious situation and be amused by it and make it amusing to others. Your job is to lighten the load and change the direction. You are likely to marry someone who is the complimentary half of your training. The challenge in therapy is to recognize and know that you fall into these patterns without thinking and without making a choice. They are reflexive and automatic. If they work well (and for many they do) they have the impact of comfortable habits. You do not need to think about tying your shoe you just do it, often while you are doing something else like conversing, or watching a ball game etc. But do you remember how hard it was originally to learn to tie your shoes? If you have raised children you probably remember the difficulty of this lesson for your kids.
The main advantage for the therapist not getting seduced into solving the conflict is that the pattern can be observed and reflected back to the client. When that is done accurately, the client has an “ah-ha!” moment and then has the opportunity to choose to continue behaving in that way (out of the childhood script and conditioning) or they have an opportunity to try new behaviors that come from the choice patterns of their grown-up selves. The choice is still theirs, the responsibility is still theirs, but the orchestration of the opportunity to choose is the therapists.

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