Is it possible to give the person asking for psychological support what they need, when they need it?
We are confronted with a society and people that have changed a lot compared to just a few years ago. In a previous article (The future of psychotherapy) I reported some data on the trends and prospects of the health system, particularly in the area of mental health.
How should the psychologist’s approach change accordingly, in order to continue to reach and help people?
Nicholas Cummings and Intermittent Psychotherapy
Since the mid-1980s, past-president of the American Psychologycal Association, Nicholas Cummings, synthesized the concept of “intermittent therapy” or “lifecycle therapy”. In 1988 he said: “The psychologist […] has the objective not only of helping the patient to resolve emotional disturbances, but also of helping him to prevent illnesses (both physical and mental) by inducing him to change his lifestyle” (Cummings, 1988, p. 169).
The idea was that of a psychologist similar to the general practitioner, to whom the person could turn in time of need. After more than three decades, this idea has not yet been accepted in Italy. And I’m not talking so much about an institutionalized and recognized figure (“the basic psychologist”), but about a service: giving people the opportunity to come for a limited number of meetings, even just one, when they feel the need, to work about what they feel they need in that moment.
Because, yes, people have needs.
Needs: Therapist vs Patient
A colleague of mine used to say: “Once upon a time there was God, and immediately after the doctor”, to remember the times when the doctor’s word was indisputable. Those times have passed. Today the patient has “transformed” into a client, in the sense of a person who chooses a service, and who wants to actively participate in it (IBM, 2008).
When he is not allowed to do this, the risks are at least 3:
- Compliance is reduced or, if we prefer, resistance to treatment is increased. Today’s society is not that of the early 1900s. Likewise, the people who make it up are not the same. Today, self-awareness and a sense of participation in major care coexist. Denying this possibility risks invalidating the work with many people, who will feel excluded from the therapeutic process and will tend to collaborate less and worse, or to abandon it prematurely.
- It forces the person into a process that he might not do for her. This applies to various aspects of the process: from the use of techniques that are inappropriate for you (although effective for the “disorder”) to the strict adherence to intervention protocols that are necessarily limited. Therefore, one will be asked to do something that the person simply cannot or is unable to do, with obvious effects on the therapeutic process. It is no coincidence that in recent years the point of view of the person has been taken more into consideration in the process of evaluating the causes of the problem, possible solutions, and the course of therapy (Duncan & Miller, 2000).
- The person moves away from the possibility of contacting us (perhaps inducing him to turn to other less qualified professionals). This is also due to the form in which we offer the person counseling or psychotherapy. If ours does not accord with what the person expects, wishes, or formally needs, he will simply go to someone else who offers it that way. Thinking that “but we give him psychotherapy / psychological counseling, the others do not” is a logical reasoning, but it starts from the wrong premises: believing that the person wants “psychotherapy” or “psychological counseling”. The person wants to get better, nothing more.
To avoid these risks, we must ensure that the services we offer (counseling, psychotherapy, etc.) do not clash with the needs of the person. One size fits all. If this has often been perceived as “using the therapeutic approach that is best suited to that person / disorder”, strangely it has not been equally understood as “adapting the ways in which one operates to that person / disorder”.
Dazzled by constructs
One impression is that often the thought is that “we have always done this”, with the implication that “this way” has always worked. Which, of course, is true. The problem is that we must also ask ourselves “when” it worked.
As mentioned, today is not the same as yesterday. Methods and forms of intervention that were good decades ago today could prove to be inadequate, overtaken by the progress of the sciences, by new discoveries, but also by different lifestyles, by the emergence of new problems, as well as by a new evolution of the “old” ones .
The idea that “like this” can continue to work, as well as being counterintuitive, risks being a double mistake. A mistake with respect to what really happens “out there” (people who stop, or do not even begin to, turn to the psychologist – in this specific example – because they are experienced / considered inadequate to their current need), and a mistake with respect to the reality of that “so”.
“Thus” is not an unchangeable objective reality. When we say that “like this” has always worked, like the idea that a therapeutic path made up of several encounters is the necessary condition to produce a meaningful and lasting change, we are forgetting that “like this” is a construct. There is nothing in “change” that prevents it from being produced in less time. There is nothing in “therapy” that prevents it from having this status and from showing its effectiveness outside of a formula that conceives it as a “path made up of more (maybe many) encounters”. On balance, in reality, there is no “therapy”: there are a series of actions carried out following certain logics – always susceptible to falsification.
In other words, we risk too easily forgetting that most of the methodologies we work with are based on constructs, on theories, which although, at best, have been severely tested by the scientific method, they are just waiting for new ones. and better theories question them. Thinking that they are ontological realities that live outside the theoretical frameworks on which they are supported or, worse, that they are factual and immutable realities, is a great limitation that we place on ourselves.
The idea that “like this” must necessarily be … like this is simply a mistake.
Psychotherapy and psychological counseling as needed
If walk-in clinics and Single Session Clinics are proliferating in the world, it is because a form has been found that adapts to people’s new needs. And Cummings’ opening sentence does not suggest that intermittent psychotherapy can be adequate only in preventive terms, or exclusively for simpler problems (Cummings himself delved into this aspect, showing its usefulness with known problems and disorders – Cummings & Sayama, 1995).
Providing a psychological service when needed can be declined in many ways, some already seen in these pages (see for example the two articles preceding this one). In general, we open up to the possibility of seeing the person in their time of need, to achieve the goal they need, in the time they need. Even a single session – but not necessarily, mind you.
Of course it is obvious that the professional must, of his own free will, begin to see himself in a different way, above all as capable of proposing what he has learned in new ways and in new forms. This without neglecting, however, the scientific evidence (otherwise we would border on a “crazy creativity”, reformulating a concept by Gregory Bateson). Indeed, often what he has to do is just the opposite: open up more to different scientific knowledge, avoiding getting stuck within the boundaries defined by a preferred approach or theory.
For example, all of this is even easier to conceive if we broaden our role and how we can be useful to people.
4 things you can do as a therapist
For example, the idea that the therapist must “solve” problems is correct, but limited. Of course, even before that is the idea that in a few meetings, even one, nothing can be solved: it even clashes with what scientific research tells us (for example, see the studies by Westmacott & Hunsley, 2010, or Simon, Imel, Ludman & Steinfeld, 2012, on why people leave therapy prematurely, even after very few sessions: most of them do so because they feel they do not need further meetings).
However, I want to emphasize here that the therapist can have different goals and propose different possibilities to people. To give some examples:
- One of these is undoubtedly helping them to solve a problem, that is, allowing them to be able to ensure that the problem is no longer a problem and that it never returns. For those who are wondering, this can also be established in cases in which a single session has been held when one gives the possibility, subsequently, to do a short follow up, to verify together that what was done in that meeting was decisive. And, next to this, leaving the door open (precisely an “as needed” service), so that if necessary, the person can feel free to return.
- A second possibility is to help the person start the change process. Not everyone feels they need to be accompanied until the final resolution of the problem. There are those who believe they simply need a start, an unlock, a kick-off, to then continue the work alone – perhaps always with the awareness of being able to return in the future (this is definitely the soul of on-demand therapy).
- The third is the possibility of helping to understand, that is, helping the person to get an idea, to have a new or further interpretation, to restructure the meaning of a situation, or even simply to confront an “expert” to have his opinion. Many people often just want to be helped to “understand better” and I believe that communicating that they can contact a therapist even “only” for this reassures them and facilitates their access to our services.
- The fourth, which is certainly not the last, is the possibility of welcoming and containing, of giving a space in which to make use of the power of catharsis, so to speak, which, although many times it is not decisive, is often precisely what a person feels the need in front of certain situations: the need to have a space in which, with the help of a professional who knows how to make this space adequate, he can feel free to express all his experiences and emotions. Without asking for anything more than that.
These possibilities exactly reflect some people’s needs. We can believe that there is more, that it is not enough, that “something else” is needed … The fact will remain that, on the one hand, it is not what the person feels and that, on the other, we are incredibly depriving us of a service which we are probably able to give better than anyone else.
Change in order not to be changed
The psychologist and psychotherapist, and in general all health professionals, may think that they do not need to change, to meet people’s needs. They may think that these needs are due to clinical conditions, unconscious motivations, resistance to change, relational power games or whatever. That is, they can endorse their own “so”, confirm the theory with itself. And they may feel that it is people who have to adapt to their own methods.
Others, however, may think that we live in a society that has always changed. Which, in a circular process, together with it also people and needs change. Which, consequently, also their lifestyles, their habits, their behaviors change. And that, while preserving our values, if we do not change we too will be changed by them, simply replaced with something that more responds to their needs.
Flavio Cannistrà
Psychologist, Psychotherapist
Founder of the Italian Center
for Single Session Therapy
Bibliography
Cummings, N. (1988). Brief Intermittent Psychotherapy throughout the life cycle. In J. K. Zeig & S. G. Gilligan. Brief Therapy. Myths, methods and metaphors, pp. 169-184. New York: Brunner/Mazel.
Cummings, N. & Sayama, M. (1995). Focused Psychotherapy. A casebook of brief, intermittent psychotherapy throughout the life cycle. Abingdon: Routledge.
Duncan, B. & Miller, S. (2000). The client’s theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, 10(2), 169-187.
IBM Global Business Services (2008). La sanità e l’assistenza sanitaria nel 2015. (online).
Simon, G. E., Imel, Z. E., Ludman, E. J. & Steinfeld, B. J. (2012). Is dropout after a first psychotherapy visit always a bad outcome? Psychiatric Services, 63(7), 705.
Westmacott, R. & Hunsley, J. (2010). Reasons for terminating psychotherapy: a general population study. Journal of Clinical Psychology, 66(9), 65-77. doi: 10.1002/jclp.20702