Writing fictional accounts of therapy can be tricky for a number of reasons. First, therapy does not necessarily proceed in a linear fashion. That’s not to say there aren’t identifiable phases and predictable sequences. The sequences and phases that make up the therapy process, along with specific therapist behaviors and skills, can be objectively measured. It’s just that the process isn’t necessarily neat. Second, client gains occur incrementally over time. You don’t get those dramatic insightful “aha” moments that are portrayed in movies in which the client is cured in one theatrical session. Third, since change can be incremental, the process may not make for exciting reading. Thus, I had to sacrifice some factual preciseness when writing Dead Works to keep the pace at a dramatic clip.
The therapeutic process tends to proceed through certain phases. When clients begin therapy, they have the opportunity to tell their story. That is, talk about what is troubling them and what they are looking for in therapy. In the first session, the therapist may ask a lot of questions to help the client with this process – essentially the therapist does an intake. During this first session and with every session that follows, the therapist uses a series of active listening and empathy skills to display positive regard for the client and to enhance the therapeutic relationship. Let’s be clear, people may find the prospect of going into an office and telling a complete stranger about their most private thoughts and feelings quite unnerving. So, the therapist has to work hard to gain the client’s trust. He/she does this by listening, being non-judgmental, and being empathic.
As client concerns become clarified and the relationship develops, goals become clearer. The therapist often has a number of different strategies at his/her disposal to help the client make the necessary changes in order to meet those goals. There strategies are heavily tied to the therapist’s theoretical orientation. You’ve heard of these theoretical orientations before – they have readily slipped into everyday usage: cognitive therapy, cognitive-behavioral therapy, psychodynamic therapy, solution-focused therapy, and so on. My personal theoretical orientation is cognitive-behavioral – and this influences my training of students, my research, and my therapy when I have conducted it in the past.
All therapists, regardless of theoretical orientation, engage in empathy and active listening in order to develop a trusting relationship. However, the speed through which they move through the phases of therapy or the factors that they focus on with the clients may differ based on the orientation. Clients will have homework, though, regardless of orientation. The process moves a bit more quickly if clients are willing to do take what they learn in therapy and apply it in real life in between sessions.
When I started Dead Works, I knew I would have to give up a lot of the therapy process. Much of the work takes place “off-screen”. It may not be readily noticeable, but Eric’s theoretical orientation is cognitive-behavioral. You can “see” this by his focus on what Greg is thinking and doing as he is coping with his problems. At the same time, however, Eric is not ignoring Greg’s emotions. He uses active listening and empathy and reflects what Greg is feeling. I try to demonstrate this for the purpose of making their developing relationship appear authentic.
I’ll talk about the content of their sessions in an upcoming blog…