![]()
1
To Do Our Work
Experience is the child of thought and thought is the child of action. We cannot learn men from books.
Disraeli
It takes two to speak the truth – one to speak and another to hear.
Henry David Thoreau
Why this Book?
A clinician for the past forty years and a teacher, consultant, and trainer for the past thirty- five years, I have come to appreciate the need for a common-sense and down- to-earth approach to the helping process. Students and colleagues who are learning ask often for direction in finding a practical guide; but what they find – and find wanting – is a literature of long scholarly treatises on theory, extended descriptions of therapeutic technique, and overblown reports on clinical research about effective intervention. Complaining that none of these offers very much usable information about how to work with people on a day- to-day basis, they go on looking for a book to fill the gaps. Theoretical frameworks and findings from research studies provide only limited help in learning the art and craft of helping. Between the ideas that science provides and the kinds of decisions the clinician must make, there is a gulf that we must bridge before action can be taken.
Clients are particular and unique in nature and character. Theory is general. The fit between the two is never perfect; nor is a strong skill base enough, for a creative leap must be made if we are to cross the space between often inapplicable theory and the concrete reality we face every day.
Over and over I have heard clinicians, both new and experienced, ask for practical guidelines, systematic direction, and suggestions for creatively working with their clients. Feeling too often inundated by jargonized and abstract proposals for effectively working with clients, they want help in answering difficult questions, which include: What do I tell clients about myself? How do I divide my focus in the beginning among establishing a relationship, developing a contract, and giving the client something concrete on which to establish a basis of hope? Just how is hope instilled? How can I enhance the process and avoid getting in the way? How do I connect with clients? How do I utilize nonverbal interactions?
This book will help you confront these questions and fill the gap in the literature. It is a practical guide to working clinically with people through the various phases of the helping process. “User- friendly,” it describes some familiar tried- and-true techniques but also concentrates on innovative methods of help- giving. Even though there are computer programs for learning these skills, it seems to me that computers – as valuable as they are – fall short, for they cannot provide human connection, the most essential dimension in the helping process. Even though you “cannot learn men from books,” books do serve, next to person- to-person contact, as handy and discriminating means to reflection and introspection. Although there is a tendency to disparage pragmatic tools for clinical practice, what we value most in our work is the application of sound principles. The ultimate test of theory is its usability in actual, direct, face-to-face transactions with clients.
It is bothersome to me that what gets addressed repeatedly about therapy at this juncture in time is what can be observed or converted into statistical research findings leading to manualized and prescribed programs of intervention or pharmacological remedies. True, each of these can be informative and helpful, but it may miss the most essential element – humaneness. They can at times be superficial. I have often found myself relying on intuition, experience, wisdom, and risk- taking when research and theory, no matter how elegant, failed to inform my work. My purpose is to re- affirm the essence of therapy as acknowledgment of the centrality of relationship, reflection, and the role of practice wisdom with a strong dose of compassion and caring. And each of these resists being quantified or analyzed.
Hollis cogently wrote that our work “is both an art and a science: an art in that it requires individual creativeness and skill; a science in that it is a body of systematized knowledge based upon observation, study and experimentation” (1969: 265). Her remarks reverberate with those of Richmond, who pointed out that any “method that ignores or hampers the individuality of the worker stands condemned not only in social work but in teaching, in the ministry, in art and in every form of creative endeavor” (1965:10). And Jung concluded that this conflict (between the arenas of art and science) “cannot be solved by an either–or but only by a kind of two- way thinking: doing one thing while not losing sight of the other” (1957: 19). It boils down to a vision of therapy that is more humane and less technocratic.
A question: Wouldn’t you prefer to see (and be) a clinician who takes time to listen, who goes beyond the manual, who sees you (and whom you see) as a person, not simply a disorder?
Apparently, when questioned about what produced healing in therapy, Freud himself named it as “love.”
This book, then, differs from other textbooks in several respects. Even though it endeavors to blend theory and practice, it is not typically scholarly and does not emphasize the “science” of our work, although it introduces a variety of objective ideas for evaluating your practice. Nor is it restricted to “left-brain” conceptual and statistical elements of the work, even though theory, analysis, and logic are essential ingredients of the mix. The “art” of the work is stressed instead, with “right- brain” attributes of synthesis, intuition, and wholeness. No reductionistic formulas or mechanical strategies are offered, but sensible tips, guidelines, “rules of thumb,” and new ideas for proceeding are given.
Different from other textbooks in that it does not elaborate extensively on any one school of clinical practice, Elements of the Helping Process: A Guide for Clinicians is integrative in the kindest sense of the word, describing sundry theories only as they pertain to, illuminate, or explain your more immediate clinical interaction. It seeks to identify theory that fits clients at different points – and under different circumstances – during the work and focuses especially on finding the most instrumental and relevant interventions. You will notice that what is encouraged is a less rigid and more fluid and personal approach to clinical practice, an approach that, informed by theory and practice, opens the way for you as you to respond appropriately, differentially, and effectively to a wide range of clients with a broad array of problems. It will facilitate your walking the tightrope between over- identification and excessive detachment, while tailoring your work to your clients rather than expecting them to fit your particular approach.
Using an informal tone, I try to speak directly to “you” rather than addressing myself to some anonymous clinician. This personal style reflects directly my bias about what I believe the work can be.
This book resembles others in the field in drawing from examples from actual practice for clinical illustrations. These are selected to be instructive about intervention and to illuminate the application of theory. I have concentrated on an array of theoretical and practical approaches that characterize each stage of the helping process. A repertoire of varied suggestions and techniques is offered, encouraging you to discover your own style. You will move from the engagement stage to termination, following the progression of the process, with special chapters devoted to creative practice methods. Interventive procedures adapted to clients’ discrete needs are identified, discussed, and illustrated. Ways to individualize your clinical practice are suggested.
General Outline of the Book
Elements of the Helping Process: A Guide for Clinicians is divided into four main sections.
Part I: Establishing the Foundation for Effective Intervention
The book’s focus and intent are discussed in Chapter 1. It also takes up some of my assumptions about the helping process, along with some basic propositions about the people we call clients. I argue for an integrated approach to clinical practice and conclude with a discussion of the need for you to be an active participant rather than a passive observer in the helping process.
Creating a “Safehouse” for clients is the theme of the second chapter. The “Safehouse” is a powerful metaphor for the helping process that clarifies and unifies such diverse clinician characteristics as empathy, good rapport, neutrality, and anonymity and the real and transferred relationship. Clients’ growth and the ability to master internal conflict and external frustration require that you establish a setting that meets their basic needs for security and affirmation. Guidelines are laid out for building such a “Safehouse” for clients. We draw upon attachment/ separation theory and elaborate upon the concept of the “holding environment.”
The third chapter focuses attention on the dynamics of the helping relationship, while stressing the centrality of “relationship” and your own awareness of self. Seven levels of relationship – the seven “I’s,” as I call them – are discussed: Individualization, Intellectual learning, Imitation, Internalization, Identification, Idealization, and Individuation. The final message of the chapter is that the essence of the helping process may not be the truth arrived at as much as it is the manner of arriving at the truth.
Chapter 4 presents some fundamental principles and novel ideas about beginning the helping process and educating clients about the nature of helping, while making possible the deeper purpose of their reviewing their life stories. Phases of preparation for the initial contact are addressed. The chapter underscores the importance of responding to clients’ valid need for structure and devotes considerable attention to what you can expect from clients and what clients expect from you. I conclude with a checklist for guiding your reflections on your work.
Part II: Configuring a Plan to Guide the Process
In the fifth chapter I discuss basic philosophy, premises, and principles of goal- setting and contracting. An outline for developing a sound contract is followed by an illustration from actual practice. The chapter reviews the benefits of contracting from the perspective of assessment and evaluation.
In Chapter 6, advances in neuroscience and genetics are addressed. Topics include the role of brain research in human behavior, hemisphericity, and the place of genetics and their overall implication for clinical practice. The chapter elaborates upon the function of mindfulness in providing effective treatment.
Chapter 7, Evaluating Client and Clinician Progress, builds upon Chapter 4 and discusses objective as well as subjective means for you to consider in evaluating client progress as critiquing your own clinical endeavors.
“Learning from a Jig- saw Puzzle” is the metaphor that rules Chapter 8, where we examine the assessment process. I review what assessment is and is not, while offering guidelines for feedback, and discuss the types and general process of assessment. A section on “labeling” concludes this chapter.
Personality types or styles and their characteristics comprise the gist of Chapter 9. Special attention is directed at the Jungian perspective followed by a personal take...
