An Ecological Approach
What constitutes good therapy for me may well be very different for you. What I can share with you, is my own perspectives as a client, clinician and human on the approaches I believe form the fertile ground for good therapeutic work.
My perspective is based on my unique field of experiences and the belief that all of our challenges are relational in nature. Whether it is the intrapsychic relationship we have with ourselves or the interpersonal relationship we have with others, relationships are the place where we meet our biggest challenges as well as our biggest opportunities for healing and growth.
Carl Rogers said:
"In my early professional years, I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?"
For me, "good therapy" and how we practice it, rests on how we engage with people.
AN ECOLOGICAL APPROACH
The medical model approach to "mental health" traditionally sees a person as someone with a set of symptoms to be diagnosed or a condition to be fixed. Questions about a person's experiences in life that enable a consideration and understanding of the bigger picture are rarely asked in a clinical setting. I can't help wondering: What if practitioners were in a position, time wise to hear more of the background story that brings a person to see them?
I believe that clinicians and health professionals alike, need to work together to adopt an ecological approach that recognises the whole person, as well as the multiple environments and contexts that influence and impact them. This means paying attention to sociocultural, relational and environmental factors and taking into account a person's biology, genetic predisposition and neurobiology.
This shift requires us to see people as more than their "pathology". It asks that we look beyond a person's challenges or symptoms and begin to recognise the tremendous courage and resilience of the human spirit to cope with life's experiences. When we can see before us, people who have adapted to their challenges ‐ rather than only seeing labels or disorders, we can appreciate the unique and protective mechanisms that for a time kept them safe in the face of danger, limited resources and minimal support.
An ecological approach recognises the wisdom inherent in all human beings. It focuses on the whole person and the experiences that have shaped and influenced them. It celebrates a person's will and their ability to adapt and survive a lifetime of challenges.
EMPOWERING & COLLABORATIVE
More than any technique or modality a therapist uses, the key to good therapy is an approach that focuses on working collaboratively with clients. Working collaboratively means coming from a place of partnership: moving away from an 'expert model' of thinking and letting go of the idea that therapists "hold" the power for change or the promise of a "cure". Being in partnership is to ask ourselves to see each person as being the source of their own power and to see them as capable of growing and transforming.
Working together in partnership means being alongside our clients: It's showing them how to do the work of honest self-examination and personal reflection. Working in this way does not mean we do not provide guidance or knowledge, rather, it means we hold a space for the people we work with whilst balancing support and challenge, independence and interdependence. It means working with people to create new experiences that give them opportunities to feel a sense of love, hope and holding.
This approach to therapy allows people to begin to experience safety, to shift their world views and relax their defences. As this occurs people become more able to integrate new experiences, more self-aware, open and flexible, and they engage in life with more vibrancy and vitality. As we continue to be with and guide our clients to access their inner wisdom and resources, we help them recognise their unique strengths and their ability to create new experiences.
HUMAN & RELATIONAL
Research has shown that the therapeutic relationship between therapist and client is an important predictor of positive therapeutic outcomes. I believe the relationship we build with our clients is at the very heart of good therapy.
Neuroscience research shows us that the development of the therapeutic alliance increases neuroplasticity. Building this relational alliance allows the brain to resist the process of cortex dissociation, allowing clients to internalize and assimilate the relationship. This stimulates ongoing neuroplasticity growth which means the benefits experienced in the relative safety of the therapy room can also support them in their everyday life.
Good therapy, however, is not about having a "perfect therapeutic relationship" or achieving perfect outcomes. As with all relationships, the relationship between therapist and client is not free from challenges and issues, nor would it be reasonable to expect it to be so. It is perhaps the very humanness of the therapeutic encounter that provides a rich opportunity for people to understand and experience themselves more deeply.
In the dialogue and interaction between client and therapist there is always the possibility of experiencing the ruptures that are an inevitable part of relationship. When we "get it wrong" or misunderstand the person we are with, we have the opportunity to repair the "tear" or the damage that was caused. When a therapist can engage in the process of repair with a client they are able to strengthen the therapeutic encounter and deepen trust. It is in the repair itself that our clients can experience deep healing as well as an emotional experience that may be new for them.
Being able to embrace our humanness with our clients in this way is powerful. By bringing our authenticity, vulnerability and more of who we are into our interactions with our clients we show that we can accept ourselves as we are, foibles and all. In doing so, we support our clients to also accept themselves.
DOES GOOD THERAPY EXIST?
"Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal, such is rarely the case: instead…therapists frequently wobble, improvise, and grope for direction. The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy. This encounter, the very heart of psychotherapy, is a caring, deeply human meeting between two people, one (generally, but not always, the patient) more troubled than the other. " - Irvin D. Yalom
My experience is that good therapy is more than an approach, a person or a belief. Rather than making my version of good therapy fit for you, I leave you with an invitation to hold the idea and goal of 'good therapy' lightly.
As therapists, rather than looking to achieve a kind of "perfect" or ultimate experience when it comes to therapy we might take some of the wisdom we often impart to our clients…That good therapy is about learning and developing ourselves, trusting that we can indeed continue to grow and love in the face of all of life's challenges, disappointments and contradictions…and that at this moment, who we are and how we are, is quite possibly good enough.
