One of the things I would like to see more of in our field is a shift away from strict linear thinking and a move toward non-linear thinking. At some level, viewing a psychotherapy case from a linear perspective may be effective, but it can also limit the clinician’s ability to formulate generative interventions. It might be more useful to view cases from a non-linear view.
Linear thinking uses reductionism as a base for problem solving. Reductionism focuses on details within the problem and then takes the problem apart by studying the parts of the problem (and then studying the parts of the parts). Reductionism attempts to find a solution by analyzing the smallest parts. This can sometimes give insights about the part being examined, but it does not assist much with understanding the “whole.” The connections between the parts can become lost and the problem is then seen as an isolated “cause.” This simple cause and effect perspective removes any questions concerning the nature of the relationship between the parts of the system. A strict linear way of thinking also does not take into account how actions affect the environment.
Let’s look at an example of how cause and effect can appear to be easy to discern, but yet also can be deceptive when we overlook the importance of “parts”:
If we ask the question of what makes a bus go, we may come up with the answer, “gas”. This response may be correct on one level, but it also lacks a more complete view of the question. Granted the bus won’t go if there is no gas, but there are other things that may prevent the bus from going, even if gas is present:
-the bus will not go if the ignition is not activated
-the bus will not go if the schedule for it to run changes
-the bus will not go if there is not a driver present
-the bus will not go if there are no tires
-the bus will not go if no one is there to ride the bus
All of these could contribute to a “cause” for the “effect” of the bus not going.
When we are doing therapy, I believe we need to be mindful that there is a greater complexity than we may realize in our clients and our therapeutic interventions need to reflect this complexity. We are all individuals, but we also interact with other individuals. We are all parts of a larger “whole” that has increasing levels of complexity. Our parts of the “whole” are in communication, which allows us to be self-correcting and self-organizing. Our “whole” takes in information from both internal and external sources which it organizes into a hierarchy of organizational levels. It is due to this organization of levels that makes simple cause and effect linear based therapy rather limited. Humans are far too complex to be understood in simple cause and effect terms. Since humans constantly interact with their environments, this creates the ability for them to create new wholes which emerge in a manner which cannot be known from isolated parts.
From a non-linear perspective, it becomes difficult to do rigidly structured therapy interventions in a “do X when Y happens” process. Instead of attempting to study the parts of the parts of the parts of a problem, it behooves us to consider being more resourceful in our interventions and consider the greater whole. Rather than focus on one part as the “cause”, taking a larger view of the interaction may provide us with more opportunities to create change.
Let’s examine a therapy case of mine through the lens of linear therapy:
Adam, a 14-year-old boy, was brought to therapy by his parents due to his not going to school, his depression, and his emotional outbursts. His mother, who was a psychologist, felt that Adam may have a mild form of autism. This had caused her and her husband to feel sorry for Adam and cater to his every whim over the years. When Adam would not go to school and have a meltdown, his mother and father would become very concerned that Adam would never be able to be responsible for his life and this caused them much worry. They would then overcompensate their attention on Adam, particularly the mother who would constantly monitor him, even when he was behaving “normally.” The father worked long hours and was not around much and relied on his wife’s information when choosing how to deal with Adam. It was a battle they faced weekly. The parents were both overly anxious about Adam’s mental health and Adam was frustrated by his parents’ actions and attempts at discipline.
At this point, it is might be easy to pick a cause (A) to this effect (B):
(cause) Adam’s behavior –> (effect) family turmoil
If this is the case, then the therapist could simply use interventions to adjust Adam’s thoughts and actions and restore harmony to the household.
On the other hand, maybe it is the mother’s constant monitoring that is creating the outbursts and depression in Adam? Or maybe it is the father’s lack of involvement in the family due to work that is motivating Adam to resort to drastic measures to get his attention? Or maybe the father’s lack of interaction with the mother is causing issues within the household and Adam’s behavior is an unconscious attempt to get mother and father to work together?
If the therapist only focuses on one “part”, then the other parts may continue to stabilize the part being affected making change elusive.
Again, the bus will not run for other reasons than just being out of gas.
Now, let’s look at the case through a non-linear therapy application:
Adam was open and friendly and his parents were educated, talkative, and kind. After spending a half hour with the family discussing the “problem” of Adam’s behavior, I dismissed Adam from the room and talked privately with his parents. I informed them that the way to help Adam was for him to experience a feeling of “helpfulness” in the family. I acknowledged their concerns about his possible autism and depression and told them I believed that his feeling “helpful” would be a great way to combat these issues. I asked who was the happiest and most optimistic person in the house. They both quickly answered that it was the father. He was referred to as the “positive cheerleader in the house.” I directed the father to pretend for the next two weeks that he was deeply depressed when he was at home with his family. The mother was to go along with this performance and to talk with Adam about her concern regarding his father’s condition.
Adam was then brought back into the room and informed that a family secret had been uncovered in therapy. This secret was that his father has been suffering from depression for a long time and has been hiding it from the family. Adam and his mother were directed to put their energy into helping the father feel better and try not to worry too much about him. The father put on an Academy Award worthy performance in the office unmasking the “secret” of his depression. The family left and were scheduled to be seen in two weeks for the purpose of checking on the father’s “depression.”
When the family returned to therapy, they reported that Adam had been very helpful to his father over the last two weeks. He had started assisting the mother a little more often as well. He had only once refused to go to school, but his emotional reaction was much more subdued than usual. The father, with a wink, stated he was feeling better with his depression. The mother reported she was experiencing overall fewer problems with Adam.
Even though client change can happen in a linear way, are we truly able to fit human behavior to a simple cause and effect no fail process? The lure of easy one size fits all therapy often neglects the reality of an alive human organism. By opening our minds to a non-linear way of examining psychotherapy, we allow ourselves a more holistic view of generative change which requires creativity and curiosity on the part of the therapist.