Are you a Lazy Therapist?

Are you a lazy therapist? If not, could you try to become one?

To me a lazy therapist is one who does only what needs to be done. He or she will relax and let the therapy session move into whatever direction it needs to take without feeling like he or she has to control it. Lazy therapists go with the flow and even sometimes shift the flow in surprising ways.

Most of us have been taught that if we are working harder than the client then something is not right. It may be that we want to the change in the client more than the client wants it. It could also be that perhaps we are attempting to get the client to fit into our therapy model. If we are lazy therapists we just let new therapy models happen all by themselves. We take whatever the client gives us and we use it to create new possibilities for the client. If we are trying to force a client into a model it feels like “hard work” and that means you aren’t being a lazy therapist.

lazy therapist

To be a lazy therapist does not mean you have to be an ineffective therapist. Quite the contrary. You may find that the more you let go of control and let the client do whatever he or she is going to do, often magical openings appear for you to do great therapy. These openings may not appear if you are working hard to get the client into a set pattern of interaction.

 
To be an effective “lazy” therapist I believe you need to do two things:

 
Improvise and Utilize

 
When we improvise we let the client takes us on a journey. We see what magically appears and we do things which seem natural in that specific moment.
After that we then utilize what has occurred in our improvisation to move our clients toward new resources for healing.
This is so different from “working hard”. This can be quite a fun, lazy way to help people.

 
Instead of badgering a client to change their thinking, why not start a discussion about something they enjoy which could lead to an experience of interaction which might shift their thinking in ways beyond anything you might have thought possible?

 
Instead of pushing a client into facing his or her fears, why not do an out of the ordinary activity where he or she can feel in charge of the situation and access the resource of confidence?

 
Instead of working hard to label a client, why not pull out your DSM and ask the client what label they would like to have, which could start a great discussion about the power each of us has to choose our own labels?

 
You could easily do all these kind of things but you may feel you are being lazy. That is a good thing.

What a Paradox!: Using Paradoxical Interventions for Fun and Change

Paradoxical interventions could best be described as when a therapist directs his or her client to perform the very problem the client is seeking to eradicate. The underlying principle is that clients’ implement certain emotions and actions for specific reasons. Usually the behavior is unconsciously created in order to meet a certain perceived need by the client. Examples of this could be the need to be noticed, the need to feel some degree of control in one’s life, the need to feel safe, the need to appear strong, etc.

By directing the client to enact the problem behavior, the therapist is assisting the client in meeting this need but at the same realizing (consciously or unconsciously) how much control he or she truly has over the behavior. The act of consciously creating the behavior can lead the client to realize that if he or she can create it, then he or she also has the ability to change it. It is important for the therapist to maintain a nonjudgmental attitude toward the client’s behavior as this acceptance of the behavior by the therapist allows for the opportunity of the problem behavior becoming a beneficial resource in the therapeutic process.

To be blunt paradoxical interventions can often be funny. Having someone consciously do the very thing that he or she does not want to do can often bring about comical consequences (it can also bring about profound healing).

Paradox

Recently I had a young lady in my office that had an issue with shoplifting. She felt she could not go to the store without stealing something. It had got to the point in which she had to have someone go with her when she went shopping to protect her from stealing. She earnestly wanted to stop her problem behavior but felt a compulsion to do it. She would steal something and as soon as she walked out of the store she would intense guilt, shame and anxiety. She felt stuck and hopeless.

After listening to her story and empathizing with how difficult it had been for her to deal with this “compulsion”, I asked her if she could feel that compulsion now in my office. She said she could. I congratulated her on being so in touch with her feelings. I then told her that I wanted her to go out to our busy office area and steal something. She was a little surprised by this request. I told her that I wanted her to go out and steal whatever she wanted as long as she let everyone know she was going to steal something. She had to ask permission to steal.

I went out to the office area with her and told the staff that my client was going to steal some things. They all looked at me and understood that I was doing yet another of my wacky interventions so they agreed without hesitation (I love the people I work with!). I then told my client to take all the time she needed to steal something. It took her a good minute or two to take something (a stapler) and we returned to my office. She handed me the stapler and told me she did not enjoy that exercise at all. I asked her to continue stealing for the rest of the therapy hour. She complied and brought me back many things from the office. By the end of the hour she was not feeling much compulsion any more. She even reported that her feelings about stealing had changed a little. I recommended she go to the store she steals from the most and tell the staff that she is going to steal something as part of her “therapy” but as soon as she walks out the door she will return it. She agreed to this idea but thought I was “crazy” (which is true).

Over the next week she found that her compulsion to steal was nowhere as intense as it used to be, in fact the one time she did take something she immediately returned it. Even though she still has some feelings that encourage her to steal, she has found a new resource due to being put in a paradox of being encouraged to steal.

I would recommend that a therapist utilize a paradoxical intervention when there is a specific problem which the client believes is involuntary. Clients often perceive certain actions they do as out of their control even though they have an unconscious strategy of how to create these actions. A therapist may direct their clients to increase the frequency of the behavior or to schedule it for a specific time each day. It goes without saying that paradoxical interventions are to be used only when it is safe and in the frame work of a positive therapeutic relationship.

Have some serious fun with these interventions (serious fun? What a paradox….).

Frame Game: How to Create Change with the Power of Reframing

One of the most important skills a therapist can have is the ability to reframe the problem which their client brings to therapy. Reframing can be defined as a method in which the therapist restates or reinterprets the client’s problem in a way in which the client can experience the problem in a new way. By directing the client to be able to experience the problem from other points of view, the therapist can change the meaning and the definition of the problem into a problem that will be a little easier to solve.

The point of using reframing in a therapy session is to change clients’ view of the problem from something as being unsolvable, into a new experience in which the problem is now something that can be changed and maybe even be appreciated.

Think of reframing as a way to suggest to your client a more resourceful and meaningful experience in which he or she can have access to different behaviors and emotions. Reframing should give your client new possibilities that he or she had not previously considered or experienced.

 

reframe

 

Here is a simple method one can use to reframe client problems:

1. Notice your client’s present interpretation of the problem
Ask yourself what other possible interpretation of the problem could exist?
Is this problem something that would be appropriate in another setting? If the context of the problem changed would it still be a problem for the client?

2. Find the most interesting new interpretation of the problem and immediately point it out to the client.

The reframe could be something that is humorous, profound, touching or just plain odd.

3. Notice how the reframe affects the client. If it works build on it, if not then discard it.

 

Here is an example of using this process:
A family came to see me for therapy due to their teenage daughter having occasional anger outbursts. The parents were very concerned with these outbursts as the family was a loving family but was very cerebral in how they interacted and as a result they were rather emotionally distant.

After hearing all the details about the “problem” of the daughter’s outbursts, I asked the parents if they truly appreciated what the daughter was doing for the family. Both parents seemed puzzled by my comment that this behavior was to be appreciated. I went on to tell them that their daughter was trying to help the family have access to more emotions than the handful they had been using. I told them that I believed the daughter was unconsciously trying to get them to “feel more deeply” rather than just “think their way through life”. I added that it took a lot of courage for a young girl to be so open with her emotions and I wondered how the parents could show her that they also had the courage to feel more often.
From that point on the parents began viewing their daughter’s anger as a cry for emotional connection with her family. Her parents began to interact with her more often and even, over time, began to show a little more emotion themselves. The level of love, openness and happiness increased in the family as a result. The problem had become the solution.
I believe reframing is an amazing tool that should be in every therapist’s toolbox.

What frames have you played with recently?