Intuition in the Therapy Room

The role of intuition in therapeutic work has been something that has not been examined as much as it should be in our clinical training. Intuition can be thought of as the unplanned forming of impressions and the drawing of inferences. The noted neuroscientist Antonio Damasio describes intuition as “a non-cognitive way of knowing things.” Most every effective therapist I have met has talked about the importance of following clinical hunches and gut feelings in his or her work.

In the early days of psychotherapy, leading figures such as Sigmund Freud and Carl Jung noted the importance of using intuition in therapy. In the fast paced, emotionally charged work that therapists deal with, there may be great benefit from utilizing the quick nature of intuition. In an article entitled “Intuitive Listening” from the journal Modern Psychoanalysis, Lynne Laub discusses many different ways that intuition can appear in clinical work. She found evidence for using intuition in such areas as metaphors, dreams, symbolism, and non-verbal communication. Other researchers have found that the use of intuition can be very effective, but only if there is ample trust between client and therapist, as well as the clinician’s trust in his or her own gut feelings. Arthur Bohart, in the article “Intuition and Creativity in Psychotherapy” from the Journal of Constructivist Psychology, writes that intuition is really inspiration that just spontaneously occurs to the therapist while he or she is in the flow of the therapeutic interaction. It appears that the topic of intuition might need more exploration as it may aid the needs of our clients within the therapeutic relationship.

 

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If intuition is so important in clinical work, why is there so little time spent discussing this phenomenon in psychotherapy training?  It may be that many professionals in the fields of psychology and psychotherapy have a desire to have their work strictly rooted in empiricism in order to be seen more as a science than an art. Intuition may be seen as too connected to spirituality and mystical leanings than aligned with “hard science.” Not having a set operational definition and application can make it problematic for researchers who are interested in investigating intuition in order to quantify its operation.

Since the prevalent approach to working in the clinical arena continues to be directed by empiricism and standardization of treatments, there is little space for teaching therapists to begin trusting themselves (and their intuition) more often. The employment of regimented therapeutic techniques often limits a practitioner’s access to his or her own internal wisdom. The “cookie cutter” approach to performing therapy leaves few openings to investigating our clinical hunches. Is there not a middle ground that not only gives therapists a structure in which to work, but also honor the mystery of our unconscious intelligence? I think there is, and most therapists who routinely follow their gut in the therapy room would probably concur.

Using our intuition may involve introducing odd statements and/or actions into the therapy discourse. What may not seem to make sense initially, might connect in ways our conscious minds might not at first comprehend. I have previously written about the importance of introducing the random into a therapy session and it may be that the random is preceded by an intuitive action.

One time I was working with a young woman who was in recovery from Methamphetamine addiction. She was trying to get her life back together and heal the hurts that her addiction had caused. She was not feeling good about herself and was constantly worried about falling back into her dysfunctional patterns. Our topic of the day was her learning to soothe herself when she became distraught instead of automatically turning to unhealthy men or drug use.

As we chatted, a strong image popped into my mind. I saw an image of a large number of birds flying. For some reason I felt compelled to trust this intuitive flash and ask her directly what “birds” meant to her. She stopped talking for a minute and sat with a puzzled look. She then told me that when she was a young girl, she and her grandmother would feed the birds that gathered in her grandmother’s backyard. As she talked about this time period, her eyes began to show tears. She explained that being with her grandmother were the few times in her life when she felt that she was “safe and good”. Upon hearing this information, I decided to see if she would be open to feeding the ducks who gathered at a pond across the street from my office. With a big smile, she quickly agreed to do this task.

In time, she found that she was able to reconnect with the feeling she had with her grandmother when she feed the ducks. She also decided that she would feed the ducks anytime she felt overwhelmed by life and needed to soothe herself.  By following my intuition, with what initially seemed to be an unrelated mental image, my client was able to find a positive resource to use for her healing with which she had previously lost touch.

My advice: Trust yourself. If you get a hunch, no matter how odd, follow it. See what opens up

The Psychotherapy Marketplace

Lately I have noticed an increasing trend in the psychotherapy field in which the marketplace of ideas has become more crowded. Every day it appears that someone has invented a new theory, therapy, or technique that is then marketed as the latest and greatest breakthrough. A flocking of therapists to training programs on these new inventions has created thriving businesses for many. The good news is that the more these offerings are marketed, the more these new ideas can be heard and explored. The bad news (at least to me), is that it may create an idea that by learning just the “right” theory, therapy, or technique, we as therapists can increase successful outcomes. Some psychotherapy marketers have gone so far as to draw a line in the sand and declare that what they are offering is the cure to most of the emotional problems for which people come to therapy. Others have been more respectful and inclusive in their offerings.

 

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I think it is important for us all to remember that, in spite of the best marketing efforts, research still shows that any one specific therapy application is not superior to any other when it comes to measuring outcomes. In an article in the journal “Clinical Psychology: Science and Practice”, Stanley Messer and Bruce Wampold found in the results of their research that there is no evidence that that any one therapy application provides the magic bullet for successful clinical work. They write:

Such results cast doubt on the power of the medical model of psychotherapy, which posits specific treatment effects for patients with specific diagnoses. Furthermore, studies of other features of this model—such as component (dismantling) approaches, adherence to a manual, or theoretically relevant interaction effects—have shown little support for it.

In fact, the most recent research on what really works in practice involves each individual client’s perceptions of the overall progress of treatment and the key determinant for success still comes down to the client-therapist relationship. Michael J. Lambert and Dean E. Barley, in an article titled, “Research summary on the therapeutic relationship and psychotherapy outcome” from the journal “Psychotherapy: Theory, Research, Practice, and Training”, found that factors such as warmth, empathy and the therapeutic relationship had a higher correlation with client outcomes than specialized treatment interventions. (For more on the factors which create success in therapy work, I highly recommend the work of Dr. Scott Miller: www.scottdmiller.com )

If it is true that specific theories, therapies, and techniques are not, as Bateson would say, “the difference that makes the difference”, then maybe this can free practitioners from any rigid allegiances in the constant changing psychotherapy marketplace.  I still encourage people to create new models and techniques and expand our field; however, I think we all need to be aware that even the greatest technique may go nowhere if a client does not have trust and a solid connection with the therapist. Unconditional positive regard for clients and having a human connection should never go out of style.

Episode 21: Steven Hoskinson Interview

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In this episode, Steve Hoskinson is interviewed. Steve is the founder and Chief Compassion Officer of Organic Intelligence, a theory and systemic clinical application of human empowerment, resiliency, and compassion to resolve the devastating effects of Post Traumatic Stress Disorder.  Steve has trained thousands of individuals in the helping professions in North America, Europe, Asia, and the Middle East in the art of the compassionate treatment of trauma.  As a leader in the Somatic Psychology field, Steve was Professional Training Faculty for the Somatic Experiencing® Trauma Institute for 17 years and is currently Adjunct Faculty for JFK University’s Somatic Psychology program. He has graduate degrees in Theology and Psychology and is a founding member of the Northern California Society for Integrative Mental Health and the International Transformational Resilience Coalition.

In this interview we discuss therapy from a systems perspective and the idea that what is wrong with therapy is the focus on what is wrong. He also discusses the crucial aspects of therapeutic context and framing, second order change, the importance of curiosity in therapy, and be able to “act in order to know”.

For more information on Steve Hoskinson and his work, check out his website: https://organicintelligence.org/

Episode 19: Elliott Connie Interview

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In this episode, Solution Focused Brief Therapy (SFBT) teacher, trainer, and therapist, Elliott Connie is interviewed about his approach to working with clients. Elliott is the founder of the Connie Institute, which hosts training events for those who are interested in learning new, cutting edge SFBT skills.

In this interview, Elliott discusses the importance of strengths based approaches to counseling, making interventions simple for maximum effectiveness, staying out of the the frame of a problem, how the expectancy of the therapist is a crucial part of the change process, and the role of therapist authenticity.

For more information about Elliott Connie and his work, check out his website: elliottspeaks.com

Episode 18: Scott Miller Interview

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In this enlightening interview, I get to talk with the one and only Dr. Scott Miller. Scott is the founder of the International Center for Clinical Excellence, an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services. Scott conducts workshops and training internationally, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He is one of a handful of “invited faculty” whose work, thinking, and research is featured at the prestigious “Evolution of Psychotherapy Conference.” His humorous and engaging presentation style and command of the research literature consistently inspires practitioners, administrators, and policy makers to make effective changes in service delivery.

In our conversation we discuss such important topics as feedback informed therapy, the misnomer of “evidence based” therapies, what aspects of psychotherapy are consistent in practice, and what can make the most difference in achieving positive outcomes when working with clients. Scott is a wealth of information and you can learn more about his work at his website: www.scottdmiller.com

Episode 16: Bob Bertolino Interview

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In this episode Dr. Bob Bertolino discusses the importance of working with a “strengths based approach” in psychotherapy, the importance of client expectancy and hope, feedback informed therapy, and working with children and adolescents.

Bob is a professor of Rehabilitation Counseling at Maryville University in St. Louis, Missouri, Senior Clinical Advisor at Youth In Need (YIN), Inc., a community-based non-profit organization in eastern Missouri that serves children, youth, and families, an a Senior Associate for the International Center for Clinical Excellence (ICCE). Bob has taught over 500 workshops throughout the United States and 11 countries, and worked with numerous national, state, and local organizations, and both the United States Army and United States Navy. He has authored or co-authored many articles and over 14 books on counseling, psychotherapy, and youth care work, with his books being published in 6 languages.

For information about his work and workshops, you can go to his website:  www.bobbertolino.com

How to Become an Irreverent Therapist

I recently came across an old article while doing some research that really got me thinking in a different direction. The article was written by Cecchin, Lane and Ray and published in the Journal of Marital and Family Therapy in 1993. It is entitled “From Strategizing to Nonintervention: Toward Irreverence in Systemic Practice”. The article discusses the shifting of focus in systemic therapy away from cybernetics and directive interventions and towards nonintervention and a focus on narrative (this shift was a huge mistake in my opinion). In the article, the authors suggest that in order to avoid the trap of being constricted in any way, therapists may want to embrace irreverence in their clinical work. This will enable them to avoid any potential limitations. It is a fantastic article that still has applications today. I was so inspired by the authors’ ideas that I wanted to share them, along with my own thoughts about how to become an “irreverent therapist.”

How to become an Irreverent Therapist

To be able to act without any restrictions on effectiveness, irreverent therapists need to take 100 percent responsibility for the actions they take and the directives they give. They must be willing to do anything within ethical guidelines to create the conditions for change to occur. If a therapist needs to be silent for the whole session in order to create change, she will. If a therapist needs to be confrontational in order to create change, she will. If a therapist needs to jump up and down on the couch singing songs from the 1960s to create change, she will. An irreverent therapist has an incredible amount of flexibility because her client is the focus of the session, not her theory.

 

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This will mean that the therapist will have to abandon any concepts, ideas, theories, or beliefs which could hamper the successful outcome of treatment. To quote Cecchin, Lane, and Ray, “therapists should maintain a healthy disrespect for any idea which restricts therapeutic maneuverability and creativity.” If you want to be an irreverent therapist, it is crucial that you successfully overcome any desire to stick to predetermined theory or technique that is regarded as the gospel truth. Any allegiance to a dogma is to quickly be rejected in order to flow with the moment as you and your client interact.  Practice laughing maniacally when you hear that a specific theory or technique is labeled “the best”.

An irreverent therapist will go out of his way to undermine and create havoc in the rigid beliefs and patterns of his clients. The order of the day is to embrace playfulness and see what happens when an inspired, uninhibited shrink gets to have fun. The irreverent therapist is also expected to poke holes in his own beliefs and patterns as he weaves a web of possibilities in his interactions with his clients. Uncertainty is not only embraced but encouraged in the therapy room. Any viewpoint the therapist or client takes as an absolute certainty in the session must be disregarded and discarded in favor of pure spontaneity and aliveness. Any certainty that the problem the client brings is unsolvable needs to be immediately dismantled in the therapy session. Spend time observing mastery of the absurd by watching a Marx Brothers movie or a Samuel Beckett play (these are much more enjoyable and teachable than most therapy textbooks).

An irreverent therapist pays little attention to how problems got started. He or she will be mostly focused on how things can shift and change. Investigation into past history and narrative explanations are kept to a minimum as the therapist redirects focus away from problem investigation and towards an exploration of client strengths and resources. Diagnostic labels are regarded with much suspicion and even disdain (maniacal laughter can be used here as well).

Try on the mantle of “Irreverent Therapist” for a week. Put it on your business cards. For this title there are no expensive, long term trainings to attend in order to obtain some silly certification. All that is needed is an openness to absurdity, an embracing of compassion, and a sense of humor.

principles

Theoretically speaking…

A theory is a generalized explanation and body of knowledge about how something operates. These explanations are used to predict and assume outcomes for specific actions. A theory stands if the results can be consistently replicated by researchers under similar conditions.

In the field of psychotherapy, research seems to come out daily promoting one theory of therapy over another. Each theory proponents pushes their theory to be the most effective and often have substantial research as evidence to its effectiveness. The rigor shown by these researchers can be impressive and their work has created shifts in, not only the content of educational training, but also funding for programs which are designed to assist the public with mental health issues.

I remember talking with one therapist who told me that the only real reason he started using his theory of therapy was that it was “evidence based”. He had not tried any other forms of therapeutic interventions because he felt there was not as much research to back up other theories. He said close to seventy five percent of his clients got better using his approach. My question to him was, “What about the other twenty five percent who don’t change?” He politely changed the subject at that point.

 

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Even though there are some great aspects to having a solid theory of how to do therapy, these theories can sometimes become cumbersome and limiting if we think each individual will automatically fit into our theory. Our clients may not have received the memo that they are to respond a certain way at a certain time due to a certain intervention. When the client does not fit the theory presented by the therapist sometimes the client is then labeled “resistant”. When a client is seen as resistant due to his or her inability to conform to the will of the therapist, the therapist may then become frustrated, angry, feel ineffective or become burned out due to his or her strict adherence to their theory.

The best way to handle the “resistant” client is to throw away your theory. This may be blasphemy to many who cling to their theories in a dogmatic, evangelical way. Many times our theories are good for some clients but not good for others (the twenty five percent). If all we have is one way to assist others we may find ourselves surrounded by “resistant” clients who make us work too hard, feel defeated and uninspired in our vocation. When we allow ourselves to create new interactions in the moment with each new client without a set scripted theory, we may find that every therapeutic encounter can feel much more exciting and creative. What if every client needed his or her very own theory of therapy?

The great scientist Karl Popper believed that theories by nature are abstract, and can only be tested in reference to their implications. Popper asserted that a theory is irreducibly conjectural and brought about by our imagination to solve problems that have come about in a distinct cultural and historical context. He felt that the truth of any theory cannot be verified by scientific testing. It can only be falsified.

To quote the brilliant family therapist Carl Whitaker: “I have a theory that theories are destructive.” Whitaker argued that too much reliance on a theory can cause a loss of objectivity for each unique person and situation. He felt this could result in a loss of compassion and care for the client. He argued that clinicians should consider give up strict adherence to theory and become alive as a real person in their sessions. As he eloquently put it, “Part of the problem is the theoretical delusion that science is curative; that enough knowledge, enough information, the right kind of facts will bring about the resolution of life’s doubts, the resolution of all distress.” I think Carl got this one right.