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The Problem With Technique(s)

There has been a shift in the field of psychotherapy toward learning and using techniques – ways of using specific intervention styles, behaviors, or strategies in order to deal with specific symptomotology . This has become increasingly popular with therapists and insurance companies for some very practical reasons: they help to focus the intervention in relation to something very specific and therefore definable; they limit the involvement of complicating factors; they can be quantified and studied; they have effect. Given these factors, it is easy to see why insurance companies would encourage and even mandate these “evidence based strategies”, or techniques: the intervention can be brief(er) – and therefore less expensive – since the focus is very specific and doesn’t include a lot of complicating factors. Therapists can feel rewarded by the support of the insurance industry, as well as feeling a sense of “knowing” and mastery of their ability to heal their patients. These are very important factors for therapists, who need to be financially remunerated, and who also have a genuine desire to help their patients to be alleviated from the symptoms that plague them. So, if a patient is plagued by anxiety, the clinician can direct them to a “square breathing” technique, or to positive visualization, or to affirmations, or to tapping alternate sides of the body, etc, etc. If someone is living with the after effects of trauma, the clinician can utilize alternate tapping, cognitive re-framing, somatic release, etc, etc. There are approaches to therapy which have constructed workbooks (or “cookbooks”) to deal with various circumstances or symptoms, and market themselves for their structure and surety in having regimented and certified ways of addressing human problems. So what could be the problem with this? Why would I, a pretty experienced therapist, be troubled by this trend? Actually, there are several reasons for my discomfort. There is a basic divergence in viewing symptoms – one approach sees them as afflictions which should be removed; another approach sees symptoms as an expression of some larger dysfunction or imbalance, which has specific and important meaning in the person’s life. In this view, the symptom occurs as the result of some unfinished business, or some unmet need, or perhaps some disparity between the person’s view of self and world and the actual circumstances s/he lives in. The symptom has a context, and is an expression of that context. And the context is an expression of the person’s needs, longings, hurts, fears, love, ambition…their humanity. So, as an alternative to having a “grab bag” of techniques (or “tricks”) which seek to eliminate the symptom, or the person’s awareness of the symptom, we can become interested and curious about the symptom. We can let the symptom tell us the story of it’s circumstances – that is, we can look to allow the person to discover how the symptom is created, what it’s meaning and purpose is, and how it can point a way to living in a manner which is more fully engaging and satisfying. At that point, it is most likely that the symptom will either disappear, or it will be experienced as part of a healthier context. For example, a rapidly beating heart may come to be experienced as an expression of excitement, rather than a potential sign of ill health; restlessness may come to be seen as an expression of a need for more engagement or stimulation, rather than simply an indication of an inability to “stay put”, etc. Simply put, we can see symptoms as signs of illness or inconveniences which need some technique to eliminate them in order to re-establish the comfort and order of the status quo – or we can see them as expressions of health interrupted, of a striving for growth that is thwarted or misunderstood. When I am faced with these alternatives, my choice is clear.