Suffering, Assessment, and Suicide (Week 7)

          In this post I'll be making a joint entry for my Assessment and Psychological Suffering classes.  There is a great deal of overlap between the two and the following is one of the more explicit instances.  The recent trend in our assessment class is discussing the importance of assessing suicidality.  In the Psychological Suffering class we talked about the Periodic Table of Elements as being metaphorical for the ways in which people suffer.  This may seem strange at first, but upon closer inspection one can find that the way in which the periodic table is organized is anything but coincidental.  There is a great deal of correlation and connection between the elements and where they are listed on the table.  Much the same, the "elements" of suffering sometimes overlap into each other and share a great deal.  Below you will find note from a chemistry class I had in the Fall of 2011 regarding the "trends" on the periodic table.

• Organized by ascending atomic number (# of protons)
• Main Groups (generally collumns):  alkali metals, alkaline earth metals, halogens, noble gas, hydrogen
• Blocks:  based on number of orbitals
• Atomic size increases down and to the right
• Ionization energy (energy needed to take an electron away):  Increases to the right, decreases down
• Metalic character (how easily they allow electrons to flow):  decrease to the right, increase down
• Bond polarity:  increases up and to the right
• Periodic Table Link 1
• Periodic Table Link 2

          So, as you can see there is/was a great deal of planning and organization involved in the construction of the periodic table.  Metaphors can't tell the whole story yet in some ways they tell more than the truth ever could.  The ways in which people suffer are certainly connected.  Each situation is unique, yet there are common themes and "elements" in them all.

          Now to tie things together with the Psychological Suffering course.  We have talked in the class about a "optimal" amount of suffering.  That is, what amount of suffering keeps enough tension in our lives to allow us to appreciate the moments when we are not suffering.  Or, perhaps, there is a certain amount of suffering required to keep "excitement" or "friction" in our lives.  In the realm of physics, friction is what allows things to move but it is also a source of resistance.  Perhaps suffering is even an essential part of "being human."  I wonder, then, if there is a certain essential "deposit" of these elements of suffering in our lives.  Do we innately have the propensity for any or all of them to inflamed.   At what point does this become crippling or problematic (the same question for "optimal suffering" as well)?  For example, it is natural for us to feel anxious about the things that matter to us, like making a life-changing decision.  When does that anxiety become inhibiting?

          A very wise Algerian Frenchman once said that "The only philosophical question left to answer is suicide."  In the Assessment class we also discussed (in a "humanistic" psychology program) if you (the therapist) would lie to your client to keep them from taking their or another life?  Of course there are professional ethical standards in place for this, but freely speaking, what if they were not?  My answer?.... You bet your *** I would.  I don't think that there is a blanket answer to this question though.  It is your job as a therapist to assess the situation and take that question in context with the client. The same goes for the "level" of the lie.  You don't have to feed them straight nonsense, but you could certainly ease the reality that if there are not hospital rooms available that they may be detained in an isolated prison cell until they can be evaluated.
          The reason I answered the way I did was quite simple in my mind.  Some of my colleagues argued that lying to the client defies the whole concept of being transparent, authentic, and honest with them.  Well, you told them the truth.  They made up their mind that they were, in no way, going (back to) jail and ultimately do kill themselves.  How does your "client-centered" ego feel now that you must live knowing that your professional philosophical prudence meant more to you than another human being's life?
          I'll conclude this post with some statistics on suicide in the United States.

• 2010 national rate of suicide = 12.4 / 100,000  (This may not seem like a lot, but in a sport's stadium holding 100,000 people, 12 of them will kill themselves; how's that for perspective?)
• 2010 Deaths by Suicide per day in the United States = 105
• In 2010 Suicide was the 10th leading cause of death in the United States (3rd for ages 15 - 25)
• States with the highest suicide rate (both sexes; most first) = Wyoming, Alaska, Montana, Nevada, New Mexico
• States with the lowest suicide rate (both sexes; least first) = New York, Maryland, New Jersey, Rhode Island, Illinois

Suicide Warning Signs

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Brief and narrative Therapy - Journal 4

          This post will conclude my thoughts on the "In Search of Solutions" book I have been reading for my Brief and Narrative Therapy class.  I'm trying to refrain from making this a full on literature review comprised of comparing likes vs dislike.  However, these posts also serve as notes and reference points for myself.  So, for this series (an probably more) I'll continue in the same fashion.

Likes:

• The authors make reference to changing the doing / viewing of the client.  I have some philosophically oriented concerns about this process, but in the vein of being "solution-focused" it is a very apt standpoint.
• The authors then elaborate to change the frequency, timing, duration, location, and sequence of the problem at hand.  I think that this is very constructive for the client's grasp of progress or control.  I would think that it would help them to feel that they can be proactive in their situation and that progress, or at least some sort of change, can be made to alter the circumstances.  This goes right along with the authors' later mention of adding new elements to the situation and attempting to break the complaint pattern.
• Therapists should evoke resources and strengths.  This is a good point to make.  The authors mention later that clients like to discuss their accomplishments.  This is not limited to the therapy room.  It doesn't make you a narcissist to enjoy telling people about your successes; it feels good to share our joys with others.  You might even say that it is "therapeutic."  Furthermore, linking performances together (as suggested in the book) can help to reinforce that sense of morale in the client to keep chipping away and making changes / progress.
• No therapy is inherently useful or not useful, it is only valuable if it works.  This may seem cold depending on how you define "works", but there is some resonance here.  Whether it is your therapy method or the client's attempts as resolution, if something is not working, there comes a time when you must realize that you're banging your head against a wall when you could perhaps just open the door.
• Sometimes the problem is that therapists fail; A) to have a clear view of the client's goals, B) to notice the client agreeing or disagreeing.  I feel that this is pretty darn important.  In the manner of being solution-based, who's solutions are you working for?  It is important to recognize a client's agree/disagreeability and adapt your therapeutic measures accordingly.  
• There is no neutrality.  I absolutely agree here.  Life is not stagnant.  Even if you are "stuck in a rut", the world keeps moving.  The only way to be neutral is through either ignorance or apathy.  One is truly tragic and the other shamefully passionless.
• Therapy is not meant to be a panacea for all of life's problems.  This statement is kind of ironic given that the title of the book is "In Search of Solutions."  However, I agree.  Therapy, in my opinion, should evoke something captivating within the client, at times it is soothing, and at other it is abrasive.  We all have bad days, you probably don't need therapy for each individual "bad day."  BUT the human mind can only take so much psychological "wear and tear" before it breaks; and thus therapy enters.  It is also important to be able to foresee the breaking point and perhaps enter therapy preemptively.  Sometimes a court, a spouse, or other external source will tell you that you need therapy.  However, when the veil is torn and we are truly, in the most frightening sense, in touch with ourselves and hit the bottom (sometimes it has to be pretty **** hard) we will know that we can not continue alone.

Issues:

• People don't inherently have problems.  Our judgments of life's events dictate whether we see things as bumps or mountains.  - This is clearly a glass half-full or half-empty argument.  It's garbage.  Perception is very important, indeed.  However, sometimes life just sucks.  Problems are REAL.  I don't know about the authors, but I have no idea how I could stomach telling a rape victim that s/he doesn't really have a problem, they're only looking at it in a pessimistic view.  Frankly, I wouldn't blame them for punching me in the face (or worse) for saying something like that.  Or take for example the survivors of Katrina or Sandy.  They don't have "problems" huh?  As the survivor of a natural disaster how they feel immediately after; probably thankful they're alive and perhaps their family and friends survived as well.  Ask them a week or a month later how it feels to live on bottled water and canned soup, have no job, no house, no car, no money, no where to go, and still be expected to "get better", "be okay", stop "mooching the system", and be "productive members of society again."
• The authors contradict themselves really severely on one account.  The state on page 137 that "clients know exactly what they need to do", yet, on page 188 one of the authors states that she is preemptively planning on working towards keeping marriages together.  I thought we were supposed to be working on what the clients wanted?  Who are you to say that the appropriate solution would be for the marriage (in this example) should stick together?  If the client is ambivalent, uncertain, or has mixed feelings, why do you get to decide for them what they really want?
• Lastly, this is not really a debate, but more or less some ambivalence of my own.  The authors say that they don't worry about setbacks and relapses, but about self-fulfilling prophecies.  Initially I wanted to agree with this statement for its long-term focus and concentration on long-term achievements rather than iatrogenic destruction.  However, take for example the person showing signs of suicidality.  There is a urban legend floating around that you should not ask the person if they want to kill themselves because that will "put that in their head" or "give then an idea."  Well, news flash... if someone is that depressed that you are concerned for their life; they have almost certainly thought about taking it themselves.  

Overall Thoughts on the Book:

          In general I think that I liked the book.  There were a lot of insightful tidbits that I think will be very useful throughout my career.  There were also plenty of theoretical assumptions that I would readily jump on board with given the context of a particular client.  This book gave me quite a few "tools" to keep in my back pocket or on a book shelf for reference.

          However, in spite of the quantity of "good" things I found in the book, I had some very adamant and outraged concerns and objections.  Some of them I would deem "unforgivable."  So, I guess my rendered verdict is the book is great for adding to a therapists "toolkit", but on a theoretical basis (for me personally) some parts make me sick.  Nonetheless I will not let my philosophical preferences and objections detract that usability and resourcefulness of the methods found in this book.

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Psychological Suffering - Week 6

 

          The other day in my Psychological Suffering class we discussed what some people refer to as the cliff-hospital model of therapy.  In this model, everybody is standing on a cliff, some closer to the edge than others.  Sometimes something causes them to step too close to the edge, or they break; they fall or they jump from the ledge of the cliff.  At the bottom of the cliff there is a hospital, a resource for healing.  The solution or outcome based therapeutic model (referenced here) suggests that we should focus our attention on building more hospitals and graveyards at the bottom of the hill because people will inevitably fall / jump from the cliff.  The solution-based model of therapy critiques past-oriented models (such as psychoanalysis) for its lengthy process.  However, here are a few ideas to chew on.

In support of past-oriented therapy - Life's events do not occur inside a vacuum.  They take place in context.  Everything is subject to its context, particularly when such things are conveyed second-hand from one person to another (i.e. client to therapist).  The context of certain events is paramount to understanding and developing future "solutions" or at least plans of action.

In critique of past-oriented therapy - Focusing on why people are falling / jumping (keep in mind that there is a vast difference between the two) is all well and good.  It may help prevent future persons from jumping or falling off the cliff.  There is one problem.  While our attention is focused on a "sampling" other people are still falling and jumping.  Past-orientation is time consuming and while that time is being consumed catastrophic consequences are developing.

          Now, back to the class discussion.  The point of the discussion in class was not to bicker about philosophical ideologies of therapeutic practice.  It was, however, to present some different ideas and cast a view of the landscape that we, as future professionals in the field, will be working with.  When class was over, I was the last person to leave the room as I had nowhere in particular to be immediately afterwards.  As I walked past the chalkboard with illustrations of this theory draw on on it I had to stop and think for a moment.  Something was missing from it.  Someone had drawn a cliff on the far left with people standing on top of it, a person falling off the cliff, and a hospital pictured to the right of the cliff.  Coincidentally the picture(s) only took up about a 2/3 of the board.  I picked up a piece of chalk and sketched a hill to the right of the hospital.  On the hill I drew a person, and in front of the person, a large circle.  As I was leaving the classroom, our professor poked his head out of his office (having heard my footsteps I suspect).  I said to him; "I felt the need to add something to our drawing", and continued down the hall. He said; "Oh?!", and trotted back to the classroom with an excited curiosity   He looked at the board, then back down the hall, ( I was taking my time to observe his response), and he said, "Nice!"
          So, I'd like to add something to the pictures at the top of this post and to the "cliff-hospital" model.

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Brief and Narrative Therapy - Journal 3

          Firstly, I have to make a correction.  I started reading the wrong book for this course and so I had a little ground to make up.  The book I was supposed to read and should have written about last week is "In Search of Solution" by Hanlon and Weiner-Davis.  So I've made up for lost time and I'm about 2/3 of the way through this book and here is what I have to say....

           In general I am liking the book.  There are several things being pointed out from a technical or strategic standpoint that I'm really enjoying.  However, there are some pretty glaring theoretical vacancies that rub me the wrong way.

Likes:

• I like the distinction that the authors make between past- , present- , and future-oriented therapies.   (for my other thoughts on this, please read my latest blog on Psychological Suffering)
• I like that the book mentions that symptoms serve functions.  Be it physiological or psychological, symptoms represent and mean something.  They are observable cues to the sometimes unseen.
• The authors also mention that therapists often think that they know what the "real" problem is; conversely the authors suggest that the statement of "the problem is _____" should come from the client, not the therapist.
• The authors state that the therapist's job is to access tools within the client in order to amplify change.  I think that is pretty accurate.  I once thought that the goal of therapy was to alleviate suffering.  I do not think I would agree with that statement any longer.  I would say that the goal is much closer to evoking something provocative   In my personal experience I have tried to "direct" my clients towards find answers / meanings / solutions through their own reflections with very little input from myself.
• The Miracle Question - "What would a day be like if you woke up and your problems were gone?  What would a perfect day be like?"  This is a very powerful question in finding out what a client's goals are and what is bothering them (what the problem is).
• The Exception Question - "What are you not doing now that could make that day possible?" - or - "What are you doing now that is stopping that perfect day from happening?"  As per the solution-based orientation of this book, this question seems fitting.  But it has a very matter-of-fact ontological stance about it; which I like.  Sooner or later life is gonna kick your ***, but what are you going to do about it?
• In order to establish an effective rapport with the client, the therapist should take note of the client's "pet phrases" and use "their language" to communicate with them.
• The authors also make the distinction, and I think it is an important one, between thinking, feeling, and doing.  The example in the book is of suicide.  Certainly there is a tremendous difference between thinking about killing yourself, feeling like it, and actually doing it.  A community college psychology professor once said something that has stuck with me; "Don't believe everything you think."
• In relation to the two questions above (Miracle and Exception), the authors state that the therapist should help the clients assess what is different when things are successful.  Certainly, even the harshest times have their sunny days.  What is different on those days can, perhaps, be replicated to increase their frequency, or at least the potential for a more common occurrence.

and now for the  - Dislikes:

• The authors are adamant about a future-oriented therapy   They criticize that past and present oriented therapies.  However, it is a fact that nothing happens inside a vacuum... everything is contextual.
• The authors also make mention of The Myth of Sisyphus.  Unfortunately for them, I am an avid Camus reader.  I'm afraid they miss the entire point of the story.  Whether this was done out of ignorance or intentional omission; it irritates me.  Who says the therapist is helping the client push the proverbial rock?  Perhaps the therapist is only whispering and watching; facilitating accelerants of both motivation and revelation of deficit   Regardless of the therapist's role, "We must imagine Sisyphus happy."
• I was accused by my classmates of being too literal, but there is a fundamental error in the authors' statement that "change is constant."  First of all it, by definition, is not.  They also state that "change is inevitable", which is better.  But these two statements are NOT the same.  It would be much more accurate to say that "the only constant is change."  There are also different types of change statistically speaking.  Geographical change occurs at a constant rate (e.g. a straight line on a graph).  Exponential change occurs in a curve.  Changes in life are NOT constant.  They accelerate and decelerate, go up and down, at varying degrees, lengths, and intensities.  Regardless of the authors' intent, the word choice was poor.
• The authors also talk about normalizing and depathologizing the client's problems.  Generally this is a good thing.  However, the way it is presented is in dangerous fashion.  When a client is always receiving confirming statements from the therapist, it is expected that the therapist will reinforce and agree with the client.  Constantly agreeing with the client is a form of side-choosing that can be very detrimental to the "search for solution."

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Research Methods / Pre-Thesis Update 2/10/13

         As can only be expected, my pre-thesis research has taken many turns and changes throughout the course of the semester thus far.  I suspect that it will continue to do so as I further refine what it is exactly that I want to research, and more specifically how to go about testing / measuring it.  So, here is the latest configuration.
          Part 1 - A test will be conducted to measure GROUP A (general population) and GROUP B (terminal cancer patients) existential anxiety via EAQ (Existential Anxiety Questionnaire).
          Part 2 - The emotion most correlated with suicidality is not depression.  It is hopelessness.  Furthermore, both group will be given two other examinations:  the Beck Hopelessness Scale and a Quality of Life Inventory.
          Part 3 - The study will conclude with a correlational analysis of the studies and groups involved.    For example, analysis of the following comparrisons:

• Group A vs Group B - Existential Anxiety
• Group A vs Group B - Hopelessness Scale results
• Group A vs Group B - Quality of Life results
• Existential Anxiety (total results) vs Hopelessness Scale results (total)
• Existential Anxiety (total results) vs Quality of Life results (total)
• Hopelessness Scale results (total) vs Quality of Life results (total)

Early assumptions - In the very, very, very early states of this research, there are still some hypotheses that are floating around in my head.

1. Group B will have a higher level of existential anxiety than Group A.
2. Group B may also have higher scores on Quality of Life results.
3. Existential anxiety and Hopelessness will have a positive correlation but the strength of the correlation may vary.
4. Hopelessness Scale scores and Quality of Life scores will have a strong negative correlation.

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Brief and Narrative Therapy - Journal 2

          In my last post in this series I discussed some thoughts on the "Brief Therapy" concepts found in this book.  I'd like to just make one more comment before moving on.  This book reminds me of a phrase that was a tagline for the television show "Nip / Tuck" that used to air on FX.  The show was a drama about plastic surgeons and one of its taglines was "Tell me what you don't like about yourself."  That phrase seems to have a lot of ressonance with the idea of outcome-oriented therapy.  "Tell me what you don't like about yourself" so we can fix it and move on.  I don't totally agree with the concept, but nonetheless its something that came to mind.
          More recently I've started reading "Narrative Therapy:  The Social Construction of Preferred Realities." As far as i've gotten in the book (about 30% or so) the idea of narrative therapy is to shift focus from a systems orientation to a "story" orientation.  Now, I really like this idea because in a therapeutic setting many things are relative.  We craft stories of lives to make sense of our worlds.  Interestingly enough, modern neurology tells us that memories are not constant.  They cange within our brains, the "chemical" memories change every time we recreate and retell them.  I am very fond of the idea of deconstructing stories for the purposes of therapy.  That is, when I ask someone to tell me about a specific story, I'm not really that interested in the facts of the story, but much more so in what the process of storytelling reveals perceptually about that particular individual.  How do the relate to the charcters and feelings within the / their story?
          However, I can't help but be left with a feeling of lacking.  Like there is just somehting missing about this therapeutic theory.  It seems very well oriented in its theoretical approach but for me, I feel like there should be more to it.  I am absolutely all for deconstructing meanings and reading between the lines in a story; but so far I haven't found anything in the book that "sticks" for me or really strikes a chord and ressonates.
          I recall having conducted a series of interviews in 2011 where I asked a series of university professors what the goal of therapy was.  The most common answer was to end client suffering.  From reading this book the authors prescribe that "the goal of therapy is to participate in a conversation that continually loosens and opens up, rather than constricts and closes down" (44).  I am not so certain about either of these statements.  Rather, I think that the goal of therapy (generally and vaguely) is much closer to creating and stirring something provacative and captivating within an individual.  Perhaps this is something good, and perhaps something not so good, either way; there is a spurring of activism out of deconstruction so deep that everything becomes rattled and all that is left to death with is what as always laid at the core.




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Psychological Suffering: Week 5 Reflection

         There were a couple things brought up in class this week that I have been trying to digest. Firstly, we were asked, if I recall correctly, to describe our experiences as a listener. Second, in regards to today's class; if you don't know exactly what you want to do for a vocation, what do you for sure not want to do?

          I do not have a large amount of clinical experience working in social services, but I did take the Intro to Counseling Practice course last semester in the education department. Part of that class entailed labs which were demo counseling sessions. I don't recall ever having a problem listening to someone for long periods of time without commenting. However, what I did find myself commonly struggling with was an inner dialogue of what I should say next or how to analyze what has just been said. This is really quite detrimental to the process because the client keeps talking while you are thinking. As a result your analysis or comments are accurate to the information previously presented, not to precisely where they left off. Essentially it took some practice to tell my brain to shut up and listen, not just hear them, but to actually intently listen to them.

           One side note I'd like to add is that I found it effective to mentally keep note of certain key words. Usually, for me, a light bulb went off whenever I heard the phrases “I think...” or “I feel...” and those would be thing I'd delve deeper into. Sometimes there is not a lot to say and a client may need to just vent or have someone who actually wants to listen to them. That is only part of our jobs though. There is a sense of expected direction or analysis-solution processing that I think is often expected of counselors. I think that this is very dependent on the client. Perhaps, for a session or two, they just need to “get some things off their chest.” Ultimately, though, if you are a therapist, one must ask if what is happening is actually “therapeutic.” Maybe “venting” is therapeutic for the client or perhaps they need a more linear approach to the sessions.

           In terms of what I want or don't want to do for the rest of my life; this has been something that I have, in the past month or so, spent a lot of time thinking about. I was looking over some different career options and what directions my academic and professional careers might take. I have always wanted to earn a Ph.D. When I was an undergrad student I wanted to go on for my doctorate, although, then, it was to be in philosophy. I am one of the first men in my family to graduate college, let alone obtain a graduate education. I have also felt that I “fit well” in an academic environment and thought that since I had the means and opportunity to obtain a graduate degree that I “owed it” to those who did not to take my academia as far as possible.

           As things changed and my life and career took me in some different directions I started looking at how I would develop myself here at West Georgia. Initially I was very adamant about the “clinical track” and obtaining LPC licensure. But there seemed to be a conflict between this and my desire to earn a doctoral degree. The fact of the matter was that if I completed the clinical program at West Georgia, most of those credit hours (including all clinical work) would not transfer to the doctoral program(s) I would hopefully be entering. I thought that proceeding with the clinical track while applying to doctoral programs would be a goo back-up plan. However, in practical terms; another year's tuition and coursework is a hell of a price to pay for a back up plan I'm hoping I don't need.

With that in mind, I decided to stick with a thesis track here at West Georgia. I'm currently looking at a few different Ph.D and Psy.D programs but that was a whole other animal. What do I want to do with my life? Well, I know that I don't want to be stuck in a cubical punching computer and telephone keys all day. I know that I want to work with people. I have a strong interest in clinical psychology in the medical setting but am also very fond of the academic arena. After talking to one of our professors, she suggested that instead of looking into scientist-practitioner models of training that I might want to look into scholar-practitioner models. After looking at several of these types of programs the idea really appealed to me. Regardless of the training model, it is my opinion that therapeutic “practical” work should be informed by clinical and academic work, and vice versa as well.

           I am still unsure if I would rather work in a medical setting or academic area in addition to my practice, but there are some things I know for sure. I know that I do not want to do a manual labor job for the rest of my life. Typically, the men in my family have been farmers, machinists, and construction workers. As I watch them get to the later end of middle-age and the end of life it has become very clear that they have spent twenty, thirty, or forty years “breaking rocks” (so to speak) and what they have to show for it is a modest income and bodies that are (almost literally) falling apart. I want to take absolute advantage of the opportunities and potential I have. I refuse, not just in academics, to accept anything less than a maximal effort from myself. I know that I will continue to push the envelope in terms of my academic potential until I feel that that fire is no longer being fed. As long as I am passionate about psychotherapy and academia I will be driven to achieve and to succeed. “Go hard, or go home” as they say.

Brief and Narrative Therapy - Journal 1

          For my "Brief and Narrative " Therapy class we have been reading "The Tactics of Change:  Doing Therapy Briefly" by Fisch, Weakland, and Segal.  I enrolled in the class because I thought it would have a very practical application.  For starters, the idea of doing therapy "briefly" is often presssure that is put on therapists and counselors by their organizatinos, employers, and insurance companies.  Those groups wnat to see results and they don't wnat to spend too muchmoney.  I'll get back to this in a bit.  I also wanted to enroll in the course because of the appeal of "narrative" therapy.  For instance, when we think of the word "narrative" we think of a story.  But when the etymology of the word is broekn down, we find that it comes from the Lating word "narrare" (to relate) and Sanskrit work meaning "to know."  This of course plays nicely with my existential-phenomenological view of psychology in regards to "relating what we know" and / or "knowing how to relate."

          Now, back to the book.  What I like about the book is that the authors' style of therapy is very outcome oriented.  Now, this is both good and bad.  First, the good.  Some of the tactics explained are very specific, practical, and insightful.  When a client comes to see a therapist of their own accord it is usually because they have a problem..The goal, as the authors see it, is to resolve the problem.  This book does a very good job of explaining and detailing action-oriented outcome generation.  There is some staunch reality to this methodology.  Firstly, there is the matter of salary.  If you, as a therapist, are accpeting insurance payments or are working for an organization who is being paid by insurance companies then you foten will have a limeited (maybe less than 10) number of sessions to work with.  I'd love to spend "as much time as needed" with every clint who walks in the door and let them work at thier own pace; but the fact of the matter is that in instances above, if you want to get paid, you have to work within certain constraints.  Your personal preference may be to go steadily and deeply with a client, but here is another idea to sit on.  Perhaps, your supervisor asks you if you asked the client if he had ever had suicidal / homicidal tendancies and you reply; "No, we hadn't gotten to that yet."  Your supervisor returns; "Really?  Because he was court appointed to meet with you after trying to stab his mother to death and trying to overdose on sleeping pills."  [Exagerated for emphasis]
          Here are some issues I take with the book.  There seems to be, for me, some ethical concerns in being process oriented.  Whether it is cognitive-behavioral therapy or brief therapy, action-based outcomes have always seemed tongue-and-cheek to me.  My personal opinion is that, while they are effective, they may only be so ona superficial leve.  The issue at hand has only been pruned and the client has learned nothing about actually dealing and existing with the problem.  Coping and closure are freuitless idealizations in many cases.  They are sentiments of giving up and giving in as if somehting tragically psychologically devastating can simply be "fixed" by sending it back to the factory, applying mechanical remedies, and polishing the surface.




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