Other Significant Approaches
Person-Centered Therapy and Related Approaches
The basic assumption of Carl Rogers’ Person-Centered Therapy is that people have a vast potential for understanding themselves and resolving their own problems without direct intervention on the therapist’s part, and that they are capable of self-directed growth. The approach focuses on building emotional rapport with a client.
Motivational Interviewing (MI) understands that difficulty in making changes often comes from a fundamental ambivalence, in which even a destructive behavior provides some sort of emotional benefit. The goal of the process is to engage that ambivalence to help clients clarify their true emotional goals, and the paths to reach those goals. MI moves beyond Person-Centered Therapy in actively engaging the person to create change,and is an important part of Dr. Mau’s practice. MI is often used for addiction recovery. Miller (1998) notes that a single session of MI before beginning a rehabilitation program can double a person’s chances of abstinence three months later. In an analysis of 381 studies of treatments for alcohol dependence, Hester and Miller (2003) found that MI type processes were the second most effective means of addressing the problem, following only Constructivist brief therapy approaches (Other approaches on the list include CBT at 13, 12 Step programs at 37, confrontation at 45, and education coming in last at 48).
Abraham Maslow’s famous hierarchy of needs proposes that people move from basic physical needs, like food and safety, to the need for love and relationship, then to a need for achievement and confidence, and finally self actualization, the need for creativity and fulfillment. Fulfilling this potential is the goal of human growth.
Dr. Mau emphasizes the importance of engaging emotional ambivalence to help you create the changes you desire. The goal is always to help you fulfill your highest potential.
“One of the metaphors I often use with my clients is the metaphor of ‘the wilderness guide,’ and the way I put that is they can hire me as a guide, because I know a lot about survival in the wilderness—my own, and I’ve traveled through a lot of wildernesses. I’ve got a compass; I can start a fire in the rain. I know how to make it through, but this is a new wilderness to me. Haven’t been in this particular wilderness before, and so I can’t quite predict what we’re going to encounter” (Sullivan, Skovholt, & Jennings, 2005, p. 59).
Psychodynamic approaches hold that unconscious processes underlie or drive human behavior. Ericksonian hypnosis is a psychodynamic approach which views the unconscious as a positive resource.
The archetype of a psychodynamic approach is Sigmund Freud’s Psychoanalysis, in which the Id, Ego, and Superego are constantly in dynamic tension with each other. Freud (1933) viewed the unconscious Id as “a chaos, a cauldron full of seething excitations.” In brief psychoanalysis focuses on analyzing the problems caused by this tension. In theory, insight into these unconscious processes leads to catharsis, or an experiencing of emotions from the past, and healing.
Psychoanalysis is the epitome of a problem-focused approach, and stands in stark contrast with Constructivist approaches, which focus on solutions.
Milton Erickson, whose insights into hypnotic processes has been highly influential in Constructivist thought, had a very different view of psychodynamic processes. Feldman (1985) contrasted Erickson’s approach with Freud’s:
“Insight is not necessary for change. As a matter of fact, hypnosis or indirection is frequently used to bypass conscious processes—and therefore to work utilizing unconscious processes. The unconscious is regarded as a vast storehouse of learning and as a context— in itself—for change. Such a view is a revolutionarily different conception of the nature and scope of the unconscious. In contrast to the traditional psychodynamic notion of the unconscious as a place full of negative forces, impulses, and ideas which are so unacceptable that they must be repressed from conscious awareness, Erickson had a positive view of the unconscious.” (p. 155).
This positive view of the unconscious, as a vast positive resource for emotional change, is highly influential in Dr. Mau’s approach to helping people change through reframing emotions. While a focus on past problems is counterproductive, Dr. Mau does have effective techniques for reframing and releasing past emotions in order to move forward. Dr. Mau is a Board Certified Hypnotherapist who operates from an Ericksonian perspective.
Psychiatry and Diagnosis
Psychiatrists are medical doctors, and the model for assessing psychological problems in psychiatry is the medical model.In describing this model, Kandel (1998) argues that all mental processes can be traced to brain function, that essentially mind is a function of brain (also see Ray, 2004). This leads to the idea: change the brain, change the mind. However, the alternative idea – change the mind, change the brain – also works (cf. Plassman, 2008; Carlat, 2010; Zubieta, et al, 2001). In general psychotropic medications can be very helpful, though they rarely eliminate a psychological problem. Therapy in addition to medication is an excellent approach for addressing problems.
The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000; hereafter DSM-5), which is the standard diagnostic tool of the medical model of mental disorders. Constructivism stands as a major alternative to the medical model as a way of looking at or understanding psychological problems. While it may be appropriate to say that a client exhibits behaviors consistent with a particular diagnosis, clients should never be told that they “have” a disorder. Diagnostic labels should be understood more as broad categories of behaviors covered by insurance than as conditions.
Dr. Mau is not a physician, he does not provide medical advice, and he generally operates from a Constructivist rather than a medical model perspective. He does work in a team approach with physicians and psychiatrists to address client problems. Clients should follow the medical instructions of their physician or psychiatrist. It can be dangerous to simply stop taking certain medications, and you should never stop taking medication without consulting your physician.
Dr. Mau is qualified to provide DSM-5 diagnoses, and will do so when this is necessary for insurance reimbursement. A DSM-5 diagnosis should be understood as a shorthand label for particular behaviors occurring presently and not as a condition of a person. Think about it: “behavior” can be changed – even if it is driven by emotion and seems involuntary, while “conditions” seem difficult to change.
Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) sees that emotional disturbances result from negative or self-defeating thinking and self-talk. The basic rubric is the A-B-C theory of personality, in which an activating event, A, triggers a belief or cognition, B, and the cognitive influence of this belief produces an emotional or behavioral consequence, C. One goal of therapy is to replace inappropriate beliefs (B) with appropriate ones.
CBT approaches often use guided imagery or progressive relaxation techniques. These are very effective approaches to emotional change, and are a core of Dr. Mau’s approach.
Brief therapy approaches are often faster than CBT. Rothwell (2005) found Solution-Focused Brief Therapy to be effective more quickly than CBT, with substantive results in as few as two sessions.