Sunday, January 31, 2010

Client v. Patient v. Behaviorism

When Dora came to Freud for treatment, though she was made to go by her father, she went as a patient. She went as anyone would go to a General Praticioner looking for a cure, looking to be fixed. It leads me to wonder in our modern day society or maybe just in general, What are people searching for when they come to a psychologist? Are they searching to be cured? Are they searching for a deep analyst of their life? Do they want someone to solve the puzzle for them and simply show them how?, Or do they want someone to sit with them and help them put the puzzle together? Or do they simply want someone to talk them through the puzzle?
When you have children around you usually have one method you stick to but from time to time you try out different methods to see whats best. I remember having to help my niece and nephew -with everything, but for example brushing their teeth. Sometimes I might say 'OK go brush your teeth' and I'll watch them and whether they do it wrong or right if they believe themselves to be finish I'll say 'OK, your done? (affirmative)... Good job! (or sometimes an indifferent 'OK' contingent on my mood). Others times I might say 'OK lets brush your teeth' and I'll go in the bathroom with them see them brush their teeth and say 'no, no, no' and then literally take over and begin brushing their teeth for them (at which they where more so annoyed as they got older). And again another method, 'OK go brush your teeth (they start brushing)... Is that how we brush our teeth? (yes or no) 'We brush like this, right?' (usually a yes) where I might then demonstrate with my finger, toothbrush, or simply explain.
Which is the best method? Well to be honest in the example of the children -All three, because you have to first do for them, and then teach them, and then at some point let go and let them do what they believe o be right, even though they or you will sometimes retrogress.
But when it comes to a patient it get a little more complicated. In client- centered (Rogerian) theory you are more so trying to get the client to solve their own problems with you are a guide, caring friend, humble empathetic listener etc. So if a patient says 'I'm having trouble concentrating in school' you might say 'So, your having trouble concentrating in school' 'Yes, I feel like can't focus' and you might say 'So your having trouble in school and you feel like you can't focus' 'Yes, my parents keep bothering me about doing better in school, but I can't focus I feel like I have some kind of disorder' and you might respond 'So your having trouble concentrating in school and you feel like you cant focus. And then your parents are hounding you?, yes -and you feel like maybe they don't understand? They don't realize that your trying but you simply can't seem to focus, and you fear you might have a disorder' 'Yeah' at this you'd probably nod and wait for the patient to continue talking. A big part, from my understanding, of Client -Centered therapy is to get the patient to hear themselves and trying and really listen to how they feel and hopefully come to a deeper understanding of their issues and hopefully cure themselves.
Lets take the same patient from Rogers 1970's Client centered chair on to Freud 1920's couch. Let's see how he would handle the same patient 'I'm having trouble concentrating in school.......(Freud would probably let the patient go on for a while until he had some sort of light bulb moment) I feel like I can't focus.....My parents keep bothering me about doing well in school, but I can't focus I feel like I have some kind of disorder...... at this Freud might say (big might, but something of this nature) 'Do think its possible that you might not be focusing in school because you want to fail, because you want to take revenge on your parents. You have a deep wish to hurt them for some pass discretion in your youth and you see failing in school as the perfect opportunity. The embarrassment, and the shame they would feel would avenge all the wrong they've done to you?' At this the client would most likely deny, but that wouldn't mean Freud was wrong because denial in fact is a very important part of the process psychoanalysis. 'What is it that your parents have done to deserve your anger... tell me your earliest memory of childhood' At this the patient may indeed discover, probably after a few sessions, some deep dark secret that buries the hate he feels for his parents. Once he relieves it from his unconscious and in to his memory he can realize the true source of his school failure and from this, unless there were further sources of his behavior he could indeed be "cured".
Now of course if this was a behaviorist psychologist B.F Skinner we may not talk about feelings or childhood at all. We may simply talk about how we can change your behavior to its desired outcome. Again moving the patient, lets have a talk with Skinner 'I can't concentrate in school', unlike the other two example this conversation may go in a completely different direction, because Skinner may not let the patient further explain the motive/s or feeling/s surrounding this issue (or it simply may not matter) before he begins to suggest different behaviors to accomplish the desired outcome of concentration. Skinner might say 'Why don't I give you a practice test on general college math, now while your taking the test I want you to raise your hand at the exact moment that you lose focus and then down when you regain focus' So maybe in the first observation the patient loses focus every 5 minutes, then every 10 minutes, then every half hour, until maybe the desired time of a hour or hour an a half of complete concentration on a given subject. Maybe after simply associating one's lack of focus to the tiring behavior of raising one's hand then lack of focus would become associated with another undesirable behavior and the patient might then be able to give up the habit.
Of course there is a lot I still need to learn about each method and other methods, but its not only a matter of usefulness -because I assume all methods work. It really becomes a question of 'What does this person want from me as a Psychologist?'

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