Can a Significant Other Provide Therapy to The Other?                                                   

Not being an ethicist I cannot speak to this question with any authority. I can, however, reflect on it as it does raise at least one intriguing clinical issue: Is it possible for a former “significant," that is to suggest intimate, "other” to be viewed objectively by either the practitioner or the client or one seeking therapy? If the answer is yes, it is feasible, does this possibility assume this objectivity is simultaneous for both parties, that is to say that both parties will be equally objective and detached from the previous relationship at the moment of their reintroduction as practitioner and client? If the answer remains yes, does this necessitate a quantifiable period of time between one’s status as significant other and becoming either practitioner or client in order for this objectivity to be realized? Assuming the answer to all these question continues to be yes and that objectivity is indeed possible, are there other implications raised by the fact that one or both parties have specific intimate knowledge regarding the other that may impact judgment as regards treatment planning and/or follow-through irrespective of objectivity? 

Just as the admiral and captain on a naval flagship dine separately from each other as well as from the crew at large—they literally dine alone so as to discourage the development of close friendships and emotional ties that could affect personal judgment regarding command decisions that necessitate the sending of one's subordinates into harm’s way—can a practitioner every truly detach him or herself from “what once was” in order to thoroughly engage in the pursuit of “what might become”?

Please know that I do not doubt the sincerity of my colleagues who suggest seeing former significant other's professionally is possible and I recognize that the vast majority of us would never intentionally jeopardize the clinical outcome of work with a client if thinking that previous knowledge of said client could result in providing subjective treatment, but we all know what we have learned and learned what we were taught, be it in the classroom, home, or previous intimate relationships. AA has a saying that is somewhat apropos here: You can always turn a cucumber into a pickle, but you can never change a pickle back into a cucumber. Albeit a bit folksy, it is nonetheless a poignant statement that speaks to the clinical issues raised in my initial ethical question: If I had been your lover, could you ever see me as other than that former lover? I am not sure I could see you as otherwise.


What do you think?
Dr.Robert

Towards an Eclectic Theory of Counseling

Counselor Educators have discussed and debated the role of theory in professional counseling since, "forever." Generally the discussion includes references to the importance of being grounded in theory so that the practitioner is "doing counseling" instead of "chatting up" an acquaintance. To this end, understanding theory and using it to center oneself as a counseling professional is productive. However, when theory becomes the issue of primacy for the practitioner, everything else tends to follow...including the services the client/patient/individual receives from the counselor. Hence, the importance of identifying a theory of eclecticism or and integrated approach to counseling that recognizes the importance of theory-drive practice, but is nonetheless sensitive to the needs of the individual with whom the counselor is working.


I have found Prochaska’s Transtheoretical Model of Counseling (sometimes referred to as the "stages of readiness to change" model - see http://www.aafp.org/afp/20000301/1409.html) to be the closest thing I have yet found to a bona fide “eclectic theory” of counseling. Its refocusing of the practitioner’s attention on the client by attending to his or her stage of readiness to change rather than presuming the primacy of the practitioner’s theoretical orientation is both refreshing as well as productive.

I agree that it is important to teach counseling theory as a “walk through the museum,” but the benefit of such a course is not that it shows student “how” to do counseling effectively so much as proffer an understanding of from “where” it originated. Personally, I have discovered that I need to have three things in order to “do” counseling effectively: (1) an understanding of why humans think and act the way we do – Personality Theory, (2) an understanding of the options available to me to do counseling – Counseling Theory, and (3) a personal “bag of tricks” born of training, experience, mentoring, etc. Whether one’s personal approach to counseling is a more fundamentalist’s adherence to “X” theory or integrated and eclectic personal approach, my argument is, one’s personal theory of counseling is essentially an amalgam of these three elements.

Prochaska’s model, for me, is a nice way to both honor the contributions of “theorists of yester year” while providing me the opportunity to practice “person-first” approaches that focus on meeting the client/patient/consumer where he or she is in the counseling process. If counseling is more about what we do with the individuals with whom we work than what we do to them, it seems that theory may well be an important component in the design of an effective vehicle to move folks from where they are to where they want to be, but it likely should not be “driving the bus.”


What do you think?


Dr. Robert