Why flexibility and therapeutic range are the future of practice
Posted Jul 25, 2016
To begin, let’s start with this understanding – what I call “free-range psychology” is an approach to practice that prioritizes flexibility and range of response over adherence to any particular way of doing therapy (e.g. Cognitive Behavioral, Psychodynamic, Interpersonal therapy, etc.).
To say that you do not favor any particular approach to therapy, but instead prefer to draw from several models, is not a popular or easy stance to take. Some fellow psychologists are prone to look at you as though you just belched. Perhaps it makes people uncomfortable because they don’t know where to place you in terms of your basic philosophy. To say that your philosophy is flexibility grounded in sound psychology may sound rootless or possibly even arrogant. But, as long as I have been in the field, there is no other approach that feels authentic for me.
Maybe it is because I came to psychology with a relatively non-conventional background. Before entering graduate school, I studied English and travelled far and wide, provided food and clothes to inhabitants of the dump in Mexico City, worked at the Vatican, hunted alligators with Shipibo Indians living on the Amazon river, held polio-afflicted kids over the toilet as a camp counselor in Peru, and co-led a public health initiative to Kusayapu, the desert that has never seen rain where the native Aymarans live in Chile. These travels have been a study in real-world diversity.
And here’s the thing about therapists…they are as diverse in personality and values as patients, and our conceptual approaches are a mosaic as diverse as the people who champion them. One clinician may approach problems from a cognitive angle, believing that the key to change is to inspect and challenge one’s thinking. Another may believe with equal fervor that facilitating experiences of emotional authenticity is the royal road to healing. Some clinicians suggest that others’ approaches “apply a band aid” to what needs years of sensitive exploration. Some approaches urge that patients aggressively challenge their problems and others suggest that change comes from accepting a problem as “a passenger on one’s bus.”
To be a free-range psychologist is to see that all of these insights may hold truth, although not all are equally likely to promote growth for a given patient. Some patients need to explore the roots of a thing – with understanding, comes release. Others are more likely to grow if we focus on present functioning and immediate behavioral goals. For others still, the best therapy may be no therapy at all. To perceive these distinctions takes discernment, and I have always felt that discernment comes from practicing with range.
However, free-range psychology does not mean operating at the fringes of the field. I do not do primal scream or re-birthing therapy. Researchers have contributed greatly to our understanding of which treatments may be more likely to work for various problems. Research should be consulted and considered, and this should be held in tension with creative responding. Free-range psychologists use tools that have been described and when necessary, create new tools that are unnamed as yet. To use a martial arts analogy, one might choose to adopt an aggressive, “hard-style” approach like prolonged exposure for trauma, or an approach as “soft-style” as recording a personalized relaxation script for a patient.
As the title of this blog series implies, we will get off the couch and range widely. Future blogs may take us into the morgue, into close contact with a live cockroach named “Cocky” who served as a powerful therapy tool, into the operating room, into the car of a patient with very concerning road rage, and to the gravesites of fallen soldiers from Vietnam. Client identities will be concealed and examples will be drawn from a variety of settings where I have worked, including college counseling centers, an intensive program for OCD and anxiety disorders, my private practice, and a behavioral health clinic in a Veterans hospital. I will be transparent about my failings at times, and will share a number of creative interventions that have been extremely powerful for some of my patients.
Finally, just as the health care field is moving towards personalized medicine, I believe that free-range psychology is the wave of the future. As therapists embrace the concept of expanding their range, more patients will find a “better fit” with their providers. As providers enter each therapy relationship with an open, free-range stance, they will be positioned to “listen eloquently” and collaboratively generate truly tailored interventions for their patients. I hope you will join me on these reflections – as always with my blogs, thoughtful comments and respectful disagreement are welcome.