2012年2月6日月曜日

How To Writing Clinical Interviews In Psychology

how to writing clinical interviews in psychology

The Humanist Interview with Clinical Psychologist Leon F. Seltzer

The following interview was originally published on the Psychology Today blog, In Therapy. It was one installment in Ryan Howes series, The Varieties of Religious Therapy, featuring representatives from twelve belief systems discussing how they integrate faith with their approach to psychotherapy. While Howes acknowledged that humanism isnt an organized religion, he maintained that it is an ideology with adherents who share common views on human nature and felt that a decidedly non-religious ethical viewpoint would lend an interesting alternate perspective to the series.

The Humanist: What is the role of religion or spirituality in your clinical practice?

Leon F. Seltzer: Rarely is humanism considered a religion, and in describing their beliefs many humanists prefer to avoid the term spirituality altogether. Placing their confidence in science rather than religion, humanists trust reason over faith. Still, I've always regarded humanist ideals as quite spiritual in that they celebrate non-materialistic values I personally cherishvalues that are (ahem) "secularly sacred" to me. That is, humanism extols such virtues and ideals as courage, fortitude, innovation and creativity, generosity, empathy and compassion. Andperhaps more broadlyit reveres altruism and a deep sense of community, justice and equal opportunity, and living in harmony with nature. Beyond that, humanism affirms the inherent value and dignity of all humans, independent of their religion or socio-economic status.

Humanism really isn't so much atheistic as it is nontheistic. It simply doesn't attend to or focus on anything supernatural, but rather aims its lens solely on the mortal life of us humans. Both what we must take full ownership of, and what we're potentially capable of. It's not really "anti-religious" as such, but it does oppose certain elements in religion that, whether excessively righteous, intolerant, or hypocritical, can culminate in actions inconsiderate of, or even cruel to, humanity. Humanism also contends that we shouldnt be living our lives passively (as though some all-powerful deity is personally looking out for us and ready to rescue us if necessary). Instead, it predicates that we should live pro-actively and in the here-and-now, accepting life as it is and consciously creating our own desired destiny.

So as a humanistic therapist, I endeavor to help clients in the kinds of self-discovery and personal evolution that will assist them either to better cope with their present-day difficulties or to transcend them altogether. I also try to help them discover (or re-discover)as is stated so eloquently in Humanist Manifesto IIIthe wonder and awe in the joys and beauties of human existence, its challenges and tragedies, and even in the inevitability and finality of death.


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The cornerstone of humanistic principles is living in accord with the golden rule. So in my work I do all I appropriately can to increase my clients' empathic caring and concern for others. In fact, many of my clients' problems relate either to their self-absorption or the heedless, single-minded pursuit of their own interests. Ironically, assisting them to get outside themselves and better identify with the wants and needs of others can be exactly the therapy they need. Additionally, I attempt to help them resolve issues through engaging others in a more collaborative and cooperative mannerversus through aggression and dominance. I regard the latter, antagonistic approach as both divisive and detrimental to their developing a healthy sense of interdependence.

As another example of applying humanistic principles to therapy, I might refer specifically to my work with couples. Here my interventions are at once contrived to challenge the assumptionsand promote the wellbeingof both parties. As long as neither spouse's interpersonal stance is untenable (as in, "It's my way or the highway!" or "You're the one who needs to change!"), I seek to help both of them grow their empathy, understanding, and acceptance of the (inevitable) differences that separate them. I also encourage both partners to uphold their integrity, rather than sacrifice it simply to keep the marital peace. But mostly, I try to get them to better appreciate and respect their unchangeable dissimilarities.

Finally, it's not their individual behaviors that need to change so much as their attitude toward one another. They need to learn that more than one perspective on a matter can be valid and not to let the harmony between them suffer merely because they don'tand maybe can'tagree on something. When this approach is successful, many of their conflicts simply fade away. For now they're able to recognize how their conjugal happiness is contingent on just such mutual tolerance and acceptance. Regardless of the couple's religious views, the principles I employ to assist them in recapturing the joy they once shared are solidly grounded within a humanist framework.

The Humanist: How does your technique or theory differ from mainstream psychotherapy?

Seltzer: As a humanistic therapistand, of course, depending on my particular client's goalsmy questions would likely be more global and existential than simply inquiring about current symptoms. In general, I attempt to help clients achieve greater clarity about who they are and their longer-term aspirations. How, that is, can their day-to-day lives become more congruent with their larger sense of purpose? To help them resolve immediate problems, I might employ techniques from cognitive-behavioral therapy and other mainstream approaches. But since, principally, I want to help them lead richer and more meaningful lives, I'll have them look beyond their present-day frustrations, too. And I'll emphasize that the perceptual shifts that can enable them to best realize their potentialas well as their heart's deepest desireswill almost certainly require that they give more thought to how they can significantly contribute to the lives of others. (Not to mention planet Earth.)


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The Humanist: Suppose several new clients come to therapy reporting they feel detached from God. How would you proceed in these cases?

Seltzer: I'd want to find out exactly what such detachment means to them. Have they been feeling forsaken by God (or possibly that they have abandoned him)? If so, how, when, and why? If their goal is unequivocalnamely, to have a professional assist them in re-establishing a lost relationship to GodI'd refer them to a pastoral counselor. (To do anything else would be to violate my integrity). If, however, they were genuinely questioning the basis of their faith, yet feeling anxious or guilty about doubting the existence of God, I'd inquire further about their therapeutic objectives.

Again, are they totally committed to regaining a connection to God, or do they simply feel (mostly because of earlier religious indoctrination) that they must be bad or sinful in harboring suspicions about a divine creator? If the latter, I'd help them work through their emotional distress and introduce nontheistic alternatives that might better reflect where they currently stand in their life's journey. I'd also let them know that their skepticism was shared by millions of people (including myself), and help them resolve whatever issues they might have about moving deliberately beyond what, till this point, they'd taken on faith. My central aim would be to help my clients locate their own unique path toward happiness and fulfillment, independent of religious convention or dogma.

In this respect, I must admit that I see myself as a thinly disguised moralist. Because when clients are still uncertain about their core values, I seek to appeal to their highest, noblest self. This is the self that would never hurt others or harm the environmentand whose every action would be guided by the golden rule. Which is to say that if their individual belief system hasn't quite "jelled," I'd try to foster in them the values I think would best serve themand the larger human community as well.

The Humanist: What is the relationship between sin and psychopathology?

Seltzer: To begin with, humanists wouldnt perceive psychopathology in terms of "sin," inasmuch as that designation reflects a theologicalnot secularoutlook on human behavior. Acts that are shameful, unjust, brutal, or cruelor any behavior devoid of caring and compassionwould, of course, be viewed negatively. At the same time, humanists are far more interested in reform and rehabilitation than in simply doling out punishment for an individual's wrongdoing.

Absent a belief in supernatural forces, the basic tenets of humanism postulate that we all need to take full responsibility for our actions (versus, say, "The devil made me do it!" or "I just couldn't help myself"). At the same time, humanists are acutely aware of the various biological, psychological, social, and environmental forces that can compel our behavior. So instances of psychopathology are viewed as empirically understandable disturbancesdeserving of the most humane treatment possible (hardly as sinful acts to be dealt with punitively).


Whatever the psychopathology, however, in therapy a client's sense of victimhood (even in cases of severe childhood abuse) is ultimately discouraged, because such a helpless stance hinders that person from reaching his or her potential. On the contrary, demonstrating to people that their past need not dictate their future is an appropriate goal for a humanistic therapist. So I strive to create optimism in them about the possibility of creating, through personal will and determination, a more positive future for themselves. Not only is such a prospect important for them to believe inin their case, I think it's absolutely essential.

The Humanist: Who or what is the primary agent of change in therapy?

Seltzer: This is a difficult question to answer. It's just so subjective, so interpretiveeven speculative. Basically, I'd say that what primarily facilitates therapeutic change is the therapist's ability to prompt clients to look within and discover what they're really about. What do they really want? What do they really need? It's crucial that they accurately identify their fundamental purpose in lifeand, too, that they unconditionally accept their inborn limitations. Needless to say, the humanistic therapist needs to be highly skilled at confronting clients, so they'll be willing to leave their comfort zone and confront themselves on all the things that previously they may have been too afraid to look at.

The Humanist: What is the most difficult part of practicing psychotherapy while maintaining your beliefs?

Seltzer: Clients who espouse a religion that is militaristic, or that takes extremely harsh positions against immigrants, gays, pro-choice advocates, equal rights, civil liberties, or other causes I feel strongly about definitely create difficulties for me. For me, such narrow-mindedness, or "superior" sense of righteousness, offends my most heartfelt convictions. Yet it's generally not appropriate to actually question clients' ideological allegiancesunless, that is, they're clearly maladaptive for them.

So I need to stay centered on their presenting issues and how I can best assist them within their own value framework. (I remember, incidentally, the time a veteran referred himself to me to work on his intransigent PTSD symptoms, arriving at his first session in a t-shirt with the letters "NRA" emblazoned across it. Almost literally, I had to bite my tongue and pretend not to notice.)

The Humanist: What is the most rewarding part?


Seltzer: Actually, expanding my humanity to develop greater understanding, compassion, and acceptance for those whose religious beliefs differ sharply from my own is probably one of the most rewarding parts of doing therapy for me. Sometimes, part of me almost recoils when a client divulges an unshakable faith in God, whichprobably because I myself have never experienced such a divine beingcan't help but feel gratuitous to me. (And unquestionably their certitude lacks the supporting scientific evidence I personally require to espouse a belief.) But then I remind myself that we all need to find our own sources of validation and support. And I never want to assume the arrogant position that my orientation is intrinsically superior to any other. What works so well for me may simply be untenable for someone else. And just as I counsel couples to develop greater appreciation for their disparities (i.e., to transmute so-called "incompatible differences" into compatible ones), I strive to do the same for those whose religious convictions substantially diverge from mine.

Now that I think about it, your last two questions might actually constitute a false dichotomy. For what I find most difficult in practicing therapy while attempting to "keep faith" with my own humanist ideals can also be precisely what, finally, I find most rewarding. Whenever I succeed in mentally and emotionally identifying with a client whose fundamental ideology contradicts my own, the insoluble gulf between us simply evaporates. And for all intents and purposes, we've become "spiritually" one. This for me represents a natural progression toward the "secular enlightenment" I strive for. At that point, the divisions between the two of usrooted primarily in differences in our genetic blueprint and educational/cultural backgroundsdisappear. And the essential humanity that vibrantly unites us is reaffirmed.

Leon F. Seltzer holds doctorates in both English and Psychology. Formerly an English professor at Queens College (CUNY) and Cleveland State University, he now lives in Del Mar, California, where he has maintained a general private practice since 1986. He is the author of The Vision of Melville and Conrad and Paradoxical Strategies in Psychotherapy, a guidebook that describes a wide array of seemingly illogical techniques that can assist therapists in effectivelyresolving difficult individual and family problems when more straightforward methods have proved unsuccessful. A blogger for Psychologytoday.com since 2008, his many varied posts have received almost 1.5 million views.

Ryan Howes, PhD, is a clinical psychologist, writer, musician, and professor at Fuller Graduate School of Psychology in Pasadena, California. Hes been writing In Therapy for Psychology Today since 2008, and in 2010 he became a contributing editor for Psychotherapy Networker magazine.



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