In my last post, I suggested
that good therapy is a relationship that promotes “the making of good
connections in all directions” (Dr. Robb Palmer, Evangelical Seminary,
Myerstown, PA). What might that definition of health suggest as goals or
desired outcomes of therapy? What factors impact outcomes that can be expected
from therapy? Could therapy make things worse? Just what are the risks and
benefits of therapy? Those are all important questions to consider. Developing
clear goals and expectations will help you make the most of your time and
resources in therapy. In therapy, as in planning any journey, it is important
to begin with the end in mind.
Desired destinations:
Therapy typically involves reaching at least one of the following three destinations: 1) a place where
you are better situated to cope with unsolvable difficulties; 2) a place where
you are better situated to reach a solution to solvable problems; and/or 3) a
place where one is better situated to participate in vitalizing relationships.
Therapy might help you to develop strategies to cope with the unchangeable, to
develop new ways of finding solutions, and/or to develop fuller self-knowing of
how you can participate more fully in vitalizing relationships. The distance to
the destination varies case by case, as does the pace of progress towards one’s
destination.
Hazards and Roadblocks:
In the course of therapy, additional
emotional, cognitive, behavioral, and/or relational difficulties or challenges
related or unrelated to the your initial reason for seeking therapy (the
presenting problem) may manifest and complicate treatment of the presenting
problem. Your presenting problem might not only fail to improve but might
worsen as a result of therapy, if underlying challenges or difficulties
manifest in the course of therapy. The therapist has an ethical obligation to
make appropriate referrals should difficulties arise that lie outside the scope
of the therapist’s expertise or exceeds the therapist’s competence.
Most therapists belong to
professional organizations that offer guidelines for their practice. You might
want to explore the website of the NIHM (the National Institute for Mental
Health), the APA (American Psychological Association), the NASW (National
Association of Social Workers), or the AAMFT (American Association of Marriage
and Family Therapy), to learn more. A number of training programs equip mental
health professionals. New Hope counselors are not medical doctors.
Therefore, if for example, the
therapist were to suspect that emotional or cognitive difficulties might be the
result of an underlying medical condition, then the therapist might question
the benefit of therapy since the therapist suspects the client needs care
beyond the scope of the therapist’s practice. The therapist would recommend a
medical evaluation. Whether or not a medical evaluation affirms or denies the
therapist’s suspicions, the client may undergo distress unrelated to the
client’s initial reason(s) for seeking therapy.
Yet, the fact of the
therapist-client relationship implies a duty to care, and therefore the
therapist acting in good faith must make such a referral, when there is
reasonable evidence of its necessity (in the above case, such would very likely
include the results of a mental status exam). There are numerous scenarios
wherein problems related and unrelated to the presenting problem exacerbate a
client’s presenting problem, and the therapist welcomes clients to discuss with
the therapist concerns regarding the risks and limits of treatment at any time.
Aaron Arnold
Counselor Intern
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