by Frank C. Sacco, Ph.D., CSI President, Scholar in Residence
The origins of psychotherapy lie in the pioneering work of the of the late 19thcentury theorists like Freud, Jung, Rank, Lacan, Anna Freud, Melanie Kline, Bettelheim, Aichorn and Karl Menninger. They were examining personal experiences and asking the question “why.” They all developed different concepts, fought with Freud and each other resulting in many different metaphors for describing human experience. They all, despite their differences, hovered over human experience and tried to help people see their own problems and open doors to change. The “why” is a dedication to understanding the client’s human experience in a quest for better quality of life for the client.
Modern approaches to diagnosing and treating psychological problems caused by trauma has become obsessed with calculation of the “what” of a problem. Problems and solutions are neatly packaged into numerically coded descriptions or diagnosis. Families have evolved over the past 30 years and many have sunk into permanent poverty, trauma, crime, addiction, homelessness, incarceration, teen pregnancy, truancy, and the school to prison pipeline is flowing at record levels. The net result is children grow into traumatic parents who beget more trauma. This is the intergeneration cycle of trauma. The symptoms this eroding of family produce include PTSD, specifically complex, developmental trauma, ADHD, and personality disorders after 18. It is important to understand that a person is not a diagnosis.
Engaging a client as a human is necessary regardless of what approach to therapy is taken. Every person is different and it is up to the therapist to discover how. The therapist’s challenge is to understand why behavior happens the way it does. Is the aggression just at home or in school? What happened to the person as they grew up, what was it like for them? Like a biographer or news reporter, the therapist needs “curiosity mindset” to build a timeline and should attempt to visit every stop in the life journey. “is there a time when you liked school?” “what did you like about it?” “What was up at that time?” Questions can help clients reflect and help the therapist open awareness and work out healthy solutions.
When a client says that she returns to her abusive mate because she is sure he will change. She knows that he is now being nice and will soon turn aggressive. The urge to say, “You deserve better, you know he is hurting you, leave now, I can help you get safe.” While this message is absolutely the correct answer to the client’s problem, the mind-numbing reality is that victims return constantly after hearing “the answer.” The curious therapist would gently inquire into what it is like when he is nice to her?” “Does he make you safe?” “Do you feel no one will care without him?” These inquiries are designed to keep focus on the client’s experience, not giving her anything by the curious and interested therapist mind enthusiastically searching for way to help the client feel relief from stress.
Clients with trauma-induced personality disorders and children struggling with current trauma respond to therapy because it is as a way to stay connected to a secure base in an unpredictable and frightening world. Therapists are easily tricked into giving advice. A curious therapist needs to become obsessed with the client’s experience. When a therapist seeks to understand, not preach or judge, the client receives a clear message of his or her value. The therapist can search for ways to help the client see or reflect on his or her behavior. Change is slow and unhealthy life behaviors are not easy to stop.
Therapists need to understand the “why” of this experience. Asking a question and exploring roots can assist clients in developing the skill of self-observation. Most clients caught in this struggle need the support of a therapy relationship to maintain some capacity to observe themselves living lives with avoidable risk and harm. The therapist in home-based outpatient therapy is in a position to “hover” and if needed to “contain” the client’s experiences. This function of outpatient therapy is a powerful resource that is very cost effective.