Therapeutic Error?

Therapeutic Error? Exploring conflicting approaches to therapeutic interventions

The session went something like this:

Client: “I’ve been really down this week. Tuesday, I came home from work late, and my son’s room was still a mess. I had warned him that I was going to take away his XBox privileges for a week if he didn’t clean it up, but he hadn’t lifted a finger.

When I took away the XBox, he blew up at me, said it was all my fault, said that because I’ve been working late so often that he’s lonely and doesn’t feel like doing anything, ever. Said I was a crappy parent and that he wanted to go live with his father. And he’s right! I AM a crappy parent, it IS my fault, I should never have fought for custody. I just want to crawl into a hole and give up.”

Me: But don’t you see that this is an example of the cognitive distortion and negative self-talk that we’ve been talking about? You’re not down because he is angry with you; you’re sad because you told yourself a lie about being a crappy parent.

You set a boundary – that is great parenting! You followed through with a rule, held him accountable, set a reasonable punishment – good parenting again!

Don’t you think you would be feeling better now if you had told yourself the truth instead of the negative lies about being a crappy parent? If you had told yourself that you were being a good parent, and that it is normal for a teenager to fight back against control?”

Client: “I guess so…”

“…My therapist always changes the subject when I talk about being depressed….” 

Later that week, this same client was in group therapy and said to another group member, “Dr. Whitehead is a good therapist, except that he always changes the subject when I talk about being depressed. He never lets me get it all out.”

I was shocked! I had thought it was a great intervention, truly helpful to the client, but her experience was quite different.

Instead of feeling helped, she felt unheard.

Was her implied assessment of me correct, that I was just avoiding walking beside her for a minute in her despair to protect myself from empathetic sadness? Or was I correct to interrupt her pattern of negative self-talk as quickly as possible and substitute a positive alternative?

I still don’t know the answer to this set of questions.

I believe in the basic value of Rogerian and other humanistic techniques as the underpinnings of good therapeutic intervention. But I also believe the basic Cognitive Therapy assumption that cognitive errors and negative self-talk are often the cause of depression, and that teaching different ways of thinking about situations can be helpful. 

Which therapeutic intervention technique works best for clients?

So whose advice do I take: Carl Rogers’ or Aaron Beck’s?

Beck might say that Rogerian therapy is palliative, but not curative. He might contend that patient, empathetic understanding of a client’s negative self-talk is like giving Tylenol to someone with a broken arm, ignoring the need for a cast and just easing the pain temporarily. 

On the other hand, Rogers might say that interrupting the expression of grief or sadness is useless. Until a client feels that they have been heard, they aren’t going to listen to you anyway. And ultimately, the client may propose their own solution, which will make it more meaningful. 

So what do you think? I really don’t know, and I’m eager to hear your opinions.


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