[From Bill Powers (2009.07.11.0853 MDT)]
David Goldstein (2009.07.11.07:28 EDT) --
DG: [About Bill Powers (2009.07.10.0003 MDT)]
In the world of mangaged care in the USA, there is an expectation that a treatment plan will be made at the beginning of therapy. After an initial meeting with the patient, I formulate a treatment plan (usually two or three goals) based on what the patient identifies as his/her presenting problem. In the second therapy session, I go over this treatment plan and have the patient sign off on it showing that the patient understands and agrees to the plan. If the patient disagrees with it, we come up with something better defined by the patient.
BP: So is this a legal document required for insurance purposes? All this is really none of my business since it's your practice and they are your clients. You don't need my approval to set it up any way you want. On the other hand, this form is going to be adopted by at least some others -- couldn't the "treatment plan" be separated from the record-keeping part? It just looks so bureaucratic, like a granting agency wanting to know what your research program is going to discover before you get any money.
Anyway planning ahead for MOL sessions isn't really realistic, is it? Neither you nor the client knows what is wrong, or what will be discovered as the explorations go on. Of course you can always describe the symptoms and say the goal is for the symptoms to go away, but you'd have to describe different symptoms for each individual. There is no reason, anyway, to think that the presenting symptoms have much to do with the real problem or its solution. You arrive at definitions and solutions as part of the therapy process.
BP (earlier):This still sounds like the person is taking some sort of pledge or promising to do his duty. Isn't it sort of obvious that a therapist's client is going to talk about his/her problems?
DG: It does seem obvious. But it doesn't always happen. People come into therapy with the experience of ordinary social conversations. Norms such as: I will not hog the conversation and talk too much. I will not self-disclose too much. I will listen to the 'expert' tell me what I should do. I will be friendly and talk about 'safe' topics, for example, weather, results of local sport events, etc. This is where the first goal comes from.
BP: Right, but are such psychological problems prevented just because the person agrees to this goal verbally (or even with a signature)? Is every person going to require this admonition at the start of therapy? The things you talk about here, it seems to me, are evidence about why the person needs therapy. If this actually has any effect on curing the things you mention, why not just have the person describe all his symptoms and then sign something agreeing not to have them any more?
DG: The ultimate goal of therapy is to help the person become 'unstuck' so that he/she doesn't need the therapist any more.
It seems accurate to describe therapy as a process whereby the person's stress level (caused by chronic error signals) is ultimately reduced so that the person no longer feels the need for help from the therapist person. It is also a very acceptable way for the patient to think about why he/she is in therapy--not because I am 'crazy' but because 'I am stressed out'.
I just don't see much advantage in trying to spell out all these details -- aren't they normally handled just as part of the therapy? And again, what will the clients think who don't have this particular problem? This approach seems to assume a sort of "typical patient", which means that it will apply only to a very small fraction of the real ones.
As I understand MOL Therapy, there are two sources of stress. You have identified internal conflicts as the major source of stress. Hence, the second goal.
However, there are other sources of stress which do pop up: overwhelming disturbances (for example, deadly storms, earthquakes, economic recession and loss of jobes; perceptions of situations which are unrealistic or inaccurate or contaminated by imagination; goals which are unrealistic or impractical for the person, even though they do not conflict with other goals; knowledge and skills of how to accomplish some goal. This is where the third goal comes from.
I don't think people need therapy because of overwhelming disturbances or stress. They need therapy because they can't reorganize and solve their own problems. That can happen for many reasons, and I think automatically blaming external events is a mistake. There are people who react to the sorts of things you describe by getting organized and doing their best to salvage something from the disaster. They're the ones you see on the news picking through the wreckage of their homes after the tornado, saying "Of course we'll rebuild; after all we're still alive and that's what matters." The person next door is crying and hopeless and doesn't know what to do. You can't blame the same tornado for both ways of behaving. Whatever the problem is, it's not outside the person. Or to put it differently, if the problem is outside the person, it's not going to be fixed by psychotherapy.
MOL isn't about stress. An athlete doing the 25th mile of a marathon is under huge stress, but doesn't need therapy. Stress just isn't a psychological problem; the problem is the inability to cope with stress. Conflict keeps you from doing the things you need to do to cope with stress; get rid of the conflict and you can stop worrying about the effects of stress because you'll simply do whatever can be done. Stress alone won't harm you psychologically.
Best,
Bill P.