Part two of the “Saving Psychotherapy” blog series. Part one can be found here.
While not the subject of as much criticism or under as much scrutiny as psychiatry and the DSM, psychotherapy has long had its critics and detractors. With multi-lens therapy, one of the criticisms of psychotherapy, that it pays too little attention to the many possible causes of human distress, is addressed and, I think, met. If you are a therapist, other helping professional, or a consumer of psychotherapy, learning about multi-lens therapy will benefit you, as it will provide you with a better understanding of what psychotherapy currently doesn’t manage to do, what it ought to do, and how it ought to do it.
What exactly is causing the emotional difficulties that your client or your patient is experiencing? You would think that this would be the question a practitioner is hoping to answer, since it is certainly reasonable to suppose that treatment should connect to causation. Yet a taste for investigating what is really going on has been lost over the decades. As helpers, we’ve moved toward too-easy labeling and accepted the idea that it is reasonable to help our clients without understanding what is going on “with” or “in” them.
This taste for investigation has been lost for many reasons, among them the following four: 1) The DSM is loudly silent on causation; 2) The idea of “symptoms” and “symptom pictures” has firmly taken hold; 3) Training programs which are psychologically-minded focus on one theoretical framework or another, reducing the complexities of causation to “what fits our model”; and 4) It is so darned hard to actually know what is going on “inside” and “with” a given person.
How can we restore something as essential to the healing and helping process as knowing what is going on? There is no perfect answer, but a step in the right direction is the following: providing helpers with multiple lenses through which to view their clients’ troubles. This multi-lens approach reminds practitioners that they shouldn’t be looking for some single cause, like faulty plumbing or a traumatic childhood, nor should they be operating from one orientation, say a biomedical or a psychodynamic one. Rather, a lot is almost certainly going on, each aspect of which may be contributing to your client’s difficulties.
This updated way of proceeding is called multi-lens therapy. It takes as its starting point that, as a helper, you do what you do because of what’s going on, not irrespective of what’s going on. The DSM seems not to care about “what is going on.” As therapists, we most certainly ought to. If your client has an actual biological problem, he needs one sort of help. If he hates his job, he needs another sort of help. If he was born with certain sensitivities, he needs another sort of help. It is absurd (and not okay) that a helper would look only at putative “symptoms” and not at what’s going on. It is likewise absurd (and not okay) that a helper would throw up his hands and say, “I don’t do causes.” Therapists may have gotten into that habit but that is a habit to break.
It may indeed turn out to be impossible to identify the cause or causes of a given client’s distress. But that is no reason not to try, and no reason to pretend amnesia about the whole matter of causation. So, how should a therapist or other helper think about causation as that word pertains to human beings? The first principle is, think expansively rather than reductively. Multi-lens therapy provides twenty-five lenses through which to view and think about a client’s distress. That may sound like a lot but that is as it should be. Causation in human affairs is neither transparent nor simple.
You can be of help to a client even if you can’t discern what’s going on. You can be of help by being warm and supportive. You can be of help by virtue of your listening skills and your ability to carefully reflect back what a client is saying. You can be of help because you understand human nature and can usefully wonder aloud about your client’s behaviors. But that you can be of help without knowing what’s causing your client’s distress doesn’t mean that you should dismiss causation as “not something I do.” To engage in that dismissal would be to shortchange your clients and, worse, to set the stage for big mistakes.
In multi-lens therapy, you take the position that there is no single way to look at human affairs. That a client is presenting a problem that he or she is calling “depression” doesn’t mean that you suddenly know what is going on. You don’t know if your client is in existential despair about having no life purposes, in a dark mood because of chemicals that he is taking that have darkened his mood, in anguish about his unraveling marital relationship, or announcing something that has always been true for him as a matter of temperament. You do not know, and the very least you can do is announce to yourself, “I do not know—let me check.”
How you check depends on your therapeutic style. But informing that style should be an understanding of what might be going on. Multi-lens therapy provides you with twenty-five ways of thinking about what might be going on. These twenty-five lenses include the lens of original personality, which helps you think about a client’s basic temperament, the lens of formed personality, which reminds you about how “stiff” and intractable personality becomes over time, and the lens of available personality, which is a useful way to conceptualize your client’s current “amount” of free will and ability to change. Also included are the lenses of biology, psychology, development, family, social connection, circumstance, trauma, stress, and more. (You’ll find the complete list in a future post.)
Acquiring a working sense of these twenty-five lenses and learning ways of using them in session make for more powerful work and more helpful work. By proceeding in this way, as a multi-lens therapist, you don’t reduce what’s going on to “treating the symptoms of mental disorders” and you don’t operate from any reductionist theoretical orientation. Rather, you accept the largeness of human reality, a largeness that includes the complex nature of causation as that word applies to human affairs. Multi-lens therapy returns the idea of causation to therapy and helps therapists work more deeply, more powerfully—and more truthfully—with their clients.