Introducing Multi-Lens Therapy

Eric Maisel, PhD
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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.

13 COMMENTS

  1. Hi Eric,

    it doesn’t seem like you respond much to comments, but I’ll put it out here anyway. Much of this blog is spot on, and maybe you’ll clarify in a future blog, but it’s REALLY important that one understands the difference between trauma and dissociation. Though trauma causes dissociation, trauma and dissociation have very different effects upon one’s personality. Dissociation has been the much more difficult issue to undo in my wife’s life than the original trauma, though the two get intertwined at points.

    If you had interest, I could discuss it further.
    Yours,
    Sam

  2. I know it’s important to teach the “mental health” workers to return “the idea of causation to therapy,” because I had a psychologist who refused to discuss etiology. But the fact our “mental health” workers collectively have ignored causation for decades or forever (???) is pretty pathetic.

    I mean how collectively stupid can an industry be to completely ignore and deny the real life causes of their clients’ distress? Such maltreatment of one’s clients is ungodly rude and, of course, harmful to their clients.

    But I guess since the primary actual societal function, historically and today, of the psychological profession has always been covering up child absuse and rape, for the rapists. I guess ethics and common decency have never actually existed within the “mental health” field.

  3. This really lost me Eric. If I were an up and coming helper I would be turned off and as a retired LISW with twenty years of post graduate experience in a variety of settings you lost me big time.
    I would urge you to buy or get at your local university library
    Anthony Stoer The Art of Psychtherapy
    Selma Fraiberg The Magic Years
    Bessel van der Klerk The Body Keeps the Score
    Also get the writings of survivors and do a thorough history of the history of psychotherapy. Bob’s books and others.
    There are massive amounts.
    Then instead of writing I would have you run not walk to either a homeless shelter, food pantry, group home, and spend time with folks – human to human – eye to eye- and listen and only talk for etiquette sake and to ask questions,
    Then maybe your local prison ministry for either the prisoners and or their families.
    Many great writers teach classes- you might want to research which regional literati teach prison classes and they could assist you in at least observing.
    Then maybe go to a Vet center and listen. Then maybe a nursing home.
    After 9/11 Mr Rogers had a discussion on its trauma for his audience. He quoted his mother saying when you need help go to the helpers.
    Sometimes the helpers YOU NEED are not in positions of power, sometimes they are the riff raff and woe to those of us who do not hear and honor their stories.
    I would be interested in hearing in your. next MIA blog about which folks who choose to learn from and your reactions and lessons learned in.., I had no idea!….. and not their stories you decided to incorporate.

  4. Excellent article Dr. Maisel. It is ludicrous for any psychiatrist or therapist to think they can be of any help to someone if they give little to no credence and recognition to causation and context. From my experience psychologists do defer to psychiatry and DSM labels (for the most part) and seem afraid to disagree with psychiatry. I agree that the problem is due largely to: “The DSM is loudly silent on causation”.

  5. It sounds a little like you’re trying to weasel “bio” etc. in there, and this sometimes indicates one’s answer to the prevalence of iatrogenic damage we see in the world today, the blight of the reckless physician, but I will let it slide for the moment. These lenses that you have a number of, must, in some sense of the expression, be metaphoric. That said, we’ve got a cliffhanger. I eagerly await the next episode, and a slideshow view of your answer to the “distressed” situation from all 25.

    • Well, Frank, bio’s likely to be in there whether we like it or not. There’s nothing wrong with it, if our alleged helper isn’t addicted to the use of the prescription pad and the so-called psych drugs, but is aware of non-drug treatments for anxiety (magnesium, maybe niacinamide), depression (B1, B3, B12, sometimes B6, sometimes thyroid among others), and other conditions with more complicated physical treatments. Notice the non-reliance on our common psych drugs.

      • personally, im all about Orthomolecular. psychotherapy…far less so. the best ‘therapy’ i ever received was a man with 3 masters, working on the phd (at long last, am i right?) telling me: you so much as drive by a clinic or a psyhciatrist’s office, they’ll call you bipolar. and..

        the meds just contain strong emotions. they don’t fix anything. and…

        ideally, therapy should have an end point, and people should get on with life.

        We’re both Christian, though. I think that’s an ‘issue’ that sometimes comes up in ‘treatment…’

        mental health, inc. is pretty much a state sponsored, socially accepted form of social control. its also (yes, I’m stealing from szasz left and right here) a religion, and i think…a rather dangerous, expen$ive one, at that.

        its worth noting that new forms of psychotherapy sound fun and exciting…

        its still conversation. on a good day, psychotherapy is a conversation that engages the client/consumer/patient/PERSON in meaningful, constructive ways. thing is…

        there aren’t many good days, and good days are essentially unheard of if you are: poor, working class, stigmatized, low status, disabled, too old, too intelligent, ask too many questions, question authority, refuse ‘meds,’ terminate ‘treatment,’ have limited insurance, have medicaid, are uninsured, even if one is too ‘middle class’ to benefit from the wisdom of the guru/therapist/whatever.

        i see that there are, in fact, well-intentioned people in mental health, inc. and i remember..

        ‘the road to Hell is paved with good intentions.’

        • “there aren’t many good days, and good days are essentially unheard of if you are: poor, working class, stigmatized, low status, disabled, too old, too intelligent, ask too many questions, question authority, refuse ‘meds,’ terminate ‘treatment,’ have limited insurance, have medicaid, are uninsured, even if one is too ‘middle class’ to benefit from the wisdom of the guru/therapist/whatever.”

          Hit the nail on the head . . . at every point. . . .

  6. I can give an example. I went to therapy asking for help for an eating disorder in 1981. They did not know what eating disorders were back then. They never heard me for the next 30 years of intensive therapy. One therapist after another after another…most of them never knew I had an ED even though I said it many times.

    I can’t count the number of diagnoses I ended up with, the cocktails, the lockup situations, the “programs” that promised to help and did not, and the shock treatments that nearly did me in.

    I suspect that the world of mental health is in such hopeless shape that what Eric is suggesting here is more or less a dream, not something that can possibly happen. I don’t think there’s hope for psychotherapy since most therapists worship the DSM and psychiatry. And they called all that “help.” It wasn’t.

  7. This article is so full of holes that It’d take a books-length critique to adequately address, just like its predecessor. But I’ll just say this: “Multi-Lens Therapy”? Why does this sound and read like gestalt redux? Secondly-with regard to reason #1 of the above four: Why is the DSM anywhere near a psychotherapist office? (Rhetorical question). Next: when did critical consciousness become so threatening to the psychotherapist profession? (this question is wider and deeper than might appear, and deeply troubling in my psychotherapeutic experience). Lastly-because this is all the hopelessness I can invest in today, when is the psychotherapy profession writ large going to offer a metaphysical critique that acknowledges-even honors!-the human psyche for it’s authority, and in the process-by extension, that human psychological symptoms may be (trauma notwithstanding!) less pathology than the Cosmos (and, of course, all levels of the social!) speaking through the therapist client (back to critical consciousness for the record).