Instructions:

Beloved Students: From the following final exam-preparatory skit, performed in class on Tuesday, July 20, 2010, generate 3 questions, and then provide answers to each.   Enter the questions in bold and answers under each in the comments section below.

Three Ways to Crack a Nut

Advanced Individual Counseling

laceName w:st="on">BrandmanlaceName> laceType w:st="on">UniversitylaceType>: July 20, 2010

Dr. Mod: Good afternoon.  Welcome to TV D, the debate channel.  Today on Three Ways to Crack a Nut, I have 2 authors and an editor, who will debate one another on preferred approaches to individual counseling. 

On my left, please welcome Judith Beck.  She wrote Cognitive Therapy: Basics and Beyond.  On my right, is Gerard Egan, author of The Skilled Helper.  And in the middle, we have Alexander Wolf, one of the two editors of Psychotherapist’s Casebook. 

I’m sorry, the other editor, Irwin L. Kutash couldn’t be here today because he’s auditioning for America’s Got Talent.  And, by the way, we’d like to wish him the best.  He’s doing an as-yet-undisclosed stunt

Dr. Mod:  Hi, I’m doctor Mod and I’m the debate moderator.  I’d like to welcome each of you to the show.  Let’s start with you, Judy. 

Gerald Egan: Oh, please.  Why don’t we just all get into robot mode?

Judith Beck:  I beg you’re pardon!  Gerry! Don’t you dare put me in a box based on your assumption that I’m my daddy.

Gerard Egan: Well excuse me!  Maybe this is the place to start singing Bridge Over Troubled Waters.  You do engage in session bridging.  Oh well, I guess that’s a step up from simply identifying faulty thoughts and attacking the thoughts one by one. 

Alexander Wolf:  It seems to me, Jerry, that you can be a bit of a robot yourself.  You and your damn lists!  If I have to read one more of your endless lists, like Suggestions for Responding with Empathy on page 183, I think I’m going to throw up.  Why can’t you be like James F.T. Bugental, the Existential Humanist?  Instead of following the growing Western trend towards “mechanization, impersonality and the objectification of persons.

As Paul Tillich wrote, “Man resists objectification, and if man’s resistance is broken, man himself is broken.”  That’s what sucks about both of you.  Sure, Judy, you give lip service to approaching persons as whole beings, and you talk about session bridging, mood check, and identifying emotions, but for you, the thoughts come first.  Just check this out here on page 79.  You focus on the human as a thought machine that produces feelings like a computer program would produce data. 

What is all of this focus on identifying automatic thoughts, evaluating and responding to automatic thoughts?  What about just being present and emotionally available for your patient, and not crowding out the unconscious with all of this structure you impose on the session. 

And Gerry, at least Judy’s structure comes from some sort of easily-identifiable, if reductionistic, model.  You just seem to be pulling things out of the blue, or, in layman’s terms, pulling things out of your…no, I’m not going to go there. 

You have an exaggerated sense of self-importance, and see yourself as some wise counseling guru.  I get tired just looking at one of your lists.  If you have to go down a list to make sure you’re responding empathetically towards your patient, there’s something wrong.

Gerard: Well, you think authenticity and presence are important, but what good are those terms if you have no way to convey them in a reified, concrete manner?  I actually spell it out.  For example, in my SOLER structure on page 134, I tell counselors: Give me an S: Face the client Squarely.  Give me an O: Adopt an Open Posture.  Give me an L: Remember that it is possible at times to Lean toward the other.  Give me an E: Maintain good Eye contact.

Judy:  But you treat counselors in training like they are babies, needing to be spoon fed.

Wolf: And you both are so obsessed with imposing a structure that you’re not even aware of the transference/countertransference process and how early childhood developmental conflicts manifest themselves in the counseling relationship. 

It is okay to focus on present behavior and all, Judy, but what about relating past history to present behaviors?  What about developmental and historical context.  Judy, you treat people like thought robots and Gerard, you treat them like babies.  Grow up, both of you.  Consider Dr. BLT’s 3 C’s context, complexity, and chaotic conflict. 

You’re both so scared of chaos, that you must obsessively apply structure, or a set of rules, to the process.  You are product-, not process-based.  You want everything to come out in a nice, neat package, so you focus on conscious, present experience and avoid the unconscious, rife with uncertainty, mystery, and ostensible disorganization.  You are both ambiguity intolerant!

Gerard: Shut up, Wolf.  You’re going to end up training grad students to become starving graduates.  Try talking to insurance companies about object relations.  Try talking about free association.  Try talking about providing a corrective emotional experience for your patient.  Try getting paid for wading heedlessly into unconscious infantile conflicts like psychoanalysis-loving Harold P. Blum would have you do. 

Wolf: We need to educate 3^rd party payers and let them know that psychoanalysis, while sensitive to the unconscious and to early childhood conflict grounded in object relations, is not entirely without structure.  Psychoanalytically oriented therapists are constantly interpreting all possible verbal and nonverbal data, formulating hypotheses and testing them out, all scientifically sound activities.  But they do it within the context of a deep appreciation for process and subjectivity over over-objectification product orientation. 

Judy:  Who do you think you are Alex?  You are grossly misrepresenting my approach.  I doubt if you have read Chapter 7 in my book, identifying emotions.  If I thought people were thought robots, would I devote an entire chapter to emotions?

Alex Wolf:  Yes, to give the appearance of being more inclusive than your dad, Aaron.  You talk about differentiating automatic thoughts from emotions on page 95, but how can you simply compartmentalize different realms of human existential experience like that.  Our thoughts and our emotions cannot be studied independently from one another.  They represent our conscious and unconscious experience. 

Both of you are all about compartmentalization of human experience.  Instead of thinking outside of the box, you want to separate everything and put it into nice, neat boxes, but human experience doesn’t work that way.   It’s a mess.  Deal with it!  Human beings are continuously conflicted.  There is constant internal conflict.  There is interpersonal conflict, and there is existential angst. 

Mod: Excuse me…if I may interrupt.  Quite honestly, Alex, I’m beginning to wonder why I invited you.  If anybody is guilty of putting things in a box, it’s Freud and his sycophantic followers.  Everything is about sex.  It’s all put into the box of the Oedipus complex or the Electra Complex. 

Alex: Now you’re misrepresenting Freud and his followers.  Sure Freud was a little obsessed with sex.  He needed to back off of the complexes a bit and he was rather deterministic and dark---too much emphasis on the id and the super-ego, not enough on the ego.  But his followers really opened up the ego, expanded up it and thus rendered it more salient than Freud, and thus representing human development in less deterministic, more humanistic terms. 

And each had their own areas of emphasis.  Sure, they all relied upon free association, which, by the way, is better than the structure you impose on the process, Judy, or the manner in which you crowd out the gradual unfolding of unconscious experience with so-called common-sense applications, Gerard. 

And they analyzed transference and resistance, instead of rushing in with artificially established, robotically delivered empathy, Gerard, or rushing in with analysis of automatic thoughts.  But according to Marks, on page 55 of my book, the ego psychologists or neo-Freudians differed in “the kind, the dosage, and the timing of interpretations.” 

As Marks puts it, “To Reik, the evenly suspended attention was crucial,” to Reich, it was all about analysis of resistance.  To Strachey, all of the emphasis was placed on the analysis of transference; and “to Alexander and Klein, it was about the analysis of the superego.”  Anna Freud, on the other hand, focused on “equidistance toward ego, id and superego---and the neutrality of the analyst toward those three structures.”  Then we have Spitz, who focused on “the development of structure within the framework of the mother/infant dyad.” 

In Malcolm J. Mark’s chapter on Ego Psychology, chapter 4 of my book, he tells us that Heinz Hartmann, for example, “went beyond the defensive functions of the ego to how the person develops and uses his or her organizing ego in adapting to life (inner and outer).”

Hartman wasn’t about sex, Hartman was about adaptation.  You know what musical synthesizers do, bringing lots of diverse sounds together, well he did that with the ego, he emphasized its synthesizing function.  This stuff is rich, it’s diverse, it’s non-reductionistic. 

Gerard Egan: Who cares about Spitz?  How cares about “the emergence of the smiling response initiating the beginning of the social relations in men?”  Was some face that the mother made the “prototype and premise of all subsequent social relations?”  Who cares about early narcissistic wounds?  Does development “require the capacity for object love and object loss, for tolerating frustration, depression, and pain?” 

Forget the Oedipus complex.  Let’s “respond accurately to clients’ feelings, emotions and mood by using “the right family of emotions and the right intensity,” and by distinguishing between expressed and discussed feelings.” 

Let’s “read and respond to feelings and emotions embedded in clients’ nonverbal behavior.”  Let’s “use variety in responding to clients’ feelings and emotions.”  Beck, you underemphasize feelings.  Wolf, the ilk you gravitate towards overemphasize it. 

Let’s “respond accurately to the key experiences, thoughts and behaviors of clients’ storied.”  Let’s “become competent and confident in responding with empathy, using empathy throughout the helping process and throughout all stages, including Stage 1: Problem clarification and opportunity identification; stage 2, discovering and evaluating goal options; and stage 3, choosing actions to accomplish goals.”

Alex: As I was saying, before being so rudely interrupted, sure, Adler focused a great deal on gathering specific information about the patient’s formative years, but you never hear Adler talking about Oedipus.  He was more interested in the family constellation, on “family factors that influence personality development---birth order, behavior modeled by parents, family values, family atmosphere, sibling rivalries and the way the child established (his/her) place in the family—(his/her) role.”

It’s about how we, as individuals, strive to overcome feelings of inferiority.  It’s all about examining a patient’s Style of Life.  There was even a cognitive component associated with Adler.  He was interested in “faulty convictions that interfere with efficient adaptation to the developmental challenges of life.” 

Then you have Jung, who relied on such phenomena as introversion and extroversion, persona, shadow, self, archetype and collective unconscious, not to mention the complex. 

Dr. Mod:  I hate to cut you off, Alex, just when you’re about to elaborate on Jung, but we’re out of time.   I hope all of you wonderful people out in television land learned that there are three ways to crack a nut, start at the head, start with a list, or start by drilling a tiny hole it and gazing at the insides until you have it all figured out!  Please tune in for the next show while these authors and this editor duke it out one more time for the sake of great debate!