The Importance of Contexts in Generating Change
Paul J. Leslie
Psychotherapy interventions usually focus on the elimination of the undesirable symptoms which have brought a client to the therapist. For example, for a client who has a “problem” with anxiety, the interventions will address the causes and the symptoms of the client’s anxiety “problem.” For a person suffering from depression, the therapy session will focus on how the client can adjust the maladaptive thought patterns causing the depression “problem.”
This method of addressing the “problem,” can be effective, however, there is the possibility that both the therapist and the client will come to identify the client with the “problem.” The client arrives at the session and explains his “problem” with anxiety. The therapist and the client explore the reasons for his “problem” with anxiety, and then they discuss how he can address his “problem.” The client leaves the session armed with interventions to help with his “problem” with anxiety. Or perhaps a client comes to therapy for her depression. She and the therapist explore the reasons for her “problem” with depression. Then they talk about some methods to alleviate the “problem” and how to adjust her maladaptive thought patterns associated with her “problem” with depression. She leaves the session armed with much helpful information for her “problem.”
Although both clients may have received help for their “problems,” unfortunately they both arrived at, and departed from, the therapy sessions with an identification with their “problems”—Mr. Anxiety and Ms. Depression. Now to be fair, the problem-addressing method of therapy can be effective, however, it can also be ineffective. As long as clients identify themselves with their “problems,” they are less likely to have a transformative change in their lives, and, as therapists, this is what we want for our clients. In order to bring about a truly transformative change, therapists must consider the client’s perspectives on life, their world-view, their frameworks of reality, and the client’s own inner resources. Every human is much more than a “problem,” and we therapists should not help to perpetuate that identification. Rather we should help clients to see beyond their “problems,” and we must guide them toward their own self-based healing. This necessitates a shift in our own approach toward our clients as we are more fully aware of them as individuals with great potential, but also aware that they are individuals who have their own perspective on their lives.
Differences, Distinctions, and Reality
All humans observe and make judgments about their lives. Even small babies observe differences and make distinctions about their environments. As we observe our environments, we are constantly distinguishing between things, people, events, and experiences. We create distinctions between “this” and a “not this.” These distinctions are based on the observation of an individual. As an example, a client who says she has an anxiety problem has already made a distinction between “anxious” and “not anxious.” The observer has created categories of “anxious” and “not anxious” therefore creating a context of feelings based on her own distinctions while, at the same time, she experiences “herself” within this self- created context. (Keeney, 1983)
The client’s reality is formed by her own distinctions which becomes her reality in the form of her distinctions. In other words, that which has been created, creates itself, and it is a reality based on distinctions which have been created by an observer (Bateson, 1979; Keeney, Keeney, & Chenail, 2015). These early distinctions lead to further distinctions which the client brings to the therapist. The client’s reality and worldview arrive with the client along with their emotions and patterns of thought and behavior. Therapists cannot ignore these realities or perceptions or worldviews because, unless moved out of these views, the client will continue to interpret and make distinctions based on those patterns and continue to see their lives and behaviors and actions from a static viewpoint. Therapists should be prepared to provide a new lens through which clients may observe their lives and actions.
The client’s frame of reference is the context in which all activity takes place. The context shapes both how the client perceives and interprets events and governs the client’s responses. According to Mozdzrez, Peluso, and Lisieck (2014) context contains the “objective facts, the subjective appraisals of those facts and emotions driven by the client’s schema dynamics (view of self, view of others, etc.). It is from a given context that ambivalence is created, problematic behaviors emerge, and solutions are discovered” (p. 57). Renowned anthropologist and cyberneticist, Gregory Bateson (1979) said, ‘Without context, words and actions have no meaning at all. This is true not only of human communication in words, but also of all communication whatsoever, of all mental process, of all mind, including that which tells the sea anemone how to grow and the amoeba what he should do next’ (p. 13).
We all tend to believe that these contexts or frames of reference which contain our perceptions are the true reality. This can be problematic when we find ourselves encased in distressed frames which are filled with limitations and restrictions. If the frame becomes set, all events simply maintain and perpetuate the frame. Clients usually find it difficult to change problem contexts because all attempts to change still remain within the distressed frame of reference. The frame defines the “problem” while the “problem” is stuck within the frame. Attempts to change the problem are often futile because clients continue under the same assumptions that led to the creation of the “problem” in the first place.
Without an acknowledgement or understanding of the client’s frame of reference, therapists may be frustrated as they attempt to solve the client’s problems while the client remains encapsulated in the rigid, preconceived context. In linear methods of therapy, therapists: a) assign etiological explanations for the client’s problem, b) label the problem into categories of disorders, and then 3) apply technical maneuvers based on these categorizations all of which places too much focus on the client’s “problem.” The problem then is reinforced, and the session becomes mired inside a stagnant and endless loop of “problem” related thoughts, “problem” related behaviors, and “problem” related emotions. In an inflexible problem-focused context, therapists will find it more difficult to move clients away from their “problems.” If most of the time in a therapy session is spent on the continuous exploration of the very issue the client wants to avoid, therapy can become stalled and locked into place. The continuous examination of the problem and the relentless searching for the root causes of the problem allow little opportunity for clients to escape from the problem. If both the client and the therapist are mired in the context of the problem, it becomes less likely that there will be a major shift in clients’ lives. As Keeney, et. al. (2015) states, “Sometimes therapists are taught to keep clients inside pathological or problem themed contexts because their model needs that framing to be able to conduct its operations. Stated differently, a problem-focused therapist needs a problem in order to perform problem-solving” (p. 39).
Within a “problem” context, the presence of the problem remains central since there has to be a problem to have a solution in order to have a solution for the problem! This circular method of problem solving in a session can result in excessive attention and focus on the problem. Problem-centered therapy often embeds the “problem” in the minds of both the client and the therapist and this constant focus on pathology in the session limits and decreases the client’s access to empowering resources.
Being stuck in a limiting context can hinder healing. The purpose of therapy then is not to struggle to eliminate the undesirable problem, but rather to move clients out of their “problem contexts.” Once the context has been adjusted, clients will have greater access to their own innate healing residing within them. This may require therapists to take whatever action is necessary, within ethical bounds, to move clients outside their own limiting contexts.
We can create change in our clients, and we can avoid becoming stuck in a “problem-centered” context. However, we must begin to focus on the unique and powerful resources that each client brings to the session. A “resource” can be defined as anything that can contribute to the client’s ability to live in a positive, healthy manner. Any experience has the potential to be a resource depending on the context in which it is presented. A resource can be an emotion, an experience, a belief, or a behavior that clients have had. From this perspective, the therapist constantly seeks what clients already possess in order to move them toward positive outcomes. When a therapy session centers on resources, clients often find their own inner capability and make changes in astonishing ways. With less investigation of the “problem” and more attention focused on resourceful client actions, ideas, or emotions, there is an opening for a shift in how clients interact with their problems. When this shift occurs, the process of transformation begins.
Emphasis on client strengths and resources is abundant in the works of the renowned psychiatrist, Milton H. Erickson. Erickson often directed his session toward finding and utilizing his patients’ inner resources so they could escape the rigid context of their problems. He rarely directly attempted to solve his patients’ problems in a linear fashion, choosing instead to provide them with experiences which gave his patients access to their own inner resources and allowed them to transcend their problems. At first glance, may of Erickson’s interventions may appear unorthodox, outrageous, or even bizarre. However, viewed from the perspective of shifting from “problem” saturated contexts, his work is much more easily understood. If we have been trained to be a “problem” focused therapist, we may find it difficult to step back and to look for client resources. It can be tricky to re-train ourselves to look for and ask about potential client resources that may be utilized to escape the confines of pathology.
This has been an excerpt from The Science of Psychotherapy magazine. To read further please log in and download the issue or article: