In dealing with clients struggling with depression over the years and also having my own struggles, I remain humbled by the fact that as a therapist, I cannot make generalisations as to how I will help this or that client.
My problem with over-generalising came with my own experience with psychotropic medications that were supposed to fix me up but from which I got the most nasty side-effects. I wasn't supposed to get these side-effects or so it seemed. No one else apparently did or it seemed to be suggested got them like I did. The doctor had generalised that since many patients did get relief that if I didn't get relief there almost had to be something wrong with me!! Something was wrong with me but it was surprising to find that other patients also had similar problems with medications as well.
I used to find that the common SSRIs (Prozac, Zoloft, Aropax [awful], Cipramil) would wind me up so much that my whole being was constantly agitated. A wikipedia article describes this terrible state as akathisia (See http://en.wikipedia.org/wiki/Akathisia.)
Actually, it was only receiving help from a psychiatrist, who himself had depression and treated himself with medication, that started me on a path of having more self-confidence in my experience. He knew that patients did not always respond well to medications and that further, some of them had horrendous side-effects with some patients. (See http://xrl.in/2vm.) However, this doctor gave me hope even though he was not the one who finally helped me more definitively. He moved interstate and I had to find another specialist
Yet, even with the new specialist, I had to fight against being given the usual dose of a known 'benign' medication. Fortunately, providentially, I started off on a very low dosage and am still on this medication to this day although on a much higher dosage.
Another issue that sometimes patients have to fight with experts about are the generics that are 'just the same' as the original brands. Well not everyone finds it so. With other categories of medications that may be so but with psychotropic medications it is very unwise to change if one is doing reasonably well on a particular brand. Differences in responses to different generics can also be felt even though pharmacists will tell you that it cannot happen.
A stimulating paper by Slife, Harris, Wiggins & Zenger (Brigham Young University) entitled Radical Relational Therapy in Practice (APA Presentation - 2005) at http://xrl.in/2km criticises the abstraction-into-practice tradition in psychotherapy.
And, while I agree that therapy is never just abstractions applied, it seems that Slife et al. do precisely what they claim to be protesting about. Let me explain.
They 'conscientiously used a relational ontology to orient all our year’s work together, with clients of all kinds' (p. 1). Now, what is this 'relational ontology' but an abstraction? Any ontology is some kind of philosophical science of being. Relations, as soon as we focus on them, become abstractions because we have abstracted them from experience. 'Relational' describes the type of ontology that one adheres to but using this contemporary buzz word does not mean one is not involved in abstraction.
Abstraction is unavoidable in therapy and can be observed in the given 'Ann' case study. The approach 'foregrounds the immediate, the richly contextual, and the authenticity of relationships' (p. 1), which states upfront that the therapy will emphasise three abstracted qualities from pretheoretical human experience.
I am not arguing against the importance or otherwise of these three qualities but rather arguing that in naming them we are necessarily involved in abstraction and thereby theory. It is a certain theory about human relationship that governs the way the therapy is conducted. For example, an unhappily married Ann says that she doesn't like herself in her marriage, to which the therapist responds with, 'Do you like yourself with me?' When she says that she does the she is asked to indicate what she is doing that allows that to happen. (Not we notice, what the therapist is doing but what she is doing.)
The therapist does not turn to either intrapsychic issues with internal objects or to disordered cognitions but focuses on what is going on in this therapeutic relationship that may lead to benefits in her other relationship.
The authors then present a 'tiny snippet of an actual therapy encounter' to demonstrate 'some important features of the relational approach'. The four summary points they draw from the case study are: '1) interpersonal connectedness is more important than individual depth; 2) a real relationship is more healing than an abstracted one; 3) being apart from community – individual autonomy – is less meaningful than being a part of it; and 4) living into, rather than abstracting from, contextual possibilities is more helpful' (p. 2-3).
To contend that these points and their terms are not 'theory-laden' is to ignore their abstracted character. However, on the other hand, nothing is wrong with abstraction as long as we don't imagine that abstractions are any substitute for mankind's fully given experience of reality.
In dealing with clients struggling with depression over the years and also having my own struggles, I remain humbled by the fact that as a therapist, I cannot make generalisations as to how I will help this or that client.
