by Tim Brunson, PhD
There is often a conflict in therapy between conformity and effectiveness. The desire to "do no harm", to remain within the scope of practice, and to comply with ethical and boundary requirements result in a hesitancy to explore alternatives that may be in the patient or client's best interest. While I would never question the compassionate intention of such limitations, they may very well present a stultifying effect on the potential benefits of therapeutic interventions. My intent here is to explore the appropriate balance between risk-taking and caution both in the intellectual development of our professions as well as regarding practical applications with subjects.
Most certainly I would be the first to admit that risk-taking is allowed within the established and accepted rules. Clinicians have license to try a variety of approved techniques. Clinton Clay, LCSW, who was one of my first NLP instructors, impressed upon me the necessity of having a collection of optional techniques – meaning that there is no one solution to everyone's concerns. Indeed, even Milton H. Erickson, MD, preached that psychiatrists should approach their practices as somewhat of an art rather than being confined by a particular school of thought. Nevertheless, when looked at with historical perspective, risky protocols are frequently viewed later as barbaric – such as frontal lobotomies and many of the methods that were once common in self-styled modern asylums. This leaves me to conclude that several of the current methods may also eventually be considered cruel and ineffective by the practitioners only a few decades from now.
Regardless, too many clinicians and theorists mistakenly regard psychology as a field of science rather than as a primitive, nascent endeavor. It is an irrefutable fact that way too much is not known about the human mind. Indeed, the neurological findings of the last couple of decades make the academic gospel formerly taught – when current psychology professors earned their degrees – questionable at best. Therefore, the field has always been one where uncertainty, philosophy, and a diverse offering of schools of theory have been shrouded in the mystique of scientific labeling. The truth is that psychotherapy without innovation and risk-taking currently would have no validity.
So, consider the role of risk in the effectiveness of therapy. Therapeutic interventions exist for only one reason and that is to transform a subject's experience from one state to a more preferred one. I will avoid here any discussion regarding the definition of sanity or mental health. It suffices to say that change is desired.
The problem is that there is always a resistance to change. If this could occur with little effort, there would be no need for clinicians. No change means staying in the status quo condition. However, this is where the suffering and discomfort is occurring. On the other hand, the suffering of change occurs when a person attempts transformation. For instance, an addiction may present unwanted costs. Regardless, it is a known state, a fact which ironically creates a perverse level of comfort. Change represents moving toward an unknown. This is difficult. It is painful when you consider the suffering that must occur.
I have frequently written and spoken that transformation requires an antithetical condition. This means that there must be something that is so compelling that either results in more suffering than not changing or provides such a tremendous level of pleasure that the suffering of change can be overcome. When studying Erickson's case studies, I often noticed that he created such antithetical conditions. This was his aim both in the homework assignments that he gave his patients and during trancework.
The creation of an antithetical condition strong enough to compel transformation is synonymous with risk-taking. The clinician presents an intervention that runs the risk of failure. The subject is also asked to take a risk as there is a departure from the status quo. However, without risk transformation will not occur. Without risk there will be no therapy.
As I watched the 2010 Winter Olympics I could not help but relate my thoughts to the risks taken by these masterful international athletes. More so than their Summer Olympic counterparts, winter sports are inherently more risky when you consider the ubiquitous presence of slippery snow and ice. The resulting uncertainty that this causes means that they performed in an environment where their level of control was always in question. Yet, here is where the beauty of their risk-taking comes in.
The common characteristic of these champion athletes has always been their ability to ride the boundary between maintaining and losing control. Yes, they push the limits. When exceeded they experience agony; when they succeed they win medals. I remember an interview with the woman who won the Gold medal in the mogul skiing event. She told the reporter that she mentally blocked out fear and risk as she single-mindedly focused on her goal. Unfortunately, as clinicians, ethical and legal boundaries prevent us from following suit. Nevertheless, the lesson here is that a willingness to embrace new methodologies and to compassionately apply them to therapy is vital to achieving progress both in the development of our fields and in the pursuit of success with individuals.
The safest arena in which to pursue risk-taking involves theoretical development. No patient is hurt if ideas are considered investigational. Yet, peer-reviewed journals, academic hiring policies, and the gate-keepers at conferences can serve to retard discourse. Sadly, this prevents the evolution of intellectual thought. For instance, in the early part of the last century the radical ideas of Albert Einstein and Niels Bohr were resisted by physics academics. Now their thoughts are printed in required textbooks. Sorry to say, we did not learn from this. More recently the concept of neuroplasticity met with same coldness. Does this mean that our current methods of establishing the validity of ideas may be flawed? I'll let the reader decide.
When it comes to working with clients and patients we must be more careful in applying radical thought. The stricture here is that clinicians must consider the limits of compassion and prudence when bearing in mind their welfare. However, I question the appropriateness when narrow mindedness prevents valid protocols from being used when they are clearly in the best interests of a suffering individual. When psychiatric practices forbid the use of hypnosis and major medical insurance companies still consider hypnoanesthesia as investigational -- despite its history being older than the chemical variant – it leads me to wonder if we have truly progressed very far from the days of the Inquisition.
A common-sense, balanced approach to risk-taking is needed if the helping and healing professions are going to progress. Although I am realistic enough not to presume that intellectual rigidity and turf protection will ever cease to be the enemy of progress, I do have hopes that advancement can be achieved – at least provided that there are a few thinkers willing to become heretics. Regardless, the prudent use of risk-taking remains an integral and necessary dimension to the act of transformation. As this obviously includes the therapist's relationship with their client, it is my hope that they find the wisdom to properly balance their limits with this fundamental realization.
The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD's and MP3's.
Posted: 02/19/2010
