Terrible, Terrible movies, Clinical Modesty, and Pondering a Ponder

This is my seventh post and it is about the ethical challenges of assessing for functioning. Post number six was about ethical differences and new Southern Rock. Post number five was about imaginary devil worship. Number four was about Public Enemy and my contrary ways. Number three was about the blues, number two was about feorabros, and number one was about Scandinavian heavy metal.

I was quite happy with the ending of the “Prudence” chapter in Doherty’ book. He describes his work with a couple who were always going to have problems, as the husband has a chronic case of “ambivalence” about his life, meaning that his long term relationships were always going to have a tinge of doubt and restlessness. Doherty responds, as a mature therapist, with acceptance, and he moves the conversation towards a consideration of whether or not the couple can accommodate his feelings and towards a discussion of his coping with those feelings (as opposed to acting on them).

Doherty writes of this couple:

They taught me something important about the wisdom of accepting what cannot be changed, without a sense of tragedy or failure. If they had had the misfortune to come to me as a therapist early in my career, I might have insisted on teaching them a lesson about not settling for a care whose engine is not fairing on all pistons (180).

This is a particularly complicated situation, and we will see many like it. When we consider our goals for our clients, how good is “good enough,” and when should we think that they should consider drastic changes?

In the case of couples counseling, the “drastic change” that might be something for us to consider is obvious, but all of our clients face similar choices. How good is “good enough”? The bottom line truth that we might lose sight of is that our clients’ circumstances provide constraints. The bottom line truth is that being a human being, unless one is extravagantly successful and miraculously well regulated, provides constraints.

I am not a religious person (replace that phrase with whatever term you prefer. . . I’m not “spiritual” or some other vague concept either), but I have found tremendous importance in the Christian tradition, particularly when it considers grace, original sin, and suffering. People suffer. People do not get "well," but then can get better. We, in the behavioral/ metal health world have limits.

Very successful people experience trauma when life stages do not work out ideally. More to the point for us, many people do not see the orderly progression that Erickson describes in their life stages. There are SES and cultural differences, to be sure, but there are also challenges that people dealing with psychological problems, a lack of support, or economic challenges will encounter.

Even people with every advantages do not go through something like Erickson’s life stages smoothly (and to his credit, he describes them as challenges). How to negotiate thinking about compromises, alternate framings, and different ways of living is what we do. I have (and will be) guarded about my marriage and divorce, but I, in retrospect, understand it as a life cycle issue. I am glad I am divorced, but I can imagine an alternative world where we learned to have a compromised relationship and stayed together. I am happy about my how my life has ended up, but what was the other path? (I am happy with our choice, but I can see another. What would be the compromises? Other people might have chosen those.) How does a therapist consider these challenges? How does a therapist do so without keeping the client’s autonomy first in mind? We are already understanding (I gather from supervision) what our clients should do while remaining out of the fray. Or are we?

I will leave you, dear reader, with a sample of the idiocy that popular culture tells us about romance. I have had a very good time laughing like an idiot at this movie.


https://www.youtube.com/watch?v=PeaguDB-v_c