You can’t always make things better. But you can make them worse.
Updated: Jul 4, 2022
So you wanna be a better counselor:? Part 6
“He doesn’t like you. He says you don’t listen. That’s a his problem though. You know how he is.” Step dad said as I sat at his kitchen table*.
I wasn’t so sure it was a “him problem.” I’d been seeing this teen for a few months, and despite my best intentions this dude hated me. Which was strange because during sessions he’d talk to me just fine. We’d walk around his neighborhood or sit out on the back porch and he’d just prattle away. Where was the disconnect? What was I missing?
So, I redoubled my efforts. After I’d finished checking in with step dad I met the teen on the back patio. I sat down, leaned forward, laced my fingers and listened with all my might. Didn’t say a word.
***
If you’ve been a follower of this blog, or have read the outcome research in general, then you’ve been disabused of the magic model myth. There is no magic model that once you learn it will make you a SuperShrink.
And yet, I think you should learn a model. To explain why I need to tell you about Emily and Laurence Allison.
The Allisons are psychologists who study expert police interrogators. Their major discovery is that the expert interrogators intuitively used basic counseling skills like holding strong boundaries, treating suspects with respect, and asking open ended questions.
Which is odd. Because basic counseling skills are just, like, basic. If experts interrogators just did basic stuff, what was their edge? I mean expert interrogators have to do something that makes them experts. Right?
The Allisons also made a second major discovery. Expert interrogators never “roughed” suspects up. They never insulted suspects to “rattle their cage.” They never played good-cop/bad-cop. They never berated suspects to give them a “reality check.”
The experts' edge was in what they didn’t do. Unlike their colleagues, the experts never did anything which made the interview go poorly.
Knowing this, one of the Allisons’ core rules when training interrogators is: You can’t always make things better, but you can always make them worse.
So how do Emily and Laurence Allison teach officers to be better interrogators and not make things worse? They teach them the therapeutic model Motivational Interviewing. Because sticking to a model won’t always make things better, but it keeps you from making things worse.
Is this true for psychotherapy? Doesn’t the Dodo Bird Verdict tell us all models are basically the same? Yes and no. The Dodo Bird Verdict is the decades old finding that no model consistently outperforms another model. This is one of the most robust findings in all of psychotherapy. For example if you were to compare two models for working with troubled teens, say, Multisystemic Therapy and Structural Family Therapy, on average they help troubled teens the same amount.
However, there’s an exception to the Dodo Bird Verdict.
While all legitimate models work about the same, some models and interventions are harmful [1]. For instance Scared Straight is an approach where you take teens and try to scare them into better behavior by visiting prisons. That intervention only makes things worse, with kids being more likely to go to jail afterwards. So, while Multisystemic Therapy versus Structural Family therapy won’t make the kid better, you should pick one and stick to it. Because sticking to a model won’t always make things better, but it keeps you from making things worse.
The temptation at this point is to say, “Well Jordan, that’s very interesting, but I’m not doing anything that major. I’m not trying to rough up my teens like a bad interrogation, and I’m not trying to scare my clients’ with the prison system.”
And you’re right. You and the social worker aren’t bursting into clients’ apartments and doing the whole good-cop/bad-cop routine. I’m asking a different question. Are you doing something similar but on a smaller level. Have you abandoned some basic skill or are you making some minor mistakes? If so, is that making your sessions go poorly?
***
About a week after my session with step son I went to my first EFT training. On day 2 we did an active listening exercise. I was told to gab away for 60 seconds while my partner was to say nothing - they were to be completely nonresponsive. After 60 seconds we did the exercise again, but this time my partner was supposed to give lots of minimal encouragement and empathize with me.
Halfway through my brain exploded. I was being a nonresponsive listener to step son! He’d prattle away and I’d silently listen. I was taking it in but I wasn’t responding. That's why he felt like I wasn’t listening.
The next week I went back and was much more responsive in my sessions with step son. Everything shifted overnight. He really opened up to me. Learning EFT gave me a model to follow. And following that model kept me from passive listening, which was making my sessions go poorly.
Things went well until a few months later. Step dad became convinced step son had been taking drugs and wanted me to pressure the teen to tell the truth. I knew it was a bad idea. There was no clinical reason to do it, but I caved to him pressuring me and pressured the teen. I completely broke the relationship. It was never the same after that. I should have just stuck to my model. Not because it would have fixed all of step son's problems, he would have still had an emotionally misattuned step father, but because sticking to my model would have kept me from making things worse.
Note*
All stories told about clients are either composites of different cases or have had significant details changed.
References
1.Lilienfeld SO. Psychological Treatments That Cause Harm. Perspectives on Psychological Science. 2007;2(1):53-70. doi:10.1111/j.1745-6916.2007.00029.x