While I certainly respect and understand the need for varying treatment modalities and theoretical orientations, I fully believe that at the core of our work lie some basic tenets that remain essential and transtheoretical in their nature. Of most personal importance are the humanity and autonomy of the client and the critical importance of the therapeutic relationship towards the facilitation of healing. While not seemingly controversial, I can vividly remember messages and experiences that left me confronted with daily conflict regarding basic approaches to treatment and an understanding of what truly heals within the therapeutic context. I can recall being told that the field has shifted, in part due to research and also financial pressures placed on practitioners by insurance companies, away from a supportive capacity and that I should reconsider my professional goals if I am unable to adjust to such shifts. This sentiment was reinforced within training experiences that pushed for shorter sessions targeting a specific disorder, strict client adherence to protocol, and a focus on goals that could be observably assessed rather than the subtle and often unconscious distress experienced by clients. Typically choosing to defer to my supervisors expertise, I was often left feeling as though I had compromised a part of my clinical integrity and worse, failed the client in some way. I can remember being advised that I should take charge of each session and that giving a client space to explore would only allow for manipulation and avoidance of target material. Moreover, I was made to understand that the therapeutic relationship is a wonderful tool to utilize during the early sessions in order to create buy-in for the real treatment that follows. Nonetheless, nothing was more invalidating than having my beliefs dismissed as youthful and inexperienced naiveté that would eventually be adjusted to meet the reality of the professional landscape.
One particularly disturbing experience involved a client’s disclosure of his mother’s passing. True to my values and beliefs on the role of the therapist, I set aside the treatment protocol and sat with my client in his pain, providing him with the space to confront his emotions, the reality of the finitude of life, and the importance of appreciating each moment. Feeling satisfied that I had provided a therapeutic experience, I was wholly surprised to receive feedback that moving away from adherence to the treatment protocol would ultimately damage progress and that while one session to deal with this issue was acceptable, no more time could be wasted by deviating from a focus on the presenting problem. I was left with a “you’ll get there” that called into question the direction I was heading and the path I had chosen for myself. How could this be the nature of field I had chosen, with dreams of facilitating another’s healing, when the humanity of the client and the authenticity of their experience is valued less than a treatment protocol?
Despite the disheartening nature of these messages, it was the knowledge that my experience was quite common among my peers that truly fostered a personal demoralization and disillusionment with the direction of the field and the subsequent nature of training. I think back to my entrance into a Doctoral training program and remember the optimism and hope shared by my colleagues, slowly stripped away and replaced with dogma forged in a system that delineates treatment as a formulaic process whereby the client is reduced to a set of symptoms and treatment is delivered with a medical objectivity that emphasizes efficiency and quantitatively measureable efficacy. What is lost when we value these things above the humanity and phenomenological experience of the client? How is healing fostered when we fail to acknowledge the immeasurable and ethereal healing force inherent within the therapeutic relationship? As I prepare to enter the field as a professional, I am left with these questions and a continuing struggle to maintain a sense of my professional identity within a system that seems to have adopted a philosophy increasingly contrary to my own. Yet hope survives as I look to my colleagues and the younger entrants into the field who similarly share in this conflict. Like the fragile and flickering flame of a candle, the light of our optimism remains present and ready for change.