Conclusion: Out of the Rabbit Hole - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Down the Relationship Rabbit Hole, Assessment and Strategy for Therapy
CONCLUSION: OUT OF THE RABBIT HOLE


When an individual, couple, or family presents for therapy, the therapist can use initial assessments to begin therapy.  There are many potential assessment tools or processes to examine relationship quality and dynamics.  Some are written multiple choice pen and paper tools, or computerized tests, while others ask for written narratives.  Assessment tools can be a set of questions designed to gather specific information or to be open-ended (such as my four simple generic questions) to prompt the individual, couple, or family to present their urgencies.  The individual, couple, or family can take the tools in therapy, prior to therapy, or as homework.  Such tools offer may offer minimal or nonexistent educational or therapeutic value or facilitate therapist credibility or rapport.  The therapist should consider interactive assessment tools that go beyond gathering assessment information for the therapist, but include educating the individual, couple, or family while also serving the therapeutic process and creating rapport and credibility for the therapist and therapy.  The Foundations for Relationships and the Devolution of Relationship tools presented can be used as such interactive assessment guides, as can the many other tools and theories included or not included in this discussion.  Assessment is not just the prelude to therapy, but is profoundly therapeutic itself.  When the therapist assesses an individual, each partner or family member, and the couple or family's ability to trust, to be vulnerable with another or each other, to self-express articulately, to empathize with another or each other, and to invest in the relationship, he or she is also teaching them about their importance.  It also prompts each person to be introspective and to hopefully, take ownership of his or her relational process and relationship foundations.  The foundations also present a template and a set of criteria for the individual, partners and the couple, or family members and the family to aspire to for having healthy relationships.  As such, it presents a template or goals and direction for therapy.  In the same manner, assessing using the seven stages of the Devolution of Relationship teaches each person about his or her stage in the relationship and what it would take for each person individually and for the couple or family to grow and mend the relationship.  It also directs therapy through reversing movement through its stages.
  
A hammer is great for driving nails, but challenging for driving screws, difficult for cracking walnuts, and ineffective for sawing wood.  Even all nails are not the same nor all hammers the same.  No therapist has the magic hammer or tools… the magic wand that will be effective for all clients.  This discussion has been on initial assessment of the relationship, in particular the couple's relationship with some relevance to the family.  Basically, initial assessment critically directs the following therapeutic process.  In reality, the effective therapist needs to incorporate simultaneous assessment, treatment, and evaluation of clients in therapy continually in all phases from beginning to end.  Assessment can be informal and intuitive or it can be highly structured.  Treatment follows strategies, areas of concern, issues revealed, and so forth as suggested or implied by assessment of what the clients present.  Growth, change, frustrations, new elements, and discovered experiences and experiences will result from treatment.  Through therapy, the therapist evaluates the outcomes and effectiveness of the treatment to date.  The results of treatment will cause an adaptation of initial theories and perceptions.  As a result, the therapist makes a new assessment, which sets off new treatment interventions or activity and further evaluation.  The therapist should continually repeat cycles of assessment, treatment, and evaluation.  The responsiveness and adaptability of professional and astute assessment, treatment, and evaluation process also builds therapist credibility and rapport for the couple.  In other words, good therapy encompasses positive outcomes in every elements of therapy.  When the client arrives in therapy, the therapy does not actually start with nothing.  The skillful and responsible therapist starts with a vast array of potential assumptions to check and examine and a tool chest of informal to formal assessment tools.  Readily available are any number of tools (interventions or strategies or techniques) that may be called upon depending on what assessment discovers about the uniqueness and challenges of a particular client.  The reader only knows that the Mad Hatter's tea party is crazy from knowing more sane tea parties.  The therapist does not fall down the rabbit hole anticipating simple rabbit attitudes, values, beliefs, and behaviors.  Rather the therapist goes into the client's world anticipating problematic antics from the Red Queen, a talking caterpillar, singing flowers, the March Hare, the Cheshire Cat, and various other psychological and emotional vermin and eccentricities.  Most critically, the therapist should be well-versed in human and relational dynamic and thus not to be surprised.  The therapist knows the client's world is a place of psychic adventures.  What arises may not be always anticipated but it should not be surprising or disappointing.  

The therapist, who has a favored therapy or therapeutic process or set perspectives, and implements them with a client without due assessment, starts with less than nothing.  He or she starts with prejudgment and therapeutic dogma- that is, anticipation that can create disastrous therapeutic self-fulfilling prophecies.  As a result, functionally treatment may become a therapeutic sledgehammer ill suited for nuanced therapy.  Assessment that was determined in graduate school, during training, from social, cultural, or religious teachings, or otherwise prior to interacting with clients will not lead to effective therapy unless by chance or luck (or possibly, perfect referral) the therapist's approach already matches with the clients' needs.  Without awareness of client rabbit holes and tea parties, the shenanigans and stubborn resistance to proffered interventions will flummox such therapists.  Great and effective comes not just from great therapeutic skills, but instead from great assessment that activates great therapeutic skills.  Unlike Alice's fall into the white rabbit's hole, the human process is not nonsensical but highly logical within the human spectrum of variability.  The outstanding therapist can see through the fluff, distraction, and flowery and dramatic presentation to see "Why, you're nothing but a pack of cards!"  Relationships work for logical reasons and do not work for logical reasons.  As those reasons are assessed, the therapist can guide the individual, couple, or family through their crazy rabbit hole and back into healthy relationships.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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