Introduction: Roles of the Therapist - RonaldMah
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Introduction: Roles of the Therapist
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Therapy? What's Therapy!?
Introduction: ROLES OF THE THERAPIST
by Ronald Mah
**Author's Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.
"To have and to hold, from this day forward, for better, for worse, for richer, for poorer, in sickness or in health, to love and to cherish 'till death do us part." So more or less states many versions of common marriage vows. Marriage is supposed to be forever although statistics and reality do not seem to indicate that. Some therapists hold that belief so strongly that they assert that they are not willing to consider divorce of the married couple as an option. A therapist who said this worked from a strong and overt Christian orientation. A common declaration in the marriage ceremony by a Christian minister or priest is, "What God has joined together, let no man put asunder." Apparently, some therapists feel that no therapist should put asunder any marriage. Or, assume that all marriages are ordained by God rather than by shotgun, pregnancy, lust, greed, fear, or other worldly dynamics. Of course, this does not say what to think or feel about an individual working on relationship challenges or unmarried couples that present for therapy. Or, if they may have issues about same-sex marriages, or those ordained or sanctioned by other religions. There may be other therapists who do not believe in divorce, especially if the couple has young children. Still other therapists may not believe in homosexuality or marriage equality (same sex marriage), inter-racial marriages, pre-marital sex, or sexual relationships before or outside marriage. Still others believe that the age of consent for sexual intercourse should be much higher or much lower and believe in polyamory or polygamy… or free love. Perhaps, some believe that poor people should not have children… or under-educated people should be forbidden have children. Or, some therapists like some people find alcohol and drug consumption vile, while others support mind-altering substances enlightening such as LSD or MMDA (more commonly known as Ecstasy). Some therapist may have very strong social and political views about a multitude of issues and about personal and social relationships. They may be very accepting of people from other cultures but abhor consider certain cultural actions as abusive such as genital mutilation. The client: an individual, a couple, or a family will work with the therapist who has consumed and manifests attitudes, values, beliefs, and behaviors throughout his or her personal and professional life. What is the therapy that the client will receive?
The therapist, Frank who is also a minister did not believe in divorce for religious reasons. He felt that his mission was to keep people married. The immediate effect of his values upon therapy would be pathologizing any desire by an individual or a partner in a couple to leave the relationship no matter how dysfunctional it may be. Guilt and shame will result in the individual if not also the couple or family. Frank's attitude about marriage may be a fit with the cultural or religious expectations of the individual or couple that they must stay together. There is a strong likelihood that Frank will ask, direct, coerce, or force the individual client or one, both, or all members of the couple or family in therapy to deny feelings and needs. Perhaps, he may direct them to pray for the spiritual strength to deny "wrong" feelings or needs. This therapist's moral/religious agenda supersedes the agenda of the any individual, both partners, and the couple or family. Or, it may match the clients' desires, but result in helping perpetuate a very painful relationship. A less dogmatic therapist would negotiate the goals of therapy between him or herself and the individual or members of the couple, rather than impose his or her values on them. What goals are culturally acceptable or unacceptable? If there is a lack of unanimity regarding goals, at the very least, that mismatching sets of goals, which may be cultural mismatches need to be on the table and discussed.
The therapist may be committed to making the marriage work or to keep every couple together whether the couple plans to have a traditional marriage or not. Or, whether there is domestic violence, child abuse, sexual abuse, emotional devastation, psychological exploitation, domination, control, or exploitation from small to large degree… previously, currently, imminent. The therapist may have boundaries that qualify and limit his or her dedication to marriage til death does them part. There is sure to be variation within any number of therapists. Perhaps, this commitment comes from incurable romanticism rather than religious views. When the therapist asserts that the partners must stay married or remain a couple, they would almost inevitably need to ignore minor to major issues of compatibility, much less the aforementioned domestic violence, psychological dysfunction, and other outright toxic or destructive dynamics. The therapist would need to minimize such issues, assert that they are all resolvable, and/or everyone is able to change. This would mean no one is intractable or everyone is amenable to therapy. Perhaps, the therapist holds a sense of therapist omnipotence or religious certainty that allows personal, therapeutic, and religious views to merge to assert that every marriage must be an absolute union. Or, that his or her other perspectives on life, functioning, and relationships are irrefutably correct. When the therapist holds an unequivocal goal of keeping every marriage intact, it takes away the right of an individual, members of the couple or family, and of the couple or family to make the decision to stay together or separate. Sometimes, the other person that the individual refers to or one member of the couple or family is so dysfunctional that there is significant ongoing and greater emotional and psychological damage to the individual or other members. Or there may be, ongoing and future physical domestic violence and child abuse. The therapist can work as hard as possible to facilitate growth and change for the individual, or in the couple or family so they can stay together, and then be willing to let the results determine for the couple or family or the individual in the relationship whether or not to stay together. However, the therapist needs to be clear that his or her roles should neither be to decide for the individual, couple, or family whether they should stay together (which includes a default assertion that the couple or family must and will stay together), or make or force the couple or family to stay together or the individual stay in the relationship.
Clients such as Vee and Carson may enter therapy and overtly ask the therapist what to do to improve their communication or their relationship. If Carson came in alone, he might ask about whether he should stay in his marriage with Vee. If Vee came alone, she might ask about ways to relieve her feelings of depression. If they brought the whole family in, they might ask for guidance to manage family conflict and improve academic performance of the children. The therapist may tell the client what to do, but discover unless he or she first has given the choice or directive the client desires in the first place. Any logical but undesired choice or directive will be disparaged, dismissed, tried, and/or sabotaged. In addition, the therapist must magically immediately set aside or resolve any complicating issues for the client that block activation of the choice or directive. These would not only include practical functional issues in the client's current life, but also any and every underlying concern from the family-of-origin, attachment issues, trauma, cultural conflicts, and anything else! Self-determination is critical for the individuals, couple, or family in therapy. Fortunately for therapist sanity, many theoretical orientations make strong statements about self-determination. "…each member of the couple must take responsibility for his or her own behavior. Once he or she knows how mistaken goals or lifestyle dynamics create problems in the relationship, then that person must take the initiative and make the effort to change his or her responses. Peluso and Macintosh (2000) in 'Emotionally Focused Couples Therapy and Individual Psychology: A Dialogue Across Theories' says the Adlerian therapist looks for the creativity in the solution and attempts to marshal the same resources toward a more equitable and constructive solution" (page 250).
The therapist is still heavily involved, but involved to support individuals, couples, and families in their process. California Association of Marriage and Family Therapists (CAMFT) Ethical Standard 1.4 (2008) states, "Marriage and family therapists respect the right of patients to make decisions and help them to understand the consequences of their decisions." The National Association of Social Workers (NASW) Code of Ethics (1999)- Ethical Standard 1.02 Self ¬Determination says, "Social workers respect and promote the right of clients to self ¬determination and assist clients in their efforts to identify and clarify their goals." The American Psychological Association in its Ethical Principles says in Principle D: Respect for People's Rights and Dignity says, "Psychologists accord appropriate respect to the fundamental rights, dignity, and worth of all people. They respect the rights of individuals to privacy, confidentiality, self-determination, and autonomy…" The therapist's role is not to confirm or perpetuate marriage by asserting its sanctity. Marriage or unmarried couples' relationships that present to licensed mental health professionals may be distressed and confused. Any number of arguably sanctified complex and involved issues for the individual, couple, or family bring clients to therapy for assistance. However, Carson or Vee as individuals or as a couple or as leaders of their family do not need the therapist's moral determinations, especially religiously based judgments further distressing and confusing their decisions on expectation, behavior, roles, and decisions.
