An observation on (my) person-centeredness and clinical interventions
This past week in my social work class on working with groups—which I love—we were encouraged by our professor to try out a small clinical intervention. As I am running a hypothetical post-hurricane disaster grief and bereavement group for my practice demonstrations, and since I am a believer in the power of self-compassion to foster resilience and healing from trauma, shame, negative emotionality, and other difficulties (e.g., Naismith et al., 2019), I opted for a brief safe-space visualization exercise. I particularly like one offered by Dr. Dennis Tirch,1,2 with whom I have had opportunities to train.
The intervention was, based on the feedback of my professor and classmates, well-formulated and received. However, the “session” thereafter did not go well. My experience in the demonstration was that most everything I said fell flat—and I was acutely aware of these missteps as they occurred. One closed question led to another. My reflections felt wooden. I poorly grasped or missed opportunities to foster mutual aid. Or so it felt in the moment; the majority of the feedback I received afterwards was positive. Some of this may have had to do with my being primed by feedback we had just received—and that I did not have time to adequately process it before my turn at group facilitation—but my sense of being-in-the-group was just… off.
Yesterday, it dawned on me: I led with the intervention (intending it as a means by which my hypothetical clients in the group could emotionally regulate amidst difficult sharing). Although my purpose was to demonstrate clinical skill, although it was tentatively offered with the preface that it was an optional activity which could be stopped at any time if discomfort was experienced, and although this was a hypothetical scenario, the intervention was still real and carried all the usual connotations of an intervention. For me, this would typically mean that it should only be offered in a spontaneous manner specific to the individual and the particular moment, if in my clinical judgement such an offering might be beneficial to the client.
Here, however, it was pre-planned, and this is incongruent with the way I want to work—it is counter to my conviction that such interventions are part of the creativity of the therapeutic process and should only come up in an unplanned way. Planning an intervention with the intention that it lead to behavioral change works for some clinicians and for some clients but is not the way I want to work; to me, this constrains the client and therapeutic process and is forcing an illusion that I know the client and what will help them better than they know for themselves. Thus, whether I realized it or not in the moment, I was thoroughly thrown off track for the rest of the “session” and unable to immerse myself in the natural relational flow of the group.
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Reference
Naismith, I., Ferro, C. D., Ingram, G., & Leal, W. J. (2019). Compassion-focused imagery reduces shame and is moderated by shame, self-reassurance and multisensory imagery vividness. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(1). https://doi.org/10.4081ripppo.2019.329