Fast forward from that young psychologist-to-be to the now-grayed-clinician and clinical educator who has long ago left behind the certainty of singular theories and unidimensional interventions. Flash forward from that youthful and devout clinical ideologue to the pragmatic and prescriptive eclectic who has worked in venues as diverse as state psychiatric hospitals and youth foster facilities, with clients equally diverging in age, background and pathology, and with methods ranging from play therapy to CBT. No longer do I trust the promise of theoretical purism, and even less those who promise to part the clouds of clinical uncertainty with a simple wave of their empirically-informed manuals. In the therapeutic relationships I trust; far less in the techniques that I use.
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And then came Phillip. Of all the grad programs, in all the towns, in all the world, he walks into mine. Phillip is a behaviorist through and through, capable of not only talking the behavioral talk but apparently walking the behavioral walk. He is facile and fluid with the principles and techniques of behavior modification, having come to his graduate training with several years’ experience on the ABA (Applied Behavioral Analysis) front lines with children and adults with developmental and neurodevelopmental challenges. While he can also sprinkle his classroom polemics with the names and theories of non-behavioral luminaries and their practices, he nevertheless remains a behaviorist to the core. Behaviorism makes sense to him. Clients’ problems filtered through a behavioral lens make sense to him. The seductive simplicity of the model and its practices give him a weapon with which to battle what he seems to most fear—relativism and uncertainty.
While I appreciate Phillip’s need to anchor his thought and practice in a widely accepted theoretical and applied modality, I am concerned with his rigidity. While I was awed in my own professional youth by world-class behaviorists who made it all sound so easy and whom I desperately emulated while I found my own clinical footing, this graduate student gets under my skin, and I am not exactly sure why. Is it because his cock-sureness smacks of as-yet unearned arrogance and privilege, or because his seeming clinical precocity is so unsettling to his classmates, who themselves are struggling to find their own theoretical footholds? Is it because his rigidity reminds me of my own all those years ago? Or maybe it is because he is so energized and zealous, while I have lost touch with those feelings over years of clinical practice. What about the possibility that this is a (not-so) simple case of supervisor-supervisee countertransference? Perhaps it is a little bit of each of these.
I am not quite sure what my role is with Phillip, as his clinical supervisor and mentor. Is it to be the empathetic clinical mentor supportively guiding him along his own chosen path? Is it to be the provocateur, challenging him to take a few steps away from his cherished beliefs, at least long enough to consider other ways of conceptualizing cases and building treatment plans? And what to do with my growing feelings of annoyance with Phillip? Do I express them directly with him, seek out clinical supervision, or simply jot down these thoughts for you, fellow clinicians and clinical educators, in hopes that doing so will give you the opportunity to ponder similar questions when confronted with your own version of Phillip?
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I must confess that I still do privately find behaviorism attractive, and its explanatory promises and practices enticing. I have quietly used its methods over the years at select times with specific clients, more so children, but prefer to view and present myself as a clinician and clinical educator who is comfortable with relativism and uncertainty and the ever-unfolding and inexplicable mysteries that are part of the psychotherapeutic relationship. Oh, that it were so simple!
File under: Musings and Reflections