In Session: What Therapists Do – Part 2

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For Part 1 – Click HERE

As we mentioned in Part 1, the main focus of a therapist’s work is helping people change. With that in mind, lets explore in more detail how therapists help people change.

There are two categories of change that a therapist can engage in.

1) Overt change

2) Covert change

Overt change is when the therapist and client are clearly working together to change something they have agreed to work on. For example, a client is anxious, and the therapist teaches the client relaxation techniques to help the anxiety dissipate. Or, a client has trouble speaking in public and the therapist helps the client face his fears. The client is aware of the explicit agenda to help the client change.

Covert change is when the therapist is working to help a client change without making it explicit that this is what he is doing. For example, say a client comes to a therapist and is struggling with anxiety. The therapist notices that the client has a lot of trouble making his own decisions and always tries to get others to tell him what to do. The therapist realizes that this pattern is harmful to the client. Therefore, the next time the client asks the therapist “what should I do”? The therapist doesn’t answer and rather says to the client “well what do you think”? By refusing to answer and putting it back on the client, the therapist is helping to shift the client’s pattern. This is covert change, as the client does not realize that the therapist is helping him change in the moment.

A good rule of thumb is as follows:

“The higher the level of dysfunction in the client, the more necessary it is to engage in covert change. The lower the level of dysfunction, the less necessary it is to engage in covert change”.

It is important to note that someone can appear to be functioning extremely well and yet be far more dysfunctional then someone who appears to be functioning worse. A good example of this is with money.

Family A has very little money and lives extremely simply. They have a lot of issues. They need money for rent, food, tuition, etc.

Family B does not live simply at all. They have almost no problems with money. The one problem they do have is the pesky letters and phone calls they get from the credit card collectors who are trying to collect the massive debt which is growing day by day.

While family B appears to be richer and have fewer issues with money, in truth they are far poorer.

The same in mental health. One person can look like he is doing very well and is only suffering from a small problem, and yet be in complete disarray on the inside. Another person can look like he is doing very poorly, and yet can be just a step or two away from doing very well.

As is obvious, when someone is completely dysfunctional and appears to be very functional, covert change plays a huge role in the treatment. That’s because the clients need to put on an appearance will get in the way of doing overt change. In addition, the client will often be extremely skilled at putting on this appearance and at manipulating those around him to play certain roles to help keep the charade going. Often the family, community helpers, and even Rabbonim have also been “taken in” to the client’s dysfunctional world and are (unwittingly) playing a role in enabling the charade to continue.

It takes a skilled therapist to notice all this and resist the subtle and often extremely powerful pressure from the client (and surrounding players) to “fall into role”. This is one of the reasons good supervision is extremely important. If the therapist does resist the pressure, and stays honest and glatt, this itself is a powerful covert change catalyst. The client will be forced to change his pattern as the old patterns of dysfunction is no longer working.

This is also why some Rabbonim and Askanim have a dim view of therapists. When someone who is completely dysfunctional and appears to be completely dysfunctional interacts with a therapist, the therapist will often notice this and not engage in the patterns of behavior that the dysfunctional person expects and demands. This frustrates them terribly and they then often turn back to those in the community and speak of how terrible the therapist is. Without the professional eye (and often hidden facts) to spot the dysfunction, it can be difficult to realize how the dysfunctional person is bending the perception of the truth around their issues.

When it comes to overt change, the job is often a lot easier than trying to help someone change covertly. Yet, even with that, the job of a therapist is still difficult even when doing overt change. Here is why:

By the time people come to therapists, they most often have already tried to change and have failed. The conventional wisdom has failed. They often have tried very hard to change, and still were not able to change.

In essence, the job of a therapist isn’t simply to help people change. That would not be so difficult! Rather, the therapist’s job is to help people change when change has been extremely difficult to come by.

A second key point is that even when the client isn’t very dysfunctional, there are areas where they do struggle that can get in the way of doing overt change. And so, there is almost some element of tricky covert change that is involved.

Yisrael Kleinman, LCSW is a published author and has a private practice in Lakewood.
He specializes in working with very skeptical highly intelligent adults who are struggling with anxiety or depression or who feel stuck in life.
He can be reached at (732)806-1699 or at yisraelkleinman@gmail.com

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