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CHAPTERCHAPTER 11

The Clinician and the The Clinician and the Therapeutic ProcessTherapeutic Process


Charles Van Riper (1979)Charles Van Riper (1979)““You can’t heal a person’s wound if you are You can’t heal a person’s wound if you are

a dirty bandage.” a dirty bandage.” • EmpathyEmpathy——authentic sensitivity authentic sensitivity • WarmthWarmth——respect or positive regard respect or positive regard • GenuinenessGenuineness——openness and the ability to openness and the ability to

disclosedisclose oneself as a real persononeself as a real person• CharismaCharisma——ability to arouse hope, appearing ability to arouse hope, appearing

confident yet humble, frank yet tactfulconfident yet humble, frank yet tactful


Additional thoughtsAdditional thoughtsZinker, J. (1977). Zinker, J. (1977). Creative process in Gestalt therapyCreative process in Gestalt therapy. .

New York: Random HouseNew York: Random House

“ “. . . some of the characteristics of a . . . some of the characteristics of a creative creative clinicianclinician include a childlike wonderment and include a childlike wonderment and excitement; patience for change without forcing; a excitement; patience for change without forcing; a love of play; a sense of humor; a positive attitude love of play; a sense of humor; a positive attitude about risk taking; a willingness to experiment with about risk taking; a willingness to experiment with different approaches and techniques; the ability to different approaches and techniques; the ability to distinguish the boundaries between themselves and distinguish the boundaries between themselves and a client; a willingness to push, confront, persuade, a client; a willingness to push, confront, persuade, and energize another person in order to accomplish and energize another person in order to accomplish the work that needs to be done; and a lifestyle that the work that needs to be done; and a lifestyle that promotes a rich background with a range of life promotes a rich background with a range of life experiences.”experiences.”


Blocks to creativity (Zinker, 1977)Blocks to creativity (Zinker, 1977)

• Fear of failureFear of failure——playing it safe and not taking playing it safe and not taking risksrisks

• A reluctance to play & experiment with ideas and A reluctance to play & experiment with ideas and techniques techniques

• Becoming stuck in a particular theoretical stance Becoming stuck in a particular theoretical stance

• Too easily giving up on a techniqueToo easily giving up on a technique

• A reluctance to push hard enoughA reluctance to push hard enough


Clinician intervention skillsClinician intervention skills

• Becoming less inhibited Becoming less inhibited • Avoiding dogmaAvoiding dogma• Opening your focusOpening your focus• Calibrating to the clientCalibrating to the client• Observing silenceObserving silence• Taking risksTaking risks• Challenging the clientChallenging the client


Developing expertiseDeveloping expertiseBerliner, D. C., (1994). Expertise -The wonder of exemplary Berliner, D. C., (1994). Expertise -The wonder of exemplary

performances, In J. N. Mangieri, & C. C. Block, (Eds.), performances, In J. N. Mangieri, & C. C. Block, (Eds.), Creating powerful Creating powerful thinking in teachers and studentsthinking in teachers and students. Fort Worth, TX: Holt, Rinehart & . Fort Worth, TX: Holt, Rinehart &

Winston.Winston.

• NoviceNovice• Advanced BeginnerAdvanced Beginner• CompetentCompetent• ProficientProficient• ExpertExpert• CharacteristicsCharacteristics• RequirementsRequirements


The noviceThe novice

• Tends to act deliberately; focuses on context-Tends to act deliberately; focuses on context-free rules (e.g., driving)free rules (e.g., driving)

• Relatively inflexibleRelatively inflexible• Pays attention to protocol & rulesPays attention to protocol & rules• Labeling & attaching terms to activitiesLabeling & attaching terms to activities

[Characteristic of students and first-year professionals][Characteristic of students and first-year professionals]


Advanced beginnersAdvanced beginners

• Like the novice, they tend to set up barriers to Like the novice, they tend to set up barriers to keep authority in their own hands. keep authority in their own hands.

• Although they now know the rules, they are Although they now know the rules, they are unsure what to do/not to do during unusual unsure what to do/not to do during unusual circumstances (driving on ice, fog) circumstances (driving on ice, fog)

• Begin to learn when to ignore or break rulesBegin to learn when to ignore or break rules

[Characteristic of second- and third-year professionals][Characteristic of second- and third-year professionals]


CompetencyCompetency

• Have motivation & additional experience Have motivation & additional experience • Make own choices, setting priorities, & Make own choices, setting priorities, &

strategiesstrategies• Take responsibility for outcome (their plan)Take responsibility for outcome (their plan)• Learn what to attend to Learn what to attend to oror notnot • Develop a sense of timingDevelop a sense of timing

[Characteristic of professionals after 3+ years][Characteristic of professionals after 3+ years]


ProficiencyProficiency

• Develop an intuitive sense of situation; able Develop an intuitive sense of situation; able to make micro adjustments (like riding a bike)to make micro adjustments (like riding a bike)

• Take a holistic approach; see patterns others Take a holistic approach; see patterns others don’t don’t

• Able to predict events with greater precisionAble to predict events with greater precision

[Characteristic of professionals after 5+ years][Characteristic of professionals after 5+ years]


Requirements of expertsRequirements of experts

• Excellence in specific domain(s)Excellence in specific domain(s)• Great dedication and persistenceGreat dedication and persistence• PracticePractice

• 10 10 – – 20k hours for chess players20k hours for chess players

• 10 10 –– 15k hours of teaching 15k hours of teaching

• read 100,000 X-raysread 100,000 X-rays


Characteristics of expertsCharacteristics of experts

• Perform appropriately and effortlesslyPerform appropriately and effortlessly• Become one with the activityBecome one with the activity——driving, flying, driving, flying,

speakingspeaking• Appear to be nonanalytic and nondeliberativeAppear to be nonanalytic and nondeliberative

• (e.g., martial artist, fluent speaker)(e.g., martial artist, fluent speaker)• Deliberate calculation is not necessary Deliberate calculation is not necessary • Behavior not easily described as deductive or Behavior not easily described as deductive or

analyticanalytice.g.,e.g., Wayne GretskyWayne Gretsky “I just go to where the puck . . .”“I just go to where the puck . . .”


Expert instructors (& clinicians)Expert instructors (& clinicians)

• Able to transfer their ability to new and changing Able to transfer their ability to new and changing situationssituations

• Willing to change strategy when appropriateWilling to change strategy when appropriate

• Flexible in approach, not likely to follow a Flexible in approach, not likely to follow a manualmanual• Opportunistic about ways to connect and change Opportunistic about ways to connect and change

(rather than following preplanned approach)(rather than following preplanned approach)


Expert instructors (& clinicians) Expert instructors (& clinicians) (continued)(continued)

• Flexible in approach, not likely to follow a Flexible in approach, not likely to follow a manual (Continued)manual (Continued)• Consider alternative responses, follow the lead of the Consider alternative responses, follow the lead of the

learnerlearner

• Become integrated individual; focus moves from Become integrated individual; focus moves from self to the other person; unusually sensitive to self to the other person; unusually sensitive to the affective concerns of the learner.the affective concerns of the learner.


Decision making: Rules & principlesDecision making: Rules & principles

RulesRules are specific prescriptions for regulating or are specific prescriptions for regulating or evaluatingevaluating • Formalized, consistently applied, often Formalized, consistently applied, often

quantitativequantitative• Follow a prescribed or programmed approach & Follow a prescribed or programmed approach &

specific techniquesspecific techniques

• Work best when the activity isWork best when the activity is • simple, context freesimple, context free• aimed at "gaming" the rulesaimed at "gaming" the rules


Decision making: Rules & principles Decision making: Rules & principles (continued)(continued)

PrinciplesPrinciples are less specific and clear cut are less specific and clear cut• Emphasize expert discretion, intuition, personal Emphasize expert discretion, intuition, personal

knowledgeknowledge• Qualitative and contextualQualitative and contextual• Allow choice of several approaches and Allow choice of several approaches and

associated techniquesassociated techniques• Work best when the activity isWork best when the activity is

• complex, dynamic, contextualcomplex, dynamic, contextual


Continuums of skillContinuums of skill

Technician Technician ProfessionalProfessional

Narrow focus on theNarrow focus on the Open focus on the Open focus on the

problemproblem person person

Guided by RulesGuided by Rules Guided by Principles Guided by Principles

Preplanned proceduresPreplanned procedures Flexible procedures Flexible procedures

Dogmatic treatmentDogmatic treatment Treatment alternatives Treatment alternatives

Technique directedTechnique directed Client directed Client directed

Intolerant of ambiguityIntolerant of ambiguity Tolerant of ambiguity Tolerant of ambiguity


Humor as a variableHumor as a variablethroughout changethroughout change

Distance Distance

Mastery Mastery

Conceptual Shift Conceptual Shift


Taking humor seriouslyTaking humor seriously

McGhee & Goldstein (1977) found that McGhee & Goldstein (1977) found that humor is . .humor is . .

Positively correlatedPositively correlated with such personality with such personality characteristics as enthusiasm, playfulness, characteristics as enthusiasm, playfulness, hopefulness, excitement, and vigorousness hopefulness, excitement, and vigorousness

Negatively correlatedNegatively correlated with fear, depression, anger with fear, depression, anger indifference, and aloofnessindifference, and aloofness


Morreall (1982)Morreall (1982)

. . . noted that a person with a sense of humor . . . noted that a person with a sense of humor is more likely to interact well with others than a is more likely to interact well with others than a person lacking humor. Individuals with a sense person lacking humor. Individuals with a sense of humor tend to be more imaginative and of humor tend to be more imaginative and flexible and correspondingly less likely to flexible and correspondingly less likely to become obsessed with a particular issue or become obsessed with a particular issue or approach to a problem. In addition, a person approach to a problem. In addition, a person with a sense of humor is more likely to be open with a sense of humor is more likely to be open to suggestions from others and to be more to suggestions from others and to be more approachableapproachable


DistanceDistance

• Distance from the situation or experience Distance from the situation or experience allows one to step back far enough to see allows one to step back far enough to see its paradoxical aspects.its paradoxical aspects.

• A result is insight, objectivity, and the A result is insight, objectivity, and the beginning of a conceptual shift.beginning of a conceptual shift.


MasteryMastery

• Humor results from Humor results from masterymastery & is readily observed in & is readily observed in the laughter of children when they problem solve the laughter of children when they problem solve (Kuhlman, 1984)(Kuhlman, 1984)

• Humor encourages communication, particularly on Humor encourages communication, particularly on sensitive matters (McGhee & Goldstein, 1977)sensitive matters (McGhee & Goldstein, 1977)

• As a relationship develops, the limits of humor can As a relationship develops, the limits of humor can expand the number of the taboos that may be expand the number of the taboos that may be violated in safety (Kuhlman, 1984)violated in safety (Kuhlman, 1984)

• The ability to appreciate & use humor has been The ability to appreciate & use humor has been shown to be related to a person’s internal locus of shown to be related to a person’s internal locus of control (Kuhlman, 1984)control (Kuhlman, 1984)


It’s It’s notnot the clown's the clown's red nosered nose..

• SpontaneousSpontaneous humor, rather than preplanned humor, rather than preplanned humor, is most effective in promoting and humor, is most effective in promoting and managing therapy interactions (Simmons-Mackie managing therapy interactions (Simmons-Mackie & Schultz, 2003)& Schultz, 2003)

• Humor and laughter result from the sudden Humor and laughter result from the sudden insightful integration of contradictory or insightful integration of contradictory or incongruous ideas (Davis & Farina, 1970) incongruous ideas (Davis & Farina, 1970)

• The result is a sudden The result is a sudden conceptual shiftconceptual shift (Morreall, (Morreall, 1982)1982)

copyright 2010 delmar, a part of cengage learning. all rights reserved. 1

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