Introduction: Dick and Jane - RonaldMah
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Introduction: Dick and Jane
Therapist Resources > Therapy Books > DownRelRabbitHole- Assessment
Down the Relationship Rabbit Hole, Assessment and Strategy for Therapy
INTRODUCTION: DICK AND JANE
**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.
This is Dick. This is Jane. See Dick run. See Jane run after Dick. See Dick run and hide. Hide Dick hide. Hide in your bottle. Hide at work. Hide in sports. See Jane run her mouth. See Jane run the house. See Jane run the social calendar. See Jane run down. See Jane run to Sally. Hear what Sally tells Jane about Dick. Stop Sally stop. Dick talks to Sally. Stop Dick stop. Jane talks to Sally. See Sally get triangulated. Run Sally run. Jane blames Dick. Dick blames Jane. Dick blames work. Dick blames Jane's mother. There is not much fun with Dick and Jane. So, they come to therapy! See the therapist fall down the rabbit hole! In the homogenized times in the 1940s, 50s, and 60s, the adventures of Dick and Jane (Gray and Arbruthnot, 1941) and their associates Sally and Spot populated the basal readers of young American readers. Highly simplistic if not also lacking in any diversity resembling the spectrum of actual Americans, the characters and behaviors are comparable to well-intended but also simplistic renditions of what an individual, couple, or family is all about. If problems arose at all, they were benign and readily managed. The stories gave an implicit message of what people, relationships, and life was supposed to look like. Psychological and psychotherapeutic theories often imply how individuals should function. This is how psychological health looks. This is neurotic. This is good communication. This is bad communication. This is a healthy family. This is a dysfunctional family. Therapist, now that you have the picture, make him, her, or them healthy, communicate well, and behave functionally. If there were so-called "wholesome" Dick and Jane persons, they ordinarily would not be the clients who seek therapy. That is, unless beneath the wholesome suburban veneer there is alcoholism, abuse, trauma, domestic violence, emotional distress, despair, and conflict, anxiety and depression, infidelity, and any of a host of minor to severe stresses and dysfunctional behaviors. The feigned innocence of the original Dick and Jane did not include the possibility that one or both may have been molested, or come from an alcoholic family system or divorced parents. Homosexuality? Heterosexuality or sex at all was not addressed although there were explicit heteronormative values and gender models presented. Mixing metaphors- the therapist has fallen like Alice in Lewis Carroll's classic "Alice's Adventures in Wonderland" (1885) down the rabbit hole and sits at the Mad Hatter's tea party. Dick and Jane exist in their version of a topsy-turvy world of singing flowers, caterpillars smoking hookahs, Mad Hatters, false disappearing smiles of the Cheshire Cat, and more nonsensical characters and dynamics. Who and what Dick may be or who or what Jane is, and/or what has been going on in their relationship (or rabbit hole), much less within their family among the children requires insightful astute initial assessment by the therapist Alice! Whether it is one person, two people in a couple, or a few members in a family, the therapist may continually be confronted with fantastic and odd occurrences incompatible with functionality outside the rabbit hole. The therapist starts with almost nothing (other than it is one person, a couple, or a family) and yet must not only make accurate assessment and diagnoses at a therapeutic tea party amidst the shenanigans of Mad Hatter, the March Hare, the Dormouse, and even a megalomaniac Red Queen of Hearts. Rather being drawn into, seduced, or co-opted by the client, couple's, or family's dysfunction, the therapist must assess and implement such into effective therapy. See the therapist. See the therapist want to run!
ALMOST NOTHING
When a client or clients present for therapy, the therapist has the barest information to begin therapy. Often there are issues about intimate or other important relationships. An individual has had problems finding and staying in relationships, or perhaps habitually finds him or herself in high toxic dysfunctional relationships. Perhaps, the relationship is with a so-called BFF (best friend forever), another family member- a sibling maybe, a teammate, a co-worker, a supervisor, supervisee, or a colleague or teammate in some social or athletic group. The therapy focus of treatment may specifically be about the relationship between the partners in a committed or married couple, or the relationships among the members of a family: a nuclear biological family, a blended family, the extended family, and/or a multi-generational family. Therapy may be for an individual, male or female, a couple, a family, but are there other important composition not yet disclosed? Is sexuality an issue; is everyone or someone heterosexual, gay or lesbian? A gay rabbit hole? A straight rabbit hole? Age may be relevant as may be class, occupation, or cultural background. A working class tea party? High tea? Three cups of tea? Assessment is necessary to find the direction of therapy. or more of the initial sessions may be largely dedicated to informal conversational or formal and structured assessment with specific diagnostic tools such as a mental status exam (MSE). A mental status exam applicable to an individual may include looking at, examining, or assessing a multitude of issues. For example, a mental status exam considers (Martin, 1990):
Level of ConsciousnessAppearance and General BehaviorLevel of ConsciousnessSpeech and Motor ActivityAffect and MoodThought and PerceptionAttitude and InsightExaminer's Reaction to the PatientAttentionLanguageMemoryConstructional Ability and Praxis
"Assessment exists primarily to gather information for counselors to better understand clients' concerns and as the underpinning for making intervention decisions. Many authors have proposed wider purposes for assessment including identifying the focus and goals of counseling, identifying the source of clients' concerns, identifying clients' self-understanding, providing new perspectives, teaching new ideas, creating evaluative structures, unearthing conflicts, serving as a stimulus for discussion, and expanding treatment options" (Forrest, 1994, page 172). While the MSE examines current status, it does not necessarily consider how the individual arrived at his or her current status. The family-of-origin, prior experiences, cultural distinctions including gender roles, class expectations, and developmental progression are among many other considerations to understand an individual's personality, values, and behavior. Similar or identical experiences in one person can manifest in divergent ways due to other influences idiosyncratic in another individual. Comparable categories for examination of a couple or a family would include individual issues along with interactional dynamics. In a couple however, 1 + 1 often equals much more than 2 or the simple sum of two sets of individual characteristics. Arguably each individual holds a multiplicity of factors. Set against or with another individual's comparable multiplicity, they result in some exponential rather than additive result. A family moreover with additional members is often significantly more complicated as well.
Various approaches to therapy may not fit the client's (individual, couple, or family) needs. The therapist who approaches a client with set strategies and tools or interventions in mind has not assessed the unique qualities of the client nor examined how the client is or is not comparable to others he or she has worked with or studied. The therapist with a favored theory and favored interventions becomes like a person in love with smacking things and particularly with a hammer! Everything looks like a nail and gets smacked. A particular therapeutic approach and accompanying therapeutic interventions can be very appropriate and effective when it matches with one individual, couple, or family's needs, yet may be problematic and unsuccessful with another client with different needs. Therapist should take care not to simplify therapy with favored assumptions for example, of homogeneous couples and couple's dynamics. Sperry (1989) notes that, "The most comfortable and easy way to practice marital therapy is to view many if not all couples and their problems as basically similar and then apply a standard therapy or mix of therapies to these couples… particularly with the 'traditional couple.' The traditional couple is a relatively young couple, married more than two but usually less than seven years, with a fairly focused set of concerns. For a number of reasons such a strategy is misguided and deprives many couples of effective treatment… couples tend to be… more culturally diverse, more dysfunctional, and more multisymptomatic, including health and medical factors. Of necessity, marital therapists have had to expand their repertories of both assessment and treatment modalities to adequately tailor their therapy to spouse and couple" (page 547)
A hammer is great for driving nails, but challenging for driving screws, difficult for cracking walnuts, and ineffective for sawing wood. Even all nails are not the same nor are all hammers the same. Therapeutic strategies and interventions for a couple with poor communication may prove inadequate for a couple with domestic violence. Work with an individual or an individual in a couple that has encountered trauma may prove significantly different from work with an individual who has or a couple where one member has had an affair. In addition, one couple's communication problems may not be the same as another's communication problems. The trauma in one client may not resonate as destructively as the trauma in another client. Uncovering important influences and factors may be "curiouser and curiouser," but always informative to the direction of therapy. The therapist, similar to any person will be drawn to types of therapy that resonate with his or her personality, style, intellectual, affective, psychological, spiritual, and other characteristics or prejudices. If the therapist does not carefully examine this dynamic, the client who may match with him or her stylistically may be well served, while another client who does not may not be well served. The therapist should stay cognizant that he or she is not doing his or her own therapy when supposedly providing therapy for clients. The responsible and responsive therapist should know him or herself well enough to adapt as demanded to the needs of a client. Therapy and interventions that suit a particular couple vary according to the characteristics, history, and condition of that couple. Therapy is best served by making an accurate assessment of the individuals, partners or members, and of the couple or family's relationship. From assessment, the therapist should then adapt therapy accordingly.
Peluso and Macintosh (2007) point out different types of assessment results that resonate for a few theoretical orientations. "Assessment is not only an important stage in the treatment of couples, but it is an ongoing process as well (Carlson & Sperry, 2000). Lifestyle assessments conducted today by Adlerians are not too different from what Adler did 70 years ago… These assessments can be in-depth or modified to fit a shorter time span, but they essentially give the therapist important data about how each person in the couple found a way to belong in the family-of-origin and get his or her emotional needs met, discover what challenges (real or perceived) with which each had to contend, and assess the overall level of discouragement (Sperry et al, 2006). In addition, lifestyle analyses can provide clinicians with important information related to current functioning… this kind of interview technique (or some of the questions) can also be adopted to gather attachment schema data" (page 259). A professional and astute assessment process also builds therapist credibility and rapport between the therapist and the client. Since the couple is made up of two individuals, assessment of each partner is often important as would assessment of every member in family therapy. There are many assessment tools or processes for individuals that the therapist can use. "Traditional approaches to career assessment have focused on the individual. Many counselors have been professionally trained, and now practice, using counseling theories that view the origin of clients' problems and the responsibility for solutions as an individual rather than as a social systems phenomenon (i.e.. couples: families: or social, cultural, and political circumstances). Even when counselors believe in and acknowledge the power of context and circumstances on individual choices and behavior, they believe the best chance for change rests within the individual, especially individuals who acknowledge their need for help and make an initial commitment to change by seeking counseling. The possibilities for creating change in family systems or social policies seem slim in comparison" (page 169).
Many therapists who conduct couple therapy may take traditional approaches to assessment derived from individual therapy orientations. They would understandably focus on the individual. "Many counselors have been professionally trained, and now practice, using counseling theories that view the origin of clients' problems and the responsibility for solutions as an individual rather than as a social systems phenomenon (i.e.. couples: families: or social, cultural, and political circumstances)," (Forrest, 1994, page 169). While acknowledging the importance of context and circumstances on individual choices and behavior, the therapist may focus therapy on one or the other individual. This can lead to a perspective that sees change as coming from one or both individuals within the couple acknowledging a need for help and commit to make such change. In addition to assessing each partner or family member, the therapist should assess the couple or family itself and the relationship or relationships. Change in the family or couple's system may not be the thrust of therapy when the focus is on an individual. A more systems orientation in couple therapy can be introduced by investigating each partner's early history while focusing on his or her early intimate relationships. Prompting each partner in turn to consider how early intimate relationships may be reflected in the current couple's relationship combines assessment and may gratify individuals desire for early therapeutic gains. Exploration of relationship history may also be very beneficial for individual clients, since most of their issues manifest in relationships. In individual and couple therapy, the first sessions are often focused around getting the clients' personal history, the family dynamics, cultural, and other experiences. Personal aspirations and goals for the therapy are explored for their relevance to the presenting issue or problem. The therapist should be more overt in directing investigation to the issue of the relationship between the partners. With a couple or family, the therapist may find it takes quite a bit of time to do the initial assessment. Hawes (2007) warns that seeking a complete assessment can cause frustration for a couple seeking quick remedy from their discomfort. They may not appreciate how important information is gained from the assessment process. Hawes recommends eliciting early recollections to smooth this process and enhance the initial intake session (page 307). The therapist may consider if the one or both partners' impatience is indicative of process or of characterological issues contributing to their problems. It may reflect a lack of insight or perhaps, avoidance of deeper issues. This may prove true for an individual client as well.
