Seven Questions for Donald Meichenbaum

The project kicks off with Cognitive Behavior Therapy co-founder Donald Meichenbaum, Ph.D., voted one of the ten most influential therapists of the 20th century.

Donald Meichenbaum (Ph.D., University of Illinois, 1966) is Distinguished Professor Emeritus, University of Waterloo, Ontario, Canada and Fellow of both the American and Canadian Psychological Associations. His experience is as broad as you'll find in this field: teaching, research, theory development, writing books and articles, advocating public policy, clinical work with inpatient and outpatient populations, therapist supervision and specializations with trauma, PTSD, schizophrenia, etc. He is currently Research Director for the Melissa Institute, an organization that utilizes psychological research to educate government and the public about violence and trauma. Needless to say, it's an honor to include him in the project.

The Seven Questions introduction discussed the Three Approaches to Psychotherapy films from 1965. Dr. Meichenbaum read the post and sent along this statement:

"By the way there is a new set of Three Approaches to Psychotherapy where Hans Strupp, Aaron Beck and I all interview a very interesting and suicidal patient named Richard. You may wish to include this on your BLOG."

Indeed I will. It has not been YouTubed, but you can find a copy for purchase here. There are actually three parts to the series: the original in '65, part two in '77 and Meichenbaum's in '86. Since this project was inspired by the Gloria films, it's only fitting that a participant in the series helps launch it.

As one of the original voices of Cognitive Behavioral Therapy, it's a thrill to have Dr. Meichenbaum begin this discussion. His answers reflect many central tenets of CBT, including what and how trumping why. I personally enjoyed his advice for fellow therapists (Question 5). Read on and check back each Wednesday. The value in this series comes from comparing answers to see the diversity in the field of psychotherapy. Enjoy.

Seven Questions for Donald Meichenbaum:

1. How would you respond to a new client who asks: "What should I talk about?"

I would ask the client to share with me what brings him/her to therapy and how does he/she think I could be of help. Early on in the session, I would explain to the patient what I do for a living:

"Let me tell you what I do for a living. I work with folks like yourself and try and find out how things are now in your life. Then I try to find out how you would like them to be. What can WE do to help you achieve these goals?"

Moreover, I would like to know what he/she has already tried to bring about these changes and what has worked and not worked, as evidenced by what outcomes? What difficulties, if any did he/she have and how did he/she handle these obstacles?

"If WE work together and I hope WE can, how would WE know WE were making progress? What would change? What would other people notice?

"One last question, if I may. Can you (the client) foresee or envision any particular obstacles or barriers that could get in the way and what could WE do to anticipate and address these should they arise?"

NOTE: Several items about these questions.

They all are WHAT and HOW questions. WHY questions are NOT very productive.

The tenor of the session is very COLLABORATVE and the WE is always highlighted.

2. What do clients find most difficult about the therapeutic process?

Keep in mind that the research data on psychotherapy indicates that the quality of the THERAPEUTIC ALLIANCE is the most important aspect of therapy. There is a need to address any behaviors and beliefs and barriers that can undermine and interfere with the ability to work together. There is a need for the psychotherapist to monitor and address what have been called "ruptures" in this alliance.

The therapist should ask clients the following questions on a regular basis:

"What did he/she think of the session? What did he/she take away from the session that he/she can work on between now and the next time we meet?"

"Is there anything I (the therapist) did or did NOT do that he/she (the client) found particularly helpful or unhelpful?"

NOTE: The specific psychotherapeutic procedures account for only a small proportion of the outcome.

3. What mistakes do therapists make that hinder the therapeutic process?

I have trained and supervised psychotherapists all over the world and the major challenge is that they DO NOT LISTEN to their clients. Instead, they act as what I call "Surrogate Frontal Lobes" for their clients by giving explicit advice. The most valuable tool that the psychotherapist possesses is the "ART OF QUESTIONING." They should use Socratic-style discovery-oriented questions. I am at my therapeutic best when the clients I see are one step ahead of me offering the observations or advice that I would otherwise offer.

NOTE: Clients are more likely to follow through on what they come up with than what the therapist offers. The therapist needs to be STRENGTHS-BASED.

4. In your opinion, what is the ultimate goal of therapy?

I would not focus on the so-called Ultimate goal, but rather work with clients to establish COLLABORATIVLEY short-term, intermediate and long -term goals that are behaviorally objective, achievable, and measureable. The goal of psychotherapy is to have the client "become his or her own psychotherapist."

I want clients to "take my voice with them." The portions of my voice that I want them to take are "ACTIVE TRANSITIVE VERBS" such as "notice, catch, anticipate, plan" and the like.

NOTE: There is a need for clients not only to change, but to have the client take credit for these changes. The psychotherapist should ask the client the following questions:

"How did you handle this situation differently from how you handled this in the past?'
"Where else did you do this?"
"How long has this been going on?"
"How did you pull this off (accomplish this)?"
"Are you telling me... are you saying to yourself that IN SPITE OF....., you were able to notice ...catch yourself...use your coping techniques of....How did that make you feel?"
"What does this mean about you as a person?"

NOTE: The ART OF QUESTIONING is the psychotherapist's most valuable tool. Mainly, these are HOW and WHAT questions.

5. What is the toughest part of being a therapist?

The toughest part of being a therapist is how NOT to get caught up with all of the questionable psychotherapeutic "BULLSHIT" that pervades the field. Almost anything can be called psychotherapy. There is a need to maintain a critical consumer discerning attitude and employ evidence-based psychotherapeutic procedures and follow empirically-based behavior -change principles. There are several psychotherapy procedures that can make clients WORSE. Any advocate that says "This is the CURE" or proposes a "REVOLUTIONARY" approach does not deserve your attention, nor you money.

Stay away from HYPE-- it is tough to do.

6. What is the most enjoyable or rewarding part of being a therapist?

Psychotherapy is a NOBLE profession and I am honored to be a member of this community. Helping clients achieve their goals and helping alleviate distress is key. For me, as Research Director of the Melissa Institute (see www.melissainstitute.org) giving research findings away is a major joy. My latest project is working with returning soldiers and their families (see www.warfighterdiaries.com). This is a project that will use podcast technology. It has major implications for how psychotherapy will be conducted in the future.

7. What is one pearl of wisdom you would offer clients about therapy?

I would tell clients to find a psychotherapist who they feel comfortable with and confident about. Make sure you feel heard, respected and that the psychotherapist asks you about "The rest of the story" or what you have been able to accomplish "In spite of."

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Donald Meichenbaum, Ph.D. is Research Director of the Melissa Institute for Violence Prevention and Treatment of Victims of Violence, Miami, Florida. Please see Melissa Institute and the accompanying website Teach Safe Schools that has received over one million HITS. His recent American Psychologist film with a young lady, Missy, demonstrates how he uses a Constructive Narrative strength-based approach with a client who has attempted suicide seven times. He has published extensively and you can GOOGLE him for a description of his publications and workshops.

Dr. Meichenbaum is the author and co-author of numerous books including: A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post Traumatic Stress Disorder, Stress Inoculation Training, Pain and Behavioral Medicine, and Facilitating Treatment Adherence. His book, Cognitive Behavior Modification: An Integrative Approach, is considered a classic in its field. He also serves as the editor of the Plenum Press Series on Stress and Coping.