6/06/07: When Psychotherapy becomes Executive Coaching

I have not been writing much which is unusual for me. It might be that I am through the major first phase of GTD implementation, I'm down to the wire about what programs I am using for all of my lists. I've tried all of them that I read about as they come out. So far I'm sold on Vitalist, with only one downside. They don't yet have both an online and offline version. Remember the Milk (RTM) just announced that with Google, they now have it both ways, that is you can write your lists online or offline, and this is attractive to me, although Vitalist works better for me, I can print out all my lists on a few pages sequentially, and its overall a great program. Sometime I will write about all the programs I've tried out, but not now. The question for me this evening is: Why am I not writing?" I'm sneaking around all day reading productivity blogs, following leads from NetVibes, and generally spending many hours doing nothing I call "produective." I wrote one very long note to my academic community about some rewrite of the dissertation handbook for students, but that is not what I want to be writing now.

Empirically Supported Treatments: Psychotherapy turning into executive coaching

The topic I've been mulling over for weeks now is the simple and typical scenario in my practice, that makes the "empirically supported psychotherapies (EST)" coming up short. When I start to see someone they often have a diganosable mental disorder. At this point I try different techniques and see what the patient responds best too. Patients may arrive drug-addicted, depressed, anxious. I do two things in the beginning of a psychotherapy: 1) work on building a therapeutic alliance, without which regardless of what techniques I use, patients don't fare so well if they don't like me and/or I don't like them. The second thing I do is try out some specific types of therapeutic techniques, and integrate them if the patient seems to like them. This can mean doing some cognitive interventions, behavioral interventions, supportive therapy type interventions.

When my patients (clients) get better
Ordinarily (but not always) my patients Axis II (bonafide mental disorders) dissolve with treatment. Then I become an executive coach. Patients don't want to leave "therapy" even when I tell them there is nothing wrong with them. They like the coach arrangement, the career building or relationship support that I provide for them. This is where the EST is blown to the winds, because I am no longer treating mental disorders. At its best, I' become a cheering squad, an ally against guilt, and a psychologist who keeps her nose into the literature, so that I can bring any advances to my patients as we work as collaborators are their career blockages, or self-sabotage in relationships. These are not mental disorders. People want to hang out with me, and that is what I do. Coaching is fun, and not quite as nerve wrecking as regular psychotherapy.

What works when patients are cured of their mental disorders
From the beginning of a therapy, I try to let people know who I am and what I do; this relieves a great deal of anxiety in the patient and they feel less fearful. By the time they are "better" and ready for what I'm calling
"executive coaching" they know me very well, and trust that I will use many techniques, in accord with what works. I ask myself: What right do I have to see people who no longer have anything wrong with them?" Plenty is my response to myself. If someone wants to pay out of pocket for the coaching they receive from me, I would feel wrong to dismiss them. Instead, we discuss the situation with clear heads. There is no "EST" designed for this phase of "psychotherapy" that I engage in, or at least not one I know about. I don't feel in competition with all the zillions of coaches around. As I said before, I'm their own psychologist, bringing articles or ideas in that might help with any remaining "problems in living." As a psychologist and a coach, I can do anything that helps. I still hang on to many of the "rules" of psychotherapy, at least to some of them. I don't invite patients out to lunch, although I have eaten with them at graduations and weddings. But the ESTs are designed for people with mental disorders, not for the well who come to a psychotherapist to help solve job problems and to otherwise help regulate their limbic system. I often think that currently, the therapist is taking on the role of the small town misister, or the wise old person in a community, a tribe. Maybe the therapist is taking on a role and function that the hair dresser used to fill. In my mother's generation, people went to the hair dresser every week for a shampoo. In their time in the chair, they talk about their families and all of their problems. Thus the hair dresser was taking on the helper function, now served by the therapist.