I was recently asked: Is Symbolic Modelling indicated for the following clients?:
Because clinicians can see any or all of the above at any time, it would be very helpful to have a very clear sense of what population groups would clearly not be candidates for this treatment approach, because it represents risks for their safety, well-being or treatment progress.
- Clients who have a metaphor landscape that is too filled with self-destructive or violent material.
- Clients who are in recovery and who need to avoid certain thoughts and fantasies that could trigger a relapse.
- Clients who have bi-polar disorder, as there is a phenomenon called the kindling effect, where a focus on certain material might trigger runaway manic episodes or depressive episodes.
- Clients with personality disorders or severe attachment disorders where they have an intense focus on dependency needs.
- Clients with impulse control disorders, who need to stay very focused on maintaining conscious control over their impulses.
- Clients whose metaphor landscape lacks any internalized memories or experiences of joy, success or worth.
First I am going to comment on all these kinds of clients in one go. Then I will address them individually. These questions make great sense for many traditional psychotherapies but do not apply so directly to one based on modelling, for three main reasons:
(a) It is not the approach itself that is contraindicated but the therapist. The skill level and experience as a therapist – especially their experience of these kinds of clients – is a key factor. Another is the client. The whole basis of Symbolic Modelling is to model how the client's system works and to work with and within
that unique system – whatever that is. For some clients this requires great flexibility, adaptability, creativity and durability on behalf of the therapist. Of course there will be times and clients for whom Symbolic Modelling is not productive but it will depend on the individual circumstances.
(b) The questions presuppose things that I would need to have evidence of before I accepted they applied to any particular client. I start from the presupposition that clients are resilient and already have the capacity to make valuable changes in their lives. And that through self-modelling their system can learn how to make those changes. If there is evidence they can't do that, or can't learn how to do that, then I will either need to significantly adjust my approach or abandon it in favour of another method. But I don't start from that premise. My clinical experience is that within each of the categories mentioned there is great variety. Perhaps as much variety as in the general population.
(c) Underlying all these questions, I guess, is a fear about working with a client's self-generated metaphors. If my guess is accurate, there is a misunderstanding of the role of metaphor. Metaphor is not some psychic aberration that is, in and of itself, either dangerous or helpful. Metaphor is part of the fabric of thought, word and behaviour. Virtually everyone, these clients included, live in a partial metaphorical world – all day, everyday. What Symbolic Modelling does is to support the client to know that. In the vast majority of cases that alone is affirming.
Therefore to not
work with a persons metaphors is, in my opinion, dishonouring that part of their humanity – especially since it is close to impossible to describe any
internal experience without resorting to metaphor. Given that the context of a psychotherapist's work is the psyche, it follows that we are going to be working in the land of metaphor – like it or not. The question then becomes how much
, and how overtly
do we do this? And that will depend on the particular client at the particular time.
As long as my own well-being is not at stake I am going to model the client's metaphors whether I am in a formal session or chatting in the corridor. In either case I will decide in the moment whether I ask one of the classic clean language questions with the full three-part syntax or something much more conversational. Either way I will still be thinking clean and modelling their verbal and nonverbal metaphors.
In relation to the specific client groups mentioned, my response is:
1. Clients who have a metaphor landscape that is too filled with self-destructive or violent material.
How would anyone know if a landscape was "too" filled with self-destructive material? The client has survived up to now with that material in their psyche, why would we expect it to be "too" much for them?
2. Clients who are in recovery and who need to avoid certain thoughts and fantasies that could trigger a relapse.
Maybe, through Symbolic Modelling, a client "in recovery" could learn better how to avoid certain thoughts/fantasies, how to handle the triggers that produce them, and how to construct more useful thoughts. I wouldn't want to deny them that opportunity. And a skillful therapist could use Clean Language to interrupt a client's process if it appeared to be heading in a dangerous direction, and facilitate them to self-model how that happened – i.e. to bring awareness to the client of the choice points they had, and how to back up once they had started down an unproductive path.
3. Clients who have bi-polar disorder, as there is a phenomenon called the kindling effect, where a focus on certain material might trigger runaway manic episodes or depressive episodes.
Surely this applies to any process which works with this client base. Everything I've said about (2) applies here also. I have first-hand experience that Symbolic Modelling can enable a client to see and work with the whole bi-polar pattern (rather than experiencing one pole and at that time believing the other pole doesn't exist or will never happen again). In other words the client can get a meta-perspective on their process and notice how it works as a whole, where the turning points are, and what needs to be happen to have more choice just before, at, and just after those turning points.
4. Clients with personality disorders or severe attachment disorders where they have an intense focus on dependency needs.
These are challenging clients to work with using any methodology. How overtly to work in metaphor would have to be decided case by case, and moment by moment. What I know is that if a client is going to directly address these patterns in the therapy they will use metaphor to do it.
5. Clients with impulse control disorders, who need to stay very focused on maintaining conscious control over their impulses.
Why would working with Symbolic Modelling prevent a client from "maintaining conscious control over their impulses"? I'd expect the opposite to happen, to enhance their conscious control.
6. Clients whose metaphor landscape lacks any internalized memories or experiences of joy, success or worth.
My reaction is, so what? The process is not dependent on the number of "positive" or "negative" memories, images, feelings or symbols. Symbolic Modelling works with the structure/patterns of a person's inner world (and behaviours displayed at the time). The client can only work with what they've got and where they are, so that's where we start. If it happens to be all doom and gloom, then so be it. But it never is. There are always specks of light, although such resources may be very well hidden. Our job is to tend to them and see how that influences the system.
As you can see, I have an aversion to giving blanket prescriptions to working with classes of clients as defined by someone's interpretation of someone else's categorisations (e.g. The Diagnostic and Statistical Manual of Mental Disorders
). And I am not saying anything goes. Far from it. I am saying that clients are individuals and I follow Aristotle's maxim: there is no science of the individual
. Therefore each case must be modelled on its own merit. Of course the amount of 'pure' Symbolic Modelling and the speed and depth I would work has to be adjusted based on feedback from the client's system, but I hope that is true of all psychotherapies.
Rather than considering general categories of clients, I think there is a more fundamental question for all therapists to consider (and everyone else for that matter): How do you know when what you are doing is working, and how do you know when it is not?
Establishing these criteria is no easy task (because they are so dynamic) but they give the therapist something by which to make their decisions, both in-the-moment and over the longer-term. One way is to know the client's current desired outcome and whether they are moving in this direction or not.