How I Work: A Discussion of Big Problems and Small Problems
I hope my readers can sympathize with my sense of humor, because a sense of playfulness in a problem solving context naturally tends to enhance peoples’ abilities to think of choices, or plans which would not come to mind in a more sober discussion. Of course, people come to see me about problems which make them upset and anxious, and those emotions are inhibiting. They may be paralyzing. Such feelings tend to interfere with the kind of thinking which generates new scenarios for dealing with old problems. I try to create an approach to problem solving which will minimize anxiety, and I use humor as a prominent feature of looking at problem solving in the way described below.
I generally enjoy helping my clients, and I also find that I look forward to challenging cases. When people ask me, informally, to describe what I do as a psychologist, I am sometimes humorously drawn to say, with deliberate over-statement, “I am a general practitioner of bad things !“
My philosophy of treatment tends to be scientifically oriented, and I tend to address problems from a practical and realistic standpoint. An important aspect of this stance is an awareness that serious psychological problems tend to have many causes and many predisposing circumstances, which all function together to maintain the problem. Therefore, when I discuss the causes of their problems with my clients, I try to avoid attributing serious problems to any single cause, because this seems to imply that the problem should respond to a single treatment intervention. Many people with difficult problems have unsuccessfully tried several single factor treatments, and have often lost hope of obtaining useful help. I often try to involve my clients in a quite literal minded but also semi-humorous style of thinking, where I can describe how it is that:
Big Problems tend to be surrounded by and protected by many smaller problems,
which make the central problem seem bigger and stronger, or, more confusing and more insoluble.
However, if some of these smaller problems can be reduced or removed,
the Big Problem will tend to become smaller and weaker.
It will become easier to figure out, and therefore easier to control.
Of course, this is a rather childish way of looking at the complex causes of many problems. However, I really enjoy the way this outlook tends to provoke silly or creative humor. It tends to make the whole context of coming to see a psychologist into a less frightening and less mysterious experience. I am inclined to think that the naïve quality of this approach to problems enables people to be able to cope with complicated explanations and complicated questions. It can easily be adapted to peoples’ individual situations.
I like to arrange a working partnership whereby treatments are adjusted in accordance with their effectiveness in controlling both small problems and the Big Problem. I encourage my clients to help me identify related problems, such as a specific traumatic history, or co-existing physical problems such as migraine, chronic pain, or PMS, or other immediate interpersonal or situational stressors. It is especially important to deal with long-standing anxiety disorders. I find that with the help of the idea, that every time a smaller problem is controlled, the Big Problem is being weakened, my clients are generally willing to accept and assist with attempts to treat designated small problems. I often discuss destructive habits as if they were small problems, and so issues such as poor eating habits, going without adequate sleep, problematic caffeine use, alcohol abuse, and so on, can be addressed. Relief from the effects of several small problems often results in considerable immediate reduction of acute distress.
Of course, addressing smaller problems at the beginning of treatment may result in the discovery that there is in fact no Big Problem, because it is not unusual for a person to be psychologically overwhelmed by a situation which involves a complicated set of small problems. Situations like that tend to feel like a Big Problem.
I like to encourage my clients to be aware of stages in their improvement, while the Big Problem is becoming progressively undermined, and to become aware of the way the diagnosis and treatment of the Big Problem usually becomes straightforward. Such self-observation has useful implications for teaching about relapse prevention, because it sets up occasions for me to explain and emphasize what will probably happen if the client allows the smaller problems to re-occur. Of course what will usually happen is that the Big Problem will again become unmanageable. I work intensively to teach my clients about relapse risks, and how to access resources if they feel at risk of relapse.
I am sure that my attraction to working with serious problems is largely due to my work experience in Psychiatric Assessment, at the Emergency Department of Calgary’s old Holy Cross Hospital. My peers and supervisors there trained me to do crisis work without becoming personally overwhelmed. Several years of apprenticeship were required for this ability to become habitual, but since work experience, it has not been difficult for me to explore different possible diagnoses and treatment plans with people who are in acute distress. I hope that my ability to remain practical and calm enables me to be reassuring for people who are in crisis. They can be confident that I will not escalate their distress, by becoming visibly anxious or fearful myself.
This approach to problem solving owes a great deal to the work of Milton Erickson and Jay Hayley.
Their publications trained me to think this way and enormously enhanced my own ability to think creatively.