What is the right intervention?

Student: “Is that the right intervention?

Me: “I don’t live in the land of right and wrong. I live in the land of cause and effect.”


Every intervention works until it doesn’t. Then we have to listen to reality instead of our concepts of “right” and “wrong.” An intervention’s usefulness is not determined by the therapist but by the patient’s response.


We intervene without knowing how the patient will respond. Every step we take, we walk into the thin air of that unknown response to be, not knowing where the patient will take us. When faced with the amazing complexity of our work, we can feel overwhelmed. Unable to bear the confusion and uncertainty, we may cling to rules.


These rules become our security blankets, which we hold onto fiercely. “Always do ____.” At a recent conference, a therapist said to me, “Once I found internal family systems 18 years ago, I never read another book.” How sad. When we adopt a system or set of rules, ritualism becomes a substitute for thinking.


In ritualism, we say, “This technique is the right, true way.” If painters thought this way, we would never have had impressionism, cubism, or abstract expressionism. They don’t reduce painting to a single technique.


In ritualism, we reduce therapy to a technique. If it doesn’t work, we do it again and again. If it still doesn’t work, we can blame the patient for being “resistant.” At least we were “loyal” to the technique.


In scientific thinking, we don’t use the labels right and wrong. We ask: did this intervention help the patient? If not, let’s assess the patient’s response to find out what her need is in this moment, then intervene again to see if we are on track. We are not loyal to a technique but to reality.


When we leave ritualism behind, we realize that every intervention is an experiment. Instead of rigidly fitting reality into our rules, we follow principles for exploring reality: e.g., assess the patient’s response to your intervention.


I don’t have anything against internal family systems therapy or any other system. They’re all useful. I am only concerned about our misuse of systems. When we become certain that our version of reality is right, unwilling to open up to our patients’ responses, we relate to our system, not to the patient. Every system is a map. But no map is the territory it depicts. That’s why we must hold our maps and theories lightly as we enter the cloud of unknowing that is therapy. In therapy we must find the courage to doubt our previous “rightness” when it doesn’t work. And through that window of doubt, the light of the patient’s reality can enter the therapist’s heart.









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