The Dilemma-Resolution Continuum
By
Robert J. Chapman, PhD
© 2003
I once heard that the acceptance
of one's aging is correlated with the awareness that one is not so much
approaching life as the follower of a disciple but embracing it as a leader. As
counselor educators, we most likely started off pursuing the ideals of favored
theorists, mentors, professors or admired colleagues only to awake one morning
realizing that we had become the theorists, mentors, professors or admired
colleagues. My grandfather used to tell me that the trick at this juncture is
to accept the mantle conveyed by the new generation of followers without
abandoning one's own role as follower--as mentee, student, and disciple. With
this in mind, I write to share some thoughts that have arisen as I find myself
considering the teachings of some new—and not so new—theorists & mentors.
When I entered the field of
professional counseling in 1972, I was committed to the pursuit of solving
problems experienced by the clients with whom I worked, "fixing what was
broken" if you will. Consequently, I was enamored of behaviorism and the
tools it provided to "extinguish" maladaptive behaviors and replace
these with new, learned, "adaptive" behaviors. This approach and its
techniques remain in my counselor's toolbox, and continue to be used regularly,
but not as the platform from which I launch my interventions, but rather as an
available means to an end, i.e., assisting the client to affect change in
her/his life. Theoretically speaking, I was next attracted to refocusing my
attention on potential solutions rather than the client's problems and inviting
clients to do the same. I must admit that this continues to be an exciting
prospect as the pursuit of mental health rather than the treatment of mental
illness is simply more consistent with my philosophy of life in general and my
metaphysical view of the world. Yet, as useful and rewarding as this
"solution-focused" approach to counseling may be, I seem to be in
transition yet again in my career.
Perhaps it is time to consider the
utility of another paradigm shift in professional counseling regarding our
objectives when working with clients...from a problem-solution continuum to
a dilemma-resolution continuum. I realize this is a provocative idea for many
in the helping professions and tantamount to heresy for those steeped in the
medical model, but what if clients seeking therapy are encouraged to “deconstruct”
their view/interpretation of stressors in their lives and approach them as
dilemmas in need of resolution rather than problems in need of solution?
Now, I do not mean to suggest that
disorders whose etiologies are steeped in physiological and/or neuro-chemical
imbalances/dysfunction should be viewed as "dilemmas," but I do
suggest that many of the “disorders” we professional counselors address may
be better, i.e., "more effectively," treated if approached in this
fashion. Even disorders like addictions where evidence seems to be rather
convincing that at least to some extent, the disorder may be steeped in neuro-anatomy,
psychopharmacology, and/or genetic anomalies, the treatment of individuals
with these “medical” conditions may be effectuated by inviting the client
to view recovery as resolving dilemmas complicated if not caused by “their
disease.”
Allow me to present something of a
case study to illustrate my point: I recently saw a student who reluctantly
agreed to meet with me at the insistence of a friend—a phenomenon all too
infrequent in the delivery of counseling services in higher education. The
student had a history of alcohol abuse and over the counter (OTC) drug abuse,
e.g., benedryl, ibuprophen, etc. Both behaviors were severe enough to have
resulted in significant problems for the student, e.g., transport to the ER for
evaluation following excessive intoxication by alcohol, but no admission.
Although no suicidality was determined, there was/is clearly “something going
on” with this student…but was it a problem, i.e., necessarily or exclusively a
“medical condition?” And if so, was a solution necessary?
My client presented, both in word
and affect, like a battered puppy. Eye contact was all but non-existent—and
this was a white, middle-class individual for whom direct eye contact is the
hallmark of assertiveness. Interestingly, this student was on the dean’s list,
had no history of chronic interpersonal problems, had a network of supportive
friends, and had maintained, although not at the time of being seen by me,
monogamous relationships. To all practical purposes, this was a successful
student that simply was not happy. Okay, “did you screen for depression
Robert?” you might ask; no, not technically. However, before you second-guess
my clinical judgment, let me share with you that by asking a couple simple
questions in the context of a metaphorical story, direct eye contact returned,
the client began to smile, and a more spontaneous exchange began to take place.
The metaphorical story is the vehicle
for this query to the group: I asked the student to image that some “serious
cleaning” needed to be done at home—I asked if that would focus on the basement
or the garage and the student stated with a smile, “basement!” I then asked
the student to look around the basement and notice all the old stuff lying
about, some obsolete, some moldy with age, so just plain “funky.” I asked
what should be done with this stuff, to which the student said the junk would
be hauled to the curb for trash pick up. I agreed that this would be a good
idea asking, “and what might your neighbor across the street say if seeing
you doing this?” The student said, getting into the rhythm of the story, “Oh,
cleaning up your basement I see, eh?” (I think my student might have been
Canadian ). I then asked, “what would your neighbor think if an hour later
as the trash truck was coming up the street you were to suddenly dash out
to the street and retrieve all the trash and replace it in the basement.”
She deftly remained in step and said the neighbor would think this to be odd
in the extreme if not that she was crazy. I then asked how often the student
had hauled “the psychic trash” back in the house?
We went on to talk about the
student’s relationship with mom and her alcoholic stepfather, but my point is,
we did so by viewing the student’s distress and “depression” less like a
problem to be solved in the traditional clinical sense of treatment than a
dilemma to be resolved in the context of a counseling relationship focused on
resolving the dilemma—a basement full of trash and a reluctance to leave it at
the curb.
As we debriefed after the first
session, I found myself talking with a different student. Gone was the indirect
eye contact and down-turned mouth. Like the student that identifies 2 minutes
as “a short time” only to be asked to hold his or her breath for 2 minutes can
instantly see the change in "how long 2 minutes is," so it would
appear that this student was able to perceive options and choices simply by
assuming a new perspective from which to view “the problem.” In short, by
abandoning a problem interpretation of the “symptoms” and instead, considering
the objective facts as indicative of a dilemma, the student was able to get
“unstuck.”
So I ask
again, I wonder what my colleagues think about the idea of moving away from—if
not abandoning—a problem-solution continuum when considering working with
clients with many of the issues clients bring to counseling and adopting a
dilemma-resolution” focus?
To read other essays by Dr. Chapman, click HERE