The Therapist’s Relationship to Complexity

The Therapist’s Relationship to Complexity 512 300 Social Work Practice

One of my all-time favourite quotes comes from the American journalist and cultural critic, H. L. Mencken, who famously wrote:

“For every complex problem, there is an answer that is clear, simple, and wrong”.

I sometimes think about that quote when I hear of therapists who are deeply committed to, or enamoured with, a particular model of therapy that they apply enthusiastically to each and every client they see. It brings to mind another quote often used in reference to this phenomenon. Originally, I learnt the quote was attributed to Mark Twain, but it seems the most likely originator of the quote is the great Abraham Maslow. The concept described is referred to as “the law of the instrument” or “Maslow’s hammer” and involves an over-reliance on a familiar tool.

The quote? In 1966 Maslow said, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail”.

Applied to therapy, if the therapist only has access to one model of therapy, which he or she has learnt well, the temptation is to frame the problems of every client within the theoretical principles of that model, and apply the treatment and intervention strategies directed by that model. If the answer is always “this model” regardless of the complexity of the client’s presentation, might this not be an answer that is “clear, simple and wrong”? The model becomes the hammer.

This can also happen in partial ways, such as when a concept or some quirky intervention dominates the thinking and activities of the therapist. For instance, when all clients are organised suddenly to have a “trauma history” or find themselves on the receiving end of a barrage of “mindfulness” techniques. In the 1980s and 1990s, Family Therapy was awash with famous clever reframes that were trotted out relentlessly to deal with complex family issues (I suspect I cannot claim innocence in those ugly episodes).

There are times, of course, when clients present with a simple, straightforward difficulty that resolves beautifully to the favoured approach of the therapist. We greet these serendipitous moments with gratitude. But often the problems presented are multi-levelled and overlapping – a labyrinth of concerns. How can the therapist position themselves to best deal with these presentations?

My position has always been that the therapist needs to be well-trained in at least two models of therapy. This allows for a binocular vision (at least) of the client’s dilemmas. It helps if the focus of the models are different, but complimentary, e.g., one behavioural, one introspective; one individually focused, one interactionally organised; one cognitive/cerebral, one body/movement focused.

The therapist who is equipped with a solid knowledge of two models of therapy – two schools of therapeutic thought and practice – has a much better chance to respond with sensitivity and nuance to the complex dilemmas of the client. In short, the therapist needs to have a deep relationship to complexity to be able to respond to the client’s complexity, and to ensure that any elegant, simple intervention has been chosen pragmatically after well-informed complex considerations.

Dr Paul Gibney