As is in the nature of crises, this pandemic has led me to reflect on what I really value in my work, and where I want to focus my efforts going forward. Throughout my career I’ve struggled to identify myself with a particular “specialty.” This is partly because I have the soul of a generalist, but also partly because my emerging specialty doesn’t fit neatly within the field’s conventional format for classifying specialties: usually something along the lines of “I study and treat psychological problems A and B in demographic groups X and Y.” Rather, I study and treat people who are seeking to ignite a certain kind of vital energy in themselves; people who are seeking to “launch” themselves in a certain way. This can take many forms, from the college athlete seeking the inspiration and mental focus to break through a performance plateau, to the wife seeking the courage to end a 15-year loveless marriage, to the would-be entrepreneur seeking the impetus and clarity of vision to quit his 9-to-5 job and pursue his startup venture full-time.
To be sure, most of my clients also struggle with psychological problems, sometimes severe ones. But that is not what sets them apart in my mind. Nor is it what distinguishes my evolving therapeutic approach from the standard “empirically supported treatments” (ESTs), on which I draw extensively. What does distinguish my approach is that it addresses the distinct needs of “my kind of client”—needs that today’s ESTs are ill-equipped to meet. For instance:
- Beyond “setting more realistic expectations,” my clients sometimes need help setting astronomically high expectations, while being ruthlessly honest with themselves about the low probability of success.
- Beyond “reappraising their catastrophic thoughts,” they need help recognizing when their “reappraisal” is just rationalization of what is in fact a looming catastrophe that needs to be faced and problem-solved.
- Beyond “taking other people’s perspectives,” they sometimes need help disconnecting from other people’s perspectives long enough to work out their own.
- Beyond “learning mindfulness skills to manage their stress,” they need help recognizing when their mastery of mindfulness has become a procrastination tool to help them avoid the much tougher and riskier task ahead of them.
- Beyond “scheduling self-care,” they may need help powering through a week without rest for the sake of a valued endeavor.
- Beyond identifying some fairly generic values to guide their action choices, they may need help articulating their own distinctive mission statement for the distinctive project they’re undertaking, in a form that captures its defining elements while allowing maximum flexibility in execution.
- And, beyond all of these particular skills, they may need help distinguishing which type of skill they need when—and developing the self-awareness and self-honesty to check what is motivating them to deploy a given skill at any given time.
Why are these needs overlooked by most ESTs? Part of the answer, I suspect, lies in my field’s current methodology for developing and validating ESTs. Most of these treatments were developed and tested with reference to the “average” person with such-and-such DSM diagnosis who enrolls in the randomized controlled trials (RCTs) used to show that a given treatment “works.” As some critics have argued, this “average” participant is a mythical entity stripped of all the “confounding” complexities and “noisy” idiosyncrasies that make up even the individual people enrolled in the studies, much less the people excluded from participating because their struggles did not fit one of our cookie-cutter diagnostic categories.
To be fair, important efforts have now been made to adapt existing treatments for those with more complex or underrepresented needs, such as racial/ethnic and sexual minorities, the recently bereaved, or those with multiple diagnoses or co-occurring medical problems. Yet such efforts have not been extended to individuals whose underrepresented needs stem from the highly ambitious and innovative endeavors they are undertaking, for example. Indeed, the very idea of developing a standardized, experimentally testable treatment protocol for this “group” implies a certain level of uniformity in the group members’ treatment goals, and in the psychological and therapeutic processes required to help them reach those goals. But what unifies the clients I work with is precisely that they defy uniformity: they are struggling to cast off conventional models and social norms, to find their own voice and choose their own way.
They are struggling to self-innovate.
Part of what I love about working with such clients is that it demands constant innovation of me: there can be no cookie-cutter recipe for helping someone do something for which there is no cookie-cutter recipe. Every innovation process will be different, and will require a different mix of psychological tools and insights and metaphors to support it. There are overarching principles, of course, but there is nothing approaching a “script” for applying those principles to the unique generative process of each wonderfully complex and unreplicable individual.
This also means a need to innovate in the realm of psychotherapy research methods: the current methods either do not adequately capture the individual variability and complexity of the self-innovation process, or do not allow for the generalization of broad therapeutic principles that can be flexibly applied to any such process. This is why I have been thinking hard about how to integrate qualitative approaches into my research, while also drawing inspiration from methods of systematic evidence-gathering and theory-building in philosophy and education.
Enter the current pandemic, and the need to cast off conventional models and innovate is suddenly much more pressing for many more people than ever before in my lifetime. For the 23 million who have lost their jobs, this means seeking new income sources in a devastated and transfigured economy; for the parents working from home, it means figuring out how to homeschool their children in-between figuring out how to navigate Microsoft Teams; for those getting married or grieving the loss of loved ones, it means finding new, socially distanced ways to celebrate and to mourn. The normal challenges of pursuing innovative solutions to one’s problems are also more intense and concentrated than usual: the knowledge terrain is insanely complex, the uncertainty is high, the stakes are catastrophic, and the voices of social pressure are strident, clashing, and ever-present. Proposing new solutions in this context can feel like stepping into a minefield. Even for such small innovations as fashioning a mask out of a scarf, one must deal with conflicting advice from public health experts, the risk of public ridicule, and lingering uncertainty about whether or how well one’s scarf-mask will actually do its job.
Yet plenty of people are innovating: in tech, in education, in biomedicine, in manufacturing, in research funding, in healthcare access, in entertainment, and in their individual lives. Perhaps this is precisely because the stakes are so high, and so little can be taken for granted; now as much as ever, we can clearly see that it’s on us—on our own fresh thinking and creative innovation—to get ourselves through this crisis.
For my part, I’ve never felt more engaged or “in my element” as a therapist, even despite all the extra grief and terror and rage and despairing loneliness I’ve been helping people process, and have sometimes had to process myself. Nearly every client I see is facing a painful new reality and, with it, an opportunity to self-innovate. Some of them don’t immediately see it this way; they think they are hampered by the loss of their old routines, or by their sudden inability to live up to the expectations other people have set for them. But often it is precisely this departure from old routines and expectations that sets them free to launch in a new direction of their choosing. My job is to help them see the runway, and to arm them with the psychological munitions they need to fuel and direct their own self-defining journey.
There is no job on earth I’d rather be doing. And in doing it, I’ve gained some insight into my own distinctive “specialty” and corresponding mission statement as a psychologist: To empower and inspire self-innovation in the people who need and can benefit from it most, in the times when it’s hardest.