How important is it for a counselor to diagnose the client’s root problem? Consider these analogies:
Imagine being diagnosed with cancer in one part of your body but having your doctor tell you that it isn’t important to discover whether the source of that cancer lies elsewhere. You wouldn’t be happy and you would likely seek another opinion. Or, consider this analogy: you keep cutting off the tops of dandelions only to find that they keep coming back. Not a very wise decision. Instead, you find the tap-root and remove it if you really want to stop the weed from growing.
In the last week I have had three conversations about identifying the source or primary cause of someone’s emotional struggle. In each case I was asked questions about the source of the problem.
Is it a chemical imbalance? Is it the result of childhood trauma? Is the primary problem his sin?
I understand these questions. They are reasonable and important to ask. As a counselor, I am trying to assess how a particular psychological problem develops in an individual. But, maybe these questions aren’t as helpful as they first appear. Here are two reasons why we ought not put too much stock into seeking out the root problem and a suggestion for a different approach than the “why” question.
- “Why” questions almost always lead to a simplistic/categorical answer. Most psychological (or spiritual) problems have multi-factored roots. There are biological predispositions, experiences, behavioral choices/habits, perceptions, beliefs, etc. all working together to “allow” the problem to develop. Usually, we do not find this kind of complexity very helpful. We like to narrow things down to single or primary problems. Narrowing down to either/or categories helps us “understand” the problem and exert energy towards a single solution. However, when we demand a primary cause, we will almost always misrepresent the problem and may communicate to others a distorted image of what is taking place. Saying that a psychological problem is the result of sin or neurochemicals or family upbringing ALWAYS flattens the problem and as a result puts too much hope in any intervention.
- “Why” rarely leads to the most important question, “so, now what?” Let’s say that we can figure out why you struggle with Obsessive-Compulsive Disorder (OCD). Your mother contracted a virus during the 7th month of her pregnancy and that virus altered your prenatal brain and caused your OCD. Okay…so now what? Notice how the why question provides interesting information and possibly helpful in eliminating the problem in future expecting mothers…but as enticing as it is, the diagnosis doesn’t help much with the, “so now what do I do about it.” In fact the desire to figure out the “why” never is as clear and easy as I have just made it in the virus example and so the search for “why” doesn’t lead to the “so now what” question at all. Now, I don’t want you to think that I care little for historical data gathering. The multifactorial etiology of our problems are worth exploring. We ought to take a look at how early childhood experiences shape our current behavior. We ought to explore the possibility of a biological predisposition to our anxiety. We ought to examine how our beliefs about self, other, and God influence our current problems. However, we explore these historical facets not because they answer the “why” question but because they help us understand “how” we function and whether we want to alter some of these shaping influences.
An Alternative Approach?
I’ve just tipped my hand in the last point. How is a better question. Finding out how a particular feature (belief, habit, experience, perception, biological process, etc.) influences current life and how a person might respond to or engage differently over a problematic emotional expression is more likely to bear good fruit. Consider these examples:
- How does your history with pornography and secret shame influence your seeking accountability from your other men in the church?
- How do you react to trauma triggers and what different responses to triggers might you want to practice?
- How do you want to think about or assess your unwanted sexual desires and feelings?
So, asking why we do what we do or why we are the way we are is interesting but not always the most helpful question from a counselor. Instead, explore your perceptions, reactions, thoughts about what is happening and explore how you might come to feel, think, or engage the problem from a different perspective or with a different goal in mind.
Musings on Faith and Psychology 
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Well this resonates. Paul McHugh suggests that he saved the John Hopkins psychology program from irrelevancy by taking this approach – and by insisting on verified results (see his book “Try to Remember”). I like the way you’ve balanced the “why” and “how” here, Phil. One question isn’t better than the other except in the particular context of its use – thus the need for balance.
Here’s a question though: How much of an up-hill struggle is it in Christian counseling to get this idea across? I’ll quote from a well-known article which seems to insist on finding the root problem. In Adult Survivors of Sexual Abuse” the author says, “This memory retrieval is necessary…” Here is a very common and influential theme that says you can’t heal until you dig back into the past. How do you approach this?
Interesting that this seems to bring the solution back to the personal responsibility and accountability. Example: How do I react to anxiety triggers and what different responses to triggers might you want to practice? With a little honest evaluation of myself and help from someone skilled in teaching those practices I would probably move quite nicely from anxiety to coping.
Excellent post. Psychologist Gordon Allport (who, as a young man, had a personal encounter with Freud) wrote about the idea of “functional autonomy” – many disorders and conditions take on a life of their own, independent of the initial cause. Therapy is most effective when it focuses on the factors that PERPETUATE the problem, not those which PRECIPITATED or PRE-DISPOSED the client. As Jonathan Grayson has pointed out: if I started smoking at the age of 16 because of peer-pressure, no amount of work on peer-pressure (even though it may still be an issue in my life!) is going to help me quit smoking when I’m 45.