“A brand-new way of working with psychotherapy clients …”
The following article by Dr. Eric Maisel was also published in Psychology Today (February 3rd, 2019). It is Part 1 of a series introducing multi-lens therapy (the related follow-on articles will appear in Psychology Today):
Introducing Multi-Lens Therapy
What exactly is causing the emotional difficulties that your client or your patient is experiencing? You would think that this would be the question a practitioner is hoping to answer, since it is certainly reasonable to suppose that treatment should connect to causation. Yet a taste for investigating what is really going on has been lost over the decades. As helpers, we’ve moved toward too-easy labeling and accepted the idea that it is reasonable to help our clients without understanding what is going on “with” or “in” them.
This taste for investigation has been lost for many reasons, among them the following four:
- The DSM is loudly silent on causation;
- The idea of “symptoms” and “symptom pictures” has firmly taken hold;
- Training programs which are psychologically-minded focus on one theoretical framework or another, reducing the complexities of causation to “what fits our model”;
- It is so darned hard to actually know what is going on “inside” and “with” a given person.
How can we restore something as essential to the healing and helping process as knowing what is going on? There is no perfect answer but a step in the right direction is the following: providing helpers with multiple lenses through which to view their clients’ troubles. This multi-lens approach reminds practitioners that they shouldn’t be looking for some single cause, like faulty plumbing or a traumatic childhood, nor should they be operating from one orientation, say a biomedical or a psychodynamic one. Rather, a lot is almost certainly going on, each aspect of which may be contributing to your client’s difficulties.
This updated way of proceeding is called multi-lens therapy. It takes as it starting point that, as a helper, you do what you do because of what’s going on, not irrespective of what’s going on. The DSM seems not to care about “what is going on.” As therapists, we most certainly ought to. If your client has an actual biological problem, he needs one sort of help. If he hates his job, he needs another sort of help. If he was born with certain sensitivities, he needs another sort of help. It is absurd (and not okay) that a helper would look only at putative “symptoms” and not at what’s going on. It is likewise absurd (and not okay) that a helper would throw up his hands and say, “I don’t do causes.” Therapists may have gotten into that habit but that is a habit to break.
It may indeed turn out to be impossible to identify the cause or causes of a given client’s distress. But that is no reason not to try and no reason to pretend amnesia about the whole matter of causation. So, how should a therapist or other helper think about causation as that word pertains to human beings? The first principle is, think expansively rather than reductively. Multi-lens therapy provides twenty-five lenses through which to view and think about a client’s distress. That may sound like a lot but that is as it should be. Causation in human affairs is neither transparent nor simple.
You can be of help to a client even if you can’t discern what’s going on. You can be of help by being warm and supportive. You can be of help by virtue of your listening skills and your ability to carefully reflect back what a client is saying. You can be of help because you understand human nature and can usefully wonder aloud about your client’s behaviors. But that you can be of help without knowing what’s causing your client’s distress doesn’t mean that you should dismiss causation as “not something I do.” To engage in that dismissal would be to short-change your clients and, worse, to set the stage for big mistakes.
In multi-lens therapy, you take the position that there is no single way to look at human affairs. That a client is presenting a problem that he or she is calling “depression” doesn’t mean that you suddenly know what is going on. You don’t know if your client is in existential despair about having no life purposes, in a dark mood because of chemicals that he is taking that have darkened his mood, in anguish about his unravelling marital relationship, or announcing something that has always been true for him as a matter of temperament. You do not know and the very least you can do is announce to yourself, “I do not know – let me check.”
How you check depends on your therapeutic style. But informing that style should be an understanding of what might be going on. Multi-lens therapy provides you with twenty-five ways of thinking about what might be going on. These twenty-five lenses include the lens of original personality, which helps you think about a client’s basic temperament, the lens of formed personality, which reminds you about how “stiff” and intractable personality becomes over time, and the lens of available personality, which is a useful way to conceptualize your client’s current “amount” of free will and ability to change. Also included are the lenses of biology, psychology, development, family, social connection, circumstance, trauma, stress, and more. (You’ll find the complete list at the end of this article.)
Acquiring a working sense of these twenty-five lenses and learning ways of using them in session make for more powerful work and more helpful work. By proceeding in this way, as a multi-lens therapist, you don’t reduce what’s going on to “treating the symptoms of mental disorders” and you don’t operate from any reductionist theoretical orientation. Rather, you accept the largeness of human reality, a largeness that includes the complex nature of causation as that word applies to human affairs. Multi-lens therapy returns the idea of causation to therapy and helps therapists work more deeply, more powerfully—and more truthfully—with their clients.
A key to practicing multi-lens therapy is listening for causal hints. Clients regularly hint in passing at what’s causing their distress. The hints we get from a client help us determine which of these many causes are more probable than the others or maybe even which is the cause. Nor is it hard to hear these hints, if we train ourselves to listen for them. For instance, say that a client is presenting a relentless “down-ness” which you’re both likely to call “chronic depression.” Imagine that your client says the following in passing:
“I was raised Catholic but eventually became a Buddhist.”
You might nod and allow this information to pass by. Or, as a multi-lens therapist, you might take this as a causal hint, hinting at the possibility that your client has had problems making sense of meaning and life purpose, problems which were not answered by her birth Catholicism and which perhaps are not being answered by her adoptive Buddhism.
You would then investigate. A hint is a door waiting to be opened. In this case, one sort of investigatory question might be: “Has Buddhism done a good job of serving your meaning and life purpose needs?” Another might be, “That’s interesting. What did Catholicism lack that Buddhism provides?” A third might be, “What attracted you to Buddhism?” Each of these questions honors the possibility that your client’s despair may be connected to her inability to keep meaning afloat and her difficulties identifying and “owning” life purposes.
You don’t know for sure that this is the case and you’re treating her announcement as a hint and not a revelation. But you may be on to something, even something crucial. You can only know by stopping your client’s narrative and asking. Many therapists prefer to rarely interrupt or even to never interrupt, but a multi-lens therapist sees careful interrupting as a key principle of helping. I find that if I interrupt in a spirit of genuine inquiry, clients are neither disturbed nor offended by the inquiry. Indeed, they relish it.
Suppose that your client mentions in passing, “As far back as I can remember, I was sensitive.” You could simply nod. Or you might consider this a causal hint that perhaps some feature or features of her original personality are implicated in her despair or are even, maybe directly or maybe obliquely, the cause of her despair.
Taking her remark as a causal hint worth pursuing, you might ask any one of the following investigative questions. You might ask, “That’s interesting and maybe important. If your basic sensitivity somehow connects to you feeling down, what does that suggest, I wonder?” You might ask, “I wonder, wouldn’t a sensitive person be down more often than the next person just by virtue of her sensitivity?” Or you might ask, “If, as you say, you were born sensitive, that’s going to amount to a lifelong challenge, isn’t it?” Each of these questions opens the door to a fruitful and likely pertinent chat about original personality: about what it means, what it signifies, and how it matters.
Consider another sort of situation. Your client says, “I’m having a terrible time at work. I see things that aren’t making sense there and when I point them out I get yelled at. I tried to tell my parents about it when I visited them and they just put me down as ‘not a team player’ and ‘not a realist.’ All I could think about was what a failure I am. I can’t figure out why my life is such a mess!” This is a lot to unpack but a multi-lens therapeutic approach provides you with a straightforward way to proceed.
You might say, “You know, there are lots of different possible causes of your distress. What you just said brings to mind at least three or four possible causes. One is that stress may be a major culprit. You sound under a lot of stress. A second is that, since you were born with an incisive mind, you don’t take easily to humbug; and that may make it much harder to deal with dishonesty at work. A third is that your family is still tormenting you. A fourth is that you can’t get past the idea that you’re bound to fail. Do these all seem to be in play?”
By saying this, which may sound like a mouthful but which is quite easy to say with practice, you’ve looked at the situation through four different lenses (the lenses of stress, cognition, family dynamics, and original personality), helped your client better understand the multiple reasons for her distress, and provided a roadmap for your work together. You can work on whichever of these your client identifies as the most pressing. At the same time, you can keep the others “at the ready” to work on as time permits, when they reappear, or when it seems smart to return to them.
Your client is likely to reply, “All of that is true!” Then you can take any one of the following approaches (or others, of course). You could say, “Which of these four seem most important?” You could say, “Let’s pick one of these to focus on – which one do you think it should be?” You could say, “That’s a lot, isn’t it? That’s probably why you’re feeling down, because so many things are combining to get you down. What do you think you might like to try, given these several different challenges?”
Your client is likely to appreciate this approach, as it matches her experience of life and honors that many challenges are confronting her all at once. She will therefore become more invested in the therapy, dig deeper for her own solutions, and feel herself in a genuine collaboration. A solid direction for the work to take is likely to emerge; and the groundwork will be laid for future work.
As to that future work, proceeding with it might sound like the following. Say that you’ve been working on stress reduction for some weeks. At some point you might say, “Remember that we agreed that there were multiple things going on causing your distress. We’ve been working on stress reduction, which is great. But I wonder if we should take a look again at those other challenges? Maybe those toxic family dynamics, those thoughts that aren’t serving you, or how your talent for seeing through humbug is affecting you are work?” In this way, you can refocus the work through any of the twenty-five lenses when and as needed.
In addition to listening for and responding to causal hints, you might want to create talking points that you begin to use regularly to communicate important ideas to clients. You might want to create a talking point around the idea of multiple lenses, freeing your client from the belief that “exactly one thing” is causing her distress; a talking point around the relationship among original personality, formed personality, and available personality, which will help your client think about her basic temperament, her stuck places, and her remaining free will; and many other useful talking points. Here is how using one of these talking points in session might sound.
Imagine that you are in session with a client who has announced that she wants to make some changes in her life.
Therapist: “Okay, so you know that you want to make some changes.”
Therapist: “Because currently you’re pretty unhappy and pretty stuck?”
Therapist: “Let’s say that we do come up with some changes that you might want to make. How free are you to change?”
Client: “What do you mean?”
Therapist: “Here’s what I mean. Let me present you with a model. Imagine that personality is made up of three parts, original personality, formed personality, and available personality. Original personality is who we are at birth: our temperament, our smarts, our native abilities, all of that. Formed personality is who we become—the hardened person we become over time. And available personality is our remaining freedom, the part of us that is still able to make changes, see through our own games, etc. I see available personality as a sort of amount that can and does fluctuate—sometimes we are less free, say when we’re caught up in an addiction, and sometimes we’re freer, say when we enter recovery. Does that make sense?”
Client: “It does.”
The preceding was a characteristic talking point of multi-lens therapy. Once you create these talking points, they are very easy to use in therapy. In this case, you’ve presented your client with three huge ideas in a simple paragraph. You’ve announced that temperament matters—that who she was at birth matters. Second, you’ve announced that her formed personality is likely to be hard to alter, given that it has “solidified” over time. Third, you’ve provided her with a picture of what “freedom” looks like, opening the door to important existential conversations.
If you can say the above, or something like it, you will have presented your client with some big ideas and a frame that she can use for the rest of her life to help her think about her own personality, about where she is stuck and where she is free, and about how she might want to “make use of her current available personality” while also “increasing the amount available to her.” That is a lot to provide a client!
Therapist: “So, thinking about this model, how much availability personality do you think you have?”
Client (thinking): “Not very much.”
Therapist: “Okay. That’s where most people are. That’s one of the things we have to contend with, that lack of freedom. So, what might help increase that freedom?”
Client (thinking): “I don’t know.”
Therapist: “Fair enough. Let’s think about it together. Imagine that you were just a little bit freer. What would that look like?”
Client: “I would tell Bill what I think. I would have more of a voice.”
Therapist: “And if you spoke up, you would feel freer?”
Client: “But that feels much too dangerous.”
Therapist: “Feels dangerous or is dangerous?”
Client (thinking): “Both.”
Therapist: “Okay. Let’s tease that apart. What’s the actual danger?”
Client: “We’d be in conflict. And I hate conflict. And it might put us on the path to divorce.”
Therapist: “Okay. What’s the feeling part?”
Client: “That’s all tied up with me having authoritarian parents and having my voice silenced again and again as a child. That still frightens me, the vision of my angry mother and my angry father. Those feelings are very large and very terrible.”
Therapist: “Okay. So, we have two truths. Speaking up is dangerous and feels dangerous. Let’s see if there’s anything to do for the one and anything to do for other. Okay?”
Here’s another situation where responding to causal hints with a spirit of inquiry and careful talking points deepens the work. Your client says, “Visiting my in-laws, who are very old-fashioned and the opposite of progressive, makes me really anxious. I get so anxious that I get sick beforehand and sometimes get too sick to travel. This makes my husband really angry, because he’s sure that I’m getting sick on purpose just to get out of visiting. He scolds me and shuns me and my way of coping is to spend hours talking to my sisters, who are the only people I can trust.”
The issue here isn’t anxiety per se. The issue is the whole picture. To provide an anxiety “diagnosis” (that is, an anxiety label) and to opt for anxiety as the sole focus is the current reductionist practice. A multi-lens therapist unpacks this narrative, looks at it through the lenses of culture and society, trauma, social connection, instinct, and perhaps other lenses as well. She replies, “There’s a lot going on here. It sounds like you’re in conflict with your husband’s family’s values or they’re in conflict with yours. That’s one part of it. Then there’s the ongoing trauma of your husband’s scolding and shunning. There’s the wonderful, positive social connection piece with your sisters. And it sounds like your body is having an instinctive, self-protective reaction to the situation, warning you that things are not okay. Does that capture what you just expressed?”
It would be lovely if you are exactly right but it doesn’t matter if you are exactly right. You are simply inquiring; and your client will appreciate it that you are trying to get a real handle on her situation. A talking point that you might add in the course of this collaborative inquiry is the following: “When there’s lots going on we have to be patient and tease apart the various threads. It won’t pay to just slap on a label and call you anxious. We want to figure out what’s going on that’s making you anxious and, more than that, we want to get your whole life improved. Agreed?”
Your current way of doing therapy may not include much teaching, explaining, or using talking points like the ones above. But if you’re engaged in explorations and investigations with your clients, as I believe you should be, that requires that you help your clients understand what you have in mind. You want to be able to say, “That’s one possible way to look at what’s going on. But there are also other ways. Can we check those out?”
If your client agrees, then you will need your talking points so that you can introduce those “other ways of looking at what’s going on” in simple and clear ways. With those talking points at the ready, you’re much more likely to learn what’s really going on, which then allows you to aim your helping in the appropriate direction. By paying real attention to what may be causing your client’s distress, you greatly increase your therapeutic options.
Of course, that you have done some excellent work discerning causes doesn’t mean that you or your client will then know what to do. But that information must prove valuable, at the very least insofar as it prevents you and your client from misunderstanding what is going on. And it is bound to suggest possible avenues to try. Whether those avenues will prove fruitful must remain to be seen. But you are traveling down them for good reasons, because you have inquired and listened.
Psychotherapy as an idea and as a practice has not completely escaped critical scrutiny. But, on balance, the critical psychology movement and other critics of contemporary mental health practices have more often taken aim at deconstructing the mental disorder paradigm, as reified in the DSM, than deconstructing the psychotherapy paradigm. Psychotherapy has managed to fly a bit below the radar of critique.
But it has needed critiquing, in large measure because it has taken too cavalier an attitude toward causation. What a doctor does is generally well justified by virtue of the fact that he is treating the causes of things as well as their symptoms. He cares if it is a virus and he cares which virus it is. What a psychotherapist does is on much shakier ground, since psychotherapy has taken a cavalier attitude toward causation and not made “investigating causes” a central activity of the practice. Therapists, provided by psychiatry with a checklist way of labeling clients, have been rather left off the hook when it comes to tackling the matter of causation.
A multi-lens therapist is on much more solid footing, since he or she can say, “I check carefully for causes by investigating the causal hints I hear and the causal clues I get. I then connect my helping strategies to what I learn. If I can’t discern what is causing my client’s distress, I can still be help, because talk helps and support helps. But I don’t act like causes don’t matter and I do my human best to figure out what’s really going on. This is no easy task, as causation in human affairs is typically complex and obscure. But I try.”
Multi-lens therapy asserts that if you are leaving out temperament, social and cultural realities, life purpose and meaning issues, and the other lenses through which a multi-lens therapist looks at her clients, you are leaving out too much. You are operating from too limited a place and making it harder on yourself to be effective by virtue of not meeting your client where she is “really at.” If you do meet her there, she will trust you more, warm to you more, engage responsively, and do more work out of session. Multi-lens therapy paints a truer-to-life picture of human reality and also makes the work of psychotherapy much easier. There’s a lot to value there.
25 Lenses Through Which to Investigate Causation:
The following list is not meant to be comprehensive. But it does a good job of not being reductionist and it allows for a lot of rich thinking and investigating.
1. The Lens of Original Personality
2. The Lens of Formed Personality
3. The Lens of Available Personality
4. The Lens of Circumstance
5. The Lens of Time Passing
6. The Lens of Mind Space
7. The Lens of Instinct
8. The Lens of Individual Psychology
9. The Lens of Social Psychology
10. The Lens of Development
11. The Lens of Biology
12. The Lens of Family
13. The Lens of Cognition
14. The Lens of Behavior
15. The Lens of Social Connection
16. The Lens of Experience
17. The Lens of Endowment
18. The Lens of Stress
19. The Lens of Trauma
20. The Lens of Emotion
21. The Lens of Culture and Society
22. The Lens of Environmental Factors
23. The Lens of Psychiatric Medication and Chemicals
24. The Lens of Creativity
25. The Lens of Life Purpose and Meaning
ERIC MAISEL, PhD
Eric Maisel, PhD. is the author of more than fifty books and a noted thought leader in the movement known as critical psychology. His books include Overcoming Your Difficult Family, Rethinking Depression, The Future of Mental Health, Helping Survivors of Authoritarian Parents, Siblings and Partners, Humane Helping, Helping Parents of Diagnosed, Distressed and Different Children (Routledge, 2019) and Unleashing the Artist Within (Dover, 2019). Dr. Maisel is a retired family therapist, active creativity coach, and critical psychology advocate. He writes the Rethinking Mental Health blog for Psychology Today, provides keynotes for organizations like the International Society for Ethical Psychology and Psychiatry, and lectures and delivers workshops nationally and internationally.