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HELPING PEOPLE HOLISTICALLY: SOME
THOUGHTS FOR COUNSELORS.
Irle M. Goldman, Ph.D. ( 1997)
People come to mental health clinicians for help when they feel stuck in their lives. They have tried
to use their own resources to overcome their pain but these have not been enough. So they come to
us for help.
The better we can help them to conceptualize their problem on a variety of levels ( without
overwhelming us or them), the better we will be able to provide them with a context for healing- a
way out of stuckness. That is why I find a holistic approach to psychotherapy so useful.
In this article I would like to discuss a framework for using a holistic approach and describe my
work with one particular client , hoping that you might find this information useful in your clinical
work.
SHAKING SHIELA
Shiela, a petite 20 year old tennis star, sat on the couch in my office. Her eyes stared away
from me, down, towards the carpet. She spoke quietly, haltingly, as if trying to squeeze her
words through a bottleneck of shame.
"My knees shake...uncontrollably... Can you help me get them back under my control?"
she whispered.
I looked down to her knees. They were still. No movement was evident. I wondered what
she was talking about.
" No" she responded, as if she had read my mind, "It happens just when I most don't want
it to happen....in front of a class, when I'm with someone I'm trying to impress...my
boyfriend's parents... people like that."
HOLISM
.
My friend Andrea Cooper once came to a class that I was teaching to talk about her
treatment program for batterers at the local jail. When a student asked her how she could tolerate
working with such a population, she answered. " I always remember the words of one of my
teachers, You sit with the person and not with the crime." That is our challenge.
How can we treat the person and not the disease? We need to be able to look at people from
a multi-dimentional lens. We need to be able to see their strengths as well as their weaknesses. We
need to see how their challenges may be their opportunities.
When you are working with a client it is best to keep many options open in your mind.
Hold open many ways of seeing what's going on with the client. Then you can have the flexibility
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of choosing the path that works the best for that particular client at that time, and for you the
therapist at that time.(Be sure that you don't leave yourself out of the equation.)
So here I was, trying to help someone get control of a symptom I could not see. My mind started
pacing. Could I help her? Perhaps the problem was medical or neurological. Could I help her to get
rid of her shaking? I could feel my inner tension and worry building.
I stopped myself. I'd helped hundreds of people before. I knew I was a good
psychotherapist. So why, suddenly, all of this self-doubt? I took a moment to breathe and to think.
I began to remember that this anxiety was a familiar feeling for me when I worked with a client
like Shiela. I was picking up on all of her self-doubt and feelings of inadequacy.... it triggered my
own, similar feelings. Now I could breathe. I could use these feelings in myself to help in working
with Shiela. They could help me both to identify the feelings ands to help me to connect with
Shiela.
Shiela was not used to getting help. She had always excelled in her chosen field, be it
tennis or academics. She chose not to enter those areas in which she was weak or vulnerable.
Now she was being confronted by a crisis, an unexpected jag on this life path. Here, in the
areas she felt comfortable in, excelled in, she would sometimes begin to shake. This was
something she didn't bargain for. Her coming to me was therefore, an admission of
failure...an uncomfortable and psychologically a dangerous position for her to be in.
Somebody once told me that the practice of psychotherapy is basically the practice of
hospitality. You offer a place for people to come to be listened to and cared for. You then deal with
their difficulties, resistance and fears about this caring relationship. As the client works these
issues through they are able to take in more nurturing and have a fuller, richer, more balanced life.
Here is where the practice of hospitality as psychotherapy could come into play. Shiela
needed to deal with her feelings about being taken care of. My task was to respect her defenses... to
honor her ability to take care of herself, while allowing her the possibility of leaning on someone
else. Her course of therapy might be seen as her ability to tolerate more dependency in the service
of her becoming more independent.
Shiela's shaking started about two years before she came to see me. One morning,
after drinking too much the night before, she woke up and her knees wouldn't stop shaking.
She was scared. Her family were teetotalers, opposed to drinking because of what alcoholism
had done to her grandfather and some of her uncles and aunts. Was this shaking proof that
she was an alcoholic too ? Was this her punishment for rebelling against her family ? Should
she have been the obedient child like her brother was?
I began to ponder...Ah! Her family! To what extent would her family play a role in therapy?
At the age of twenty her developmental task is to allow herself more separation and independence
from her family. This is usually accompanied by the need to deal with the anxiety of being more
independent in the world while maintaining supportive connections to friends. This time is often a
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difficult, confusing and conflictual time for many young adults. Dealing with the push-pull of
relationships with friends, boyfriends, family and self at such a time can create a great deal of
anxiety. Was this the dynamic that was going on underneath her shaking?
Shiela decided not to drink again. The shaking passed... at least temporarily. A few
months later, while demonstrating a tennis position to her class, she noticed her hands begin
to shake again. She was mortified. What would the students think of her ? How could she
teach them? No one else noticed. Her boyfriend was teaching the class with her. He told her
later, in response to her questions, that he did not notice any difference from her usual class.
But Shiela did. She kept noticing the quivering, that shook her fingers when she was
around people who she was trying to make an impression on.. And so began the journey that
brought her to me.
I began to think about these new bits of information. Shiela had a boyfriend whom she
trusted and confided in about her problems. Could he be of help? Would Shiela's relationship with
her boyfriend help to illuminate the pattern of her problem and the path towards healing? Would he
be able to provide information which could help us develop a treatment plan? Did the fact of their
relationship indicate that she was able to connect with others in a way which could alleviate her
anxieties and allow others to soothe her. This would be a positive indication for the potential of
psychotherapy to help her.
Also, I noted that she was able to stop drinking. This showed that she had the ability to
change her behavior in a way that could help her to deal with her problem. A major strength! The
discipline and energy that it took for her to become a tennis star could also serve her well in her
following up on suggestions and ideas that would come from our sessions together.
THE HOLISTIC COURSE OF TREATMENT
I ask Shiela to contract with me for a ten-session course of therapy. It seemed to me that ten
sessions would allow us to explore many of the avenues that might be useful while giving her a
reasonable financial and time commitment. During that time we approached her issue on several
levels . Here are some of the ways we worked together..
Referral: Get help from others. You don't have to work alone
1) I asked her to contact her physician for a referral to a neurologist. Although she agreed to this
request, she never followed through.
Behavioral-Interpersonal-Creative
2) We role played her most feared situations and constructed ways that she could deal with the
embarrassment about her shaking. e.g. tell the class that she had injured her wrists working out the
previous day etc.
Behavioral-Cognitive-Creative
3) I supported her in experimenting...trying to put herself into situations where the shaking would
occur and in figuring out different ways to deal with it... e.g. talking to others about her problem so
that they could support her at times of need. This approach took an interesting turn because
whenever she would share her fear with others, she couldn't shake....but the fear remained that the
shaking would return.
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Physical- Interpersonal (be a teacher)
4) I taught her relaxation exercises, breathing patterns and ways of distracting and soothing herself
when she felt the shaking coming on.
Cognitive-Affective (Historical)
5) We reviewed her history, her family, her growing up years. We explored when and how she felt
adequate and inadequate with others...How she judged herself. What she learned in her family and
school about trusting others and showing fear.
Cognitive- Affective (Developmental)
6) We talked about her being 20 years old and what that meant to her...How it felt to be leaving her
parent's house, to be engaged, to be expecting herself to be independent.
Affective
7) We explored what her life would be like if she could show more of her vulnerability...what her
fears were about it and what her hopes were if she could be that way
Interpersonal-Systems
8) We invited her boyfriend in for three sessions in which he shared his view that Shiela was often
trying too hard to appear perfect. He touchingly told of his own crisis of when his arm was
damaged in an accident. People would stare at him because of it. A series of botched surgical
procedures taught him how to have compassion for himself in dealing with the challenges of life. It
was clear to me that this was a major reason that Shiela was attracted to him. She could learn from
him how she could be more compassionate towards herself ( at the same time she was terrified by
this notion).
Interpersonal
9) We discussed our relationship and how frightened she was of becoming too dependent on me. I
shared the stories of similar times in my life when I wouldn't let others support me because I feared
that I would be seen as inferior to them. In this way, we began to bond in a less hierarchical way.
Humor
10)We joked about her problem...created outrageous scenarios of what she could do when she
started shaking...how she could turn it into a new tennis serve, or teach each of her students how to
shake in the same way. Humor helps. It gives perspective and relief when there seems like there is
no other out.
Follow-Up
Six months later I called her to see how she was doing. She reported that she was able to cope
much better with her anxieties about shaking.... they haven't all gone away but she feels she has
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many more ways to deal with them. I congratulated her, wished her well, and told her that I was
available by phone or in person if she wanted any further help.
CONCEPTUALIZING HOLISTICALLY
I dealt with Shiela from various perspectives. I viewed her process through various lenses.
There was the biological level. We all occupy physical bodies which manifest the biological and
chemical parallels to our psychological processes. It's important to recognize this level. Would it be
best to see Shiela as having a mostly physical disorder? Would medication help her? Did she need
to see her primary physician for a checkup and perhaps a referral to a neurologist? Should we try to
alleviate the symptom through medical intervention? Would this be the simplest and best way of
treating her? Is this what she wants and would it work?
On the behavioral level the shaking could be seen as an unwanted habit. One day she started
shaking because she drank too much. Someone may have commented about it. She began to worry
that someone would see her in this state and think badly of her. So she created a cycle of worry that
perpetuated the symptom of the shaking hand. She couldn't get it out of her mind, or her body.
In this conceptualization, her shaking can be seen as mostly a behavioral, learned problem
that is best dealt with through unlearning. I could teach Shiela relaxation exercises while conjuring
up images of the feared situation. Perhaps just her talking about her shaking in the safety of my
office could alleviate it.
Or perhaps we should concentrate on the affective level of her problem. Her shaking may
be a way for her body to tell her that it is time for her to deal with her fears...that it is time to stop
just overcoming them or hiding them (as she has learned to do so well in the past.) It is time to
express them and integrate them into her personality.
Sheila has had a long history of overcoming fears, of pushing herself to be the best: The
best athlete, the best teacher, the best daughter. Perhaps this symptom is telling her that it is time to
let up on that role. . her that is can be too burdensome...Maybe it is time to experience the fears, to
go through them. Maybe it is time to learn to accept this part of her and respect it in order to
achieve a better balance in her life.
In this area, the therapist's job would be to be with her in her fear... to help her to be more
tolerant of the fearful part of her. to help her to become a more whole and integrated being. (This
means the therapist's personal work is in learning even more to tolerate and accept his/her own
fears .)
Or perhaps the shaking has more to do with the way she thinks about the world and thinks
about herself. How she conceptualizes the world in terms of strength and weakness. How her
shaking hands had proved to her that she was weak (which is so unacceptable to her).
Perhaps our work has to do with her expanding her judgment of the world of others of
herself so that shaking hands may be seen as a welcome call for help, or as a way to show her
vulnerabilities so that she can connect more wholly with others and with herself. Maybe this is the
cognitive challenge.
Or perhaps the shaking can be seen as a gift from the Universe...God..A Higher Power..or
from her psyche...a spiritual challenge. A gift that is telling her that she has some work to do. That
this work has something to do with how she is being seen, how perfect she appears; what she need
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to do in order to get to the next level..accepting her humility?, her anger? her imperfections?
Perhaps it is a guide to the next level psychologically, interpersonally, and/or spiritually.
WORKING HOLISTICALLY
All of these ways of seeing the client and her symptom are true...all might be useful at the right
time, in the right place. That is why It is important to be able to work on a variety of levels. When
one falls flat , loses its energy, you are then able to transfer to another level in order to help the
client. ..Much in the way that a portable phone can flow between ten channels. When one is full of
static it automatically moves to another channel to allow clearer communication.
In determining which level to work in, a lot depends on where the client is at. Where his or her
energy is at and hat she or he is open to believing. What is attractive to her/him as a path towards
healing and resolution. And what you, the therapist, believes in and is interested in at that time..
As clinicians it is important to remember that although we categorize the various parts of people's
experience, e.g. the cognitive, affective, biological, behavioral, spiritual, we are always, in fact,
treating a "whole" person in all of his or her aspects.
Essentially, the differentiation of a person's experience into various segments is a false one.
We can talk about the biological, behavioral, affective(feelings), cognitive(thinking),
relationship, creative, spiritual and many more aspects of experiencing a particular person but we
must remember that these are only ways of conceptualizing. These concepts do not really exist
outside of our thinking. They are just a way to look at the same person through different lenses in
order to be able to help them better.
If we look at an X-Ray of a person we are seeing that particular person through a different lens
than if we saw him or her with our own eyes. Both ways of seeing are true and correct Each has its
uses, its place and purpose.
Because the lenses are different does not mean that the person is different. Nor does it mean than
any one way of looking at a person is better or worse, truer or more false. All can be true all can be
good. The only question is which is most useful at a particular time for a particular purpose.
Sometimes it is more useful to follow a more biological angle; sometimes it is more useful to
follow a more spiritual angle. The art is in knowing what you want to use, when you want to use it,
and how you want to use it.
Let me also point out that just because an intervention works does not prove that the problem
existed only at that level. When there is a change in the serotonin level in the brain when someone
is depressed, it does not mean that this change "caused" the depression. We are very complex
systems with many interconnections. A failed relationship may have triggered the disappointment
which triggered the sadness which interacted with a history of being unable to tolerated sadness
because of a mother who drank alcohol whenever she felt sad which triggered the client's
depression which triggered the seratonin. It's Kind of like the Old Lady Who Swallowed A Fly!
We are complex. We have multiple links,( It is said that every cell in our brain can have 10,000
connections to other cells) , steps, connections, between how we think, what we feel, how we relate
to others, how we think and feel about ourselves, how we give meaning to our lives, the messages
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our genes provide us, our experience of our families, luck, our economic and political experiences,
etc. etc., etc.. All of these and many more are/can be connected to the etiology and resolution of a
depression, anxiety disorder, sleep disorder, or any of the diagnoses described in DSM-IV. All of
these could also be connected to our achievements, the joys of our lives. From being able to write
a symphony to being able to listen to that symphony joyfully and completely.
When we are able to look upon people in this way -in a multi-faceted holistic way- we open up
to many pathways towards healing. We open up to a map in which the direction towards
healing, towards greater self-understanding, towards self-fulfillment and self-love has many
pathways and many possibilities.
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