When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

And yet these so-called "mental disorders" do little more than equate designated patterns of behavior, emotion, or thought—called syndromes—with alleged psychological malfunctioning. Such syndromes are no more than sets of symptoms that can be collected together in a wide variety of different ways, but depending upon how they are grouped, distinguishable syndromes can be pointed to and named. This is a highly arbitrary process very much like fortune-telling using tea leaves, which depends on the pattern seen or imagined in the tea leaves at the bottom of a cup.

During the past three decades, clinical psychology and its less formal cousin, counseling, have also undergone noticeable change. They have been the traditional sources of a large number of diverse approaches to psychotherapy and counseling. But in the past thirty years, the large number of approaches to psychotherapy and counseling has, in practical reality, shrunk considerably. This has been due to the rapid dominance and virtual monopoly that has been gained by cognitive-behavioral therapy, also known as rational-emotive therapy. Insurance companies have been attracted like flies to the sweetness of the comparatively brief treatment period touted by cognitive-behavioral therapy, and practitioners have similarly been attracted by the ease of using its one-size-fits-all approach.

And so where the changes in psychiatry have been inflationary in its authorized catalogue of "mental disorders" known as the DSM (Diagnostic and Statistical Manual of Mental Disorders), clinical psychology and counseling have been on a deflationary course that has progressively narrowed the treatment options available to many people.

Despite the passage of time, When You Don't Know Where to Turn remains the only step-by-step self-diagnosing guide to counseling and therapy, a guide that seeks to direct individuals—by respecting and responding to the very great differences that exist among individuals—to approaches to counseling and therapy that may be most likely to benefit them—taking into account the nature of their own individual problems, their different degrees of willingness and abilities to learn and to change, and their differing individual situations in life, including their financial resources and the amount of time that they are willing to devote to therapy.

Such a customized, individually-centered perspective is not popular today. The human population continues inexorably to expand while our healthcare system insists on general applicability and streamlined efficiency. Individual problems in living are more easily and rapidly "processed" when they can be subsumed under specifiable diagnostic and treatment codes. In this increasingly mechanized process, the individual person and the individual problems of living he or she is attempting to cope with tend more and more to be ignored or neglected, and his or her diagnosable "disease entity" becomes the object of attention.

These comments are not a polemic against current trends and fashions; they are rather intended to place in perspective the changes that have occurred in the mental health field during the past three decades since the first edition of this book came off the press. What a reader might take away from these preliminary remarks are these suggestions:

* to recognize that, like so much that is a human production, today's classification system of mental disorders is unlikely to be the final word about the human condition, but that its proliferating list of mental disorders should be taken by the humble at least with a grain of salt, and rejected wholesale by those who are more critically inclined;

* to accept the fact that it is becoming harder with the passage of time to find one's way to a mental health clinician who is not recipe-oriented, due to the in-fashion monopoly that prescribes cognitive-behavioral therapy, and due to the pressures on the healthcare system to process people and their problems faster and at lower cost; and, finally,

* to realize that, when it comes to problems of living, those who are willing to accept a healthy measure of responsibility for their own choice of practitioner and treatment are most likely to find a practitioner and a treatment that meet their individual needs.

From this point of view, When You Don't Know Where to Turn continues to offer readers a heightened consciousness of alternatives to treatment that do still continue to available, though they can be somewhat harder to find in some areas of the country, and to give readers a sense of what those alternatives have to offer and for which kinds of problems and personalities they may best be suited.