From Lemons to Lemon Aide
  by Jim Esposito, M.A. LCMHC, NCC

For many years the mental health profession has been similar to that "Charlie Brown" scene where Lucy has a "psychiatric stand" dispensing mental illness diagnosis like lemon aide. This "disease model" has defined the profession for the majority of its existence. In fact, to this day, insurance companies will not pay for treatment unless the client is assigned a mental illness diagnosis and treatment is considered "medically necessary". While the mental health field continues to be anchored in this orientation around working with "pathology", there have been developments in the past several years that offer a more hopeful and refreshing staring point.

It's only logical that you can't produce something from nothing. If you conceive a person as an embodiment of symptoms and disorders, you are left with very little with which to work. This has given rise to a paradigm shift to a "strength based" perspective where, besides focusing on disabling symptoms, the clinician makes room to discover and explore qualities, abilities and resources that could serve to offset the disability. These qualities could be in the person or their environment. In some way, the disease model isolates people from their environment and relationships, which can be critical compensating factors. Put in terms of resiliency-based research, therapy has, for too long focused on the risk factors in a person's life, that is, examining what would contribute to tendencies to engage in self-defeating behaviors rather than examining what characteristics contribute to a person's capacity to be resilient against vulnerable factors in their life.

This approach has actually been around since the 1950's in the field of child development research. In one study, children who were raised in poverty with many attending risk factors such as exposure to drug abuse or violence were insulated or protected from negative outcomes when important protective factors intervened such as a relationship with a caring adult or successful engagement in school were present in their lives. These factors were found to be sustained throughout their lives.

At Counseling Associates we are very committed to a strength based approach beginning with our intake process in which we will examine the protective factors in an individual's life. Even within symptoms potentially functional traits can be found. In anxiety one can find sensitivity to one's environment; in opposition and defiance one can find independence; in guilt on can find the capacity to take responsibility; in compulsion one can find persistence, etc. As mentioned above, protective factors are not just drawn from the individual, but also their environment, including the family and community. Individuals are always part of a larger ecology and not tapping that resource reduces our options, especially if the individual possess limited resilience. Here is a list of the categories of protective factors we might examine when assessing a client.

Individual

  • Competence in various areas or a drive toward competence
  • Liked by peers
  • Sociable
  • Self-reflective, minimally impulsive
  • Flexible problem solving skills
  • Capacity for empathy
  • Good verbal communication skills
  • Stable relationships with peers and adults
  • Academic competence/reading skills
  • Prosocial value system
  • Socially perceptive
Family
  • For males, families with greater structure, rules and parental supervision, along with a father figure who encourages emotional expression.
  • For females, families that balance emotional support and risk taking with an absence of overprotection.
  • Families that expect participation with chores and responsibilities.
  • Families with strong religious or spiritual belief systems that provides children with a coherent and meaningful way of understanding their experiences.
Community
  • Concerned and involved relatives and neighbors.
  • Teachers who have a commitment to the whole child and extend interest beyond academics.
  • Available mentors.
  • Schools that can be flexible to accommodate special needs.

The new role of a therapist is that of a detective not searching out deep dark areas of psychological disorders, but rather, the strength and resilience of the client and their immediate environment. So getting back to another Charlie Brown and Lucy moment, when Lucy pulls the football away from Charlie Brown and he falls flat on his back for the millionth time, the old school therapist would pathologize Charlie as gullible and incapable of learning from past experiences. The strength based therapist would say that he has an amazing capacity for trust.