Q: What treatment philosophy and framwork do you use?

Perhaps the most common answer to this question is “eclectic” because most practioners do not stick to one framework for all that they do for every patient that they serve.  The problem with the “eclectic” answer is that it does not explain to anyone what frameworks they are familiar with and use. It also does not explain when it is used, how it is used, or with what population it is used.  Couple this with a hesitation, for some practioners, to admit any bias or personal beliefs about patients and their respective difficulties, and you get some vague ambiguous answers.

My belief and philosophy begins with the potential of every individual regardless of the reason(s) they are seeking treatment.  This is evidenced through the wide range of patients I have treated and in the multiple settings I have worked and treated them.    I have worked with patients who are victims of abuse and patients who are criminally involved and are abusers.  I believe that everyone is worthy of help and treatment and, most important, to receive that treatment with respect and dignity. I also believe in the need for the multitude of settings that exist and offer treatment; from outpatient facilities to incarceration facilities.  The true answer to the question, however, really is eclectic because it really depends on the patient you are treating and their respective difficulties.

I have been fortunate enough to study under the tutelage of some of the foremost experts in clinical social work while working toward my master’s degree at the Columbia University School of Social Work.  As such, many of them have greatly influenced the manner in which I assess and view patients and the manner in which I provide treatment.

From the onset, I have a steadfast belief in the Eco-Systems Perspective (Carol H. Meyer).  This is particularly true in the assessment and diagnostic phases of treatment.  This perspective takes into consideration transactional relationships between persons and environment.  This includes, but is not limited to, various systems a person may be involved with.  For example, how the person interacts with all systems they are involved with (schools, friends, family, courts, etc..) lends significant information to the assessment and treatment process. 

Consistent with the eco-systems perspective and approach, I have a belief in the works of Richard Cloward and, in particular, the Strain Theory and Anomie.  These theories lend themselves to the belief that criminal behaviors stem from environmental factors and social structures.  While they do not excuse criminal behavior, these theories help inform the treatment that I provide to this population.

The foundation of the treatment I provide is primarily Cognitive Behavioral Therapy (CBT).  Although I recognize that some issues are multifarious and deeply rooted in a wide range of factors (i.e. social, economical, past abuse, childhood traumas, situational factors, etc.) that could have taken place over the course of decades, I do also believe that treatment should be goal oriented and time limited.    

If a patient is in treatment for several months or years, it should be to work on multiple goals.  Further, many patients can be treated effectively throughout several “episodes” of treatment.  Sometimes treatment is effective in getting people over a hurdle in life and they are well functioning until another hurdle presents itself.  For these reasons, another episode of treatment may become necessary. 

Other foundations of treatment that I am familiar with and borrow from regularly in my practice include components of Dialectical Behavior Therapy (DBT).

For family therapy, I was provided training and clinical supervision in Structural Family Therapy (by Salvador Minuchin) from the Minuchin Center  from  1/96 to 10/98 while employed at Atlantic Behavioral Health as a Clinical Coordinator.  I find components of this theoretical framework very useful today.  This is particularly true of assessment of family conflict.  Additionally, the didactic framework and approach of Murray Bowen and the Family Systems Theory/Bowen Theory also contributes to my knowledge base, beliefs, and approach to family treatment.

Moreover, for patients who are criminally involved and have a history of hurting others, I believe in the Supervision Team Framework. This Supervision Team Framework means the therapist, with the express written consent of the patient, does not work in isolation but works in a collaborate effort with the salient agencies involved with the patient.

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