A General Practice of Therapy

I remember as a kid wanting to be a teacher. I applied to medicine because I got good marks and that’s what you did. I got in, and it seemed like a good idea at the time. I didn’t enjoy it much in the early years of the degree, but with time and experience the practical aspects appealed, and the experience of making a difference to someone was very satisfying. I was headed down a surgical path until the 80 hour weeks, as interesting as they were, made me realise that family life and having children would be pushed to the side. I switched paths to General Practice and was surprised that I really enjoyed it, particularly getting to know people and families and being involved in their ongoing wellbeing.

After 10 years in General Practice most GP’s have seen everything once and are moving into more specialised interest areas. For me medicine was becoming a “paint by numbers” experience, with practices and protocols taking any hint of creativity from its practice. The one area this wasn’t happening was in mental health, where mainstream medicine was sorely lacking in effectiveness. It was at this time that I was taking stock and looking at my books I realised most people were coming to see me for counselling. I began to feel a fraud as I’d had no training in counselling as an undergraduate, and even in the general practice training programme at that time, we had one afternoon with a psychologist and a weekend workshop with Steve Bidulph.

It was then that a flyer for The Diploma of Solution Oriented Psychotherapy Run by Doug Carter and Rob McNeilly at The Brief Therapy Centre in Hobart, arrived in my in-tray, and I liked what it said. It was about assuming resourcefulness and helping people reconnect with their own nascent strengths to move past the problem, rather than diagnosing and pathologising. I knew my patients were resourceful. I often thought if I’d been through what they had, I didn’t think I’d be doing as well as them, so I was keen to find out more.

I went along, and from the first I was hooked. It was exactly what was missing in medicine, which is a problem fixing approach. The solution oriented approach seemed to be the missing half, the other side of the whole, and with both I no longer felt stuck. After 4 years of training I began teaching the approach and found it amusing that I had come full circle.

General Practice provided a unique environment for practicing small aspects of therapy and building skills, and medicine in many ways was a good grounding to work with people who are suffering. I am interested in doing good work, but research into effectiveness of therapy is mostly unhelpful to the practitioner wanting to do better. There are a few notable exceptions including Scott Miller and his work on FIT and Bruce Wampold who wrote The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy work, which is a marvelous distillation of outcome research.

The tangle is in part that psychological studies can’t be blinded. As Jay Haley said in 1994 “The realisation that a therapist influences the data he theorises from and cannot be objective, has caused therapists to realise they are part of the truth they seek.”

I am interested to explore what we should learn, how we can teach and what we should practice to improve effectiveness in the management of mental health and wellbeing. Part of this is what questions should we be asking, that if they were answered we would know what to do?


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