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Helping As an Art and Science

Posted by Anthony Salerno on July 14, 2021

AnthonySalerno2Before leaving my group each week, I create space to engage with one of my favorite facets of Evoke’s staff development--reviewing what our participants refer to as “yellows” (the list of weekly treatment goals and assignments for each student that are documented on yellow sheets of carbon-copy paper). Not only do these conversations allow me to clarify my intentions and vision with specific assignments, (and, yes, to also spare field instructors from having to decipher my notoriously poor handwriting) but they also allow me to gauge and cultivate each instructor’s creativity and insight into the therapeutic process. And following my conversations this past week, I found myself reflecting on what a special opportunity this is for our participants, our staff, and our clinicians.

Being a clinician whose introduction to mental health work began with my experiences as a field instructor, I did not realize how well-prepared I would feel in starting graduate level coursework. Despite there being a cornucopia of skills, techniques, theories, and interventions that I gained during my experiences back in graduate school, the intangible, intuitive, and relational factors that I began cultivating while I was in the field were and remain invaluable to my clinical development. As I considered this balance, one that Young (2017, p. 18) captured most eloquently in his acknowledgement that, “the effective helper is both creative and intellectually competent, a Renaissance person who appreciates both the science and the art of helping," I felt drawn to illuminate the skill and art that each member of our team provides beyond just the weekly sessions.

Reflecting on Young’s words, it is a fairly straightforward acknowledgment that helping, and in effect counseling or therapy, must be approached as a science. Grounding my theoretical approach in an evidence-based orientation, and using techniques and interventions that have demonstrated reliability over time is unequivocally important to me in meeting best-practice guidelines. However, in a notable publication by Miller et al. (1997), the authors provided estimates on the impact of the four most common factors responsible for clinical change:

  • client and extra-therapeutic factors (the things that happen independent of any clinical support offered): 40% 
  • the clinical relationship (how well we connect with our clients): 30% 
  • outcome expectancy (how much the client believes in the work): 15% 
  • therapeutic model or specific techniques used (the assignments and approach we use to support clients): 15% 

Their findings were a great affirmation that steps taken to improve the clinical relationship could also have a significant impact on a client’s ability to change. Thankfully, this principle is elucidated often in graduate level coursework. The power of the therapeutic relationship simply cannot be understated.

As I recall my own experiences of beginning coursework designed around the practical application of clinical skills (in a sense, “the art of helping”), the anxiety and trepidation that impacted many of my peers presented differently for me. Being asked to leave behind the “comfort” of conceptual, textbook-based therapeutic simulations (in this case, “the science of helping”) felt natural and exhilarating! I remember feeling eager to translate the many first-hand experiences I had accrued as a field instructor into the brick-and-mortar sessions I began facilitating. And to my pleasure and that of my fellow field-instructors-turned-clinicians, the Evoke model had thoroughly prepared us all to take those steps (please read my friend Elinor’s recent blog on the integral role that field instructors play within our treatment team here).

During my tenure in the field, I was given countless opportunities to refine the artistic nature of the therapeutic support I offered, and I came to love the freedom of expression I was afforded as an instructor. The time I spent as a novice helper forging connections, establishing trust, and serving as a container for intense emotional experiences crystallized into the foundation of my present clinical work. As a field instructor, what I lacked in depth and richness regarding the scientific nature of helping, Evoke helped me cultivate the ability to perform it as an art.

A metaphor I often shared that captured this dynamic further connected treatment to cartography. As a field instructor, I came to view each therapist as a mapmaker. My goal each week became using the therapist’s treatment plan as a guide for navigating the mysteries his or her clients faced. And extending the metaphor further, even when lacking familiarity with the intricacies of each theory or technique a therapist might draw from, Evoke prepared me with the skills to recognize and navigate around the prominent theoretical landmarks.

As I wrote at the start of this post, I cherish being able to connect experiences drawn from my own therapeutic development while working with Evoke’s current generation of field instructors. By making time to gauge the level of artistic sophistication each instructor brings to the process, and then matching those abilities to my client’s needs, I gain the opportunity to outline treatment maps that leave space for our instructors to bring themselves fully and authentically into the process. Furthermore, by providing opportunities for the children in my group to connect and build rapport with multiple team members each week, I believe our work aligns with Miller et al.’s findings about the power of therapeutic relationships. While both the science and art of helping are necessary considerations in providing effective treatment, creating space for our talented community of artful helpers to flourish has become a huge boon to the therapeutic process here at Evoke!

References
Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. Norton.
Young, M.E. (2017). Learning the art of helping: Building blocks and techniques (6th ed.). Pearson.

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