The Clinician

“I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”  (Abraham Maslow, psychologist, 1908—1970)

In the arena of mental health care, there are three types of providers: the theoretician, the technician, and the clinician.

Sigmund Freud was theoretician.  His theory was psychoanalysis. Psychoanalysis was the tool he used to understand and treat patients.  Freud described his patients according to their ids, their defenses, and their superegos.  He placed patients on his couch and asked them to free associate. He would then make interpretations, trying to make the unconscious conscious. Psychoanalysis was Freud’s hammer.

B.F. Skinner was a theoretician.  His theory was behavior modification (specifically, operant conditioning). Behavior mod was the tool he used to understand his subjects, both human and animal.  Skinner described his subjects according to stimuli, rewards, and responses.  Skinner tried to modify the behavior of his subjects by reinforcing desired behavior and extinguishing undesired behavior.  Behavior mod was Skinner’s hammer.

In the mid-20^th century, psychoanalysis and behavior modification were the prevailing theories informing mental health care.  Each theory had its adherents, some of whom became theoreticians in their own right, expanding and rewriting the works of Freud and Skinner.  Some went on to develop novel theories, viewing mental health through new lenses, creating new and improved hammers.

There are only a few practicing theoreticians. There are far more technicians. A technician works with neither the depth of the theoretician, nor the breadth of the clinician (which I shall get to shortly). The technician works from one model, trying to implement and imitate the work of the theoretician. An informed technician reads journals and attends conferences. A skilled technician may be a warm, genuine, and imminently relatable individual.  Often aided by manuals and algorithms, many technicians are effective therapists.  However, the technician ultimately relies upon the theoretician’s hammer.

 In contrast to the theoretician and the technician, the clinician uses a broad array of lenses in order to explain, understand, and ultimately treat the client.  A clinician first listens, unbiased by any one theory, and then customizes a therapy suited to the unique needs, strengths, and challenges of the presenting client.  The clinician is a pluralist.  The clinician knows that no single theory is sufficient to understand human complexity.  The more theories that are understood, integrated, and utilized, the clearer the understanding of the client.  The clearer the understanding of the client, the better the chances for a successful outcome.  For any one theory, the clinician may not have the theoretician’s depth of understanding.  However, the clinician has a breadth of understanding and a range of tools that the theoretician often lacks.

Whenever I taught psychotherapy, I wanted to inspire future clinicians.  I taught multiple psychological and behavioral theories, believing that each model taught was another tool added to the student clinician’s toolbox. With multiple tools in the box, the student was less apt to enter into practice seeing only nails and using only hammers. By providing them with multiple tools, I tried to prepare students for the craftsmanship of clinical care.