Elliot Benjamin Book Collection

NOTE: This article was published in the Journal of Humanistic Psychology in 2011,

Volume 51: Issue No. 1: pp. 82 – 111     http://jhp.sagepub.com/content/51/1/82

 

Humanistic

Psychology and the

Mental Health Worker  

Elliot Benjamin

 

Abstract

This article discusses the precarious relationship of humanistic psychology

to the mental health worker in our current managed care, empirically based,

behaviorally focused, excessively medication-oriented mental health system.

Some of the challenges, frustrations, and potential successes of bringing real

and nurturing human relationships in the context of humanistic psychology

into the day-to-day involvements with clients for the mental health worker

are described. Some of the particular ethical dilemmas of the mental health

worker attempting to work in this context of humanistic psychology are

discussed, inclusive of the enormous difficulties of bringing humanistic psychology

into the all pervasive medical model that controls mental health

practice in our society. Through a series of case descriptions, the author

provides a narrative account of his own experiences in attempting to bring

the authentic nurturing relationship context of humanistic psychology into

his various mental health worker jobs. The author reaches the conclusion

that this relationship context of humanistic psychology is in actuality being

practiced by many mental health workers without knowing it by name.

He further concludes that in spite of the challenges and frustrations of engaging

in real and nurturing relationships with clients as part of the mental

health worker’s job in our current society, the core ingredients of empathy,

authenticity, and realness of bond between client and mental health worker,

which are the hallmarks of humanistic psychology, are apparently being

practiced with partial success through the cleverness, flexibility, and humaneness

of mental health workers despite the enormous obstacles against this

kind of humanistic practice.

In this day and age, humanistic psychology and the mental health worker are

in a precarious relationship. The mental health worker, especially in contemporary

Western society, is expected to deliver treatment based on “empirically

supported” behavioral objectives, is generally working for a mental health

agency funded by the state and using strict psychiatric classification guidelines,

and has been educated to be familiar and appreciative of the widespread

usage and “benefits” of psychiatric medications. Where, one might ask, is

there room for the quaint old notions of empathy, unconditional positive

regard, authenticity, genuineness, and so on that were introduced by Carl

Rogers (1961), one of the key founders of humanistic psychology, more than

half a century ago? (see also Benjamin, 2008b; Elkins, 2007, 2009a).

The

mental health worker, as I am using the term, typically is a young

or middle-aged adult with or without a college degree, who is working with

mentally disturbed children or adults in a mental health program. If the

mental health worker has a college degree, he or she is likely to have majored

in a psychology-related field. It is somewhat ironic that, in my own case,

having decided to become a mental health worker after semiretiring from a

long career as a mathematics professor, in spite of all my esoteric ideas and

writings about humanistic psychology, my official mental health worker classifications

are Behavioral Specialist, Direct Support Worker, and Mental

Health Rehabilitation Technician/Community. These do not sound like very

humanistic titles; the titles reflect the current thinking in our modern “scientific”

world of psychology. I have been trained as a mental health worker to apply

strict behaviorist psychology to the clients in my care, in particular Applied

Behavioral Analysis (Kearney, 2008).

How does a mental health worker with a humanistic psychology orientation

survive in today’s mental health system? In David Elkins’s (2009a)

recent article in the

Journal of Humanistic Psychology, titled “The Medical

Model in Psychotherapy: Its Limitations and Failures,” he concluded with

the following:

It is radical to suggest that the best way to deal with the medical model

is to reject it completely. However, in our day, psychotherapy is under

unprecedented attack by the very institutions that should be supporting

it. The medical establishment has little respect for what we do, and the

health insurance industry would like nothing better than to turn psychotherapy

into a “quick-fix” center owned by Wall Street or replace it with

an inexpensive pill . . . It may be time for humanistic psychologists to

start another revolution in psychology. This time the revolution would

involve rejecting the medical model, breaking away from the medical

establishment, and telling managed care and the health insurance industry

that we will no longer require their services. (p. 82)

I find Elkins’s (2007, 2008, 2009a, 2009b) portrayal of the damaging

effects of both the medical model and managed care, as well as his recommended

remedies of preserving humanistic psychology, to be timely, cogent,

and tremendously important for humanistic psychologists to pay very careful

attention to. However, I believe there are rich alternative contexts where

humanistic psychology can be practiced, one of which is the context of community

mental health fieldwork; that is, mental health work in the homes and

communities in which clients live and work, practiced by mental health

workers who are not licensed psychotherapists, of whom I am one. From my

own experiences as a mental health worker the past few years, I have

found that most of the mental health workers in my agencies have a basic

“humanistic” deep down desire to relate genuinely and caringly to their clients

but are saddled with an overwhelming amount of behavioral expectations

from their supervisors and agencies. To keep their jobs they have little choice

but to go along with the required behavioral programs, counting the number

of targeted behaviors exhibited, checking off the extensive lists of treatment

data sheets, monitoring their clients taking their prescribed psychiatric

medications, and accounting for how they spend all their time with clients in

accordance with the behavioral objectives of the program. These complicating

external challenges to relating to clients in an authentic humanistic

person centered way (Rogers, 1961) are especially difficult to overcome

because of the standardized short-term therapy allotment enforced by managed

care (Elkins, 2008). However, in spite of all these behavioral, medical,

and managed care expectations and requirements, I have seen that the

humanistic realness, genuineness, and empathy of the mental health workers

somehow tend to sneak into relationships with their clients. When you are

spending 6 to 40 hours a week with one client, it is difficult to not become

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personally and emotionally involved with your client. It becomes a rather

sophisticated learning skill to satisfy the behavioral expectations and requirements

of your mental health agency while retaining the humaneness and

dignity of the client–mental health worker relationship that you feel in your

bones, in spite of the fact that you know this relationship may be time bound

in the context of managed care short-term therapy.

I believe that the extended organic immersion of the mental health worker

into the lives of his or her clients could be a very real source of therapeutic

value for clients. This kind of extended involvement into the lives of clients is

rich with possibilities of experiential and phenomenological value, incorporating

potential heuristic and autoethnographic research methodologies into a

humanistic psychology context (Camic, Rhodes, & Yardley, 2003; Chang,

2008; Ellis, 2009; McQuade, 2006; Moustakas, 1990, 1994; Rogers, 1961;

Sela-Smith, 2002). A vivid illustration of intensive organic mental health

work is given by Annie McQuade (2006) in her portrayal of her own

immersion into the lives of mentally disturbed people living in the streets. In

comparison with the client visiting the professional office of a therapist for

50 minutes a week, there is a tremendous opportunity for the mental health

worker to truly understand and have an impact on the actual day-to-day realities

that mental health clients experience. However, it is also true that the

mental health worker is generally not trained in the basic ingredients that have

been found to nourish therapist–client interactions, inclusive of empathy,

authenticity, and realness of bond with client (Elkins, 2007; Wampold, 2001),

which are simultaneously the hallmarks of humanistic and existential psychology

(May, 1969; Rogers, 1961; Schneider, 2008; Schneider, Bugental, &

Pierson, 2001; Watkins & Bohart, 2001).

To complicate matters even more, in addition to the mental health worker

not being trained in the aforementioned beneficial qualities of a psychotherapist,

the mental health worker is being trained in our contemporary

“evidence-based” behavioral and medication-oriented psychology society

(Benjamin, 2008b; Elkins, 2007, 2009b, Watson & Bohart, 2001). However,

as I have indicated above, I believe that the essential human qualities of

empathy, authenticity, and realness of bond are sneaking through the cracks

regardless of the official behavioral expectations of our managed care

society. As Elkins (2009b) has described the essential difference between

mainstream psychology and humanistic psychology: “humanistic psychologists

view psychotherapy not so much as ‘treatment for mental illness’ as a

liberating interpersonal process that helps clients to grow and that provides

support during critical times” (p. 285). It is precisely this “helps clients to

grow and provides support during critical times” that I see as the primary

potential humanistic impact of the mental health worker on his or her clients.

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However, as I mentioned earlier, the mental health worker is saddled with

many rules and restrictions from the state, mental health agencies, and managed

care administrators in regard to how he or she is able to relate to clients.

Certainly a number of these rules and restrictions are involved with preserving

the rights and safety of mental health clients. But I believe it is also the

case that some of these rules and restrictions are quite arbitrary and have the

effect of preventing the mental health worker from contributing in a constructive

manner to the humanistic vision that Elkins (2009b) has described

(see above).

This humanistic vision that Elkins (2009b) has described is consistent with

the first of three components of evidence-based practice as set forth by the

American Psychological Association (APA; 2005), namely, “best research

evidence.” Elkins (2007), using Wampold’s (2001) extensive research studies

comparing the effectiveness of a wide variety of psychotherapy practices,

concluded that the core ingredients of successful psychotherapy are the empathy,

authenticity, and realness of the client and therapist bond, which happen

to be the hallmarks of humanistic psychology (Rogers, 1961; Watson &

Bohart, 2001). The APA’s (2005) third component of evidence-based practice,

namely, “patients’ characteristics, values, and context,” are especially relevant

to the humanistic community mental health work that I am advocating for.

The extensive involvement of the mental health worker in the lives of his or

her clients ranges through the various ingredients highlighted in the APA’s

(2005)

Policy Statement on Evidence-Based Practice in Psychology, inclusive

of being responsive to the patient/client’s specific problems, strengths, personality,

sociocultural context, preferences, behavior, familiar factors,

employment stressors, major life events, and so on.

However, the mental health worker has virtually no official power in the

therapeutic hierarchy in which he or she works in a mental health agency. As

was conveyed to me in the context of one of my recent mental health worker

training workshops, we (in my capacity as a mental health worker) are at the

bottom rung of the ladder with regard to having input on decisions made in

the treatment of our clients. It was suggested that we advocate for our clients

the best we can, but how seriously we are taken will depend on the personalities

and interests of our supervisors and agency administrators. The fact

that I have a master’s in counseling, am a registered State of Maine counselor,

facilitate monthly psychology and mental health workshops at one of

my mental health agencies, and am currently working on my candidacy

essays to obtain a PhD in psychology does not at all change this relatively

powerless scenario for me. Because my doctoral psychology degree is not

clinical and I will not be obtaining a counseling license, I have no more

power and influence with my clients than any other mental health worker at

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either of the two mental health agencies that I work for. I simply will become

a mental health worker with two PhDs (mathematics and psychology) and

a commitment to having real and authentic relationships with my mental

health clients—no more and no less.

It is in the context of a person making a commitment to having real and

authentic relationships with mental health clients that I believe the greatest

potential value and impact that mental health workers can make in the context

of humanistic psychology lie. In this article, I will describe some of my

own challenges, difficulties, and successes with assimilating my behavioral

work as a mental health worker into a bona fide humanistic psychology context,

through a narrative description of my work with some of my mental

health clients at four mental health agencies. In one of my mental health

agency jobs, for the past year I have conducted monthly training sessions for

mental health workers, inclusive of workshops that I have developed titled

“Treating the Person First in a Medication Oriented Society,” “Creativity and

Mental Disturbance,” and “Ethical Dilemmas in the Human Sciences.” My

workshops are geared toward informal discussion of psychological, philosophical,

and mental health issues, and I frequently hear about the challenges

and issues that mental health workers in my groups continually face in trying

to maintain authentic supportive relationships with their clients. These challenges

and issues often pertain directly to some of the rules and restrictions

of the state and my mental health agency that I have alluded to above, and

I will be describing some of my own experiences with overcoming these

challenges and issues in the context of working with my mental health

clients.

The aspect of being intimately and directly involved in the lives of clients

by spending many hours a week with them in their homes and communities

is an incredibly rich source of therapeutic value. It is my contention that

these kinds of community-based therapeutic relationships may very well be

a possible means of (unofficially) practicing humanistic psychology as well.

I would like to see mental health workers be able to tap into this therapeutic

value and potential in a much greater capacity then they presently are able

to do. I believe that incorporating existential and humanistic psychology

into the training of mental health workers as a significant part of their training

would be a highly effective way of contributing to this potential therapeutic

value for mental health clients.

Ethics and the Mental Health Worker

The mental health worker is trained assiduously in the practice of ethical

guidelines and proper reporting procedures in his or her work with clients for

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a mental health agency. These ethical guidelines are set forth to the mental

health worker as firm boundaries that must not be crossed, as the consequence

of violating these boundaries is immediate dismissal from the job. However,

it is ironic that at the recent 2009 annual APA meeting in Toronto, Melba

Vasquez, veteran board member, coauthor of the APA ethical guidelines, and

candidate for upcoming APA president, gave a workshop titled “Psychotherapy

Outside the Box—Boundary Crossings Versus Boundary Violations”

(APA, 2009). In this workshop, Vasquez proceeded to describe the ambiguous

nature of the APA ethical guidelines when it comes down to actual

face-to-face contact with real people in a psychotherapy context. Vasquez

described how she frequently engaged in what she referred to as “boundary

crossings” when she decided that it was in the best interest of her clients for

her to do so. This included attending social events of her Latino clients, hugging

clients, and sharing aspects of her own personal life with her clients.

These “boundary crossings” were what she considered to be of extreme

importance in maintaining the rapport between her and her Latino clients,

and these are in harmony with the substantial research that has demonstrated

that the core ingredients of successful psychotherapy are indeed the empathy,

authenticity, and realness of client and therapist bond that Carl Rogers (1961)

formulated more than half a century ago as the guiding principles of humanistic

psychology (see also Bohart & Tallman, 1999; Elkins, 2007; Wampold,

2001). It is ironic though that when it comes to ethical guidelines and boundaries

for the mental health worker, the subtleties and ambiguity of ethical

practices that APA ethical guidelines coauthor Vasquez described, is so easily

dismissed.

It might be instructive to take a brief detour from the pragmatic situations

of ethical guidelines and rules for the mental health worker in order to put

this whole ethics topic in a wider context. Lawrence Hinman (2008) described

the extremes of ethical absolutism and ethical relativism and advocated for a

middle ground of ethical pluralism in which one formulates generic ethical

and moral principles that are shaped by the particular circumstances of individual

human beings in a variety of social contexts. Hinman related his view

of ethical pluralism to the Aristotelian version of practical wisdom, virtue,

and character as follows:

Aristotle’s account of practical wisdom also provides a useful insight

into ethical pluralism. The virtuous person always acts in light of a

general conception of human flourishing. Each of the moral theories

we have studied in this book contributes to our understanding of human

flourishing, and the virtuous person of practical wisdom is able to

balance these competing theories in particular situations, discerning

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which is most morally significant in a specific case . . . Moreover, in

the Aristotelian view, it is not simply a question of telling the truth or

lying; it is also a matter of how the truth is told (with care and consideration

about its impact or with crassness), when it is told, and to whom

it is told. (Hinman, 2008, pp. 287-288)

Hinman’s (2008) description of ethical pluralism and Aristotelian practical

wisdom is highly consistent with the ethical boundary crossings described

by Vasquez (APA, 2009), and appears to be increasingly appreciated in its

complexity and subtleties by the APA. However, for the mental health worker

employed by a mental health agency, these kinds of ethical complexities and

subtleties are all but lost, as the overriding rules of thumb are the firm rules,

restrictions, and boundaries handed down by the administrators of the agency,

which I would place under the heading of ethical absolutism.

The higher level ethical considerations portrayed by Vasquez (APA, 2009)

are also consistent with the higher levels of moral development described by

a number of psychologists and philosophers.

In philosopher Ken Wilber’s (1995) view:

There is general and ample agreement that human development goes

through at least three broad stages: the human at birth is not yet socialized

into any sort of moral system (it is “preconventional”); the human

then learns, from itself and from others, a general moral scheme that

represents the basic values of the society it is raised in (it becomes

“conventional”); and with even further growth, the individual may

come to reflect on its society and thus gain some modest distance from

it and gain a capacity to criticize or reform it (the individual is to some

degree “postconventional”). (p. ix)

In my own role of mental health worker at my two mental health

agencies, I am under the same inflexible “conventional” ethical guidelines

and boundaries as my counterparts. However, I am also well aware of the

complexities of dealing with ethical guidelines in real live situations with

mental health clients, and my background and commitment to the foundations

of humanistic psychology put me in continual conflict with the policies

of my mental health agencies versus the higher ethical (Aristotelian

“postconventional”) inclinations that are deep within me. The examples that

I will give from my mental health agency work illustrate the kind of conflict

that I continually face in my work, and I believe that this kind of conflict is

prevalent in the day-to-day interactions of mental health workers with their

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clients. I will begin my personal/professional illustrations of humanistic

psychology and the mental health worker with a description of my initial

mental health work as a part of a counseling internship at a mental health

agency, with a child diagnosed as having Asperger’s syndrome. My mental

health/counseling work at this agency lasted only 6 weeks, as I was promptly

fired from my job, as I describe below.

My Initial Career Change Experience

as a Mental Health Worker

I began my late-in-life career transition from mathematics professor to mental

health worker nearly 3 years ago, as I managed to find a mental health agency

willing to employ me as a mental health worker while I started to satisfy the

requirements of my counseling internship to obtain a counseling license. But

to cut to the chase, I was fired after 6 weeks. I will never forget the shock of

being called away from the kids I was working with, first thing in the morning

about 20 minutes after I arrived for work, being sent to a large conference

room with only my immediate supervisor and the human resources director

present, and being told that I was being asked to resign effective immediately

or else I would be terminated effective immediately with additional adverse

consequences for my future mental health job prospects.

I was then followed back to my working space, and with the children

I had been working with and other staff watching, I had to retrieve my

belongings and drive home, now an unemployed mental health worker.

With all my unhappiness and complaints of my 21 years as a mathematics

professor, never could I even have imagined a scenario like this taking

place.

Why did I get fired from my initial mental health job in my new career?

Of course the answer to this question depends on who is giving the answer,

but I think it is safe to say that I did not adhere to the ethical guidelines and

rules of my mental health agency when it conflicted with my inner sense of

what felt right to me when relating to my clients. Or in a more theoretical

context, I could say that I chose to listen to my “postconventional” higher

ethical values in opposition to the “conventional” ethical rules and restrictions

that my mental health agency required me to follow. This was in large part

related to disagreements that I had about how a child was physically restrained

at my agency, my written communication with a parent in response to a

child’s personal request for me to do so, and my inclination to encourage the

creative interests of my little client diagnosed with Asperger’s syndrome that

were in conflict with some of the structured behavioral expectations of my

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agency’s program, as I describe below. However, from my perspective

2½ years later, I can see that I was naive about the political ramifications of

how much I asserted myself at my agency, and I also have learned that my

strengths and inclinations are working in community mental health where

I have a relative degree of freedom and independence, as opposed to working

in a continual fishbowl atmosphere at a structured hierarchical mental health

agency.

As it turned out, I managed to soon find another mental health job, in

which 2½ years later I am still employed, along with a second mental health

job that I have been working at for nearly 1½ years. I seem to have found my

niche as a mental health worker late in life, and I am certainly considered by

my agencies to be quite the mental health worker oddity, having a PhD in

mathematics and a master’s in counseling, and I’m in the process of obtaining

a second PhD, this one in psychology. Although I have enjoyed teaching

monthly continuing education training workshops at my second mental

health agency, what is most important to me in my new career as a mental

health worker is the way in which I work with my clients, for I believe that

I have somehow managed to retain the essence of humanistic psychology in

my day-to-day work with clients. I chose to accept the rigid pronouncement

of the State of Maine’s licensing board that none of my coursework from my

master’s in counseling program in the 1970s would count toward my counseling

license, presumably because my coursework could not accurately be

described because of the fact that my school, Boston State College, was

incorporated into the University of Massachusetts back in the 1980s. I chose

to accept my being merely a “registered” State of Maine counselor, knowing

that not obtaining a counseling license would prevent me from obtaining any

kind of reasonably paid mental health job with any kind of respectable status

or significant influence in my mental health community. I chose this because

at my advanced age and career I did not want to take a lot of courses I had

already taken and had little current interest in. My tremendous desires and

inclinations were to pursue my interests in humanistic and transpersonal psychology

as part of my PhD psychology program at Saybrook University,

and this is precisely what I decided to do.

However, an unexpected consequence of my decision is that I have been

able to truly experience the I–thou relationships that Martin Buber (1970)

eloquently wrote about, while I found a way of practicing the essence of

humanistic psychology with regard to the authentic relationships I have

experienced with my clients (Bohart & Tallman, 1999; Elkins, 2007).

My poor economic and low career status as a mental health worker has

been well worth it to me, as I have been far happier in my recent nearly 3 years

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of employment as a mental health worker than I was for the previous 21 years

I was employed as a mathematics professor. As I will describe below, in many

respects I have been able to engage with my clients in ways that have transcended

the medical model, managed care system that I officially work for,

and I can relate well to Maureen OHara’s advice about practicing humanistic

psychology outside of the medical establishment, as cited in Elkins (2009a):

The age-old idea of work as something akin to a sacred calling, a vocation

inspired by a desire to serve humanity, drives many therapists who

choose to buck the tide of managed care yet still want to be in private

practice. Another powerful moral incentive is their determination to

remain free and independent. Certainly, the ideal of service is more

compelling than any hopes of getting rich. It is an ideal that these clinicians

often believe has been misplaced by the therapeutic community

over the last decade or two. (p. 82)

I can also relate well to Elkins’s (2009a) conclusion in his article “The

Medical Model in Psychotherapy”: “We might also feel more in charge of

our professional lives, sleep a little better at night, and have more passion

and excitement about going to work each day” (p. 83). Although Elkins and

O’Hara are talking about leaving the medical model entirely and going into

private practice as a psychotherapist, I believe there is an opportunity to

engage in community mental health field work on the official lowest level of

the totem pole, while experiencing authentic therapeutic relationships with

mental health clients. Because of its minimal economic rewards and status,

it is not work that I would have intentionally chosen, but it is work that I am

presently grateful for having the privilege of being able to do, as I will now

describe.

In my initial 6-week career transition job as a mental health worker and

counselor intern, the child I was most involved with was a 7-year-old boy

diagnosed with Asperger’s syndrome as well as attention deficit/hyperactive

disorder (ADHD;

Diagnostic and Statistical Manual of Mental Disorders,

4th ed., text revision [

DSM-IV-TR]; American Psychiatric Association,

2000). I will give this child the fictitious name Charles and describe some

of my experiences of working with Charles in a humanistic capacity. As

I learned during my month and a half of internship, when a child is diagnosed

with ADHD it is virtually impossible for this diagnosis to be removed.

The reason for this is the fact that the child is put on various psychiatric

medications and the assumption is that the ADHD symptoms are improving

because of the medications and that without the medications the ADHD

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symptoms would be much more severe (Baughman, 2006; Benjamin, 2008b;

Breggin, 2008; Degrandpre, 2000; Healy, 2002). Charles was certainly a

child who liked to be active and move around a lot, but when he was

involved in an activity that he enjoyed, his attention span and activity

absorption were truly remarkable. Charles had demonstrated intensive

focus and absorption in a number of diverse activities, such as playing one

of my mathematics enrichment Numberama games (Benjamin, 1993),

playing the electronic keyboard and learning drumming rhythms, putting

together a water pipes puzzle, playing the number game Yatze, creatively

putting various structures in the water sprinkler on the playground, and

playing Bingo. These qualities and characteristics that I had observed in

(and activities I had participated in) 7-year-old Charles were in my mind

the prime ingredients of a potential future creative scientist. This is consistent

with studies that have shown a definite trend of scientific creativity,

especially in the area of physics, in children with high-level forms of autism

(Baron-Cohen, 2000; Fitzerald, 2004).

Charles’s diagnosis of Asperger’s syndrome implied that he had significant

problems in the social context of interacting appropriately in mutually

engaging ways with other children (see

DSM-IV-TR; American Psychiatric

Association, 2000). I did not disagree with this description of Charles, as he

certainly did have problems in his interacting with other children and also

needed to learn to be more adaptable with regard to constructively engaging

in activities that he may not have been particularly interested in but were

expected of him as part of my agency’s program. Intensive absorption in a

particular area of interest is a common feature of Asperger’s syndrome

(Fitzgerald, 2005; Webb et al., 2005). However, this kind of intensive

absorption is also a dominant feature in what has been described as “eminent

creativity” (Runco & Richards, 1997) and in my own definition of the

“successful creative artist” (Benjamin, 2008a). But as I read over all his

psychological and psychiatric evaluations, it struck me that this intelligent

and creative child was essentially viewed and classified according to his

problem areas rather than his strengths. Charles was not being treated with

respect, appreciation, and openness to his potential areas of creativity, in a

humanistic psychology therapeutic context.

Charles had seemed to take a genuine liking to me, and I wondered if he

somehow sensed that I saw what was special in him; that is, I saw his deep

potential artistic self that yearned to emerge. Little Charles had been given

numerous and varied medications since he was 4 years old, and it appeared

that his problems were directly related to the early neglect and possible abuse

from his biological parents, although it is quite possible that he may have also

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been adversely affected by all the medications he was taking (Baughman,

2006; Benjamin, 2008b; Breggin, 2008; Degrande, 2000; Healy, 2002). The

community mental health center that Charles and I took part in was quite

structured and socially oriented. The programs of activity of this agency

were extremely behaviorally focused, and although their programs of activity

appeared to be beneficial to most of the children who took part in them,

I must also say that their appreciation of a child’s potential creative interests

and abilities were severely lacking. Whatever I was able to accomplish with

Charles with regard to helping the potential creative artist/scientist in him to

emerge in the short period of time I worked for this agency, I needed to do

when virtually no one else was around.

Charles was the child I most looked forward to working with in my

mental health agency internship site. I saw my Artistic Theory of Psychology

(Benjamin, 2008a) in a microcosm when I was in the presence of Charles.

The intelligence and creativity were there but so was the aloofness, the “in

his own world” quality, and the social difficulties of interacting appropriately

with his peers. Thus, the healthy adjustment to society factor in my definition

of the successful creative artist (Benjamin, 2008a) was going to be a

severe challenge for Charles to achieve. Our mental health agency’s extreme

emphasis on behavioral programming contained various individually

designed behavioral reinforcement treatment plans. I believe that this

environment was likely effective in helping Charles learn how to be more

“normal” in his social interactions with other children, and I am in agreement

with the agency that this was a fundamental and important learning

task for Charles to accomplish. However, I also think that the potential creative

abilities of Charles should have been more appreciated and included in

his treatment plan, and this is where humanistic psychology could have

filled an important gap in Charles’ treatment program. But in my capacity as

a mental health worker I was severely limited to make any substantial

changes in Charles’ behaviorally oriented treatment program, and my involuntary

departure from the agency certainly did not help Charles. From a

humanistic psychology and education perspective, during his free time at

the agency, that is, apart from the group-structured social activities, Charles

should have been able to choose activities of his own choice and free will

(Neill, 1960; Rogers, 1961, 1969), rather than the limited range of social

emphasis activities the agency allowed him to choose from. But perhaps the

biggest lesson I learned from this whole frustrating experience was in the

context of the politics involved in trying to bring real and nurturing human

relationships into the realm of the day-to-day work of a mental health

worker.

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Mathematics Enrichment/Mental Health

Worker at a Children’s Mental Hospital

In my “Art and Mental Disturbance” article (Benjamin, 2008a), I have given

some illustrations of my work in a humanistic psychology context with

severely disturbed mental health clients, which stemmed from my mental

health worker night attendant job at a mental hospital more than 30 years ago.

I will now give a more recent illustration of an experience I had in which

I found myself in an unexpected humanistic and artistic psychology context

with a teenage girl at a mental hospital for children (see Benjamin, 2009).

In fall of 2001, I was volunteering to give my mathematics enrichment

Numberama lessons (Benjamin, 1993) 1 hour every other week for 4 months

at a children’s mental hospital in Maine, and I found myself having a rather

unique mental health worker experience. The patient at the hospital who had

the most impact on me was a girl of 15 or 16 years, whom I shall refer to as

Allison. I did not have access to the clinical files of the children I worked

with at the hospital; therefore I can only make educated guesses regarding

their diagnoses. Allison struck me initially as an angry and combative teenage

girl who had no interest whatsoever in taking part in my proposed

Numberama activities, even though she was part of a group of four or five

hospital residents, all of whom were younger than she was, who were scheduled

to be in my group. However, somehow or other it came about that

Allison and I shared a rather unusual interest within the hospital environment:

Paganism.

For a number of years I had been attending yearly Neopagan festivals

with my son in western New York state (Benjamin, 2004), and when Allison

made some comment about being interested in Witchcraft, an uncanny chord

was struck between us, much to the surprise of the other children and the

hospital staff. Gradually Allison began to confide in me all about her mystical

experiences, extrasensory perceptions, magical powers, and so on.

I realized that it was quite likely that Allison was diagnosed with some kind

of schizophrenic disorder and quite likely with borderline personality disorder,

related to her general angry and combative ways of relating to nearly

everyone at the hospital (see

DSM-IV-TR; American Psychiatric Association,

2000). But I found myself gradually disclosing to Allison things about

my life and my relationship with my Wicca girlfriend at the time that

I shared with very few people. It turned out that Allison herself was Wicca,

that she was brought up this way in her family, and she strongly recommended

me to read the classic pagan novel

The Mists of Avalon (Bradley,

1983). I took Allison’s advice quite to heart and proceeded to read this thick

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book even though I rarely read novels, and I found myself thoroughly relating

to the Wicca focus of the legend of King Arthur.

Thus, each time I came to the hospital to do my Numberama lessons,

Allison would become more and more friendly to me and even willingly

agreed to participate in my Numberama group activities, occasionally

acknowledging that my teaching strategies and program did have some

value. Allison was not someone who particularly enjoyed mathematics, but

the rapport we established in a humanistic psychology context (Elkins,

2007; Rogers, 1961) was strengthened as she was able to view me as primarily

a math teacher and not another “shrink” to work with her as part of a

social service agency. For me, I felt like I was entering some kind of bizarre

no-man’s-land in a somewhat similar way to my experience of working at a

mental hospital as a night attendant and subsequently as a group facilitator

for ex-mental patients at my community mental health center in Massachusetts

in 1980 (Benjamin, 2008a). The bond that I was establishing with Allison

was part of a truly nourishing and creative life process for both of us, in the

fundamental context of the basic principles of humanistic psychology and

psychotherapy (Elkins, 2007; Rogers, 1961). When I arrived at the hospital

to do my Numberama lessons I could often hear Allison yelling at staff

members, threatening and formidable in her anger. But as soon as she saw

me, her anger and bad mood would begin to evaporate, as she very much

looked forward to being with someone whom she could truly talk to about

the things that mattered most to her in life. Somehow we always found some

time to talk, either before or after my Numberama lessons, and the words

that come to me to describe Allison at these times are in the context of

“sweet” and “charming.” Finally Allison was sent home from the hospital,

and my initial Numberama experience at the hospital in a humanistic psychology

authentic relationship context came to a natural end.

Allison had conveyed to me how she learned to stop talking about her

interest in Wicca, magic, and extrasensory perception with the psychologists

whom she was required to be treated by and who gave her large doses of psychiatric

medications. She knew very well that the only way she would ever be

considered “normal” enough to be sent home was if she pretended to no longer

have these unusual thoughts and images. And I knew far too well how right

Allison was about this from my own life experience as well as from some of

my radical readings in psychology, which have been further reinforced by

some of my more recent radical psychology readings and writings (Benjamin,

2008a, 2008b; Elkins, 2009a; Feinstein & Krippner, 1997; Grof, 1985;

Jamison, 1993; Jung, 1936/1961; Krippner, 1975; Laing, 1967; Lukoff, 1988;

Maslow, 1971; Panter, Panter, Virshup, & Virshup, 1995; Richards, 2001;

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Runco & Richards, 1997; Scotton, Chinon, & Battista, 1996; Szasz, 1974;

Tart, 1975; Wilber, 1995). I am now fully aware and confident that in a number

of contemporary views of mental disturbance, a premium is put on the creative

expression of the mystical experiences of an individual like Allison.

I like to believe that, in my brief mathematics enrichment/mental health

worker engagement with Allison, I offered her the experience of realness,

empathy, and genuineness that are the hallmarks of humanistic psychology

(Elkins, 2007; Rogers, 1961). I look on my experience with Allison in a much

more successful and satisfying way compared with my experience with

Charles (as described above), regarding how I was able to engage in a productive,

authentic, and empathic therapeutic relationship with a patient in a mental

hospital while in an official mathematics enrichment/ mental health worker

capacity.

The Challenges of Practicing Humanistic

Psychology as a Mental Health Worker

As can be seen from my previous two personal illustrations of trying to

practice humanistic psychology through engaging in authentic nurturing

relationships with clients while in a mental health worker context, there are

some very real challenges that can make it difficult or impossible to accomplish

this, but there is also room for actions to meet these challenges, at least

some of the time. To further illustrate these kinds of challenges, I will

describe some of my more recent experiences working with clients in the

present mental health agencies that I am employed at as a mental health

worker Behavioral Specialist and Direct Support Worker.

At the mental health agency that I have been employed at for the past

nearly 3 years, I am required to follow state treatment plans that include various

objective reinforcements of desired behaviors along the lines of Applied

Behavior Analysis (Kearney, 2008). However, my clinical director frequently

couples this strict behavioral outlook with a decidedly humanistic and even

transpersonal perspective, talking about the priorities of building “caring

relationships with firm boundaries” with clients and advising us to follow our

inner spiritual guidance and our place in the universe. At first, this seemed

completely contradictory to me, as I believed that humanistic and transpersonal

psychology was at the opposite ends of the spectrum from behavioral

psychology. However, the timing was such that I experienced Steve Hayes’s

Acceptance and Commitment Therapy at around the same time that I started

this job, and I realized it was indeed possible to combine behavioral psychology

with humanistic and even transpersonal psychology (Benjamin, 2007;

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Hayes, Strousahl, & Wilson, 1999). It should be mentioned though that this

is a sensitive and delicate process, and it requires a highly unusual combination

of qualities in a mental health worker or clinician to effectively

accomplish this.

However, I will also convey that it is of concern to me that my clinical

supervisor has lately been talking about the “interchangeability” of mental

health workers being assigned to work with clients. I believe that this is

directly related to using the allotted number of hours the state allows the

agency for reimbursements and is one of the key challenges of practicing

humanistic psychology for the mental health worker, as I will describe below.

To illustrate concretely the challenges of bringing a humanistic psychology

orientation into my current behavioral community mental health work that can

be feasibly met at least on some level, I would like to describe my recent work

with a 16-year-old boy with whom I had been working on and off for 2 years,

for generally 8 hours a week. For the first 6 months of our working together,

I had been successfully building up a trusting and enjoyable personal relationship

with this boy that focused on engaging in activities in the community,

such as tennis, bowling, billiards, hiking, bicycle riding, roller skating, getting

together with his adult friends, and so on. While we were engaged in these

activities, my client gradually would open up to me more about his inner feelings,

concerns, and goals. However, because of the limit to state funding, our

work together needed to come to an end, even though I believe my client

would have greatly benefited from being in a continued therapeutic relationship

with me (Elkins, 2008; Miller, 1996). My agency rules are very strict in

regard to preserving our boundaries with clients, and once the official work

with a client ends, any kind of continued contact is strictly forbidden (see my

above discussion in the section “Ethics and the Mental Health Worker”).

During the whole course of our work together, I was required to go through

my supervisor for any communications with my client or his family between

our sessions. These are the agency rules I needed to follow to maintain my

mental health job, as establishing firm boundaries with clients had been

strongly impressed on us in no uncertain terms.

However, at the same time I was aware deep down that these extreme

boundary conditions felt to me like they were antithetical to the core ingredients

of humanistic psychology, especially the ingredients of therapist

genuineness and the authenticity of the client–therapist relationship (Elkins,

2007; Rogers, 1961), and I was thinking of myself as being in a “therapeutic”

mental health worker relationship with this client. Indeed, from a multicultural

perspective, these artificial boundary conditions may be construed to be

quite counterproductive to effective psychotherapy with clients (Alsup, 2008).

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I wanted to be able to stay in contact, at least occasionally, with my client after

our official working together time ended and to see how he would be doing in

working toward his goals. It felt “inhuman” to me to so abruptly cut off from

him simply because the state refused to reimburse my agency any longer, and

I subsequently learned that research studies have supported my intuitive

strong feelings that this abrupt and premature ending to our relationship was

not beneficial to my client (Elkins, 2008; Miller, 1996). I was indeed in the

midst of the conventional versus postconventional ethics deliberations that

Wilber (1995) has described (see above), but I also was facing the significant

added complication of being in danger of losing my job if I chose to follow my

higher ethical values.

Although I have gradually learned to accept and make the best of the

reality of the state and my agency’s policies in this regard, I believe that this

abrupt and artificial severing of the relationship between the client and mental

health worker displays the extreme challenge of maintaining a humanistic

context of relating to clients for a novice mental health worker who is working

in our managed care mental health system (Elkins, 2008, 2009a, 2009b;

Miller, 1994).

This personal/professional situation I have described brings the whole

issue of professional mental health ethics sharply into focus (see above), as

there are no stipulations against remaining in contact with a client after a session

ends in the ethical guidelines put out by the American Counseling

Association (1995), which is consistent with the APA’s perspective on ethical

practices as described by Vasquez (APA, 2009; see above). However, my

story with this teenage client did not end after my initial 6-month period of

working with him, as a year and a half later he and his mother requested that

I work with him again (there was an official 6-month waiting period between

state-approved treatment plans), which I did for another 3 months. In the year

and a half since I had worked with my client, he had significantly regressed,

as he recently had been placed in residence in a mental hospital after being

suspended from school for assaulting a teacher and had criminal charges

placed against him for destroying property. At my initial meeting with my

client, his mother, and my mental health supervisor, my client refused to come

out of his room, and I was quite apprehensive about working with him again.

However, it turned out that my client and I reestablished our bond of working

together in a harmonious way, he made progress in his ability to constructively

control his anger, and he recently transitioned into a public high school.

But the ethical conflicts between the “conventional” ethical restrictive

guidelines of my mental health agency and my “postconventional” ethical

values by no means abated. I found myself immersed into my client’s world

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as he became increasingly more comfortable and trusting of me, divulging to

me his privileged information with regard to not taking his prescribed medications,

smoking marijuana, and so on. I considered the trust my client was

placing in me to be sacred. However, it was pointed out to me by one of my

mental health worker colleagues that if I were in an official counseling relationship

with my client, then I would have the option of not divulging

privileged information he reveals to me, but in my present mental health

worker capacity, I was required to document and officially communicate to

my supervisor any “controversial” information my client shared with me.

The situation became more and more complicated for me, especially as I was

sympathetic to my client’s experience of his mother being exceedingly controlling,

authoritarian, condescending, and focused solely on the negative

aspects of his behaviors toward her. I was also very affected by all that I had

learned (and was teaching) about the dangers and questionable benefits of

psychiatric medications (Baughman, 2006; Benjamin, 2008b; Breggin, 2008;

Degrandpre, 2000; Healy, 2002).

As it turned out, my second time period of working with my client ended

rather abruptly, as he was caught with a bag of marijuana that he obtained

with the help of his father, and his mother decided that she did not want me

to continue to work with him. However, the larger issues regarding the ethical

conflicts for a mental health worker trying to retain a humanistic way of

working in a traditional managed care, medication-oriented, behavioral setting

have remained with me. One crucial aspect that has enabled me to

survive in this humanistic context for the past nearly 3 years is directly related

to the humanistic style of supervision that I have been very fortunate to continually

experience from my immediate supervisor in one of my agencies.

My strong values of relating in a real way to my clients, retaining the freedom

to be responsive to my clients’ needs and interests as much as possible,

bending the agency rules without breaking them when the situation appears

to me to be warranted, and so on have all been wonderfully supported by my

supervisor. I sometimes forget that things would be very different for me if

this were not the case, but I describe in the next section a brief scenario that

I experienced with a different supervisor who was much less humanistic and

sensitive and had a much more rigid behavioral way of working that ended in

a very unfortunate way for my client.

The ethical dilemmas for the humanistic mental health worker in today’s

mental health agencies are very real and immense. As I have continually

experienced these past few years, these ethical dilemmas bring to the surface

a confusing array of one’s strong values versus much of what humanistic

practitioners agree are harmful and detrimental practices of our managed

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care, medication-oriented, behavioral mental health system (Elkins, 2008,

2009a, 2009b; Miller, 1994, 1996). Having a supervisor who can support the

mental health worker coming to terms with his or her best course of action in

these ethically confusing circumstances is ideal, though by no means common

from what I have learned in my communications with my mental health

worker colleagues. However, in my own psychology and mental health trainings

that I facilitate in a humanistic education style (Rogers, 1969) and have

described above, I have given my mental health worker colleagues the opportunity

to discuss their professional ethical work–related confusions and

issues. My mental health worker colleagues have appeared to greatly appreciate

this, and my trainings have been popular at my agency for more than a

year. I believe that humanistic mental health workers who have the educational

qualifications may contribute greatly to the plight of others in the field

by offering these kinds of humanistic education open-ended ethical issues

discussion groups at their own agencies, though of course this requires the

support of open-minded administrators who have some appreciation of the

humanistic perspective to mental health, which may or may not be feasible at

one’s particular mental health agency.

Anecdotes From the Experience

of a Mental Health Worker

At this point, I would like to supplement my above description with a few

brief anecdotes of my work with some mental health clients that I believe

further illustrates some of the challenges as well as opportunities mental

health workers are currently facing in our managed care, medical model

mental health system. In particular, my next example illustrates the pitfalls of

behavioral psychology when it is not feasible to assimilate it into a humanistic

psychology context, with the mental health worker caught in an unworkable

no-win situation.

In my same community mental health job as described above, I had entered

the home of my new 15-year-old cognitively impaired mental health client to

work with him for the first time. As soon as I walked in the door, my new

supervisor greeted me with my client’s comprehensive educational diagnostic

report and the visual reinforcement star board that she wanted me to use with

him. This went completely against my instincts, as I knew that I first needed

to build up a personal relationship with my client, establishing rapport and a

positive association between us so that he would be looking forward to me

working with him. I was not closed to eventually using some kind of behavioral

reward system with visual cues but only in due time after I had built up

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a bona fide relationship with him, along the basic tenets of the core principles

of humanistic psychology (Bohart & Tallman, 1999; Elkins, 2007; Rogers,

1961; Schneider et al., 2001). Suffice it to say that I stuck to my principles and

began building up just this kind of relationship with my client, as I refused to

be involved with the behavioral visual reward system until I had done so. It is

also interesting that while I was building up a humanistic relationship with

both my client and his stepfather, I found myself calming down the stepfather

who wanted to throw my supervisor out of his house for working so mechanically

with my client, who was not responding well to her efforts. Unfortunately

this story does not have a happy ending, as when I returned from being away

for 2 weeks for a professional conference and vacation, I was informed that

the family had decided to terminate their involvement with my agency,

because they were not willing to work with my supervisor in their home.

With this same agency, I had been working for 3 months with a severely

disturbed physically large 17-year-old boy with Asperger’s syndrome, who

had threatened to kill people at his school. This client had great difficulty

spending much time with any mental health worker and was exceedingly

emotionally dependent on his parents. I gradually succeeded in developing a

constructive relationship with my client, taking him out in the community to

go bowling, and spending 4 hours a week with him. However, my agency

was frustrated that there were many more hours the state was willing to fund

for this client that were being wasted, at a significant financial loss to the

agency. My concerns that increasing the number of hours for this client

would backfire and become antithetical to any progress he was making fell

on deaf ears. Other staff members were brought in to increase the number of

hours working with this client to a total of approximately 15 hours a week.

It did not take very long for my client to have an extreme “meltdown,” physically

assault his parents, and have a lawsuit filed against him. My client’s

involvement with my agency came to an abrupt end, and another lesson of

the insensitivity of my mental health agency to the real needs of their mental

health clients versus the financial needs of the agency was impressed on me.

To give an example of some of my more positive mental health experiences

at this same agency, I will give a short account of my work with a highly

aggressive and impulsive physically strong 7-year-old client, diagnosed with

pervasive developmental disorder and mood disorder (see

DSM-IV-TR;

American Psychiatric Association, 2000). I was called into the case after the

previous female mental health worker decided she could no longer work with

this client, as his physical aggression, frequent assaultive episodes, and boundary

violations of her were more than she could handle. I was able to establish

firm boundaries with this client, and he appreciated that I responded to what

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he was persistently and single-mindedly interested in doing. What was this

persistent and single-minded activity that my 7-year-old client was so interested

in doing? We developed the routine of riding bicycles in search of beer

bottles. My little client had his entire garage filled to capacity with beer bottles

and cans that he and his mother would return for extra cash. It was not just

beer bottles and cans that he would collect, as soda bottles and cans and nonalcoholic

beverages of various types also made their appearance in our outings

and his garage, but his passion was undoubtedly for finding beer bottles.

He would repeatedly ask me about how different beers taste, and his favorite

beer bottle outing was to drive to the dancing bar in a nearby town and rummage

through the parking lot and woods in search of beer bottles. We thus

established a harmonious relationship through my responding to his somewhat

questionable 7-year-old interests, through which he made significant

progress in his abilities to control his highly negative behaviors. Focusing on

beer bottles is not something I would generally recommend for working with

a 7-year-old, but in this case I believe it represents an example of effective

mental health work in a humanistic psychology context of establishing a real,

authentic, caring relationship with a very difficult little client. I will also note

that my supervisor in this case, who is the same humanistically oriented supervisor

I described above, had sufficient understanding. appreciation, and trust

in how I was working with this client to allow me to pursue this rather unconventional

way of working with a 7-year-old child.

I would like to give one final personal/professional illustration of the challenge

of imparting humanistic psychology in the context of the job of a mental

health worker. In my mental health worker job that I have been doing for

nearly a year and a half with the second mental health agency, I am working

20 hours a week with a moderately impaired developmentally disabled

21-year-old male client who has Down’s syndrome (see

DSM-IV-TR;

American Psychiatric Association, 2000). In this capacity, my mental health

worker job official expectations have predominantly been involved with

working on daily living skills, although a few months ago my client transitioned

into a community integration program with higher level community

skill expectations. There have been the usual state checklists with tabulating

the number of times he needs assistance or a reminder to use the bathroom,

make a store purchase, practice safety skills, and so on. His chart is quite thick

and contains a number of reports of difficult interactions with previous mental

health workers in which he had become physically assaultive and destructive

of property. However, I was introduced to working with this client by job

shadowing with his transitioning mental health worker who had an obvious

enjoyment and a very natural humanistic attitude toward working with him.

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We went to his favorite place: the gazebo in the park, and I watched him

happily take out all his toys and coloring books from his briefcase and industriously

color in one of his coloring books for more than an hour. I learned

how sweet and gentle and cooperative this young man could be, as long as he

was given the time and space he needed to do things in his own way and not

be rushed beyond what his natural organic constitution could tolerate.

It has not been very difficult for me to learn how to juxtapose my agency’s

official state checklist requirements with allowing my client to have the

relaxed time and space that he needs. I have found that given my intention

to be in this kind of humanistic relationship with my client, he is more than

willing to meet me halfway when there are time constraints and expectations

of him that do need to get done, such as his volunteer work, and so on. The

upshot is that my client and I have enjoyed a harmonious and comfortable

working relationship for nearly a year and a half, which has included us

playing music together extending to performing for his community center

with me playing the piano or drum and him playing the bongo, a regular

routine of us going to the gazebo in the park and playing our drum and

bongo together, and a regular structure of going to the library where my

client looks through picture books and magazines for 1 to 2 hours, while I

industriously make progress in the books I need to read for my doctoral

psychology program or grade the mathematics homework assignments for

the online mathematics courses I am teaching.

However, I have also seen how my client could react quite negatively to

mental health workers who rush him and order him to do things without

being sensitive to his slow nature and unique ways of going about things.

My client goes every day to a community mental health center for developmentally

disabled adults, and it is a credit to the mental health workers at this

agency how flexibly and caringly they treat him. My client generally is the

only one still eating his lunch at the table long after everyone else has finished

eating, and the mental health workers and supervisors at this community

center are patient and responsive to his eating needs. When they play bingo,

my client has a very difficult time leaving before the games end, and this is

always a conflict for me as I have been told that the community center and

my agency cannot “double dip” as the state would not pay for both agencies

to work with him at the same time. For a while, this was quite a challenging

situation for me to deal with, but the community center has unofficially bent

their rules, letting me spend time with my client for him to finish the bingo

game he is playing when I arrive, even giving him a little prize at the end of

each game, which is supposed to be given only to people who win the game.

This is most definitely bending the rules, but the other clients do not seem to

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mind, as everyone seems to realize that it is a small price to pay for my client

to remain happy and not throw a tantrum and for me to be able to continue

to work with him.

Somehow my client and I have an uncanny click of personalities, in that we

each need a good deal of slow low-key time, and our library time together has

served this purpose very well for both of us. Our sharing of library time has

been a continuous positive central core of our mutually satisfying relationship,

although unfortunately my client’s mother does not appreciate the therapeutic

value of our sharing of this slow library time together. This recently developed

into a major issue of how I spend my time with my client and whether I

would be able to continue working with my client. This made me feel quite

sad and angry at the time (although I was eventually able to find a workable

way to resolve the challenge), and it was representative of one of the many

challenges facing the mental health worker trying to practice in a humanistic

context of relating to his or her clients.

With regard to my client’s love of music, I have been continually impressed

with the very real sense of rhythm that he displays in our drumming sessions,

as when I keep our beat going with syncopated rhythms and truly lose myself

in the process, he is very much in synch with me, and we are “cooking.” This

drumming experience seems to be something of a higher self-experience for

him, as in these precious moments he is no longer a moderately retarded

Down’s syndrome client, but he is a human being experiencing the inherent

joys of making music and feeling the life fulfilling rhythms of the universe. He

greatly enjoys moving his body to the rock and roll music we listen to on my

car radio as we are riding along, singing in his hoarse incoherent voice that

frequently brings joy and laughter to me in his presence. When I am on vacation

or in a training workshop and cannot work with him, he tells me that he

misses me, and lately he has asked me if I miss him as well. I once conveyed to

him that my brother had died, and he was able to genuinely understand and feel

my sadness. This young man has become very special to me and very much a

part of my life. The time we spend together is very comfortable and fulfilling

for both of us, and our relationship to me is a hallmark of humanistic psychology

relating in a context that goes way beyond intellectual understanding.

My client and I are both fortunate to be involved in a humanistically

oriented mental health agency that demonstrates an understanding and

appreciation of my client’s needs and personality. When it was discovered

that because of state regulations my client could no longer “work” his 2 days

a week at my agency, consisting of between half an hour and an hour each

day of taking out the garbage, taking the bottles to the recycling center, and

watering the plants, my agency and his parents came up with a creative

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solution. His parents have been consistently sending a weekly check to my

agency so that my client is able to continue the parts of his “work” that are

state allowed as long as he does not get paid. But my agency transforms my

client’s check into a bona fide agency check, and my client still has his

employee mailbox. As far as my client knows, he is still one of the “workers”

at my agency, we still go there 2 days a week, he still goes to the bank afterwards

to cash his check and then on to McDonalds, and all is well. This to

me is a prime example of an inspiring and effective way of pooling family

and agency resources to maintain a humanistic way of relating to a client in

spite of the obstacles that are presented by managed care and the state.

Conclusion

In conclusion, the mental health worker and humanistic psychology are in a

complicated relationship. From my own experiences as a mental health

worker, it is very clear to me that there is a rich source of opportunity to be

engaged with clients in an authentic, real, and caring relationship that is the

essence of humanistic psychology. On the other hand, mental health workers

are continually saddled with many rules, regulations, and restrictions by

both their mental health agencies and the state, which seriously threaten and

interfere with this potentially humanistic way of relating to their clients.

In my own mental health work, I have worked through ethical deliberations

on a number of occasions, and I have been fortunate to be working for one

agency that has an essentially humanistic orientation and another agency

where I have a direct supervisor with a humanistic perspective in relating to

both her staff and clients.

However, many mental health workers are not as fortunate as I have been,

and even with all the humanistic supports and understanding that I have experienced

at my agencies, I have also learned how tenuous and exceedingly

difficult it can be to maintain a humanistic perspective of relating to clients in

these modern times. I have learned from firsthand experience that a mental

health worker who wants to relate to his or her clients in a humanistic psychology

context needs to proceed with the utmost caution and skill, walking the

tightrope between humanistic relating and the rules and requirements of his or

her mental health agency and the state.

I believe this can be accomplished, but that it will require a concerted

effort to teach these skills to mental health workers who have this desire.

I view my own monthly training workshops for the past year at one of my

agencies as a modest step in this direction. I have taught about the established

dangers of an excessive use of psychiatric medications, the conflicts

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of interest for psychiatrists, and the pressures exerted on them by large pharmaceutical

companies and an alternative viewpoint in relation to Asperger’s

syndrome, bipolar disorder, and mental disturbance in general, involving

creative potential in its most positive aspects.

I have also offered my fellow mental health workers an educational atmosphere

involving safe, confidential, open-ended discussions of various ethical

dilemmas that include an opportunity to share what is currently going on for

them in regard to ethical issues they face in their day-to-day work with clients.

This has been an enriching engagement for me as well, and it is one where my

advanced educational qualifications have been acknowledged and respected,

as my having a PhD was attractive to my agency and the state with regard to

me offering these trainings (even a PhD in mathematics). However, it is also

the case that because of budget concerns my trainings have recently been put

on hold, as full-time in-house staff have taken over all trainings. Unfortunately

it is unlikely that in the future I will be allowed to continue my trainings,

and thus we once again witness the challenging scenario of trying to practice

humanistic psychology, and in this case humanistic education as well, in the

harsh day-to-day realities of our current mental health system. If I am not able

to continue my trainings, it will certainly be another major disappointment

for me in my mental health work, as I believe my trainings have been a

channel for me in which humanistic psychology has filtered through, whether

or not it was known by that name. However, perhaps offering these kinds of

training workshops at mental health agencies may be a way that others who

have the necessary educational requirements can take advantage of.

From what I have experienced, it is highly unusual for anyone with a PhD,

or even a master’s degree, to be working as an ordinary mental health worker

for a mental health agency. But the opportunity to experience a client’s world

in his or her own home and community for 8+ hours a week is rich with

therapeutic potential that is way beyond what one can learn from a client

through a weekly 1-hour office visit, or even a weekly 1-hour visit in the

client’s home, where the problem behaviors may very well not be seen and

the natural ongoing relationship over time between client and mental health

worker is not experienced. It is also work that I continually find to be refreshingly

“human” and rejuvenating, although quite challenging as well. Perhaps

it may be work that others like me who are near retirement age and have a

humanistic psychology perspective along with higher degrees may want to

consider. Perhaps we can form a network of mental health workers with a

humanistic psychology background and perspective who have master’s

degrees and PhDs; but then again, perhaps I am dreaming. At any rate,

I believe that this kind of concerted effort is most definitely warranted, as

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Journal of Humanistic Psychology 51(1)

from my own experience as a mental health worker I have found that there is

a large network of mental health workers who very much want to work with

their clients in an empathic, authentic, and real way, that is, in a humanistic

psychology context of relationship.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the authorship

and/or publication of this article.

Funding

The author received no financial support for the research and/or authorship of this

article.

References

Alsup, R. (2008). Existentialism of personalism: A Native American perspective.

In K. J. Schneider (Ed.),

Existential-integrative psychotherapy (pp. 121-128).

New York: Routledge.

American Counseling Association. (1995).

Code of ethics and standards of practice

(Rev. ed.). Alexandria, VA: Author.

American Psychiatric Association. (2000).

Diagnostic and statistical manual of

mental disorders

(4th ed., text revision). Washington, DC: Author.

American Psychological Association. (2005).

Policy statement on evidence-based

practices in psychology

. Retrieved January 19, 2010, from http://www.apa.org/

practice/resources/evidence/ebpstatement.pdf

American Psychological Association. (2009).

117th convention: August 6-9, 2009:

Convention program

. Washington, DC: Author.

Baron-Cohen, S. (2000). Autism: Deficits in folk psychology exist along superiority

in folk physics. In S. Baron-Cohen, H. Tager-Flusberg, & D. Cohen (Eds.),

Understanding

other minds

(pp. 73-82). Oxford, UK: Oxford University Press.

Baughman, F. (with Hovey, C.). (2006).

The ADHD fraud: How psychiatry makes

patients out of normal children

. Oxford, UK: Trafford.

Benjamin, E. (1993).

Numberama: Recreational number theory in the school system.

Swanville, ME: Natural Dimension.

Benjamin, E. (2007). An integrative non-integral psychotherapy model. Retrieved

January 1, 2009, from http://integralworld.net.

Benjamin, E. (2004). On neopaganism.

PagaNet News, 12.

Benjamin, E. (2008a). Art and mental disturbance.

Journal of Humanistic Psychology,

48

, 61-88.

Benjamin, E. (2008b). The person vs. the pill.

AHP Perspective, February/March,

23-25.

Downloaded from

jhp.sagepub.com at SAYBROOK GRADUATE SCHOOL on September 16, 2011

Benjamin

109

Benjamin, E. (2009).

Artistic psychology, mathematical giftedness, and mental disturbance

in children

. Unpublished manuscript.

Bohart, A., & Tallman, K. (1999).

How clients make therapy work: The process of

active self-healing

. Washington, DC: American Psychological Association.

Bradley, M. Z. (1983).

The mists of Avalon. New York: Knopf.

Breggin, P. (2008).

Medication madness: A psychiatrist exposes the dangers of mood

altering drugs

. New York: St. Martin’s Press.

Buber, M. (1970).

I and thou (W. Kaufman, Trans.). New York: Scribner. (Original

work published 1923)

Camic, P. M., Rhodes, J. E., & Yardley, L. (2003).

Qualitative research in psychology:

Expanding perspectives in methodology and design

. Washington, DC: American

Psychological Association.

Chang, R. T. (2008).

Autoethnography as method (Developing autoethnographic

inquiry)

. Walnut Creek, CA: Left Coast Press.

Degrandpre, R. (2000).

Ritalin nation: Rapid fire culture and the transformation of

human consciousness

. New York: Norton.

Elkins, D. (2007). Empirically supported treatments: The deconstruction of a myth.

Journal of Humanistic Psychology, 47

, 474-500.

Elkins, D. (2008). Short-term linear approaches to psychotherapy: What we now

know.

Journal of Humanistic Psychology, 48, 413-431.

Elkins, D. (2009a). The medical model in psychotherapy: Its limitations and failures.

Journal of Humanistic Psychology, 49

, 66-84.

Elkins, D. (2009b). Why humanistic psychology lost its power and influence in

American psychology: Implications for advancing humanistic psychology.

Journal

of Humanistic Psychology, 49

, 267-291.

Ellis, C. (2009).

Revision: Autoethnographic reflections of life and work (writing

lives).

Walnut Creek, CA: Left Coast Press.

Feinstein, D., & Krippner, S. (1997).

The mythic path. New York: Tarcher.

Fitzgerald, M. (2004).

Autism and creativity. New York: Brunner-Routledge.

Fitzgerald, M. (2005).

The genesis of artistic creativity: Asperger’s syndrome and the

arts

. Philadelphia: Jessica Kingsley.

Grof, S. (1985).

Beyond the brain. Birth, death, and transcendence in psychotherapy.

Albany: State University of New York Press.

Hayes, S., Strousahl, K., & Wilson, K. (1999).

Acceptance and commitment therapy:

An experiential approach to behavior change

. New York: Guildford.

Healy, D. (2002).

The creation of psychopharmacology. Cambridge, MA: Harvard

University Press.

Hinman, L. M. (2008).

Ethics: A pluralistic approach to moral theory (4th ed.).

Belmont, CA: Thomson Wadsworth.

Downloaded from

jhp.sagepub.com at SAYBROOK GRADUATE SCHOOL on September 16, 2011

110

Journal of Humanistic Psychology 51(1)

Jamison, K. R. (1993).

Touched with fire: Manic-depressive illness and the artistic

temperament

. New York: Free Press.

Jung, C. G. (1961).

Modern man in search of a soul. New York: Harcourt Brace.

(Original work published 1936)

Kearney, A. J. (2008).

Understanding applied behavioral analysis. London: Jessica

Kingsley.

Krippner, S. (1975).

Song of the siren: A parapsychological odyssey. New York:

Harper & Row.

Laing, R. D. (1967).

The politics of experience. New York: Ballantine.

Lukoff, D. (1988). Transpersonal psychotherapy with a manic-depressive artist.

Journal

of Transpersonal Psychology

, 20(1), 10-20.

Maslow, A. H. (1971).

The farther reaches of human nature. New York: Penguin.

May, R. (1969).

Love and will. New York: Dell.

McQuade, A. (2006). Revisiting the interiors: Serving the mentally ill living in the

streets.

AQAL: Journal of Integral Theory and Practice, 1, 116-150.

Miller, I. J. (1994).

What managed care is doing to outpatient mental health: A look

behind the veil of secrecy

. Boulder, CO: Boulder Psychotherapists’ Press.

Miller, I. J. (1996). Time-limited brief therapy has gone too far: The result is invisible

rationing.

Professional Psychology: Research and Practice, 27, 567-576.

Moustakas, C. (1990).

Heuristic research: Design, methodology, and applications.

Thousand Oaks, CA: Sage.

Moustakas, C. (1994).

Phenomenological research methods. Thousand Oaks,

CA: Sage.

Neill, A. S. (1960).

Summerhill: A radical approach to childrearing. New York: Hart.

Panter, B., Panter, M. L., Virshup, E., & Virshup, B. (Eds.). (1995).

Creativity and

madness: Psychological studies of art and artists

. Burbank, CA: Aimed.

Richards, R. (2001). Creativity and the schizophrenia spectrum: More and more

interesting.

Creativity Research Journal, 13(1), 111-132.

Rogers, C. R. (1961).

On becoming a person. Boston: Houghton Mifflin.

Rogers, C. R. (1969).

Freedom to learn. Columbus, OH: Merill.

Runco, M., & Richards, R. (Eds.). (1997).

Eminent creativity, everyday creativity, and

health

. London: Ablex.

Schneider, K. J. (Ed.). (2008).

Existential-integrative psychotherapy. New York:

Routledge.

Schneider, K. J., Bugental, J. F. T., & Pierson, J. F. (Eds.). (2001).

The handbook

of humanistic psychology: Leading edges in theory, research, and practice

.

London: Sage.

Scotton, B. W., Chinon, A. B., & Battista, J. R. (1996).

Textbook of transpersonal

psychiatry

. New York: Basic Books.

Downloaded from

jhp.sagepub.com at SAYBROOK GRADUATE SCHOOL on September 16, 2011

Benjamin

111

Sela-Smith, S. (2002). Heuristic research: A review and critique of Moustakas’

method.

Journal of Humanistic Psychology, 42, 53-58.

Szasz, T. (1974).

The myth of mental illness. New York: HarperCollins.

Tart, C. T. (Ed.). (1975).

Transpersonal psychologies: Perspectives on the mind from

seven great spiritual traditions

. New York: Harper & Row.

Wampold, B. E. (2001).

The great psychotherapy debate: Models, methods, and

findings

. Mahwah, NJ: Lawrence Erlbaum.

Watson, J. C., & Bohart, A. (2001). Humanistic-experiential therapies in the era of

managed care. In K. J. Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.),

The

handbook of humanistic psychology: Leading edges in theory, research, and

practice

(pp. 503-520). London: Sage.

Webb, J. T., Amend, E. R., Webb, N. E., Goerss, J. Beljan, P., & Olenchak, F. R.

(2005).

Misdiagnosis and dual diagnoses of gifted children and adults: ADHD,

bipolar, OCD, Asperger’s, depression, and other disorders

. Scottsdale, AZ: Great

Potential Press.

Wilber, K. (1995).

Sex, ecology, & spirituality. Boston: Shambhala.