The Assumptive Worlds of Psychopathy IX: The World of Aspirations
An assumptive world of Aspiration encourages this move of empowerment. It is a case, once again, of recognizing that the world in which one dwells might be “crazy” even if we are not personally crazy. It is perfectly appropriate to aspire to and act on behalf of a desire to move away from the anxiety-filled, crazy world of the cliff. This does not mean in any way that we have escaped the pain, but it does mean that we are learning about the pain that comes with living on the edge of the cliff. We can turn this into clean pain that leads to new learning and new levels of care for self and others—the multiple levels of generativity that Gary Quehl and I write about (Bergquist, and Quehl, 2020).
At this point, Rosmarin offers several concrete suggestions concerning ways in which assessment tools might be of benefit to the people he is seeing. At this point, he borrows again from the world of medicine and the assumptive world of mental health. According to Rosmarin, we just need an objective measure of a person’s state of mental health in order to make a diagnosis and prescribe treatment:
Patients could begin by completing self-report assessments (like the PHQ-9 for depression and GAD-7 for anxiety). These measures take just minutes to compete and help clinicians screen people for common mental health problems such as worry, social anxiety, panic, unwanted thoughts or obsessions, compulsive repetitive behaviors, alcohol/substance use, nonsuicidal self-injury, and suicidal thoughts or activity.
Ah, if it were only so simple. I do commend Rosmarin, however, for moving on to the identification of environmental stressors (the “crazy world”) that impact one’s quality of life:
With that information in hand, psychologists could also identify stressors in the patients’ lives such as finances, relationships, and work, and the patients could learn steps for dealing with them. For example, someone struggling with work-related stress could be trained to practice a two-minute mindfulness exercise each day. Someone in a strained relationship could be coached to raise their concerns in a loving manner with them partner, before issues be come major impasses. People who feel sad; anxious, or worried could learn to recognize and accept their distress, so they don’t develop full-blown depressive or anxiety disorders.
I agree that self-report tools can be of value in helping us paint an immediate portrait of one’s client/patient and I am pleased that Rosmarin gives consideration to the painting of a broader landscape of the person as they are living in their environment (thus enabling them to consider leaving the cliff). For this broader landscape rendering to occur, there must be something more than the administration of objective tests. Some listening should also take place. And it is not just listening for environmental stressors. It is also listening to the client/patient’s life narrative (White and Epstein, 1990) This narrative is of great value, from an aspirational perspective, in helping us gain a clear sense of how this person finds and frames purpose and meaning in their life. If they are anxiety and in pain, what does this anxiety and pain mean to them? What can they learn from this anxiety and pain? It is important, once again, to remind us that we should not just be in the business of helping our clients/patients eliminate the pain and find some kind of unrealistic happiness (the Era of Hedonia). Clean pain is saturated with new learning, change and empowerment. It provides guidance for movement away from the current cliff.