I had the great good fortune of befriending the late Dr. Bernard Lown, a cardiologist and the winner of two Nobel prizes. One was the Peace Prize for his leadership of Physicians for Social Responsibility in establishing the nuclear test ban treaty with Gorbachev. The other was for inventing the portable defibrillator. 

For many years I have recommended his book The Lost Art of Healing to people who have wanted more readings in the spirit of The Seven Challenges or Mastery Counseling. It explains how medical healers have lost touch with patients, including literally physical touch, and about the need to reverse this degradation. 

When my wife, Claudia, and I had high tea with Dr. Lown and his wife here in Tucson, he told us that at one point in his medical practice he wondered why he was making so few referrals to specialists compared to most of his physician colleagues. Upon reflection, he figured it out. The difference was that he spends a considerable amount of time talking with his patients. He knows them well — so well that he can explain most medical findings from labs and other studies based on this knowledge. He doesn’t need to jump and make referrals in response to every little anomaly he notices. 

Dr. Lown wrote about the lost art of healing. I’ve been concerned about the lost art of counseling. I’ve watched as the profession has been industrialized by insurance companies. Colleagues who had entered the field as caring individuals became almost robotic providers of services working on a conveyer belt, with shortened therapy sessions and the constraints imposed by administratively defined “lengths of services.” They lost the joy of healing. Many of them retired early.  

The decline of counseling seemed to start in the 1970s when psychologists were first required to provide a DSM diagnosis in order to get insurance reimbursement. Obligated to use this system, I remember fellow graduate students and professors agreeing we would never start thinking so narrowly about people. We knew human problems were multi-faceted and profoundly affected by life’s circumstances. We knew it was not “all in the head” and no simple mental health classification would be particularly meaningful or helpful in our work. Soon, other professional groups started pursuing insurance dollars, first social workers, and then counselors. Roll forward to modern times and you hear all the recently minted mental health professionals clinging to the diagnostic lingo as if it explained so much. This one is a “depressive,” that one is OCD, and the other is borderline. Diagnostic labeling has even become part of mainstream conversation. Friends, families, and co-workers often reduce their understanding of one another to simplistic diagnostic labels. It seems there are as many oppositional defiant individuals as people who rub others the wrong way. There are as many manic-depressive individuals as there are mood swings that the circumstances of life deliver. My friend and colleague, Sharon Conner, put it colorfully: “When your dog dies in the morning, you’re a depressive, and when you win the lottery that same night, you are manic. That makes you bi-polar.” 

These days, insurance companies require mental health practitioners to quickly establish a diagnosis and treatment plan before we have had ample time to truly know our clients and an opportunity to build a therapeutic alliance that would allow for full and honest disclosure. (By the way: The diagnostic label so quickly provided then becomes part of the medical record that follows individuals for their entire lives.) Often the insurance driven rush is followed by the implementation of evidence-based programs, many of them formulaic with prescribed protocols and some of them even scripted. The industrialization of counseling has been the demise of listening to our clients’ stories. It has been pushed aside by listening that is driven by an agenda of quickly categorizing our clients with a diagnosis, developing a treatment plan, and directing comments toward a speedy fix of counselor-defined solutions.   

In Mastery Counseling and The Seven Challenges, we offer a counterpoint. Although most service providers are still burdened by and obligated to work within a system dominated by a medical model, we still can reclaim some of the humanity and listening skills that have been lost. In The Seven Challenges, our emphasis is on building relationships and creating a safe atmosphere in which clients can fully tell their stories (Challenge One). Counselors practice the skill we call “listening to understand.” We keep our focus on hearing our clients’ points of view and concerns from their voices. We are interested in the circumstances of their lives (Challenge Four). We emphasize the importance of asking questions that follow the thread of our clients’ stories. The challenge is to keep this as our primary focus. At the same time, we do the minimum to comply with the requirements of our industrialized field but strive to resist the drift into counseling that is dominated by its demands. We know that agenda-driven counseling can lead us into a rabbit hole with distorted and distracted listening and a rush to draw conclusions and offer premature advice. We guard against this tendency and monitor ourselves to keep it at bay. We want to provide caring and individualized help. To succeed in our work, we support the return to commonsense, empathic listening as we get to know our clients and promote their self-determination.