Conceptual Hygiene, what a concept.  Do your conceptual frameworks floss before bed?  Do you change the models you hold most dear like you change your clothes?  Do you claim your perspective to be eclectic because you have commitment issues?  Has your EMDR protocol met your psychodynamic model in the resonate field of intersubjective relations while attempting to resolve early attachment trauma with Ativan and klonopin?  Hmmm.

Conceptual hygiene is the notion that we should be clear and clean with the concepts and conceptualizations we use.  What do we really know?  How do we know it?  Can we hypothesize about what we see while remaining open to new information or do we reject new information when it fails to fit our hypotheses?

As a young undergraduate student I was told by a crusty old professor,  you will be introduced to a number of different theories throughout my training, he said “Have an intimate affair with each, but marry none.”  And while this is itself a fixed perspective, it suggests that while we intimately embrace our theories and models and we should also wear them like loose clothing.

But what does this really mean in practice?  When must our clinical judgement supersede a manualized treatment or protocol?  How do we decide when our bag of tricks needs to expand, that we have become comfortable in our clinical practice.  How do we keep our interventions consistent with the exploration of our hypotheses?

It has often been said that it takes 10,000 practice hours to attain mastery.  But that is actually a misnomer.  Its 10,000 practice hours at our growth edge.  We become confident about what we do as the result of repetition, but confidence is not competence.

As therapists we are trained in theoretical frameworks largely predicated on our personal predispositions and the orientation of the schools we attend.  Then we get exposed to many different models and theoretical paradigms some of which are congruent and some of which are grounded in principles and assumptions that may not be readily integrated  or compatible with our foundational training.

The challenge we face is to know what we know and what we don’t know.  And that’s a tall order.  Theories and models help us organize information into a context that is meaningful.  We need to be mindfully self-reflective while we honor our different impulses, embrace our intuition, and remain clear that we must, as appropriate, get confirmatory information from our clients.

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