Thirty years ago, Mahoney (1991) recognized a profound transformation in how individuals experience and understand their lives, identities, and relationships - expressed through consciousness, emotion, and intention. Mahoney called this an axial shift in human understanding, a turning point that has since gained momentum. Over the past three decades, this shift has reshaped the way we construct meaning, share our stories, and take action in the world (Gilligan & Price, 1993), shaping the very fabric of contemporary culture. For psychotherapy, the implications are both urgent and exciting. As Miller and Hubble (2017) point out, our profession must rise to the challenge of advancing the quality of clinical work to meet an increasingly inclusive and expansive collective worldview. This moment calls for more than adaptation - it calls for bold innovation.

In my supervision and clinical practice, I embrace and encourage innovation as key to the transformative work we engage. By embracing new ways of thinking and practicing, we don’t just keep up with change - we help shape it. As clinicians, we have the opportunity to lead, to create, and to reimagine what is possible in human healing and growth. Our field thrives not by holding onto tradition alone, but by daring to evolve.

General Systems Theory (GST) can be summarized as follows: GST emphasizes the importance of organization, the relationships between parts, and a focus on patterns rather than linear connections. GST advocates for considering events within their contextual environment rather than in isolation from it (Steinglass, 1978).

Systems thinking views individuals as integral components of larger dynamic systems, often referred to as the social matrix (Sager & Kaplan, 1972, p. 5). This perspective requires a conceptual shift away from the historically and culturally rooted linear cause-and-effect thinking commonly found in scientific discourse. The systemic perspective involves prioritizing interactional questions about "what" and "how" over individually oriented "why" questions. Although this shift is easier said than done, practicing it - focusing on mutual causal interactions - serves as the cornerstone of systemic therapy.

Psychotherapists trained in systemic thinking can effectively work with a variety of relational systems and groups, including workplace teams, social groups, and larger organizations, not just couple and family relationships. Williamson (1982) highlights how systems thinking has significantly enhanced our understanding of group dynamics (p. 54), making those who employ this perspective particularly skilled at leading diverse groups across various settings (p. 10).

The concept of relational critical consciousness (Vargas & Taniguchi, 2014; Vargas, 2016) offers a rich and nuanced extension of the idea of conscientization proposed by Freire (2000). Developing a relational critical consciousness calls individuals to deeply reflect on the myriad judgments, expectations, and anticipations that shape their sense of self within the intricate tapestry of interpersonal relationships. By cultivating this heightened awareness, relational critical consciousness serves as a vital countermeasure against the entrenched myths and subtle influences of individualism, which often elevate solitary pursuits at the expense of meaningful connections. Such individualism can reinforce societal norms and beliefs that render relationships invisible and paint dependence as a negative trait (Fineman, 2004).

When individuals embrace relational critical consciousness, they become adept at recognizing how cultural values associated with autonomy can overshadow the vital importance of community and connection. This understanding sheds light on the relational injustices that arise when one's focus is narrowed to the self, illustrating how this narrow lens can diminish the visibility of the rich, interdependent nature of human relationships. Furthermore, committing to a relational critical consciousness requires an intentional focus on recognizing, integrating, and celebrating these connections. Exercising a relational critical consciousness means placing relationships - whether with family, friends, colleagues, or the broader community - at the center of one’s life experiences. This shift in perspective transforms how we interact with the world, encouraging a more inclusive and compassionate approach to our shared existence rather than relegating these connections to the background of our lives.

The overarching framework I use for enhanced systemic work, conceptualizing psychotherapy, and clinical case consultation is based on the sequential practice of therapeutic Assessment, Goal development, and Interventions (AGI). This means therapeutic progress and case consults are focused, first and foremost, on a thorough assessment of the concerns that bring a client to therapy. A rich exploration of the presenting concern has favorable implications for therapeutic impact and is necessary for establishing a transformative goal with the client. The client's goal, likewise, has a significant effect on the course of therapeutic interventions. 

A person cannot travel within and stand still without. ~James Allen, As a Man Thinketh

Skill in listening is a prerequisite for useful clarification (Kemp, 1971, p. 95). Ambiguities are common in everyday narratives and are often resolved without our explicit awareness (Mahoney, 1991). Engaging clients actively in exploring their lived experiences contributes to positive therapeutic outcomes and allows clinicians to portray accurate assessments (Gilligan & Price, 1993; Ruesch, 1961). This process of therapeutic exploration is essential for grasping the presenting concerns that clients bring to therapy, and for explicitly connecting the client to their respective experience - especially when clients are confused or ambivalent about their experiences.

One of the goals of therapy is to help clients gain a better understanding of themselves. By exploring, inquiring, and clarifying a client's accounts - rather than imposing the therapist's perceptions or interpretations - meaningful discussions about the client's concerns can take place, ultimately helping to solidify their goals. It is vital to approach therapeutic inquiry with respect, as questioning can sometimes diminish the client's comfort level.

An accepted disparity between the values we profess and the actions we take becomes embedded in our customs. ~John Gardner, Morale

A therapeutic assessment differs from a diagnostic assessment's aim to categorize experience. In a therapeutic assessment, the aim is to narrow dissonance between the client's described and lived experience. 

The therapeutic assessment is focused on the client's initially reported presenting concern. According to Watzlawick, Weakland & Fisch (1975), in order to be solved, a problem, first of all, has to be a problem and the translation of a vaguely stated problem into concrete terms permits the crucial separation of problems from pseudo problems (p. 111). Additionally, a focused therapeutic assessment of the presenting concern generates experience-anchored process-grounded functional insights (Mahoney, 1991) for the client - maximizing the outcome gains from the assessment phase. This approach assures clients connect to, and find value in, their respective lived experience (Satir, 1988). A focused assessment of the presenting concern is vital to the course of therapy, as we cannot know in which direction we need to grow, until we first know where we are (Chaleff, 2009, p.38). 

The most important domains of human understanding and professional assistance lie not so much in the contents of personal realities as in their ongoing processes. ~Michael J. Mahoney, Human Change Processes

Undoing the past in the present.

The starting point in a course of psychotherapy is always in the present moment (Ruesch, 1961). A process-focused approach respectfully explores relational experience specific to what is happening in the here and now - including all that takes place within the individual and their relationships with their external environment (Kemp, 1971, p. 87). Typically, a process-focused lens views what's currently happening as fodder for interpersonal insights (Bloch and Crouch, 1985) and functional insights (Mahoney, 1991) to what may be happening similarly in multiple areas of a client's life, what happened in the past and what can be reasonably anticipated to happen again. When we assess for similarities of experiences that exist in multiple areas of a clients life, we gradually strip away outer details to uncover the underlying structure - or process - that holds these experiences together (Cheng, 2018). Hofman, Hayes and Lorscheid (2021), define "process" as theory-based, dynamic, progressive, contextually bound, modifiable and occurring at multi-levels. 

As soon as you want something, a part of that want is the fear you won’t get it. ~ Joel Kramer, The Passionate Mind

Change can be daunting for some clients, making the goal-setting phase one of the most transformative moments in psychotherapy. Defining and pursuing a goal requires a unique kind of vulnerability—one that differs from simply sharing past or present struggles. Expressing a deep desire, need, or long-held dream can feel profoundly exposing, and taking action toward that goal often challenges the self-stabilizing forces of homeostasis. In many ways, stating or pursuing a goal carries more emotional risk than discussing the initial presenting concerns. Yet, the good news is that goal development also creates powerful opportunities for growth.

The next phase - translating goals into action - is often the richest, the true goldmine of psychotherapy. For meaningful change to occur, clients must take steps, however small, toward living more effectively (Egan, 1975, p. 39). This process calls upon core capacities such as personal agency, integrity, purpose, and hope. It requires courage, congruence, and ethical commitment, especially for those who have endured unmet needs, trauma, marginalization, or a sense of a foreshortened future. Yet, it is in this space - where vulnerability meets action - that transformation becomes possible.

There are only two tragedies in life: not getting what you want—and getting it. ~ Oscar Wilde, Lady Windmere's Fan

A concretely defined and reachable goal safeguards the client against getting caught up in homeostasis and compounding/repeating rather than taking new actions (Watzlawick, Weakland & Fisch, 1974, p. 111). Once a single transformative client goal is established, there is additional therapeutic value in exploring the concerns that may keep clients from reaching their goal. Therapists who fail to explore the risks a client may face in reaching their goal, unwittingly facilitate their client's return to homeostasis - comprised of dynamic self-stabilizing processes.

Greater precision in definition and taxonomy is key to clinical practice and important toward conceptual clarity (Bloch and Crouch, 1985, p. 258). There is value in embracing and facilitating greater specificity toward expanding our conceptualization of practice and grounding our psychotherapeutic endeavors for enhanced clinical efficiency and therapeutic outcomes.

Bloch, S., & Crouch, E., (1985). Therapeutic factors in group psychotherapy. Oxford University Press, New York.

Chaleff, I. (2009). The courageous follower; standing up to and for our leaders (3rd ed.). Berrett-Koehler Publishers, inc. 

Cheng, E. (2018). The art of logic in an illogical world. Basic Books.

Egan, G. (1975). The skilled helper: a model for systematic helping and interpersonal relating. Brooks/Cole Publishing Company, Monterrey, CA

Fineman, M. A. (2004). The autonomy myth: A theory of dependency. New York, NY: The New Press.

Freire, P. (2000). Pedagogy of the oppressed. New York, NY: Continuum.

Gilligan, S., & Price, R. (Eds.). (1983). Therapeutic conversations (1st ed.). W.W. Norton & Company.

Hofman, S., Hayes, D., & Lorscheid, D.N. (2021). Learning process-based therapy.  New Harbinger Publications. 

Kemp, C.G. (1971). Small groups and self-renewal. The Seabury Press, New York

Mahoney, M.J., (1991). Human change processes. Basic Books

Miller, S & Hubble. (2017). How psychotherapy lost its magic; the art of healing in an age of science, in the Psychotherapy periodical, March/April 2017 issue.

Ruesch, J. (1961). Therapeutic communication. W.W. Norton & Company. 

Sager, C.J., & Kaplan, H.S. (Eds.). (1972). Progress in group and family therapy. Bruner/Mazel Publisher, New York. 

Satir, V. (1988). The new people making. Science and Behavior Books, Inc.

Steinglass, P. (1978). The conceptualization of marriage from a systems theory perspective. In Paolino T. J., McCrady B. S. (Eds.), Marriage and marital therapy:

Psychoanalytic, behavioral, and systems theory perspectives (pp. 298-306). New York, NY: Brunner/Mazel Publishers.

Vargas, H.L. (2016). Raising relational critical consciousness to enhance empathy in clinical hypnosis, American Journal of Clinical Hypnosis.

Vargas, H. L., & Taniguchi, N. (2014). The myth of autonomy: integrating relational critical consciousness in clinical supervision (Unpublished manuscript).

Watzlawick, P., Weakland, J. H. & Fisch, R. (1974). Change (1st ed.). W.W. Norton & Company. 

Williamson, D.L. (1982). Group power. Prentice-Hall, Inc. Englewood Cliffs, NJ