As a field, we were obsessed with methods, approaches, tools, theoretical orientations, and schools of thought. Money poured into establishing treatment efficacy differences have not yield much fruit; therapists investment in time, effort and money to train in specific models have not demonstrated improvement in our results.
I suspect that one of our key mistakes is a failure to learn first principles, instead of methods.
As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.
~ Ralph Waldo Emerson, Essayist and Poet
First principles is about deconstructing to the fundamental truths or origins. Aristotle calls this “the first basis from which a thing is known.” (‘origins’; archai).
For instance, no amount of cooking is going to make a dish with bad ingredients taste good. One the first principles of good cooking is using fresh ingredients. No amount of embellishment to a song is going to make a tune stand out if it does not have a strong melody. One of the first principles of good songwriting is a strong melody.
At this point of my thinking, I view first principles as a set of mental short cuts (i.e., heuristics, or what Nassim Taleb calls “rules of thumb”) that organises the way I think, and subsequently, guide the way I approach a situation (often, a challenging or difficult situation) in therapy.
In a previous post, I talked about the the three types of knowledge that we can immerse our appetite for learning.
To recap, content knowledge relates to the clinical theoretical understanding that you have of a client’s presenting concerns (e.g., depression, obsessive compulsive disorder, schizophrenia).
Process knowledge relates to the the moment-by-moment interaction between client and therapist (i.e., what you will say).
Finally, conditional knowledge relates to how you would work differently with someone who is depressed due to bereavement, compared to someone who is also depressed but has a history of domestic violence.
Depending on the phase of our professional development, we would have different levels of focus in these three types of knowledge.
Applying First Principles Thinking
Pulling together the content, process, and conditional knowledge, here is a concrete example of what I mean by first principles on an applied level:
1. When a conflict arises between you and your client and your client gets angry at you:
– First Principle = Disarm by Agreement: Instead of defending your point, disarm the situation by not becoming defensive, or even trying to clarify your point. Rather, take the position of your client’s inner world, and speak from there.
– e.g., “You know, as I think about what you just said, I can’t believe how insensitive I’ve been. You are right. I haven’t been here for you when you needed me most… not wonder you are angry at me”
2. When a conflict between you and your client arises and your client gets angry at herself:
– First Principle = Target of Emotion: Instead of pondering on her self-blame, help your client face the angry she has towards you which she has negated.
– e.g., “Do you notice that when we were facing the issue earlier, you went straight to getting anger at yourself? What if we face the emotion together? Can we invite this into our conversation? What is your feelings towards me when I wasn’t there for you when you needed me most?”
Why do We Need First Principles?
First principles are GROUNDING IDEAS, not GROUND RULES.
First principles organises us with a form, not a formula. A form gives you a rough guide on how to operate; a formula tells you a fixed rule on how you must operate.
First principles are not meant to be formulaic, and it’s not about having stock answers to pull out from your toolkit. First principles provide you mental representations of how to handle a situation, roughly. First principles are about having a compass to guide you on an uncharted terrain with your client; it’s not a detailed roadmap.
Without clear first principles, even though we say we are intentionally taking a “not knowing” position, we behave like we don’t know what to do in every new situation. We say, “we will response to the client’s presentation at that time,” or we say, “It depends.” The truth is, most of the time we do not have a mental model of how to approach especially a challenging situation.
Renowned basketball coach John Wooden says this,
“You win by becoming a better player of the game at large, not by adapting your technique to every new team you face. Your opponent will always be changing; it’s a losing race. But if you master the game, you will have skills and knowledge you need to defeat whoever you face.”
First Principles is a first step at mastering the conversational craft of psychotherapy.
What is NOT a First Principle?
– Case conceptualisation: Case conceptualisation or formulation are not first principles. A first principle will give you not only a rough guide of how to think, but also roughly how to handle a situation (recall content + process + conditional knowledge);
– Algorithm: A first principle is not algorithm. An algorithm provides a list of clearly defined steps on how to approach and solve a situation. Whereas a Principle is a rough mental model to guide you in a somewhat uncharted terrain;
– Rule: A first principle is a grounding idea, not a ground rule. There are rough mental “rules of thumb”;
– Theory: A first principle is not a theory. Theories may be governed by principles, but theories are less of a “good guide” on how to therapeutically engage with a given client. Saying that one of your principles is to be empathic is not a principle. It’s a theoretical idea. A first principle must provide the estimates of HOW to explicate empathy in particular situations.
Before we develop tools and methods, let’s develop first principles. It’s important to note that even though I’ve talked extensively about the implications of deliberate practice in our field, deliberate practice is a methodology, not a goal. Let’s not get caught up with any methods. Once we are able to go to the base of the semantic tree and articulate the first principles, we will have at our disposal an array of different and expansive methods and approaches, far beyond those articulated in psychotherapy schools of thought.
The truth is, first principles thinking is annoying, because unlike a set of clear instructions, or an algorithm, first principles do not spell out what to do each step of the way. Once again, it’s not a detailed map, but a guiding compass. Besides, a map is useless if you don’t know where north is!
Treat first principles as signposts for the journey.
What If I don’t Have Clear Principles?
Most likely, you already have some. It’s probably not been deliberated and explicated consciously.
Stay tuned for the next blog post on Three Ways to Develop First Principles in Your Clinical Practice. In the mean time, I would love to hear what you think about the distinction between first principles and methods, and how you apply this idea into your practice.
 See Terence Irwin’s book, Aristotle’s First Principles
 See Nassim Taleb’s book, Antifragile.
 John Wooden, A Game Plan for Life, 2009, p.41