Many people avoid going to therapy because they're afraid to reveal a personal problem. They fear being judged, diagnosed, or possibly looked down upon. In a Facebook culture, where everybody is always taking selfies to prove what a great time they’re having, who wants to admit they are depressed, anxious, or struggling to cope with life?
Nah. No thanks, doc. I'll keep my private life to myself.
But before you dismiss therapy outright, let me tell you this. What I do is join forces with people. I do not judge, moralize, criticize, or condemn. I understand that human beings are flawed, vulnerable, irrational, and occasional conflicted.
There are no perfect human beings. Everyone struggles, sooner or later. Life is hard.
I cannot make life less hard for you — no one can. Nor can I change your past, your history, the things that have happened to you. What I can do, however, is join forces with you as you try to make progress towards some goal.
Suppose you’re struggling with a problem and you ask someone you trust for advice on how to solve it. Most people are only too happy to give it to you. Maybe they have personal experience with the concern in question, or maybe they know somebody who had a similar problem. Either way, this very well might you help you. Especially if it’s a practical problem and not too complex.
Or maybe you consult the all-knowing internet, a magazine, or a book. In our world, advice is not hard to come by. It’s everywhere. And if that’s true, why would you bother going to a therapist with an emotional concern? Why not just use one of the other readily available resources?
Many people have, in fact, made this very argument to me.
In social settings, sometimes people will ask, “So, um, what do you tell people who have problem x?” As if giving advice is what therapy is about.
Except it isn’t.
Advice is generalized information that can be tailored to the many, but therapy is tailored to you. Your problem may be similar to the problems that others have–-indeed, many emotional concerns are universal––but your circumstances, goals, and needs are likely to be different. Moreover, your problems do not occur in a vacuum. Your personal history is unique to you and it serves as a broad context in which to understand your problem.
As a therapist, I listen carefully to my clients. I take pains to get to know who they really are, something a columnist in magazine will not do. I try to understand my their unique psychologies. And I lock in on the various psychological factors–-thoughts, feelings, conflicts, beliefs–-that keep them stuck.
Do I give advice? Sure. Sometimes.
But not all clients need advice. Some clients need to listened to and understood at very deep level (think: unconscious mind). Some clients need to be encouraged, coaxed, or persuaded to try something new, even though it feels risky, hopeless, or fearful. Some clients need to have someone believe in them, support them, or root for them as they try–-yet again–-to make a change. Some clients need to be confronted with self-discrepancies or self-destructive behaviors (gently). Some clients need insight into patterns of behavior, relating, or resistance. Some clients need to clarify their feelings, often hidden, or simply experience them in the presence of a caring human being. Some clients need to be challenged. Some clients need acceptance.
Some clients need all these things, and more.
If years of doing therapy have taught me anything, it’s that most human problems--depression, anxiety, relationship issues, career troubles, et cetera--are more complex than they appear on the surface.
Which is why common advice so often fails.
A therapist cannot change you. He can listen to your deepest concerns; clarify your wishes and wants; help you understand your emotions; challenge your thinking; be objective about your situation; invite exploration; support good efforts; coax you to try, just try; nudge you to stand up for yourself; confront your inconsistencies and irrationalities (gently); ask hard questions; appreciate your strengths; applaud your successes; provide information; teach new skills; worry about you; make direct suggestions; help you understand how dysfunctional beliefs are not serving you; and welcome your presence. But he cannot change you.
Only you can do that.
If you change, it’s because you took action. Maybe a small step here and there, a shift thinking or behavior, a risk, a new pattern. If you change it’s because you experimented with the idea of doing things differently. Maybe instead of fighting your truest, deepest nature, you made peace with it (and yourself). Maybe you treated yourself with love instead of criticism. Maybe you came to believe you were enough, just as you are.
If you change, it’s because you made it happen. You were willing to experience the discomfort that comes with resisting old habits and building news ones.
If you change, it’s because you made it happen, not your therapist.
When something bad happens, the pessimist thinks: there’s something wrong with me, it will effect everything I do, and it always going to be this way. I am crap, my whole life is crap, my life will always be crap.
When something bad happens, the optimist thinks: there’s something wrong with this situation, the rest of my life is okay, and it –– whatever “it” is –- is only temporary.
The pessimist lives by the three Ps: personal, pervasive, permanent. (It’s me, it’s everything, it’s forever.)
Pessimism + rumination (mentally going over and over things that have happened) puts people at risk for becoming depressed. Bad things happen to everyone, but not everyone becomes depressed, and some people bounce back more quickly.
(Note: there are other factors that predispose people to depression, of course. Biology, temperament, and early parental loss, for instance.)
Pessimism is a thinking pattern. When people who are depressed come to therapy, we often try discern the role thinking patterns play in how the client interprets his or her world. Depressives have a habit of personalizing everything. They also have a tendency to use selective abstraction –– that is, they pick out the one or two negative things about a situation and ignore the rest. Therapy for the depressive is often a process of identifying perceptions, thinking patterns, and beliefs –– and restoring perspective.
We can change our thinking patterns, but it is not enough to say, “Think Positive.” This is simply too general and too broad. We need to be specific. We need to pinpoint the specific ways the depressive thinks and then examine those patterns for distortions and logical alternatives. As you might imagine, this type of changes take a little time, not to mention commitment, focus, effort, and repetition.
By the way, I do not mean to minimize the role that external events play in our suffering or, for that matter, our happiness. Such things matter a great deal. But what does it mean to be a hardy individual? What does it mean to cope well with the slings and arrows that life shoots our way?
How you think matters.
Sometimes a crisis occurs when you didn’t see it coming. (Getting fired. Becoming seriously ill. Losing someone you love.) Sometimes a crisis occurs when too many things come at you at once. (The refrigerator goes out but your checkbook is empty and then you get the flu and then...) Sometimes a crisis occurs when a problem you ignored or pretended not see brings unwelcome consequences. (Your spouse decides to proceed with a divorce after months, probably years, of feeling like the marriage is not working.)
No one likes a crisis. We become overwhelmed, anxious, worried, upset, despondent. Sometimes we have to make hard choices. Or experience loss. Or make a change we’d really prefer not to make, thank you very much.
Getting through a crisis is seldom easy. More often than not, we have to put our thinking caps on and problem solve like the dickens. We have to tolerate the inevitable distressing emotions. We have to find the courage to face our fears. Sometimes we cry, or protest, or fight. And when these things don’t work, we go back to problem solving again. Talking about it –- seeking support, wisdom, guidance –- often helps. There is no one-size-fits-all solution to a crisis, of course. Your situation may be different from mine.
And yet sometimes there are hidden opportunities in a crisis. Maybe the crisis will force us to change something that needed to be changed. Maybe the crisis will result in the creation of new directions and new patterns. Maybe the other side of the crisis, once we get through it, is actually a better place to be.
Maybe, just maybe, your next crisis has something to teach you. Food for thought.
“What advice would you give for–– “
Let me stop you right there. Psychotherapy goes well beyond simple information or advice. It’s ultimately a process of understanding how your unique psychology–-complex patterns of thoughts, feelings, and actions––contribute to your distress or problems.
Unlike self-help books or advice columns, therapy is tailored specifically to you. Your concerns, your situation, your personality, your history. Common advice tends to be universal. Therapy is specific.
“Okay, but does therapy really work?”
Most people report that it does. There are many ways to feel better. Mood, symptoms, relationships, satisfaction with life, problem resolution–-these are just some of the changes clients may report. And scores of research studies have consistently confirmed that therapy does indeed help people.
Which doesn’t mean it’s a panacea or even that a successful outcome is guaranteed. Truth is, the outcome of therapy depends on your goals, the type and severity of the problem you are trying to address, and your motivation to do psychological work. Still, most people report after seeking treatment they feel better off than before they started.
“What can I expect from the process? How does it work?”
The first session is a bit unsettling for many people. After all, you’re talking to a professional that you don’t know yet, and you’re talking about the most problematic aspects of your life, which can arouse strong feelings. But the good news is, the process of opening-up gets easier. We go at your pace, and we seek to understand, not judge.
In the early sessions, I do a lot of careful listening. Your life is like a story, complete with characters, plot, and narrative. My first task is to listen for those themes that tie your life story together. But as we go, you can expect me to begin making comments. These are anything but casual. They are designed to give you input, feedback, direction, suggestion, and interpretation, and they are directed at the way you think, feel, act, and react.
Sometimes the changes that people need to make are obvious, but sometimes not. And almost all change is accompanied by resistance. The middle stages of therapy are all about working together to understand the various forces that are holding you back. Frequently these “forces” are psychological, but sometimes they are social or practical. Therapy is as much about figuring why you haven’t been successful in personal change as it is in knowing what to change.
“How long does therapy take?”
There is no set length for therapy. To a large extend, it will depend on the problems you are trying to address and the goals you are trying to accomplish. Although some problems require longer-term work (e.g., maladaptive personality patterns), most problems do not.
Frankly, therapy is best viewed as an investment in your best asset–-you. Yes, it costs money, time, and energy, but if you improve your psychological functioning, you might just end up happier, wealthier, and wiser.
“But I’m not crazy–-I don’t need a therapist. I just want to feel better.”
Well, my definition of crazy and your definition may be two different things. What I can say is that most people have problems, issues, imperfections, struggles, and suffering of some kind. That just makes you human. Seeking assistance with these things makes you smart.
Therapy has one overarching goal: to help you alleviate distress.
Of course, distress can take many different forms. Sometimes it is a set of symptoms, like those associated with anxiety or depression. Other times it may involve a key relationship, such as a romantic relationship or a marriage. And still other times it may involve a problematic situation, such as a divorce process, job issue, or a family matter.
Therapy helps you understand––and change––the underlying emotional factors that are driving your distress. During the course of therapy, you can expect us to explore your unique psychology. This may involve emotions, thinking patterns, core beliefs, key relationships, and your personal history. Once we understand the factors that are contributing to your emotional patterns, we can then figure out the steps you need to take to make lasting improvements in your life.
Psychotherapy requires your full participation. It’s a highly collaborative process. By coming to sessions, you are essentially inviting someone else to join forces with you as you take steps to address your concerns and improve the quality of your life.
Therapy is not easy to describe. There are many methods and techniques, and even these will vary to a degree depending on the personality of any given therapist. But in therapy, here are some things I routinely do with almost all clients/patients:
- I listen. I use my head (knowledge), heart (compassion), and experience (wisdom).
- I ask questions. Clarifying questions. Questions designed to make you think, go deep into the core of who you are and who you’d like to be.
- I teach. The human psyche is delightfully complex. It’s a rich stew of defenses, feelings, motivations, beliefs, conflicts, anxieties, avoidances, values, temperament. The more you know about your own psychology, the better you become at adapting to the world. I strive to help you understand yourself more deeply. At the same time, we live in a social world, so I also strive to help you understand the key people in your life.
- I provide support. We all need somebody to encourage us, believe in us, root for us. Never underestimate the power of having somebody in your camp. After all, human beings are hard-wired for social connection. We need the support of others to help us become our best.
- I give feedback. I make observations, summaries, interpretations, and suggestions. Sometimes I try to get you to focus on what is (acceptance), other times I ask you to consider what could be (possibilities). Or maybe I’ll help you “connect the dots” of your life, pull things together in a new way. And unlike common advice, which tends to be universal and good for all of us, when I make a direct suggestion it’s usually quite specific to you and your circumstances.
This is what therapy is really about.
It’s about joining forces with a professional as you work to address your most pressing concerns.
Sometimes when people first walk into a therapist’s office they fear they’ll be judged or scrutinized. Maybe they feel embarrassed or ashamed because they have a problem, and maybe that problem is difficult to talk about. But what therapists know is that everybody has problems or issues sooner or later, and that none of us is perfect.
Therapy is about working together. Therapy is about forming an alliance. Therapy is about establishing goals and working towards them with support, encouragement, and insight.
Why is a therapist valuable to you? Yes, we are trained in human behavior, and yes we have experience in helping others. But we may also have a measure of objectivity about you that you may not have. When you are trying to get unstuck or see your way through a difficult time or alter a pattern of behavior, this can make a big difference.
In an age of text messaging, social networks, e-mail, and cell phones, the idea of meeting face-to-face with an actual person sounds almost quaint. And yet that's precisely what therapy is all about. It's about taking an hour every week or so to engage in honest communication about those aspects of your life that are most vital to your well-being.
The aim of therapy is to help you work your way through distress. Of course, distress can take many forms. Maybe you’re struggling with a set of symptoms, like those associated with anxiety or depression, or maybe you're trying to get a handle on a problematic relationship. Or maybe life has sent you a curve ball –– a divorce, a job loss, or an illness –– and your head is spinning.
If human beings functioned strictly according to logic, we’d seldom run at cross purposes with ourselves. But human beings are emotional beings. We feel pain, compassion, joy, anger, sadness, fear, shame, and guilt –- and these feelings are rarely more powerfully felt than when they occur in the context of relationships with people.
Therapy helps you deepen your understanding of yourself. As we begin to examine the particular nature of your distress, we’ll discover emotional and behavioral patterns. The core of these patterns may involve contradictory feelings, hidden motivations, or maladaptive beliefs that bias your perception of the world. When you are distressed, it’s easy to get stuck. Therapy is a process that helps you identify the internal barriers that are keeping your stuck so you can move past them.
We want to get you moving again, moving in the direction you really want your life to go.
Therapy isn’t about doing things to people; it’s about doing things with them. When you invite a therapist to help you, you’re inviting him or her to join forces with you. It’s you and me against your problem, pain, symptom, concern, pattern, or barrier.
In therapy, you talk, I listen. Mostly. Sometimes, especially when I become more confident in my understanding of your unique psychology, we’ll reverse roles and I’ll do a fair share of the talking. I will provide input. Because I am not you, I may have a measure of objectivity about you that you might not have. Also, I know a few things about how the human psyche works.
What do you talk about? Usually in the first session people have plenty to say because they’re explaining the problem. But sometimes in the second session they’re not sure where to go from there. Don’t worry. I’ve done this before; I can help you with that. But think of it this way: therapy is about having an extended conversation about the most vital aspects of your life. You may be surprised by how much we have to talk about. Problems are often quite complex. It may takes us some time to understand what’s really going on with you.
If you’re struck, we’ll try to get to the bottom of why. If you’re in emotional pain, I’ll listen with my heart, not just my head.
Ideally we meet weekly. We need to establish a routine, a rhythm of working. You don’t have to take the same time slot every week, but it often helps if you can. This creates consistency and expectation.
Sometimes people will come to sessions hoping that their mere attendance alone will be enough to create change or transformation. By simply showing up, they hope that something will rub off and they’ve get better. But therapy doesn’t work that way. Therapy requires your active participation. I can’t emphasize that enough. Therapy may require you to discuss painful memories or emotions. It may require you to try experiments with new patterns, or takes small risks. It may require you to speak the unspeakable or put difficult experiences into words. It may require several rounds of trial-and-error. If you’re going to try therapy, you must be prepared to exert effort.
We start with where you are at. Yes, we identify the basic direction you want to go (values, purpose), which will naturally lead us to think about certain destinations that you have not yet reached (goals), but we start with where you are at. Don’t be afraid to tell the truth about who you really are. We all struggle; we all have flaws, pain, loss, and history. Because I am a human being, I am just as likely to struggle in life as you are. This is why I have compassion for you. I know emotional pain myself; how could I not? So don’t be afraid to show me where you’re really at. In my practice, I have encountered just about every form of human suffering you can imagine. When it comes to human problems, there is little you can say that will surprise me. I will not judge you because of the way function (or fail to).
Change is possible. I know it is; I see it every day. And yet change, or personal transformation, is rarely linear and rarely fast. In fact, often the early phases of change are barely noticeable. But that does not mean they’re not occurring. Sometimes one key difference becomes a small snowball rolling down a hill. It gets bigger and bigger as it grows. If you’re going to try therapy, give it some time. Making a course correction in your life is more akin to turning a big ship than to turning a boat. In other words, it takes a while.
Therapy isn’t designed to make people into perfect persons; there are no such things. Nor is it designed to cure life; there will always be factors outside of your control, difficult situations and people, stress and struggle. What therapy is designed to do help people create lives worth living. I want people to feel fully alive, fully engaged, excited, moved, effective, and productive. By working through internal barriers, we increase the chances of that happening for you.
Sometimes people avoid seeking psychological services because they are too embarrassed or ashamed to talk about their pain or problems. “He’ll think my life is such a mess,” someone might think to themselves. Or, “She’ll wonder why I waited so long to contact a therapist.” These thoughts and fears become barriers to seeking help.
But here’s what I really think. Most are people are doing the best they can. None of us –- and I mean none us –- is exempt from pain, suffering, and loss, and that includes psychologists. There are no perfect human beings, which means that we all have flaws, we all make mistakes, and we can all get caught in unproductive patterns.
As a therapist, I offer compassion, not judgement. I offer to join forces with you, not tell you what to do. My job is to help you help yourself get past those barriers that are keeping you from creating a life worth living.
“Is there a reason why he/she can’t come to phone?” I ask.
If there is a legitimate reason, I’ll move forward with the conversation. If not, I’ll ask either to speak with the person in question or I’ll suggest that he or she call me directly.
Sometimes parents are put off by this. But the first step in receiving help is taking ownership of the problem. Initiating the process of therapy oneself –- through that first call –- sets something in motion. It is a declaration: “I want my life to different, and I am willing to do something to make that happen.”
The client we don’t like to see is the (adult) son or daughter or the spouse who has been coaxed, prodded, or pushed into therapy, and is simply agreeing to attend to appease mom, dad, or a significant other. This is a very different thing than making the choice to start therapy.
If you adult son or daughter is struggling, I do think it is wise to share your concerns with him or her in a compassionate fashion. If you think they could profit from professional help, I also think it is fine to provide them with a number to call, a web address to check out, or some other resource. But let them start the process. Let them choose.
In terms of therapy outcome, choosing makes all the difference in the world.
In my job, I sit with people every day and talk about the aspects of their lives that are not working. In this way, you could say I catch people at their worse. But that’s only half of the story.
People are always more than their problems. You are more than your moods, your distress, your weaknesses, or your history. You are also your values, commitments, identity, relationships, and potentials. You are capable of goodness and change. You are your strengths (even if you do not know precisely what they are), and you are capable of joy, laughter, connection, and deep engagement with the world.
Therapy is not just about solving problems or alleviating distress. It’s also about finding ways for you to be at your very best.
But not just any kind of talk.
If you’re going to get to your core pain, you’ll have to speak honestly about your self. You’ll have to tell the truth about what you really feel, what you really think, who you really are, what you really want.
If you’re going to make progress, sooner or later you’ll have to drop your emotional armor. You’ll have to let somebody see behind the mask.
Ordinary social discourse usually requires you to put on a good face, cover up, pretend things are fine. This kind of talk might get you through the day, but it will not help you heal, discover new things about yourself, or resolve problems.
Your words can be used to convey information. But they can also convey emotion, experience, memory, conflict, contradictions, complexities, dilemmas, secrets, insecurities, hopes, dreams, and above all, possibilities.
Talking helps, especially when you have the right listener.
A good listener asks good questions. A good listener keeps the focus on you. A good listener will challenge you, especially if you fall into the trap of trying to put on a good front.
A good listener will offer input, interpretations, and counterpoints, but not at the expense of being heard, understood, or supported.
A good listener talks, but not too much.
Talking helps. Especially if it’s the right kind of talk, with the right person, about the right things. You in?
This is one of the oldest debates among therapists. Do we call the people we serve clients or patients? And does it matter?
The word “patient” has medical connotations. But strictly speaking, therapy isn’t a medical procedure, no matter what the insurance companies say (it’s a relationship). By contrast, the word “client” emphasizes the business aspects of the arrangement. To be sure, a therapy relationship is a business relationship because it’s something you pay for. But it is so much more than that. There are few other professional relationships that are so personal. Perhaps neither label is satisfactory.
Regardless of the label we use, the person in therapy has to admit he or she has a problem if the therapy is to work. And she must also agree, by virtue of seeking help, to be open to the therapist’s judgement, influence, recommendations, and care. Whether we call you a client or a patient, you are still assuming a role –- one who needs help, guidance, insight, change, support, or encouragement. Accepting this role is really the first step of the therapy process.
Which is why I am reluctant to let adults call on behalf of other adults in making appointments.
“I’m calling for my husband,” a caller might say. To which I reply, “Is there a reason why he is not able to use the phone himself?”
“If he wants therapy, please have him call me.”
This may sound harsh to some. But what’s really at stake here is whether the intended client or patient is ready to assume the role of being in therapy. If he is, he must declare the role for himself by owning his problem and owning his need for help. It is not enough to merely agree, at his wife’s coaxing, to come to the office for a consultation. He must decide if this is what he wants for himself.
Think of it this way. If you go to a medical doctor, he or she can do things to you –- an injection, a surgery, a check of vitals. You can consent to let these things happen. But a therapist does things with you. Without your full participation in the process, nothing much happens.
You are a “patient” in the sense that you are under the care of a therapist, but you are a “client” in the sense that you have purchased the services of a guide who knows the psychological terrain. But perhaps the real question isn’t which label we pick, it’s whether you are ready to do something about your problem.
Expressing anger in therapy is easy enough. Anger is an easy emotion to label and, it seems, discharge.
Usually we know when we feel sad, but deep grief, sobbing grief, is something we often fear. Some will try to avoid it altogether. Others will express it, just not in front of a therapist.
Guilt nags at us. It’s uncomfortable but not unbearable, and often it is accompanied by a nagging sense that we need to make things right.
Anguish is psychological pain. When it’s bad, it’s gut-wrenching. When it’s mild, we are upset, distressed, unsettled. We want it to stop.
Shame is a powerful emotion. When we fee ashamed, we feel don’t just feel that we have done bad (guilt), but that we are bad. Shame prompts us to withdraw, pull back, or even hide if the emotion is intense enough. To be “exposed” would be having our badness revealed. Better to cover.
Sometimes the emergence of emotions are preceded by anxiety. Anxiety is easy to understand when it is directed at something external–-a social situation, a snake, a spotlight on performance. But we can feel anxious in responses to our own emotions, too. Indeed, sometimes the anxiety is so pressing that we believe it is the only thing we feel, and it takes some reflection to identify the deeper emotions that are behind it. Negative emotions, especially powerful emotions like deep grief or shame, are necessary, just not always welcome.
Broadly speaking, emotions are true guides. Without them, we would not be able to make good decisions, have preferences, values, responses to danger, know when we have been violated, or recover from loss. Emotions are a very important part of therapy, especially when someone is trying to recover from emotional injury.
When a toddler is happy, she hugs. When she is distressed or sad, she cries. When she is frightened, she runs. Toddlers are not conflicted about their emotions. They do not worry about the time or place when expressing them. Adults, however, must learn to control their emotions, express them at appropriate times, in some cases conceal them, and understand how they relate to perceptions, thoughts, and actions. But sometimes this process gets off track. Sometimes we have to stop and relearn how to identify, experience, express, or regulate emotions before we can move on with life.
Human beings do not operate strictly according to logic and reason. We are emotional creatures, for better or worse. Therapy is simply one way of helping you sort things out.
Most people worry to some extent, but some people worry excessively, whether they need to or not. It’s as if their brain is a worry machine and they can’t find the “OFF” switch.
The excessive worrier jumps to worse case scenarios. If he has a headache for several days in a row, he doesn’t assume he’s having tension headaches. He’s more likely to think, “Oh my God, I must have a brain tumor.” Other explanations, if they are considered at all, are bypassed on the way to the worst possible outcome.
Worry is typically concerned with ordinary realms of life: health, finances, relationships, job, children. Worry is a form of anxiety.
Excessive worry can disrupt sleeping patterns because it increases bodily arousal. Worries can distract us, making concentration difficult, which is why it is sometimes mistaken for ADHD. Worry can also be a burden to the worrier’s spouse or significant other because the worrier may need constant reassurance that worry isn’t likely. All in all, excessive worry is exhausting.
When I work with someone who worries too much, the first thing I do is ask them to externalize their worries, i.e., talk about them in the session, in considerable detail. We unpack them one-by-one. Invariably, we’ll discover what cognitive therapists call “thinking errors.” Some these might be:
- Confusing the possible with the probable. (Very common thinking error)
- Failing to consider the simplest explanations first.
- Assuming that if a worry comes true one won’t be able to cope.
- Over-estimating the relevance of someone else’s health problems to one’s own life.
- Confusing prevalence with salience. (e.g., plane crashes are salient but not prevalent)
What we do in therapy is try to put the worrisome thoughts back into perspective. Just because something is theoretically possible it doesn’t make it likely. And if x should happen, well, what would you do then? You might as well answer the question. It takes courage to face your fears –– even when they are hypothetical. But this is one way you have of not letting them control you. So I might ask, “Have you ever coped with anything like this before? Has anyone else? If so, what have they done?” Or: “Objectively speaking, how bad is this fear?”
Anxious thoughts are future-oriented. It’s as if we’re scanning the road ahead of us, watching out for the threat of danger. In therapy, I ask people to identify the threat. Frequently the threat can be reduced. For example, driving defensively, sober, without looking at your smart phone, will drastically reduce the odds of getting in a car accident. Note, however, that the risk is not eliminated, just reduced to manageable proportions.
People who struggle with worry often wish that therapy will banish their anxiety and fears completely. But of course life seldom works that way. There are some things we control and many things we do not. But some threats, perhaps most, can be reduced enough so that we don’t need to stay vigilant about them.
And yet, it takes time to turn off the worry machine. It takes focused attention to practice new thinking skills and regain perspective. Which isn’t to say we should never anticipate dangers or scan the road ahead for threats. Indeed, it is probably adaptive to devote a certain amount of attention to these things. It’s just that it seldom helps us to stay stuck in this mode.
A silver bullet has come to be a metaphor for the idea of having single solution that creates maximum results. But when it comes to stress, personal problems, symptom relief, or maladaptive patterns, there are no silver bullets.
In therapy, we pay attention to the particulars of your unique psychology. Perceptions, thoughts, feelings, motivations, beliefs, fears, wishes, dreams, personal history, relationships –- these are just some of the elements that may be contributing to your distress. Because your psyche is so complex, solutions to your problems, whatever they are, are unlikely to be simple.
A psychologist will not solve your problems for you. What a psychologist can do, however, is join forces with you as you struggle to overcome emotional concerns. The difference is crucial.
Here are just some of the ways I can be of assistance:
I help people identify their blind-spots.
I help people translate the messages they’re getting from their psyche.
I help people understand other people.
I help people develop insight into their own motivations, patterns, and personality.
I help people create a workable plan for change.
I help people regain perspective, especially during times of distress, conflict, or fear.
I help people keep their goals in sight, especially when resistance kicks in.
I help people sort themselves out, or make sense of what has happened.
Never underestimate the power of join forces with someone as you seek to make progress in your life. I am all for independence, autonomy, and strength of character. But human beings accomplish some of their best work when they recruit others to help them achieve their goals.
If you need help, get it.
Don’t try to build your life boat alone. You might miss something.
Examples of complex problems are:
- Post-traumatic stress disorder
- Recovery from sexual abuse
- Emotional injuries from childhood (e.g., neglect, emotional deprivation)
- Self-injury (e.g., cutting)
- Eating disorders
- Personal dysfunction
1. Complex problems require special sensitivity and care. By its very nature, therapy –– i.e., talking about the difficult and problematic aspects of one’s life –- can stir up negative feelings, especially anxiety. If you struggle with a complex problem, negative feelings may be especially difficult for you to manage, and it’s the therapist’s job to be mindful of this and to make sure we don’t try to go too fast.
2. Complex problems requires a strong therapeutic bond. If you have a complex problem, you want to feel as though you and your therapist are a good team. You both agree upon the goals for therapy; you feel comfortable enough to say those things that others might not have wanted to hear; you trust your therapist enough to talk about your struggles with trust. A good bond is especially important if you’re going to risk revealing aspects of yourself that are complicated by intense guilt, shame, or pain.
3. Complex problems require a therapist who knows what he or she is doing. If you have a complex problem, look for an experienced therapist, especially one who has experience with your type of concern, and one who has received good training. Be wary of the therapist who promises too much or claims to treat all types of problems. When looking for a therapist, don’t be afraid to shop around. (Tip: if the therapist has a website, don’t skip the “About” or “Bio” page.)
One final thing. Complex problems can be overwhelming, but it is possible to get better and to improve the quality of your life. Don’t give up.
Every now and then, people will ask questions. Here are some of the more common ones along with my answers.
Q: Why did you become a psychologist?
A: I became a psychologist because I’ve always been interested in people. I became a psychologist who practices therapy because I wanted to make a difference in other people’s lives.
Q: Does therapy really work?
A: Actually, the therapy process has been subjected to been hundreds of well-controlled studies. And what they show is that people who receive therapy are roughly 75 to 80 percent better off than those who don’t (with comparable issues). Having said that, I hasten to add that results vary and many factors contribute to the success of any given therapy experience, not the least of which is the client’s motivation.
Q: Aren’t most shrinks a little crazy themselves??
A: Stereotypes abound in our culture. Unfortunately, therapists are often poorly portrayed in movies and television. Most mental health professionals are hard-working, well-trained individuals who spend years learning their craft. They vary in terms of personality, style, gender, and personal issues. Fortunately, one does not need to be perfect to be helpful to another human being. One does need, however, to be well-trained, compassionate, and endowed with an ample amount of what we might call “emotional intelligence.”
Q: How can you understand me if you’ve not been through what I’ve been through?
A: This presumes that I use my own personal experience as the basis for understanding and helping my clients. Frankly, there is a lot more to it than that. The human psyche is (delightfully) complex. When I listen to people discuss their concerns, I rely considerably more on my training, professional experience, and knowledge than I do on my own personal experience.
Q: How can you stand to listen to people talk about their problems all day long?
A: To a large extent, I think therapy is a vocational calling. Not everybody is suited to do it, and certainly not everybody wants to do it. But for me, working with people is a privilege. I enjoy my work. I like the idea of helping people understand themselves (and others) better so they might lessen pain and improve their lives. My job isn’t for everybody, but it is for me.
Q: Who does therapy cost so much?
A: Actually, I think is a bargain when you consider the potential payoffs. You are your best asset. If you’re unhappy, depressed, anxious, stuck, struggling, lost, or whatever –– what would it be worth to you to move past this place and get on with life? For most people, it’s worth a lot. And the cost of not getting past this place is generally quite high.
Having said that, there are many expenses involved in being a therapist that are not immediately apparent. Therapists charges the fees they do because they need to account for their training, experience, inherent limitations on their time, continuing education, self-care, malpractice insurance, overhead, and more.
When you find a therapist who offers an unusually low fee, buyer beware. This may indicate someone who has no or little experience in the field, or someone who under-estimates the practical realities of running a therapy business for the long run. With therapy, you really do get what you pay for.
Q: What do you tell people who––
A: Let me stop you right there. Therapy is not about giving generalized advice. People are as unique as their fingerprints and the solutions that work for one person might not work for another. In therapy, I pains to understand you as you are. I tailor my approach to the needs of any given individual or couple. Problems may be universal (e.g., anxiety, depression, relationship difficulties), but the personal issues that drive those problems can be highly specific to a particular person. Because of this, generalized advice just won’t do. Therapy must be tailor made for you.
Q: On your “About” page it says you have an “exuberant” dog. What’s up with that?
A: I like dogs. Even dogs with high energy that live to play, walk, eat –- and play some more. As far as I’m concerned, dogs are pretty good teachers.
- You aren’t as committed to change as you thought.
- The change you’re trying to make is too radical.
- You are trying to change more than one thing at a time.
- You let a “lapse” turn into a “relapse.”
- Your plan is missing something.
- You’ve lost your focus.
Okay, so what you can do about it?
First ask yourself a question: Are you really ready to make this change now? Don’t be afraid to admit it if you aren’t. There is no reason to think you have to work on something now just because you’ve flipped the calendar over to a new year.
On the other hand, if you’re serious about making a change, you’ll have make a deep and abiding commitment to it. One way to do this is to make a list of payoffs that the change would provide. The longer your list, the more likely you are to stay motivated. A benefits list also provides something you can refer back to on tough days.
Negotiate with Resistance. Your mind and body will resist change because of built-in homeostatic mechanisms. As you step into the zone of discomfort, your psyche may very well send you the signal that it much prefers the status quo, thank you very much. This can be true even when the status quo is hurting you. (Example: social anxiety holds people back and it costs them. Moving towards more social behavior will increases anxiety, at least for a while, but this doesn’t mean it’s the wrong thing to do.)
You probably won’t make resistance go away entirely. Change, at least the kinds that matter most, are rarely comfortable. But you can negotiate with it by changing just one thing at a time, or by making the change small. Either one of these strategies is more likely to lead to success.
Don’t let a lapse become a relapse. Reverting back to old behavior (falling off the wagon) is to be expected. This because change is rarely linear. Usually it’s more like two or three steps forward and one step back. What matters is the overall trend. When a lapse turns into a relapse, it usually means we’ve fallen into the trap of all-or-nothing thinking –- we’ve let ourselves believe one mistake (or one bad day) spoils the whole program. When that happens, it’s a short step to chucking the entire change business. Be mindful of the tricks cognitive errors can play on your progress: keep lapses in perspective.
Re-examine your plan. For example, if you’re decreasing old behavior, are you replacing it with something else? When discomfort, tension, fatigue, or anxiety sets in, how will you cope? Who will support your efforts? (Never underestimate the value of having emotional support.)
Track your change. If you don’t track your change somehow, it’s easy to lost sight of it and get distracted by other things. Tracking change helps you keep your goals and progress at the forefront of your mind. This is important because your attention is a limited resource. These days, there are countless ways to track change. You can find tools on the web, or simply create your own (e.g., spreadsheet, journal).
Good therapy always starts with careful listening. If years of practice have taught me anything, it’s that the human psyche is marvelously complex. When people experience distress, or rather, when they feel enough distress to “talk to someone,” it usually means they’ve had enough of feeling the way they feel, but the problem, whatever it is, is either not going away or not yielding to their usual ways of coping with life.
As a psychologist, I listen carefully because it’s foolhardy to think I could know all about you without taking pains to understand the complexity of your circumstances, psyche, and history.
Unlike common advice, which gives you universal solutions to ordinary problems, therapy is tailor-made specifically for you. Every person has a story to tell about who she (or he) is and how she came to be, and more often than not her distress is woven into the broader narrative of her life. I don’t just listen with my ears; I use my eyes and heart, too. In the early part of therapy, my job is to make sure you feel understood.
But therapy is more than just careful listening; it’s also about giving input.
As human beings, we are bound by our own subjectivity. We have blind-spots. We may not grasp the big picture of our personalities because we are on inside of ourselves looking out. This is where a therapist can be especially valuable to you. Whether you’re trying to change something about yourself, or accept something (a vastly under-appreciated aspect of therapy), it’s always helpful to have someone who can help you discover themes, patterns, and biased views you have about yourself. Just as you need someone to understand you, you may also need someone to interpret, challenge, or confront a mindset that’s holding you back.
Of course, this sort of input needs to done with sensitivity and care. Therapy is never about passing judgment or requiring people to change. Rather, it’s about self-understanding, other-understanding, and sorting out the complexities of your emotional life. New information about the self often brings with it new possibilities for the self.
Emotional distress, symptoms, and vexing personal problems are your psyche’s way of informing you that something about your life isn’t working. In therapy, we tune into the message, puzzle over it, and figure out just what actions you might take to make your state of mind better.
Maybe you’ve had your first session. You’ve explained your problem or concern to your therapist, and you felt like he understood you. Moreover, you feel comfortable talking to him, and you’ve decided that therapy is right for you. Things are looking up, and maybe, just maybe, you are starting to feel better already.
But when the next session rolls around and you think, “Now what? What do I talk about?”
Here are some ideas to stimulate your thinking.
- When you reflect on the week, what were the key events, problematic areas, or stresses?
- What thoughts came to you since we last me? Did our prior session prompt any new reflections?
- Take a moment and go inside yourself. Let your “mud settle,” as a Taoist might say. What are aware of right now? What do you feel? What’s on the top of your mind? Dive deep into your immediate experience.
- What is the status of the problem that brought you here? Is it the same? Different? Better? Worse?
- Did you try anything different? Did you take an actions that might improve your life? What were they? Evaluate them. Think of them as mini-experiments in how to live. What steps might you take?
- If you took steps but they didn’t work, what got in the way? What blocked your progress?
- Did your psyche present you with any dreams?
- Likewise, are you a daydreamer? Where do your daydreams take you? Do you see any themes?
- What things in your life are you avoiding? Avoidance and anxiety go together like hand and glove. Where are your deepest anxieties?
- Relationships matter –– a lot. Relationships have the power to hurt us, help us, and heal us. Relationships also provide a context for learning something about ourselves. We discover who we are in relation to other people. How have your relationships influenced you?
These are just some ideas for getting started, for getting more deeply acquainted with your own psychology.
Don’t worry. I promise you, we’ll have something to talk about.
Technically speaking, no. But in everyday language these words have become interchangeable.
Consider an example. If you’re looking to make a career change, you can seek out “career counseling” (which I sometimes do, by the way), but no one would mistake this service for psychotherapy. It simply does not have the psychological depth that true psychotherapy does. “Counseling” is a broad term. (An attorney will give you legal “counsel,” for instance.)
Admittedly, the line between “personal” counseling and psychotherapy can be so thin as be appear invisible. Which is probably why these words have come to be used as synonyms for each other. But ideally, therapy should deal with your inner life, your relationships to self, others, and world, and your behavior patterns. “Personal” counseling is concerned with these same processes, though some practitioners shy away from using the counseling label because they think it does not imply the depth that the psychotherapy label does.
Unfortunately, all of this can be a little confusing if you are the person who is trying to get help. Psychotherapy is a pie that’s divided among psychiatrists, psychologists, social workers, and counselors. (There are also pastoral counselors and nurses with graduate degrees in mental health.) These days, most psychiatrists specialize in treating mental disorders with medications, leaving the other occupational groups to duke it out for a piece of the psychotherapy/counseling pie.
Unless you need medication, don’t get too caught up in the title or degree when you’re looking for a mental health practitioner. What you want is the right practitioner, one who has experience with your type of concern. You also want to feel comfortable with that person. As it turns out, the fit between client and therapist is a bit mysterious. It’s not always clear why one pair clicks and another doesn’t. What we do know, however, is that this bond or connection is crucial to establishing a good working relationship. Indeed, a good relationship is a much stronger predictor of therapeutic success than the title or degree held by the practitioner.
In sum: I don’t care if you call me a psychologist, psychotherapist, therapist, or counselor. Frankly, I am all of these things. What I do care about, however, is whether you and I can establish a productive relationship that is useful to you. The stakes of your emotional life are just too high for it to be otherwise.
The aim of psychotherapy is to help you improve your life. It’s not enough just to feel better. We want you to actually get better. There is a difference.
When you feel better, you are less bothered by negative emotions, dark moods, and symptoms like anxiety and depression. Of course, we all want to feel good. No one wants to suffer needlessly. But getting better is more than just how you feel in the moment. It’s about identifying internal obstacles that are holding you back, pattern-breaking, and taking new action.
For some, getting better may mean restructuring the way they think, relate, or act. For others, it may mean calling old, dysfunctional beliefs out into the open and challenging their validity. For most, it will involve taking a close look at the ways they cope with stress, manage anxiety, or deal with internal conflict. If you really want to get better, and not just feel better, you’ll have to make a project of personal change.
Which is why psychotherapy isn’t for everybody. Many people just aren’t that interested in digging into their own psyche. It’s not that they don’t want solutions to their problems or concerns, it’s that they want a fast cure, a simple answer, or a solution that requires minimal effort. Therapy offers you none of these things.
Therapy requires hard work, collaboration, and willingness to endure feeling a bit unsettled while you’re in the process of sorting yourself out. Therapy isn’t just about talking, complaining, or venting, it’s about exploring new avenues for construction action.
Obviously you can take action on your own; you don’t need a therapist to make changes in your life. But there are advantages to working with a psychologist. We all have blindspots. Moreover, most of us do not see ourselves and our issues in the most objective light. A therapist can give you feedback, input, and insight that is tailored specifically to you and your situation. A therapist can also provide support, encouragement, and, if need be, the occasional well-placed nudge if you start to falter or backslide.
Sometimes people will make the mistake of leaving therapy as soon as they start to feel better. Their symptoms subside. They are no longer held hostage by a negative mood. Their hope has been restored. They'll leave a polite sounding message on my voicemail: "Thank you, but I think I'm going to postpone my next session." And then I won't here from them again. Fair enough. The client decides when enough is enough. But in these instances, I often feel as though it was a missed opportunity.
Ideally, therapy gets to the core. The core pain, the core issue, the hidden belief or feeling or motive. Real change –- change that endures –- takes time.
You can feel better with a few glasses of wine, a shopping spree, or an antidepressant regimen. But you can get better by stepping back, taking stock, and altering your behavior. This is what good therapy is about.
- What will he think of me? Will he think I'm crazy, bad, or stupid?
- She'll diagnose me
- He'll try to talk about things I don't want to talk about
- She'll push me to do things I'm not ready to do
- It won't work anyway, so why bother?
- He'll try to psychoanalyze me
- She'll try to blame everything on my mother or father
- He'll be too stuffy
- She'll be too loosey-goosey
- He'll be like one of the t.v. shrinks in sitcoms
- She won't understand me
But here's what your psychologist is really trying to do...
- Understand you. See things from your point of view
- Join forces with you. Collaborate
- Put your problems / concerns in a context that makes sense
- Communicate his / her understand back to you –- to make sure it's right
- Understand your goals
- Figure out what you need, what's best for you
- Be professional but human
- Help you understand yourself better
- Help you understand others better
- Help you
Maybe you don't want to go to a therapist. Maybe you don't think your problem is really that bad, or maybe you don't have the time, energy, or money. So what can you do?
You can read books. Books are a terrific source of information, and the right information, at the right time, can be very helpful. The first step in the change process is almost always to increase your level of awareness about your problem, issue, or pattern, and books are one way to do that. Of course, books will also offer you solutions. (See my very special book list)
You can try talking to a friend, confidant, or clergy member. We all need a sympathetic ear from time-to-time. We need objective feedback, but also somebody who cares about us. Ideally, try to pick someone who does not have a stake in your problem (which is often the issue with family members who try to help us). A true connection with another, caring person will probably make more difference than any other self-help remedy you can try.
You can try expressive writing. That is, writing candidly about your emotions or problems. Believe it or not, research has found that expressive writing really does help. Interestingly enough, it helps our bodies, not just our psyches.
You can try exercise. Maybe you're sick of hearing about the benefits of exercise, but the truth is, it's a cheap form of therapy. Research has shown that exercise helps with both anxiety and depression. It just works.
You can try taking vacation from work. Any emotional problem is made worst by stress. And for many, work is stressful. A vacation won't solve your problems per se, but a little time away from work may allow you to rest a bit, or play, which in turn may result in a change of perspective about your real problems.
Learn to meditate. There are simple forms of meditative breathing practices that can help. There's a reason why meditation has long been a part of some of many religious traditions, and there's reason why holistic approaches to medicine have become so popular, and why, these days, the trend in mental health is towards "mindfulness." Meditation works. Meditation calms the body.
If these remedies don't work, well, maybe therapy is what you need.
In social situations, when people find out I'm a psychologist, it's not uncommon for someone to pull me aside and say, "So what advice would you give for problem _____ ?" (Fill in the blank with your favorite personal problem.)
People confuse advice with therapy, but they are very different things. When we give advice, we're passing on universal solutions for problems that are usually straightforward. Frankly, the right advice can be a godsend under the right conditions. And fortunately, many of life's problems and frustrations can be solved this way. Human beings can profit from the experience of their neighbors, friends, and resident experts.
But personal problems are usually complex. Moreover, part of what makes them so vexing is that they don't always yield to logic. But there's a reason for this. Personal problems may involve thought patterns, suppressed feelings, hidden motivations, self-limiting beliefs, defenses against conflict or emotional pain, and not-so-obvious payoffs for dysfunctional or unproductive behavior. If your problem is not solved by common advice –– that is to say, "one-size-fits-all" solutions –– it may very well be that your psyche is running at cross purposes with itself.
When someone gives you advice, they're giving you generalized information, a solution that should work for everybody who has this problem. But when a practitioner provides you with therapy, you're getting a process that is ultimately tailored to you and your unique situation. Therapy helps you understand the complexities of your own personality and psyche, but it also helps you understand the forces that keep you stuck.
In any case, you can imagine how much I dislike the advice question when it crops up, say, at a dinner party. Usually, I turn to the person and say, "Well, that depends..."
Are you dissatisfied or are you distressed? Coaches help people become more satisfied, happy, clear, or productive. Therapists help people feel better.
Coaches are fond of saying they ask the right questions to get you back on track. They focus on the here-and-now, not your personal past. They don't deal with your emotions. So if you've got a time management problem, or a procrastination problem, or you're trying to figure how to achieve your dreams, working with a coach may very well be exactly what you need.
But if you're struggling with some form of a emotional pain –- depression, anxiety, global distress, anger, relationship distress –- or you're struggling to function –- sleep, work, eat, play, relate –– don't call a coach, see a therapist.
- Therapy helps you feel better.
- Therapy helps you understand the nuanced dynamics of relationships.
- Therapy helps you understand yourself better (e.g., your true nature, motivations, strengths).
- Therapy helps you grow as a person.
- Therapy helps you alleviate symptoms (e.g., depression, anxiety).
- Therapy helps you function better.
- Therapy helps you cope with stressful experiences.
- Therapy helps you face your fears.
- Therapy helps you clarify your purpose in life, or your direction.
Therapy can help you do all of these things, or some of these things, depending on your goals and your willingness to commit to the process.
What therapy is not, however, is a passive experience. Therapy requires your full participation. Therapy requires you to join forces with another human being who just happens to be a trained professional.
The general idea of therapy looks like this: Therapy –––> insight into self –––> behavior change.
The above formula makes it looks so simple. But behavior change is anything but. Why? Because human beings resist change. Human beings seek self-consistency, even when that consistency produces unwanted results. The real value of a therapist is that he or she helps you work with, and through, resistance.
In an age where everybody communicates by text messages, social networks, e-mail and cell phones, the idea of meeting face-to-face with an actual person sounds almost quaint. And yet that's precisely what therapy is all about. It's about taking an hour every week or so to engage in honest communication about those aspects of your life that are most vital to your well-being.
The aim of therapy is to help you work your way through distress. Of course, distress can take many forms. Maybe you’re struggling with a set of symptoms, like those associated with anxiety or depression, or maybe you're trying to get a handle on a key relationship. Or maybe life has sent you a curve ball––a divorce, a job loss, or an illness––and your head is spinning.
If human beings functioned strictly according to logic and reason, we’d seldom run at cross purposes with ourselves. But human beings are emotional beings. We feel pain, compassion, joy, anger, sadness, fear, shame, and guilt–-and these feelings are rarely more powerfully felt than when they occur in the context of attachments with other people.
Therapy helps you deepen your understanding of yourself and those around you. As we begin to examine the particular nature of your distress, we’ll discover patterns. These patterns may involve contradictory feelings, hidden motivations, or maladaptive beliefs that bias your perception of the world. The good news is, once these patterns are identified, they are changeable, especially if you are open to new possibilities.
It takes courage to seek therapy. Many people avoid it because they are afraid that being in therapy (read as: asking for help) makes them weak. But does it really make you a weak if you are willing face those aspects of your life that are not working? Or does it make you courageous?
Or maybe even smart.
Suppose I put it like this: If you were faced with the task of crossing a mountain range that you were unfamiliar with, would you rather go it alone or hire a guide?
A psychologist is a guide. He knows the territory of the human psyche. If you're trying to overcome an emotional issue, yes, you can go it alone. But a guide will help you reach your destination more quickly, especially if you’re prone to run in circles.
Give therapy a try. You might be surprised by how much it helps.
First, it's okay to be nervous. Just about everybody is. If you think about it, this normal because you're about to meet with a stranger to talk about your personal life.
If you're like most people, you've already begun to think about what you might say. And yet, even as you say it to yourself, well, it sounds crazy. You wonder, do you really need therapy, after all? And who says this process will actually help anyway; it's just talk, after all. How does talking help people? Can't your just talk one of your good friends?
Then again, you're tired of feeling the way you feel. Whatever the problem is, you're sick of it and you want it to go away. You're tired of feeling stuck. If the problem is serious, maybe you feel stuck and embarrassed or ashamed. How did it come to this? What will this guy think of you? Will he judge you? Diagnosis you?
So you go to your first appointment. When you arrive in his waiting room––is this the place?–-you see that it's not nearly as big as your physician's office. No one else is there. Just you. And then him, when he comes out of his office to greet you. He invites you into his office. Oh my, he actually has a couch. Are you expected to lay down? Is this psychoanalysis? If it is, this isn't what you signed for. He smiles. No, he says, the couch is for sitting. The couch comes in handy when couples come to his office.
So you sit down. Your anxiety has spiked a bit, especially when he asks you where you'd like to start. Hey, isn't that his job? Isn't he supposed to ask lots of questions...?
Hi. I'm Dr. Gibson, but please feel free to call me John.
Take a moment to settle yourself. A deep breath sometimes helps. And take your time; we're not in a hurry. Start anywhere. Yes, I'll help you with questions. (What's the problem? Can you give me and example of the problem?) My goal at this point is to listen to carefully to you to make sure I understand things from your point-of-view.
You may wondering whether I’ll think your crazy, bizarre, or abnormal. Well, I’ll let you in on a little secret: everybody has problems and issues, even psychologists. It's difficult to be human and not have problems of one sort or another.
You may be worried about whether I’ll secretly pass judgment on you, especially if you reveal some of your darkest thoughts and feelings, your problems, or stuff you done that you’re proud of. To the contrary, passing judgment rarely helps anybody. Showing compassion, however, does.
You may worried you’ll be “just another case of [x],” and that I’ll come across as too clinical. But nothing could be farther from the truth. My clients are people, not cases. They have distinct personalities, feelings, hopes and dreams, and yes, distress. I'm in the business of investing in people, in helping them create new possibilities. A case is something you study; a client is someone you help.
Although first session often feels unsettling, most people find themselves relaxing into it as we proceed. In part, this because they are putting their problems into words, and frankly, this can be helpful in and of itself because it often permits the release of negative emotions. But also, most clients come to experience me as an ally, a person who joins forces with them against their problem. Obviously I cannot do psychological work for my clients, but I do know the territory pretty well. I am a resourceful guide.
At the end of your first session, you'll want to ask yourself how comfortable you feel talking to me. In therapy (as in life) fit is everything. Not every individual or couple naturally fits with every therapist. You want to feel understood, and know that this therapist has experience with your type of problem.
Therapy is not friendship; it's a professional relationship that's asymmetrical relationship by design. Unlike friendship, which has a natural give-and-take, in therapy the focus is always on you.
Welcome. Let's make therapy a productive experience for you.
Although it’s very common for individuals to call my office in search of Cognitive-Behavioral Therapy, it’s rare for someone to call and ask for Psychodynamic Therapy.
And yet recent research has now shown psychodynamic therapy to be an “evidence-based” practice. In other words, research shows it works.
to see the article featured in Scientific American
. This article highlights the work of Jonathan Shedler, who conducted a meta-analysis to show that psychodynamic therapy is indeed effective. Meta-analysis is a sophisticated statistical technique for putting studies on a common yardstick so that can be quantitatively compared).
What is psychodynamic therapy?
Well, for starters it’s not psychoanalysis, though many people erroneously equate the two.
Whereas cognitive therapy places emphasis on cognition or thought, distorted thinking, and dysfunctional beliefs, psychodynamic therapy places emphasis on emotion, processes of self-deception, anxiety, and hidden feelings -- in the context of relationships.
Whereas cognitive therapy stays strictly in the here-and-now, psychodynamic therapy places symptoms and problems in the context of one’s personal history.
Whereas cognitive therapy relies heavily on psycho-education (how thoughts influences emotions and behaviors), psychodynamic therapy relies on discovering patterns and themes in the patient’s psychological life, which may be just outside of the patient’s everyday awareness.
Cognitive therapy has received a great deal of air-play in the last couple decades, so people are aware of it. And frankly, unlike psychodynamic therapy, cognitive therapy is easy to understand. But some problems do not yield to cognitive interventions. Sometimes we really do need to get dig just a bit deeper into the psyche to resolve certain types of difficulties. Psychodynamic therapy is one way to go about that. It’s nice to see researchers put their stamp of approval on the method.
It takes a bit work to find the right therapist, doesn’t it?
Do you go with a psychologist (PhD), social worker (MSW), or counselor (MS or MA)? Do you search for a therapist who is the same gender as you, or who is about the same age? Can you rely on your insurance company to point you in the right direction, or should you ask around to find out who’s good? Or do you just figure they’re all pretty much the same, so why not hunt for the therapist with the lowest rates?
Well, folks, here’s what the research says.
Age, gender, and academic degree have not been show to be strong predictors of therapist effectiveness. In other words, men can do effective work with women (and vice versa) and young therapists can work effectively with older clients. Moreover, psychologists tend to be just as effective as social workers or practitioners with other degrees.
What does matter is whether your therapist has had experience with your type of problem, and how comfortable you feel when you talk to him (or her). These are the two things you should be looking for.
It’s relatively easy to determine the therapist’s level of experience (you can do this from a website, or a quick telephone conversation). But the only way you can truly figure out how comfortable you feel talking to the therapist is to make an appointment and try him out for a session.
So much of what happens in therapy depends on the therapy relationship itself. Our dentist or physician may work on us, but our psychotherapist can only work with us. We must trust her enough to disclose highly personal and private information, and we must rely upon her support as we confront those aspects of ourselves that we feel least proud of.
Don’t pick your therapist on the basis of gender, age, credential, race, reputation, or price. Pick him (her) on the basis of his experience and how comfortable you feeling sitting across from him in his office.
A few years back, I taught a graduate class in group therapy. One of the exercises I had the students do was to break into small groups and complete the following exercise: “Each of you will have five minutes to talk about yourself. While one member is talking, the other members must listen intently. What you talk about is entirely up to you, but you must talk for the entire time and the other members of the group must listen with respect and without comment.” After the exercise was completed, we’d come back to the class and talk about what happened.
What most students discovered was that five minutes of talking about yourself is actually harder than it sounds. They’d start out strong, talking the usual biographical identifiers like what program they were in, whether they were married or not, where they were from, what their goals were in pursing a graduate studies, and so forth. But they tended to exhaust this public-self information fairly quickly. Then they had to decide what to reveal about their private-self. Mind you, I put no stipulation on what they talked about. That was entirely their call.
The point of the lesson was to get the student-therapists to reflect on what their future clients might be experiencing when they came to therapy for the first time. The first-time client is faced with trying to figure not just what to say, but how much to say, and how to say it. It’s not unusual for people think about going to therapy for a while before they actually get themselves to that first appointment. After all, maybe the problem will go away, or maybe they’ll be able to resolve it on their own. If they finally decide that therapy is what they need, they’ve generally had some time to rehearse what they’re going to say--at least for those opening few minutes. After that, they’re not sure what to expect.
Here’s the thing: therapy is all about the private self. What you think about and feel; what want and need from others; how your react; and more. If therapy is to be life-changing, we must plunge into the deep waters of your subjective world. This is where real change happens.
Therapy is not about one person giving advice to another. Rather, it’s about one person inviting another person to make contact with their truest, deepest, most private self. When this happens, you forge an inner strength. You become clearer about who you are and about what you need to do make your life better.
Related post: Will Therapy Help?
When I originally set up my practice several years ago, one of the promises I made to myself was that I would create an environment that would allow me to do my very best work. I could have joined a group practice, but the idea of working solo appealed to my introverted nature. Likewise, I could have hired a support staff (associates, receptionist, billing specialist) to make a my practice bigger, but I what I really wanted to do was to make something that was simple by design.
If you rummage through my blog, you'll find a post in which I suggest that happiness may be a by-product of playing to one's strengths. Frankly, this is why I set up my practice the way I did. I sought to leverage my strengths as a practitioner. Rather than try to be all things to all people, I narrowed my focus. For instance, I don’t provide psychological testing, therapy for children, group therapy, or evaluation for the courts. These are valuable services but they not my areas of strength. What I do best, I believe, is provide individual and couple therapy for adults.
And I have strong feelings about the way I believe a therapy practice should be run. For instance, I do not believe in providing therapy as if you were running an assembly line––that is, seeing as many patients as possible in any given workday to maximize your income. When practitioners take this approach, it's easy to fall into the trap of treating every client the same, regardless of his or her situation, problem, or personality. I don't think this is the way good therapy is done. Rather, every therapy must be tailored to meet the needs of any given individual or client.
Of course, doing therapy this way means that I have to place thoughtful limits on how much I do and the way I do it. It also means that I have opted not to take on managed care contracts, which offer practitioners a higher volume of referrals in exchange for discounted fees. I prefer quality of service over quantity. If I have an advantage over big practices that do work with managed care companies, it’s that in my practice nobody slips between the cracks. Every client I work gets my complete and undivided attention.
I suppose you could my life has a quest: I have devoted my adult life to understanding the human psyche. Even though my graduate school days are long gone, I still study. I seek out the best information I can find, from the best minds and the most talented researchers. I reflect on my life and the lives of others, and I seek wisdom wherever I can find it. My job is to help people alleviate distress and create more meaningful lives. This is what I do. This is who I am.
If this were an infomercial, I’d promise that therapy can help anyone, anytime, anywhere, and I’d guarantee results in thirty days or your money back. But this isn’t a commercial and I’m not trying to sell you anything.
Frankly, therapy is work. When it comes to alleviating distress or creating personal growth, effortless change is a myth. If you want the pain to stop, regardless of the form it takes, you’ll have to direct your attention to your inner life, your relationships, and your actions. You’ll have to seek new insights into who you really are, and you’ll have to tolerate the anxiety that invariably comes from giving old patterns and trying new ones.
Still with me? I hope so. Because therapy works for most people, most of the time. Research consistently shows that people who undergo therapy are better off than approximately 75-80 % of the people who don’t (but have comparable problems or concerns). Frankly, therapy results may not be be guaranteed, but these are pretty good odds, if you ask me.
Psychotherapy asks you to reflect deeply on your life: who you are, what you think, what you feel, and what you do. Believe it or not, this is not as easy as it sounds. All of us, it seems, are prone to a bit of self-deception. One of the benefits of working with a therapist is that he or she can help by virtue of having a measure of objectivity about you that you might not have. Of course, only you know what it’s like to be to you and to have had your life experiences. But if you’re like most of us, you will not always see yourself clearly. This is where a therapist can help you. A therapist will listen carefully to you and work very hard to understand you and your situation from your point-of-view. But after getting to know you, he or she will have insights about you that you may not have had. These insights, by the way, are informed by psychological knowledge and clinical experience. Your therapist tries to give you input that is unique to your particular psychology. This is the beginning to change.
Sometimes I get e-mails from people who are surfing the web, looking for answers. Maybe they want therapy, or maybe they’re just sending out missives to let somebody in the world know that they’re hurting. I always write them back and I invite them to call my office if they are serious about therapy. Usually, I don’t hear back. (The person who is serious about starting therapy is more apt to pick up the phone in the first place and make an appointment.) But I always wonder about the e-mailer I never hear back from. Did they find another therapist? Did they find a solution? Did they decided to bear the status quo for a little longer? Or were they doubtful about whether therapy--the so-called “talking cure”--could actually help them?
Again, if this were an infomercial, I’d say yes, absolutely, results guaranteed. But I tend to believe people are smarter than that. They know infomercials prey on their frustrations and secret wishes for easy, fast results (we all have them). Better, I say, to tell the truth. Therapy can help, but only if you’re willing to throw yourself into the project of finding out who you really are.