Thursday, December 27, 2007

Say the Odd Thought

They say some things are better left unsaid. If you're in church, court or a board meeting, this is probably true. But not in the therapy session. It's all fair game here, no matter how odd it may seem.

This is one of the best ways therapy is different from other types of relationships. Censoring your words is not necessary - in fact, I'd recommend you don't.

Sometimes these odd thoughts give us great information. You're talking about a co-worker and suddenly your sister's face pops into your head. Whenever you think of your hometown you get a lump in your throat. You just had a fantasy about yelling at your therapist. Whenever someone mentions the ocean chills run down your spine. You've been zoned out for the past couple minutes and didn't hear a word the therapist said. In the rest of the world, these thoughts, feelings and impulses would be kept quiet. But in therapy, fair game.

These odd thoughts can help us understand deeper parts of you - parts of your self few people see. If I had to summarize the function of therapy to one single element, it would be deeper understanding of ones self. Not just the stuff on the surface, the deeper material too. Some odd thoughts have deep meaning, even deeper than you might be aware of. Kind of like dreams.

You've heard of the concept of the "Freudian Slip"? That's when the deeper thought sneaks out past our censors and into our speech. Like telling a love interest you like their sex, when you meant to say socks. This odd thought thing is similar, only you're discussing all the slips you thought about but managed not to say.

It's a little risky sharing these thoughts you normally keep to yourself. But soon you'll see how helpful it is. Give it a shot.

Saturday, December 22, 2007

Intimacy Starts With "I"

A little something for couples (written to men, but applies to everyone):

The most vital, passionate, intimate relationships are experienced by two people who know who they are as individuals and who have a deep desire to share their self with their partner. Intimacy is not about being dependent on one another or completely independent. It involves true interdependence: two people coming together to support and love each other deeply while still maintaining their own identity.

Think back to the beginning of your relationship, when you first got serious. You couldn’t keep your hands off each other. It didn’t matter if you were in the car, in the movie theater, or in her parents’ living room. You were thinking about being with her, and she was thinking about being with you. School, work, friends, sleep—nothing else mattered.

Let’s explore the circumstances for a moment. You had your life, and she had hers. You had your own place; so did she. You had different friends. You had a deep, rich history that was brand new to her, and she had her own interesting past. You talked about all sorts of things, agreeing on some, disagreeing on others. You were different people with different lives, and that’s part of what made your courtship tantalizing. You were crazy about each other. Her stories fascinated you, and you were eager to tell her yours. The two of you looked forward to all the incredible things you were going to experience together, especially sex. You were free to be yourself, and she was mesmerizing.

As your relationship progressed toward marriage, the two of you drew closer to one another and you shared more and more of your lives together. You may have found that you were willing to spend less time with your own friends, and she was too. Instead of “I,” “me,” and “mine,” the language of the relationship changed to “we,” “us,” and “ours.” Because of your love and desire to make each other happy, you occasionally put your own needs and wants on hold to accommodate her. These personal sacrifices are some of the most loving acts we do for one another.

Over time, however, this accommodation can have its downside. Surrendering your own wants is not always best for the relationship. For example, it may not be a big deal for you to agree to spend your vacation with your mother-in-law this year, but spending every summer with her for the next forty years may cause some problems. As a couple, you face numerous situations that require each of you to state your honest opinion rather than to acquiesce. Issues such as where you’ll live and how many children you’ll have require both of you to express your opinions. When you develop a habit of accommodating rather than stating your feelings, resentments build and the passion can start to fade.

Accommodation and diminished passion are normal in marriage, and many couples accept these patterns as facts of life. But you want more than normal or average. Passion comes from taking the risk to be emotionally vulnerable in your relationship. Therefore I invite you to be open and honest with each other, to be who you really are, to rekindle the flames of your romance. When you hold back, you are cheating yourself of the joyful, passionate intimacy that keeps love alive and makes sparks fly in the bedroom. This active, alive, intimate, and honest connection is called a vital marriage and is possible only when a couple is willing to face their fears of vulnerability.

Tuesday, December 4, 2007


You were bitten by a dog as a kid, and dogs still frighten you. The lady working at the deli reminds you of your third grade teacher. The guy next to you on the plane looks like your college buddy Stan, so you start telling him the kind of obscene jokes Stan would love. But he's not amused.

This tendency to relate and equate past relationships with current ones is normal. In order to make sense of new information we look to a related template already on file and examine similarities and differences. For example, based on your experience with your wise, gentle and physically limited grandmother, you would tend to treat all elderly women in a manner similar to her initially. You might see one at the corner, and with arm extended and a big smile you offer to help her across the street, only to find she's neither physically limited nor gentle. Whoops.

Part of the work of therapy is exploring this very issue. We all transfer our templates from prior relationships onto new ones - and from the first phone call you begin transference with your therapist. The structure of therapy encourages it.

Therapists typically maintain a stance of objective neutrality. This means they usually don't share a whole lot of information about their personal lives or their privately held thoughts, feelings or judgments about the material you bring up. This varies from therapist to therapist, of course, and different psychological theories do this to a greater or lesser degree. But generally speaking, the therapist is a blank canvas. They do this because what you transfer onto them says something very important about you.

John (a fake client) has been in therapy three months and comes into his session looking agitated and suspicious. I ask him how he is and he answers with "oh, wouldn't you like to know?!" It turns out John was laid off from his job, and he's assuming I will be angry with him. He entered the session preparing himself for the lecture I would give him about his failure to accept responsibility. By further exploring this, we find that he experienced his dad as critical and unempathic, and assumed I would respond the same way. In fact, I felt sadness and compassion when I heard his news, and I shared this with him. By pointing out this inaccurate assumption, John was able to understand why he tends to withdraw whenever he gets bad news: he expects other people to criticize him like his father used to, even though this has rarely proven true. He transferred his father's response onto me.

It seems we start with a limited number of templates at our disposal, the most powerful ones coming from our early caregivers. We tend to assume most new people will respond in ways similar to these original templates, even when there is evidence to the contrary. Some of the most important work in therapy is examining these old molds to see how they've shaped our relationships and our development. Challenging, difficult growth comes when we try to develop new templates.

Not all dogs bite. Not every old woman wants our help. Not everyone responds like John's dad. Therapy and the therapeutic relationship is one of the best places to check our assumptions. We might be playing according to rules that no longer apply.

Thursday, November 1, 2007

No, it isn't.

The therapist's chair provides a unique perspective on culture. Our primary task is trying to understand the thoughts, feelings and behaviors of our clients. Over time we start to see patterns, both on an individual and societal level. We see trends, styles, popular sentiment, even lexicon change gradually, one unrelated individual at a time.

Here's a phrase I've heard a lot recently, from all types of people: it is what it is (iiwii for short). The phrase seems harmless enough, but I actually think it can be a bad sign, psychologically. It's a defense mechanism.

We hear it all the time, particularly from athletes on losing teams. As spoken by the coach of the UCLA football team who lost to a horrible Notre Dame squad. USC loses to the Oregon Ducks, same statement. USA Today even named it the 2004 Sports Cliche of the Year. There are t-shirts, blogs, tattoos, even a support group utilizing this phrase. Here's a discussion describing how iiwii has replaced "it's all good" in common parlance. The urban dictionary tries to define it, but none of the definitions quite capture what I see in my office.

The problem is, iiwii is a deceptive statement. The words and tone imply acceptance of the current state of affairs, but the underlying sentiment is frustration and helplessness. Don't get me wrong, I'm quite familiar with irony, cynicism and satire. But that's not what this is. This is a defense mechanism. Not only that, it's the Ebola virus of defense mechanisms: denial.

Let's say I have a client, a man who has been in a miserable marriage for 20 years. Every perceptive muscle I have tells me he feels angry, sad and very stuck. But I ask him how he feels and he drops the iiwii bomb: "I don't know," he says "my marriage is what it is, and that's that." Here is my translation: This situation makes me very upset, but I'm powerless to change it, so I'm trying to push away my feelings and begrudgingly accept my helplessness. I don't want to talk about it anymore. We both know he has strong feelings about it, but iiwii won't let us get there. That's what a defense mechanism is: any mechanism that protects (defends) us from unwanted thoughts, feelings, or drives.

I'm not trying to be grammar police, or take away freedom of speech. I actually don't mind the phrase when used appropriately. I'm just calling out iiwii for what it often is: denial. Normal, healthy emotional processing includes 1) injury 2) feeling the emotion 3) expressing the emotion, then finally 4) acceptance. What I'm seeing is people wanting to leapfrog steps 2 and 3 in order to avoid the pain and get to the acceptance. They hope that shortcut won't hurt as bad.

But you know what? Bypassing the emotion doesn't work. It has to be expressed sometime. Talk to someone who took antidepressants following the death of a loved one. Prozac doesn't eliminate the grief, it just postpones it. Emotions like grief and anger are natural, necessary phases we must experience in order to move on. In order to achieve real acceptance. And what happens when we don't deal with the underlying emotions? Most of mankind's health and relational problems. I'm afraid that's the harsh reality.

Monday, October 22, 2007

How to Forgive

After years of discussing hurt and forgiveness, some things have come into focus. There are four elements necessary for healthy forgiveness:

1. Express the Emotion - Whatever the crime/injustice/violation/slight, the forgiver needs to fully express how it made him feel. Anger, sadness and fear are common responses. By the way, it is ideal if the victim is able to express her emotions to her perpetrator, but not essential.

2. Rebuild Security - In order to forgive, the forgiver needs to feel a reasonable amount of assurance that the violation won't recur. Let's say you step on my toe. In order for me to rebuild security, I'm going to need some verbal commitment from you that you'll try not to step on my toe again, or I need to decide to keep my feet away from yours, etc. Some mechanism needs to be in place to let me know I'm safe again.

3. Understand - The forgiver needs to develop some framework to understand why the violation happened in the first place. Why was my toe stepped on? We're on a crowded train? You're a clumsy dancer? You hate me? Oh, you're drunk, I understand. The brain will search for this reason and can't stop (or forgive) until it has one.

4. Let Go - This is making a conscious decision to drop the grudge and resentment. It's the hardest step for most people. Holding a grudge is a powerful thing - you can get someone to suck up to you for years by lording his misbehavior over him. Letting go means stepping down from the nobility of victimhood, becoming an equal again, and promising not to point back to her infraction every time you're losing an argument. Letting go is not forgetting - most of us can't choose what we remember. It's choosing to return to a place of equal power.

Research shows forgiveness greatly benefits the physical health of the forgiver. Seems that holding a grudge is bad for you.

Monday, October 15, 2007

Feelings 101

It's typical for therapists to ask about feelings. It's also typical for clients to dislike being asked. The truth is, many problems can't be resolved with a shift in thoughts and behaviors alone. Most of the time in order to grow we have to work through feelings.

While it's hip to talk about feelings in our Oprah society, we're not all good at it. A common trick is share a thought masquerading as a feeling. Starting a sentence with "I feel...." doesn't mean you're experiencing or communicating your feelings. I see people do this all the time. Take this couple:

Spouse 1: "I feel that you broke the garbage disposal."
Spouse 2: "I feel like you didn't look at it closely because you don't care."
Spouse 1: "Well, I'm just telling you how I feel."

Not feelings. In fact, any time "I feel..." is followed by "that" or "you" or "like", we're not talking about emotions. Most of the time, those are thoughts, beliefs, or judgements. No, you don't feel that NASA should pursue a mission to Mars. You believe it. It's your opinion. It's a thought, not a feeling.

Feelings can be broken down to some combination or degree of sad, mad, glad or afraid (some experts might also throw in shock, love and/or envy). That's it. Degrees of sad might range from bummed out to devastated, while anger might range from annoyed to enraged. Sometimes feelings combine, creating frustration (sad + mad), bittersweet (sad + glad), etc.

And what makes these feelings, rather than thoughts? Feelings can be felt, actually physically experienced. It might take a little practice, but a simple way to get in touch with real feelings is to become aware of the physical sensations you have in your body. When people experience emotion, their body tends to feel a certain way, unique for everyone. When people are sad they may feel a weight in the chest and shoulders. People feeling angry might report an expansive, explosive sensation in their chest and arms. Fear tends to be a weight in the stomach. Joy is often a light, energized feeling throughout the body. But again, it can be different for anybody.

Monday, September 17, 2007

How Do You Feel?

As I said last month, two questions help jump-start any stalled therapy session. I've convinced you to talk about what you want. Now, I embrace the cliche and ask you to talk about your feelings.

Why? Getting in touch with emotion helps inform decision making, resolve issues from the past, and increase self-awareness.

When we make important decisions, we use both our brain and our gut. Think about your decision to take a job, move into a new place, enter a relationship with someone - you probably used both logic and emotion to make those decisions. The absence of either could cause problems.

By the way, in our world logic tends to be valued more highly than emotion, making people reluctant to admit that emotion plays an important role in decision making. Rather than just admit that feelings were a factor in a decision, we tend to go overboard with rationalization ("sure, it's nice that it's a convertible, but I chose it because it gets 3 more MPG!").

Sometimes people are so overwhelmed by emotion that they can't deal with it all at once. The tragedy of abuse, loss, rejection, abandonment, or other forms of pain can just be too much. So they feel what they can at the time and store away the rest for later. Some would call this "sweeping it under the rug," others would term this repression. As much as we might like, these unexpressed emotions don't just go away - they stay within our psyche and body until we let them out. I know, it's starting to sound a little new-agey, but there is truth here. People can hold on to unexpressed emotion for years, decades, even the rest of their lives. Problem is, the body wasn't meant to hold on to that kind of pain for too long - it can start to break down. Still, many people choose the slow burn of repression over the sharp pain of letting emotion out.

Part of your identity lies in how you emotionally respond to the world around you. Your feelings determine facets of your personality, your relationship style, your opinions, and how you view yourself. When clients tell me they don't really know who they are or what they want, I direct them toward their feelings. Along with your thoughts and experiences, your feelings determine your deepest sense of self.

Research has shown that men and women experience emotion equally, but women tend to express while men repress. No big shocker there. In the next blog I'll give a quick lesson in getting in touch with emotion.

Tuesday, August 14, 2007

What Do You Want?

When you're stuck in a therapy session, unsure of what to talk about, you can always fall back on two questions: "what do I want?" and "how do I feel?" These usually provide plenty of discussion material, primarily because they're so difficult to answer. Let's start with "what do I want?"

It's challenging to answer because 1. people tend to be out of touch with themselves, and 2. different parts of us want different things.

Most of the time, we're out of touch with our wants, our feelings, even our needs. We get so wrapped up in the details of our day that we ignore our need for connection and rest, eat when we're not hungry, work a job we don't enjoy, pass by the gym, the church and the park, and fail to nurture our most important relationships. We ignore these wants and needs because we're beholden to our To Do lists and cell phones. Or maybe it's others we're beholden to. I know many people who are intensely aware of the wants, feelings, and needs of those around them, but oblivious to their own. For people in this category, answering "what do I want?" means putting aside lists, details, obligations and masks in order to reacquaint with ones self. It might take practice, and therapy is a good place to practice.

Others experience a conflict of wants. You want the chocolate cake but you also want to lose weight. You want a job that pays more money, but you'd also like to work less. You'd like to work on your relationship, but you also want to avoid arguments. These conflicting wants come from different parts of yourself. The demon on one shoulder says eat the cake, the angel on the other says hit the gym, for example. We all have different parts that want different things, the challenge is determining which ones we'll listen to, or if we'll compromise. Some people are able to develop a competent system for resolving these internal conflicts, sort of like having a moderator inside to determine a winner or strike a deal. Again, great material for a therapy session.

Wednesday, June 27, 2007


Are you being present in your therapy session? More than physically attending the session, are you showing up mentally and emotionally?

Exploring the past, visualizing the future and talking about situations outside therapy is some of the most important work of therapy. But so is the present. Many therapists call this focusing on the "here and now": the thoughts and feelings that are taking place within you and between you and your therapist at a given moment.

It can be pretty intense. Maybe something the therapist just said made you angry or suddenly you feel sad for no apparent reason. Perhaps you feel confused or have an odd thought that you wouldn't mention in regular social situations. Bringing that material "into the room" (more jargon, I know) and talking about it while you're feeling it can be incredibly enlightening and productive. Examining a feeling in the moment can uncover meaning you'd never get to by looking at it later. But it's also vulnerable and intimate - which is why many people would rather talk about what happened 20 years ago or the jerk who sits in the next cubicle at work.

So here's a challenge. When you're sitting in your next session ask yourself: "What am I feeling here with the therapist, right now?" Then take it a step further and talk about it.

Friday, May 25, 2007

Poetry About the Process

Something different here today. A poem written by an anonymous therapy client (reprinted with permission, of course). Enjoy, and feel free to share your thoughts:

Sit and talk
About fears, ideas, dreams, and memories
About pain, pride, grief, and regret
Open the safe and let the hobgoblins out
Trusting, cautiously, that they will be tamed
By you

Recline and discuss
All the plans, blockades, piecemeal parts, young and old
All the people, places, times, and events
The bricks that form the house I have become
Tell me if this structure is sound
I never knew

Relax and divulge
What I’m feeling, wanting, ashamed of, and needing
What I can do, cannot, want to, and won’t
The map has lines, each country has borders
No matter how much, how many
Or how few

Nest and ponder
How I got here, where I’m going, what I’m for, why I am
How I choose, relate, sabotage, and hide
In search of a compass, you show me I have one
Telling me, without speaking, exactly
What to do

With the process, moment, relationship, and emotion
With the words, the looks, the tone, and the person
This unit congeals, realizing its purpose
What I am, how I am, where I am
And who

Monday, May 14, 2007

"I just wanna be"

Name that movie.

Let's take this therapy discussion to a philosophical level. First, we need to define a couple terms:

Interpersonal: of or pertaining to the relations between persons.

Intrapersonal: existing or occurring within the individual self or mind.

Therapy is both an interpersonal and intrapersonal process. So far, most of this blog has been about the interpersonal facets of therapy: how the empowered client prepares for and communicates with the therapist. But the intrapersonal process of therapy deserves equal time, if not more.

Being in therapy is more than filling an hour each with week with an appointment. It is a personal choice to enter into a season of introspection, vulnerability, and openness to change. A season where you spend time looking at yourself - why you do what you do, think what you think, feel what you feel, and are who you are. It's important to be aware of this - therapy is all 168 hours of the week, not just the one or two you spend in session. The more you allow yourself to engage in this intrapersonal process, the more you'll understand about yourself. And the more you understand yourself, the better able you will be to make decisions, relate to others, change the things you can and accept the things you can't.

"So what can I do to understand myself?" you may ask. Our culture loves to have things to do: Depressed? Follow these 5 steps. Bad relationship? Complete this homework. But rather than check off boxes on a list, your time is better spent getting used to being with yourself. How does one do this? I cringe at the idea of telling someone how to "do" being. But I'll give it a crack.

First, stop doing the things that distract you from yourself. Turn off the tv, ipod, cell phone and internet, forget about the dishes and laundry for a minute, sit down and be quiet. It's amazing how difficult this can be.

Next, try to quiet your mind. People often find that a few minutes of silence results in an anxious recital of regrets or things to do. Promise yourself you'll take time to think about those items later, and go back to the quiet.

Finally, ask yourself how you feel. Then let yourself feel it. You're being.

That's all Crash Davis wanted.

Thursday, May 3, 2007

A "Relationship"?

It's a relationship. Some would say "a different kind of relationship" but I don't, because all relationships are different. Your relationship with your brother is different from your relationship with the girl who delivers newspapers which is different from your relationship with your mayor, but they're all relationships. Each are a unique intersection of two lives. The easy answer is to start with describing what it isn't, so I'll start there.

It's not friendship. There are friendship qualities like communication, mutual respect, support and the sharing of feelings involved, but that's about it. You won't be having your therapist over for a barbecue, or calling her on the phone to chat while you wait in line at the DMV, or sending him funny e-cards.

It's not a priest/pastor/rabbi/shaman relationship. You may choose to discuss spiritual issues, experience epiphanies, or confess transgressions, sure. But therapists don't absolve sin and don't typically act as God's mouthpiece.

It's not a medical relationship. The two of you are meeting to try to resolve a problem that causes distress, thereby relieving pain, but the interaction is different from the medical model. While it might be appealing for us to go under anesthesia and wake up to find our depression floating in a jar of formaldehyde next to us, therapy requires a more action from the client.

It's not a pep talk. Some folks evaluate the effectiveness of their therapy by asking "do I feel better after the session?" Often, the answer is no. For starters, things often get worse before they get better in therapy - you may enter with a problem and then realize after a few weeks that the problem is deeper and more serious than you thought. This doesn't always feel good. But with patience and effective treatment, you'll start to feel more clarity about the issue, and therefore more control over it. A perpetual state of happiness is not the desired outcome from therapy - that would be an impossible goal. Greater awareness of yourself, access to your thoughts and feelings, and control of your behavior is a more realistic outcome.

So that gives us a glimpse of what it's not, let's look at a few ideas about what it is.

It's like a personal trainer relationship. People go to personal trainers with a goal - lose weight, get toned, drop a dress size, whatever. The trainers work with you to develop a plan of action, stand next to you as you do the work, give encouragement, and revise the plan if obstacles arise. It's collaborative, but notice the different roles: trainers use their knowledge and experience to guide the process, but you do the physical work and reap the benefits.

It's like a mirror. We often have a hard time seeing ourselves accurately, and sometimes our friends' and family's feedback is more about their issues than ours. Therapists are trained to see a person as objectively as possible. They may see things in your thoughts or behaviors that other people don't or are unwilling to tell you. It's not uncommon to hear a client say "I had no idea I did that - no one ever told me."

It's like re-parenting. I'd better tread lightly here. I'm not saying that therapy replaces parents, or that parents are bad at their job - "blame the parents!" is a tired old battle cry in psychology. What I am saying is that sometimes therapy helps fill some gaps or re-tool some messages we heard in childhood. A man may have had a great relationship with his parents, but their difficult divorce left him unclear about how healthy relationships work. A woman may have grown up in a family where expressing emotion was taboo, an old rule that causes problems in her adulthood. The therapist can represent a different voice for the client, one that guides them toward healthy relationships and behaviors.

More than any of the above descriptions, however, every therapy relationship is unique. I've met with hundreds of clients in therapy, and no two relationships are exactly alike. Talk about what you want it to be, then make it so. It might be one of the most important relationships you'll ever have.

Monday, April 30, 2007

The Rule Book

As we work to empower clients to get the most out of their therapy, we start by taking a look at the framework of the relationship. Long-held myths and misconceptions often leave clients feeling unnecessarily confined in what they say, ask, or do in sessions. Let's straighten this out.

In the spirit of collaboration, I'll propose some ideas and if you have ideas for changes or additions, please let me know!

10 Rules for the empowered client in therapy:

1. Clients can ask any question they want.

Too many clients censor themselves because they believe it is impolite or against protocol to ask the therapist questions. This censorship restricts the authentic communication in the session. You might not always get the answer you were looking for, but you might learn something about therapy or about yourself in the process.

2. Clients can talk about anything they want.

It's your time, your session, your life. You're paying the bill, so you can talk about anything you want. To get the most out of your therapy, have a clear idea of what you'd like to cover before the session.

3. "Odd" thoughts are allowed & encouraged.

The apparently random thoughts or memories that we keep to ourselves in the rest of our life are absolutely fair game for therapy sessions. In fact, they can be among the most illuminating material you cover.

4. Clients can take their own notes.

Writing down your thoughts and feelings between sessions has proven invaluable for many people. It greatly improves the flow and continuity of sessions.

5. Clients get to take the whole hour.

Most therapy "hours" are 45 or 50 minutes, giving the therapist time to write notes, return phone calls and attend to personal business before the next session. Show up for your session 10 minutes early to collect your thoughts and plan what you'd like to talk about in the session.

6. Issues between client and therapist take top priority.

Problems within the relationship need to be addressed first because all other work will be impacted. Don't wait for the therapist to bring it up, he may not even be aware there is a problem.

7. Clients choose how they want to be helped.

Are you looking for feedback? Someone to sit with you as you think out loud? Wisdom, advice, professional opinion? A companion as you face some difficult emotions? Fine, all are welcome in therapy - just tell the therapist how you want to be helped with your issue of the day.

8. Clients and therapists team up against obstacles.

Problems arise all the time in therapy. That's the nature of the work. Try to remember it's you and your therapist teamed up against the problem, not you vs. the therapist. If it feels like the latter, be sure to talk about it (point 6).

9. Clients don't need to take care of the therapist.

The pleasantries of the outside world aren't necessary in therapy. Christmas cards, "how was your weekend?", sugar-coating difficult material, and avoiding conflict are not needed. Therapy is one place that is all about you. You pay plenty for this time - let the therapist meet her social needs on her own time.

10. Clients can ask for a status report at any time.

You're always entitled to know where you stand. Are you reaching your goals, engaging in the process sufficiently, or getting caught by an obstacle? Feel free to ask. Better yet, give your own opinion and collaborate on the status report with your therapist.

Your thoughts?

Thursday, April 26, 2007

Power to the People

Psychotherapy is supposed to be a collaboration - therapist and client working as equal partners to achieve the client's goals. This is the ideal. But all too often, it's not the reality.

Why? Consider this: therapists have from two to eight years of graduate training learning their role in the therapist chair. They have thousands of hours of experience honing their craft. There are roughly 500 recognized theoretical orientations (approaches to problems and their origins) for them to choose, practice, and perfect. The client entering therapy for the first time has none of this training and experience.

This imbalance results in countless hours of frustration for numerous clients - and therapists, too. It's like pairing Tiger Woods with someone who's never picked up a club and expecting them to win the tournament. The gap in skill, training, and experience is often too great. For many, the first few months of therapy is spent raising the client's therapeutic aptitude to a workable level. Even then, the client is adopting the orientation of the therapist - which may or may not be the best approach for the client's personality or issue.

It's time for a change. Clients need to be empowered to know what they want, ask for it, and participate in the process. We're stuck in a medical model mindset where the patient is passive recipient of the doctor's intervention. This doesn't work in therapy. In fact, there is a movement in medicine to make patients their own case managers - equipped with more information about themselves and their condition (thanks to the internet), patients want to take control of their treatment away from the MD's and insurance companies. Shouldn't this be even more the case in psychotherapy? Collaboration requires client empowerment, not passivity.

I'm hoping this idea of client empowerment shakes some people up. Especially therapists.

Check back as the plan for this revolution unfolds.

Thursday, April 19, 2007

Being In Therapy

"How does this work? What should I talk about?" Every therapist has heard these questions, and most clients have asked them. This blog will take a stab at giving some answers.

The simple answer is: talk about yourself. Therapy is a laboratory where you and your therapist meet regularly to explore this one topic. Why you think, feel and behave the way you do, how you came to be the person you are, and what can be changed if you so desire.

Anyone who has spent some time being in therapy knows how this simple task can become quite complicated. There are an endless number of approaches to exploring one's self. Should you rehash your week? Talk about your childhood? Your dreams? Do you mention the discomfort you feel when the therapist gives you a certain look? Your doubts about the effectiveness of therapy? Or should you wait for the therapist to ask you questions? Each are valid approaches, but it can be confusing to know which one most effectively helps you reach your goal: to understand yourself better, resolve your problems, and not waste your time and money.

As a psychologist with a decade or so of experience, I've dealt with this dilemma plenty. I often need to spend the first several sessions helping clients learn what to do and say to get the most out of their treatment - at a significant expense to the client. It occurred to me that there exists a huge rift between client and therapist where the process of therapy is concerned: therapists spend many years learning theories and techniques of psychotherapy, while the client may know nothing. No wonder many clients leave therapy frustrated, unable to reach their goals because the process remained a mystery to them.

My goal for this blog is to level the therapeutic playing field. I'd like to equip clients - beginning as well as current - with the tools necessary to get the most out of their time, money, and emotional expenditure. I plan to talk about:

1. How to find and begin therapy
2. The rules and roles within therapy
3. How the exploring/healing process works
4. How to relate to the therapist
5. Topics many choose to cover in therapy
6. How to overcome roadblocks in therapy
7. Knowing when and how to end therapy

Thanks for joining me, and I welcome your feedback.

*NOTE: While I am a psychologist who will be discussing the process of therapy, I will not be conducting any on-line therapy. I welcome your questions about how therapy works, but know that I won't be giving specific advice about your particular personal issues - hopefully, some of what I discuss will help you get that kind of assistance from your therapist!