Present?

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.

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:

Who

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

Engage
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

"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.

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.

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?

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.

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!