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?

Time to go to your first appointment. But maybe traffic is bad, or you get caught by a train, or it takes longer to get there than what you thought. When you finaly 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...?

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Hello there. 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.

Tags: First Time Client

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.

(Click here 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.

Tags: psychodynamic therapy

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.

Tags: Finding a therapist

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.

Tags: Approach, work

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.

Tags: Therapy