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.
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.
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.
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?
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.
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.
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.
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.
Two findings are emerging from the research. One is that your willpower can be depleted. It’s as if you only have so much self-control to go around, and once you’ve used up what you’ve got you’re much more likely to give in to desires and temptations.
Example: you manage to be “good” at breakfast, lunch, and dinner, but when the end of the day comes, you find yourself “giving in” to cookies or drinks.
Or course, some people have more success than others in the self-control department. But if the research is to be believed, it may not be that their willpower is so strong as much as they’ve hit upon a simple strategy that helps them preserve what willpower they’ve got. They go out of the their way to avoid temptation in the first place.
Example: instead restraining yourself in the cookie aisle, you avoid it entirely, thereby saving yourself from having to exhaust a precious resource.
The late Peter Jennings said he returned to smoking during the 9/11 crisis. Apparently the marathon coverage he provided exhausted him. He knew better than to revert back to an old destructive pattern, of course. But the stress of working so hard apparently depleted his supply of self-control. (He died of lung cancer.)
- 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).
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.
Therapy is also about self-acceptance. Sometimes when you relax your defenses and openly explore your own mind, you’ll discover who you really are, what you really want, or who you really want to be.
Or maybe therapy will bring you into direct contact with your flaws, your limitations, and your past mistakes. We fix what we can, but often as not we must learn to have compassion for ourselves. We make peace the idea of being imperfect. Indeed, in many cases, we embrace it.
We change behaviors, habits, patterns –- especially when they hurt us. But we accept wants, wishes, needs, dreams, and temperaments.
Therapy is a balancing act. We chance what we can, we accept what we can’t. This sounds remarkably similar to the Serenity Prayer, does it not?
God, grant me the serenity to accept the things I can not change,
Courage to change the things I can,
And wisdom to know the difference.
Or, if you prefer, a Moose Goose rhyme...
For every ailment under the sun
There is a remedy, or there is none;
If there be one, try to find it;
If there be none, never mind it.
Therapy is never just about change. It’s also about getting to know who you really are, imperfections and all.
Frequently, we know what we need to do, or what's good for us. The rub is getting ourselves to do it. Oh, sometimes our intentions will carry us through. We brace ourselves, put our shoulders to the wheel, and push. Willpower is a wonderful thing when it works. But what about when it doesn't?
Usually it's a matter of having contradictory commitments. For instance, we can be committed to change even as we are committed to avoiding discomfort. And make no mistake, change produces discomfort. As we try on new behaviors, roles, identities, we feel unsettled, uncertain, perhaps even a bit anxious. Your psyche would very much like it if you remained self-consistent, thank you very much. Even when that consistency is hurting you.
If you're committed to a project of personal change, of feeling better, or making progress on your problems, you'll have unpack your inner life. You'll have to delve into thoughts, feelings, fears, wishes, dreams, and more, and you'll have become deeply acquainted with your truest, deepest self –- even the parts of yourself that defy logic or common sense.
But look on the bright side. Your psyche is delightfully complex. Were it not, you'd be uncreative, uninspired, unfeeling, uncaring, unoriginal, and unfun. You'd be boring. And who really wants that?
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
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.
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.
Have you made any resolutions? Many people do. Yet, if the research is to be believed, most people will give up on their resolutions after a month or two.
What can you do to increase the likelihood of success? I'd suggest, at the very least, three things.
1. Whatever the change is, make a list of the payoffs. A thorough, a detailed list. Give some serious thought to this one. Why? Because more benefits equals more motivation. Once you've completed the list, read it often.
2. Find some way to track your progress. These days, there are countless ways to track progress. Web-based tools, iPhone apps, Moleskine notebooks, spreadsheets, whatever. We manage what gets measured. Indeed, some studies suggest that self-monitoring itself is an "intervention" because it provides us with systematic (and hopefully detailed) feedback.
3. Find somebody who will support your efforts. The risk of telling someone about your project is that you'll have to face that person if you fail. But the benefit of support is that it increases your chances of sticking with something, especially if you're trying to do something that is emotionally difficult (i.e., causes you to move out of your comfort zone). We all need encouragement and praise. Good social support is worth its weight in gold.
Happy New Year.
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.
Maybe you want to feel better or do better or make some personal habit change. Maybe you’re fed with the emotional or behavioral status quo, whatever it is, and you tell yourself you want to change, but something -- something almost as powerful as a magnetic force -- pulls you back. What is that something?
Could be any number of things. Here are some possible candidates.
• Willingness to tolerate anxiety or discomfort
• Support from others
• Willingness to exert effort
Awareness. Obviously, changing anything about yourself starts with awareness. First you must be aware that you have a problem. Of course, it’s not awareness that holds you back so much the things that block awareness: minimization, rationalization, blaming others, and denial. These things are like veils that keep you from seeing the true consequences of the problem or issue. First step: lift the veil. See reality clearly.
Motivation. Recognizing that something is a problem doesn’t necessarily mean you’re motivated to do anything about it. Indeed, many people wait until the consequences of having the problem outweigh the discomfort of facing it before they embark on change. But it doesn’t have to be this way. You can make a list of the consequences to build motivation. And you can make a list of the benefits of change.
Willingness to tolerate anxiety or discomfort. Almost of any change generates anxiety or discomfort as you move out of your comfort zone and experiment with new thinking and action. Human beings are nothing if not self-consistent. Stepping out of old grooves, even grooves that are ultimately not in your best interests, will trip the alarm in your psychological system. Anxiety or discomfort is an uncomfortable state. To make it go away, you revert back to old patterns. But this is a trick. This is what keeps your stuck. If you’re serious about change, you must be willing to bear a bit of discomfort.
Know-how. Knowing how-to lose weight is not the same as knowing how-to get undepressed or how-to conquer agoraphobia. Problems vary and solutions vary. Do your homework. Study the strategies that others have used to solve your particular problem. Don’t re-invent the wheel if you don’t have to.
Support from others. Change is something you can do alone, but it’s probably easier when you have someone in your camp who is willing to root for you. Someone who knows not only what you’re doing, but why you’re doing it. Someone who cares enough about you to pick you up when you stumble. Never underestimate the value of supportive relationships. Conversely, be wary of those individuals who have something to gain if you fail. (e.g., domestic violence).
Willingness to exert effort. If only the infomercials were correct: that there really was such a thing as effortless change. But real change -- change that endures -- requires hard work. You must focus on the problem, think about it, feel the discomfort associated with it, come up with strategies or solutions, and start anew when lapses occur, as they most certainly will. If a problem is really a problem, you must be willing to throw some effort at it to make it different. Maybe that means reading books, tracking progress, attending therapy sessions, or just keeping the problem front and center for a while. No one will do for it; indeed, no one can.
If you are trying to change, don’t be discouraged by lapse, relapse, or resistance. To the contrary, expect these things. They’re simply part of the process.
If you are trying to change, know that change is seldom linear. It’s two steps forwards, one step back (or maybe sideways). Learn to look at the trend, not the moment.
If you are trying to change, celebrate your victories. We never outgrow our need for praise. Being an adult, however, means that sometimes we must provide it for ourselves.
If you are trying to change, but you are not there yet, give yourself the gift of self-compassion. There is little be gained by treating yourself badly when you aim at a target and miss. The rule of change is always about successive approximations, not absolutes.
For so many problems, the secret to real change is not in the strategies but in the persistence. You must try and then try some more. Persistence, along with the belief that you can change, wins the day.
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.
(Seth’s blog posts are pithy, which is one the reasons I read him.)
I agree with his statement. Psychologists, for instance, do not change people. But they do help people change themselves.
What’s the difference? Better yet, why bother consulting a psychologist if all help is self-help?
Answer: what psychologists really do is help you understand the emotional elements behind resistance. When we try to change something about ourselves, we take a step or two but soon fall back to old patterns. Why? Why do we have this contradiction in ourselves?
This is what a psychologist tries to help you understand. You may consciously will new behavior to come about, but if it fails, is there a belief or feeling or schema that’s holding you back? Probably.
Human beings are remarkably self-consistent, even when the behavior in question is maladaptive. If you want to change, you’ll have to de-automate the pattern. (Yes, I just made that word up.) If the problem is serious -- depression, anxiety, eating disorder -- it’s not likely to yield to willpower alone. You’ll have to dig deeper.
Fortunately, you don’t have to do this alone.
Related post: Digging Deep in the Psychological Soil
Sometimes in therapy we need to focus on emotional reactions to situational problems. A common example of this is the person who is in the throes of a stressful experience. A divorce perhaps, or a job loss, or maybe the death of a family member. In these instances, we try to help the person marshal their resources and figure out healthy ways to cope with a difficult and painful situation.
But what does it mean to dig deeper into the psychological soil?
Symptoms related to depression and anxiety are often tied to underlying issues that have to do with dysfunctional beliefs about oneself (or others), or with feelings that have been avoided because they are simply to painful to tolerate.
Sometimes we speak of schema -- packets of information that contain beliefs, emotions, memories, sensations. Schema help us navigate the world because they allow us to make use of prior knowledge. But schema about oneself, especially if it is negative, can color the way we evaluate our personal experiences. If one has a schema, for instance, that one is inadequate, inferior, or defective in some way, one is much more apt to selectively filter out information that refutes this notion but allow information in that confirms it.
In therapy, going deeper often means uncovering these schema and examining them for truth. The thing about schema is, we often develop them when we are very young, which is say, when we are not yet mature, experienced, or wise. And because they've always been there, or so it seems, we seldom question their validity and we don’t always appreciate the long shadow they cast over our lives.
Because schema are often planted early, they are not easy to uproot, especially by oneself.
But this is precisely what a therapist can help you do. We can dig deeper. Uproot the bad. Save the good. Help replant as necessary.
Related post: Core Belief: Inadequacy
What is the purpose of suffering?
This is not a question psychologists can answer. We can establish that suffering exists, in all its various forms, but no psychological theory can explain why it exists in the universe. This is the bailiwick of theologians and holy persons, I suppose.
And yet, in my role as therapist, listening to people in psychological pain, I’ve come to believe that suffering has something to teach us. At least if we let it. Suffering teaches us about compassion. Because if we did not suffer, if we ourselves never knew distress, how would we ever feel compassion for our fellow man? If would be too easy to ignore him, dismiss him, judge him.
There is nothing quite so heart-warming as watching one panic-attack sufferer, or depressed person, helping another.
Come to think of it, therapists are people, too. Which means we’re not exempt from suffering, pain, or loss. Which is why we listen with our hearts, not just our minds.
Frequently people come to therapy because they feel anxious or depressed and they want those symptoms to stop. Fair enough.
But knowing that you’re depressed or anxious is just the beginning. What we really want to know is why these symptoms are occurring, or rather, what they mean. Although it’s true that some individuals inherit a predisposition towards certain kinds of symptoms, this does not mean there is no psychology involved. Symptoms are not causes. They are expressions of underlying issues. Just as your body gives you pain to signal something is wrong, your psyche gives you anxiety and depression to signal the presence of psychological issues. These issues are complex, and may involve thinking patterns, belief systems, conflicted emotions, relational patterns, responses to stressors, and possibly temperament.
Sure, you can take a pill to feel better. Frankly, drug companies would rather you did. They’d rather you chalk up your symptoms to the so-called “chemical imbalance.” The chemicals they’re talking about are neurotransmitters, chemical messengers in the brain. What drug companies fail to mention, however, is that there is no actual medical test for a chemical imbalance. Moreover, medication isn’t the only thing that alters your neurochemistry. Life changes your brain chemistry. As does therapy.
It’s not that I’m against taking pills for relief of symptoms. I routinely refer people to psychiatrists, especially in cases of severe, unremitting depression. Indeed, some clients need both therapy and medication to combat their symptoms before they can begin to function again. What I am suggesting, however, is that we listen to your symptoms in a deep way. Not just as something to be rid of, but as clues to your psychological system.
Sometimes symptoms are just your psyche’s way of telling you that it’s time to trying walking a different path. But unless you listen for deeper meanings, how will you know which way to go?
(photo credit: simonsterg)
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?
This type of belief has at least three powerful consequences.
First, you’re more likely to find evidence to support your notion of not being good enough when you size up situations, and you’re more apt to reject evidence that contradicts it. Beliefs bias our perceptions.
Second, if you belief, deep down, that you are truly inadequate, you’re much more likely to experience strong, crippling emotions such as despair, sadness, hopeless, and shame. Beliefs influence our emotions.
Third, you’re more likely to develop compensatory strategies for the belief, even if you are not aware of the particular psychological functions that these behaviors serve. For example, you work extra hard in virtually at all endeavors, accepting nothing less than perfection. It’s as if you’re engaged in a constant series of personal tests of self, always trying to prove that the belief is not really true. Unfortunately, perfection is difficult to achieve, especially if you strive for perfection in all things. Conversely, someone else with this belief may take the opposite strategy: he or she may try to avoid endeavors where there is a risk of failure. This strategy helps you avoid being reminded of the belief. In other words, it helps you avoid painful emotion that accompanies the belief.
Once the inadequacy belief is installed into the psyche, it’s resistant to change. Our psyches are built in such a way that we seek consistency in our views of ourselves, even if those views are erroneous, painful, or maladaptive. The notions that we hold about ourselves go stronger as time goes on, no doubt from sheer repetition of concluding and re-concluding that, once again, we come of short.
So what can we do about it? One of the things I ask my therapy patients to do is to explore the validity of the conclusion. Beliefs about self often start when we are young. Unfortunately, we may draw conclusions about ourselves using child or adolescent logic; we do not have the wisdom and experience that we will acquire in adulthood. Yet, even after we acquire such wisdom, we seldom go back and edit the self. Rather, we take our earliest conclusions for granted. They must be true because they feel true, and because we’ve always thought that way. I ask my clients to give themselves permission to examine these bone-deep beliefs through the eyes of their adult selves. Maybe you really are inadequate, but then again, maybe not. Maybe things aren’t quite as simply as they appeared to you as a child. Maybe you have learned some things about yourself as adult (or your situation growing up) that were not factored into the early--dare we say, premature--conclusions that you reached about yourself.
This is how we start.
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.
This is part II of my post on behavior change. In part I said that I'm often asked how people change. Although there is no one-size-fits-all answer to this question, I did suggest a first step, which was useful for building motivation: make a list of all the ways your problem is costing you.
Now, for part II, I'm going to suggest you turn my first suggestion on its head: make a list of the payoffs the problem is giving you.
At first it may seems counter-intuitive to think this way. After all, a payoff implies something positive. If a problem is a problem how can it have a positive aspect to it? Let me illustrate what I mean with a common example: problem drinking.
Payoffs for problem drinking might be:
1. Generates positive affect (good feeling)
2. Reduces bodily tension from stress (calms the self)
3. Makes social interactions easier (decrease social anxiety)
4. Turns off the anxiety switch
5. Blots out memories
(And so on..)
In this example, the payoffs are fairly easy to spot. In the short run, alcohol can be quite effective in helping you cope. Unfortunately it's the long run that kills you.
Making a list of the potential payoffs is helpful because it helps you realize you may have to address more than just the defined problem. A problem drinker may be thrilled to finally get the monkey of alcohol off of his back--until he realizes he also has to deal with the underlying anxiety issue (or negative moods) masked by the alcohol. Making a list of payoffs helps you anticipate what you might miss if you decide to let the problem go.
The key point is this: sometimes our problems serve us in some hidden way. They may allow us to reduce anxiety, generate good feeling, or give us a reason to avoid something we’d rather not face. This may not be true with all emotional problems, but if you’re thinking about making a change you give it some thought.
And yet, here’s one tactic you might try: as your first step, make a list of all the ways the problem is costing you. This doesn’t mean you’ve committed to change yet, it may only mean you’re getting ready.
Example: Let’s say you want to lose weight. (And who, in our culture, doesn’t?)
What’s the “price-tag” of this problem?
1. You find yourself squeezing into your jeans. Uncomfortable.
2. You find yourself worrying about your health. (Blood pressure, anyone?)
3. You find yourself spending too much money on food.
4. You worry about whether your partner or spouse finds you attractive.
5. You’re more easily winded going up stairs.
6. You don’t sleep as well.
7. (.....you get the picture. )
Why do this? Simple. Making a list of what the problem costs builds motivation.
Even if you’re not ready to make that change, this is a great way to start. In fact, while you’re working up your courage, review your list every day for a while.