The five factors of how I do therapy:
RELATIONSHIP. I approach work with a client humbly, and my own flaws make it easy for me to listen without judgment. When my clients sense this it may put them at ease. I make whatever resources I have available to my clients —my curiosity about people, playfulness, knowledge, resourcefulness and gentle candidness.More…
For example, the relationship exists almost exclusively within the sessions. But it’s still a real relationship and the therapist is a real and, at least in my case, flawed person. I approach work with a client humbly, and my own flaws make it easy for me to listen without judgment.
When my clients sense this, it may put them at ease. I make whatever resources I have available to my clients—my curiosity about people, playfulness, knowledge, resourcefulness and gentle candidness.
ASSESSMENT. Let me say first that I am never the expert of a client. My clients are experts of themselves. My expertise is in my intuition, honed by training and experience, for helping people to understand themselves and to gain access to their blind spots. We then work together to clarify what needs to be addressed, identify steps to take, and then I walk alongside my clients as they take the steps.More…
In fact the relationship itself plays an assessment role. For example, the dynamic between my client and I tells me a lot of what is going on with her—I can feel it. Sometimes her feelings are in sync with her words and sometimes they’re is not. When they’re not it’s usually the feelings that are more on target. This points me to her blind spots. I make assessments through my head, heart, and gut. My head gives me technical knowledge related to psychology and human development; my heart is the connection with my client and fuels capacity for empathetic understanding; my gut is a kind of physical intuition where you can feel sadness or tension before anything is even said.
A word about diagnosis. People are complex. There is no litmus test for emotional experiences . Diagnoses are useful concepts but are imperfect concepts, nonetheless. And certain cases diagnoses are more useful than in others. For example, some manifestations of bi-polar moods have clear cut manic and depressive periods. Naming this problem is very useful because many people respond well to medication and in most cases it’s the best option. On the other hand, sometimes a diagnosis cannot sufficiently capture what’s going on. For example, often mild depression or anxiety are very situationally based. It can be from tension in a relationship or stress in the workplace and a diagnosis cannot adequately capture what’s going on. I am very cautious about unnecessarily labeling human experience.
WHAT GOES ON IN THERAPY? I try to put clients at ease so that they can feel safe enough to talk freely about their thoughts and feelings. I hope to create an environment where clients can let down their guard. If we hit it off the therapeutic relationship acts as a staging ground for the client to try different ways to be and act.More…
The feelings between a therapist and their client also plays an important role in therapy. For example, the client may subconsciously transfer feelings about their father or boss on to me and see me as disapproving or alternately as wise. This is caused “transference” because feeling toward someone else in the client’s life is transferred on to the therapist.
This is actually expected and helpful. Let’s imagine, for example, that I say something to a client that offends him. We can explore whether or not the his reaction was proportional to what I said—if it is inflated, that’s a clue that it may be a transference of, say, his critical father. If not, I apologize. If the client recognizes it as a transference we can work through feelings and I can help him to see sometimes when he feels criticized by his boss, he may be transferring his feelings about his father on to his boss. Other times the client may have strong feelings of warmth and safety. He may feel that the therapist feels kindness and respect toward him. Often this is accurate. At moments like that I may help the client to feel the kindness and respect toward themselves.
With a skilled therapist the client can even become temporarily dependent on the therapists warm regard. The therapist can then help guide him through and gradually work to help him recognize his competence for doing this independently. As a fellow human I can help him to feel less isolated by showing that I and others share similar problems.
This is especially important when the client is weighed down with something he feels is shameful. Shame creates the feeling that if others knew about it, one would be viewed with disgust. The impulse is to disappear. It is often a powerful moment when the client has the courage to share something he is ashamed of, and the therapist accepts him without pause.
STORIES. There is a universal need to have ones story told. A key component of how I do therapy is to help clients tell their story and for them to know that I have heard them. Once they find their voice, clients are more able to tell their story to those in their life whom they most want to be known to.
The problem is, that many things can block us from telling the story we need to tell.
The things we see through this lens are exquisitely poignant, are deeply personal and hard to articulate. We tend to be shy when we think about expressing them since they are not discussed in normal conversation. There is a wonderful passage in a coming-of-age novella by, Stephen King. He writes:
The most important things, are the hardest things to say.They are the things you get ashamed of because words diminish your feelings – words shrink things that seem timeless when they are in your head to no more than living size when they are brought out. The worst thing is the secret stays locked within not for want of a teller but for want of an understanding ear.
Therapy offers the space and time to say the hardest things. These moments when a client takes the risk to speak of these experiences to a therapist who is listening carefully, almost feel sacred as they transcend normal conversation. And, as a therapist, I can say it is an honor to be present with another, one to one, as they find the words that speak of what they see through the lens of their deepest heart and hear themselves tell it thereby gaining insight, clarity, and feel less alone in the universe.Often people come in to therapy without a coherent sense of their own story. They’re past experiences can feel like loose disconnected pieces.
The irony is that we need to tell our story in order to these pieces to come together and an attentive listener helps us to realize that the story is already in us. Of course, one doesn’t need to go to therapy to tell ones story. The story can imagine through speaking to anyone who will listen attentively and without judgment or their own agenda. The story can emerge through journaling, or even reading a memoir or a TedTalk of someone with whom you identify. Sometimes, though rarely, it can happen spontaneously, perhaps stimulated by a meaningful encounter. One’s story comes together in one piece. People from a spiritual often feel it is transcendent and comes from outside themselves.But sometimes our head gets stuck in replay, not of our actual story, but of a script we are acting out from our childhood or earlier experiences as an adult. This is when therapy can help. I help people to find their story by telling me and often I can actually see things fall into place. Through active listening, interest and follow up questions I help the coherent narrative to manifest itself. The other shift I see is the client shifts from feeling like a things happened to them to feeling like a protagonist of their story. For people with trauma or
a deeply painful childhood, this is especially transformative.
The events that “happened” become a story of injury and their own journey to healing and thriving. A story that is told a number of time truly becomes a story one has mastery of. Even traumatic incidents lose some of their outsized proportion becoming gradually just another significant moment among others—a moment that shaped you but no longer defines you.
TRY THIS AT HOME. Therapy will often quite naturally stimulate people to apply what they’re learning about themselves between sessions. People, also, frequently have insights between sessions and some will write them down. But sometimes, particularly during periods in therapy when the client is working hard and dredging up some difficult feelings, there is a tendency to lock it in a box until the next session. While sometimes this gives the client a needed break, I mostly encourage clients to continue to work on things at home. Mindfulness is one of the main things I recommend for clients to practice between sessions.More…
Meditation is a training of our attention. It allows us to step out of distracted thought, and helps us arrive in the present moment in a balanced and clear way. Gelles explains that many forms of meditation and that most religions have contemplative traditions. He quickly adds, “there are plenty of secular ways to meditate [and] mindfulness meditation has become increasingly popular.
Mindfulness meditation is the simple, but not easy, practice of paying attention to the present moment with a kind, accepting, none critical disposition. “The goal”, writes Gelles isn’t to stop thinking, or to empty the mind. Rather, the point is to pay close attention to your physical sensations, thoughts and emotions in order to see them more clearly, without making so many assumptions.”
With practice it can yield profound results, making room for more kindness and equanimity, even in difficult situations. With patient, regular practice starting with as little as 1-5 minutes a day, we can begin to escape the trap of our ruminating minds. As one who finds meditation challenging because I easily get caught up in the future and worries, I have benefited immensely despite not being very good at it—now there I go and judge myself! (See, I told you I’m not very good at it.)
A teacher at the Buddhist Center in Baltimore (link) pointed out that mindfulness practice is not the moment where we are in the present. It is the flow of being in the present and then wandering off into thought and then recognizing this and gently returning to awareness, like a gentle dog trainer who herds a mischievous puppy back to its spot. Tara Brach emphasizes that a desire to return to the present and the act of returning actually exercises the mind’s muscle to stay in the present. With clients I often use the analogy of working out regularly as one does
to stay physically fit.It’s important to note that the goal is not to become a “good meditator”, the goal is to be more mindful in the present moment throughout the day, and by staying with it this will happen. Meditation a way to make this happen.
The biggest challenge for me is to not avoid the present moment because of strong and difficult emotions like fear and sadness, particularly when my current life situation is generating realistic fear or sadness. This is why I was particularly drawn to the writings and presentations of Buddhist nun, Pema Chödrön. The foundation of Buddhism is the problem of inevitable suffering. Born and raised in the United States as a woman prone to anxiety, she became the student of ___________. As a fellow anxious person, I particularly love her book, When Things Fall Apart (link) She jumps right into the hard stuff in her first chapter, Intimacy with Fear. It occurred to me that the psychological purpose of fear is to get our attention—to become aware of something that it is vitally important to be aware of. Fear provides the emotional/physiological alertness necessary for survival.
While this evolutionary trait has been success (we’re still here after all), it has also saddled us with millions of years of conditioning. Unfortunately, because of this evolutionary residue we tend to greatly overreact, to fight or to flee, when simple alertness and attention are what we need. The goal of mindful practice is alert awareness. With true awareness and the space to breathe, we can face what we fear without fighting it or fleeing it. Practicing mindfulness develops what is called a “beginner’s mind” a mind open and free of conditioning. In one sense, mindfulness is a process of unlearning the conditioned responses of anger and fear.See NYT-How to meditate by David