The five factors of how therapy can help:
The core of how therapy can help is the relationship between the client and the therapist. It has many aspects in common with any authentic relationship. One key difference is that the therapeutic relationship is solely for the benefit of the client. For the therapeutic relationship to be client-centered, therapy has some different boundaries.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.
A good assessment from an objective person is an important factor in how therapy can help. 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 the problem, identify steps to take, and then I walk alongside my clients as they take the steps.More…
Assessment is an ongoing process. While I’m good at sniffing things out, therapy is not detective work. The therapeutic relationship is at the forefront, and the assessment is in the background.
The relationship itself plays an assessment role. For example, the dynamic between my client and me 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 not. When they’re not, it’s usually the feelings that are more on target. This contradiction between her words and feelings points me to her blind spots. I make assessments through my head, heart, and gut. My head allows me to apply my knowledge of psychology to what I see in my client. I can feel empathy for my client when my heart connects with her and fuels my capacity for empathetic understanding. My gut is a physical intuition where I can feel sadness or tension even before she speaks.
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 bipolar 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 is 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 the human experience.
WHAT GOES ON IN THERAPY
I try to put clients at ease to 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–a crucial factor in how therapy can help.More…
The feelings between a therapist and their client also play an essential role in therapy. For example, the client may subconsciously transfer feelings about their father or boss to me and see me as disapproving or alternately as wise.
Transference is actually expected and plays a vital role in how therapy can help. Let’s imagine, for example, that I say something to a client that offends him. We can explore whether or not his reaction was proportional to what I said. Overreactions are clues 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 see that sometimes when he feels criticized by his boss, he may be transferring his feelings about his father 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 kindness and respect toward themselves.
With a skilled therapist, the client can even become temporarily dependent on the therapist’s warm regard. The therapist can then work to help him recognize his competence for doing this independently. As a fellow human, I can help him feel less isolated by showing that I and others share similar problems. This feeling of shared experience is significant 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 dares to share something he is ashamed of, and the therapist accepts him without pause.
STORIES (Part One).
There is a universal need to have ones story told. A key component of how I do therapy is to help clients tell their stories and for them to know that I have heard them. Once they find their voice, clients can tell their story to those in their life to whom they most want to be known.
The problem is that many things can block us from telling the story we need to tell.More…
It may be that the experience is too painful, we are humiliated, or we fear we are weird or crazy. But often, we keep even beautiful and meaningful experiences to ourselves. Certain experiences feel profound, and we can see deeper and farther when we view our world and experience from that perspective.
The things we see through this lens are exquisitely poignant, are deeply personal, and are hard to articulate. We tend to be shy when we consider expressing them since they are not typically discussed in everyday conversation. There is a beautiful passage in a coming-of-age novella, The Body, 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. When a client takes the risk of speaking of these experiences to a therapist who listens carefully, the moment feels sacred. It is an honor to be present with another as they find the words to describe what they see through the lens of their deepest heart. It is moving for the client to and hear themselves tell it, thereby gaining insight, clarity, and feeling less alone in the universe. Often people come into therapy without a coherent sense of their own story. Their past experiences can feel like loose, disconnected pieces.
STORIES (Part Two).
The irony is that we need to tell our story for these pieces to come together, and an attentive listener helps us 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 emerge 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 listening to a podcast of someone with whom you identify. Sometimes, though rarely, it can happen spontaneously, perhaps stimulated by a meaningful encounter. Another way that therapy can help is to make us more open to the therapeutic opportunities that pop up naturally.
Ones story comes together in one piece. People with spiritual orientation often feel it is transcendent and comes from outside themselves. But sometimes, our head gets stuck in replay mode, not of our actual story, but of a script we act out from our childhood or earlier experiences as an adult. This is how therapy can help. I help people find their story by telling it to me, and I can often see things fall into place. Through active listening, interest, and follow-up questions, I help a coherent narrative to manifest itself. I often see a shift. The client shifts from feeling like a thing happened to them to feeling like the protagonist of their story. A story told many times truly becomes a story one has mastery of.
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 dredging up complicated feelings, there is a tendency to lock them 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. Therapy “homework” is the follow-through phase of how therapy works.More…
Mindfulness. Mindfulness is one of the main things I recommend for clients to practice between sessions. What is mindfulness? David Gelles wrote a New York Times article on meditation that is very helpful for those curious about mindfulness meditation. (See NYT-How to Meditate https://www.nytimes.com/guides/well/how-to-meditate?auth=login-email)
Gelles quotes Tara Brach, a prolific mindfulness teacher saying,
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, noncritical 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 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 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 exercises the mind’s muscle to stay in the present. With clients, I often use the analogy of working out regularly 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.
My biggest challenge is not to avoid the present moment because of intense and difficult emotions like fear and sadness. Therefore, I was particularly drawn to the writings and presentations of the Buddhist nun, Pema Chodron. 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 a student of Chogyam Trungpa Rinpoche.
When Things Fall Appart. As a fellow anxious person, I particularly love her book, When Things Fall Apart. 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 successful (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 overreact greatly, 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 or fleeing it. Practicing mindfulness develops 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.
I find that sometimes all it takes from me is a little guidance for my clients to make mindfulness exercises a valuable “try this at home” practice. In this way, clients contribute significantly to how therapy can help by helping themselves.