For twenty-eight years I have provided counseling and psychotherapy services to individuals, couples, and families in Syracuse, New York and the surrounding area. I have worked with people of all ages from different ethnic groups, religious affiliations , cultural experiences, sexual orientations, professional and career fields, and educational backgrounds. Many of the people I have worked with have had some previous counseling experience, some which they have deemed helpful and others not so much. Often I am asked what factors contribute to a successful counseling experience. Over the years, I have found that to a large degree therapeutic success is determined by four major factors (1) the therapeutic relationship created between therapist and patient, (2) the relative mental health of the patient, (3) the degree to which there is a shared belief system between therapist and patient regarding how human problems and solutions are viewed, and (4) the ability of the therapist to achieve the right balance of therapeutic support and challenge for each individual.
The therapeutic relationship created between a therapist and a patient is vital to the process of psychotherapy. By this I mean that you have a good working relationship with your therapist and that there is a sense of trust and likability between the two of you. It is important that you respect and value one another as human beings. The process of psychotherapy can, at times, become quite difficult both emotionally and psychologically. During such times, it is important for you to have established a belief that your therapist has your best interest at heart, is capable of doing what he/she says they are going to do, and is someone that you can trust to help you figure out what is going on in your life.
Mental Health of Patient
The relative mental health of a patient speaks to the kinds of resources that a patient possesses to deal effectively with life's demands. Characterisitcs such as an ability to face reality, being courageous despite one's fears, an ability to tolerate difficult emotions, and an ability to look at different perspectives about an issue are examples of these skills. The more a patient possesses these qualities already, the more potential there is for growth and the more likely a patient will be able to handle the process of therapy well. If a patient doesn't possess these characterisitcs as they enter therapy, it makes the process of psychotherapy more difficult. In these situations, the focus of psychotherapy would typically be to help the patient develop these resources.
Shared Belief System
Sharing a common belief system means that you and your therapist are on the same basic page when it comes to understanding the origins of your problems and the process by which change will occur. This doesn't mean that you and your therapist will have identical beliefs, but rather that you share enough common ground to make the relationship work. In the end, your therapist will have a particular view about your concerns, about how they developed, and what needs to happen in order for you to resolve your problems. If you agree with their perspective, it may increase the opportunity for change. If you don't, you might find it difficult to work with your therapist and may need to seek alternative treatment provider.
Therapeutic Support and Challenge
Since we all have different life experiences, it makes sense that not everyone will need the same amount of therapeutic support and challenge. Some people may need more therapeutic support while others may need more therapeutic challenge to achieve their intended outcomes. The appropriate balance of support and challenge is determined by a patient's historical experiences as well as my education, training, and clinical judgement. When done well this blend of support and challenge increases the likelihood of a patient being able to grow and change.
Therapeutic support is comprised of providing a patient with understanding, empathy, and compassion. It is my hope that from this support a patient will feel safe, secure, understood, and valued as a person. With this support, I believe a patient can come to trust both me and the therapeutic process. This trust often leads to a situation where a patient is much more likely to explore areas of concern in an effort to create positive change. Trust is also important in creating a good therapeutic working relationship. Once the therapeutic alliance is established, therapeutic challenge can be utilized to bring more awareness to a patient and provide opportunities for the patient to expand what they know about themselves and the world. Through the use of interpretation and/or confrontation, the patient is challenged more directly to face parts of themselves that are discrepant or inconsistent in an effort to become a more integrated and whole person. Consequently, the optimal mixture of support and challenge, increases the likelihood that a patient will feel cared for and understood, while also challenging the patient to go beyond what is known to create a new way of being.
While support and challenge help people grow, many people hang on to old less than effective strategies and coping mechanisms out of fear. Often people's coping strategies have helped people avoid the difficult emotional and psychological aspects of their life's problems rather than address them head on. These avoiding behaviors often result in some immediate relief from the realities of life for a person. The relief that is obtained reinforces the use of the coping strategies because it feels better than facing the problems head on. Unfotunately, the use of these tactics in the long run often create more suffering for a person because their pain simply gets stockpiled, they wall themselves off from authentically engaging life, and much of their life energy goes into fueling defensive operations rather than towards life energizing growth and development.
If I have learned anything in all these years, it would be that our legitimate suffering always finds a way to express itself in the end. Regardless of how people have tried to protect and defend their pain from bleeding into everyday life, sooner or later that which troubles us will become evident. In many cases, our suffering comes out as physical symptoms. I have reviewed research which suggests that 80% of primary care doctor visits reflect unresolved emotional and psychological issues rather than pure medial problems. It is easy to see the steep emotional and financial price we pay for not directly addressing our issues. If we want to be happy and live meaningful lives, we have to learn to directly face ourselves and embrace what is real. Our most profound psychological and emotional healing comes from this process. Unfortunately, we live in a society that is more than happy to help distract us from our pain and avoid the need to directly address our problems. If someone hasn't been very effective in addressing their life's concerns, that isn't going to change overnight. New ways of addressing one's life do not magically materialize. They develop through honest work and effort to more directly face yourself and address your issues head on. Unfortunately, because human beings are so good at denying the truth, many well intentioned people find that their goals to change go unrealized. This is why psychotherapy was invented.
Psychotherapy is a process to assist people in an effort to restore prior emotional and psychological functioning or to develop a new level of functioning in the world. In my opinion, a therapist takes on the role of nurturing environment and through experiencing the patient in the therapeutic relationship is able to discern the optimal balance of support and challenge to facilitate growth in the patient. Through this process, the origin (s) and the mechanism (s) which keeps a patient's struggle in place begins to reveal itself. In many cases, if not all, the therapist learns more about the patient's struggle from experiencing them in therapy than from what the patient tells the therapist their problems are. From this experience, the therapist is able to utilize their training, their theoretical knowledge, and their clinical experience to help focus the patient on relevant issues associated with their personality, relevant issues associated with their historical and/ or current environments, or relevant issues associated with the interplay of both if needed.
My sincere hope is that these therapeutic efforts will assist the patient in healing their legitimate suffering and develop healthier resources for them to more effectively engage life.