Open the yellow pages section of any phone book or browse the internet to find the name of a counselor or psychotherapist in your area and what will you find? Most likely an overwhelming number of names of providers, maybe some of the services they offer, and issues that they may work with. However, beyond this very little is offered to assist a potential patient in making an informed decision about what kind of therapy they need, what kind of therapist best suits them and their particular situation. Consequently, people are often left to select a therapist based simply on the kinds of problems a therapist may specialize in, the savvy of a therapist's advertisement, or a recommendation of a friend.
Let me be frank. As a profession we have not done a good job of educating the public about the different choices people have when seeking psychotherapy. This leaves many people with the false impression that all psychotherapy, and psychotherapists for that matter, are relatively the same. The truth is that there are many different theories about psychotherapy and about your particular concern. Therefore, anyone seeking therapy should know what these differences are because they guide the content, process, and experience you will have being in therapy.
Some of the most significant differences that exist between particular therapists concern (1) how they view the problems presented to them, (2) how they view the goals of psychotherapy, (3) how they view the function and role of the therapist, (4) how they view the role of the therapeutic relationship, and (5) how they view the role of the client's experience in therapy. Together these types of issues speak to the overall perspective or theoretical orientation of the therapist. It has been my experience that the choices a therapist makes about these issues reflects a therapist's training, experience, personality dynamics, and philosophy of life. The following link will give you information about some of the more major theories of psychotherapy: www.strisik.com/therapy/approaches.htm
View of Presenting Problems
I believe that many presenting problems (could be depression, eating disorders, sexual issues, relationship concerns) reflect some kind of difficulty with underlying developmental and maturational processes. These processes may involve emotional, psychological, physical, intellectual, and spiritual components. The trick is to figure out the connection between the presenting issue and the underlying cause (s). Do these problems refer to on-going historical issues or do these problems reflect more acute issues that have just become problematic? Do they reflect vital resources missing in a person that creates historical struggles or do they reflect reactions to adverse life circumstances? This struggle to understand how nature and nurture interact is an important one. Some problems seem to reflect issues that concern more about our nature, some seem to reflect issues concerning the consequences of how we were nurtured, and some problems seem to reflect struggles with both our inherent nature and the nurturing environments we have been raised in.
The following descriptions highlight some of the major concepts that I utilize in my work. These concepts come from humanistic psychology, from family systems therapy, and psychoanalytically oriented psychotherapy. I believe that these concepts are directly related to the majority of presenting issues that patients bring into therapy. When done well, the connections between a patient's problems and the underlying theoretical concepts that may be utilized to explain them, makes it possible to bring meaning to a patient's world that can previously seem so mysterious and perplexing.
Through my training and clinical experience, I have come to believe that no one theory about human nature and behavior is capable of adequately explaining all that we are as human beings. Consequently, twenty-seven years of being in private practice has lead me to explore and utilize aspects of humanistic psychology, family systems therapy, cognitive-behavioral therapy, and psychoanalytic psychotherapy traditions in my work. I explain these ideas in the psychotherapy services page of my website. I found these theories to make the most sense to me and have had the most utility in my work with patients. This integration of different theoretical perspectives, coupled with an expanding appreciation of what it means to be human, has resulted in a greater clinical sophistication in working with my patients.
From humanistic psychology, I see how we can struggle to live meaningful and authentic lives. It is not always easy to be who we are. I am aware of our deep concerns, and fears, around issues of death and dying. I have seen, and know, the temptation to avoid our legitimate suffering only to suffer neurotically in its absence. Finally, and most significantly, I am aware both personally and professionally how difficult it is to truly be responsible and accountable for our own lives.
From family systems theory, I continue to be amazed how one's family of origin remains a powerful force in understanding many people's current life issues. No matter how old or young, our family of origin remains an influential part of life because of how much we internalize growing up. This internalization process can set a blueprint for us that appears to determine patterns of thinking, feeling, and behaving in life. A main function of our families is to help us grow and develop emotionally and psychologically into mature adults. This ability to help us individuate and separate into our own personhood is vital for our own mental health. Many people carry unresolved childhood issues with them into adulthood. They consciously, and unconsciously, try to meet their childhood needs in their significant relationships, their marriages, their families, and even in their work environments.
From cognitive-behavioral theories, I have found the idea that we can disturb ourselves from the kind of thinking that we do. Many times, we carry with us irrational beliefs that we have learned in our childhoods. We may also focus on negative thoughts and worry about things that are outside of our control. These types of cognitions can be hurtful to our mental health and have an adverse effect on our behavior.
Finally, from the psychoanalytic traditions, I have found that many of my patient's struggles reflect the concepts of thwarted life energy, the Oedipal struggle, conflicts with sexual and aggressive drives, defenses against difficult emotions, thoughts, and behaviors, the transference of unresolved issues from their past onto others in their current life, and problematic personality dynamics which have interfered with intimate, mature relationships. I have found that patients often play out their conflicts in therapy through transference/countertransference dynamics. When these dynamics become know, they are analyzed, understood, and work through in the therapeutic process.
There may be times that a patient's particular problem(s) does not seem to reflect my theoretical underpinnings. Should this happen, I typically explore other theoretical perspectives that might provide perspective and guidance to our work. If I am not able to get additional understanding through this process, I would utilize clinical supervision with a more knowledgeable therapist to better understand the patient's concerns. If this does not shed new light on my patient's concerns and I felt I was not able to provide the patient with what they wanted, I would work with my patient to find a psychotherapist that can.
Goals of Psychotherapy
There are different ideas about who sets the goals in therapy and what the goals should be. Basically, these issues can be determined by the patient, by the therapist, or by both patient and therapist. In some cases, like court- mandated therapy, the therapy goals will determined by an outside party.
My thinking about this has changed over the years. Initially, I felt it very important for the patient to solely determine the problem they were suffering with and the goals of therapy. I would work with the understandings that the patient brought with them. However, the problem that I began to experience over time was that a patient's determination of the problem and their goals did not always match up with my training and knowledge about the particular situation. This conflict facilitated my decision to utilize a collaborative model of defining the problem and setting goals in therapy. By this I mean that it is important to understand where a patient is coming from in defining their presenting problem (s) as well as their goal (s) for therapy. However, I have found it is equally important for me to be able to share how I view the problem (s) and see potential goal (s) for therapy. I believe through a process of dialogue that we can establish a collaborative understanding of both problems and goals for therapy. I believe the ultimate goal of therapy is to reduce emotional suffering and develop more effective ways to be in the world.
Therapist function and role
I see my function and role in psychotherapy to facilitate growth and development in my patient. Over the years, I have found that the majority of patients that I see do not really understand the origin (s) of their problems and have little idea of how to proceed from where they are. Therefore, I believe there are two important tasks for the therapist to achieve: (1) to provide some understanding to the patient about the roots of their emotional and psychological suffering and (2) to help them move from where they are to where they want to be.
Consequently, I am constantly trying to understand the connection between how a person's presenting issues relates to the underlying theoretical concepts that guide my work. When done well, these connections can bring comfort to people by providing them with an explanation for things that have contributed to emotional pain and psychological unsettledness. Psychotherapy grounded in sound theoretical principles not only guides the work of the therapist, but also helps the patient understand themselves in a more meaningful way. There are two major ways in which I try to educate my patients about these concepts of development.
First, there are times that I directly use theoretical concepts in session to educate my patients about what I think may be going on for them. This is done in an effort to assist them in understanding something about themselves. This doesn't mean that I force my patients to accept my interpretations, but rather that I offer it as a possible explanation for what is going on. I fully expect that my patient and I will use these opportunities as a jumping off place for the mutual exploration of its therapeutic merits.
Secondly, there are times that I will focus on the dynamics that are present in the therapeutic relationship. I will explore what it is like for the two of us to work with each other. Through this psychodynamic work, a patient may begin to realize that some of the interactions present in therapy are familiar to them and reflect historical struggles that they have experienced throughout their lives. Psychotherapy gives a patient the ability to work through these issues in a safe environment.
For me, helping a patient move from point A to point B requires a good working alliance and a willingness to utilize the therapeutic relationship as a testing ground for new ways of being in the world. In a sense, psychotherapy becomes a learning lab where a patient, in a safe environment, can learn and practice more effective ways of being, experiencing, and interacting. From the safety of the therapeutic relationship, patients then transfer this new learning out into their world.
Research indicates that the therapeutic relationship created between patient and therapist is important to the work and potential outcome of therapy. It is vital for a patient to feel safe, to feel heard, be respected, and not judged. When a patient feels these things from a therapist, they are much more likely to open up and be more authentic about what is going on in their life. This enables the therapist to more accurately understand the patient and, in turn, provide the appropriate treatment.
Another important factor in establishing a good therapeutic working alliance is a shared belief system between you and your therapist. To a certain degree a potential patient must be aware of, and believe in, the ideas that a therapist is going to use to help them. If your therapist's ideas make sense to you, then it is likely that you will find this experience helpful. Without this shared patient/therapist philosophical foundation in place, you may find that your working alliance is negatively impacted, therapy may not be very effective, and you may be left feeling unsatisfied in your therapeutic work.
Patient experience in therapy
My hope for a patient in therapy is that they would begin to feel a variety of things as a result of this process. I would hope that they experience a greater ability to engage the world in meaningful ways with integrity, dignity, and self-respect. Specifically, I hope that people would see an increased ability to:
1. face reality and address it as it exists.
2. be self- aware and reflect on themselves both internally and externally.
3. recognize, tolerate, and regulate one's own experience without shutting down or acting out.
4. be responsible and accountable for themselves.
5. face conflicts directly with confidence and ability to resolve whatever is presented.
6. possess a solid identity, sense of cohesion, and integrate parts of one's self.
7. be humble.
8. to work and love.
9. chosse truth over comfort
10 stay open to one's own fears, prejudices, and biases.
11. be informed by the past, but not imprisoned by it.
12. be rather than to do
Is everyone ready for Change?
Just because a person comes to therapy does not mean that they are really ready to change. The awareness of this lead to the development of a readiness to change model which looks at where a person is on a continuum of being ready to change. The model of readiness for change consists of five stages ( pre-contemplation, contemplation, preparation, action, and maintenance). The link provided below is intended to give you more information which may help you assess your own readiness to pursuing psychotherapy: www.takingcharge.csh.umn.edu/activities/stages-readiness-change