APPROACH TO TREATMENT


THE MYTH:
People who go to therapy must have a "problem" or have something "wrong" with them.
People who go to therapy are crazy or sick. I know I'm not crazy or sick.
If I can't handle a problem on my own, there must be something really wrong with me.
The therapist will make me talk about things I don’t want to talk about.

THE REALITY:
Therapy is best thought of as a special form of learning.
People use therapy to understand their past, their present, their relationships, and themselves.
People use therapy to try out new ways of doing things.
Eighty percent of people who go to therapy report that they are better off.
Therapy can improve close relationships and how we feel about our selves. Clients say it, and research proves it.

You may know this already: talking with someone we trust can be very helpful. Therapy is similar to other effective methods used by many of us when we want to learn, when we have to learn something new, when we want to try out new ways of doing things, or when we are ready to change something in ourselves and our lives.

THE BOTTOM LINE:  Therapy is not proof of a person's defect or deficit. Quite the opposite, it is a form of learning chosen by thoughtful, self-directed, and pro-active individuals discovering and using their strengths.

MY APPROACH: There are currently over 400 child and adult psychotherapy models or methods. I will not apply a method to you.  Instead, the choice of methods is determined by learning your ideas and experiences and by the your progress, session-to-session. (There's more about this below these bullet points.)

I am trained and experienced in these conventional, scientifically tested models:
  • Cognitive Behavioral Therapy (CBT) and Trauma-Focused CBT. Our thoughts about a situation influence our feelings and behaviors, but our thoughts may be incorrect or may have become disorted. Through therapy, you can literally 'change your mind.'
  • Solution Focused Therapy. What will be happening in the future, when you reach your goal? What have you ever seen, even once, that tells you that your goal could be reached?
  • Family Therapy. Many problems in our lives get started and are maintained between individuals, more than within an individual. Problems can be changed by changing how people communicate and act towards each other.
  • Attachment Therapy.* Addresses problems of children and adults in their close relationships, their self-image, and behaviors arising from early neglect, trauma, or inconsistent parenting. "Holding therapy" and "rage reduction therapy" are not used.Which therapy model or technique will be effective for each person?
Based on findings in 40 years of psychology outcomes research, I use three principles in deciding which methods to use with each client:
  • Elements within clients and their lives account for more than 87% of change. The client’s preferences and ideas about how she or he makes changes are used to guide the choice of therapy method. Clients are helped to see changes that result from their own wisdom and efforts.
  • Elements within therapy, including the client-therapist relationship, accounts for as much as 13% of outcomes. My relationship with clients is part of what brings about change. It is not just a means to “client satisfaction.”
  • Use reliable and valid measures of how the client feels about the therapy relationship and about outcomes or progress. Frequent assessment of these 2 "arrows" - the therapy relationship and the client's progress -- are used to track how well the client is doing and to alter the approach when needed.
In short, there are many arrows in the quiver. If one type does not hit its mark, we use another.
After all, most of us have some idea of how successful change has happened for us in the past. Some of these might be: having a good helper, trial and error, waiting for the right time, getting away from negative consequences. Learning how each client has brought about change in the past can be important in selecting the "arrow" or therapy approach for today's problem. In our work your voice as the client is privileged, improvement in your life is believed in, and a strong partnership between us is formed using the principles above.
Source: Hubble, M., Duncan, B., Miller, S. The Heart & Soul of Change (1999)


People generally say they have come to therapy for 1 of 3 reasons. Two reasons are self-directed, and the third easily becomes self-directed:
  1. They want to discover their own way to reduce some pain or problem.
  2. They want to better understand something about themselves or about life.
  3. Someone else has forced them to come. Our first step is to identify what the client wants from therapy.
1. "I don’t know how to say --- (something) to my wife (husband, child, other family member, friend, boss).”
"I don’t know how to stop myself from --- (complaining, nagging, being afraid to say what I really want, yelling, drinking, repeating the same bad habit, being late to important appointments, feeling guilty). It's not helping, but I keep doing it.”
This use of therapy gives us more tools, like becoming an advanced carpenter after being a beginner. A beginner carpenter might say, “I have only one tool, a hammer. I use it on every carpentry job. Hmmm, maybe that’s why I got fired yesterday. Instead of fixing a window, I used my hammer and broke it." An experienced carpenter might say, “I can fix almost anything, because my toolbox is full. I have hammers, lathes, levels, drills, saws, pliers, wrenches, and other stuff, too.”

How does therapy help us have more tools?
Therapy can help us come up with more and better relationship tools (be more focused on our close relationships) and life tools (be more focused on ourselves), such as:
  • knowing our partner better (this is the friendship part of love)
  • scheduling arguments (often leads to fewer bad arguments)
  • hearing criticism without feeling too hurt and without reacting defensively
  • developing our own interests (improves long-term relationships by increasing autonomy and intra-dependence, not dependence)
  • involving children in chores insteading of just bringing them along
  • correcting children without anger
  • helping children express their feelings (“emotional intelligence” contributes to overall psychological health, relationship skills, and self-awareness)
  • supporting one of your children without taking sides against the other
  • accepting children’s negative feelings without condoning their negative behaviors
2. “I want to understand my family better."
"I want to understand why I always had problems with this person in my family, whom I really love.” Imagine a long wonderful afternoon of looking through the family photo album with a real (or imagined) Beloved Family Member and talking in depth about everyone in the family: the ones who are (or were) nice, strange, cranky, good, or mean. In this use of therapy, clients look forward to setting aside a quiet hour for themselves to remember, explore, and understand how they came to be the person who they are.

For example, almost every one of us has some kind of “intimacy issue.” Some clients say, “I keep having this problem in my life. Maybe some of this intimacy problem is connected to the way I grew up. I want to understand this.”

Many people find that being close to people is harder than it should be. Sometimes we fear rejection or we fear being abandoned. Sometimes we are afraid that if someone gets to see “the real me,” she or he won’t love me as much. We may feel suffocated by the wishes or needs of people close to us - our partner, our child, or other family members.

When we don’t address these “intimacy issues” we don’t know how to talk things over in a satisfying way. We don’t tell the people close to us what we really want and need. We are not sensitive to other’s needs. We don’t have a good balance between being aware of ourselves and being aware of people close to us.

3. “I was forced to come here."
"My wife (probation officer, social worker, doctor) said I have to come to therapy.” Even if someone forces me to go to the gym, I could end up enjoying myself. My attitude might be, “I’ll show them! I’m going to turn this into something good for me!”

How does this work in therapy? I start out by using a simple form that asks the mandated (or forced) client to assess how well he or she is doing in 4 areas of life. As we discuss the form, the client sees how he (or she) can be in the driver’s seat, even though someone else has sent sent her (or him) to therapy.
  • I don’t assume that the change that is sought by the other person, (wife, probation officer, etc.) is the change that the client wants to make.
  • We might set up a goal of “working towards getting X off of my case.”
  • We might list what would have to happen in order to make the other person or agency feel that therapy was no longer needed.
  • We might list the positive things about the client that the other person or agency does not realize.
In short, the client’s goals and ideas about change are my priority. Often we can negotiate a compromise between the goals of the client and the complaint of the probation officer, social worker, partner, etc.

* Dyadic Developmental Therapy, Daniel A. Hughes, Ph. D.









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