Creating Distinctions in Psychotherapy

Many times we are guilty of buying into the maps of reality that our clients bring to us. We often are not clear on how clients are creating their maps. I think we all need to stop and ask our clients (and ourselves) what distinctions were made to create their problems. Making a distinction is the first thing we do when we create some action, emotion, or thought. Making a distinction is how we create a problem (or solution).

 

distinction

 

Any “thing” that exists has to also “not” exist. We distinguish the “thing” from something else.

For example, someone who is “not happy” has to have experienced “happy” previously in order to experience “not” happy. When someone tells you they have never been happy, it is that they cannot focus on those times they were happy, not because they have never experienced happiness. They cannot “not” be something they have never been.

Nothing exists by itself. We end up making the distinctions between “thing” and no thing”. When working with our clients it is a good idea for us to figure out, as Gregory Bateson suggested, what is the difference that makes the difference (distinction).

If a client states he or she is suffering from depression, we as the therapist need to find out what is the distinction this person created to label what they are experiencing as depression (and as a “problem).

 

Example 1:

Client: I am really depressed right now.

Therapist: How do you know you are depressed?

(The therapist is asking for information on how the client has made a distinction of “depressed” and not depressed”)

Client: I sleep too much and don’t go out with my friends these days.

Therapist: So, if you were sleeping less and interacting with your friends more, then you might not feel depressed?

 

Distinction:  depressed / not depressed

Depressed: sleeping more and interacting less

Not Depressed: sleeping less and interacting more

 

 

Example 2:

Client: I am a horrible mother.

Therapist: How do you know you are a horrible mother?

Client: I yell and scream when the kids won’t behave.

Therapist: So if you could speak softer when your kids behaved, then you would be a good mother?

 

Distinction:  good mother / not good mother

Good mother: speak softer

Bad mother: yell

 

At this point, these distinctions are then framed into a context we like to call a “problem.” The context then determines how the person experiences their emotions, actions, and thoughts. By asking questions that push the distinction out of the problem context, the client can gain access to more flexible ways of responding to their situation.

 

GregoryBateson

“Without context, words and actions have no meaning at all. This is true not only of human communication in words, but also of all communication whatsoever, of all mental process, of all mind, including that which tells the sea anemone how to grow and the amoeba what he should do next.”

-Gregory Bateson (1904 – 1980) Anthropologist, Social Scientist, Linguist and Cyberneticist

 

Using Example 2 of the client who believes she is a bad mother:

Client: I yell and scream when the kids won’t behave.

Therapist: Those kids must mean so much to you for you to get that passionate about them doing the right thing.

 

(This comment begins to move the client out of the problem context set up by her distinction between what is a good mother and what is a bad mother. It forces one to question how a “bad” mother could also be “good.”)   

 

Client: Yes, but I need to learn to not be so loud and angry.

Therapist: Sure, but it does let them know that you care enough about them that you will not be negligent and let them get in trouble. In fact, you are willing to really speak up to love and guide your kids.

 

At this point, the context of the behavior has been changed and the distinction between good mother and bad mother has become a little blurry. If a mother who loves and cares for her children can also be loud and yell, then it is difficult to maintain the original distinction.

Take a problem a client gives you and do the following:

  1. Draw a distinction to identify one “thing” from the other:

thing / no thing

2) Try to understand one “thing” in relationship to the other:

thing / no thing

3) Now, try to understand the other things in relationship to the one “thing”:

thing (thing / no thing)

 

Now, use this formula and stretch your psychotherapy brain:

pathology / not pathology

spiritual / not spiritual

healer / not healer

etiology / not etiology

outcome / not outcome

theory / not theory

psychotherapy / not psychotherapy

 

Creating Symbolic Tasks

Have you ever worked with someone who remained stuck in the problem he or she brought to therapy despite all the great cognitive oriented applications put into practice? I have found that many times clients’ intellectual insight alone will do very little to change their emotions or behavior.  You may find that, in addition to traditional therapy work, giving your clients a unique experience can often assist them in becoming more flexible in how they deal with a specific problem or situation. I believe this may be due to how the experience is registered in their unconscious minds. We often think that if we consciously “understand” our problem, then we can rationally solve it. This can sometimes work very well, but many times we end up stuck in a loop of rumination with little access to a way out of the loop.

I discovered that designing and implementing unconscious symbolic tasks for clients can assist them in finding a way out of their rumination loop. I believe this type of tasking bypasses the rational mind and goes to the heart of the unconscious mind, which takes in information in symbolic ways. These tasks are created for the purpose of representing clients’ problems (as well as the solutions) to clients’ unconscious minds. The goal in using these tasks is to express the problem and subsequent solution in a metaphoric way. The task is something that can be experienced outside of the therapy room and can allow clients to integrate healing experiences in a way that is unique to them.

 

unconscious symbolism

 

In my exploration of other healing traditions, I have found that it is not uncommon for healing practitioners to request their clients do tasks which are out of the ordinary and represent the inner struggles the clients are going through in their lives. The tasks given are beyond the realm of left brained language and reason, but, instead, operate purely on right brain symbolism. For instance, a Mexican shaman, who worked with a woman suffering from emotional turmoil related to childhood issues with her mother, directed the woman to buy a large watermelon and tape a picture of her mother on it. She was then to carry the watermelon on a long, arduous hike through the mountains. At the end of her hike, she was then directed to look at the picture of her mother for five minutes and then smash the watermelon. She was then to bury the watermelon and write her mother a letter telling her mother how much she appreciated the good things her mother had done. After this act was finished, the woman was no longer upset about her childhood issues. The symbolic task appeared to clear up the old emotional wounds that still persisted.

I view giving clients unconscious symbolic tasks as a way to give them more flexibility and resources in working through the present issue being faced. Once the task has been completed, clients will have experienced an action which may release them from unconscious, automatic patterns of the past and help them realize that they have more options than they may have previously considered. Using strange tasks in therapy may sound a little ridiculous to our regimented, linear thinking, but to our unconscious mind, these tasks can be a gateway to different healing experiences.

 

unconsciou ssymbol 2

 

I often structure the tasks in this way:

  1. Listen closely to the metaphors and words clients use to describe their problem.
  2. Envision how the problem can be solved in a symbolic act. For example, the woman with the watermelon was able to put down the heavy watermelon (burden) after a long, tiring effort and then symbolically “destroy” the burden and reclaim her power.
  3. Have them do something that they have never done previously.  It must be an out of the ordinary action in order to interrupt unconscious patterns.
  4. Make the task something that requires some effort, but is not completely overwhelming to clients. If it is too much or too hard, most of the time clients will not do it.

 

Some examples:

-A woman experienced much apprehension when talking with her mother due to her mother’s past behavior of always verbally shutting the woman down when she was a child. Her mother was argumentative and had to always be right no matter what the topic being discussed.  Talks with the mother were often contentious and anxiety provoking. Now, as an adult, the woman attempted to avoid interactions with her mother due to her anxiety about her mother arguing and shutting her down. I directed the woman to find a doll and tie it tightly with string from its neck to its feet and then hide it in her closet for two days. After that time, she was to use scissors to cut the doll lose. The woman found a doll that her mother had given her many years ago (and strangely enough the doll resembled the woman) and performed the task. After doing so, the woman noticed she no longer was worried and apprehensive about talking to her mother.

 

-A couple were on the verge of divorce due to constant arguments related to the husband’s binge drinking and the wife’s enabling behavior. They were directed to use a cloth to wash their dishes and then to leave the cloth out on the kitchen counter for three days. They were then to take the sour smelling cloth to the back of their property late that night. The husband was to dig a three-foot by three-foot hole while the wife held a flashlight and supervised his digging. They were then to bury the cloth and sit without speaking for ten minutes while they thought about the meaning of the task given (they were not supplied with one when it was assigned). When they reported back to therapy three weeks later, the husband had begun controlling his drinking and the wife decreased her enabling behavior.  They felt their marriage had been saved by this task.

 

-A man who had been severely abused by his step mother as a young child continued to feel intense fear and panic about her, even though he had not seen her in 25 years. He stated that he believed she had spellbound him to live in fear and she wanted to cause evil in people’s lives. He was presented with an Ouija board and given a piece of paper to write down all the bad things his step mother had done to him. He had to tape the paper to the Ouija board and throw it in a fire. He then had to take the ash from the fire and use it as fertilizer for a new plant he was to put in his yard. He noticed a reduction in his fear after his task was completed.

 

I believe clients already have what is needed to create a desired change in their lives inside themselves. It may be that they just need an out of the ordinary experiential process for the change to occur.  These unconscious symbolic tasks are not stand alone therapies, but it can aid therapists who have reached the limits of what conscious understanding can do.

 

 

Intuition in the Therapy Room

The role of intuition in therapeutic work has been something that has not been examined as much as it should be in our clinical training. Intuition can be thought of as the unplanned forming of impressions and the drawing of inferences. The noted neuroscientist Antonio Damasio describes intuition as “a non-cognitive way of knowing things.” Most every effective therapist I have met has talked about the importance of following clinical hunches and gut feelings in his or her work.

In the early days of psychotherapy, leading figures such as Sigmund Freud and Carl Jung noted the importance of using intuition in therapy. In the fast paced, emotionally charged work that therapists deal with, there may be great benefit from utilizing the quick nature of intuition. In an article entitled “Intuitive Listening” from the journal Modern Psychoanalysis, Lynne Laub discusses many different ways that intuition can appear in clinical work. She found evidence for using intuition in such areas as metaphors, dreams, symbolism, and non-verbal communication. Other researchers have found that the use of intuition can be very effective, but only if there is ample trust between client and therapist, as well as the clinician’s trust in his or her own gut feelings. Arthur Bohart, in the article “Intuition and Creativity in Psychotherapy” from the Journal of Constructivist Psychology, writes that intuition is really inspiration that just spontaneously occurs to the therapist while he or she is in the flow of the therapeutic interaction. It appears that the topic of intuition might need more exploration as it may aid the needs of our clients within the therapeutic relationship.

 

INTUITION

 

If intuition is so important in clinical work, why is there so little time spent discussing this phenomenon in psychotherapy training?  It may be that many professionals in the fields of psychology and psychotherapy have a desire to have their work strictly rooted in empiricism in order to be seen more as a science than an art. Intuition may be seen as too connected to spirituality and mystical leanings than aligned with “hard science.” Not having a set operational definition and application can make it problematic for researchers who are interested in investigating intuition in order to quantify its operation.

Since the prevalent approach to working in the clinical arena continues to be directed by empiricism and standardization of treatments, there is little space for teaching therapists to begin trusting themselves (and their intuition) more often. The employment of regimented therapeutic techniques often limits a practitioner’s access to his or her own internal wisdom. The “cookie cutter” approach to performing therapy leaves few openings to investigating our clinical hunches. Is there not a middle ground that not only gives therapists a structure in which to work, but also honor the mystery of our unconscious intelligence? I think there is, and most therapists who routinely follow their gut in the therapy room would probably concur.

Using our intuition may involve introducing odd statements and/or actions into the therapy discourse. What may not seem to make sense initially, might connect in ways our conscious minds might not at first comprehend. I have previously written about the importance of introducing the random into a therapy session and it may be that the random is preceded by an intuitive action.

One time I was working with a young woman who was in recovery from Methamphetamine addiction. She was trying to get her life back together and heal the hurts that her addiction had caused. She was not feeling good about herself and was constantly worried about falling back into her dysfunctional patterns. Our topic of the day was her learning to soothe herself when she became distraught instead of automatically turning to unhealthy men or drug use.

As we chatted, a strong image popped into my mind. I saw an image of a large number of birds flying. For some reason I felt compelled to trust this intuitive flash and ask her directly what “birds” meant to her. She stopped talking for a minute and sat with a puzzled look. She then told me that when she was a young girl, she and her grandmother would feed the birds that gathered in her grandmother’s backyard. As she talked about this time period, her eyes began to show tears. She explained that being with her grandmother were the few times in her life when she felt that she was “safe and good”. Upon hearing this information, I decided to see if she would be open to feeding the ducks who gathered at a pond across the street from my office. With a big smile, she quickly agreed to do this task.

In time, she found that she was able to reconnect with the feeling she had with her grandmother when she feed the ducks. She also decided that she would feed the ducks anytime she felt overwhelmed by life and needed to soothe herself.  By following my intuition, with what initially seemed to be an unrelated mental image, my client was able to find a positive resource to use for her healing with which she had previously lost touch.

My advice: Trust yourself. If you get a hunch, no matter how odd, follow it. See what opens up

The Psychotherapy Marketplace

Lately I have noticed an increasing trend in the psychotherapy field in which the marketplace of ideas has become more crowded. Every day it appears that someone has invented a new theory, therapy, or technique that is then marketed as the latest and greatest breakthrough. A flocking of therapists to training programs on these new inventions has created thriving businesses for many. The good news is that the more these offerings are marketed, the more these new ideas can be heard and explored. The bad news (at least to me), is that it may create an idea that by learning just the “right” theory, therapy, or technique, we as therapists can increase successful outcomes. Some psychotherapy marketers have gone so far as to draw a line in the sand and declare that what they are offering is the cure to most of the emotional problems for which people come to therapy. Others have been more respectful and inclusive in their offerings.

 

Marketing

 

I think it is important for us all to remember that, in spite of the best marketing efforts, research still shows that any one specific therapy application is not superior to any other when it comes to measuring outcomes. In an article in the journal “Clinical Psychology: Science and Practice”, Stanley Messer and Bruce Wampold found in the results of their research that there is no evidence that that any one therapy application provides the magic bullet for successful clinical work. They write:

Such results cast doubt on the power of the medical model of psychotherapy, which posits specific treatment effects for patients with specific diagnoses. Furthermore, studies of other features of this model—such as component (dismantling) approaches, adherence to a manual, or theoretically relevant interaction effects—have shown little support for it.

In fact, the most recent research on what really works in practice involves each individual client’s perceptions of the overall progress of treatment and the key determinant for success still comes down to the client-therapist relationship. Michael J. Lambert and Dean E. Barley, in an article titled, “Research summary on the therapeutic relationship and psychotherapy outcome” from the journal “Psychotherapy: Theory, Research, Practice, and Training”, found that factors such as warmth, empathy and the therapeutic relationship had a higher correlation with client outcomes than specialized treatment interventions. (For more on the factors which create success in therapy work, I highly recommend the work of Dr. Scott Miller: www.scottdmiller.com )

If it is true that specific theories, therapies, and techniques are not, as Bateson would say, “the difference that makes the difference”, then maybe this can free practitioners from any rigid allegiances in the constant changing psychotherapy marketplace.  I still encourage people to create new models and techniques and expand our field; however, I think we all need to be aware that even the greatest technique may go nowhere if a client does not have trust and a solid connection with the therapist. Unconditional positive regard for clients and having a human connection should never go out of style.

“Coleyology” Interview

I was recently interviewed by the lovely and talented Nicole Lemaster for the “Coleyology” podcast, a program which focuses on consciousness, mental health, and holistic living.

Coley

In this lively, personal, and candid interview, Nicole and I discuss such things as focusing on therapy client strengths, framing problems, co-creating novel experiences, hoodoo, the paradox of trust, writing books, and humor in the therapy room.  She was a delight to interact with and I really enjoyed our chat.

To listen to the interview, go HERE

New Book Now Available!

My latest book, Unlimited Resources: Simple and Easy Ways to Find, Access, and Utilize Client Strengths and Resources to Facilitate Change, is now available.

Unlimited Resources COVER

I wrote this book for psychotherapists who are interested in directing their therapy sessions toward a focus on client strengths and resources instead of an excessive focus on problem investigation and client pathology. I offer case studies, transcripts, and practical examples to give therapists and coaches simple methods for implementing resource directed ways of working.

To get your copy, go here.

That is so random….

My present belief system is that clients seek help from a therapist due to their feeling stuck in some way. Their ability to work through what they perceive as a problem is hindered by their attempting to deal with the problem with a pattern of action/reaction which furthers to cement the pattern and, unfortunately, makes it worse. If clients are continuing to perform the same patterns of action, thought, and emotion toward the problem, then the problem will be maintained and clients will feel it insurmountable to overcome. This will lead to them perceiving their problem as a personal reality and their automatic responses to this “reality” further solidifies the pattern.

In order to facilitate a change in these patterns, I believe therapists must be comfortable talking about and doing things that are unexpected and random. Our therapeutic interactions are there to provide clients with new information which can be used to alter the patterns which have previously caused distress. When new and random information enters their present perceived reality, then their reality has to adjust. Sometimes merely giving straightforward logical information in dialogue may not be very effective due to the brain being stuck in a deeply entrenched pattern. Introducing the random into a session can cause the brain to experience different and new realities which can create a shift in how clients respond to their problems. As Gregory Bateson stated in his classic text, Mind and Nature, “Without the random, there can be no new thing.”

Lucky Dice showing a pair of sixes.

Random information can come from anywhere. Sources such as popular culture, spirituality, childhood hobbies, fine arts, etc. can all introduce new information about different ways to respond to old problems.  Further examination of the problem and trying to solve the problem only continues the process of the problem. Introducing the random or unexpected into the problem alters the problem.

I once had a client who was dealing with social anxiety issues and panic attacks due to a variety of factors. He was very worried about running into people he used to know and their observing how little he had advanced in his life. He stated he knew he was depressed and was not in a good place to talk to former friends as he “did not want to burden them” with his problems. When he did go out he would sometimes have a panic attack which would cause him to immediately return home. He felt stuck and more depressed due to his inability to go out often.

PATTERN: Go out –> worry about seeing someone he knows –> think about the present condition he is in and the shame he has about it  –> have a panic attack –> immediately go home

I heard him state that he didn’t want to “burden others” with his problems. I immediately latched onto how a desire to not burden someone was actually an act of compassion. I told him that his concern for how other people feel was quite remarkable. I complimented him on how compassionate he was to willingly allow himself to suffer so that others would not suffer. I told him it was possible that his unconscious mind could even be creating these panic episodes to help shield others from feeling his pain. He responded favorably to my conjectures. Our conversation on compassion continued as we discussed many other examples of times he was kind to others. Since he was a religious person, we also discussed the spiritual role of compassion and the many saints who had shown great compassion while going through hardships.  The topic of compassion was a “random” entry into the interaction as neither of us expected it to appear. It did not fit the prearranged pattern of the problem.

I then told him that it was not fair for him to waste his compassion being alone at home. We had to come up with some way for him to help others with his strong sense of compassion. I told him he had much to teach all of us about how to become more compassionate in our lives. I reminded him about the hardships that the various saints had to face trying to spread their messages of hope to others. I let him know that he could not fully show compassion by staying at home. He needed to find somewhere to interact with others on a small scale to help them learn to have compassion toward themselves. He agreed that this was important work to do. In time, he found that when he did go out he was not as nervous as before and he found that he could interact with people with fewer panic episodes. The random inclusion of “compassion” into the pattern caused his reality to adjust. His previously self-defeating fear was now a source of compassion to be shared with others.

Random information does not come from a scripted, rehearsed treatment protocol. It can only come from an alive interaction with room for spontaneity. It also does not come from excessive problem investigation. When we allow the random to show up in our therapy room, we can let it flow as we ride the wave of interaction.

Healing Trauma with Hypnosis in Nashville – January 27-29, 2017

Join me and Courtney Armstrong for a dynamic 3-day workshop that will teach you how to effectively heal trauma using a respectful, strengths-based hypnosis approach. This high-powered workshop worth 25 CE’s that is filled with experiential activities and practice sessions that help you discover: 1) why hypnosis is one of the most gentle and effective evidence-based tools you can use for reconsolidating traumatic memories, 2) how to use hypnosis to quickly rewire the brain and activate inner healing states, and 3) how to easily adapt interventions to fit your client’s spiritual, cultural, and personal needs.

This training will qualify you for LEVEL 1 Certification in Courtney’s cutting edge “Trauma-Informed Hypnotherapy“.

You’ll learn that hypnosis is not scary or complicated, but merely a way of communicating with the emotional brain where our emotional memories, attachment schemas, and automatic patterns are stored. You’ll see that when you speak to the emotional brain in a language it understands, it updates rather quickly and painlessly. Clients typically enjoy the hypnosis approach we’ll be teaching you, and often finish sessions feeling relieved and uplifted, rather than tired, retraumatized, or drained.

Don’t miss the fun, fascinating, and educating event!

For more information go HERE!

Creating Ethical and Effective Directives

I received a question the other day about the use of directives in psychotherapy due to my having written other posts about applying absurdity and paradox as effective therapeutic directives. The question I received is “How do you do directives in an ethical manner”? This question caused me to pause as I usually do not think about how I do directives as being unethical at all. Upon further reflection I think the question came about because of the power distribution within the session in which directives arise. In order to give directives, the therapist has to become the “director” of the session and cannot be merely a passive onlooker. This can create concern for those who are uncomfortable with having a larger amount of power and control in their therapy sessions. I completely understand this concern.

 

Ethics

 

To address this concern, first, I must state that if you are a therapist it is crucial that you adhere to the ethical guidelines set forth by the organizations who are involved in your licensing (APA, ACA, NASW, etc.). Thoroughly knowing what is appropriate and what is not in the ethical codes is an important part of being a professional therapist. If there is uncertainty on one’s part about a course of action, I recommend consulting with a colleague or supervisor to bounce ideas off of so that one can have a better perspective on a directive. The allure of power can be seductive so it is imperative that we in the healing profession proceed with caution. At the same time, we need to not be so uptight and worried about what we are doing that we lose our spontaneity and creativity.

Secondly, I think the best way to use directives is to simply ask yourself, “Would I be willing to do what I am asking my clients to do?” If the answer is “yes”, then implement the directives. If the answer is “no”, then do not implement the directive. If we are unwilling to do what we are asking of our clients, then not only are we not congruent with the therapeutic offering, but we are also putting unnecessary burdens and expectations on the people we are trying to help. By approaching directives with this mindset, it creates an opportunity for us to expand our own comfort zones. If we ask our client to do an odd action to change his or her patterns of interaction, then why not implement that same pattern in our own lives? It may help us become less regimented and more creative in how we approach our own problems. I have a rule that I never ask any of my clients to do anything that I would not be willing to do. This helps keep me mindful of the issue of power in the therapeutic relationship and also reminds me that there are areas that I need to work on and expand in myself.

A recent example of this occurred when I had a client who was very anxious about having things in order. She specifically was bothered by the idea of germs in her home. I was able to get her to agree to not wash one of the pans she used in cooking for two days (it was no small feat to get that agreement!). This allowed her mind to observe that not having everything perfectly clean would not automatically lead to excessive germs and sickness. As I gave this directive, I noted that I can be a bit of a neat freak in my own home. I make my bed and wash my dishes daily and do not like things out of order. As a result of giving her the directive to not wash a pan for two days, I decided to implement a similar directive for myself. I did not wash a pan for two days nor make my bed. This may seem like it is not a big deal to some of my readers, but for me it was an annoyance to alter my usual routine. It did pay off as I reminded myself that routines are sometimes made to be broken and it also gave me a level of congruence with my client.

If you direct your client to stand up more for himself in situations where he would previously back down, then make sure you are willing to stand up for yourself in a situation where you usually back down. If you want your client to expand her comfort zone by try something new, then make sure you are willing to try something new outside your comfort zone.  By being willing to do what we ask of people we can defend against potential ethical issues.