Blog Posts

  • Which industry are you in?

    I am surprised how many well meaning therapists I meet who identify how they do therapy as “emphasizing client’s strengths” are not aware of how easily they forget to look at their client’s strengths. I find that these therapists start out doing well with emphasizing the client’s resources but seem to get lost during therapy by focusing too much on the problem the client brings to the session. Further, many of these dedicated therapists can often overlook resources that could clearly be expanded upon.

    I have wondered why this happens and today I think I may have stumbled on the answer.

    When humans get under stress we fall back to the conditioning with which we are comfortable. This could be behaving in ways we learned earlier in childhood or habituated ways of moving the body due to repeated experience. When we get perplexed or stressed we often fall back into our old programming. I think that this is what may be happening for some of these therapists. When a case becomes difficult, upsetting, surprising or overwhelming, we as therapists may not be aware of how easily it is for us to go back to the mindset we picked up during the training we received in graduate school.

    Much of what we learned in school was about client “illness” not client strengths. It is natural to revert back to our previous therapeutic conditioning when we get stuck and don’t know where to go. This is why quality supervision is so important to keep us all aware of when we get off track and derail into pathology-land (as long as your supervisor is someone who focuses on client strengths and not illness).

    I remember reading Michael Hoyt’s book “Constructive Therapy” where Steven de Shazer commented about how tough it was to get well trained therapists to focus on client strengths and resources. Referring to these therapists he said, “They are not mental health professionals, they are mental illness professionals. It’s not a mental health industry; it is a mental illness industry.

    What kind of industry do you want to be apart of: mental health or mental illness?

    Let’s see how many of us can transcend our “conditioning” and choose mental health.

  • Unlimited Possibilities: An Interview with Bill O’Hanlon

    I am happy to share with you all a very brief interview I conducted recently with Bill O’Hanlon, a good friend and one of my mentors. Bill is a renown psychotherapist and an acclaimed international workshop presenter. He is also a prolific author writing over 36 books (one of which got him on Oprah!). Bill was the only work-study student of the late Dr. Milton Erickson and has authored several books on Erickson’s unique approaches toward healing. Bill is a Licensed Mental Health Professional, Certified Professional Counselor, and a Licensed Marriage and Family Therapist. He is clinical member of AAMFT (and winner of the 2003 New Mexico AMFT Distinguished Service Award), certified by the National Board of Certified Clinical Hypnotherapists and a Fellow and a Board Member of the American Psychotherapy Association. Bill is someone who deeply understands the importance of a resource directed approach to helping clients.

    bill_speaking

    Bill, you are known for being a therapist who works from a resource focused, solution oriented perspective. What started you on the path toward viewing therapy this way?

    Meeting Milton Erickson. I met him when he visited Matthews Art Gallery at Arizona State University, where I worked as a work study student. I learned who Dr. Erickson was that day, read an article about his worked and become intrigued.

    As I learned more, I sensed at first, then later learned more, that he had a very different approach to change. He viewed people as having “the answer within,” only much of the time the answer was non-conscious – that is, the person knew it but they didn’t know they knew it.
    So, Dr. Erickson taught me to approach change as evocation rather than instruction (as an approach such as Cognitive Therapy takes) or correcting deficits or damage (as much psychodynamic work or trauma work attempts to do). He believed each person had inner and social/environmental resources that would provide the seeds for solution or fully formed solutions.
    I developed the first iteration of my extraction of those ideas and called it “Solution-Oriented Therapy,” but changed the name when Steve deShazer co-opted a similar name for his Solution-Focused Therapy. I began to call my work “Possibility Therapy.”

    Can you define what “Possibility Therapy” is and what specifically it offers? 

    Possibility Therapy has two main components: Acknowledgment and Possibility.

    The first comes from the influence of Carl Rogers on my work. I think people rarely follow therapists into the change process until they feel accepted, understood and validated. But often those elements, while important starting points, are not enough to create change.
    So, I added the second aspect of Possibility Therapy: Inviting people to change their patterns, their viewpoints and their contexts to move forward. And because only that person/couple/family/company knows what is right for them, the task of the Possibility Therapist is to get people unstuck and open possibilities, not to tell people the right way to live, express themselves, etc.
    So, this is not a normative model that defines what is psychologically, emotionally or relationally healthy, aside from a few common sense ideas (It’s not okay to hurt people). Possibility Therapy doesn’t rely on diagnosis to guide treatment, but instead on clients’ expressions of concerns and longings: What does this client want to stop or get away from or have less of (The Concern) and what does the client want to have or where do they want to be in their lives when therapy is done (The Longing).
    What three qualities do you think are most important for any therapist who is interested in working from a “possibility” perspective?
    1. Being optimistic about the possibilities for change.
    Some therapy models see people as damaged or incapable. Possibility Therapists see clients as capable and able and as having resources, not as being damaged or having deficits.
    2. Being flexible
    Because Possibility Therapy has no set normative/diagnostic model and is willing to use any method that is respectful and helps relieve suffering, no dogmatic theories or methods are used.
    We are generally guided by four ways to the change process:
    1. Accepting and respecting the client and his/her viewpoints, interests and felt experience without trying to fix, correct or change who they are;
    2. Changing the Viewing: Helping the client(s) shift their perspective,interpretation or focus of attention by telling stories or gently challenging the truth or reality of their current unhelpful perspectives and meaning attributions;
    3. Changing the Doing: Helping clients try action, interactional and language experiments to shift what is happening in their lives.
    4. Changing the Context: Getting the person to shift their environments, the people and places they spend time around, the parts of their backgrounds and influences (family, cultural, spiritual, religious, gender training and orientation, etc.) they draw upon or identify with.
    We use stories, non-conscious change methods such as hypnosis, small language changes, and other methods to accomplish these four things.
    3. Ability to connect
    Research shows that the quality of connection between client and therapist makes a big difference in the positive outcome in treatment. This includes listening, respect, a sense of one’s one competence and the competence of the clients.
     
    Over the past few years it appears that in some ways psychotherapy has moved back to looking at human behavior through the lens of the disease model. What advice do you have for other therapists who may be discouraged by the present state of the profession?
    The disease model is one way to look at things. Some “alcoholics” have used this model to save their lives by switching to seeing themselves as having a disease rather than a moral weakness, so that model, when used in the service of change, can be useful.
    The problem comes when therapists develop what I call delusions of certainty or hardening of the categories and they actually believe their own theories. This is akin to psychotic delusions in that often the clinician believes that the ideas they have projected on reality are the one and only truth.
    If that or any other theory is acceptable to the client, helps empower rather than disempower him or her, fine. If not, there are many other theories that are just as valid and may help more.I tend to lean away from the pathologically-oriented, disease models, except when I don’t. (Hence the name Possibility Therapy.)
    What recent developments in psychotherapy have made you most excited?

    Actually research outside of psychotherapy on the brain that shows peoples’ brains can change all through life: that brains and nervous systems are plastic (changeable). I was taught the “fixed” brain model when I learned neurological psychology and it was discouraging. If an adult got brain damage, there was little to be done.

    Also, research showing that genes, which give the broader limits of what is possible and not possible for human beings, are not where the action is, but instead gene expression (or epigenetics), which can be changed by thinking, environment, actions and interactions, is where thing are more dynamic and changeable.
    I believe Milton Erickson discovered these phenomena clinically before science found evidence of them and he infused me with this “change-oriented” and “possibility-infused” point of view.Using hypnosis for some 30+ years has shown me how mutable what looks like fixed experience and physiology actually is.
    In your forthcoming book, you outline and discuss non-medication ways to deal with depression. What motivated you to write about this particular subject?

    I experienced a severe depression when I was younger and almost killed myself. Having survived that to live a happy and productive life made me committed to helping others, which I have done for years in my therapy practice.

    But it is “depressing” to see an entire culture hypnotized by the unscientific claims of pharmaceutical companies that depression is a “brain disease,” so I thought I would write about six non-medication ways of relieving depression that have clinical validity as well as research evidence to help challenge this fixed and pervasive view. The book will be out next year and is titled: Out of the Blue: Six non-medication ways to relieve depression. It will be published by W.W. Norton.
    In addition to your books and international speaking, what other areas are you presently working on that might be of interest to your fellow therapists?

    I teach and coach people (mostly online these days) about how to become authors at www.GetYourBookWritten.com. I have coached over 100 books into publication (including yours soon, I think, Paul) and my goal within the next few years is to have coached over 1000.

    I also teach and coach people to be paid public speakers, and to use the Internet to spread their work, become known as experts in their topic areas and earn passive income online while helping others.

     Is it true that you secretly want to be known as the “James Taylor” of psychotherapy?

    I do play guitar most every day and James Taylor was one of my early guitar heroes and I admire his ability to have longevity in his career. Sting and Paul Simon are some other musician heroes that show how to have a long career and keep growing and reinventing oneself.

    I think that being a therapist is very much akin to being a musician. One has to learn the craft and rules of the skill and then be able to improvise!

    Absolutely! Thanks for your time Bill.
    I highly recommend Bill’s work to any therapist who is interested in finding practical methods to assist his or her clients in changing their lives for the better. As Bill stated he has been coaching me in writing a new book on the work of Milton Erickson through his book course. The course has been excellent and very helpful to me. For more information on Bill O’Hanlon, his books, audios and trainings go to his website www,billohanlon.com
  • The Simple Secret to Gaining Trust

    trust

    I was recently talking with a new counselor who was in the process of completing her internship. We were talking about the things she was finding challenging as she began her new life as a therapist. One of the things she expressed concern about was on her ability to establish trust with her clients. So far she had not had too many issues but she told me she still worried what to do to ensure she was seen as open and honest as a therapist. She related to me that she had read about the importance of explaining to the client every detail about what she was doing to gain trust. She had also read about how important it is to match how clients sit and the pace they speak in order to create unconscious rapport.

    After listening to her for a minute I asked if she really wanted the one big secret that I have found in gaining trust from most of my clients. I told her that this one simple secret would not only help her obtain trust in most cases but also improve her overall ability to generate successful therapy sessions. She immediately was intrigued. I told her that it was only two words: “Be yourself”.

    When we are authentically ourselves we generally don’t have to explain in detail everything we do to our clients or sit in certain ways to gain unconscious rapport. When we are comfortable being who we are, most people are comfortable with us. The truth is there will always be some clients who are not going to be comfortable with anyone. However, I do believe that if you are completely yourself most people will recognize that if you are up front about who you are then you must be up front about everything else. If a client is not comfortable working with you due to you being authentic then it wasn’t a good fit for therapy anyway. 

    Being yourself is something that is not a canned performance that you have to act out. I recently watched a video of a therapy “expert” whose method of gaining rapport with his client was by constantly prefacing any comment he had by asking the client, “May I have your permission to make a comment on what I just heard?” He did this over 8 times! Tell me who in the world interacts in such a canned, inauthentic manner and expects to gain real connection with a client?   

    Be yourself. Your authenticity will win you more trust in the therapy room (and in life) than you can ever imagine.

  • Rebel against the Label

    DSM5

    I was reading this article about the American Psychiatric Association (APA) planning a third comment period for practitioners who are concerned about the “medicalizing” of the new DSM-5. For those who don’t know the DSM stands for the Diagnostic Statistical Manual of Mental Disorders and is put out by the APA as a manual of classification for mental disorders. Since it was first introduced in the 1950s it has grown substantially every edition due to the increasing numbers of disorders it offers.

    More and more mental health practitioners are growing concerned about the rampant diagnosing that is required in the mental health field. Many disorders make normal human reactions to situational distress something labeled pathological. The need to label clients with a diagnosis in order to be paid by insurance companies has been around for many years. I have witnessed many therapists move away from taking insurance so as not to have to label their clients with a diagnosis of them being “sick”.

    I can appreciate the intention of the original DSM as it was designed to give a standardized criteria with which every practitioner could be in agreement. If a client goes to a therapist and their records say he or she has been diagnosed Bipolar II, then the therapist will know what symptoms the client has been experiencing and can work accordingly. However, what has been happening is a explosion of diagnostic labeling that has led to a massive increase in the push for pharmaceutical interventions with little true healing for the clients who are being labeled. Also, the stigma of having a diagnosis can often be counterproductive to the therapeutic process.

    A couple of months ago I worked with a client who had been referred to me. This client was very open about her anxiety and the sexual violence that she had been through over the past few years. She told me she felt hopeless because she had been given the diagnosis of Bipolar I, Obsessive Compulsive Disorder and Borderline Personality Disorder. I was shocked. First of all according to the DSM she did not fit the criteria for any of these disorders (NOTE: If you are a mental health professional and are going to give a diagnosis please make damn sure you are giving the correct diagnosis, particularly if your client is now labeled in the eyes of her insurance company as someone ‘unstable‘). Secondly, her problem was simply that she was recovering from years of experiencing trauma. Her jumpiness around loud noise, her desire to make sure everything around her was in order and her emotional outbursts when she was stressed were all just symptoms of Post Traumatic Stress Disorder. Once I explained to her how the brain works when people go through trauma and she saw that it was a common response to long term stress, she began to relax. She sat quietly with tears in her eyes. Up until this moment she didn’t know why she acted and felt the way she did but had been led to believe she was mentally ill. She asked me, “Does this mean that I’m not crazy?” “Hold on a second!” I said, “I never said you weren’t crazy!” We both laughed and then began our work on giving her the tools she needed to begin healing. She has made wonderful progress and now has a sense of hope for the future. The label she had been given gave her no comfort or hope that she could ever be more than a diagnosis. Where is the healing in this process of labeling humans?  I have a friend who refers to the DSM as the “Blade Runner Manual”. He may be right.

    My questions to my fellow therapists are this: What would it be like for you if you did not have to answer to insurance companies and could move past DSM labels? What if all you had to do was just treat the person in front of you instead of categorizing them as a diagnostic code? Would moving past rampant diagnosing allow us to see more potential than pathology in our clients?

  • Novelty in Therapy

    I was reading an article today from Dr. Ernest Rossi, who is a leading researcher in the field of mind/body therapy. Something in the article jumped out at me. In the article he writes:
    “The essence of psychotherapy becomes a process of facilitating “creative moments” that are encoded in new proteins and neural networks in the brain……Experiencing creative moments is the phenomenological correlate of a critical change in the molecular structure of proteins within the brain associated with the creation of new cell assemblies, memory and learning. Molecular transformations in the brain in response to psychological shock, arousal and novelty is now recognized by the author as the deep psychobiological basis of psychopathology as well as the educational, constructive and synthetic approach to healing and psychotherapy.”

    (You can read the whole article here)

    What Dr. Rossi is spelling out here for us is that psychotherapy needs to be a process that actively generates creative novelty in order to have an impact on the brains of our clients. If this is the case, then it is no wonder so many therapists do not see as much results in their work as they would like to see. Many (not all) therapists spend their time excavating their clients’ history to find the origins of all the bad things that brings clients into therapy. This problem focused perspective does little to create a new experience for the client. Too much time on problems solidifies problems.
    I don’t know of too many graduate school programs that teach beginning counselors to be really novel and creative in order to assist clients to change. If a major event or situation caused “psychological shock, arousal and/or novelty” in our clients to create their negative issues then why wouldn’t the clients need to experience different kind of shock, arousal or novelty (the good kind) in therapy to activate their own resources to begin to heal? If we get knocked off course by something different than we usually experience, don’t we need something different to put us back where we were? What kind of novel approach can we give our clients? 

    Many of the legendary therapists (Whitaker, Erickson, Satir, Perls, etc.) all were great at giving their clients a unique experience to facilitate the psychobiological healing process. This type of creative novelty in therapy is not something that one can learn from a textbook. It is something that must come from within the therapist. The only way to find out what kind of novel and creative things we can begin doing in therapy is to roll up our sleeves and jump in.  

    Have you tried?:

    -asking your clients to change seats with you if they always sit in the same place

    -ask your child clients if you can speak with an unusual accent for the whole session

    -tell stories that emotionally move the client but do not outwardly relate to their issue (but unconsciously gives them tools to grow)

    -really laugh out loud when something funny happens in session

    -ask your adults clients to color with crayons with you during the session so you both can relax

    -write a song or poem with your client about the particular issue he or she is going through 

    -direct your clients to conduct healing rituals to assist them in moving forward with their lives (for my post about rituals go here)

    Come up with your own novel way of approaching therapy and see what kind of magic can happen.