Blog Posts

  • 3 Surefire Ways to Destroy your Effectiveness as a Brief Therapist

    Brief Therapy has become very popular over the past 30 years. It is a therapy model that focuses on direct solutions to client problems. Brief Therapy is firmly rooted in the present with an eye toward changing the future. I consider much of my work to be centered in the arena of Brief Therapy and have found much value in its approach. I also have seen many colleagues attempting to work from a brief orientation make three types of mistakes which often derail their success. I offer up these mistakes as a way to assist my fellow shrinks in recognizing where not to go when working as briefly as possible.

     

    MISTAKE #!

    Spend as much time as possible getting your clients to understand the root cause from which all their problems originate

     

    I find way too much time is spent by therapists (from a variety of theoretical orientations) attempting to find the root cause from which all their client’s problems come from as if this alone will create massive change in how clients interact with their problem. Understanding etiology alone will do little to create life enhancing changes for your clients. It is action and experience which will move them in new, empowering directions.

    I remember being in a supervision session with a therapist who was working with a client who had sought therapy for anger issues. This therapist was complaining about how her client just didn’t understand that her anger came from her relationship with her mother. When asked how the client was now doing with her anger since she entered therapy, the therapist said the client was much better and had not had any issues with anger for several months. The logical (to me) question was, if the client is no longer having anger issues what does it matter whether or not she ‘understands’ where those issues originated? If she is better why continue to focus on a non-problem? I was told that even though she was no longer having anger issues, the client had not really changed until she could see the connection between her mother and her anger. I bit my tongue and stayed quiet.

     

    Failure

     

     

    MISTAKE #2

    Focus on using specific techniques with every client

     

    A therapist with a rigid adherence to a technique can be a dangerous thing. Too often we as therapists learn something new and feel we have to use it with every case that comes to us. I have seen therapists who even run and market their practice based on one technique. They may have some successes but I have rarely found any technique work every time with every one, no matter what the marketing angle of the creator of the technique states. Too much time is wasted in therapy by shrinks who try to force their clients into rigid categories in order to ‘fix them’ with a specific technique.

    I once worked with a man who suffered from constant anxiety and ADHD. He had seen psychiatrists and other counselors to no avail. I did every technique I could think of to help him. I tried systematic desensitization, mindfulness, cognitive restructuring, hypnosis, etc. to no avail. Finally one day out of exasperation I asked him, “What if you are just an anxious person and that is OK to be anxious?” He thought for a minute and then said, “You know, I haven’t ever thought about it being OK. For some reason I feel better when I think it is OK.” The next two sessions I saw him he was much more relaxed because he was no longer trying to be “not anxious”. I wasted a lot of time trying to get him to fit my technique when all he need was some self-acceptance.

     

    MISTAKE #3

    Forget your client is a human being and not a problem to be solved.

     

    Too many therapists want to rush in and find a quick solution to their client’s problem without building appropriate rapport or connection. If you don’t have a good foundation of trust and respect it is hard to get your clients to take directives from you on how to change. The client is not a robot simply needing an adjustment to his or her nervous system. He or she is a human with a story to share. Honor the story and find how much more effective the therapy process can become. When we as therapists first work toward creating a human connection rather than accelerating preconceived solutions, we can create magic in the therapy room.

     

    Do you have any other tips or advice to brief therapists? If so, please share them!

     

     

  • Three Act Therapy

    What if you could view your therapy sessions as three act performances?

    What if you could guide your therapy sessions as if they were screenplays which unfold in a creative, spontaneous manner?

    I have found the use of a three act arrangement to guide the therapy process to be a useful concept when working. I first learned of this when reading the book “Improvisational Therapy” by Bradford Keeney. This can be a very helpful map if your goal is to move a client out of a problem context into a resource context.

    Keeney views a therapy session not unlike a script for a movie, in which the session is composed of stories with a beginning, middle and end. The role of therapy is to be a live performance in which therapist and client together move through these three acts. With the frames of the acts set in place, it is up to the performer (therapist) to engage in an improvisational performance to assist the client in maneuvering into new contexts and possibilities. This aids the therapist in scoring and keeping track of where he or she is in the session and if a session has progressed at all.

     

    Act I of the story involves the introduction of the problem the client brings to therapy. Act I is rooted in a problem context. Unfortunately most therapists stay stuck in this part of the performance. In this context the problem is investigated in great detail. It is carefully examined and interpreted by the therapist. The problem and its etiology are ruminated upon in the hopes of changing the problem. Changing the problem is futile if the performance of therapy never moves beyond Act I. No matter what the therapist does or says, until the context of the session has changed, both therapist and client are stuck in the problem. Interpretation and diagnostic explanations for behavior are located in Act I. The goal of the therapist is to get out of this part of the performance as soon as possible.

    Act II is the part of the performance linking the beginning to the end. This act is seen as the fulcrum where things can move forward or plunge backwards. This is where topics or ideas occur which are unexpected and surprising. The therapist often is working with a new theme which may have little to do with the problem the client brought into the session.

    Act III is the part of the performance where the client has moved beyond the previous limitations of the problem context. The client is now in a resource context in which the problem may have been reframed or new resources have been introduced which enable the client to change his or her situation.

     

    With this blueprint, there are no set techniques for the therapist to move his or her client out of the problem context as this way of performing therapy favors spontaneous interaction between therapist and client. The only goal is to move both the client and the therapist into a resource context in the shortest amount of time possible. To accomplish this change in context, the therapist must do whatever he or she must do to push past Act I.

     

    Act I

    problem context

    Act II

    moving forward

    Act III

    resource context

     

    This structure of performing therapy avoids interpretation and pathology, Focus on these can freeze the context of therapy in the problem-context. If therapy is focused on either the problems brought in by the client or his or her attempted solutions, therapy is still stuck in a problem context. This means that the therapy session may be cut off from any access to resources that the client can use to aid in his or her own healing. By moving out of the problem context and into a resource context, the problem itself can even appear to be a resource in itself.

     

    Here is an example using three act therapy:

     

    A young woman came to see me for therapy due to long bouts of depression. She also had started cutting herself in a very specific place so that no one would see she was cutting. Cutting this way allowed her to continue her self-injury behavior without those close to her being aware of it. Upon hearing her describe the structured cutting procedure she used I was struck by how much consideration and time she put into cutting herself in this manner. I asked her how she knew how to cut herself in just the right way to stay within the same specific, small area of her body. She told me she really didn’t know.

    I told her it was interesting that a part of her unconsciously knew just how to geometrically cut herself to avoid serious harm and avoid detection from others. I let her know that this let me know that she was talented in the area of visual and spatial activities. We then began a discussion about her interest in art and design, which then led to a directive from me that she was to begin doing more drawing and painting to satisfy the visual and spatial part of her. I informed her that she had been denying the creative artist inside her for far too long. She told me she had always wanted to explore graphic arts but was unsure if it was a good career path. The next time I saw her, she had rapidly increased her art work and quickly decreased her cutting while feeling less episodes of depression.

     

    Act I

    Depression

    Act II

    interest in art

    Act III

    unleashing the creative artist

     

    By moving this woman out of the problem context she was able to access the resources she needed to channel her focus into a more creative, positive outlet rather than a focus on the presenting problem. In this way of performing therapy, each session is viewed as a single session therapy. Additional sessions are treated as new cases.

     

    Try this way of performing therapy out and let me know how it works for you. I would love to hear what results you got by using this concept.

  • Death as a resource?

    I have included a video I made a couple of years ago which was on my private practice website. This video is about how sitting with death can be a resource for experiencing more aliveness in you life. I was recently reminded of how contemplation of one’s impermanence can be a life enhancing process while working with a client suffering from anxiety. This client was so caught up in the day to day worries that plague so many people that he couldn’t seem to relax. He had become so worried that he wasn’t sleeping well and had mild anxiety attacks. After talking with him for a little while I asked him what he would do if tomorrow was his last day on earth. He became quiet and thought for a moment. He finally replied, “Well, I wouldn’t be worried about all the crap I was worrying about today!” From that point on we looked more into his life from the perspective of what was really important versus what we mistakenly view as important. For him, the thought of death became a resource which allowed him to let go of many of his worries and instead, focus more on what was truly meaningful to him.

    I hope you enjoy the video.

  • Dead or Alive?

    I received an email today from a reader who wants to create more aliveness in her therapy sessions. She writes:

    “I really get what you are writing about on your blog but I am a little clueless about how to practically make my sessions more alive. I know my clients benefit from our time together but I feel our sessions could be more. I don’t want to have any sessions that feel dead but sometimes I guess I feel stuck. What do you recommend for me to do to start being more alive?”  

    This is a great question! There are many different ways to change the way you interact with your clients.  It is always up to the individual therapist to figure out what works best for him or her. I don’t think we should lose perspective of our work as being interactional. Too often we get hung up on getting our clients to understand or have insight into various etiology. These processes rarely create generative change in a person.  It is the interaction between client and therapist that determines how much aliveness there will be in a session.

     

    remember the dead therapy session

    In remembrance of dead therapy sessions……

     

    Here are some quick ideas to keep a therapy session from being dead:

    1. Change the location of where you work. If there are other offices in your location see if you can use a different one each time. Where I practice we are always shuffling  offices as it creates a new environment for both therapist and client to interact.
    2. If you can’t change locations, try changing seats. Ask your client where he or she would like to sit differently then you also sit somewhere you would not usually sit.
    3. If you find the session growing tiresome, then stretch! Stand up and move. Leave the room for a minute or two. You can ask your client to stretch with you. Maybe walk around the outside of the building together for a minute. This creates physical energy which helps mental energy.
    4. If possible, see if you can find a co-therapist. Working with someone else adds energy and aliveness. I have really enjoyed working with other therapists on cases in the past. I learned much from someone else’s  point of view.
    5. If you are getting burned out in how you work it may be that you are focusing too much on the client’s problem.  Once your client has sated what the problem is and has felt heard, try focusing the majority of your time on the resources in his or her life which can help move him or her into a new direction. As I have written previously, too much problem investigation helps solidify the problem. Focus on resources and you may be amazed how quickly your client begins to change.
    6. Have you and your client do something creative together. This could be drawing, painting, tai chi, writing, or anything else that creates some good energy.
    7. Give your client creative homework  assignments. Change happens outside the therapy room so don’t miss a   chance to give a fun, creative assignment that will help you client have a resource driven experience.
    8. If you are feeling stuck with your therapy, then throw away your favorite theory for a week or two. Religious adherence to theory is a sure fire way to stop aliveness in a therapy session.

    These are just a few ideas which may assist a session in “waking up”. I would to love to hear from other creative therapists on ways they ensure their sessions are alive.

     

  • The Fully Functioning Therapist

    I have always been drawn to Carl Rogers’ idea of a “Fully Functioning Person”. Rogers believed fully functioning people are able to freely use their talents and abilities, realize their true potential, and work toward gaining an in depth knowledge of themselves. Rogers listed 5 distinct characteristics fully functioning people have:

    1. Openness to experience – A person who is fully functioning is completely open to experience and is more able to listen to him or herself while being fully aware of his or her own feelings. This person looks forward to having unexpected events and situations which expose him or her to new ways of thinking, feeling and acting.

    2. Live more in the present – A fully functioning person lives fully in each moment of his or her existence. Each moment is perceived as new and different from what went on previously. Excessive planning and structure is not something this person engages in.

    3. Organismic Trusting – A fully functioning person does not solely rely on ideas and norms set down by organizations and institutions. The trust of one’s own judgment is what ultimately matters.

    4. Freedom – This person feels free to live his or her life in any way he or she chooses. One is responsible for his or her own actions and lives a life devoid of approval seeking.

    5. Creativity – A fully functioning person is open to alternate ways of seeing the world. This person does not censor his or her unique ideas but rather embraces them.

     

    Carl Rogers

    Dr. Carl Rogers (1902 – 1987)

     

    As I was discussing this topic with students in the counseling class I am presently teaching, I wondered out loud to the class how many professionals in the mental health field are truly “fully functioning therapists”? It really got me thinking of how many of us really need to challenge ourselves in moving toward Roger’s idea in our professional lives.

    When we think about the majority of people working in our field maybe we should ask the following:

    How many are really open to new ideas and experiences so different from their set theories?

    How many approach their sessions as a spontaneous performance without any allegiance to using only the latest evidence-based techniques?

    How many really get into the “Zen” of the therapy moment and totally trust their unconscious minds to deliver the right comment at the right time instead of calculating limiting structures of interactions which yield moderate outcomes?

    How many throw caution to the wind and interact with clients in a free spirited process of discovery in which even the therapist has no idea of what direction the sacred journey of healing will take?

    How many delightfully engage in each therapy session as a new challenge of finding creative interventions for change that amuse and surprise clients?

    I believe the closer we all move toward becoming fully functioning therapists, the more effective and alive we can become in our work.

    Are you a fully functioning therapist?