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.

Episode 15: Rachel Hott Interview

rachel-hott

In this episode Rachel Hott, co-director and co-founder of the NLP Center of New York, is interviewed. Rachel holds a Ph.D. in clinical psychology and is a certified Master Practitioner and Trainer of Neuro-Linguistic Programming (NLP). She is a licensed clinical psychologist and holds a Masters degree in Dance/Movement Therapy. Rachel has also been a course leader for American Management Association, a private consultant for executives, and has been trained by Jack Canfield to facilitate self-esteem trainings. Her specialization areas include: Performance anxiety, Sexuality, Life Transitions, Addictions and Healthy Lifestyles including weight control, sleep and exercise. In addition to NLP, she includes Thought Field Therapy, Eye Movement Desensitization and Reprocessing (EMDR), and Self-Relations in her therapeutic repertoire. Rachel is sought after as an international presenter on NLP and Communication.

In our interaction Rachel discusses what specifically NLP is and how it can be applied, how to work with a variety of clients, and how to operate within client’s subjective realities.

To find out more about Dr. Rachel Hott, check out her website: http://nlptraining.com/

Episode 14: Utilization of Client Values

values

In this episode, I discuss the importance of using clients’ values to aid in obtaining successful therapeutic outcomes. Too often therapists forget that each client has a unique set of values that, when explored, can give him or her enormous resources to pull from to aid in healing. By being open to investigating and using these resources, we can assist our clients in finding surprising ways to navigate and move beyond the inevitable struggles in life.

How to Become an Irreverent Therapist

I recently came across an old article while doing some research that really got me thinking in a different direction. The article was written by Cecchin, Lane and Ray and published in the Journal of Marital and Family Therapy in 1993. It is entitled “From Strategizing to Nonintervention: Toward Irreverence in Systemic Practice”. The article discusses the shifting of focus in systemic therapy away from cybernetics and directive interventions and towards nonintervention and a focus on narrative (this shift was a huge mistake in my opinion). In the article, the authors suggest that in order to avoid the trap of being constricted in any way, therapists may want to embrace irreverence in their clinical work. This will enable them to avoid any potential limitations. It is a fantastic article that still has applications today. I was so inspired by the authors’ ideas that I wanted to share them, along with my own thoughts about how to become an “irreverent therapist.”

How to become an Irreverent Therapist

To be able to act without any restrictions on effectiveness, irreverent therapists need to take 100 percent responsibility for the actions they take and the directives they give. They must be willing to do anything within ethical guidelines to create the conditions for change to occur. If a therapist needs to be silent for the whole session in order to create change, she will. If a therapist needs to be confrontational in order to create change, she will. If a therapist needs to jump up and down on the couch singing songs from the 1960s to create change, she will. An irreverent therapist has an incredible amount of flexibility because her client is the focus of the session, not her theory.

 

Jester-_Joker_Card001

 

This will mean that the therapist will have to abandon any concepts, ideas, theories, or beliefs which could hamper the successful outcome of treatment. To quote Cecchin, Lane, and Ray, “therapists should maintain a healthy disrespect for any idea which restricts therapeutic maneuverability and creativity.” If you want to be an irreverent therapist, it is crucial that you successfully overcome any desire to stick to predetermined theory or technique that is regarded as the gospel truth. Any allegiance to a dogma is to quickly be rejected in order to flow with the moment as you and your client interact.  Practice laughing maniacally when you hear that a specific theory or technique is labeled “the best”.

An irreverent therapist will go out of his way to undermine and create havoc in the rigid beliefs and patterns of his clients. The order of the day is to embrace playfulness and see what happens when an inspired, uninhibited shrink gets to have fun. The irreverent therapist is also expected to poke holes in his own beliefs and patterns as he weaves a web of possibilities in his interactions with his clients. Uncertainty is not only embraced but encouraged in the therapy room. Any viewpoint the therapist or client takes as an absolute certainty in the session must be disregarded and discarded in favor of pure spontaneity and aliveness. Any certainty that the problem the client brings is unsolvable needs to be immediately dismantled in the therapy session. Spend time observing mastery of the absurd by watching a Marx Brothers movie or a Samuel Beckett play (these are much more enjoyable and teachable than most therapy textbooks).

An irreverent therapist pays little attention to how problems got started. He or she will be mostly focused on how things can shift and change. Investigation into past history and narrative explanations are kept to a minimum as the therapist redirects focus away from problem investigation and towards an exploration of client strengths and resources. Diagnostic labels are regarded with much suspicion and even disdain (maniacal laughter can be used here as well).

Try on the mantle of “Irreverent Therapist” for a week. Put it on your business cards. For this title there are no expensive, long term trainings to attend in order to obtain some silly certification. All that is needed is an openness to absurdity, an embracing of compassion, and a sense of humor.

principles

Episode 6: Future Orientation and Inspiration in Therapy

tree

This episode offers a view of therapy that focuses less on the past and is oriented more toward clients’ future goals and dreams. By having clients get in touch with what most truly inspires them, it is much easier to shift away from problem focus and move into a focus on client resources. The differences between motivation and inspiration are discussed, as well as creating an inspiring future for the therapist.

 

Theoretically speaking…

A theory is a generalized explanation and body of knowledge about how something operates. These explanations are used to predict and assume outcomes for specific actions. A theory stands if the results can be consistently replicated by researchers under similar conditions.

In the field of psychotherapy, research seems to come out daily promoting one theory of therapy over another. Each theory proponents pushes their theory to be the most effective and often have substantial research as evidence to its effectiveness. The rigor shown by these researchers can be impressive and their work has created shifts in, not only the content of educational training, but also funding for programs which are designed to assist the public with mental health issues.

I remember talking with one therapist who told me that the only real reason he started using his theory of therapy was that it was “evidence based”. He had not tried any other forms of therapeutic interventions because he felt there was not as much research to back up other theories. He said close to seventy five percent of his clients got better using his approach. My question to him was, “What about the other twenty five percent who don’t change?” He politely changed the subject at that point.

 

theory

 

Even though there are some great aspects to having a solid theory of how to do therapy, these theories can sometimes become cumbersome and limiting if we think each individual will automatically fit into our theory. Our clients may not have received the memo that they are to respond a certain way at a certain time due to a certain intervention. When the client does not fit the theory presented by the therapist sometimes the client is then labeled “resistant”. When a client is seen as resistant due to his or her inability to conform to the will of the therapist, the therapist may then become frustrated, angry, feel ineffective or become burned out due to his or her strict adherence to their theory.

The best way to handle the “resistant” client is to throw away your theory. This may be blasphemy to many who cling to their theories in a dogmatic, evangelical way. Many times our theories are good for some clients but not good for others (the twenty five percent). If all we have is one way to assist others we may find ourselves surrounded by “resistant” clients who make us work too hard, feel defeated and uninspired in our vocation. When we allow ourselves to create new interactions in the moment with each new client without a set scripted theory, we may find that every therapeutic encounter can feel much more exciting and creative. What if every client needed his or her very own theory of therapy?

The great scientist Karl Popper believed that theories by nature are abstract, and can only be tested in reference to their implications. Popper asserted that a theory is irreducibly conjectural and brought about by our imagination to solve problems that have come about in a distinct cultural and historical context. He felt that the truth of any theory cannot be verified by scientific testing. It can only be falsified.

To quote the brilliant family therapist Carl Whitaker: “I have a theory that theories are destructive.” Whitaker argued that too much reliance on a theory can cause a loss of objectivity for each unique person and situation. He felt this could result in a loss of compassion and care for the client. He argued that clinicians should consider give up strict adherence to theory and become alive as a real person in their sessions. As he eloquently put it, “Part of the problem is the theoretical delusion that science is curative; that enough knowledge, enough information, the right kind of facts will bring about the resolution of life’s doubts, the resolution of all distress.” I think Carl got this one right.

Episode 2: Gaining a Potential Not Pathology Mindset

Mindset

In this episode we cover four elements which contribute to gaining a resourceful, creative mindset for performing psychotherapy. Having a “potential not pathology” mindset in therapy aids the practitioner in such ways as seeing every client as unique, having flexibility in therapeutic applications, and training oneself to constantly look for client strengths and resources.

You are part of the action!

When we are conducting therapy it is not uncommon for many of us to feel as if we are outside observers as to what is going on with our clients. We think we have a different perspective as we are not directly experiencing what they are experiencing. We often hold that we can be objective as we are outside the action that is taking place in our clients’ lives. Even though this view sounds logical, it may be that this view is limiting our ability to create change for clients.

When we have this perspective as being outside the interaction our clients are engaging in, we can sometimes struggle to adjust their behaviors and thoughts in order to create a shift in clients. If, on the other hand, we view ourselves as being part of the interaction, we find that our very presence can create openings for change to occur. Let us consider how being a part of the interaction is different from interpreting clients’ actions.

If we are interpreting clients’ actions as an “outside observer”, we can only give clients our perspective. This can sometimes be helpful but it can also just take the form of merely giving information. Having information can be helpful but it does not guarantee that our clients will change anything in their lives. Just knowing information does not create an experience for clients to feel firsthand what the adjustment to the pattern of interaction is like. Some clients may take the information they are given and run with it but many will hear it, think about it and find that nothing changes as the patterns of interaction have not been altered.

In contrast, by assuming that you are now part of the pattern of interaction, it becomes much easier to create therapeutic shifts in clients by the use of your own behavior. If your therapy session is an interactive process that now incorporates you the therapist (which it is), anything you do on your part to adjust the interactional patterns can result in shift in those patterns. By no longer believing you are outside of the interaction, you now have the ability to adjust the patterns clients bring to therapy by merely adjusting yourself.

 

interaction

 

As Keeney wrote in the classic text, “Aesthetics of Change” (1983):
“The traditional view is that a therapist treats a client through a given intervention. However, it may be useful for a therapist to imagine a client’s behavior as an intervention. His interventions, so to speak, attempt to provoke the therapist to come up with a useful directive or solution. In this reverse view the therapist’s behavior is problematic when he fails to help the client. Treatment is successful; when the client provokes the therapist to say or prescribe the appropriate action.”

Essentially, the patterns of interaction involve the therapist and to believe the therapist is not a part of the interaction is limiting to the ability of the therapist to create changes in those patterns. By changing yourself in the session, your clients cannot help but be impacted. Any action you take to shake up the pattern will be felt by your clients, unless all you are doing is giving them more and more information.

Since you are a part of the interaction, imagine how freeing this can be to you as a therapist! You no longer have to rigidly adhere to treatments and theories. No matter what therapeutic orientation you have you can become more effective as your mere presence in the session is able to open the doorway to new possibilities.

Are you a Lazy Therapist?

Are you a lazy therapist? If not, could you try to become one?

To me a lazy therapist is one who does only what needs to be done. He or she will relax and let the therapy session move into whatever direction it needs to take without feeling like he or she has to control it. Lazy therapists go with the flow and even sometimes shift the flow in surprising ways.

Most of us have been taught that if we are working harder than the client then something is not right. It may be that we want to the change in the client more than the client wants it. It could also be that perhaps we are attempting to get the client to fit into our therapy model. If we are lazy therapists we just let new therapy models happen all by themselves. We take whatever the client gives us and we use it to create new possibilities for the client. If we are trying to force a client into a model it feels like “hard work” and that means you aren’t being a lazy therapist.

lazy therapist

To be a lazy therapist does not mean you have to be an ineffective therapist. Quite the contrary. You may find that the more you let go of control and let the client do whatever he or she is going to do, often magical openings appear for you to do great therapy. These openings may not appear if you are working hard to get the client into a set pattern of interaction.

 
To be an effective “lazy” therapist I believe you need to do two things:

 
Improvise and Utilize

 
When we improvise we let the client takes us on a journey. We see what magically appears and we do things which seem natural in that specific moment.
After that we then utilize what has occurred in our improvisation to move our clients toward new resources for healing.
This is so different from “working hard”. This can be quite a fun, lazy way to help people.

 
Instead of badgering a client to change their thinking, why not start a discussion about something they enjoy which could lead to an experience of interaction which might shift their thinking in ways beyond anything you might have thought possible?

 
Instead of pushing a client into facing his or her fears, why not do an out of the ordinary activity where he or she can feel in charge of the situation and access the resource of confidence?

 
Instead of working hard to label a client, why not pull out your DSM and ask the client what label they would like to have, which could start a great discussion about the power each of us has to choose our own labels?

 
You could easily do all these kind of things but you may feel you are being lazy. That is a good thing.

Therapist as Client, Client as Therapist

I was talking with a wonderful fellow therapist the other day who told me that she does not follow many of the directions she gives her clients in her own life. We laughed and said that this is often true for many of us as we are all human and have our own personal issues we need to work through. At the same time I have felt that by working with my own clients I am really the one who is the client. What I mean by this is that often the directives and insight I may pass on to my clients is really what I need to be doing or feeling. If I pay attention to the dynamic of interaction between me and my clients I can clearly see that I am not an outsider looking in but rather a part of the therapeutic process and the designation between who is the client and who is the therapist can become blurred. I do not mean that I am spilling out my persona issues through disclosures to the client but rather knowing the things that are said to the client are really meant to be heard by me as well.

I see no difference between self and other in the therapy room. If a client tells me that he or she is frightened to take a certain action, I will gladly assist them in coming up with creative ways to deal with his or her fears. At the same time these same directives are also for me! I have areas of my life where I am fearful so these directives are also meant to be taken by me to move past my limitations. If someone feels stuck in an area of his or her life, the process I help them become unstuck is the very process I need to personally take to become unstuck in some area of my life. If I become frustrated with a client’s lack of motivation in therapy, then this is a great reason to examine where I am not showing much motivation in my own life. If a client is having issues with emotional regulation it is a reminder to me to continue working on my own processing of emotions.

 

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All of this transformational information comes up from the wonderful area of my unconscious mind. I never truly know how a session will turn out so I am often amazed at the incredible information I am giving the client that is really for me. The clients are a reflection of me and I am a reflection of them. Seeing my work as a therapist in this way has allowed me to have more compassion for the people I work with as it is really me that I am working with!

If you have been a therapist long enough you start to notice that people seem to show up in your office with issues which may mirror what you are going through in your life at that moment in time. It is wonderful that they do show up as you get to explore parts of yourself that you might have avoided exploring otherwise. What a wonderful spiritual practice of seeing your clients as your teachers! There is no need to run off to ashrams in India, shamans in Peru or monasteries in Tibet when you have the greatest teachers sitting in your own office.

Which amazing teachers have you encountered in your therapy office?