Present and accounted for

As therapists we are taught to focus on our clients and be as present as possible to their needs. This one aspect of therapy is one of the most important things we can do to activate the potential in our clients.

It has been shown many times that it is the relationship between the therapist and the client which aids in creating real change not simply theories or techniques. The best gift therapists can give to their clients is the gift of their presence. In our culture, which has become a constant stream of distractions, people are rarely aware of the importance of simply “being” with someone. By the simple act of connecting with another human being we can foster incredible transformational changes.

But we have to be present in order to be present.

It is not uncommon for us to drift off and focus on other things as our clients are speaking with us. We begin to wonder about things that do not pertain to the person who is courageous enough to share their life story with us. It doesn’t mean we are bad therapists, it just means we are not present. If we can catch ourselves drifting off and return to embrace even the most mundane parts of what our clients are telling us, we may find that our effectiveness expands.

 

presence

Recently I had a situation in which I learned first-hand how important being present was to assisting others heal. I had a client, who I will call “Tony”, who had come to see me for anxiety issues. He had been having panic attacks which kept him from performing at work and at home in ways he would have liked. He also suffered from a variety of health issues which caused him to dip into depression from time to time. We had done some good work together in his first few sessions and his panic attacks were gone and his attitude toward his health issues had improved. He was doing so well that I had even attempted to terminate the therapy. He declined to terminate and told me he felt he need to continue coming. Most of the time when I saw him, he mostly talked about his day to day life which I thought had little serious content to it. I would often find myself drifting off and slightly dreading his visits as I was getting bored with our interactions.

One day he was talking and I found myself drifting off and focusing on things that I had to do later that evening. He pleasantly talked and shared many things about how he interacted with others in his work place. I began to watch the clock and ponder how soon I could end the session. Finally, it came the time to stop our session and I let Tony know that we had come to the end of our time.
As I stood up to walk to the door, I noticed Tony’s eyes were a little moist with the beginning of tears. He looked at me and told me with a slight quiver in his voice, “Doc, I really appreciate our sessions so much. Since I lost my father and brother I just don’t have any other male I can talk to and be myself around. Being in here with you has really helped me in a lot of ways. I don’t know what I would have done without our talks.”

I was shocked. I told him that I was honored to work with him and that it was all part of the job. Inside myself though, I felt horrified by my behavior of not being present in our sessions. I felt like I was a phony. I had not really been listening. I had thought that since Tony’s initial problem was mostly gone there was not much reason to stay as focused. I was ashamed by my lack of insight. I was just too busy in my own little world that I had, unknown to the client, cheated him out of my presence. I learned a lesson in that moment.

From that point on, when Tony came to see me I worked very hard to focus on him and stay as present as possible as this is what he needed more than any technique or theory. He taught me a wonderful lesson without knowing it. The more I am present with my clients, the more I can help my clients. I have always known this idea but yet I had forgotten. It is good to be reminded.

BOOK REVIEW: The Therapeutic Aha!

Lately it is rare that I get to read a good book on counseling that makes me sit up and say, “YES!” But this is exactly what happened when I read the latest book by Courtney Armstrong entitled, “The Therapeutic Aha!: 10 Strategies for Getting Your Clients Unstuck” . Courtney has written a wonderful book which is easy to read and easy to implement in your practice.

 

Therapeutic Aha

The focus of the book is how our clients often need novel experiences within the therapy session to create a shift in their lives. While praising the effective treatments of Cognitive based therapies, Courtney also points out that many times clients may be already challenging their thinking but still need something else to create a change in how they interact with their world. The needed “something else” is a new experience. This book gives an easy to understand explanation of how the emotional/reactive brain works and fun, creative strategies on how to help it change. The case stories in the book are really interesting and the lessons they contain are worth re-reading.

 

In essence, this is a book which will teach you how to help others heal from trauma while igniting (or re-igniting) your passion for being a therapist. I highly recommend it and I have personally told Courtney that I wish I had written it. I look forward to much more fantastic work from Courtney Armstrong.

A Letter From My Future Therapist Self

Last night I was thinking about the journey of self-discovery I have been on as a therapist over the past few years. I have learned so much and am still learning every day. Truths that I once held dear have fallen away to be replaced by new ideas and concepts which often seem paradoxical. I wish I could have saved myself some trouble over these past few years by avoiding some silly mistakes. These mistakes were part of my journey and in the end I am grateful for them.

Having said that, how different it would be if I were able to go back in time with the things I know now? It would be very different! I thought about what if I had the ability to save myself some trouble by writing a short letter to my younger therapist self. What would I say in the letter? I decided to write out my advice to my younger self and share it here.

letter

 

Dear Younger Paul,
I hope you are doing well. I am writing to you in the hope that I can save you some time and trouble in your therapy work. I know you are doing the best you can right now so I hope that this information from your future self will be of benefit to you as a therapist.

1. Stop trying to “fix” people.
I know how much fun it can be to look like a wizard but you end up just giving clients a short term fix which does little for them in the long run. Seeking solutions to their problems only causes you to burn out and get frustrated when they end up showing you that they never really wanted to solve the problem to begin with. Allow people to be where they are and who they are in the moment. Even in really bad cases you need to remember that the person in front of you is a human being with an issue and not a problem to be fixed.

2. Don’t worry so much about giving the client insight.
I know it is a wonderful feeling to connect the dots of a person’s present behavior to his or her past history but it does little to change anything. Knowing why you do something is nice but changing that something is better. Digging deeply in the psychological dirt to get someone to change only gets you tired and dirty. When clients have access to resources they can change much easier than relentless searching for etiology. “Understanding” gets you little mileage outside the therapy room.

3. Don’t feel the need to take credit
Sometimes people change and it is due to your influence but yet they think they alone are the reason for the change. Let them believe this as it will help them heal more than you realize. They gain confidence from thinking they alone are responsible for the change. Confidence is one of the best resources to have. Put your ego’s need to be recognized for your skill to the side and congratulate them. Let them know how proud you are of them and thank them for coming to see you. It is about them not about you.

4. The latest, greatest technique means little compared to a therapist who is genuine, empathic and caring
Stop sweating having to learn every little new technique or idea which comes your way. I recommend checking them out but in the end it is really the relationship between the therapist and client which allows change to take place. Even if you have the best technique in the world, if the client doesn’t feel safe, trust and like you it is not going to work. Be who you are and accept your clients as humans who are worthy of love in spite of the crappy decisions they made. The rest will take care of itself.

5. Work on yourself.
Don’t think you have it all together. You are human and have your issues as well. Stop trying to preach and start working on yourself. Go get more therapy if you need it. The more you grow, the more you can help your clients. You are not as smart as you think you are when it comes to your own life. Shake up those well-worn patterns which have limited you in the past. Anything you do to help yourself will eventually help you become a better therapist.

That is it for now, Paul. I hope you take these lessons to heart and see what can happen when you apply them. I will let you in on something that is going to happen in your future as a therapist: You are going to make a lot of mistakes and you also help a lot of people transform their lives. I have found that you can’t have one without the other. Funny world, isn’t it?

Hang in there as I know you can do great work if you put your mind to it.

Sincerely,
Future Paul

P.S. Don’t sweat that situation that is happening to you right now. It will all blow over and no one will care in a year or so.

P.P.S. I would recommend saving more money than you are doing right now.

P.P.P.S. I love you.

Three things I learned about therapy from studying Hoodoo Doctors

I recently wrote a book about the magical and healing practices of the Coastal Southeastern United States called, “Low Country Shamanism”. My goal in writing the book was to give readers an overview of the practices of the art of hoodoo/conjure as practiced in the low country areas of North Carolina, South Carolina and Georgia. I researched the shamanic practices of the traditional “root doctors” and offered personal narratives from modern day authentic hoodoo/conjure practitioners and those influenced by the art. I enjoyed learning about these indigenous practices and got to meet some really interesting people.

 

low country

From this work I also gained insight into how to structure a good therapy session for my psychotherapy clients. Now before you think that I am going to bring out voodoo dolls and magical potions, let me assure you that these aspects of a hoodoo healing are quite practical. By adopting these ideas into your session I think you will find that you are more effective and creative.

 

1. The Hoodoo Doctor already assumes from the beginning that you will be healed.
The ability to project absolute confidence to your client is so important. If your client does not feel you have confidence in your ability to help them then they may feel they are unable to change. No matter what the client brings to us we need to project confidence in our abilities as therapists. Even if we do not know if we can assist them, a big part of healing is the “acting as if” we can assist the client. We are not making wild claims or offering 100 percent guarantees that clients will be healed but we are giving them hope by not giving up before we get started. People go to therapists and hoodoo doctors for hope as they have usually done everything they know how to change.

 

2. The Hoodoo Doctor will often insist on odd rituals to aid in the healing process.
Rituals can be a very powerful way to create change in therapy. If nothing else, it causes a shift in the patterns in which the client has been consistently using. Once this shift happens the client can see that he or she has more resources in how to respond to situations the previously thought. For example, a hoodoo doctor may ask someone who feeling depressed to carry as special amulet designed by the hoodoo doctor and walk around his or her house 15 times a night at a specific time chanting, “Spirits help move me to healing”. This simple act may be enough to alter the person’s pattern of staying inside and ruminating on all the problems in his or her life. This small change could bring about larger changes. We as therapists also can create new rituals and patterns for our clients to use for surprising results.

 

3. The Hoodoo Doctor is involved in the healing as much as the person seeking help.
Once the person approaches the hoodoo doctor for help, then the hoodoo doctor is an integral part of the whole healing process. They don’t do healing, they ARE healing. The hoodoo doctor is as much a part of the process as the person seeking help in that anything the hoodoo doctor does will have an effect on the person suffering. This is second order cybernetics in which the observation of the healer influences what he or she sees as the process of healing is influenced by the realities of all parties involved. If we, as therapists, recognize that we are not observers of our clients’ therapy process but are active participants in the process, what remarkable changes can we create when we begin to change ourselves? Instead of expecting therapy to move as a set model of interaction we can create marvelous new interactions that are not limited to academic theories. If the hoodoo doctor begins a spontaneous ritual to heal his or her client, this ritual will be new and unique to the client. The act of someone doing something can create change in surprising ways. Don’t wait for a set time to do a set technique. Become alive and create!

 

Now go do that hoodoo that you do so well…..

What a Paradox!: Using Paradoxical Interventions for Fun and Change

Paradoxical interventions could best be described as when a therapist directs his or her client to perform the very problem the client is seeking to eradicate. The underlying principle is that clients’ implement certain emotions and actions for specific reasons. Usually the behavior is unconsciously created in order to meet a certain perceived need by the client. Examples of this could be the need to be noticed, the need to feel some degree of control in one’s life, the need to feel safe, the need to appear strong, etc.

By directing the client to enact the problem behavior, the therapist is assisting the client in meeting this need but at the same realizing (consciously or unconsciously) how much control he or she truly has over the behavior. The act of consciously creating the behavior can lead the client to realize that if he or she can create it, then he or she also has the ability to change it. It is important for the therapist to maintain a nonjudgmental attitude toward the client’s behavior as this acceptance of the behavior by the therapist allows for the opportunity of the problem behavior becoming a beneficial resource in the therapeutic process.

To be blunt paradoxical interventions can often be funny. Having someone consciously do the very thing that he or she does not want to do can often bring about comical consequences (it can also bring about profound healing).

Paradox

Recently I had a young lady in my office that had an issue with shoplifting. She felt she could not go to the store without stealing something. It had got to the point in which she had to have someone go with her when she went shopping to protect her from stealing. She earnestly wanted to stop her problem behavior but felt a compulsion to do it. She would steal something and as soon as she walked out of the store she would intense guilt, shame and anxiety. She felt stuck and hopeless.

After listening to her story and empathizing with how difficult it had been for her to deal with this “compulsion”, I asked her if she could feel that compulsion now in my office. She said she could. I congratulated her on being so in touch with her feelings. I then told her that I wanted her to go out to our busy office area and steal something. She was a little surprised by this request. I told her that I wanted her to go out and steal whatever she wanted as long as she let everyone know she was going to steal something. She had to ask permission to steal.

I went out to the office area with her and told the staff that my client was going to steal some things. They all looked at me and understood that I was doing yet another of my wacky interventions so they agreed without hesitation (I love the people I work with!). I then told my client to take all the time she needed to steal something. It took her a good minute or two to take something (a stapler) and we returned to my office. She handed me the stapler and told me she did not enjoy that exercise at all. I asked her to continue stealing for the rest of the therapy hour. She complied and brought me back many things from the office. By the end of the hour she was not feeling much compulsion any more. She even reported that her feelings about stealing had changed a little. I recommended she go to the store she steals from the most and tell the staff that she is going to steal something as part of her “therapy” but as soon as she walks out the door she will return it. She agreed to this idea but thought I was “crazy” (which is true).

Over the next week she found that her compulsion to steal was nowhere as intense as it used to be, in fact the one time she did take something she immediately returned it. Even though she still has some feelings that encourage her to steal, she has found a new resource due to being put in a paradox of being encouraged to steal.

I would recommend that a therapist utilize a paradoxical intervention when there is a specific problem which the client believes is involuntary. Clients often perceive certain actions they do as out of their control even though they have an unconscious strategy of how to create these actions. A therapist may direct their clients to increase the frequency of the behavior or to schedule it for a specific time each day. It goes without saying that paradoxical interventions are to be used only when it is safe and in the frame work of a positive therapeutic relationship.

Have some serious fun with these interventions (serious fun? What a paradox….).

Enlightening Discussion: My Interview with Mind Science TV

I was very honored to be asked by my good friend Richard Hill to do an interview for Mind Science TV. Richard is currently the Vice-President of the Global Association of Interpersonal Neurobiology Studies, the Director of the Mind Science Institute in Sydney, Australia and a great psychotherapist whose “curiosity-approach” to therapy is something many therapists will want to check out. Richard was kind enough to do an wonderful interview with me here.

Our “interview” was more like a great discussion among friends which could have gone on for hours. We discussed the ground breaking work of Milton Erickson, how excessive focusing on the problem a client brings to us in therapy may actually inhibit healing, book writing and helping clients deal with the challenges of life in creative ways.

I hope you enjoy our discussion.

Frame Game: How to Create Change with the Power of Reframing

One of the most important skills a therapist can have is the ability to reframe the problem which their client brings to therapy. Reframing can be defined as a method in which the therapist restates or reinterprets the client’s problem in a way in which the client can experience the problem in a new way. By directing the client to be able to experience the problem from other points of view, the therapist can change the meaning and the definition of the problem into a problem that will be a little easier to solve.

The point of using reframing in a therapy session is to change clients’ view of the problem from something as being unsolvable, into a new experience in which the problem is now something that can be changed and maybe even be appreciated.

Think of reframing as a way to suggest to your client a more resourceful and meaningful experience in which he or she can have access to different behaviors and emotions. Reframing should give your client new possibilities that he or she had not previously considered or experienced.

 

reframe

 

Here is a simple method one can use to reframe client problems:

1. Notice your client’s present interpretation of the problem
Ask yourself what other possible interpretation of the problem could exist?
Is this problem something that would be appropriate in another setting? If the context of the problem changed would it still be a problem for the client?

2. Find the most interesting new interpretation of the problem and immediately point it out to the client.

The reframe could be something that is humorous, profound, touching or just plain odd.

3. Notice how the reframe affects the client. If it works build on it, if not then discard it.

 

Here is an example of using this process:
A family came to see me for therapy due to their teenage daughter having occasional anger outbursts. The parents were very concerned with these outbursts as the family was a loving family but was very cerebral in how they interacted and as a result they were rather emotionally distant.

After hearing all the details about the “problem” of the daughter’s outbursts, I asked the parents if they truly appreciated what the daughter was doing for the family. Both parents seemed puzzled by my comment that this behavior was to be appreciated. I went on to tell them that their daughter was trying to help the family have access to more emotions than the handful they had been using. I told them that I believed the daughter was unconsciously trying to get them to “feel more deeply” rather than just “think their way through life”. I added that it took a lot of courage for a young girl to be so open with her emotions and I wondered how the parents could show her that they also had the courage to feel more often.
From that point on the parents began viewing their daughter’s anger as a cry for emotional connection with her family. Her parents began to interact with her more often and even, over time, began to show a little more emotion themselves. The level of love, openness and happiness increased in the family as a result. The problem had become the solution.
I believe reframing is an amazing tool that should be in every therapist’s toolbox.

What frames have you played with recently?

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.

 

counselling-room-

 

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?