WHEN THERAPY GETS STUCK: HOW THERAPISTS CAN HELP GET IT MOVING AGAIN

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Busy going nowhereThe attached article is long, but worth taking the time to read. It does a great job of describing how therapy relationships often get stuck into a comfortable but stagnant routine that can go on for years. Unfortunately, this sort of therapeutic stagnation is especially common. I believe more therapists than not are comfortable with stagnation and allow their clients to pay for long-term therapy that goes nowhere without giving it a second thought. I appreciate the author’s candor in describing his own experiences with this model and I even more appreciate that he became uncomfortable with his clients’ lack of progress, analyzed the reasons for his own complacency, and found ways back into productive work. The author does a great job in describing how therapy can get back on track again.

The concepts this author describes are the same ones I talk about all the time: collaboration and evaluation. It’s so important for therapists to involve clients in evaluating their progress, and to empower them to make the final determination of what is going to happen next. This article describes how effective evaluation and decisions can be made. If you are considering therapy it’s a good idea to read through these processes so that you can ensure that a similar process takes place in your sessions.

This article goes on to describe some common mistakes that therapists make when therapy has reached a dead end. These are also worth reading, as these are very unfortunate mistakes that therapists make in personalizing the client’s lack of progress or treating them like they are “resistant” and either stupid or unwilling to make necessary changes. Please, if you get in a relationship where you feel like this GET OUT and find another therapist.

Beyond that, the article offers up a few more suggestions for how to get therapy moving again. As a therapist I found these last couple of pages interesting. As a client or potential client it may provide more detail than is helpful to you. In any event I strongly recommend reading at least the first four or five pages of this article. It’s provides a good education into how a lot of therapy really works. http://www.psychotherapynetworker.org/magazine/recentissues/2013-mayjune/item/2129-when-therapy-is-going-nowhere

QUALITY PSYCHOTHERAPY PREFERED OVER MEDICATION – BUT HARDER TO FIND

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Find a Therapist in ChicagoGiven the work I do matching individuals and couples with counselors, I found the article in the link below very interesting. It addresses the contradictory finding that while a majority of clients say they prefer psychotherapy to medications, studies show that the use of psychotherapy alone is decreasing while the use of medication alone is increasing.  The article states that a lot of the reason for this shift is due to the high level of marketing done by pharmaceutical companies and the low level of marketing done by those that develop and research psychotherapy models.

No doubt this is an accurate representation of the marketing realities, especially given the enormous advertising budgets that pharmaceutical companies possess. Consumers who want to find quality services have to search for information regarding the best approaches because it’s not readily available. And they have to do this during a time when they likely don’t have much energy to do research or “shop around” for therapy.

Those of us who spend time seeking qualified professionals know how hard the “shopping around” can be. While there are many professionals who use evidence-based approaches skillfully, there are many who don’t. Finding a skilled professional who is a good fit for one’s problems can be like searching for a needle in a haystack. I can’t tell you how much time I spend pouring over websites and directories trying to sort out the good therapists from the bad. Literally hundreds of therapists are out there that all say the same thing: they provide a safe environment for clients to share their stories, or they will provide a trusting relationship where clients can heal. I can’t tell one of these therapists from another and I don’t know how clients can either.  Some of them probably do good work, but many of them don’t.

So, is it any wonder clients are turning to medication for symptom relief instead of shopping for therapists?  The odds of finding a good therapist are against them, but finding a psychiatrist who will prescribe medication is easy.  I wish I had a solution to this problem. If you’re in the Chicago area, of course, Compatible Counseling Solutions is here to help with a personal assessment and referral. We will also continue writing these blog pieces and presenting articles that can help you be a better and wiser consumer. For more information on this particular topic, please read the attached article.    http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?_r=0

OVER-ANALYSIS IS CORE STRATEGY FOR WORRIERS AND PERFECTIONISTS

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Overworked BusinessmanI admit it. I’m a chronic worrier and a perfectionist. I come by it honestly. My mother is the champion of worrying and she taught me well. In her case, she feels she has no purpose if she’s not actively worrying about the people she loves. For me, it’s not so steeped in meaning. I have learned from a lifetime of being told to BE CAREFUL! that to make a mistake would be a catastrophe, so I over-think every move before I make it. A lot of us are like this, but know how dysfunctional it is and how much it limits our capacity to experience joy and richness in our lives.

I saw this little article the other day that says that analytical thinking is the primary tool of chronic worriers. Since analytical thinking is my primary modus operandi I was intrigued. The article describes that worriers and perfectionists use systematic processing and analysis to check and double check themselves due to a lack of confidence in themselves and fear of making decisions.  Having grown up in a family that scans the environment for every possible source of disapproval before making a decision, I know how limiting this level of systematic processing can be. And I’ve seen it a lot in the clients that come to me for help who want to make changes in their lives but are afraid that others will not approve.

So, for the most part I really liked this article and thought it would be worth citing here. The article poses that by using cognitive-behavioral therapy one can learn another way to manage thoughts that’s not so debilitating as over analyzing. I’m a big fan of cognitive-behavioral therapy, so I have no problem with that. But the article starts out also talking about gut instincts, stating that chronic worriers are people who don’t listen to their gut.  I had hoped that the article would go on to talk about intuitive thinking and the value of trusting your gut instincts. Unfortunately, however, the article never got back to talking about intuition after that first statement.

I recommend reading through the article if you have problems with over-analyzing or with worrying. Cognitive Therapy is an excellent option for the worrier. I recommend, however, balancing cognitive work with work on learning to sense and trust intuition. Listening to intuition means listening to the heart and following your internal “knowing”. This is a skill we are all born with but squash out of ourselves as we learn that over-analysis is more highly regarded. If you are interested in ridding yourself of that pesky voice that keeps you from trying out new options and ways of being I recommend finding a therapist that will help you to trust your intuition as well as challenge your negative thought patterns.  In the meantime, please take a look at the article. http://psychcentral.com/news/2013/08/31/chronic-worriers-tend-to-rely-on-analysis-not-gut-feelings/59057.html

LIFE TRANSITIONS ARE OPPORTUNITIES FOR GROWTH

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Find a Therapist in ChicagoIt’s been about 3 months since I’ve written a blog post. I didn’t initially intend to take a break, but I ended up needing to spend more time with my family this summer, so I decided to discontinue my blog posts until after Labor Day.

So now here we are in September. A lot has happened in my life as my oldest child moved into her first full-time apartment and my youngest child graduated from high school and left for college 1800 miles away from home.  I’m feeling the silence of an empty house most acutely.

I realize that fall is a time of transition for everyone, as we turn our attention from the relaxation and fun of summer back to more focused work.  So I tried to find a solid article about the challenges people face in autumn as the world speeds up again. Unfortunately, all I could find was articles about preparing young children for school, and the ways that the trees change their colors during fall. So I decided to go back to a more personal approach and sought out an article on major life changes and transitions, since that’s what I’m most closely relating to.

The article I found on transition was written a couple years ago, but is as relevant today as it was then.  It talks about the inevitable fears that accompany transitions and the necessity of questioning one’s thoughts, feelings and beliefs in order to move forward in a positive way. When talking about challenging thoughts and beliefs the author describes being open to opposing ideas as the key ingredient. That may sound a little simplistic, but undergoing a major transition is possibly the best and easiest time to open ones’ mind to new ideas. When the whole world has changed, one’s perspective on that world also changes and it’s easier to consider something different. When it comes to challenging feelings, those of us who tend to control and suppress our feelings find it’s a little harder because the solution the article proposes is to just allow for the passage of time. If you try to change your feelings or stuff them away, you will often find that they rise back up with a vengeance and can become overwhelming. With time, though feelings are tempered. New experiences come along that allow us to look at the changes in a more positive way and allow new, positive feelings to come in and sit with and eventually replace our sadness.

Finally, I think the last paragraph in the article is the most important. In order to create positive change during a time of transition one needs to be open to taking new risks and making mistakes along the way. It takes a willingness to make oneself vulnerable if one is going to make something great out of the inevitable transitions in our lives.

Best wishes to all of you as we enter this exciting time of change and renewal. For the complete article see: http://healthpsychology.org/how-to-cope-with-transition-and-change/

THE ANSWER TO THERAPY THAT GOES NOWHERE

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Find a Therapist in ChicagoThe attached article is intended for therapists, to help them get out of work that is going nowhere with their clients.  It provides an important reminder for therapists of what we’re actually supposed to be doing with clients and then gives valuable lessons on how to get back on track.  I think this article is valuable for therapy clients as well, however, because people will recognize themselves in the examples that are described in the article, and it may help them to see what shouldn’t be happening or that it may be time to change in therapy or therapists.

The key to what’s going on in these cases of stuck therapy and can be found in the fifth paragraph on the first page.  Once again, the problem seems to be that the therapist and client are not setting goals and evaluating progress on a regular basis.  Instead they’re just going from week to week.

The author goes on to suggest how to remedy the situation.  He’s right on target that many conscientious therapists who realize they’re stuck in a vicious cycle will make an abrupt shift in focus either through confrontation or through trying a new technique without warning.  New therapists, in their zeal to learn and practice new models, do this all the time.  They genuinely want to “unstick” the therapy but their methods seem to come out of nowhere because they make these abrupt shifts.

What the author suggests is a gentle evaluation process where the therapist and client work together to evaluate where they are at, and re-contract on how to move forward.  Sometime the outcome of this process is that therapy comes to an end.  This is a perfectly legitimate outcome.  Maybe the client has actually achieved what he or she came for and is now just passing the time, or maybe their priorities have changed.  If the therapy is to continue, the process changes based on an analysis that therapist and client have made together.  So there are no big surprises.

This article continues on past this point for a few more pages, and is a good read if you’re interested in details about how different scenarios get played out when therapy is stuck.  If you don’t want to read that much, stick to the first 2-3 pages. They give a good picture of where things ought to be going in therapy.  If you have a therapist who doesn’t want to go there with you then it’s time to think about what you really want, and make sure you get it elsewhere. A lot of therapists enjoy the week to week narratives of therapy that goes nowhere, but it’s your money and time so make sure you get the services that are most helpful to you. http://www.psychotherapynetworker.org/magazine/currentissue/item/2129-when-therapy-is-going-nowhere

THERAPIST SHARING OF VULNERABILITY IS EMPOWERING TO CLIENTS

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Find a Therapist in ChicagoIn my last post I discussed Brene Brown’s groundbreaking work on the importance of allowing ourselves to show vulnerability and address our feelings of shame with an open heart.  I’d like to build a little more on that topic by sharing an article that describes a therapist’s personal experience with tragedy and how he overcame emotional paralysis by allowing himself to be ok with his own vulnerability.

I think many, if not most therapists believe it’s their responsibility to be emotionally strong and to exhibit an unwavering invulnerability to events that would send others spinning into depression or worse. Similarly they believe the best therapist is a detached therapist; one who is always the expert, can be objective all the time and can stay out of the muck that the client is going through. As it turns out nothing could be further from the truth.

In the attached article the author discusses his own personal struggle with physical pain and depression, and how it almost caused him to close his practice permanently.  I really enjoyed this article because the author talks so candidly about what he went through and how he needed to let go of his view of himself as an “expert” and come to see himself as another very vulnerable human being. It’s a very nice story about how suffering can lead to wisdom and a greater capacity to be honestly self-disclosing in the service of helping another heal.  It’s further evidence of how one’s weaknesses can become their strengths and how vulnerability and willingness to show imperfections can become one’s best allies. http://www.psychotherapynetworker.org/virtual-conference/state-of-the-art-2011/day-1/item/2094-dark-passage

SHAME AND FEAR OF VULNERABILITY ARE CENTRAL TO MANY OF OUR PROBLEMS IN LIVING

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Find a Therapist in ChicagoI love Brene’ Brown’s work.  She is absolutely my favorite researcher, author, and speaker on issues of mental health and wellness.  Her work is centered on the experience of shame and development of shame resilience, which is largely achieved through overcoming our fear of being vulnerable and taking emotional risks.

I first learned of Brene’ Brown’s work last September when I was asked to watch her Ted Talk on The Power of Vulnerability.  When the video ended I was left sitting with my mouth hanging open.  That’s it!, I thought.  That’s the center of so many of the things that we and our clients experience.  Since that time I’ve looked for articles I could share of Brene’ Brown’s work, but it seems that her writing is largely confined to books (which are definitely worth reading, but I wouldn’t post them in a blog).

So, yesterday I found this article that was written after its author completed an interview with Brene’ Brown.  The article describes 5 of the most important premises in her work.  If you’d like to get a taste of Brene’ Brown’s work it’s a good place to start.  It essentially asserts that, 1). When you allow yourself to be vulnerable with others you can expect to have amazingly good outcomes, though you’ll have to deal with feelings of horror that you’ve possibly made the worst mistake ever by exposing yourself; 2) Narcissism is really just a strong defense that we create to protect us from our fear that we’re not good enough; 3) Shame is the intense feeling that we are unworthy of belonging or are flawed. It expresses itself in gender specific ways for men and women; 4) The best way to get over shame is to share yourself with a deeply empathic person or people; 5) We must embrace our failures and the prospect of failure if we ever want to truly succeed with greatness.  The effort that goes into great successes always starts with the willingness to fail repeatedly until one gets it right.

I recommend reading through this article, which I attached below, to get a better taste of the central theme of shame and vulnerability.  I also recommend viewing Brene’ Brown’s TED talks, which are posted on You Tube or at Ted.com.  I have posted a link for the TED talk on vulnerability just below the article.  Enjoy. http://www.romankrznaric.com/outrospection/2012/10/16/1729

http://www.ted.com/talks/brene_brown_on_vulnerability.html

REDUCED FEELINGS OF CONNECTION AND THE INCREASE IN COMMUNITY VIOLENCE

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Find a Therapist in ChicagoIt seems appropriate to address the issue of community violence since we’re seeing random acts of violence increasing at such an alarming rate. It seems we barely get past one last violent massacre before we’re on to the next one.  Everyone’s asking the same question: what’s going on?

A lot of the discussion is about guns and the need for gun control, and rightly so.  Much of this would be happening if guns weren’t so accessible and if we didn’t see so much gun violence on television and other media.  I have to believe, however, that there’s more going on here than just exposure to gun violence and easy access to guns. Gun violence is becoming more commonplace but not everyone is going out and shooting up movie theaters or bombing marathons.

The attached article provides a strong argument that what what’s happening is that we’ve lost our sense of connection to others, which allows us feelings of belonging and respect. It discusses the basic survival instinct and describes that when an animal is attacked it does everything it needs to escape but then shakes the threat off and returns to its herd.

The article then goes on to say that the biggest threat humans have is of fear itself, and a lot our fear is about losing our dignity or our ability to be effective in a world of increasing inequality.  The more people are unable to get their basic needs met, the more they feel threatened, which causes their survival instincts to kick in and often leads to violence.

I think it’s true that the more inequality increases, the more people feel threatened and lash out.  The other thing that strikes me about this survival scenario, though, is how alienated we are from each other in general. For humans there isn’t much of a herd to return to anymore.  We’re so much on our own and so isolated.  Social media, which has allowed us to reconnect with all sorts of people that we may have lost track of, and potentially stay “connected” with hundreds of people is a part of the problem.  With our improved technology we no longer need to talk to people face to face or voice to voice.  The more we can text, post, or message people the less we need to actually be with them.

Honestly, I don’t know how we’re going to get basic resources back in the hands of the 97% so that we live in a healthier environment, but I do know that we can all do our part to improve our basic connections with the people we know.  So my advice for anyone that wants to do their part to make a healthier social environment is to get off Facebook and Twitter, slow down the texting, and make plans to get together with someone you haven’t seen or talked to in a while.  The more we facilitate real and genuine connections the less alienated and isolated we will be, and maybe in some small way it will start to spill over into the larger environment.                                   http://www.alternet.org/news-amp-politics/could-our-deepest-fears-hold-key-ending-violence

EVALUATING THERAPY IS OFTEN EASIER SAID THAN DONE

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Businessman Talking, Businessman ListeningI spend a lot of time talking about the importance of evaluating progress in therapy.  It’s a core topic whenever I talk with a therapist about joining my referral network.  Too many therapists let the process of therapy go on and on without ever evaluating progress with their clients.  Every therapist I work with signs off on a set of principles, one of which is that they evaluate progress regularly with their clients.  Getting genuinely good feedback from clients can be a challenge, though, for a variety of reasons.  A lot of clients will avoid giving negative feedback because of discomfort with confrontation, and because they don’t want to hurt the therapist’s feelings.  And therapists do, sometimes, get defensive about negative feedback. Therapists, however, really need to pull for negative feedback, though, if they want to improve. Many don’t go that far in their evaluation discussion with the client because they just don’t know how.  If the client says they’re happy with how things are going, that’s the end of the conversation.

I hope that both therapists and therapy clients will read the attached article that gives pointers to clients on how to evaluate and give feedback to the therapist.  Although I wholeheartedly believe therapists have a responsibility to facilitate this discussion, they often don’t, and real progress can only be made if clients feel they can be honest and direct.

Please read through the outline provided in the article if you would like some help in structuring a discussion with your therapist about progress.  If you can initiate this discussion it could have a dramatically positive impact on the quality of your therapy and could help you move forward more quickly. And very many therapists will appreciate your candor and strive to incorporate feedback into their work with you.  If your therapist is defensive or discourages you from the discussion it may be a sign that it’s time to change therapists.  It’s your time and your money.  You have the right to the best help possible. http://www.psychologytoday.com/blog/in-therapy/201209/how-give-feedback-your-therapist

THERAPIST SELF-DISCLOSURE AND WILLINGNESS TO BE HUMAN WITH CLIENTS

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Find a Therapist in ChicagoToday I spent an unusually long time scanning articles for something interesting to talk about.  I was looking for something new on the importance of the relationship between the therapist and client.  It’s not hard to find articles on therapeutic relationships, but few go beyond saying that the relationship is the most important factor, and that the characteristics most important to a strong therapeutic relationship are empathy, respect, and genuineness.

Ok, but what else? That can’t be all there is to it. I know that most therapists pride themselves on their empathy, respect and genuineness toward their clients. Yet most that I know of are not particularly effective at helping their clients resolve their presenting concerns.  Many of them simply sit with their clients each week, listening intently, nodding, maintaining good eye contact, reflecting back their understanding of what the client is saying, and maybe asking a few probing questions. The relationships may be decent, but while some clients report that they enjoy therapy things aren’t really improving in their lives outside of the therapy session.

Then I found the attached article. This writer talks of her lifelong effort to maintain boundaries in her professional relationships with clients.  Yet one day when she is at the supermarket with her own screaming and tired child she encounters a client whom she’s seeing for help with parenting.  She’s mortified that her client is seeing her struggle to maintain control and composure with her child. She’s sure that the client will realize that she’s incompetent and will fire her before their next session.  But that’s not what happens.  The client comes in to the next session feeling empowered and more focused than ever on improving her parenting.  The experience of seeing the therapist’s own struggle helped to humanize the therapist for her.  She could see for the first time that the therapist really did understand her problems and wasn’t just pretending to.  It helped her to consider that if the therapist could keep trying then she could too.  It was a breakthrough moment.

I just love stories like this that make it ok for the therapist to be another person in the room.  We, as therapists, know that it’s not ok to take over therapy and make the session be about us.  We know how important it is to maintain a therapeutic focus on the client.  But really, is it so awful to use our own experience to help the client to feel less alone?  Do we have to be a completely blank slate?  I am so happy to see this article, and how it changed one therapist’s perspective so that she could bring more tools from her own life to her work with clients. I’m a big fan of appropriate therapist use of self, because it can empower clients to be courageous in making change. For me, that’s the best way a therapist can show their ability to be genuine in their relationships with clients.                http://www.psychotherapynetworker.org/populartopics/ethics/504-nightmare-in-the-aisle