A GoodTherapy.org News Update

One of the principle ideals behind the concept of good therapy is that it should be non-pathologizing; that is, difficulties faced by clients should not be seen as intrinsic, inescapable diseases, nor should treatment focus on “healing” an issue in such a way. There are many reasons why a departure from pathologizing therapy is beneficial, both for the client and for the mental health professional (not to mention the field at large). But recently, psychotherapist Tammie Fowles published an op-ed piece that describes, if incidentally, a particularly important idea in the argument against pathologizing.

Fowles notes that all too often, approaches to therapy seek to internalize emotions, transforming knee-jerk reactions and emotional reflexes into complex ideas about what is wrong with the self. In this way, the experience of fear at the sight of someone being assaulted or the emotional reactions sustained during a store robbery might be turned on their head and used to reflect something maladaptive or insufficient within the client. Yet while the examination of why we react as we do has the potential to enlighten and heal, attributing our feelings to being a certain kind of person or having an emotional “script” that we follow based on some internal problem can not only disrupt the healing process, but can ignore the greater picture. Read the rest of this entry

© Copyright 2009 by http://www.GoodTherapy.org Therapist Columbia Bureau - All Rights Reserved.

by Noah Rubinstein, LMFT
Executive Director GoodTherapy.org

The phrase “good therapy” encourages a misconception: the idea that there is such a thing as pure good therapy, a process exempt of any problems or issues. In the same way that a good marriage is not one without problems, but rather one that works through problems – so is good therapy. No therapist is perfect and no therapy can be provided perfectly, no matter how ideal a therapy may be in theory. Even those of us who do the best we can to be conscious of our inner world and attuned to the therapeutic process have aspects we are unaware of, pieces of ourselves unhealed, and mistakes we make. Good therapy is the sum of all the experiences, internal and external, occurring as a result of the imperfect psychotherapy process; and it leads toward self-awareness, growth, and the release of extreme feelings, energies, and beliefs. And what a blessing it is that even the best therapy can be lined with areas of unawareness, mistakes, challenges to the therapeutic relationship, and yet still turn out good…like a marriage. Perhaps we even need a little bad therapy mixed in with all the good? As paradoxical as that sounds, think of the beautiful repairs you and your life partner may have made, the important problems you’ve worked out with friends, and perhaps the repairs you’ve made in therapy with the people you work with. A solid repair improves the connection and deepens the trust. So, cheers to road bumps in therapy, within all relationships, and within ourselves! Read More about ‘Good Therapy, Bad Therapy, & Everything in Between.’

© Copyright 2008 by http://www.GoodTherapy.org Therapist Schaumburg Bureau - All Rights Reserved.

A GoodTherapy.org Featured Column written by Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

When we were scratching around wondering what to call our counseling practice we coined and rejected a lot of possibilities. Some names we considered were obscure, some taken, some boring, and a few were just plain silly. Then we took a look at what it is we actually do, and what we don’t do. The main thing that separates us from most alcohol rehab programs is the fact that we don’t have a “program.” What we do have is a lot of experience and research into what works for different people. The primary offering we have for our clients is the certainty that the solution to their specific problems and set of circumstances will be, like themselves, unique – it will truly be their empowering solution, not ours, or AA’s, or Moderation Management’s, or someone else’s canned prescription. We don’t dictate, we help you find Your Empowering Solution.
Read the rest of this entry

Written by Noah Rubinstein, LMFT, LMHC

Dear Friends,

GoodTherapy.org received an email today from a therapist concerned about one of the principles of good therapy: collaboration. I was surprised at first, but after reading her email I could see the validity of her concern and how she could be led to it by the way the definition was written. She was concerned that working collaboratively might re-traumatize a person. I believe she was equating collaboration with total non-direction. I wrote back to her to clarify. I thought I would copy my email here so others with similar concerns could be reassured, and so we could have a forum about it if people would like. Below is my email and a better approximation of the spirit of collaboration. I hope you will add your wisdom to the discussion.

Hi Anonymous Therapist,
Your email is a gift to me…. I can see how the idea of collaboration as written on GT might mislead people into thinking that collaboration is something it is not. I hope this email will begin to clarify to you what collaboration means for me and for others who work similarly. Although I have not had anyone else contact us with a similar concern, there may be others, and so perhaps I will update the definition on the website. Or actually, I may add another principle which I’ve been meaning to for a long time: Safety. Collaboration does not preclude safety, as you are concerned about…. Anyhow, my thoughts are a bit scattered tonight as I’m tired from a long day…. But I know if I don’t respond now other things will preoccupy me.

I too guide people through the process of healing sexual, emotional, and physical trauma. I work collaboratively and I help people to heal from the worst of the worst and to heal safely…. I have been taught to heal collaboratively by a number of wise and experienced mentors. My definition of collaboration is, at best, only a poor reduction of their wisdom and of what I see occurring in the therapy room.

The spirit of collaboration is about helping a person to access their own Self (the calm, curious, compassionate, wise, and clear center) and, once “in” Self, it’s about trusting the Self of the client to take each and every gentle step toward caring for the parts which have been wounded or, perhaps, appreciating the ones which protect. In the same way that most of us know in our hearts what to do for the distressed and sad child who runs to us for help, we can also learn to open our hearts to our own inner wounds. So, it’s much different from the therapist providing all the care and wisdom (which teaches the client to continue searching outside herself for redemption)…. Collaborative work is like teaching one to fish for themselves, as opposed to feeding one a fish. Once in Self, a person can do most of the work as the therapist helps, here and there, to keep it going on track. So you can see that teaching one to fish is not directionless. If we do not trust the client’s Self to know how to attend to a part, or care for a wound, then we are not allowing the healing process to happen. I believe that without the presence of Self, healing is only simulated.

The client’s Self will not lead them to places they are not ready to go. Parts of the person might do that, but not Self…and this is one of many reasons it’s useful to help a client to access Self. I have seen that working without collaboration can raise a client’s defenses/resistance (and rightly so), can rush and re-traumatize, and can lead people to places that are not relevant to healing. Collaboration, in my estimation, is the safest way to heal trauma. I did hear your concern that if a therapist works collaboratively the client will lead themselves prematurely and unsafely into the trauma. This is not true in my experience. It’s actually quite the opposite.

For more information on collaboration, Self, and parts, I recommend checking out the Center for Self Leadership and Internal Family Systems Psychotherapy at www.selfleadership.org. I believe that the model described by Richard Schwartz is one of the most comprehensive and safest ways to heal trauma, and it is done collaboratively. I also believe that any successful healing, regardless of the model, is collaborative…for collaboration is the spirit of the healthy client-therapist relationship (or any other kind of relationship) you describe.

I hope this helps. I’m open to dialog about this if you like. Also, I’m thinking I may add this to the blog as way to open a forum about it. I look forward to hearing from you and thanks again, Noah :)

© Copyright 2007 by http://www.GoodTherapy.org Therapist Westlake Village Bureau - All Rights Reserved.

It’s easy to find a counselor, but perhaps more difficult to know if you’ve found one who’s right for you. There are a number of questions you can ask which will help you to choose a counselor. This short article outlines 14 of these questions, in no particular order (please note, the words “therapist” and “counselor” are used interchangeably). Thanks to the GoodTherapy.org members who contributed their ideas to this article! If there are other important questions to ask or things you’d like to add to this list, please post a comment below.

1. What does it feel like for you to sit with the therapist? Do you feel safe and comfortable? Is it easy to make small talk? Is the person down to earth and easy to relate to, or does he feel cold and emotionally removed? Is the counselor “stuck in her head,” or overly emotional and empathic? Is the therapist a “know it all” or arrogant? Sure, for many of us going to a therapist for the first time is a bit anxiety provoking, and it’s important to tease out our own “stuff” from the actual counselor. But, if a counselor doesn’t feel like a good fit for you, that’s okay; there’s absolutely no contract or rule requiring you to continue working with any counselor. However, it’s important to check if there’s a part of you avoiding therapy through a dislike or judgment of the therapist. If you find yourself reacting negatively to every counselor you see, then the issue could be yours and may warrant you sticking it out with a counselor in an effort to work through your fears of beginning therapy.

2. What’s the counselor’s general philosophy and approach to helping? Does your counselor approach human beings in a compassionate and optimistic way? Does she believe humans are born loving and lovable, or does she believe people are genetically deficient? We at GoodTherpy.org are biased and believe that good therapists and counselors adhere to the elements of good therapy.

3. Can the counselor clearly define how they can help you to solve whatever issue or concern has brought you to therapy? An experienced counselor explains how she can help, is able to give you a basic “road map,” to her approach and can even give an indication of how you will know when therapy is finished.

4. Does the counselor seek regular peer consultation? An important professional activity for any wise counselor is regular consultation with peers or consultants. Consultation serves a number of purposes, such as, but not limited to, reviewing cases, receiving advice, getting unstuck, discovering one’s own blind spots, and noticing how one’s own “stuff” may be getting in the way. Consultation provides a counselor with a necessary reality check, a degree of objectivity, and feedback. Even the best therapists benefit from the help of others.

5. Can your counselor accept feedback and admit mistakes? A healthy counselor is open to feedback and to learning that something he said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.

6. Does the counselor encourage dependence or independence? Good therapy doesn’t solve your problems; it helps you to solve your own. Likewise, good therapy doesn’t soothe your overwhelming feelings; it helps you to soothe your own. Like the old proverb, therapy is most powerful when it helps people to learn to fish for themselves rather than rely on another to feed them. If your counselor provides wisdom, answers, or emotional support without encouraging you to access your own resources, it is more likely you will become dependent on your therapist to help you feel better, rather than on yourself.

7. Has your counselor done his own therapy? One of the best ways to learn how to help someone to heal is to do your own therapy and to experience the healing process firsthand. Thus, therapists who have been in their own therapy benefit from this as a learning experience and are probably better equipped to help because of it. Most good healers are wounded healers, those who in the process of healing their own wounds developed the know-how to help others to heal theirs.

8. Does the therapist have experience helping others with the particular issues for which you are seeking therapy ? The more experience one has addressing a particular issue, concern, or problem area, the more expertise one has developed.

9. Does the counselor make guarantees or promises? It’s important for a therapist to provide hope, but not absolute unconditional guarantees. If you have the will to change and put in the necessary time and energy, healing is possible. Most of our wounds and defenses are the result of what has happened to us and to those around us. Healing can happen quickly in psychotherapy –but only after getting safely through the layers of protective gate keepers, which understandably can take a long time. So, although everyone is capable of healing, changes can take years to happen for some people and, unfortunately, because time is limited, some may never achieve the level of healing they desire in this lifetime. Additionally, people are not always at a time and place in their growth in which they are ready to heal and a given therapist may not be the right one. Overall, there are numerous factors at play in the therapy process which may contribute to or interfere with healing; some of which we are conscious, others of which we are not. And so, there are no guarantees without conditions. Here is more info on how “Sometimes We Can’t Help.”

10. Does your counselor adhere to ethical principles such as boundaries, dual relationships, and confidentiality? There are numerous ethical guidelines designed to keep counselors from harming clients. Most importantly, there is a guideline against dual relationships. When a therapist enters into a therapeutic relationship with you, he or she should not have any other relationship with you, such as teacher, friend, employer, or family member, though there are some exceptions to this rule in villages or very rural communities. The principle behind this guideline is really about whose needs are getting met. A therapist should be there to meet your counseling related needs for empathy, understanding, support, guidance, unburdening, and healing. When a counselor gets his or her own needs (emotional or otherwise) met by the client, he has crossed a boundary and the therapy process can be damaged or ruined. This is one of many ethical guidelines and it’s important for a counselor to adhere to these. For more information on Ethical Standards you can visit these links:

AAMFT Code of Ethics

APA Code of Ethics

ACA Code of Ethics

NASW Code of Ethics

11. Is the counselor licensed? Licensure implies that a counselor has engaged in extensive post-graduate counseling experience which, depending on the state of licensure, may include up to 3000 hours of required supervised experience. It also means the counselor has passed a licensing exam. There are many unlicensed therapists who have years of experience and do excellent work, but licensed counselors have, in general, though not always, jumped through more hoops and have undergone more extensive supervision than unlicensed counselors. You can contact your State Professional Licensing Board to verify the licensure of a provider.

12. Does the counselor have a graduate degree? There are numerous people who call themselves “counselors” or “therapists” because they have taken a weekend seminar or have learned a certain therapeutic approach. But without a graduate degree in counseling, psychology, social work, marriage and family therapy, or another related field of study, such a person lacks the education, training, and skills to provide safe psychotherapy and counseling. It is highly recommended to only work with counselors and therapists who have graduate training. People without graduate-level education in a mental health field may lack the necessary skills and know-how to properly diagnose and treat issues, and there is a great danger in misdiagnosing and mistreating. Psychology is an enormous field and human beings are multifaceted and complex. It takes years of education and training to effectively help people. Without the proper training there is enormous risk of causing harm.

13. Does the counselor have post-graduate training? Many new counselors fresh out of graduate school have had excellent book learning but lack enough actual counseling experience to claim expertise and feel totally confident. Post graduate training in a particular approach to psychotherapy is often the next step in a new counselor’s career and is helpful in getting a new counselor to the next level, in which they have more confidence and know-how.

14. Have any complaints been filed with the board? If so, what are the complaints and have they been satisfactorily resolved? To see if a counselor has a record or is under investigation, you can check with your state licensing board, usually under the state department of health or occupational licensing.

© Copyright 2007 by http://www.GoodTherapy.org Therapist Fort Lauderdale Bureau - All Rights Reserved.

Is there an ‘Element of Good Therapy’ that is not described in our document? If so, please feel free to suggest it to us so we’ll consider adding it.   You can make your suggestion by replying to this post in the reply box below.  If you don’t see a reply box, Click here to make your suggestion.   Please remember that your suggestions will be viewed publicly.  I’ll respond to you in this blog, so check back if you’re interested.  Thanks for helping!  Noah :)

© Copyright 2007 by http://www.GoodTherapy.org Therapist Houston Bureau - All Rights Reserved.

We are limited. We greet our clients with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to “Be” with our clients. We have parts of ourselves that want to do good work. We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so. Yet, there are times when we can’t. We believe a good therapist never gives up hope that a person can heal in this lifetime, but also recognizes that he or she may not be the one to help, that the time may not be right, or that the client may not be ready, and that, for whatever reason, one may never do the work we envision them doing. To do good therapy it helps to let go of expectations and outcomes for ourselves and for the people we work with, though without giving up.

© Copyright 2007 by http://www.GoodTherapy.org Therapist San Diego Bureau - All Rights Reserved.

Good therapy often times needs to go deep. There seems to be a split in the mental health field between approaches that emphasize cognitive solutions and those that emphasize emotional/somatic solutions. Both are important. However, our experience is that healing takes more than insight about a problem, cognitive countering, and surface behavior change. Rather than turning away from, countering, or compensating for our suffering, healing requires an exploration into the depth of the wounds that fuel extreme beliefs, feelings, and behaviors. To counter and turn away from is “more of the same” and only leads to more suffering. Also, healing requires feeling; as it is often said, “If we can feel it, we can heal it.” Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the wounds, pain, and burdens which lurk beneath. Good therapy helps one to process and complete whatever hidden and unhidden wounds one has harbored. Treatment without going deep can be like stitching up a wound without taking the bullet out; it’s more likely to remain sore and require ongoing attention. “Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular.” ~ Carl Jung

© Copyright 2007 by http://www.GoodTherapy.org Therapist Chicago Bureau - All Rights Reserved.

Have you ever felt upset about something and just wanted somebody to listen to you? I know my dear wife has asked me on a number of occasions to “just listen.” Even I, as a therapist who helps and guides others to listen to each other day in and day out, can find it hard to relax the impulse to do something about it. Yes, part of it is because I care. But moreover it’s because it can be hard to sit with how I feel to see another suffer…. And trust me, I intimately know the misunderstood feeling I have when someone’s anxiety gets triggered by my expression of some minor suffering I’m experiencing. I know the feeling of wishing my uncle could just listen to me or give me a hug when he, instead, tells me what I should do, or worse, tells me some universal truth like, “It’ll get better.” I know he’s only trying to help me and trying to shield himself from his own discomfort at seeing his nephew not perfectly okay, and I love him for it regardless. I know this doesn’t sound like it has much to do with therapy, but I believe it does; and on a deeper level than just a therapist not solving their clients’ problems. The realm of the intra-client relationship, the way one relates to his or her inner world/ego states/parts, is where I believe the truth that solving one’s problems with a little “s” actually interferes with Solving one’s problems with a big “S,” shows itself quite profoundly. Let me explain by telling a story:

I recently spent some time with a terrific person who is working toward transforming a part of her that fears love is not coming nor is meant to be for her. I received her permission to post this and for the sake of confidentiality I’ll call her Jennifer. In the process of Jennifer’s exploration of this belief, she discovered she took the belief on during elementary school in response to being excluded, disliked, and rejected by some of her peers. Having healed from similar experiences, I could relate to her…. So, with us knowing that this elementary school girl harbors some of the wounds or burdens which fuel the belief, we set out on a journey toward healing the school girl. Jennifer could see the school girl sitting on a swing all by herself in the school yard with her head down and shoulders slumped over. It looked dark and cold and Jennifer could sense her pain. I asked Jennifer how she felt toward the school girl and she reported feeling curious and caring toward her. At that point I asked her to go inside, and if it feels right, to show the little girl she cares about her. Jennifer closed her eyes, went silent for about a minute, and then reported back how a part of her wanted to fix the girl. This “fix it” part presented itself in a nurse’s uniform and was providing the girl with a list of things she could do that would help. Because this part had some difficulty separating we spent the rest of the session getting to know the problem solving nurse. What Jennifer discovered by listening to the nurse is that the nurse hasn’t known of any other way of helping and helps with great enthusiasm because she’s afraid of what it would mean to never heal the little girl. This evoked lots of appreciation for the nurse and we spent time recognizing how necessary and useful these parts are in many kinds of human situations.

I imagine there will be more to learn about the nurse along the journey toward Jennifer healing the school girl and I’m confident Jennifer will be able to reassure and relax parts of her that carry protective concerns, like the nurse. One thing I know for certain is that the little girl will heal when Jennifer can, without trying, doing, or forcing, sit with the little girl, open her heart and just BE with her. This is how solving is done without solving and how healing is done without trying. If we ceaselessly scrub the skinned knee it won’t scab over. If the inner nurse, in her effort to help, continues to give instructions to the little girl, the girl will never be known. If she is never known, understood, felt, or witnessed, her feelings will stay stuck and healing won’t happen. I know it’s a bit overused but, if we can feel it we can heal it.

So I guess the wisdom that struck me in working with Jennifer was a big reminder that on the deepest level, the most important piece of healing is Being. If we can be with our suffering, our suffering will heal. It’s simple, but profound to me. Though, not as easy to do as it sounds. I think it’s because Western culture has taught us, in our families, in the workplace, and in school, to suck it up, to get over it, to just do it, to move on, to not look back, to be strong, and to not show weakness. As a result many of us grow up afraid to show our real feelings to others and even to ourselves. Many of us have not learned how to be with ourselves or our loved ones when one is suffering because, maybe, no one was really there for us. I hope this will change on our planet. I encourage all of us to take time to be present to our own feelings and to be present to the feelings of our fellow human beings.

© Copyright 2007 by http://www.GoodTherapy.org Therapist Denver Bureau - All Rights Reserved.

There are many models of therapy to choose from. We believe there are a handful of common denominators present in all forms of “good therapy.” These elements are described below:

Non-pathologizing

Viewing a person as greater than his or her problems is the hallmark of non-pathologizing therapy. It does not mean problems do not exist; it means NOT viewing the problems as the whole person or the whole person as the problems. Working non-pathologically does not negate pathology, it depathologizes it. So for example, rather than labeling a person who’s angry as an angry person, non-pathologizing therapy views one’s anger as just an aspect of the person, but not all of who the person is. We do justice to a person’s true nature when we remember that behind the layers of protection, no matter how self-destructive or hurtful to others one has been, there is a lovable and vulnerable soul at the very core.

Empowering

Empowering therapists maintain the belief that people can grow, heal, and transform. This hope is held no matter how intense one’s defenses and wounds are. People can heal if they want to and if they can contribute to their own growth whatever is sufficient and necessary to that end. When a therapist views a person as fundamentally flawed or incapable of change, the person is more likely to feel and become flawed. Yet, one is more likely to discover one’s true nature when therapy sees beyond wounds and defenses. Some people may not heal in this lifetime, but let the therapist not be an additional barrier to whatever other obstacles may be presenting.

Collaborative

Collaborative therapy can be established when a therapist encourages a client to become the co-therapist. Therapists who work collaboratively trust the client to know herself (or have the potential to know herself) better than anyone else, and trust the client to know what issues to address and what direction to go in therapy. This orientation puts the client in the driver’s seat of therapy. The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who once wrote, “Each patient carries his own doctor inside him…. We are at our best when we give the doctor who resides within each patient a chance to go to work.”

Self

Self is a state of being that a therapist can embody when with his or her clients. It’s defined by Richard Schwartz and IFS therapy as a state of calm, curiosity, compassion, creativity, confidence, courage, connectedness, and clarity. Self is considered a requisite of good therapy because it is this state that allows a therapist to work collaboratively without pushing, without pathologizing, and without re-traumatizing. For more information on Self please visit the Center for Self Leadership.

Relationship

Beyond technique and theory is the realm of the relationship: the ongoing human-to-human connection which provides the foundation for change. The relationship is the safe container which allows one to more fully and completely feel the presence of Self while in the presence of another. The therapeutic relationship benefits from a therapist who embodies Self and feels an unconditional positive regard in the face of whatever the client may be experiencing. Without a therapeutic relationship there is no therapy.

Depth

Good therapy often times needs to go deep. There seems to be a split in the mental health field between approaches that emphasize cognitive solutions and those that emphasize emotional or body-oriented healing. Both are important. However, our experience is that healing takes more than insight about a problem, cognitive countering, and surface behavior change. Rather than turning away from, countering, or compensating for our suffering, healing requires an exploration into the depth of the wounds that fuel extreme beliefs, feelings, and behaviors. To “counter and turn away from” is more of the same and only leads to more suffering. Also, healing requires feeling; as it is often said, “If we can feel it, we can heal it.” Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the wounds, pain, and burdens which lurk beneath. Good therapy helps one to process and complete whatever hidden and unhidden wounds one has harbored. Treatment without going deep can be like stitching up a wound without taking the bullet out; it’s more likely to remain sore and require ongoing attention. “Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular.” ~ Carl Jung

Sometimes We Can’t Help

We are limited. We greet our clients with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to “Be” with our clients. We have parts of ourselves that want to do good work. We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so. Yet, there are times we can’t help. We believe a good therapist never gives up hope that a person can heal in this lifetime, but also recognizes that he or she may not be the one to help, that the time may not be right, or that the client may not be ready, and that, for whatever reason, one may never do the work we envision them doing. Good Therapy means letting go of expectations and outcomes for ourselves and for the people we work with, though without giving up.

If there is a principle of “good” therapy which you’d like to suggest, please feel free to share your ideas with us. Click here to view the models of therapy list.

© Copyright 2007 by http://www.GoodTherapy.org Therapist Portland Bureau - All Rights Reserved.