Blogging on Good Therapy

For adolescents with depression not responding to an initial treatment with a selective serotonin reuptake inhibitor (SSRI; a class of antidepressant drugs), switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms, compared to just changing medications, according to a study in the February 27 issue of JAMA. (more…)

by Jeanine Austin, Ph.D.

Click here to contact Jeanine and/or see her GoodTherapy.org Profile

I once read a static that said many people die each year choking in restaurant bathrooms. Apparently, people in public places are often embarrassed that they are choking and they run to the bathroom to hide. This got me thinking about the fact that many of us are tempted to hide out when we are ashamed rather than seek help.

Healthy shame may help us to recognize when we need to change our behavior or adhere to healthy social norms. When we hold onto shame and begin to over-identify with our shameful feelings or behavior we move into toxic shame. Toxic shame can cripple us emotionally; it may keep us from moving forward in our life and we often find ourselves on a downward moving spiral to self-doubt and ultimately self-hatred.

Some people who tend toward perfectionism will react with shame when anything manifests in their life that looks unpleasant. Their pain is often doubled in that they have to deal with the pain of the situation and also the pain of shame. If they hide out with their shame they may also miss opportunities to be supported and loved by those whose love is unconditional. (more…)

by Van Wiesner, Ph.D.

Click here to contact Van and/or see his GoodTherapy.org Profile

Patricia Love, Ed.D. and Steven Stosny, Ph.D. are contrarians in the book How to Improve Your Marriage Without Talking About It (2007). Instead of endorsing traditional talk therapy methods for improving relationships such as, well, “talking”, they offer a more behavioral approach based largely on psychological differences in the genders as gleaned from research and their vast clinical experience. Early on the authors assert that couples “are not disconnected because they have poor communication; they have poor communication because they are disconnected” (p. 5). I have reread that sentence dozens of times sensing the paradigm shift this statement represents. (more…)

by Patti Desert, LCSW-C, CEMDR, CP

Click here to contact Patti and/or see her GoodTherapy.org Profile

The word holistic has been used to describe health care practices that include acupuncture, massage therapy, Reiki, naturopathy, and homeopathy. These practices attempt to bring harmony to the physical, energetic, and/or nutritional states of individuals.

Holistic Psychotherapy also seeks to bring balance between these systems. However, as with all psychotherapy, its primary focus is the treatment of psychological and emotional pain that manifests in depression, anxiety, trauma and related disorders. It is the way in which holistic psychotherapy treats these disorders that marks its departure from conventional psychotherapy and denotes its singular effectiveness.

Generally speaking traditional psychotherapy focuses on problematic thoughts and behavior, interprets the underlining meaning of these thoughts and behavior, and then provides solutions that are practiced by clients and adjusted as circumstances warrant.
Unlike traditional psychotherapy, Holistic Psychotherapy optimally fosters growth and healing by noting the synergistic relationship between all the ways we experience ourselves and the world—thinking, feeling, doing, and sensing. Holistic practitioners then channel this knowledge through methods that support the healthy interaction between the processes of the thinking mind, the feeling body, and the emotionally laden spirit to bring growth and healing. (more…)

by Jennine E. Estes, M.A., Marriage and Family Therapist Intern

Click here to contact Jennifer and/or see her GoodTherapy.org Profile

It is very important to show your partner that you are trust-worthy….and here are some quick tips.

1. Follow through with what you say. If you tell your partner that you will be home by 8:00, come home no later than 8:00pm. If you are going to be late, call them and let them know ahead of time.

2. Don’t be unrealistic. Avoid saying that you will “Always” have your cell phone on or you will “Never” turn your phone off. This is unrealistic. Sometimes your phone will die or you might forget it or you might not hear it ring. Instead, tell your partner that you will try your best to answer the phone. And then….follow through with what you say (tip #1).

3. Let your Partner in. If you have a wall up, it hides things and creates a suspicious feeling from your partner. Avoid the suspicious behavior and be an open book. The more open you are, the more trust you can build.
(more…)

Dear Members and Visitors to GoodTherapy.org,

Today we were pleased to present the third teleconference in the GoodTherapy.org Winter Teleconference Series: Trauma Free Marketing for Therapists presented by Becky DeGrossa, MA, the developer of New Generation Practices: Trauma-Free Marketing for Therapists. Much thanks to Becky who volunteered her time to present to GoodTherapy.org members about her “follow your heart” approach to marketing and building a practice.

To support those of you who attended today’s teleconference and who may have more questions or would enjoy having a forum to discuss Trauma Free Marketing for Therapists & Counselors, we created this blog entry to serve as a forum where you can post your questions, leave comments, and engage in a dialogue about it. I hope you will feel welcome, whether you attended the conference or not, to join us in the discussion. Becky has kindly agreed to visit the blog and answer questions about her marketing approaches. So please feel free to post questions, concerns, feedback.

To view the comments or make your own, simply scroll to the bottom of this particular article and click on the “Comment” link.

For more information about Becky and the services she offers, visit New Generation Practices.

Enjoy,

Noah :)

Noah Rubinstein, LMFT, LMHC
Executive Director
http://www.GoodTherapy.org

by Arthur Becker-Weidman, Ph.D.

Click here to contact Arthur and/or see his GoodTherapy.org Profile.

Dyadic Developmental Psychotherapy is a treatment approach to trauma, neglect, loss, and/or other dysregulating experiences that is based on principles derived from Attachment Theory and Research.

Dyadic Developmental Psychotherapy involves creating a safe setting in which the client can begin to explore, resolve, and integrate a wide range of memories, emotions, and current experiences, that are frightening, stressful, avoided or denied. Safety is created by insuring that this exploration occurs with nonverbal attunement, reflective non judgmental dialogue, along with empathy and reassurance. As the process unfolds, the client is creating a coherent life story or autobiographical narrative which is crucial for attachment security and is a strong protective factor against psychopathology. Therapeutic progress occurs within the joint activities of co regulating affect and co constructing meaning.

Nonverbal attunement refers to the frequent interactions between a parent and infant, in which both are sharing affect and focused attention on each other in a way such that the child’s enjoyable experiences are amplified and his/her stressful experiences are reduced and contained. This is done through eye contact, facial expressions, gestures and movements, voice tone, timing and touch. These same early attachment experiences, which are fundamental for healthy emotional and social development, are utilized in therapy to enable to the client to rely on the therapist to regulate emotional experiences and to begin to understand these experiences more fully. Such understanding develops further through engaging in a conversation about these experiences, without judgment or criticism. The therapist will maintain a curious attitude about the memories and behaviors, encouraging the client to explore them to better understand their deeper meanings in his life and gradually develop a more coherent life story. This process may be stressful for the client, so the therapist will frequently “take a break” from the work, provide empathy for the negative emotion that may be elicited, and reassure the client about his efforts and the therapeutic relationship.

The primary therapeutic attitude demonstrated throughout the sessions is one of playfulness, acceptance, empathy and curiosity (PACE). (more…)

by Jeanine Austin, Ph.D.

Click here to contact Jeanine and/or see her GoodTherapy.org Profile

“Big ego is lack of trust in your own soul.” ~ Lauren Brownell (Vermont Artist)

We all know exactly what people mean when they describe someone as having a big ego. They are describing someone who is very self-referenced and self centered, often with mind-bending hubris, and perhaps someone who thinks we should worship gratefully at their feet. For some of us, a big ego may call to mind the “big ego anthem” You’re so Vain by Carly Simon. (On an ironic note-it was rumored to be written about Warren Beatty who I happened to say hello to last Saturday. He was warm and friendly. No trace of ego!).

When we talk about this type of ego, we aren’t using Sigmund Freud’s definition of the ego. In his seminal work, he defined three aspects of the self: the ego (the core self), the superego (the conscience) and the id (the primitive and impulsive self). In our current vernacular, we talk about a big ego in the way that A Course in Miracles describes the ego. In Marianne Williamson’s classic A Return to Love, she writes, “In Course terminology, our entire network of fearful perceptions, all stemming from the first false belief in our separation from God and one another, is called the ego. The word is used differently here than the way in which it is often used in modern psychology. It is being used as the ancient Greeks used it-as the notion of the small, separated self.”

When anyone is running around with a big ego, we can be assured that the person is operating from fear. (more…)

by Mary Ellen Barnes, Ph.D.

Click here to contact Mary and/or see her GoodTherapy.org Profile

The conversation began easily enough, “My brother is bleeding our parents into the poor house with his unending demands for money - money to support his addictions – and they don’t seem able to stop giving it to him, even though he isn’t getting any better. What can we do?”

Or we hear from the parents themselves, “How can I get my spouse to stop giving our adult daughter money she just spends on booze or drugs? Her promises are worthless and the demands endless.”

It’s not an uncommon condition. Parents are living longer, some adult children make childishness a career, and it isn’t easy to say no to a son or daughter, regardless of their age. Then add in the grandchildren, hostages held for ransom as your child essentially blackmails you into supporting their drug and/or alcohol abuse: “Give me the money or I will kill myself,” or “they will starve,” or “we’ll be on the streets,” is the implied or actual threat, yet the money does no good. (more…)

A GoodTherapy.org Featured Column written by Cedar Barstow, M.Ed., C.H.T.

Click here to contact Cedar and/or see her GoodTherapy.org Profile

What a pleasure to go to the site here at GoodTherapy.org and find responses to the Ethics Column from Sam and Sally and Meg and Rob. I want to appreciate you for your interest in ethics and for your thoughtful and thought-generating words.

Grief and the Sensitivity Cycle

Both Meg and Rob were thinking about grief. So a bit more about that. Grief, of course, has it’s own rhythm and pace, and is a process….neither to be rushed nor clung to. I’m reminded of the Sensitivity Cycle from the Hakomi Method. The Sensitivity Cycle describes the process of becoming more and more sensitive and effective. It has four phases: clarity, effectiveness, satisfaction, and relaxation. All four phases need attention and organically move on to the next. In thinking of grief, for example, first you need to be clear about what you’re grieving, then take some kind of effective action, then find and integrate some satisfaction from the action you took, and then relax and let go—so that you will have made space for a new cycle. It is easy to get stuck at each phase and with grief it seems that the most common place to get stuck is in letting go. Getting unstuck and letting go when it is time seems to involves having a “gut” sense of the timing. It also involves trusting that letting go of the process of grieving for a person, thing, or event, doesn’t mean letting go of it all, but rather knowing that you have integrated it, or the learning from it, within you.

In responding to Sally who is looking for some more depth, I’d like to say something about two kinds of ethical decision-making edited from pages 59-61 of my book: Right Use of Power: The Heart of Ethics. I find that we as professionals most often think of ethical decision-making simply and solely as the second kind I describe as complex decision-making without putting conscious attention toward ordinary moment, every day kind of ethical decision-making. (more…)

The GoodTherapy.org team sends our deepest condolences to the family of Dr. Kathryn Faughey, who was fatally stabbed Tuesday night in her New York City office. All of us here at GoodTherapy.org feel the terribly painful loss and the horror of this awful incident.

We hope that the many therapists and counselor of the world, who dedicate their lives to helping and caring for the well being of others, and who are likely deeply affected by this incident, will work through any secondary trauma and take very good care of themselves. The profession of psychotherapy requires effective counselors to keep their hearts open to those who seek their help and guidance. Incidents such as these in which a client directly and severely harms their therapist challenges the ability of other therapists to stay centered, calm, compassionate, and confident. May we all do what is necessary to both take care of ourselves and to remain helpful to those we serve.

~Written by Anonymous 2

Electric feeling in my face
threading up from my tummy.
Something vibrating, trying to escape.
to run from danger, to go back home,
upward to the Formless

Feels like a dried up cocoon,
like a shell washed up on the beach:
lifeless… crusty… scared….dead,
embalmed….. sarcophagus
covered with think crust

Just one sign of life, a faint red glow, a dying heart.
Wordless, it rocks with acknowledgement of my presence
I move closer
He has no age, he is unborn.

Invite light
Open space above my head
Invite hummingbird and grandmother spirit
Grandmother spirit translates:
This fetus was not wanted
This fetus was lost and abandoned
This fetus died many generations ago

Died within my mother’s mother when she was not wanted
Died within my mother when she was not wanted
Died within me when I was not wanted

The fetus hides from other’s eyes
Other’s eyes stir it and awaken fear within it
The way eyes looked upon it and hearts felt upon it over many years past,
The fetus is afraid of being killed by eyes and hearts.
Lost, hidden, terrified.

I tremble with grief
I tremble with grief
I tremble with grief
For this fetus, for my mother, for my mother’s mother.

What’s that I hear?
The fetus wants to be reborn
Sadness
Hope

Asking for God
Asking for God
But I don’t know how
Asking for God

Something is happening
Grandmother spirit hands the fetus to God
God picks it up and I become the fetus
I am held by God
God is enormous
Enormous and full of love
God loves the fetus and the fetus cries

What’s that I hear?
The fetus wants to be reborn.
Sadness
Hope

God holds the fetus in the palm of his hand and
gently washes it through the current of a river
cleansing the dark charcoal crust and
washing the burdens of rejection away.
And from deep within the lost layers of burdens emerges a glowing heart
that God holds in the palm of his hands

God passes this heart through his body and gives birth to a star

The star shines of many changing colors
God places the shinning star within my heart.

Hope.

©Copyright 2008 Anonymous 2. All Rights Reserved. Permission to publish granted to GoodTherapy.org. If you’d like to comment on this story, Anonymous 2 has given us permission to accept comments here. All comments are moderated.

The items listed below are significant red-flags and important information for anyone in therapy or considering therapy. If any of the following red-flags appear during the course of your counseling, it may be time to reevaluate your counselor or therapist. Should you recognize one of these red-flags, the first step, in most cases, is to discuss your concern with your counselor. Try talking candidly about what’s bothering you. A good therapist should be open and willing to understand your concerns. If your counselor doesn’t take your concerns seriously or is unwilling to accept feedback, then it’s probably in your best interest to consult with another therapist about it. Most therapists mean well and are willing to take accountability for their own “stuff.” So, it’s also important to give your therapist the benefit of the doubt…all people make minor mistakes. And sometimes what people think is their therapist’s issue, is actually their own. These “blind spots” can be the most difficult to see and are well worth taking about with your therapist.

It’s also important to note that the following red-flags have varying degrees of significance. Some of them are very serious violations of ethical standards, such as a therapist attempting to have a sexual relationship with a client. There is no exception to this rule and if you find yourself in such a situation you are advised to report to the state professional licensing board and consult with other professionals. However, a number of the red-flags listed below do have “exceptions to the rule” and depend partly on the context. For example, it’s generally unacceptable for therapists to have dual relationships with their clients. So if a counselor is treating the neighborhood barber for his depression, the counselor goes to a different barber to avoid confusing the “client-therapist” relationship. However, in small communities it can be impossible to avoid certain dual relationships. Ethical guidelines are flexible enough to take this, and some other exceptions, into account.

In no particular order, it is a red flag if you find that your: (more…)

by David Walton Earle, LPC

Click here to contact David and/or see his GoodTherapy.org Profile

Use anger correctly and positive results can happen! This statement is very shocking, for it is in direct contradiction with experience. Most people have witnessed the sharp and cutting blade of anger as it slashes and cuts its victims and have experienced the unresolved anger that creates emotional distance be-tween themselves and their loved ones. It is natural to experience anger, but how can it achieve positive results?

When anger destroys a relationship, it was not used correctly. When the ex-pression of anger works in a positive direction, it clarifies to others the bounda-ries necessary for all successful and healthy relationships. Anger communicates a warning that a perceived violation has occurred and provides the necessary energy to do what is necessary to correct the situation. As strange as it may ap-pear, without anger there can be no successful relationships! (more…)

by Allison Weliky, MA

Click here to contact Allison and/or see her GoodTherapy.org Profile

1.Slow down. When you feel yourself getting angry or going into reactive energy slow yourself down and begin to get curious and to explore what is going on for you. Is your reaction actually about what is going on in the moment or is this situation actually reminding you of something from your past, for instance, how you were treated by a former partner, or how you were treated by your parents or primary caregivers. Once you have taken your time to see more clearly what is happening, if necessary, respond and communicate from this place.

2.Communicate clearly. Don’t expect your partner to be a mind reader. Our culture has brainwashed us into believing that love means that our intimate partners always know what we need without us having to express anything. I’m sure you’ve heard people say things, at the beginning of relationships, such as: “he just knew what I was feeling, I didn’t have to ask, she just understands me without me ever having to explain myself.” Although, there is some truth in these statements, at some time in most relationships, there is a need to communicate one’s needs and not take it for granted that our partner “just knows.” Clear communication and the necessity to express one’s needs do not mean that you are no longer in love; it actually means that you are really beginning to trust yourself and your partner. (more…)

A GoodTherapy.org Featured Column written by John Rhead, Ph.D.

Click here to contact John and/or see his GoodTherapy.org Profile.

A few years ago I was sitting down to begin one of my weekly therapy groups when I had a slight epiphany. I realized many other therapists in all sorts of places were going to be doing the same thing that day, and I felt a sense of connection with them as we all did our best to bring healing to ourselves and our clients. About a year ago, while meditating and praying outdoors at dawn, I had a similar experience. This time it was more explicitly spiritual, as I had the awareness that all around the word there were many others joining me in that very moment, doing our best to invoke and/or join The Divine in the healing of our planet. I shared these experiences with the members of two groups of which I have long been a member—The American Academy of Psychotherapists, a group which believes that the healing and growth of the client is inextricably intertwined with the healing and growth of the therapist, and the Earthtribe, a group that integrates ancient nature-based spirituality with modern psychotherapy. Both groups emphasize direct experience over cognitive understanding. In the descriptions of my experiences as I shared them with these two groups I coined the term “The Unseen Sangha.” (more…)

Would You Marry Yourself— Or Someone Like You?

by Debra L. Kaplan, MA, LAC, LISAC

Click here to contact Debra and/or see her GoodTherapy.org Profile

A glance at many magazines today will offer practical advice and “how to” strategies for the pursuit of the man or woman of our dreams. Let’s face it—sexy tag lines and catchy subtitles make for good print copy but do little for building healthy and sound relationships. Projecting our wants, expectations or intentions onto our partners-to-be only serves to foreshadow the inevitable relational demise. It is as if we build in our own obsolescence from the very start.

How is that possible you may ask, “when I’m doing all the right things, paying close attention to selecting my partner, and looking at what he or she has to offer the relationship?” I admit that these words sound counter intuitive, however, first consider this proposition.

Would you marry yourself or someone like you? Do you like the person you are and what you have to offer, enough to marry yourself? (more…)

by Lisa Dale Miller, LMFT

Click here to contact Lisa and/or see her GoodTherapy.org Profile

As a long term yogic and vipassana meditator, and a mindfulness-based psychotherapist who regularly teaches meditation practices to my patients, I find the growth of mindfulness as a clinical intervention very timely. Last year, I attended two conferences focused on the use of mindfulness as a clinical intervention: “Meditation and Psychotherapy” at Harvard Medical School and “Mindfulness and Psychotherapy” at UCLA.

Interestingly, the conference at Harvard featured a greater percentage of presenters who do not use meditation as an intervention in their clinical work. For them, mindfulness is a teachable skill set, extrapolated from a way of viewing life gained from sustained Buddhist meditation practices. These presenters included: Steven Hayes, founder of ACT, Lizbeth Roemer, U Mass GAD researcher and clinician, Tal Ben-Shahar, Harvard Lecturer on Positive Psychology, and Jayme Shorin, LICSW, sensorimotor trainer. The fact that the organizers of the Harvard conference felt it necessary to devote over half of the presentation time to methodologies that do not include meditation was, for me, significant.

Though this might be expected at a “Mindfulness and Psychotherapy” conference, in fact the UCLA conference featured more presenters discussing the use of meditation and compassion practices as a clinical intervention. These presenters included: Thich Nhat Hahn, Vietnamese Buddhist monk and meditation teacher, Jack Kornfield, Tara Brach, Harriett Kimble Wrye, and Trudy Goodman, all psychologists and meditation teachers, and Dr. Daniel Siegel & Harvard neuroscientist Sara Lazar presenting the neurobiology of meditation. (more…)

by Sarah Jenkins, MC, LPC

Click here to contact Sarah and/or see her GoodTherapy.org Profile

“Well, when one’s lost, I suppose it’s good advice to stay where you are until someone finds you. But who would ever think to look for me here?” - Alice “Alice Adventures In Wonderland” by Lewis Carroll

“I warn you dear child, if I lose my temper, you lose your head. Understand?”
- Queen of Hearths “Alice Adventures In Wonderland by Lewis Carroll

You know her. You have met her before. Curious and unsuspecting, Alice goes down the rabbit hole, following the ever late, white rabbit. Her naivety gets the better of her. Tumbling down a dark chamber, Alice falls and finds herself facing temptation. “Drink me,” it instructs. She complies, without question, doing the very thing it compels her to do. Regrettably, she then notices, it is too late. There is no return. She is small, too short to reach for the key, the very key to open a way out. Then, a piece of cake presents itself to her, “Eat me” it instructs. She complies, astonished and horrified as her body stretches to become nine feet tall.

How many times have you just “known” that something was not good for you, and you did it anyway? How many times have you said to yourself “this time it will be different” or “I won’t do that again,” to find yourself doing the very thing you don’t want to, yet again. Why do we do this to ourselves, even though we want something different? (more…)

A GoodTherapy.org Featured Column written by Greg Madison, Ph.D.

Click here to contact Greg and/or see his GoodTherapy.org Profile.

What kind of response does ‘the community’ offer to its members who are experiencing distress? Increasingly since the 1950s, many British and North American mental health services have been devolved to the community level. This de-institutionalization is promoted as an indication that we live in progressive and caring societies. The ‘community care movement’ is based upon the idea that institutions segregate people from the rest of society and that this is unacceptable. But I wonder if the development of community care policy really is an expression of these laudable intentions. As I will suggest later, the tragic shooting deaths in Dunblane Scotland in 1996 offer a bleak backdrop for confronting the lack of care in our communities and our attitudes towards our fellow citizens who are psychologically distressed. (more…)