Blogging on Good Therapy

By Reverend Doctor Silvia R. Behrend

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

So many of us understand counseling to be an art, a marriage of knowledge and a certain ability to use that knowledge elegantly, incorporating intuition and spirituality. In my experience as a minister offering counseling and as a chaplain in a hospital, I have found that there is another dimension to the “art” of counseling: the intentional creative process coupled with the understandings of self-psychology provide a transformational template that has love and compassion at its center.

In my work as a minister and as a counselor in private practice, I make no distinction between the words soul and self. I use them interchangeably; either word connotes the “essence” of the human being. The work of the self or soul is to become whole, being born and being human already means that the essential ‘isness’ is compromised simply by being in the world.

I have found that one way to help the soul reach toward wholeness is to engage it on the slant. That is: rather that directly confront the ‘issues’, ‘wounds’ and ‘trauma’ experienced by the soul, the cut-off elements of the soul can be enticed into integration. This is possible through the use of the arts. In my particular experience, I have used the art of stone carving to illustrate that the soul can emerge from hiding in a loving, compassionate and non-pathological manner.

My work in this area has been formed by the understandings of self-psychology and my own experience in creating art as well as facilitating that process for others. I would like to articulate a simplified version of the theory of Self-psychology Then, using my student’s own experience, I will demonstrate how engaging in creating art, in this case, stone carvings, allowed them to see themselves differently and integrate the cut-off parts of themselves with love and compassion. (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

“Altruism is a natural expression of human development and a healing force in society…Caring coupled with imagination and enterprise is the essence of creative altruism. If we ignore our capacity for compassion and care, we diminish the texture of our lives, our ability to help others heal and grow, and our collective potentials for social healing. By opening ourselves to the reality of shared being, we enhance the wonder and richness of the world and liberate the creative and constructive energies of the human heart, mind, and spirit.” —Tom Hurley

Karen Armstrong adds to her statement about the need for an ethic of compassion: “The early prophets did not preach the discipline of empathy because it sounded edifying, but because experience showed that it worked. They discovered that greed and selfishness were the cause of our personal misery. When we gave them up, we were happier. Egotism imprisoned us in an inferior version of ourselves and impeded our enlightenment.” Fascinatingly, recent neurological research by Moll and Jordan Grafman has shown that taking action in the best interests of others is coded in the brain. In a study in which they scanned the “brains of volunteers as they were asked to think about a scenario involving either donating a sum of money to charity or keeping it for themselves,” the results showed that “when the volunteers placed the interests of others before their own, the generosity activated a primitive part of the brain that usually lights up in response to food or sex. Altruism, the experiment suggested, was not a superior moral faculty that suppresses basic selfish urges, but rather was basic to the brain, hard-wired and pleasurable.” (Moll and Jordan Grafman are neuroscientists at the National Institutes of Health. Quote is from an article by Shankar Vedantam, The Washington Post, May 28, 2007.) There is an surviving and thriving impulse and advantage for those who develop and use their capacities for social intelligence. This social intelligence is accessed through the social engagement nervous system referred to on page 91 of Right Use of Power: The Heart of Ethics. (more…)

by Noah Rubinstein, LMFT
Executive Director GoodTherapy.org

The GoodTherapy.org Team received a question today from Brit, a visitor to GT, in response to the featured article, “50 Warning Signs of Questionable Therapy & Counseling.”

Brit writes, “Should a good therapist in the beginning stages of the therapy request a historical summary of the client in order to provide good counseling? I have a friend in counseling and the therapist did not ask for historical family information. This friend comes from alcoholic family…..Should we be concerned?”

My guess is that there are many answers to this question. With so many different philosophical orientations, different approaches, and models of therapy, not to mention different generations of therapists all trained differently to some degree, the range of responses might be quite varied indeed. Some therapists spend hours gathering historical data and completing initial evaluations, others work in the here-and-now, preferring to dive in to the work on the first meeting, and others are somewhere in the middle. And of course a lot of what a therapist begins with depends on the presenting problems and the client’s needs. (more…)

A GoodTherapy.org Featured Column written by Dennis Thoennes, Ph.D., ABPP

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

Recently a client described an icy meltdown she and her husband had with one another. This is not an uncommon event in the lives of couples I see. I noticed I began to consider a variety of therapeutic frames I could utilize and directions I could take to facilitate the client’s self exploration and find a way to understand such a difficulty and find acceptable alternatives. Then something else happened.

I noticed I am much more familiar with this “icy meltdown” experience than I’d care to admit. I so often fall short of the expectations I have of myself as husband, human and therapist. Then I recalled a line I heard in a workshop conducted by Stephen Levine, “Have mercy. Have mercy.” Pema Chodron also addresses this in her book “The Wisdom Of No Escape”.

We are all so human, so incomplete, so flawed and often have such high expectations of ourselves and others. This can set the stage for a life of unmet expectations and a long and painful traverse of life. Certainly there are instances where we cut ourselves or others too much slack.

Often we want so much from others and ourselves. What would “have mercy” actually look like. It could mean compassion for myself and others. I realize that I want to help my clients be free of suffering and to be happy. Sometimes this is a noble veneer covering my desire to have my clients think highly of me and refer people to me so I can have the prestige, the income, the life I fantasize. (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…)

Written by Greg Madison, Ph.D.

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

*Focusing is a natural way of being with our own experience, patiently, until it becomes more clear.

Unbeknownst to most clients, psychotherapy remains governed by many theories and boundary ‘rules’, the actual purpose of which may be to protect the therapist from his or her own anxiety . In this short piece, an existential therapist uses Focusing to attempt to remain open to the difficult experience of being with a dying client. Through this example of his work in an acute hospital setting, Greg suggests that Focusing can be a crucial aspect of redefining therapy as a human relationship rather than an expert one.

The medical and nursing team called me to meet Loyola, a patient who was refusing to accept her terminal diagnosis and return home. Walking onto the ward I became aware of a nervous feeling in my stomach… (more…)

Written by Jeanette Raymond, Ph.D.

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

If you are considering entering into psychotherapy chances are it is because of a strong sense of unease within yourself. There is a powerful urge to get rid of that discomfort no matter how it is manifest. It may be anger, jealousy, guilt, feeling constantly wounded, fear of losing an important relationship, or a sense of frustration/dissatisfaction with the way  life is. Often there is a need to feel in control of your life, or a desire to discover if you are lovable no matter how bad you think you are. Sometimes there is a massive fear of change and needing a place where the world can stop for a while. Whatever the initial reason for seeking psychotherapy the basis for the work will mean exploring the relationship you have with yourself. The process can be long and arduous and it takes courage and forbearance. It requires allowing yourself to pass through many stages of self-discovery while you get relief from your discomfort. (more…)

Written by Marcia Singer, MSW, CHt

What do you do to relieve persistent physical discomfort, pain or illness? Do you reach for pills? Supplements? A trip to the chiropractor or massage therapist? Do a cleansing detox? Perhaps you meditate, do some yoga or take a walk? Maybe you’ve had the difficult choice of whether to undergo surgery -or even chemotherapy.

All of these kinds of methods may be a valid part of a total healing regimen at some time in a life. But if you have the inclination to look within, deep inside is a Knowingness about the “heart” of the condition. This core contains the “information” you need to help you achieve the changes that wellness requires. Tuning in is making the BodyMind connection. (more…)

Recently, someone asked GoodTherapy.org to include Personality Disorders within our list of Concerns Addressed (this is the list of concerns that people can select when searching for therapists and the list that all members select from when creating their listing). Our decision was a unanimous “no” and we thought it would be fair to explain why and to give our members the chance to make an argument for the use of the “Personality Disorder” diagnosis. I should say that we do support the inclusion of “personality disorder” symptoms in our list of concerns and we are currently working on translating these to fit into our list…. Please feel free to add your comments to this discussion below by clicking on the comments link directly below this post.

The following is our reasoning: We believe that by labeling a person as personality disordered or, in its more gentle form, stating that a person has a personality disorder, we are essentially claiming one’s personality, their personhood, their essence, is fundamentally flawed. What else are we, other than our personality? Such a diagnosis is very likely, if not absolutely, to produce more shame, worthlessness, and rejection in a person who probably has enough of it already. I don’t care how it is framed, normalized, or expressed: having a diagnosis called “Personality Disorder” says one thing: you are fundamentally flawed.

Please don’t get me wrong, I’m not saying I’ve never worked with people who’s inner systems fit the criteria for the DSM categories of Borderline, Narcissism, and others. The difference is that I don’t use the categorical and shaming word “Personality Disorder” to describe a person’s experience and I don’t view people as fundamentally flawed. Deeply wounded, yes, powerfully protected, yes, but fundamentally and irreparably flawed, no.

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We are limited.  We greet our clients with great hope.  We have spent countless hours studying or 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, the client not 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.

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 more of it is 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 me expressing 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 ok, 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:

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A common concern that many people have in therapy is a fear that if they go close to the old feelings they’ve exiled is that they’ll get overwhelmed and reexperience the original trauma.  It makes sense that anyone who has spent years avoiding  vulnerable feelings would be afraid of doing the opposite.  Nonetheless, I know there are many creative ways therapists help people to heal trauma successfully, without flooding or overwhelm.  I thought it would be interesting to ask others to comment on how they help people to go near the pain without overwhelming or making the trauma worse. 

Much of what I do to help heal trauma I learned from Richard Schwartz and the Internal Family Systems (IFS) model he developed.  In the IFS model the key to healing trauma without flooding or overwhelm is bthrough helping the client to approach the parts of them which carry the extreme feelings while he or she is embodying a state of “Self.”  Self is a state of curiosity, calm, compassion, courage, confidence, clarity creativity, and connection.  It’s described by Schwartz as “they eye in the hurricane” and has been demonstrated as accessible by even the most defended and wounded of us.  When we approach the wounded parts of ourselves from Self, the intense feelings harbored inside are modulated in a way in which they don’t overwhelm us.  I explain this to clients who need more information about how it works by comparing it to how a parent soothes a child.  Imagine a baby crying in a room.  A mother who feels anxiety or frustration in response to a crying baby is more likely to intensify the baby’s anxiety and feel overwhelmed herself.  But if a mother, in response to hearing her baby cry, feels compassion, and approaches the baby with this energy, the baby will feel it and will relax much sooner than a baby with an anxious parent.  This compassionate energy not only affects the child, but it has a way of making us immune to being overwhelmed.  Healing trauma works the same way.  When we approach the parts of ourselves that have been suffering and wounded in an open, calm, curious, and compassionate we will be shielded from the pain and the pain will not overwhelm.  Healing this way for the client is like simultaneously being the container and the contained…

There are many variations and techniques within the IFS model which help to prevent overwhelm.   I’m interested in hearing from you about what ways you use to avoid overwhelm with your clients, regardless of what model of therapy you use.  Please feel free to share.