GoodTherapy.org Therapy Blog https://www.goodtherapy.org/blog Exploring Healthy Psychotherapy 2024-04-02T14:59:34+0000 en-US https://wordpress.org/?v=6.5.3 From Service to Support: A Veteran’s Guide to Healing the Pain That Is Unseen https://www.goodtherapy.org/blog/from-service-to-support-a-veterans-guide-to-healing-the-pain-that-is-unseen/ b6fbfbc68e67d2b4cf7113ba797c1a71 2024-05-16T15:47:35+0000 Goodtherapy
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My journey from the disciplined ranks of a US Army combat engineer to a bastion of support for those battling internal wars has been both enlightening and deeply personal. This path, paved with both my own experiences and those of the individuals I've had the honor to help, underscores a critical yet often overlooked side of veteran care: the silent, unseen wounds of PTSD and complex trauma. Through this article, I aim to delve into the transformative potential of trauma-informed care,...
GoodTherapy | From Service to Support: A Veteran's Guide to Healing the Pain That Is UnseenMy journey from the disciplined ranks of a US Army combat engineer to a bastion of support for those battling internal wars has been both enlightening and deeply personal. This path, paved with both my own experiences and those of the individuals I've had the honor to help, underscores a critical yet often overlooked side of veteran care: the silent, unseen wounds of PTSD and complex trauma. Through this article, I aim to delve into the transformative potential of trauma-informed care, advocating for a shift from merely enduring survival to embracing a thriving existence, especially for veterans confronting the specter of suicidal ideation. 

Unveiling PTSD and Complex Trauma 

PTSD and complex trauma are more than clinical terms; they are lived realities for countless veterans, embodying the enduring aftermath of combat and service. Unlike physical injuries, which are visible and quantifiable, these mental health challenges lurk unseen, their symptoms echoing the tumult of past traumas. Veterans may find themselves in the grip of intense flashbacks, plagued by insomnia, or wrestling with an incessant sense of alertness that transforms even the most mundane environments into potential threats. Such manifestations are not merely remnants of their service but pervasive influences that color every side of their daily lives.  The journey of understanding these conditions is akin to navigating a labyrinth, where each turn reveals new challenges and complexities. PTSD, traditionally associated with a singular traumatic event, can sometimes overshadow the nuanced and compounded nature of complex trauma, which arises from prolonged exposure to distressing experiences. This distinction is crucial in tailoring interventions and support systems that acknowledge the depth and breadth of the trauma experienced by veterans. 

The Silent Battle Within: A Closer Look 

Beyond the clinical symptoms lies a more profound struggle—a battle for identity, meaning, and connection. Many veterans, accustomed to the camaraderie and purpose found within the military, find themselves adrift in civilian life, where their experiences seem alien and incomprehensible to those around them. This disconnection fosters a sense of isolation, worsening the symptoms of PTSD and complex trauma and, tragically, steering some toward suicidal ideation.  The story of "John" (a pseudonym to protect confidentiality) is illustrative of this struggle. A veteran of multiple deployments, John's return home was marked not by peace but by a relentless battle with his memories and a pervasive sense of dislocation. In our sessions, it became clear that John's journey to healing needed more than just coping strategies; it demanded a redefinition of his relationship with his past and a rekindling of hope for his future. Through a concerted approach grounded in trauma-informed care, we embarked on this journey together, navigating the intricacies of his experiences with empathy and patience. 

Trauma-Informed Care: A Beacon of Hope 

The essence of trauma-informed care lies in its acknowledgment of trauma as a pervasive element that influences the physical, emotional, and psychological well-being of individuals. This approach shifts the paradigm from pathology to understanding, emphasizing the need for safety, choice, collaboration, trustworthiness, and empowerment in the therapeutic process. It challenges us to see beyond the symptoms, to recognize the person grappling with the trauma, and to tailor our interventions in a manner that is respectful, informed, and healing centered.  For veterans like John, and indeed for many others, trauma-informed care offers a pathway out of the darkness. It is not a quick fix but a journey—a process of rebuilding trust, redefining self-worth, and rediscovering purpose. By integrating principles of safety and empowerment, we create a therapeutic environment where veterans can explore their traumas without fear of judgment, where their stories are heard and validated, and where healing begins with understanding. 

Expanding the Narrative: Education, Advocacy, and Community Engagement 

The journey from service to support does not end with individual therapy; it extends into the realms of education, advocacy, and community engagement. It is about broadening the narrative around veterans' mental health, challenging stigmas, and fostering a society that recognizes the sacrifices of its veterans not just in words but in actions. By educating healthcare professionals, policymakers, and the public about the realities of PTSD and complex trauma, we can build more robust support systems that reflect our collective gratitude and responsibility towards those who have served. 

In Conclusion 

The transition from surviving to thriving is more than a personal journey for veterans; it is a societal imperative. As we continue to explore and advocate for trauma-informed care, we not only aid in the healing of our veterans but also enrich our collective human experience. The scars of service, though unseen, are indelible markers of sacrifice and resilience. By acknowledging these wounds, by offering our understanding, empathy, and support, we honor the entirety of the veteran experience, fostering a community where healing is not just possible but embraced. 
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How to Navigate Two Different Parenting Styles https://www.goodtherapy.org/blog/how-to-navigate-two-different-parenting-styles/ fa5164f1c4393a3019f2bd92f5145f71 2024-05-07T15:15:55+0000 Goodtherapy
Goodtherapy
Parenting is difficult on its own, but when you and your partner, or co-parent, have different approaches to such an all-consuming role, frustration is likely to flair, impacting not only your relationship with each other but also your children.    But while our knee-jerk parenting reactions may vary, with the right communication and effort, it’s possible to incorporate more blended, consistent styles, all while maintaining one’s unique parenting strengths and personality.   Know yo...
GoodTherapy | How to Navigate Two Different Parenting Styles Parenting is difficult on its own, but when you and your partner, or co-parent, have different approaches to such an all-consuming role, frustration is likely to flair, impacting not only your relationship with each other but also your children.    But while our knee-jerk parenting reactions may vary, with the right communication and effort, it’s possible to incorporate more blended, consistent styles, all while maintaining one’s unique parenting strengths and personality.  

Know you are not alone 

Even when you’ve ensured as many pieces as possible are in place to parent — achieving work-life balance, and being physically and emotionally healthy — parenting is a stressful and difficult endeavor. Of course, it’s also rewarding, but you’d be hard-pressed to find an involved parent who hasn’t had days where they’ve felt drained, in more ways than one.    In fact, according to one Pew study, about 62% of respondents said parenting has been harder than expected, with about a quarter saying it’s a lot harder than anticipated.    When you and your partner have different parenting styles, it can make parenting that much more difficult, as it requires navigating additional relational challenges, beyond those between you and your children alone.   

Why people parent differently 

Because each partner was raised in a different household and holds different personalities, it should almost be expected that each parent will have, at times, competing notions about the best approach to, say, disciplining their child.   It’s also important to keep in mind that there also tend to be differences in parenting approaches based on cultural background and even gender. In the same parenting survey, about half of mothers say they take on a more overprotective role, compared with 38% of fathers. The latter is also more likely to state they offer their kids too much freedom, and that when it comes to disciplining, they are less likely to waiver than moms.   Parenting styles differ based on cultural backgrounds as well. Research shows that some countries rely more heavily than others on sibling parenting, whereby older children take on central caregiving roles. Physical affection, not just from parents, but by other family members and friends, also varies significantly across countries and backgrounds. It’s important to take all of this into account when working with your partner, or co-parent.   Let’s recap some of the most well-established parenting styles, which may help you identify which feels most applicable to you: 

Authoritarian 

Such an approach relies solely on parents as the decision-makers and leaves little room for kids’  autonomy. Obedience is at the center of authoritarian parenting, and the idiom that kids should be “seen and not heard” encapsulates the dynamic.  

Permissive 

Scant enforcement of rules and disciplines characterizes this type of parenting. Those who grew up with a permissive parent typically experience a childhood where consequences were verbally communicated but were not always followed through on. Accountability for bad behavior could easily be skirted with enough complaining or frustration directed at the parent.  

Neglectful 

There are some similarities with permissive parenting in that discipline is often lacking, but neglectful parenting takes it a step further. While a permissive parent typically expresses concern, or conversely, love and affection, neglectful parents show tremendous indifference to their child’s behavior and needs.  

 Authoritative 

Typically considered the gold standard, an authoritative parent typically employs a carrot-and-stick approach to parenting. Rules and expectations are clearly communicated, as are disciplinary measures, which are followed through on. However, unlike authoritarians, authoritative parents take in children’s perspectives and emotions when making decisions.  

Find something that works for everyone 

Finding common ground 

Finding common ground in your parenting styles will be your secret weapon. Figure out what are some of the baseline rules and consequences that will be enforced the same way among both parents.   Not allowing kids to “divide and conquer” will not only signal you and your partner are on the same team, but in the long run, it also provides a sense of security for children.  

Disagree behind closed doors 

We can’t always time when conflicts will arise. But to the extent possible, it’s important to save disagreements — especially when it pertains to parenting styles — between the two of you.  In the words of psychiatrist Dr. Alan Ravitz:   “In my own family, I know there were times when I thought my wife was too harsh and there were times when she thought I was too easy. The important thing is to present a united front.”  Even if you disagree with a particular reaction from your partner — barring extreme circumstances — try not to vocalize your disapproval in the midst of their interaction with your child, as this can undermine their authority, and subsequently, yours as well.   

Constantly communicate 

Regular communication is paramount for the success of any relationship, but when you add raising kids in the mix, it becomes that much more important. With working parents and busy school schedules, set aside time with your partner for parenting “check-ins”. During these agreed-upon times, you can talk about discipline approaches, behavior trends you’re noticing that may be cause for concern, or conversely, optimism. By structuring such discussions, both parents can become a more united front and well-prepared on how to approach worrisome incidents as they inevitably arise.  

Seek counseling 

Sometimes, an objective, third-party professional can help families navigate the messy ins and outs of not just parenting, but marriage as well. Couples counseling can help you and your partner understand each other’s thought processes and emotional patterns when it comes to parenting. And during family therapy, you can also dig deeper into your child’s behavior and subsequent reactions.    Online directories like GoodTherapy can help you find the therapist that works best for your family's challenges, needs and background.    
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Where to Start: Mental Health in a Changing World https://www.goodtherapy.org/blog/where-to-start-mental-health-in-a-changing-world/ d6ec80f970221d6222d1711a95baf3f8 2024-05-01T15:33:47+0000 Goodtherapy
Goodtherapy
May is Mental Health Awareness Month, and there’s no better way to start it off than taking the first step in seeking help or assisting those who would like to start counseling. Doing so raises awareness and helps break down negative, long-held beliefs — many of them untrue — about what it means to attend therapy, whether as an individual, couple, or family.   For those new to the process, and understandably ambivalent, let’s discuss how you can play a key role in changing societal a...
GoodTherapy | Where to Start: Mental Health in a Changing WorldMay is Mental Health Awareness Month, and there’s no better way to start it off than taking the first step in seeking help or assisting those who would like to start counseling. Doing so raises awareness and helps break down negative, long-held beliefs — many of them untrue — about what it means to attend therapy, whether as an individual, couple, or family.   For those new to the process, and understandably ambivalent, let’s discuss how you can play a key role in changing societal attitudes toward mental health — even before you even sit in a therapist's office — and what contributes both positively and negatively to our mental state, and how to go about finding counselor suited to your needs.   

Create Awareness 

Fortunately or unfortunately — depending on how you look at it — we are always connected, digitally at least. Our smartphones ensure we are only a couple clicks away from responding to a bombardment of text messages, staying up-to-date on current events, responding to work emails, or coordinating your kids’ carpool schedule.    And work pressures remain one of the top stressors in our lives. A Gallup poll showed that U.S. workers report feeling the highest levels of stress, with 57% of respondents stating they feel stressed on a daily basis, even though almost half feel there is a stigma around talking about mental health in the workplace.    While we surely have more convenient lives in many respects, in other ways, life stressors have become more omnipresent, with the separation between work and home life increasingly muddied.  We may think this is just how life is — going through the motions, checking things off the to-do list — but if the last decade of heavy smartphone use has taught us anything, it’s that the hyper-connected world we live in is not necessarily better for our mental health. In fact, some studies have found a positive correlation between increased digitization and symptoms of anxiety and depression.   That flies in the face of the myth that you should have experienced a particularly tragic event to need therapy. To the contrary, many who find they are experiencing symptoms of depression or anxiety are dealing with a more insidious form of such conditions, ones which are the product of a variety of external factors we often deem positive — working long hours, access to innovative technology and overabundance of material goods. While all these have positive aspects to them, they sometimes prevent us from being present and checking in with ourselves emotionally.  

Behavior and Attitude 

Lots of progress has been made in de-stigmatizing mental illness and therapy, but more work remains. Current attitudes often vary greatly depending on gender, age, cultural background, religion, socioeconomic status, and upbringing. For instance, data from the American Psychological Association shows the greatest increases in unmet need for mental health services were among Latino and Asian populations, as well as those identifying with two or more races. And women also tend to seek mental health services at higher rates than men.   Never before have U.S. companies been so generous with offering employees mental health days — rather than just sick days — as well as added benefits, such as subscriptions to meditation apps and mindfulness coaching.   The more therapy and mental health conditions are discussed openly and honestly, the less alone people will feel seeking therapy. And we intuitively understand that the less lonely individuals feel about the struggles they’re enduring, the less likely they are to suppress it.  But because different demographics and groups of people view therapy differently, it’s particularly valuable for those harboring particularly stubborn stigmas to take the courageous step of seeking help and discussing it with trusted family members and friends, as well as creating more diverse representation in the field of mental health.   

Starting Therapy 

Starting therapy, whether it’s with a new therapist or your first-ever experience, can feel overwhelming. After all, the reasons you’re seeking counseling are likely accompanied by feelings of vulnerability, discomfort, or even shame. But the process doesn’t have to be stressful.  

Know why you are seeking therapy 

There may be a defining event that was the genesis of certain symptoms or feelings of despair, anxiety, anger or depression. But it’s also likely you can’t pinpoint specific moments. It’s important to understand what you hope to get out of therapy, as well as what you’re currently experiencing, regardless of how familiar you are with the underlying causes.  For example, a husband and wife may not quite understand why they are fighting on a regular basis, but pinpointing what they hope to get out of therapy — a healthier relationship less riddled with accusatory remarks and assumptions — is a good first step. For both couples and individuals, it’s important to seek change, especially internally, and understand what you hope to get out of therapy.  

Identify important traits and experience 

Woman who struggled with ADHD burnout talking to her therapistThere are some logistical considerations to take into account, including insurance coverage or whether you prefer face-to-face or teletherapy. Each option has its pros and cons, and it will come down to your own personal comfort level. But depending on your financial situation and benefits, be sure to research what your bill will look like for both types of sessions.   From there, it’s helpful to consider a therapist’s traits and experience you’d find particularly compatible. For some, working with a mental health professional who has worked with clients struggling with substance abuse disorder is critical. Or perhaps seeing someone who shares a similar cultural background or religion is important. Gender can also play a role, as research has shown that nearly 70% of female clients prefer a counselor of the same sex.  

Use online directory tools like GoodTherapy 

Even after taking all of these factors into account, people often abandon the search once it feels difficult and time-consuming. After all, someone seeking a therapist is often already feeling overwhelmed, and meeting regularly with professionals who don’t seem like a good fit is draining and demotivating.   To lessen those chances, and before meeting one-on-one with any available therapist who happens to accept your insurance, use online directory tools like GoodTherapy to filter your search for criteria that are important to you.   You can also refer to the GoodTherapy guide for a more robust breakdown of what to expect out of therapy and how to start the process.  

Be an Advocate 

You don’t have to be a mental health professional or have a large social media following to be an advocate for therapy and mental health. Anyone can make a commitment to check in more with loved ones.   Four ways to check-in: 
  • Ask to meet up or schedule a time to call 
  • Express gratitude for your relationship/friendship  
  • Send a message that lets them know they’re on your mind 
  • Follow up about something they’ve previously discussed with you  
Remember, small interactions like this play an outsize role in de-stigmatizing mental health conditions, including depression or anxiety. And showing support for counseling and professional help also goes a long way. After all, nine out of ten people have said that stigma and discrimination have impacted their lives when it comes to mental health.   Make sure your loved ones know where to find therapists that can respond to their needs and know that getting help is the first step toward a more fulfilling life. 
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How to Talk to a Therapist about Depression https://www.goodtherapy.org/blog/how-to-talk-to-a-therapist-about-depression/ df64a07d9d7feb07f41e653bcc6e57c0 2024-04-30T15:14:56+0000 Goodtherapy
Goodtherapy
By the nature of how depression manifests itself, it’s often hard for those in its grip to seek any support, let alone therapy.  And while it may seem like everyone else isn’t struggling, there’s a good chance that’s not the case. In fact, major depression is one of the common mental illnesses, affecting about 8% of all American adults every year.   But it doesn’t have to remain that way. Though there are some tell-tale signs of depression, other indicators aren’t quite as o...
GoodTherapy | How to Talk to a Therapist about DepressionBy the nature of how depression manifests itself, it’s often hard for those in its grip to seek any support, let alone therapy.  And while it may seem like everyone else isn’t struggling, there’s a good chance that’s not the case. In fact, major depression is one of the common mental illnesses, affecting about 8% of all American adults every year.   But it doesn’t have to remain that way. Though there are some tell-tale signs of depression, other indicators aren’t quite as obvious, and a mental health professional can offer an objective analysis of your situation, as well as a safe place to discuss some of the underlying factors contributing to one’s symptoms.   If you think you may be struggling with depression, learn about the benefits of seeking therapy and how to discuss depression with a trusted professional 

Differences between depression and anxiety 

Individuals experiencing depression may also have anxiety, and it can be difficult to decipher where one ends and the other begins. After all, it’s normal to feel sad or anxious throughout our lives, but depression and anxiety should be taken more seriously when it begins to interfere with daily functioning. A declining job performance resulting from depression, or retreating from activities with friends due to social anxiety is a sign to seek professional help. Because each condition requires different approaches, it’s important to understand the differences between each. 

Anxiety 

Anxiety is characterized by a jittery, apprehensive feeling, usually about something that could happen in either the near or long term. Virtually everyone experiences feelings of anxiety at some point in their lives, but it’s typically considered a disorder when such thought patterns are ongoing in nature. Those with such conditions often feel uneasy, with “what-if” thoughts that are more future-focused particularly prevalent. 

Depression 

Depression, on the other hand, typically carries a sensation of consistent exhaustion or fatigue, physically and/or emotionally. Many describe it as feeling like there is something weighing them down, as if performing the simplest of tasks – making one’s bed, running errands – feels, at times, extraordinarily difficult. While anxiety is typically associated with apprehension about current or future events, those with depression typically report feelings of hopelessness. 

Types of depression 

Stressful and life-altering situations can cause us to feel depressed throughout our lives. Grief from the loss of a loved one can trigger depressive symptoms, such as a loss of energy or intense feelings of sadness or despair. These grief-related emotions may remain for a long time, but many people are able to return to a more functional psychological state over several months, perhaps within a year in more extreme cases, in which they’re able to perform daily responsibilities, experience positive emotions, and maintain healthy relationships.  But clinical depression occurs when symptoms occur over an extended period of time and interfere with daily functioning. There are various forms of depression, some of which arise out of particular circumstances: 

Seasonal affective disorder:

SAD tends to arise as days get shorter during the wintertime, in addition to, in many cases, colder weather. The combination of lower temperatures and less light can alter our moods and even routines.   

Perinatal:

This type of depression is seen during pregnancy or in the first year after giving birth, commonly known as postpartum depression. An abrupt life change, less sleep, and hormonal changes lead to emotional and psychological blues for many parents, but prolonged feelings of sadness or despair may point to something deeper.  

Bipolar disorder:

Manic episodes, characterized by high energy and, in many cases, delusions of grandeur, are part of bipolar disorder. But what tends to follow are periods of depression, leading to low energy, isolation, and less overall activity. Therapy is important for those with the condition, but it is also usually paired with medication treatment.  

Persistent depressive disorder:

Major depression is noted for its extreme symptoms, particularly ongoing changes in appetite, lack of social activity leading to self-isolation, and other symptoms that get in the way of daily functioning, like holding down a job. By contrast, however, persistent depressive disorder is characterized by slightly less intense symptoms that remain for around two years or more.  

Benefits of discussing depression with your therapist 

Maintaining a supportive network of loved ones, including friends and family, is a powerful way to stave off the most intense symptoms of depression. There are other ways to lessen the intensity of symptoms, such as staying physically active, eating healthy, and adhering to a routine most days.   But therapists are experienced and objective professionals that can help contextualize feelings and symptoms. They help navigate underlying causes that are exacerbating one’s symptoms and help find ways to change, accept or adapt to external circumstances.    Therapists can also identify thought patterns that are particularly damaging, or conversely, beneficial. They are well-equipped to help clients develop skills that combat insidious and counterproductive thoughts and behaviors, especially those that exacerbate depression. They can also help you set realistic treatment goals – such as a daily walk or social connection – and monitor your progress.   While continuing to seek support for your social network is key, just like with a physical illness, it’s also important to talk to a trained professional who understands how to navigate and help treat such mental health conditions.  

How to talk to your therapist about depression 

Mental health professionals will often do an assessment as you begin treatment to understand why you are seeking therapy, what approaches may or may not work, and if and what symptoms are contributing to your decision to seek counseling. Think of it like a questionnaire that involves a range of inquiries into your personal life, background, medical history, and more. The point of such evaluations is not to interrogate you but to make sure your sessions are as impactful and tailored to your needs as possible.   Remember, everything you say is confidential, so as difficult as it may be, it’s important to be honest about your emotional state.  

Types of therapy that may benefit someone with depression 

Cognitive behavioral therapy  

CBT teaches individuals to identify and track their thoughts and behavior patterns, particularly those that contribute to depression. These thought patterns are often decades old, meaning they seem so second nature and automatic that we don’t even recognize we have the power to change.  But CBT can help reverse unhelpful thoughts, which in turn, leads to more desirable behaviors.  

Interpersonal therapy  

Therapists employing this type of therapy help individuals improve relationships with others, in turn promoting their own mental health. During IPT, clients can deepen important connections, healthily resolve conflict, and set boundaries necessary for personal growth and fulfillment. This can prevent isolation and spur social engagement, a key barrier to long-term depression.  

Mindfulness-based cognitive therapy 

This therapeutic approach takes the benefits of CBT and combines it with mindfulness techniques, such as meditation. These types of practices help anchor us in the present moment, which helps combat feelings of anxiety or depression, often stemming from thoughts about the past or future.  

Seeking Help  

While depression may feel insurmountable, it is a very treatable mental health condition. With the right plan and professionals to guide you, studies have shown that anywhere from 80 - 90% of patients respond favorably to treatment. Research has also shown that psychological treatments like talk therapy can have comparable effects on depressive symptoms as antidepressants and even more powerful impacts than medication long term.   Make sure you are using an online directory that helps filter therapists and mental health professionals with important characteristics or experience, as well as those who can take your insurance. Doing so through platforms like GoodTherapy can jumpstart your therapy journey to make it as easy as possible to start feeling more like yourself.  
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Nutrition and Culinary Skills in Eating Disorder Treatment https://www.goodtherapy.org/blog/nutrition-and-culinary-skills-in-eating-disorder-treatment/ 27047a3ee9274ce643a9fd85870745d1 2024-04-29T15:13:41+0000 Goodtherapy
Goodtherapy
The appropriate level of eating disorder care depends on a patient’s ability to consume and retain proper nutrition. A qualifying criterion to enter a residential treatment center is that they are unable to maintain the necessary nutrition intake required for their physical and psychological health. A second criterion is that they have difficulty maintaining reasonable nutrition consumption for themselves while living at home, even while receiving care in a partial hospital program or...
GoodTherapy | Nutrition and Culinary Skills in Eating Disorder TreatmentThe appropriate level of eating disorder care depends on a patient’s ability to consume and retain proper nutrition. A qualifying criterion to enter a residential treatment center is that they are unable to maintain the necessary nutrition intake required for their physical and psychological health. A second criterion is that they have difficulty maintaining reasonable nutrition consumption for themselves while living at home, even while receiving care in a partial hospital program or intensive outpatient program.   Residential treatment provides necessary, 24-hour support for the patient with a multidisciplinary team who will help interrupt the personal battles patients experience to balance their nutrition intake. Over time, the patient can regain personal intake management, develop their independence and confidence in eating, and transition to a lower level of care.   Nutrition rehabilitation interventions hold a vitally important role in the residential level of care during eating disorder treatment. As each patient works towards recovery, they achieve the best results with hands-on food experiences that engage all their senses, including seeing, smelling, touching, and tasting. Living vibrantly with food encompasses being able to hold conversations about food and cooking as well.  

With these thoughts in mind, Hidden River developed a unique and customizable nutrition and culinary skills training program for their patients.  

Research supports this approach: A narrative review from 2018 found that culinary skills programs ultimately boost young people’s healthy eating behaviors (1). Let’s take a closer look at the main tenets program. 

Nutrition Evaluation  

To start, each patient participates in an in-depth nutrition evaluation by a Registered Dietitian. The assessment reveals the patient’s current and historical relationship with food. The assessment reviews the patients’ beliefs about the various categories of foods, food habits, food-related social activities, and their process of eating in a variety of social settings.   Many patients have misconceptions about foods and food products that contribute to their disordered eating. When the Registered Dietitian and patient review the assessment results, they identify key issues to address and reasonable goals to achieve over the course of treatment to receive the most benefit. The highest goals may include nutrition education, enhancing their food selection, broadening their palate, and establishing a realistic home-based meal plan menu.   

Culinary Knowledge Evaluation 

At admission, the patient participates in an interview about their culinary knowledge, food preparation experience, and cooking skills. The patient will be given several unique quizzes to obtain their baseline of culinary knowledge. The assessment and interview approach reveals their level of culinary comfort on the Likert Scale. The unique quizzes assess the patient’s current knowledge surrounding grocery shopping, meal planning, food preparation, safe food storage, and the use of basic kitchen appliances and utensils. The food preparation skills assessed include spicing, baking, boiling, basting, frying, roasting, and the use of sharps. Additionally, they consider a patient’s understanding of kitchen safety, techniques, cleaning tips, and more.  When the RD and patient review the assessment results, they identify where the patient will benefit most from the culinary skills training program. All patients will be guided through the standard features of the program that include establishing a realistic home-based meal plan menu, grocery shopping, developing kitchen safety knowledge and skills, and possibly even preparing a meal or snack on their home-based meal plan. Additional education and skills training will be added to the patient’s treatment experience based upon their unique needs in preparation of establishing their aftercare plan.     The culinary evaluation also determines the steps needed to accomplish the established goals. Some patients lack adequate culinary skills and benefit from receiving basic education and training. Other patients are well-versed with culinary skills and benefit from taking on the challenges related to fearful foods, uncomfortable textures, tastes, or smells. The Registered Dietitian supports the patient to begin the culinary skills training program from a safe emotional and psychological position.  

Individualized Meal Plans 

Based on the results of the nutrition assessment, the patient and Registered Dietitian collaborate to create a customized daily meal plan that focuses on resolving fear, increasing confidence, and supporting their medical nutrition needs. The daily meals and snacks are prepared by in-house chefs with fresh ingredients. The patient will fill out a weekly menu for each meal that offers a main course and an alternative. The foods consumed are monitored to ensure the patient ingests the adequate energy intake their body requires. 

Nutrition Education 

Each patient participates in daily supported meals and snacks and weekly nutrition education lectures. Throughout the treatment, patients tackle personalized food challenges to resolve distorted thought patterns, irrational fear, and self-destructive behavioral patterns. Nutrition education provides science-based information on nutrition, micro-nutrients, digestive processes, and how the body uses the nutrition it receives. Education is designed to address food and body misconceptions through accurate information of food and body science. 

Nutrition Programming 

Each week the patient’s schedule includes many food exposure episodes as the key feature of the program. In addition, they will participate in one individual nutrition counseling session per week, one nutrition education group, and a culinary skills training event. 

Exposure Response Prevention Therapy 

Exposure Response Prevention (ERP) therapy focuses on helping individuals improve their distress tolerance skills as they face their fears. Eating disorder recovery is particularly challenging because patients are frequently confronted by triggers — in the kitchen, at the dining table, in the grocery store, and so on. During their time in residential treatment, it’s imperative that the patient's practice skills enable them to handle these diverse events by enhancing their situational awareness, arresting impulsive actions, implementing effective responses, and boosting their confidence.   The ERP program works by identifying their resilience strengths as well as personal vulnerabilities promoting a range of emotional distress that activates eating disorder behavior. The Registered Dietitian and patient identify the patient’s mild, moderate to severe emotional distress reactions from a multitude of nutrition and culinary experiences reviewed. The ERP program is categorically arranged to strengthen the patient’s ability to successfully manage events that create a moderate distressful emotional response with the goal of reducing the emotional response to the mild range.   Once this goal is achieved, a subject higher on the moderate to severe scale of distress may become the area of focus. The Registered Dietitian and patient keep in mind that practicing distress tolerance skills during the ERP sessions is the primary skill to realizing a successful outcome. Ultimately, the patient is guided to address forthrightly many distressful facets of their life that hinder their ability to consume their daily nutrition requirements. When the patient returns home to resume an improved quality of living, it is important that they have the knowledge with the forethought of applying effective distress tolerance skills to enact healthy eating behavior.  Hidden River’s program is in part developed from current research which suggests that culinary skills training programs are especially effective when combined with ERP therapy. Specifically, one study revealed that, based on the shared symptoms of anxiety and anorexia nervosa, ERP is an appropriate treatment approach to avoid relapse of eating disorders (2).  

The most common hope is that the nutrition and culinary skills program assists patients in healing their relationships with food.  

Each individual experiences an emotional connection to food, tying specific memories to the meals. Family relationships and vibrant social events often include meals. In that sense, food is so much more than nutrition. Food is part and partial to the celebration of relationships with family and friends. Cultural traditions as well are ripe with the inclusion of food to highlight one’s heritage, express appreciation, and show love. Ultimately, when a patient begins to rediscover food as part of a joyful life, they can rest assured that the path to healing is possible.  References 
  1. Muzaffar, H., Metcalfe, J.J., Fiese, B. (2018). Narrative Review of Culinary Interventions with Children in Schools to Promote Healthy Eating: Directions for Future Research and Practice. Current Developments in Nutrition, 2(6). 
  1. Steinglass, J.E., Sysko, R., Glasofer, D., Albano, A.M., Simpson, B., Walsh, T. (2011). Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. International Journal of Eating Disorders, 44(2). 
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What am I missing? Part 2: Applying Attachment Theory to Treatment and Recovery https://www.goodtherapy.org/blog/what-am-i-missing-part-2-applying-attachment-theory-to-treatment-and-recovery/ 8f7ba8753d91e6d2bba5e5a9f1134998 2024-04-12T14:15:30+0000 Goodtherapy
Goodtherapy
Addiction is an attachment disorder.  Human beings, addicts or not, only know and repeat what was modeled for them during childhood.  I like to call ages 0-10 healthy narcissism given that the world, as it should, revolves around the child.  If the child is not fed, he/she will be hungry; if the child is not given shelter, he/she goes without shelter; and if the child’s diaper is not changed, he/she will be wet.  Moreover, if, for example, the child’s parents divorce, who is at fault in...
GoodTherapy | What am I missing? Part 2: Applying Attachment Theory to Treatment and RecoveryAddiction is an attachment disorder.  Human beings, addicts or not, only know and repeat what was modeled for them during childhood.  I like to call ages 0-10 healthy narcissism given that the world, as it should, revolves around the child.  If the child is not fed, he/she will be hungry; if the child is not given shelter, he/she goes without shelter; and if the child’s diaper is not changed, he/she will be wet.  Moreover, if, for example, the child’s parents divorce, who is at fault in the child’s mind?  Obviously, given that the world revolves around the child, the child believes he or she is to blame.  ‘If I just would have cleaned my plate’, ‘If I would have been a better boy…’, ‘If I just would have kept my room clean.’  These types of messages form the messages or models for future behavior of the child.      Part I of this article provided a definition and basic framework for Attachment Theory. Attachment theory provides that most individuals did not grow up with a model for secure attachment; thus, treatment for addiction requires providing a model of secure attachment so that individuals can practice healthy behavior in response to pain and discomfort other than acting out in addictive behavior.     Theoretically, Mary Ainsworth PhD (1969) defined secure attachment as developing when a caretaker shows awareness of a child’s emotions and quickly attends to the child when distressed.  The child’s perception is that the caretaker is consistent in presence and provision; thus, the child feels safe in exploring their world because of their sense of certainty that their caretakers will be there for them in a nurturing manner if needed.  Overall, attachment theory assumes that the experiences of childhood relationships shape adult attachment style; thus, for example, the reason why adults who were physically abused as children have a high propensity for abusing their children.  This is the behavior that was modeled and typically the only mode that the adult has for responding to anger. 

The Scientific Link Between Attachment and Addiction: 

Attachment theory posits that an infant learns necessary skills for survival and the development of an Internal Working Model (IWM) whereby the definition of how the person views the world, themselves, and others is defined.  “Attachment representations show predictive associations with a wide range of pathological behavior including personality disorder(s), mood disturbance, [substance dependence] and psychopathology” (Caspers, Yucuis, Troutman, & Spinks, 2006).  Therefore, the authors conclude that childhood attachment styles (secure or insecure) have a direct impact on the prevalence of Substance Abuse Disorders.     Researchers Kendler and Prescott (2006) reviewed the findings of the Virginia Twin Study of Adolescent Behavioral Development (VTS) for the purpose of exploring the depth of influence between genetics and environment as it relates to addictiveness and mental health disorders.  VTS had a sample size of 2,762 white twins between the age of 8-16 years old and their families.  Kendler and Prescott concluded that there are no genes specifically responsible for Substance Use Disorder, but rather, there are genes that an individual can inherit that predispose them to patterns of behavior closely associated with Substance Use Disorder.  Additionally, the authors concluded that if children are brought up in “protective environments”, even though genetically they are predisposed to patterns associated with Substance Abuse Disorder, the environment has a likely potential to be a protective factor against Substance Abuse Disorder.   The Brain:  Finally, researchers have directly correlated neurobiology of the human brain and the importance of caregiver attachment relationships during childhood to mental health in adulthood (Miehls, 2011, p. 82).  Additionally, the research has indicated that insecure attachments during childhood affects, negatively, the development of certain areas of the brain.  Moreover, Miehls states “relationships have the capacity to rebuild certain parts of the brain that influence our social and emotional lives,”) (Miehls, p. 81).     The benefit of the connection between neurobiology and attachment is that brain neuroplasticity (the ability of the brain to be re-formed) allows for a corrective experience or secure attachment model during adulthood leading to positive changes in the patient; thus, lessening the need to utilize addictive behavior to deal with abandonment, trauma, abuse, and emotional pain etc.  Moreover, the implication for treating substance dependence indicates the importance of a secure attachment relationship between the clinician and the patient to provide a baseline model or definition.   

Addiction as an Attachment Disorder 

The attachment system of a person is developed as a child in proportion to the relationship between the child and the caregiver; thus, if the attachment process is deficient, the child will have issues related to emotional regulation.  Therefore, as an adult, the person is likely to utilize drugs and other substances to regulate emotions as a means of adapting to an inability to regulate emotions learned as a child (Kohut 1977).    Drugs create an ability for a person to have the illusion of self-esteem, self-confidence, worthiness and “increase feelings of being alive” (Kohut 1977).  An addict attempts to define comfort and security (missing in their vocabulary) through the use of addictive substances or behavior; however, outside sources other than secure modeling will lead to continued dysfunctional definitions and continued addictiveness.   

Treating Addictiveness and Substance Dependence through Attachment Theory:  

Recent studies have positively confirmed that a direct link exists between insecure attachment and substance dependence (Schindler, Thomasius, Sack, Gemeinhardt, 2007; Schindler, Thomasius, Sack, Gemeinhardt & Eckeert, 2005).     “Attachment Oriented Therapy” (AOT) has been described as “a way of eliciting, integrating and modifying styles represented within a person’s internal working model” Flores (2004) p. 214).  Flores (2001, 2004) goes on to explain that the IWM must be changed or addiction will continue or substitution of one addiction for another will persist.  The key point is that when an individual begins to learn (which requires a model) how to self-soothe, thus, learning how to regulate emotions and feelings, they will avoid seeking outside sources as a means of managing these emotions (Blaine & Julius, 1977; Flores, 2001; Flores, 2004).   The vast majority of individuals in treatment today have been exposed, multiple times, to the treatment experience; Therefore, what is missing?  Why the extreme difficulty in remaining sober?  Haven’t they been taught well?  Has the education system (the treatment industry) failed them?  The answer is not black and white, but rather, exists within the statement:  We must begin to treat patient’s differently.  The idea that we are able to teach patient’s how to stay sober doesn’t equate to their ability to apply what they have learned or feel safe enough to explore the deeper problem of why they continue to utilize addictive behavior to escape emotional pain.  AOT is rooted in providing a “secure base” for an individual so that they may begin to explore themselves from the inside out.  Attachment theory correctly posits that by providing a model in treatment of a safe, secure base, the patient will have the ability to cease seeking answers outside themselves (drugs, alcohol, sex, food etc.) and begin to heal from the inside out.  Moreover, by providing this safety, patient’s have the ability to express and feel emotions in a vulnerable and authentic capacity; thus, the willingness to address the problem, rather than the solution (the addictive behavior).     “A Different Way to Treat People”  

Conclusion 

Overall, what is missing in treatment today is the understanding and compassion of being relational with patients.  The irony in this statement is that AA promotes compassion and being relational with individuals; however, this is the part that most traditional treatment misses. Alternatively, traditional treatment provides an education as opposed to modeling behavior that provides the ability to develop secure attachment needed for change.    Unfortunately, most addicts (probably most human beings in general) have not had a model for secure attachments, thus, leading to substance abuse and addictive behavior as a means of avoiding emotional pain. For treatment and thereafter, AA and therapy to be effective, the following suggestions are necessary: 
  1. Treatment must be focused on modeling secure attachment.  This requires risk on the part of the treatment provider and a demonstration of self-disclosure and identification from the treatment team as opposed to a one-up position of authority; 
  2. Development of trust and alliance with the patient is critical if the patient is going to address and change learned abusive and dysfunctional patterns during childhood; thus, leading to the need to utilize addictive behavior as a means of avoiding emotional pain; 
  3. Continuation of care is critical.  Thirty days in treatment merely scratches the surface.  Without a long-term aftercare plan, i.e., Partial Hospitalization, Intensive Outpatient and therapy, that focuses on abuse, attachment, and secure attachments, we can expect relapse rates after inpatient treatment to remain near 5-7% within one year of inpatient treatment; and 
  4. “A different way to treat people” must become the norm as opposed to the exception in treatment. 
 
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What am I missing? Part 1: Defining the Problem and Attachment Theory https://www.goodtherapy.org/blog/what-am-i-missing-part-1-defining-the-problem-and-attachment-theory/ 47f65d55420deb11b8f67fb96102c8c3 2024-04-11T14:13:40+0000 Goodtherapy
Goodtherapy
“what am I missing; I keep relapsing and don’t know why I have such a difficult time remaining clean and sober?”   How we treat addiction in treatment must change.  The idea that we can provide information and teach an individual how to remain clean and sober is a fallacy.  Most addicts and alcoholics are above average in intelligence and the question is “Don’t you think if they could be taught how to stop destroying their life they would merely read a book and the problem would...
GoodTherapy | What am I missing? Part 1: Defining the Problem and Attachment Theory“what am I missing; I keep relapsing and don’t know why I have such a difficult time remaining clean and sober?”   How we treat addiction in treatment must change.  The idea that we can provide information and teach an individual how to remain clean and sober is a fallacy.  Most addicts and alcoholics are above average in intelligence and the question is “Don’t you think if they could be taught how to stop destroying their life they would merely read a book and the problem would be eliminated?”  The answer is “Of Course.” Who would choose to drink, drug, or addictively act out knowing their life is over if they do?”  Nobody.  Thus, people know and they still partake in these behaviors.     Therefore, the answer is not merely education.    Facts: 
  • 9% of the U.S. population meets the criteria for substance use disorder (SUDs) (Substance Abuse and Mental Health Services Administration 2010); 
  • Drug-related suicide attempts increased by 41% from 2004-2011 (Drug Abuse Warning Network (DAWN);
  • Therapeutic alliance is one of the greatest predictors of positive treatment outcomes (Straussner, 2012). 
“Until an addict or alcoholic develops the capacity to establish mutually satisfying relationships, they will remain vulnerable to relapse and the continual substitution of one addiction for another (Phillip Flores)  

What is Attachment Theory? 

“Most of the psychopathology seen in the alcoholic is the result, not the cause of alcohol abuse.” (Valiant, 1983).  If we don’t begin treating the problem, which quite possibly stems from a lack of secure attachment modeled during childhood, as opposed to the solution, addictive behavior, we can count on continued treatment failure, often called resistance to treatment.  Resistance to treatment seems to be a way of saying it’s the patient’s fault not ours.  Therefore, we put the cart before the horse.  The result of putting the cart before the horse is the following: 
  • We admit a patient to treatment with distorted definitions of concepts learned as a child, i.e., honesty, hope, faith, courage, integrity, willingness, humility, brotherly love, discipline, perseverance, awareness, service 
  • The patient learned these definitions from their caregiver or parent from the models presented to them as children.   
  • How would the patient know these definitions are potentially dysfunctional if it is all they know?
  • How effective will step work be if the patient doesn’t have a model or healthy definition of what the principles of the steps espouse?   
Attachment theory assumes that the experience of childhood relationships shapes adult attachment styles.  These experiences create the road map or internal working model for how the individual will perceive himself and others relationally (Bowlby, 1973).    The basic premise is that we only know what we know.  For example, two men are sitting in the park discussing zoo animals.  The one man asks the other if he has ever seen an elephant, to which the other man replies ‘no, what does it look like?’  The man states, ‘it is a large grey animal that has four hoofs, rough skin, floppy ears and trunk in the front’.  The other man states ‘you mean like the tree trunk outside?’  The man replies ‘no, not a tree trunk’.  To which many asks ‘You mean like the trunk of my car?’  The point is that the man will only know what an elephant looks like if he sees a picture or goes to the zoo.  Similarly, if a child grows up with caregivers who are physically present although not emotionally present, thus, lacking a functional definition of emotional availability and intimacy, the child is more likely to have a stunted view of being emotionally present for others in their life.  It is very possible that when this child becomes an adult, their innate need for secure attachment will not be met unless they see a model of what healthy attachment looks like.  The basic principle of Attachment Theory is that those with secure attachment (stronger emotional relationship with caregiver) are better able to regulate emotions and have fewer relationship problems.  However, disruptions in the attachment system (insecure attachment) can lead to vulnerabilities in the sense of self and others as well as relationship problems; thus, leading to shame, co-dependency, and a need to numb pain via addictive behavior.  Therefore, if we don’t address and model secure attachments to patients, they will stay stuck in the solution of continuously seeking to avoid and discharge pain through addictiveness.     Research suggests that relationships influence brain development and “relationships have the capacity to rebuild certain parts of the brain that influence social and emotional lives; clinicians can help clients to alter their attachment patterns with a secure clinical relationship.  (Miehls, 2011, p. 82).    The bottom line in defining Attachment Theory is that the goal of treatment needs to be focused on changing the definition and model of what it means to feel included, loved, and secure.  “The inability to establish healthy relationships is a major contributing factor to relapses and the return to substance use.”  (Flores, 2004).  Thus, the answer to “sh*t what am I missing?” is: Not having had a clear model of secure attachment because it was partially or completely missed during childhood.  As Flores stated:  “Therapists must be able to challenge, soothe, care, love, and if necessary, fight with a patient if they are able to provide a full range of emotional experiences that can potentially come alive in an authentic relationship. (Flores, 2004, p. 259).   To sum up part one of this article, unless we provide a solid definition of concepts that we see as normal (based on definitions that were modeled) albeit dysfunctional and damaging, the way we work the 12 steps will be flawed and based on dysfunctional definitions, lacking much change in behavior.  Alternatively, we can utilize the 12 steps as a corrective experience by interpreting each step as follows: 

 Interpreting the 12 Steps from an attachment perspective: 

Step 1:     The experience of abandonment;  Step 2:     Permission to hope; integration to others;  Step 3:     Taking a risk (vulnerability) to attach  Step 4:     Taking a risk to attune with self  Step 5:     Taking a risk to attach to another person  Step 6-7:  Correcting and repairing relationship with self  Step 8-9:  Correcting and repairing relationships with others  Step 10:   Personal responsibility for securely attached relationships in my life  Step 11:   Solidifying a secure attachment to my Higher Power  Step 12:   Increasing my ability to model securely attached relationships to others 
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How to Prepare for Couples Therapy https://www.goodtherapy.org/blog/how-to-prepare-for-couples-therapy/ 603fec2807588cba885e72d03d666103 2024-04-10T14:30:50+0000 Goodtherapy
Goodtherapy
From navigating parenthood to coping with work stress, there are a seemingly endless number of challenges couples will have to grapple with over the course of their relationship, and sometimes we need a little extra help to get through the more trying times.    In fact, one survey found that about 70% of respondents wished they had better information on how to deal with conflicts in their relationships.   However, being open to couple’s counseling demonstrates a relationship where b...
GoodTherapy | How to Prepare for Couples TherapyFrom navigating parenthood to coping with work stress, there are a seemingly endless number of challenges couples will have to grapple with over the course of their relationship, and sometimes we need a little extra help to get through the more trying times.    In fact, one survey found that about 70% of respondents wished they had better information on how to deal with conflicts in their relationships.   However, being open to couple’s counseling demonstrates a relationship where both partners are committed to improving themselves and each other’s lives.  Therapy may be daunting for those who have never been, but it certainly does not have to be. Learn how to find the right therapist for you and your partner and make the most out of your sessions.   

 Preparing for Therapy 

Decide between in-person versus online therapy 

Before committing to a couples therapist, it’s important to determine whether you and your partner prefer in-person or online sessions. While most private insurers now cover both methods equally, it’s important to double-check with your plan to confirm. Once you consider the financial implications, you’ll also want to determine what works best for you and your partner.   Some find in-person therapy to be more personal, as nonverbal cues – such as body language and mood –  can be harder to decipher over a video call, and building trust with a therapist may be easier face-to-face.   On the flip side, many people prefer online therapy due to its convenience. Finding roughly an hour each week that works for three individuals’ schedules is not easy and being able to do so from the comfort of your home could increase the likelihood of long-term commitment. You may also find a therapist who is particularly experienced in working with clients with similar backgrounds or concerns as you, and it could be worth it to proceed online if they are not in close proximity.  Despite initial concerns, particularly before the pandemic, teletherapy can be just as effective. One study found that 74% of couples switching from traditional in-person therapy to online therapy experienced a positive shift 

Set realistic expectations  

Let’s outline what you can expect and not expect out of couples therapy.   According to Lori Gottlieb, a prominent psychotherapist who is well-versed in both individual and relationship counseling:  “The hardest part of couples therapy is accepting that you will need to improve your response to a problem (how you think about it, feel about it, or what to do about it). Very few people want to focus on improving their response. It’s more common to build a strong case for why the other should do the improving,” she said.   Regardless of why you’re seeking couples counseling, understand that, if done well, such therapy will require a change in behaviors and thought patterns for both parties  Here are some tough questions that will likely surface during sessions: 
  • What can you do to make it easier for your partner to change behaviors you find frustrating? 
  • Do you expect your partner to treat you better than you treat him/her? 
  • Do you expect your partner to treat you better than you treat yourself? 

Common Stigmas and Misconceptions Behind Couples Therapy 

Unfortunately, it’s not uncommon for one person in a relationship to be more willing to go to counseling than the other. This may be due to stigma around couples therapy, which is often rooted in the idea that seeking therapy means a relationship is doomed and/or there is an unwillingness to acknowledge arising fractures in a relationship.     While about 60% of respondents in one survey stated they believe the stigma for such therapy has decreased, about a third still stated that it was a barrier for them in seeking counseling.   But according to renowned couples therapist Dr. Margaret Rutherford, seeking a professional third party to help navigate your relationship challenges in a supportive and objective way is something even the healthiest of couples benefit from, and seeking professional counseling before deeply toxic patterns set in is the best way increases couples’ chances of long-term happiness.  “As a couples therapist, hearing ‘We came in before there was a real problem’ is music to my ears,” Rutherford said.  Other misconceptions include the concern that at least one partner will be scolded or reprimanded, or that the therapist will be one-sided. Counselors may be firm in holding you or your partner accountable in your statements or behaviors, but they should always communicate directly yet respectfully as well.  

 Questions to discuss prior to couples therapy 

Your sessions will be most effective if you begin counseling with an understanding of what you and your partner’s primary challenges and goals for therapy are. This can be as specific or broad as necessary, but outlining your obstacles and what you hope to accomplish out of counseling will provide a good starting point for your therapist, and it’s also an opportunity for you and your partner to ensure you are both aligned.    Just like participation in a professional setting or on a sports team, if the group is not working toward the same goal, progress will be slim at best, and relying on one player or colleague to carry most of the weight would be unfair. Similarly, with couples, make sure you have a conversation about the top recurring issues you hope to remediate in the most respectful and blameless way possible. Remember, therapy objectives should not result in placing an overwhelming burden on one party.   Let’s take a few examples: 
  • If infidelity has been an issue in your relationship, instead of stating that your goal is to make sure your partner doesn’t cheat – or conversely, that they don't do things that make you want to cheat – a blameless objective would be to trust one another again and experience organically derived intimacy.
  • Financial stress is one of the top relationship stressors. If this is the case, an ideal goal could be, for instance, that you both adhere to a budget and lifestyle that leaves each partner satisfied and fulfilled.  

Key Takeaways for Couples 

Be patient: Remember that our deeply entrenched thoughts and behaviors do not change overnight, and it takes time to alter such patterns in ways that translate to definitively positive outcomes.   Stay focused: Being as specific as possible in the challenges your relationship faces (all while staying blameless!) will also help you find the perfect fit of a therapist.   Consider different therapeutic approaches: Research the types of therapy that you and your partner would benefit from. One approach that is particularly useful for couples is emotion-based therapy, which can help partners better understand their emotional responses and those of their significant other.   Find therapists with particular areas of expertise:  You may also want to search for a therapist with experience and credentials working with the specific issues your relationship is struggling with, whether that is substance abuse, infidelity or a particular mental health condition.    Once you’ve identified some of these traits and attributes, use online search tools such as GoodTherapy to find the perfect fit.      
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How Emotion-Focused Therapy is Used in Couple Counseling https://www.goodtherapy.org/blog/how-emotion-focused-therapy-is-used-in-couple-counseling/ d8fd56a1a6ad915d84a0c47aecdeacf1 2024-04-04T13:40:56+0000 Goodtherapy
Goodtherapy
There is no one-size-fits-all approach when it comes to couples counseling, as each relationship comprises different challenges and experiences. But some therapeutic strategies have proven to be particularly effective when untangling stressful, tense partner dynamics.   Emotion-focused therapy, in particular, is one of the most commonly used tactics that relationship counselors use to help couples establish more secure attachments with their partners. One analysis from the New York Center fo...
GoodTherapy | How Emotion-Focused Therapy is Used in Couple CounselingThere is no one-size-fits-all approach when it comes to couples counseling, as each relationship comprises different challenges and experiences. But some therapeutic strategies have proven to be particularly effective when untangling stressful, tense partner dynamics.   Emotion-focused therapy, in particular, is one of the most commonly used tactics that relationship counselors use to help couples establish more secure attachments with their partners. One analysis from the New York Center for Emotion-Focused Therapy showed that 90% of couples showed significant improvement after EFT sessions compared to the control group who did not receive such therapy.   Let’s examine how it differs from other strategies and whether it can benefit your relationship as well. 

What is Emotion-Focused Therapy 

Popularized throughout the 1980s, the therapeutic practice helps clients better identify, explore, accept, and even alter their own emotions. The essence of EFT is rooted in our awareness and relationship to our own emotions, both positive and negative, subsequently boosting emotional intelligence and improving our reactions to events and external behaviors.   According to an American Psychological Report:  “Emotions are seen as crucial in motivating behavior. People generally do what they feel like doing rather than what reason or logic dictates. It follows that to achieve behavioral change, people need to change the emotions motivating their behavior.”  EFT is used in a variety of therapeutic settings, such as individual counseling, and family or group therapy as well.  

How is emotion-focused therapy used in couples therapy 

Benefits of EFT in relationship settings 

Every successful relationship relies on healthy emotional dynamics, wherein each partner is not only aware of their own emotions but has the tools to regulate them and is also comfortable being vulnerable with the other person.  In the words of Dr. Sue Johnson, one of the founders of emotion-focused therapy: “To foster connection we need not just to spend time together as companions, but to also risk sharing softer, deeper emotions. We must learn to hold each other’s feelings in a way that calms our nervous systems and gives us a deeply-felt sense of safe connection.”  That makes EFT a particularly useful approach in couples therapy. Let’s take an example of an exchange where such an approach could be valuable:  Person A: Would you like to go out somewhere this Friday? Person B: I don’t know, you probably don’t want to go anywhere anyway.  Person A: [Shrugs, rolls eyes, walks away]  In EFT, Person B’s dismissive response to the question would warrant further exploration if re-enacted or described in an EFT session. Upon further examination, it may reveal that they are feeling frustrated that Person A doesn’t take the initiative to make plans to do enjoyable activities together, something that Person B may find important as part of a fulfilling relationship. Conversely, Person B’s emotional response - as evidenced by rolling their eyes and ignoring their partner - may derive from feeling like, no matter how much effort they make, it’s never enough.   Though brief, these emotional reactions can teach therapists and their clients a lot about not only the root of recurring arguments but what can be done to address them. 

Stages of EFT Couples Counseling  

EFT is typically administered over a finite number of sessions – often ranging from eight to twenty – with a few key phases demarcating the level of progress achieved: 

Stage 1: De-escalation 

Oftentimes, when a couple first begins counseling, there is a common communication cycle, where one person may lob a criticism – intentional or not – at their partner, who subsequently responds defensively (intentional or not). These exchanges often escalate to the point where it’s hard to resolve the original discussion that surfaced, to begin with.   In the de-escalation phase, each couple should become aware of how they each play a role in perpetuating emotional distress in such exchanges. 

Stage 2: Restructuring 

Once couples have an understanding of how their actions impact the other person, therapists will start introducing guidance on alternative ways of responding, all with the intention that these prompts or questions will help each partner become more curious and empathetic to the other’s feelings.

The main goal of this stage is that each person in the relationship feels more comfortable being emotionally vulnerable and accepting their partner’s emotional and attachment needs.

Stage 3: Consolidation

Once deeper trust is established in the second stage, therapists will help couples navigate ways to more effectively communicate, which includes ways to better express their needs. Some level of conflict will always be a part of every relationship, but enhancing our ways of discussing old problems and disagreeing in the future is the key to reducing tension and building trust.  

Things to Consider 

While this applies to various therapeutic approaches, couples therapy can bring negative emotions to the forefront, particularly those that individuals have suppressed or been loath to confront for a long period of time.   Emotion-focused therapy, especially during relationship counseling, requires us to address difficult feelings, behaviors, and thought patterns head on. While this may feel vulnerable and at times even painful, it’s also best to do so in the presence of a trained mental health professional who can help process raw, emotional wounds in a healthy way.  
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How to Stop Fighting and Start Communicating with your Partner https://www.goodtherapy.org/blog/how-to-stop-fighting-and-start-communicating-with-your-partner/ 0097000ab67b0c5a8b85cbf3c1a79e06 2024-04-02T14:59:34+0000 Goodtherapy
Goodtherapy
“Stop fighting with each other and start fighting for one another”- Staci Lee Schnell  ...

GoodTherapy | How to Stop Fighting and Start Communicating with your Partner “Stop fighting with each other and start fighting for one another”- Staci Lee Schnell 

In a fight, there is a winner and a loser and most of us want to win.  So, if you are fighting with your spouse, and you are the winner, that would make them the loser.  Do you really want your partner to be a loser?  Wouldn’t it be better if your marriage was the winner?  If you stop fighting and start communicating with respect, you both win and more importantly, your marriage wins.  Communicating clearly and effectively with your spouse allows for a healthier and happier marriage.    It’s perfectly okay and completely normal to have disagreements and different points of view from your partner.  Having different thoughts and ideas, shouldn’t be a cause for a fight but rather a cause for good conversations, where both of you are heard and validated.  Validation is essential in honoring your spouse’s different opinions.  But how can you validate them if you aren’t listening to them?  Active listening can alleviate interruptions, misunderstandings, and heated emotions as well as promote being in tune with your partner’s thoughts and feelings.  

 The following is a communication tool to try out that promotes active listening and validation: 

Step 1: Partner A is the speaker while Partner B is the listener.   Partner A speaks, without blame, their truth, point of view, or issue.  Partner B listens without interruption. Feel free to take notes.  Step 2: Partner B says, “What I heard you say is…” and in their own words summarizes what they heard Partner A say.  Then Partner B says, “Did I get it right?”  Partner A answers “yes” or “no”.  If yes, Partner B says “Is there anything else?”  Partner A answers “Yes” or “No”. If no, it’s time for step 3.  If Partner A answers no to “Did I get it right?” they stay calm, they don’t get upset at their partner, they simply try saying it in a different way.  Partner B tries again with, “What I heard you say” and “Did I get it right?”  Don’t move on to step 3 until Partner B gets it right and Partner A has nothing else.   Step 3: Partner B now validates Partner A.  If an apology is needed, this is the time.  This step is about making Partner A feel completely heard and understood.  It doesn’t mean that Partner B needs to agree with Partner A, it merely means that Partner B shows their understanding of Partner A.    Step 4: Switch speaker and listener roles and repeat steps 2 and 3 in the new roles.  Step 5: Now that each has been heard and validated, come up with a plan of action.  The next time this happens we are going to do this…, this is the decision, and compromise we are making…, we can agree to disagree.  The above communication tool promotes active listening, which brings about a positive change in attitude towards each other. Instead of fighting, couples are communicating honestly and effectively with less defensiveness and anger.   Paraphrasing, summarizing, and clarifying allows for true validation.    Validation communicates to your partner that the relationship is important, even if you do not agree with the issue or issues at hand.  Mutual validation is essential in a healthy and happy relationship because each feels heard, valued, and understood.  Feeling validated by your spouse can help one to feel appreciated, and loved and that their opinions are worthwhile.   The timing of the above communication tool is truly important.  If one of you is feeling heated or flooded, take some time to calm down.  Take 10-20 minutes to reflect on your emotions and ask yourself some questions. Why am I upset? What am I trying to convey? What triggered me? How can I express myself clearly?  These questions will help you focus on what and how to say what has upset you, as well giving you the time you need to get calmer.    Make sure to not sweep the event, issue, or topic under the rug and not discuss it.  Don’t hold back to avoid conflict. That will only promote resentment for the unresolved issue or issues. Resentment can make one feel that the relationship is in a constant ill state. After 10 or 20 minutes, come back together and use the above communication tool. If the circumstances don’t allow for the conversation to be had right away, put a pin in it and revisit it as soon as possible. If you want you can set an appointment with each other to have the needed discussion.    Marriage Counseling can help couples clearly and effectively utilize the active listening and validation techniques described above. Couples Counseling helps to create a better understanding of each other, deepen emotional bonds, reestablish intimacy and trust, and overall improve your relationship and marriage.    
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