Romantic love can be all consuming. In the beginning stages of a relationship, one or both partners may be overwhelmed with feelings of affection for the other partner. Couples may want to spend all of their waking hours together and actually crave each other’s presence when apart. These feelings are not uncommon in many budding romances. However, when they persist and lead to unhealthy behaviors, this type of love can become destructive. Much like an addiction to drugs or alcohol, people who experience love addiction pursue their drug at the expense of their friendships, careers, family members, and even self-respect.

In a recent article, Dr. David Sack, a psychiatrist and addiction specialist, explains what love addiction is. He says that people who are in addictive relationships experience limerence, a term introduced by psychologist and author Dorothy Tennov to describe love obsession and dependence. Limerence mimics new romantic love, but unlike true love that constructively develops into reciprocal, mutual affection, limerence is usually destructive. When one partner exhibits limerent behaviors, they may begin to cross emotional and physical boundaries in order to secure the attention and affection they need. Even when the feelings are not returned, the limerent partner may continue to chase after the other partner. Sack says, “Behaviors may become dangerous, such as stalking or unwanted contact, and require outpatient or residential love addiction treatment, professional counseling, and/or 12-step work.”

Limerent relationships are not all bad. Although most end with one partner being rejected and hurt, some actually grow into healthy and mutually loving unions. Individuals who display limerent behavior in one relationship may continue to do so in future relationships, creating a pattern of destruction and disappointment. Sack suggests that individuals who believe they are involved in a limerent relationship, either by their own actions or those of their partner, work with a professional to identify the negative behaviors. Understanding the cause of the limerent patterns will help an individual become aware of why they behave the way they do and give them an opportunity to transform negative patterns into more positive and promising ones.

Source:
Sack, D. (2012, June 28). Limerence and the biochemical roots of love addiction. From the Huffington Post. Retrieved from http://www.huffingtonpost.com/david-sack-md/limerence_b_1627089.html

Related articles:
What to Look for in an Addiction Therapist, Part 1
(Don’t) Keep Coming Back

According to a recent article, being completely honest with your mate about infidelity might not always be the best strategy. Clinical Psychologist Bruce Stevens explained that understanding the need to be honest about the affair can help guide the decision whether to do so or not. Stevens has worked with couples for more than two decades and said that his experience has shown him that only about half of marriages survive after an affair has been revealed. He says, “After an affair is found out, it’s like a bomb has been dropped on the relationship and you cannot predict how it will go.”

When someone confesses to having an affair, it can create a sense of chaos unlike any other the relationship has ever experienced. Stevens knows that couples who put in the effort to work through the many issues that arise after the affair have a good chance of salvaging their relationship and usually have a stronger, better, healthier relationship because of it. Stevens says that many people admit to their affair in order to assuage their own guilt. He believes that this reason should not be the motivating factor for full disclosure. Stevens says there is no guarantee that both partners will be able to overcome the damage caused by the truth and thinks it’s almost like playing Russian roulette.

The good news is that Stevens also thinks that there is significant hope for couples who can be realistic after they go through the pain of discovering an affair. If both partners are willing to accept responsibility and recognize that they are both human beings, flawed and imperfect, they have a very good chance of moving forward in their life together. Regardless of whether partners choose to come clean about their infidelity or not, Stevens reminds us that affairs are like fairytales. They are illusions that allow us to temporarily escape reality. The difference is, affairs rarely end “happily ever after.”

Related articles:
Reasons for the Affair
When Is the Marriage Really Over?
The 5 Truths Every Married Person Needs to Know About Affairs

Religion has been shown to be a stabilizing factor for mental well-being. Research has demonstrated that people who have religious beliefs tend to have better mental health, physical health, and more satisfying relationships than those who do not have any religious beliefs. Religious individuals who seek therapy may look specifically for a therapist who is of their religious affiliation; however, many choose to work with secular therapists in order to receive an unbiased assessment of their psychological state. Because of this, it is important to understand how religious clients view the treatment they receive from secular therapists. Carrie L. Cragun of the Department of Educational and Counseling Psychology at the University of Albany in New York was curious to find out if religious individuals held negative or positive opinions of secular therapists and the treatment they provided.

Cragun recently reviewed assessments from 11 Christian individuals who had received therapy from secular therapists. She evaluated whether the clients reported their experiences as positive or negative and how religion influenced their reports. Cragun found that the majority of the clients reported positive experiences from the secular therapists. This was most often the result of working with a therapist who was open and willing to discuss religious beliefs. The therapists who were judgmental and less inclusive with respect to faith were seen as providing a negative therapeutic experience. However, when therapists explained that they were unqualified to discuss their client’s religion, the clients respected that response and still rated the overall experience as positive.

Religious beliefs play a significant role in the lives of many clients. This study demonstrates that many individuals do not feel comfortable initiating discussions about this important topic to therapists. “Results suggest that creating safety for clients to discuss their religious identity and beliefs could begin on intake,” Cragun said. “Therapists could ask about clients’ coping methods or specifically about religion and spirituality.” Providing an environment in which a client feels fully accepted regardless of religious devotion or ambiguity will set the stage for full disclosure in other areas. Cragun believes that the best place for this to start is when students are studying to become therapists. Learning about the importance of multicultural issues and how to integrate these issues into therapy will allow therapists to be more inclusive of clients from every ethnic and religious background.

Reference:
Cragun, C. L., Friedlander, M. L. (2012). Experiences of Christian clients in secular psychotherapy: A mixed-methods investigation. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0028283

Never underestimate the power of talking with someone who really listens.

Our culture doesn’t encourage people to talk about their emotional pain. Our culture teaches people to suppress their feelings. People tell each other not to “whine” about problems or not to “dwell” on them. People are told to “get over it” and to “be strong,” meaning “don’t feel anything—and if you do, don’t talk about it or show it.”

One example of this is when only certain emotions are deemed “appropriate.” Anger, especially for men, is more acceptable than sadness or anything vulnerable. So, for many men, emotions like sadness, loneliness, disappointment, anxiety, guilt, and shame get funneled into expressions that look like anger. Unhealthy coping mechanisms—such as using alcohol, other substances, or addictive activities—are taken up in order to push the genuine feelings down. These provide some temporary relief but, ultimately, undermine a person’s strength, health, and functionality.

Most people, when they feel upset, benefit by talking to someone who listens patiently, nonjudgmentally, empathically, and who shows that he/she understands at a deep level. There is something basic in the way human beings react when receiving this simple, but skillful, response to talking about their emotional pain.

Depression is no different from any other emotional pain, in this sense. [fat_widget_right]If everyone who felt depressed was comfortable talking about it to a good listener, we would have far fewer depressed people—possibly even fewer people on antidepressants.

Recently, a psychiatrist who was treating a friend of mine said that few people truly have a chemical imbalance causing their depression. Maybe this is why some research shows that antidepressants work about as well as placebos. Maybe the placebo works because the patients get some caring human contact before taking the pill. Human contact goes hand-in-hand with talking. We all need to see people smile at us, be warm toward us, perhaps even touch us in a friendly, appropriate way. Warm, caring human contact is essential for us to live and thrive.

Ideally, we would all have this in our lives without having to pay someone to get it. We would all have friends, relatives, spiritual leaders, mentors, teachers, or healers around to listen and care when we are upset. Yet our culture no longer supports this basic need. We are too busy. Many of us come from families who have abused us, or from whom we are separated. We often live alone, or have only our immediate family around. We are not connected to a church or community where this kind of talking may have been more available in the past. Instead we put value on the rational, over the emotional, to the extreme. As a result, many people end up trying to hide their tears and vulnerability, thus creating more alienation and isolation. Ironically, suppressing our feelings and being deprived of warm contact actually makes us more susceptible to depression, making people think they have even more to hide.

So if you are feeling depressed or in emotional pain, try to find someone you can talk to—someone who will listen deeply and without judgement. Talk to him/her about everything that’s seriously bothering you, and keep talking until you feel relief (even if you have to go through several people to have as much time talking as you need). If there’s no one in your life like this, and you don’t think you can find anyone, find a good therapist. It will help to do your talking with a highly trained, skilled, and naturally intuitive professional. You owe it to yourself to do whatever it takes to prevent depression, or deeper depression. It’s really so simple (though not always easy), yet so important.

Most classes of antidepressant medications, including the selective serotonin reuptake inhibitors (SSRIs), are thought to require 2 or more weeks of use before therapeutic effects become noticeable. The consumer guidelines for a drug like Celexa (citalopram) clearly advise patients not to expect immediate benefits but to continue taking their medication as prescribed. However, a recent study has cast doubt on the notion that SSRIs really take weeks to build up to therapeutic levels. If the results are confirmed with subsequent experiments, then our understanding of these medications will be greatly enhanced. Observing the neurochemical mechanism behind specific SSRIs will naturally lead to more beneficial prescribing patterns and better patient outcomes.

In a study of the SSRI Celexa, 26 participants were given either a single dose of the drug or a dose of placebo, a harmless sugar pill. None of the participants had depression, a fact which allowed researchers to study specific physiologic responses without interference. Three hours later, participants were shown images of frightened faces while brain activity in their amygdala was measured via magnetic resonance imaging. Psychiatrists have theorized that hyperactivity in the amygdala is a measurable effect of depression that places the individual in a constant state of heightened anxiety. In the single-dose Celexa study, participants given medication showed a muted response in their amygdala when viewing frightened or anxious faces. Researchers observed a spike in amygdala activity in those who received placebo. These findings demonstrate that potentially therapeutic effects begin as quickly as a few hours after the first dose of Celexa, and by extension any SSRI. Interestingly, none of the participants reported either a change in mood or unusual side effects. The study authors theorize that the action on the amygdala has both immediate benefits on an unconscious level and longer term effects on anxiety.

Depression is often described as a constellation of symptoms and effects. Because of its many manifestations, the disease is a long way from being fully understood. There is currently no fool-proof, one-size-fits-all treatment for depression. Research on antidepressant medications like Celexa helps us identify what’s happening in the depressed brain. Armed with that knowledge, we can tailor more effective medications in the future. The study under discussion, for example, highlights the possibility that Celexa’s beneficial effects begin with the amygdala, the brain’s primitive fear center. More importantly, these effects begin almost immediately, contrary to previous assumptions.

References
Murphy, S., Norbury, R., O’Sullivan, U., Cowen, P., Harmer, C. (2009). Effect of a single dose of citalopram on amygdala response to emotional faces. British Journal of Psychiatry, 194(6), 535-540.

Therapy as a sacred ritual might sound a bit pompous to some. After all, therapy is often considered something of a “have to,” not a “want to.” I would like to consider that therapy is something other than a way out of struggle, depression, and pain. My clients teach me each week that something beautiful is explored, born, or manifested in our weekly get-togethers. As they make their weekly voyage to therapy, they pledge to themselves the opportunity to discover the full range of their experience.

Like a good cup of coffee in the morning, therapy is like a morning jog-so-you-can-get-going kind of ritual. Whether writing morning pages in our journals to scribe our thoughts, or pulling the garden vegetables from the earth for tonight’s dinner, therapy has its place in our lives. It is like sacred nourishment for our soul. It is a commitment to understanding ourselves more intimately, completely, and thoroughly, by doing our weekly sit-in with our therapist.

As my clients cross the threshold of becoming, I see the meaning therapy has become to them and the rituals that they encounter.

Setting the Stage
Upon making the first appointment, it has begun. The ritual begins with a friendly, “Hi, how are you.” The client’s “call” embarks on finding a therapist who will see, feel, and hear them most authentically. They seek to connect their experience with someone who will honor and embrace them. Testing the waters, they may begin with a brief explanation of their story in a “give and take” sort of fashion until a connection is made. Upon feeling a spark, the conversation deepens, which consummates an appointment. This reciprocal dance begins the sacred ritual of setting the stage of meeting, time, and place.

Entering Sacred Space
After arriving, entering the room, closing the door, and with sacred agreements signed, both the client and I begin entering into the depth of what will be shared and discovered. While sitting in front of me and releasing the tension, the client intimately begins the next ritual. The sacred opportunity to be fully seen, heard, and felt has begun. Time and space become a blessed opportunity away from tiring commitments, chores, and obligations. There is sacredness in saying the unsaid and feeling the unfelt before me as their therapist. A trust begins to unfurl as the holy journey to revealing and expanding is explored. Highs and lows, struggles and gains, celebrations and sorrows are all fruit for the harvesting. As my clients explore the depths of their experience, I enter my role of providing safety, empathy, and challenge. Each week, building on the last session, the client and I meet with a greeting and enter into sacred space.

Bridging the Gap
Often clients enter therapy with some blockage to unravel, relationship to untangle, or goal to achieve. As we work through the existing sludge to get to the other side of their desire, I notice that my role vacillates among many. The roles of mentor, educator, and guide work many vantage points to include inner-child work, adult development, and familial understanding. The gap of our work together contracts and expands as we discern emotional terrain, physical symptoms, and insight. Weekly, as we deepen, each of these becomes a sacred practice. Commitment to healing, commitment to knowing, and commitment to discovery become not only tasks, but a revered journey. Our deepening relationship begins to transform, soften, and deepen. There is a sacredness in the reciprocity and trust which now gather their place at the altar of unfolding.

Packing Up
As the merger of relationship between the client and therapist expands and deepens within the context of an hour, there must be time to choose the “take with” nuggets of insight and knowledge gained. Much like camping in the park, we sort through, pack up, and continue our journey back to the familiar. Reflecting, we ponder the sacred meaning of this particular hour. The client and I ask ourselves, “What did we learn?” We take a look back and gather threads of awareness and pieces of clarity as we seek to create meaning of this experience. Moments are given to encapsulate the importance of the discovery by way of closing statements, new visions, and take-home assignments. As the hour quickly ends, the door opens and we say our goodbyes. The sacred journey ends and begins with hope and uncertainty as we look forward to unfolding, yet again, what is to become of our meeting together.

Related articles:
Healing Through Expressive Arts Therapy
Therapy for Self Growth

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

Families need to be together. After all, the family as a group exists to provide support, nurturance, food, shelter, resources, and a stable future to each member. While most families have their ups and downs, even stressed, impoverished, chaotic families want to live with one another. When is it in the family’s best interest for members to separate from one another? Can leaving the family home for a short while ever bring healing to the relationships in the long run?

Family separations occur in American culture in formal and informal ways. Formally, families can legally be ordered to separate by the courts because of domestic violence, child sexual, emotional, or physical abuse or neglect, chronic drug or alcohol abuse, and/or failure to educate and when there is a threat to the life, health, and well-being of one or more family members. Typically, less-intrusive assistance has been attempted at many levels before a court order occurs, including weeks or months of child-centered school counseling, family therapy, marriage counseling, social work support, addiction treatment, spiritual community support, or elder advocacy.

All of these actions occur at local, county, and state levels because we as a society believe that we have a stake in supporting and sustaining healthy families. State laws vary but generally have been written with family reunification as the end goal of this intervention process, wherever possible. Violent fathers, neglectful or addicted mothers, and abusive siblings can and often do change and grow into healthier, happier parents, spouses, siblings, and grandparents. We want families to get along well and have what they need to contribute to the world. No one benefits when families are so chaotic and dysfunctional that it takes dozens of people and thousands of hours and dollars to try to help.

[fat_widget_right]More informal separations occur every day, particularly among highly distressed married couples. Unable to live in the same home without physical or emotional pain, one member of the couple leaves the home temporarily and lives elsewhere. Unlike a formal, legal intervention of family separation, this kind of separation is less likely to change the marital interactions at all. What it usually does is create less fighting and conflict in the home, while increasing the stress of the separating spouse and any children in the family. The only person who may feel any relief is the remaining spouse, and this relief is generally temporary. The focus is shifted to the dozens of life details that, once shared, have to be renegotiated, from grocery shopping and bill paying to getting a child to baseball practice.

Unless a separated couple gets professional support and assistance immediately, the family begins to reshape around the absence of the separated parent. Children feel neglected and forgotten, no matter how diligent the separated parent is in spending time with the children. There is just no adequate substitute for living together, and the children’s behavior often suffers. The couples will simply shift their conflict away from one another in the short term and have no real plan of action for getting everyone back together. Because separation only tones down conflict and doesn’t solve it, I almost always suggest that separated couples who want to remain married work at getting back together as soon as possible, and always with professional family or marital therapy. If this is not the chosen path, statistics predict this couple will end up divorcing.

Separation is often a necessary choice when family behaviors become violent, abusive, or dangerous. But in nearly all cases, families should be helped to heal and reunify as soon as possible. Separation is not the best course of action unless it is the only course left for health, safety, or stability’s sake. Every one of us needs to feel like we belong and to be part of a group of people who know, appreciate, sacrifice for, and value us most of all. At our best, these are our families. It’s worth the effort to make them as healthy, whole, and loving as possible.

Related articles:
Three Truths Every Couple Needs to Know About Marriage
Want Family Therapy? These 4 Problems Should Be Treated First
Harness the Power of the Marriage Bond

“Immediacy is the act of discussing in the here-and-now how the therapist is feeling about the patient, about himself/herself in relation to the patient, or about the patient-therapist relationship,” said A. Jill Clemence of the Department of Psychiatry at Albany Medical College. Immediacy has been shown to be a critical component of the therapeutic alliance and can have a significant impact on the client’s ability to process emotions. “Immediacy is also conceptualized as a potent technique for managing an alliance rupture, for moving beyond a patient’s defenses, and for providing emotional support,” said Clemence, lead author of a recent study highlighting the effects of in-session immediacy.

Previous research has shown that clients respond better when a therapist readily identifies a disturbance in the therapeutic relationship and addresses it in a positive way. However, few studies have looked at immediacy as it occurs. “Because the act of disclosing alone is insufficient for facilitating change, the ways that timing, tact, and competent delivery of immediacy interventions impact the patient’s ability to process affective material and deepen personal exploration requires further investigation,” Clemence said, explaining the motivation for her study. Using the Therapeutic Environment Scale (TES) and the Therapist-Patient Interaction Rating Scale (TPIRS), Clemence examined the effects of immediacy in a session between a therapist (Dr. V) and client (Alice) as it occurred.

“Immediacy, when used in an active and acknowledging way by Dr. V, was found to deepen Alice’s exploration of affective and interpersonal material,” Clemence said. The alliance was ruptured from the onset, and when Alice’s attempts at immediacy were ignored, it worsened. “However, when Dr. V actively engaged Alice using immediacy during a later segment of the interview, this appeared to move the pair out of rupture and into a more effective working alliance.” Clemence added, “The ability and willingness of the interviewer to engage the patient on an affective level in active discussion of the here and-now relationship may create the opportunity for building a positive alliance and furthering exploration of relationship themes in the moment.”

Reference:
Clemence, A. J., Fowler, J. C., Gottdiener, W. H., Krikorian, S., Charles, M., Damsky, L., & Johnson, B. (2011, December 19). Microprocess Examination of Therapeutic Immediacy During a Dynamic Research Interview. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0026090

As a companion piece to the 50 Warning Signs of Questionable Therapy article, it’s important to understand there are many signs of good therapy as well. After all, good therapy has been proven to help people from all walks of life, in thousands of different situations, and in countless ways.

Good therapy is all about helping the person seeking help to feel better, to make healthy decisions and set healthy boundaries, to move from a place of poor emotional health to good emotional health, to make connections with others, and to replace sadness, anxiety, anger, and frustration with happiness, peace, and hopefulness for the future.

Because the “Warning Signs” article is so focused on the therapist and the behaviors they engage in—or don’t engage in—we wanted the “50 Signs of Good Therapy” to put the focus on the person in therapy, which is exactly where it belongs.

While the “50 Warning Signs of Questionable Therapy” is structured in a list format, these 50 signs of good therapy are structured along thematic lines.

Themes include:

• Training/credentials, experience, and professionalism
• Informed consent and other legal issues
• Communication and client focus
• Empathy and the therapeutic relationship
• Progress

Below is a listing of the 50 signs of good therapy, placed in order by theme:

Training/Credentials, Experience, and Professionalism

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Most states and other municipalities require that therapists or counselors meet specific education and training requirements. Though these vary from location to location, all therapists must be educated, trained, and must follow basic professional codes of ethics and guidelines. The foundation for good therapy exists when:

1. Your therapist is trained appropriately and meets all local and/or state guidelines for providing therapy.

2. Your counselor seems competent and experienced enough to help you with your issues and does not appear overwhelmed by them. While it is possible you may see a counselor who does not have the training or experience to help you with your problems, they should always let you know if that is the case.

3. Your therapist explains the therapeutic process and how you can benefit from it, without guaranteeing your success or promising that “everything will be okay.” The bottom line is that no one can make such guarantees—neither the therapist, nor you.

4. Your counselor always maintains professional business practices by keeping the focus on you. They prepare ahead of time for your sessions by reviewing notes or action items from previous sessions. They keep your appointments; are generally on time; and demonstrate they are paying attention by not answering their phone, checking their email, or otherwise becoming distracted during your sessions.

5. Your therapist provides a diagnosis if necessary but remains steadfastly focused on helping you to manage any such diagnosis and get better. The diagnosis remains the backdrop for therapy, not the focus of it.

6. Your counselor understands and communicates to you that there are many effective approaches to therapy, and no one approach can meet the needs of every client. They model open-mindedness about other approaches to therapy.

7. Your counselor explains what psychotherapeutic technique they plan to use, welcomes and answers any questions you may have about a specific technique, and requests your comments for any technique that may be new or different for you.

8. Your counselor is active in the therapy community and regularly interacts with other professionals. It is this regular collaboration with other professionals that keeps your therapist current and able to provide the best therapy for you.

9. Your counselor provides insight and knowledge that you otherwise might not have seen. This insight clearly comes from experience and training.

10. Your therapist maintains a good balance between your thoughts and your feelings without neglecting or diminishing either one.

11. Your counselor always demonstrates a balanced and appropriate level of emotion during sessions. Because good counselors are empathic and genuinely care for their clients, sometimes they express emotion when learning about a client’s experience. For example, if the client has experienced the loss of a loved one, the counselor may show sadness. While some emotion is appropriate, an abundance of emotion is generally not okay. Good therapists maintain their focus on you and not their own emotions.

12. Your therapist helps you to work through highly vulnerable feelings or memories in a safe and therapeutic way that does not re-traumatize you. Because of your work together, they know when it is safe to deal with these feelings or memories and when it is not. They neither push you to “go there” nor do they prevent you from “going there.”

13. Your counselor has also experienced being in therapy. Many counselors choose this field because they’ve had positive therapy experiences themselves, and they want to do the same for others. For those who have not experienced therapy prior to entering a counselor education program, most curricula require counseling students to participate in therapy, even if briefly so. This allows therapists to understand therapy from the client’s perspective.

Informed Consent and Other Legal Issues

The term informed consent is common among therapists. It simply means that the client should be made aware of any and all benefits and risks of therapy or a particular treatment or technique so that he or she may make the best decision about proceeding with the therapy. Informed consent is often a legal requirement as well, and these next few signs of good therapy are specifically about informed consent and other legal issues. The foundation for good therapy exists when:

14. You receive a packet, commonly called intake forms or informed consent, to complete before or with your first appointment. This packet should explain how therapy with your counselor works, what your rights are as a client, the fee schedule, insurance information, privacy information, and more. Your therapist should also answer any questions about this packet to your full satisfaction.

15. Your counselor explains to you that therapy is always your choice. They should make you feel comfortable with the choice to discontinue therapy or to choose another therapist. Some people decide to leave therapy before the counselor thinks it is healthy to do so, and your therapist is obligated to express any concern if you opt to discontinue therapy before the therapy has been “completed.” However, this concern should not make you feel as if you don’t have the choice to leave.

16. Your counselor maintains your confidentiality at all times. While there are some occasions when it’s necessary for a counselor to break confidentiality, these are typically outlined very carefully in the state’s or other municipality’s legal and ethical guidelines for counselors. Though the guidelines vary depending on where you live, generally speaking, a counselor can divulge the contents of a therapy session or sessions if the client or another person appears to be in imminent danger, or if the court requires information for a legal proceeding. You may want to check your own local and state guidelines.

17. Your counselor maintains the confidentiality of other clients as well. While your counselor may tell you anecdotal stories of other people’s experiences with counseling if there is a therapeutic value to you, they should never reveal the identities of other clients or give you any information that would allow you to identify them.

18. Your therapist responds openly and honestly to any questions you may have about complaints filed with the licensing board. We recommend that you always check with the licensing board to make sure your therapist’s license is current and that there are no unresolved issues.

Communication and Client Focus

Effective communication and the relationship between you and your counselor are probably the most important and indicative factors in whether or not your therapy will be successful. While everyone has different communication styles, it is the counselor’s role to be clear throughout the counseling process. A key part of effective communication is the focus of the counselor—which should always be on you. The foundation for good therapy exists when:

19. Your counselor explains right up front how they can help you. They give you concrete examples of what they will do, what you will need to do, and how you will know the therapy is progressing.

20. Your counselor regularly checks your progress against your goals and helps you to understand where you are and where you may still need to go.

21. You feel a connection with your counselor that shows they really believe in you and in the goals you have set for your life.

22. Conversations with your counselor seem natural and balanced. They neither talk too much nor too little. They use terms and language you understand and explain any concepts that may be difficult or confusing.

23. Your counselor helps you to see your own role in your level of happiness and recognizes that, while some people in your life may influence you negatively, blame is a destructive force and cannot be part of healthy choices.

24. Your therapist balances the day-to-day needs of managing your symptoms using effective coping skills with the need to work through and resolve the underlying root causes of those symptoms. By focusing on both, they are better able to help you progress and move forward than by putting all therapeutic attention on one or the other.

25. Your counselor models the behavior they are trying to help you with. They are thoughtful with comments and responses. They remain calm and speak at a moderate volume and are not antagonistic or aggressive with you.

26. It is clear that your therapist’s sole purpose is to help you—without focusing on meeting their own needs, talking excessively about themselves, disclosing personal information that does not hold some therapeutic value for you, or enlisting your assistance with anything that is outside the purpose of helping you.

27. Your counselor recognizes they may not have all of the answers or be able to help you in some circumstances. They freely acknowledge any mistakes, welcome your honest feedback, and use these as learning experiences in order to better help you and understand your needs in the future.

Empathy and the Therapeutic Relationship

Empathy, or being able to “put yourself in somebody else’s shoes,” is a hallmark of good therapy. And therapists are often naturally empathic, as this is one of the common reasons they choose to be therapists in the first place. Demonstrating empathy within the therapeutic setting helps the client to feel safe, to feel understood, and ultimately to feel like they can make progress.

Empathy is what helps build a relationship with your therapist. And your relationship with the therapist is key to the success of therapy itself. Without a strong relationship, the therapist has little chance of genuinely helping the client work through difficulties, and the client has an equally low chance of progressing.

A number of the warning signs refer to a “dual relationship,” which is quite simply one where the client knows the counselor in another context or setting besides the counseling environment. This secondary relationship can cause confusion for the client, which is why it’s typically an ethical issue. Good therapists maintain a productive and professional relationship with you at all times. While the relationship with your therapist can seem quite close—after all, you are sharing your most private thoughts, sometimes over long periods of time—therapists are trained to manage this closeness and not cross the ethical line of becoming friends or romantic partners. The foundation for good therapy exists when:

28. Your counselor maintains a professional relationship with you at all times.Their demeanor could be friendly, but they never depict your relationship as a friendship.

29. Your therapist treats you as a “whole person,” an equal who is not defined by your issues, and does not make negative judgments about you. You feel genuine care and concern from your therapist. One of the hallmarks of good therapy is known as unconditional positive regard. This is an idea that is taught in counseling programs across the country; it maintains that the therapist should see clients in a positive light regardless of any behavior, lifestyle, or other issues.

30. Your therapist is respectful of your values and belief systems and does not exhibit an agenda founded on personal values or belief systems. They are sensitive to your culture and religion and use aspects of these as part of your therapy, when appropriate. If they lack knowledge about your beliefs, they ask questions in a respectful way to gain better insight.

31. Your therapist knows you well enough to understand any physical boundary issues you may have and does not “move into your space” or touch you without asking if it’s okay with you.

32. Your counselor empathizes with you at an appropriate level, such as a natural or fitting response or level of emotion to your life’s experiences, and not one that is either overdone or exaggerated, or flat and almost nonexistent.

Progress

Finally, your progress in therapy is the ultimate indicator of whether or not you are receiving good therapy. After all, regardless of how competent or skilled your therapist may be, you getting better is what really counts. Before we get into the final list, it is important to note that just because someone is not making progress doesn’t mean the therapist is bad or incompetent. Therapy by its very nature is highly subjective and influenced by the varying needs, readiness, and styles of both the client and the therapist. Sometimes a client may not be ready for therapy and sometimes the therapist and the client are not a good fit.

With regard to the changes listed below, it should be mentioned that they don’t usually happen all at once; instead, they often happen gradually and in different sequences. The foundation for good therapy exists when:

33. You feel better! You notice that you are happier, calmer, at ease more often, and more hopeful about the future.

34. You are resolving your own issues and not looking to your therapist or anyone else to fix things for you. A good therapist guides you to your own best solutions. They are not “rescuers” who are there to save you from the issues you are facing. Instead they help you achieve insight into your own thoughts, feelings, and experiences so that you can make the right choices for yourself and move toward a healthier emotional state.

35. You handle life’s ups and downs more easily and with more control over your emotions. You see the difficult times as part of life and are less likely to become overwhelmed by them.

36. You are more forgiving and accepting. You are seeing those around you, including those who may have hurt you, as humans who may have simply made mistakes just as you have.

37. You are more connected to yourself and your own emotions, to those around you, and to life in general. You look forward to living your life and not just moving through it.

38. You are beginning to see things differently. Your perspective on life and everything around you is changing, and you see solutions where you may have seen problems in the past.

39. You are making different choices and looking at your own needs more often. You recognize that you have choices you didn’t used to think you had.

40. You smile or laugh more; your whole demeanor is more positive and future-focused.

41. Other people are noticing differences in you, and they are beginning to react to you in different and more positive ways.

42. You are getting along better with the other people in your life—from your friends and family members, to your coworkers, to strangers you come across on a day-to-day basis.

43. You have more hope for a brighter future for yourself and for your loved ones.

44. You have some sort of plan or goal for what you want your life to be, and you’re working towards that goal.

45. You are setting healthy boundaries with the people in your life and actually building stronger relationships because of it.

46. You notice that you’re feeling better outside of the therapeutic setting and not just while you’re talking to your therapist.

47. You feel safe both emotionally and physically.

48. You feel important, competent, and significant in the lives of those around you. You know you have value to them and to yourself.

49. You feel stronger and better able to express your own needs and desires. You don’t feel victimized by the actions of others.

50. You are making your own healthier choices for your behavior, for your thoughts, and for your feelings.

Hypnotism can be a useful and versatile tool for addressing sexual concerns, including several types of sexual problems (such as non-medically caused erectile dysfunction and low desire) and negative body image, shame, and sexual inhibitions. Hypnotism can help discover and correct inner obstacles to sexual health and pleasure. As a skill set, hypnotism is used in a complementary way by many types of helping professionals. Hypnotism also provides the foundation for a growing group of professional practitioners variously known as consulting hypnotists and hypnotherapists.

I spent a good portion of 2011 working on a doctoral project related to this topic. The literature search was extensive, fascinating, and deeply frustrating. Part of my frustration had to do with the strange history and frequently tarnished reputation of hypnotism, which has created a number of public and professional myths and misconceptions. Another complication had to do with the diversity of practitioners who use hypnosis to address sexual problems; licensed therapists (and sex therapists in particular), clinical sexologists and sex coaches, professional hypnotists and hypnotherapists, and a wide variety of erotic hypnotists (professional and amateur) have all found human sexuality to be fertile and often lucrative terrain. This meant that my literature search ranged from peer-reviewed articles in journals, to popular “how to” erotic hypnosis books, and everything in between. While I labored on my project, I found myself thinking that one lifetime would not suffice to understand it all. The history and use of hypnotism for sexual concerns is that broad, that deep.

What does stand out is the efficacy and promise of hypnosis in this area. This is supported by numerous peer-reviewed articles, as well as books by authors and practitioners such as Dr. Daniel Aroaz, who has became a tremendous guiding light to me.

Another thing that stands out is the almost universal lack of training in the specialty I’ve come to call “sexological hypnosis” – the application of hypnotism to sexual and gender concerns. My concept of sexological hypnotism is based on the triple-pronged idea that:

• (1) more therapists, counselors, and other licensed professionals should be trained in sexology (a multi-disciplinary study of human sexuality, which includes but is not limited to clinical considerations)
• (2) more therapists, counselors, other licensed professionals, and sexologists should be trained in hypnotism
• (3) more consulting hypnotists and hypnotherapists should be trained in sexology, human sexuality, and gender studies – particularly those who want to offer hypnosis for sexual problems.

However, there are no comprehensive programs which specifically address the application of hypnotism to sexual and gender concerns. The one hypnotism school I found which includes sexuality courses in its curriculum was founded by a man (now deceased) who believed that most women don’t have an orgasm – they have a “climax” – and that “ethnic sexuals” are distinctly different than non-ethnic sexuals (whatever that means!). In other words, discredited ideas and inaccurate information is likely still a part of this school’s curriculum, as the books are still published and sold without revision. (Incidentally, none of these books cite even a morsel of research or contain a bibliography or list of sources – however dated!) Hypnotists trained in this school get something worse than no sexuality education at all – they are sold an old “clunker” when they rightfully deserve a Ferrari. Clients may suffer as a result.

Up-to-date, comprehensive training in human sexuality is crucial because people whose understanding of human sexuality is limited to their own experience (or a few books or workshops or outdated programs) may have a skewed perspective on the bigger picture of adult, consensual diversity. Such practitioners may pathologize or misinterpret any behavior or expression that seems out of the ordinary to them. This is a disservice to clients who seek assistance with sexual or gender concerns. Issues of erotic or gender authenticity – so crucial to sexual health and well being – may not be acknowledged, let alone addressed, respected, and supported.

I would like to see more real training and expertise in this area. In my doctoral project, I designed a 150-hour certificate course capable of delivering the triple-pronged training that I wish already existed. In 2012, I hope to teach the entire program, in addition to the partial courses I now offer online through Creative Sexuality and Sex Coach U. As a dual practitioner, I’ve experienced the value of combining clinical sexology with hypnosis and believe that my clients are generally well-served as a result.

Related Articles:
What Do Your Sexual Fantasies Mean?
An Introduction to Clinical Sexology
An Introduction to Holistic Psychotherapy

We all have this wall around us. It is a very defined wall that protects us from harm. At times, it prevents us from opening our eyes to something we might benefit from, but don’t necessarily want to hear. Resistance within us is very thick and it gets even thicker as we move along in our daily lives. Our routines become redundant, predictable, and too comfortable until we become unknowingly complacent. We feel there are no other alternatives, and feelings of sadness, disappointment, and annoyance creep in. These emotions seem to stick around no matter our efforts to entertain ourselves—be it with friends and outings or any extracurricular activities. Many times alcohol, gambling, and other mood-altering substances take the place of healing, as a means to self-medicate—a means to escape the vicious cycle we have created.

When we finally reach rock bottom—which varies for each person—things can go one of two ways: seeking help or staying stuck. Even when reaching out for help, we’re still separated by that wall of resistance: the old, familiar ways of thinking. In order to begin breaking old patterns, we need to learn to listen, to allow the information to penetrate even though we may feel extremely uncomfortable (especially if it challenges our beliefs and comfort zones.) It is then, when we listen and process the information and perhaps attempt to allow different alternatives to seep in, that our resistance lowers. Seeing and thinking differently is an essential tool to resume life with a new vision and attitude.

Whether advice comes by request or unsolicited from friends, relatives, or a therapist, the best suggestion is often the one that makes you feel the most uncomfortable. It’s the one that will lead you to your destination of choice. Having short- or long-term goals is important, but the time frame in which they occur is not. It’s the route you take that makes a difference.

The route consists of your behavior, meaning the steps you take; not the old familiar actions, but the new actions that stimulate you, challenge you, and lead you in directions you haven’t yet traversed. So, in essence, we still carry the protective wall, but it’s more flexible, adjustable, and creative. At all times we are in full control of our emotions, thoughts, and behaviors. All we are doing is choosing to make different choices, implement new behaviors, and allow new feelings to formulate and flow within us.

[fat_widget_left]In a nutshell, the paragraphs above describe individual therapy/counseling. Typically, therapy is something one seeks when in need, not when in want. The outcome is usually extremely rewarding, as you have done the work yourself, and you have not given up. In essence, therapy is about never giving up on your better self; thus it’s called self-growth!