When a person is in need of an organ transplant, a process referred to in medical circles as a “transplant work-up” begins. This process is lengthy, as it is necessary to make sure the person is medically and psychologically fit for organ transplantation. Often, a social worker who works with transplant cases will conduct the psychological evaluation to identify any mental health issues the person may have that warrant consideration, as well as take stock of the emotional support network currently in place.

Typically, the emotional support network consists of family, friends, and the person’s transplant team. The transplant team includes doctors, nurses, and social workers. During the transplant work-up process, at the time of the transplant, and immediately after transplantation, the person has access to potentially dozens of people who can provide emotional support. The emotional support provided is almost ’round-the-clock if the person is hospitalized while waiting for transplantation. If the person is stable enough to remain at home while waiting for transplantation, they are in and out of doctor’s appointments so frequently that they, too, have consistent access to emotional supports as part of ongoing care.

[fat_widget_right]

What happens after organ transplantation? In the year following the procedure, the person continues frequent visits to doctors’ offices and the hospital for invasive check-ups to control for rejection and illness, as the person is immuno-suppressed. These frequent visits allow for continued access to professional emotional supports. However, as the person begins to improve physically, the appointments steadily decrease and may decline to as little as once per year. With this decline in physical check-ups, the person gradually loses ready access to professional forms of  emotional support. The transplant social worker is constantly working with new patients, and the cycle continues.

Organ transplant recipients may not have identifiable mental health issues pre-transplant, but lifestyle changes, medications, and immuno-suppression—necessary for the organ transplant to be successful—can take a toll mentally. Transplant patients can experience depression, anxiety, grief, survivor’s guilt, and other concerns. Sometimes, life becomes much more difficult after transplant due to unforeseen complications, job loss/change, loss of insurance, and a shift in caregiver roles. Sometimes, people are not able to do the work they once did. Transplant recipients may not be accustomed to a daily medication routine.

How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Post-transplant, people may become hypercritical of their own thoughts, feelings, and behaviors, especially if those thoughts, feelings, and behaviors do not align with the “gift of life” ideology commonly associated with transplantation. How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Person-centered therapy can help transplant recipients by giving them more control, with appropriate guidance. Transplant recipients have not had control over their illness or their treatment. Person-centered therapy can help by allowing the transplant recipient to process their experience and develop a more cohesive sense of self.

The genuineness, unconditional positive regard, and empathic relationship that is the nature of person-centered therapy can allow for deep healing among transplant recipients. Each transplant recipient has a unique experience to share. Some have been sick for years, some caught a fast-acting virus while on vacation abroad. Some are young, some are not. Person-centered therapy encourages the individual to choose the topics discussed in session, navigate and find solutions to their concerns, and decide how often to meet and when to stop therapy. For many, it’s the first step toward regaining a sense of agency in their lives.

I’m so impressed with you! First of all, in spite of your fear of being judged, you have taken the very courageous step of writing in with your question. Second, it sounds like the daydreaming and fantasizing have served as a very adaptive behavior—you have been able to get some relief from the depression and low self-esteem by escaping into your imagination. Unfortunately, it seems like this coping strategy has taken on a life its own and become somewhat of an impediment to your ability to function in your daily life.

In some ways, what you are describing isn’t completely dissimilar to how substance-abuse issues can develop—someone is in discomfort, seeks relief in alcohol or drugs in order to escape the discomfort, and ultimately comes to depend on the substance to an extent that it interferes with life. That said, one critical difference between what you are describing and substance abuse is that there is quite likely some real value in what you are using to escape. Most successful people begin their journey toward success by imagining it—they dream about their success and then they begin creating goals (and working toward them) that will move them toward their dream. I suspect that the life you have created in your imagination is closer to the life you desire than your actual, current life is. If my suspicion is accurate, then it makes sense to do what you can to start moving toward the life you have imagined for yourself.

Given your struggles with depression and self-esteem, you might be thinking: easier said than done! This is certainly true, but it does not mean that it is impossible to live a life closer to the one you imagine; it simply means that you need to get treatment to address the depression and self-esteem. Right now, these issues might be all that is keeping you from working on making your fantasy life a reality.

This brings me to your fear of disclosing your fantasy world to a therapist. First, there is no shame in the fantasy life that you have created; in fact, I believe it will ultimately serve as a road map to move you to the life you have been dreaming about. However, if you are still feeling anxious about sharing this world with a therapist, know that you don’t have to in a first, second or even third session. In fact, I would say if disclosing it is so anxiety provoking that it is preventing you from seeking treatment, do not disclose it until you are confident that you have a trusting, therapeutic relationship with a therapist. Sometimes when people disclose too much before a really strong working alliance is established, they feel exposed and vulnerable to an intolerable degree and they leave therapy prematurely.

You can avoid this by finding a therapist who you believe could be a good fit for you and setting up an initial session. You might even set up an initial session with a couple of different therapists and see who you feel most comfortable with. Once you believe you have a good match, work on building a strong therapeutic relationship and when you feel ready, open up about your fantasy life. As the depression and self-esteem issues begin to be addressed and you open up about your fantasies, you just might find that these very fantasies will become your road map and your therapist will serve as a supportive guide as you follow the map to your dreams.

All my best,
Sarah

You sound deeply frustrated, and understandably so. You’re feeling pulled between a very important friendship and your educational/professional goals. That is a very tough spot to be in.

I’m curious to know if you have tried to talk to your friend about this. It seems to me that maybe you have not, since you indicated that you “don’t want to mean and tell her to knock it off.” If you haven’t yet spoken to her, I would encourage you to think about doing so. It isn’t “mean” to let a friend know what you need. Consider what you might want if the roles were reversed. If your behavior was making it difficult, or even impossible, for your friend to achieve something that was important to her, wouldn’t you want to know? You wouldn’t want to hinder the pursuit of her goals, would you? And if she was courageous enough to be honest with you, I imagine you would adjust your behavior and support her efforts.

Let her know how much you value her friendship and explain that, because you value it so much, you need to be honest about something that has been troubling you. Your assurance that she is important and valued might mitigate any rejection she feels after being asked to back off a little. Hopefully, she will respond by hearing you out and adjusting her behavior to be more supportive of your goals. Your requests are reasonable and appropriate. The worst-case scenario is that she doesn’t understand where you are coming from, takes your request very personally, and chooses to end the friendship. If your very reasonable request evokes such an unreasonable response, it might be time to question the quality of the friendship. If you can’t ask your best friend for support in achieving your goals, then how strong is the friendship? You probably know her well enough to predict how likely this worst-case scenario is.

You might also want to ask yourself why her needs seem to be more important than yours. Is this something that comes up often in your relationships? Do you have a tendency to put the needs, desires, and feelings of others over your own? Is this behavior detrimental to you? If you answered yes to those questions, it might be a good idea to work with a therapist on these issues. It’s possible that an underestimation of your self-worth might be impacting many areas of your life, and a therapist could be invaluable in helping you sort these things out.

Gathering the courage to talk to your friend and/or find your own therapist might take some time, and it seems like you might need some tangible solutions right now. From your brief note, I’m not clear on whether your work is academic or professional, or whether you work in an office or elsewhere. Either way, it might be useful to find some other location to do your work. For example, if this is happening in a college dorm room, try going to the library or a study lounge to do most of your work, and make plans to meet up with your friend after you finish working. If this is happening in a work setting, try working in a conference room or putting some headphones on at your desk to discourage chit-chat. You can still plan to have lunch together or spend some time together after work.

Finding a balance between work and relationships is a challenging task, but it is one that most of us have to deal with at various points in our lives. While this situation may be a bit overwhelming at the moment, it is also an opportunity for you to figure out what strategies work best for you in attaining this balance. You can add what works to your toolbox for the future and toss strategies that don’t work.

All the best,
Sarah

As marathon runners pass mile after mile, many reach a point where they suddenly feel that they cannot go on. They may feel an unimaginable weight come over their body, a depletion of mental and emotional resources so complete that they can’t imagine taking another stride.  They have “hit the wall.”

A similar phenomenon can occur in therapy. You may enter therapy with the commitment and determination of a runner who has just begun to train for a marathon. Then, just as suddenly and inexplicably as a runner hits the wall, you may, at some point, feel unable to move forward in therapy. You may feel like you have painstakingly explored each and every issue that brought you into therapy, but that your life has yet to change and you are no better equipped to make decisions or take actions than when you entered therapy. You have “hit the wall” in your therapy work.

It is important to acknowledge that things likely have changed for you—the changes just might not be dramatic or easily noticeable.  Say, for example, you entered therapy because you feel a great deal of loneliness and have trouble maintaining relationships. After a few months in therapy, your loneliness has likely decreased somewhat, simply as the result of having a solid and stable relationship with your therapist: a relationship that you are maintaining.

So while you still may not have an intimate partner to go home to on a daily basis, you may feel a bit less lonely and might have developed some new relationship-building skills. This kind of progress may seem quite small and insignificant, but it represents the necessary foundation for achieving the ultimate goal of developing healthy, fulfilling and lasting relationships. The question then becomes: how can you break through this wall and continue making progress towards your goals?

First, talk to your therapist about your frustration with therapy. You won’t be the first person who has expressed frustration with the process and you won’t be the last. A good therapist is not going to take this personally or be offended; they will view it as a natural part of the therapy process. This conversation creates an opportunity for you and your therapist to explore the smaller changes that have occurred and put them into the context of the bigger picture. This may be enough, in and of itself, to get you moving again and break through the wall.  If it is not, your therapist may be able to suggest some different interventions that can be effective in moving therapy forward.

One such intervention might be bibliotherapy. Your therapist could suggest a book that might be useful to you, then, in subsequent sessions, explore your thoughts and feelings about the book. At first glance this may seem a bit like a really expensive book club, however, the book your therapist recommends will be a book that deals with the primary issues that brought you into therapy. The conversations in your sessions will be very focused on how your thoughts and feelings about book relate to your own issues. Therapy can, at times, be quite painful, and you can grow weary of constantly talking about yourself. Bibliotherapy affords you the luxury of being able to talk about yourself through a book, and can be a strong force in breaking through the wall.

Another possible intervention is dream analysis. Whether you view dreams as being a window into the subconscious, like Freud, or simply as your brain’s way of continuing to work through your thoughts, feelings, and events of the day as you sleep, they can certainly provide grist for the mill. If you and your therapist opt to use this intervention, you will likely be asked to keep a notepad and pen at your bedside. As you awake, you will immediately begin to write down the dream that you just had. Like, bibliotherapy, you will bring this into your next session and work through it with your therapist. Exploring your dreams and discussing possible meanings may be just what is needed to break through the wall and take your therapy to the next level.

Journaling is another potential way to break the wall. Your therapist may ask you to keep a small journal with you at all times. Record any strong thoughts, feelings, or experiences throughout your day. You may also be asked to set aside some time each day to write in your journal. Like both of the previously mentioned interventions, you will bring this into therapy, explore the content of your journal, and discuss how it relates to some of the concerns that led you to therapy in the first place. It can provide new material to draw upon in order to push yourself through the wall and into a more productive place.

There are myriad other interventions that can provide the nudge you need to break through the therapy wall. Like anything else in therapy, there is no “one size fits all” approach, so don’t be shy in telling your therapist what is and is not working. Remain open to the process and give honest feedback to your therapist about the interventions being used. You will almost certainly break through the wall, continue the work of therapy, and experience the joy of living the freer and more fulfilling life you deserve.

Therapist: “Sounds like you’ve been busy.

Sonya: “I have. I feel like I’m always busy… too busy. I never have time to just enjoy life. I can’t remember the last time my husband and I had any quality time together. I worry about our relationship sometimes, but we rarely find time to talk about anything other than our kids.

Therapist: “You’re worried about your relationship, but you’re both more focused on your kids than each other.

Sonya: “Yeah. It scares me that we can’t find any time to focus on each other. We just can’t seem to make our relationship a priority.

Therapist: “You’re scared that your relationship isn’t a priority.

Sonya: “I am. I don’t know what I would do if our relationship fell apart. I can’t even imagine life without him.

If you read the above vignette and felt like Sonya’s therapist was just paraphrasing and repeating everything she said, you’d be right, sort of. Sonya’s therapist isn’t repeating her statements because she’s disinterested or bored, however. The above conversation is a perfect example of the Rogerian technique called restatement. Restatement is a basic counseling intervention and one of the hallmarks of Rogerian psychotherapy. This technique involves capturing the essence of a client’s statement and then restating it. The most rudimentary function of this approach is to provide an opportunity for clarification. If a client hears something in the therapist’s restatement that differs from what he or she meant to convey, the client can clarify and make sure he/she and the therapist are on the same page before continuing. On a deeper level, the technique can also serve as an effective way to probe clients’ statements– when clients hear their words repeated back to them, they know their therapist understands them. This understanding often encourages clients to delve deeper into the issue at hand.

Although often effective, restatement interventions can sometimes leave clients asking the question, why does my therapist sound like a parrot? Why am I paying someone to repeat everything I say back to me? How can this possibly be helpful? And even if it is helpful, why can’t I just ask a friend to repeat what I say?  To better understand how powerful a therapist’s restatement interventions can be, let’s take a closer look at one of the most basic tenants of Rogerian psychotherapy: the client is at the center of the therapeutic experience.

Rogers’ theory and approach to psychotherapy places such value on the client that Rogerian therapy and Client-Centered, or Person-Centered, therapy are terms that are used interchangeably. At its core, this means that clients are viewed as the experts on themselves. The therapist’s role is not to interpret clients’ experiences or make suggestions by giving them direct advice, but rather to serve as a mirror to the client, allowing them to see themselves, as they are, and to use this self-awareness to inspire changes.

Take the example given above. If Sonya were talking to a friend, the friend’s response to the first statement would probably have been one of commiseration. Her friend might have reviewed the events of her equally grueling day, complaining about her difficult boss, her overscheduled kids, and her forgetful husband. Alternatively, the friend might have shared some of the strategies that she uses to manage her time. In either case, the friend would have jumped into the spotlight and the focus would have shifted to the experience of two people, rather than remaining centered on Sonya. This is absolutely fine, and even valuable, within the context of a friendship, but it does not allow Sonya the opportunity to look more deeply into why her harried days are so distressing. A therapeutic relationship, rooted in Rogers’ theory, on the other hand, creates an environment and the dynamics necessary to explore issues at the deepest levels.

While at first glance, the Client-Centered restatement approach seems easy, even lazy, and it takes a great deal of training and practice to do it effectively. It requires considerable discipline to sit and listen– not to interject your own agenda, not to offer advice, not to tell your own story–but to hold up a mirror so clients can see themselves and determine whether the image they see aligns with who they wish to be. It also requires therapists to trust that clients have the answers within themselves. When clients are given the time and space allowed for by Rogerian therapy, they develop the insight necessary to move toward real, life-changing action.

Have you ever been in a relationship that challenged your assumptions and beliefs about yourself and the world around you? If so, then you know how powerful and life changing some relationships can be. Imagine then, forming a relationship with a professional who is trained to develop relationships that encourage self-exploration, insight and positive change. Carl Rogers, founder of person centered psychotherapy, outlined three essential ingredients of  a successful therapeutic relationship – unconditional positive regard, genuineness and empathy.

Therapy can be a difficult, and even painful, process, wherein clients explore the good, the bad and the ugly within themselves, perhaps for the very first time in their lives.  As clients explore, the therapist’s attitude towards them will either encourage them to continue the exploration, regardless of what comes up, or the therapist’s attitude will shame them into shutting down. Therapists who have unconditional positive regard for their clients accept them as they are without conditions or judgments. Unconditional positive regard is paramount in the therapeutic relationship; it not only allows, but encourages clients to explore parts of themselves that they have never been permitted to explore. Free from the fear of rejection, clients can fully and honestly explore themselves, past and present, and their desires for their future.

The concept of genuineness in the therapeutic relationship, simply put, calls for therapists to be themselves, and to interact authentically and sincerely with their clients. Genuineness requires therapists to have a high level of self awareness, coupled with a willingness to share the experiences of their clients in a way that is beneficial to the clients. For example, if a therapist is feeling disconnected from a client as he reports the events of his week, the therapist might say something like, “I’m feeling a little disconnected from you right now.  I hear the events you are reporting, but I’m not hearing anything about how you experienced them, how you felt about them, or how they impacted you.” Chances are if this is how the therapist experiences the client, this is also how other people in the client’s life experience him. However, people rarely provide such frank, insightful feedback to one another in everyday life. This genuine statement from his therapist may lead the client to develop some insight into why he feels a distance and lack of connection in his personal relationships.

Perhaps most central to the development and maintenance of the therapeutic relationship is the concept of empathy.  Empathy goes well beyond the more common notion of sympathy. Sympathy is simply feeling badly that someone is going through a difficult time. Empathy on the other hand is the ability to put yourself in another person’s shoes, and to view, feel and experience the world as that person does. Imagine, for example, how powerful it is to have a therapist take the time to actively listen to a client who has lost her mother.  The empathic therapist, who has worked hard to fully understand her client might say something like, “It sounds like your mom was the only person who ever made you feel taken care of, and now that she is gone you’re feeling very alone and scared.”  Until this point, people have probably told the client that they are “sorry for her loss.”  Through empathy, however, the therapist has offered something much deeper– something that makes the client feel understood and solidly connected to the therapeutic relationship.

Beginning therapy can be a very difficult step to take. You may be concerned that your interaction with the therapist will be cold and clinical, or that the therapist will judge you harshly. These concerns are quite common, but also quite contrary to the Rogerian therapeutic relationship. If you are considering therapy and believe you would thrive in the kind of relationship described in this article, consider seeking out a person centered therapist near you.