Narrative Therapy

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If someone pointed a gun to my head and forced me to admit what my preferred counseling method was, I could not say I was a reflective eclectic. That would get me shot. It’s not really an answer. I would have to confess that I have a soft spot for narrative therapy. I might get shot anyway because few know what that is. Continue reading

Living with Stress

workshop_6933-1_edited-1You’re not supposed to choose to have stress, but many people do, for good reasons and bad. For many, very many, stress is an acceptable price they pay for values they hold dear.

I’ve known people who are so dead set against having stress that they don’t try anything new because it’ll make them nervous, they don’t go anywhere because people might look at them funny; they continue smoking cigarettes because they’ll feel like crap if they quit; or they don’t get attached to anything because, when they lose it, they’ll grieve. For a while, sometimes a long while, they are gloriously stress free. It looks as though they’re doing well. They don’t give their families any trouble. They are not spending their days in misery.

The problem is that their lives are getting smaller, and smaller, and smaller. The day will come when they see the price they paid to be stress free and, guess what? They’ll fall into despair. They will have dug themselves a fox hole so deep, they can’t get out of it.

Contrast that to the person who works so hard at his job that he drives himself into the ground, not eating, not sleeping, not even caring how he feels as long as he meets his objectives. He doesn’t want to destroy his health, but he accepts it because he’s doing something important. Compare it to the wife who sticks with an alcoholic, abusive husband, determined to bring him around to fulfill the promise she sees in him. She may prefer not to be hurt, but she will accept being hurt if it means that she is good. Or look at the performer who endures stage fright before each show. It’s no fun puking up your guts in the dressing room, but the applause makes it worth it. There are people, plenty of people, who do hard things. When you do hard things, you get stress, because there’s only so much a person can take. It’s the cost of doing what is difficult, if not impossible.

Those people might come to see a therapist, too; hoping to alleviate their stress. But their stress isn’t going anywhere because they won’t do what they have to do to get rid of it: quit trying to do what is difficult. The won’t quit doing what’s difficult because only the difficult really matters. This is how they make their lives mean something.

When they put it that way, I don’t blame them.

The moral of the story is that you can put up with anything, even stress, as long as it’s meaningful. Additionally, if you are putting up with stress, it had better be.

The Clock

IMG_1396I’d like to continue my series about the things in my office. Today, let me introduce you to the clock.

My relationship with the clock is a troubled one. Sometimes it’s my savior, my teammate, my partner, other times it’s my rival. It’s a valuable tool and a necessary evil. It’s the symbol of all I hate, but it, of course, doesn’t have any feelings about me. It just ticks steadily, no matter how I feel. Continue reading

Neuro-Linguistic Programming

Bringing you the best of mental health

If you’re going to learn how to be a psychotherapist, you should study psychology and acquaint yourself with all the theories of human behavior. I believe it also helps to read Russian novels and ponder philosophy. You can do worse than have a solid grounding in statistics and research design if only to wade through the malarkey that tries to pass itself off as science. If you’re going to do your psychotherapy in a large organization, you should be able to practice politics. But if you really care about being a good therapist, you need to study magic. Continue reading

The Uses of Uncertainty

Bringing you the best of mental health

In 1900, for eleven weeks, Sigmund Freud met with a teenage girl stricken by hysterical mutism. We know this woman by the name Freud gave her, Dora. It wasn’t her real name. Precipitating the symptoms, she had accused an older family friend of making sexual advances to her. The family friend denied it and her father didn’t believe her. Continue reading

Solution Focused Brief Therapy

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Some people think psychotherapy is like getting their teeth cleaned. For others, it’s like getting their teeth pulled.

There are some who value a comfortable, long term relationship with a therapist: someone who doesn’t judge, someone who lets them be who they are and go at their own pace. They go periodically to get things off their chest. Their therapist doesn’t have much to say, but they don’t go to hear her talk; they go so they can. There may be some uncomfortable moments; but, going makes them feel better. Therapy is supposed to clean out all those toxic thoughts before they eat away. It relieves the pressure building so they don’t explode. It’s maintenance, not renovation. Successful therapy, for them, means they always have someone they can talk to about anything. Rogerian Person-Centered Therapy is this way. So is Psychoanalysis.

There are others who don’t look at therapy that way. They would never consider seeing a therapist unless they absolutely needed to. They come in with a problem and expect it solved. They want some advice on how they can handle that toxic boss, the nagging spouse, the episode of depression, the heavy drinking, or those pesky panic attacks. Successful therapy, for them, means they don’t have to come anymore. They might as well be saying, if a tooth is diseased, don’t clean it, pull it before it corrupts the whole body. Those people are asking for Solution Focused Brief Therapy.

Solution focused brief therapy may be a description of any therapy that is solution focused and brief, but it’s also a specific brand name approach that they teach in therapist school and write books about. The hypnotist, Milton Erickson started it all. Insoo Kim Berg and Steve de Shazer later elaborated. You don’t get hypnotized when you go to Solution Focused Brief Therapy, at least not in the usual sense of the word. Instead, your therapist will ask you what we call the miracle question:

If you woke up one morning and a miracle had occurred so that your problem was gone, how would you know it?

You might say something like, “When I come home, I won’t dread seeing my wife.”

The next question will ask you to rate this dread on a ten-point scale. This will help you see progress better.

Then you’ll get some other questions like: When is your dread less severe? “When I haven’t been drinking.” How have you coped with dread so far? “If I screw up, I just tell her.” What are the parts of your life that is free of dread? “I don’t feel it at work. I give them my best at work.” The answers to these questions can suggest particular tasks for you to do towards helping you feel less dread. You’ll have homework that your therapist will ask about if you return.

In Solution Focused Brief Therapy you’ll get a therapist who asks a lot of pointed questions designed to get to the heart of the matter. She won’t just wait for you to get there. She’ll bring you there and hold you accountable for doing something to help yourself. There will be no exploration of how the dread started. Your therapist won’t ask you about your childhood. The whole technique is about harnessing your existing strengths towards a solution to the problem. It’s not like getting a tooth pulled in terms of pain; only in terms of the aggressiveness of the therapist’s intervention.

Should you be asking for Solution Focused Brief Therapy? It depends on what you need. If you’re totally miserable, in crisis, ready to cash in your chips or go for broke, then you probably don’t need to dick around, exploring your childhood. You need a therapist who’s willing to be directive. You don’t have time to waste. You need a solution, fast; so, you should be in a therapy that focuses on solutions. It doesn’t really have to be brief, per se; but it has to be fast acting. If it works, great. If it doesn’t, you need to know soon so you can try something else.

You should also as for it if you don’t think you’ll be going for long. If going to a therapist is hard for you, or if you can barely afford it, then you’ll want to make the most of the little time you have.

You don’t necessarily need brand-named Solution Focused Brief Therapy. There are lots of therapeutic techniques that are solution focused and expected to be brief. Cognitive Behavioral Therapy and Motivational Enhancement are two that come to mind. But you do need a therapist who is willing to pull teeth if he has to. Not all are.

If you are not that bad off; or, if you had been suffering, but now you’re doing better and want to maintain your gains, then the kind of therapy you need, if you need any, is more like getting your teeth cleaned. It’s often a good idea to keep a therapist on retainer, so to speak, and check in from time to time. It’s a good idea for everyone to have someone to talk to. It may not have to be a therapist. If you have one, mental health hygiene can be performed by a good friend, a non-reactive spouse, a calm parent, or a trusted self-help group. If you don’t have one, or if they ones you have aren’t up to the task, then you may need a therapist, but not the kind that’ll pull out every tooth.

Don’t let your insurance company decide what you need if you can help it. Your insurance company would like you to only engage in brief, solution focused therapy because they think it saves them money. They are like those people who skimp on maintenance: people who don’t change their oil, don’t paint their house, and don’t clean their teeth. Insurance companies are always penny wise and pound foolish because they’re hoping that by the time all the neglect of your physical and mental health has run its course, you’ll be off their rolls and on Medicare.

There are often therapists who specialize in one method or the other. The therapist who thinks of therapy as a cleaning is going to be relatively quiet, unobtrusive, and reflective. You’re going to be doing most of the talking, not him. It doesn’t really matter what he thinks or what he says, what matters is that you talk freely, without fear and without anyone controlling you. The therapist who thinks of himself as a kind of mental health hygienist is very willing to do that.

The other kind of therapist, the brief, solution focused therapy kind, is not going to be happy listening to you talk about how dysfunctional you are, week after week, without trying to do something about it. It’s not that he’s impatient with you, it’s more like he feels it’s his responsibility to take action. He doesn’t want to be accused of fostering dependency. Just listening doesn’t seem like he’s working hard enough. Moreover, he has lots of ideas. Because the duration of therapy is brief, solution focused therapists see lots of people and ask those people to try lots of things, so they know what works and what doesn’t.

The best kind of therapist, I believe, is the kind who can both pull teeth and clean them, depending on what’s needed. A reflective eclectic, in other words. Someone with a lot of tools at his disposal and knows how and when to use them.

Click here to go to the Institute of Solution Focused Brief Therapy

Cultivating Change

If you hang around a therapist’s office long enough, or around anyone who’s seen a therapist, they’re going to tell you that you can’t change another person; you can only change yourself.

Basically, it’s true; but, like many adages, there’s more to it than that. Continue reading