Working Together
The course of therapy will obviously depend on what your goals and presenting concerns are, in our work together. However, if you have been in therapy before you will probably notice that I work somewhat differently from the majority of therapists.
I normally follow the model called TEAM-CBT. This is an acronym that stands for Testing, Empathy, Assessment of resistance, and Methods.
The “CBT” part stands for Cognitive-Behavioral Therapy, but is kind of a misnomer, because the methods used in this model can come from any approach. The Testing part is something that happens not only during the first intake, but at each session. Shortly before we start our sessions, I will ask you to fill out short questionnaire that will tell me about your current satisfaction with life and what issues are on the table. After each session, I will also ask you to fill out a session rating survey, which will give you a chance to let me know whether the session worked for you or not, and whether something needs to be addressed. This is based on the assumption that I cannot guess how you are doing, nor how well I am doing by your standards. This allows me to match therapy closely to your needs.
Empathy
The Empathy part is what you probably would expect from any therapy session, and indeed, it ought to be part of any course of therapy, with me or anyone else. It ensures that I understand you to the best of my ability and that you feel understood. The resulting connection between us is called the therapeutic alliance, and is an indispensable component of any successful therapy. However, empathy is not enough to effect change. If our sessions were limited to your talking about the problems of the week, and getting your distressing thoughts and emotions off your chest, what would happen is that you would simply be focusing more and more on the problems, and because we tend to get more of what we bring our attention to, although you might feel better in the moment, but nothing will change. Once I know that you feel heard and understood (I might even ask you, sometimes, for a letter grade on how successfully I gave you empathy), you will often hear me issue an invitation, asking you what you would like my help with, among the issues that you have presented.
Resistance
Both psychotherapists and clients assume that, because they show up for therapy, people are ready to get help and change. However, if that were true, change would happen by itself. What keeps us stuck in place, is what we call resistance. The patterns of thinking that cause us trouble are also present for very good—and functional—reasons. Our difficult emotions arise straight from the values that we hold in our lives. If I feel lonely, it is because I care about human contact. If I am sad and embarrassed when someone criticizes me, it is because I value respect from others. Emotions also have their benefits; when I feel anxious or worried, they can be a motivating force for me to act. In the third part of the model, the Assessment of resistance, the factors that led to a situation are given their due, and all the positive reasons for their existence are brought to light. This is necessary because jumping straight into “fix-it” mode without honoring the reasons for such things as worry, fear, shame or loneliness would quickly backfire. Resistance would just dig its heels in, and no change would be possible. My mentor, Dr. David Burns, says that all failure in therapy stems from a failure in the assessment of resistance.
Methods
What seems to be the meat of the subject, the Methods, is actually the quickest part, if the steps above have been taken care of. I have over 100 powerful techniques I can draw from, and they can sometimes result in full recovery in the span of a single, extended session (I know this may sound hard to believe). Because each person is different, some techniques that work for one person may not work for another and vice versa. This is why we will sometimes try different approaches to find the one that suits you and the situation best. In 99% of cases, cognitive techniques will be used (listen to my podcast episode, You Feel the Way You Think, for an explanation of how our thoughts create our emotions). For these, you will need to put your thoughts and emotions down on paper—this will be part of your homework—usually on this worksheet called the Mood Journal. Whether the approach is cognitive or not, there will always be some homework to be done in-between sessions. The time we spend together only represents about 1% or less of your week. It would be unreasonable to think that it would be enough to create impactful change. This is why you will be asked to use some self-help techniques on your own, during the remaining 99% of the time. Your own involvement in the process is a necessary ingredient to your recovery. In my experience, clients who refuse or choose not to do the homework do not improve. Those who do the homework show positive changes, sometimes in a spectacular manner.
Extended Sessions
One factor that can greatly speed up the process is the scheduling of extended sessions. The Mood Journal that I mentioned above takes on average 2½ hours to process. When this process is split up into two or three sessions, spaced out by a week, the momentum is lost from one session to the next, with all the intervening life events that can occur. It is greatly recommended to work with me in an intensive manner, doing the bulk of the work inside extended sessions. It may feel like it is more expensive at the outset, but the result is a much faster recovery and saves money in the long run. Other techniques (like EMDR) also take longer than the standard, 50-minute therapy session length. In fact, this so-called “50-minute hour” —usually scheduled weekly— is merely an actuarial invention that makes it easy for clinics to schedule clients at the top of the hour, leaving enough time for notes and paperwork before the next appointment. But it has never been proven to be the most effective. We will use that format (which is the basis for my hourly honorarium) for our intake session, and for subsequent check-in and maintenance sessions; but that is often not where the most transformative work takes place.
Let’s Talk
If this speaks to you, schedule a free consultation with me, and I will be happy to talk to you more about it.