How do I do therapy?

Everyone wants to live a rich, full life. Everyone wants to be happy and fulfilled. Sometimes barriers develop that keep us from being able to solve the problems in our life that could lead to contentment.

As a Marriage and Family Therapist I work with individuals, couples and families to understand the barriers and develop plans for removing them. Once the barriers are out of the way, a person, or a family can use their own skills to solve the problems effectively.

So what are some barriers that I see often and how do I help people lift them?

Here are some common barriers:

Too much rigidity: perfectionism, hyper-rationality, overly relying on logic, obsessing, high level of dominance, withholding, defensiveness, passive/aggression, aggression, an emotional shell or shield, fear of intimacy, controlling behaviors

Too much flexibility: a lack of boundaries, a difficulty in assertion, passivity, hard time saying no, being unwilling to disappoint others

Too much emotionality: hyper-sensitivity, reactivity, aggression, anger issues, being overwhelmed by emotions

Anxiety: worry, obsessing about work, the future, the past, controlling behaviors, forgetfulness, difficulty staying present

Depression: hopelessness, helplessness, low energy, low mood, forgetfulness, difficulty staying present

ADHD: trouble focusing, forgetfulness, problems with organization, difficulty staying present

Drug or alcohol abuse: habits and patterns that develop over time and sometimes include a biological component

Beliefs based on family of origin: my family was like this, so we’re supposed to be like this…, or the shadow of that- we’re not going to be like this because my family was like this and it was awful.

Trauma: emotional/relational traumas from earlier in the relationship, cheating, handling a transition or loss poorly, financial trauma, trauma from childhood abuse or neglect.

These are a few common barriers that I see in couples, families and individuals that come in for therapy. They are complex problems. It’s always an act of courage to come in for therapy. It takes bravery to look at yourself and your family and say you’re stuck, I’m stuck. I’m always humbled by my client’s courage.

So how do I work with people to lift these barriers?

I collaborate with them. It is very important for me to work closely with everyone to understand the specific barriers in their life. Depression in one person often doesn’t look anything like depression in another person. Forgetfulness or having a hard time being present might be anxiety, depression, ADHD, rigidity, or too much flexibility. It’s important to understand the full dimensions of the constraint so that all useful ideas can be tried. I try to help clients shine a light on their roadblocks. We do this together. I have some ideas that I bring to the process, but I never know more about a person then they do themselves. I do believe that people are more than the sum of their thoughts, feelings and behaviors. These are temporary expressions of a greater whole.

I use curiosity and compassion a lot. I want to know how people are affected by their barriers. I want to really understand their perspective of their struggle so that I can offer something that will hopefully help. This process of curiosity, compassion and probing without judgment can lead clients to a place of understanding something new about what’s constraining them. It can give them some hope about a different angle to approach the barrier.

Often times, I see clients gaining understanding of their constraints by taking some of my plans home and having them not work. I offer up experiments, rather than homework. Experiments give us data no matter what the outcome. You can fail homework, you can’t fail an experiment. If you don’t do an experiment we can look at what kept an attempt from happening. There is likely going to be some connection to the overall barrier. There is no shame in trying an experiment and finding out that you’re too overwhelmed to actually pull it off. There is a barrier keeping you from being able to make the change happen. What is overwhelming you? Thoughts? Feelings? Other behaviors? The experiment that doesn’t get attempted might tell us a lot about the constraint.

I’ll also offer up my hypotheses, from my training and experience. These ideas are not served up as the “truth”, rather I think of them as a view I have that could be useful or could be off the mark. Trying to understand human nature is complex and requires bravery, self-compassion and flexibility. I try to help my clients feel this flexibility in how I offer up my views. They may be on the mark. They may be off the mark. Clients may not be ready to hear what I’m offering up. Maybe something I offer up will plant a seed that pops up later.

I also use Feedback Informed Therapy. It’s 4 questions at the beginning of each session and 4 questions at the end of each session. This works kind of like a stethoscope works for a doctor. It gives me a view of something that I can’t see directly. It lets me understand what I’m doing that’s hitting the mark and what I’m doing that’s off track by asking directly.

Once clients have a sense of the barriers that are keeping them from being able to access their own powers to change, we can start coming up with plans for lifting the barriers. There is almost always some new behavior that has to happen. There is often a change in emotions that has to occur. There is often a change in thought that has to happen as well. Thoughts, feelings and behaviors are the tools we all have at our disposal for moving through reality.

Thoughts can be challenged with other thoughts. Meanings can change when more narrative context is understood.

Feelings can be changed with other feelings. It takes an emotion to change an emotion. Feelings can be soothed with skills. Relationship patterns can change or modify feelings. Relational interactions change neural pathways.

Behaviors can be modified using organizational skills and willpower. New actions can be taken knowing that feelings and thoughts will follow.

So we look at the barriers. We work hard to understand them and agree on what they are in detail. Then we develop a specific plan for removing the barrier. We implement the plan. Hopefully, the plans work. If they don’t work, we look at what kept them from working and we use this new information to look at the barriers again. Then we come up with a modified plan and implement it. Hopefully this plan works. If not, we get more information and modify again. This compassionate and curious, back-to-the-drawing board approach lets clients consider all the options available to them and cultivate a sense or flexibility and hope in the search for a better life.