On Practicing Therapy
On practicing therapy – an incomplete treatise
1) I encourage clients to passionately live according to their own values. (How does drug use fit?) “What do you want your life to stand for? What eulogy would you like to hear at your own funeral?” Then, concrete goals can be identified that inform a valued path. Then identify behaviors that might lead to the goals. Also identify barriers (usually psychological) that can be dealt with through mindfulness, exposure, acceptance and diffusion.
2) Experiential avoidance doesn’t work. It creates more stress and arousal. Deliberate attempts to suppress thoughts and feelings can increase their occurrence and impact. Turn toward and accept depressing thoughts and feelings.
3) I encourage looking at thoughts as just thoughts, not looking at the world through thoughts. “Thoughts are not facts…” This can free clients from the distorted reality they often create. A negative thought mindfully observed will not necessarily have a negative function. The “problem” is not the presence of particular thoughts, emotions, or urges. It is the constriction of a human life.
4) “Here now” is always the perspective from which events are directly experienced and thus cannot be threatened by the difficult nature of psychological content.
5) The inability to accept one’s own behavior prohibits any ability to change. This bears repeating over and over…Said another way:
6) Both Eastern and Western philosophy and psychology are converging on the understanding – backed by scientific research – that “allowing” experiences rather than suppressing or avoiding them is of great benefit. Mindfulness has to do with the quality of both awareness and participation – “living awake.” It is done nonjudgmentally, in the moment. It involves “awareness, nonjudgmental observation, ‘beginners mind,’ staying in the moment, acceptance and letting go…”
7) Again, the powerful concept is acceptance - “to take what is offered.” - defined in various ways. It means – in its essence – focusing on the current moment, seeing reality as it is without filters and delusions, and accepting reality without judgment. “The world is perfect as it is…” Radical acceptance is radical truth - experiencing something without the haze of what one wants and does not want it to be. “Total allowance now…” and not just parts of it. Thoughts, opinions, preferences, judgements are generally not at all helpful in this context. Accepting really is receiving a gift; the balance is always gratefulness for what is.
8) The solution to suffering is to increase acceptance of the here and now, and decrease craving and attachment. It is a skill that can be developed. “Fighting against,” can create more tension and inner turmoil.
9) “Pain is inevitable; suffering is optional…” This again refers to the way we create suffering by resisting what is. It is not so much a painful event that causes hurt but our attempts to push it away, change it, judge it, and label it wrong – “this shouldn’t be happening…” Actually, it should be happening because it is…This suffering is never done “now,” but is more futuristic, “how I can change it?” The clear message, and one of all good therapy, is to stay with what is happening, not what one wants to happen. “I just want to be happy,” says a client, to which we reply, “That’s what you want. What is true?”
10) Self-Creation – Actions retype the motivating message in your mind. Acting adds strength to the motivating idea behind what you’ve done. The sheer fact of acting on any belief or feeling makes you believe or feel it more. Act on a feeling or belief and you reinforce that belief. The premise behind an act is reinforced by the act. We are frightened because we run… An example is habit or addiction. Immediately giving in to the craving initially satisfies and reduces the motivating impulse behind it, i.e., reduces the craving. But the ultimate effect is to strengthen it, increase the craving. We sometimes call this “waking the beast,” or “poking the bear.”
11) Freud assumed one had to change inside before acting in a healthy way. He believed you must pick apart one’s childhood before you can change or be happy. Not true. We try to help our clients understand the powerful connection between actions and subsequent feelings. Facing one’s fear (an action), reduces that fear; running increases it. The paranoid who checks his lock five times when leaving, reinforces his paranoia (after the initial reduction of anxiety). The addict reduces craving by using – then it increases… If you don’t act on a motivating feeling, it wanes and dies.
12) This is important: real change generally (always?) requires a person make changes in her life-style. Another way to come at that: “Doing the same thing over and over and expecting a different result, is madness…” A major life-style change would be to face one’s problems instead of avoiding them in hopes they’ll disappear. Any acts of avoidance based on fear, will only reinforce that fear. Another would be to stop using drugs, which keeps reinforcing the craving and the need to take drugs. This will also help change the way you see yourself, even your value. Being kind reinforces being kind. A different angle on, “Resistance creates persistence…” All the mythic and religious themes of life-through-death endorse the value and necessity of pain in the emergence or our full and authentic identity.
13) Kindness, compassion for other, even identity with the world condition of hurt and suffering…These inform everything above and are the real essence of psychotherapy, without which you have words without meaning, direction without purpose, appearance without substance. Here’s another truth about therapy and therapists: this must be our path as well, not as a final destination, but the path itself. Kindness is healing, almost any way it manifests. We (as therapists) become, as the hammer to the carpenter, the tool of our trade… The relationship with our client is our main instrument of cure.
14) This is why, when we decide it’s time to do our own work, we pick therapists that are also in therapy, or a sound consultation with a trusted resource. The obvious if extreme examples of not doing this are when therapists try to impress their clients, get overly hurt by something they say, try to keep them in therapy beyond when they need it, or otherwise lead them down a path of the therapist’s agenda and not the clients. This comes under the general heading of a therapist confusing their needs with their clients, and putting those needs first, almost always without awareness. This is unhelpful at best, but also unethical and perhaps worse.
15) And to be clear, one does not, or could ever find, a therapist with no needs, no wounds. However, these very scars can be the depth and breadth of skillful and compassionate work, if recognized and integrated as part of the richness and humanness of that therapist. It’s not so much, “yes I get it – I’ve been there,” as, I am there, with openness, bravery and acceptance… Perhaps a guidepost to helping our clients accept themselves, their flaws, their imperfections, their secrets, is to fully accept our own….Only then can we keep them out of the way. This is what I hear when someone says, “Life experience…”
16) We emphasize a relatively unified and simple view of change. This framework emphasizes the power and influence of the therapist’s personality as a facilitator of growth. It is not what the therapist does or says so much as who she is. The first and foremost element of change, then, is the therapist’s presence – her excitement, her enthusiasm, and the power of her personality. A relationship is forged, and as we said above, this is our main instrument of cure. We must acknowledge that we become role models and as such, our own character is the driving force behind growth. We model authenticity, courage, vulnerability, strength, overall integrity, and self-care, among other traits.
17) Many people dedicate their lives to actualize a concept of what they should be like, rather than to actualize themselves. There is a mountain range between self-actualizing, and self-image actualizing…
18) A great teacher once told me that anything unexpressed can become toxic, even love, she maintained. This surely applies to most of our clients, many of whom have made a lifestyle of withholding, keeping secrets, hiding and so on. Unexpressed emotions compromise vitality, the élan vital, and can be part of the architecture of depression and anxiety.
19) It’s a good idea to check our motivation for saying anything. If you do this automatically, you won’t become stymied or congested, but probably more effective. At least half of what I say is almost certainly unnecessary and can be obstructive… “The principal hazard of our profession is the narcissistic belief that we really are special…” (Herron, 1984) On the other hand, there was a study done in 1991 that found therapists no more narcissistic than others. (Clark, 1991)
20) Can we talk enough about listening? Our clients want and need to be heard, often having spent lives not so. They must know that what they say is worth listening to, no matter how much effort is required to hear it.
21) In order for real growth to happen, the client must be willing to experience intense confusion, disorientation, and disturbance. She must be willing to risk all this for the possibility of a better existence, and sometimes all she has to go on is the therapist word. The therapist’s job is to encourage this risk taking, which if modeled by her in the sessions, begets this courage in the clients. We are sometimes required to frustrate a client (refusing to answer questions, etc.), so they are forced to find their own way. He will find out that what he expects from the therapist, he can do quite well for himself.
