My Approach to Therapy
I believe that you are the expert in your own life. My job as a therapist is to provide a safe and nonjudgemental space to discuss your life in a meaningful way. I believe that everyone has the right to express a different and personal reality. I also believe that the power of a strong therapeutic relationship is capable of providing support, comfort, and honest feedback. People tend to heal when they are truly understood and when they honestly put in the work. Together we will work to establish your goals, find real solutions, and validate your experience in life. Approaches that I use stem from Narrative Therapy, Dialectical Behavior Therapy, and Relational Psychotherapy.
Narrative Therapy is a collaborative and non-pathologizing approach to counseling that positions the client as the expert in their own life. A narrative approach sees a person’s problems as separate from the person, that the person is in a relationship with their problems, not that a person is defined by their problems. The narrative approach assumes that people have inherent skills, wisdom, abilities, and experiences that can be drawn out to assist the client in changing their relationship with their problem. It is a way of working with people that takes into consideration the broader context of their life, particularly in areas of diversity including class, race, gender, sexual orientation, and ability.
Through paying attention to themes, plots, and over all stories the narrative therapy sessions can help clients see what feeds problems, avoid problem saturated language and stories, and find small slivers of hope and strength within that problem saturated narrative. The over all goal of narrative work is to begin to tell a new story, empower the client with the skills and abilities they have discovered and most likely always possessed, and transcend their problem saturated story.
DBT (Dialectical BehaviorTherapy)
DBT is an approach that utilizes Mindfulness and Non-Judgemental thinking to provide specific skills to people in 4 specific components or areas.
1. Mindfulness: The foundation of DBT, this component of focuses on the idea of being Dialectical. Which is this notion that 2 ideas can be true at the same time. This premise is suggesting that a lot of the things we suffer from are simply our inability to accept that 2 ideas are in fact true in any given situation. For example, I can be mad at my teen aged son and love him all at the same time. Another example, a couple can be very distant from each other while at the same time close in certain ways. This doesn’t mean that 2 ideas are always true at the same time, it just is saying that it is possible. Over time our minds find it helpful to think in very black and white terms, in very didactic terms. But, the reality is that life is full of grey areas. Being dialectical means that we can learn to tolerate the grey area and that we use open minded, nonjudgemental thinking as much as possible. So, in the mindfulness component of DBT open mindedness and non-judgemental thinking are the focus. Specific skills such as using the 5 senses to ground us in the moment and give us a sense of being present and grounded in our life are the focus of the mindfulness component of DBT. Using our “Wise Mind” is the goal of DBT. We accomplish this by avoiding extremes of emotion and logic and finding a balanced space in our mind that is both emotional and logical along with our instincts, intuition, and our life experience.
2. Emotional Regulation Skills: The ability to tolerate emotions on a consistent basis and not have unwanted reactions to feelings is the goal of this component of DBT. Often times people are led to therapy due to consequences they have suffered as a result of being too reactive to their emotions. Through various skills, founded in mindfulness work, we develop the ability to tolerate emotions. An example is to clarify that emotions are not facts, they are feelings. Also, feelings don’t last forever they pass, over time. Or, we can focus on the idea that feelings give us very useful information about our needs, which we can then take time to get met in a healthy way. For example, if I am feeling lonely, then maybe I should reach out to some people and make a social connection. Another popular aspect of emotional regulation skills is to stay busy when we are feeling intense emotions. Often times it can seem that in order to be “spiritual” we need to sit and breathe and act like a monk. Well, sometimes that works for people, but often times it’s also ok to just keep moving and stay busy to distract ourselves at times. These skills seem obvious right? These are the kinds of ideas that are very common sense and often times just require reminders and creativity to apply to every day life. DBT is full of common sense ideas that come from our own inherent wisdom that we often just need reminders and examples of ways of applying them into our daily life.
3. Interpersonal Effectiveness: Finding ways of reducing tension and conflict while raising our ability to tolerate tension and conflict is the goal of this are of DBT. Through learning to validate other’s feelings, focusing on using language that is non combative, talking about our feelings, and being more assertive we can find more effective ways of being in our relationships. In fact, learning what is effective and what isn’t effective and being mindful of those things that work is a DBT skill. Often times we repeat behavior that is not effective and remain stuck. DBT suggests spending our energy on skills and behaviors that work well and avoiding those that don’t. Again, DBT is filled with common sense concepts, and at the same time clients find DBT to be incredibly helpful in their daily life when applied properly.
4. Distress Tolerance Skills: Have you ever felt like you were in a crisis? Distress tolerance skills are skills that we use when we are feeling extremely intense feelings and possibly are very close to acting out in unsafe ways, perhaps relapsing in sobriety or other self harm behavior. This component is filled with skills that calm us down, bring us back to our bodies in the moment, and help us activate wise mind. Essentially, this component teaches skills that are meant to help us pause when in crisis mode and tolerate the difficult feelings. Radical Acceptance is a very popular skill that is developed in this module of DBT. Radical Acceptance is when we accept a situation exactly the way it is, knowing that there are certain things we have no control over in that scenario and we cease fighting it, in that moment. Of course there are always things that can be changed, but often times we need to pause, accept something the way it is, before we can move on and work around something in a healthy way. For example, many people find that divorce is a very difficult time in life, especially when it is first initiated. Using radical acceptance a person could accept the fact that the divorce is going to occur, freeing up energy to work on other areas of their life and learning to tolerate the emotions associated with the divorce.
As you can see DBT is not necessarily a style or a technique. Although, through my trainings in DBT and my own personal work I have come to love DBT and it’s skills, this is more of an example of some of the concrete skills that I lean towards when working with clients. Narrative Therapy and Relational Psychotherapy are more of the tone and the feel of how I work with client’s in sessions.
Relational Psychotherapy focuses on the idea that much of our suffering stems from the ways in which we interact in our relationships with others. In order for a person to remain emotionally healthy, one must maintain fulfilling and satisfying relationships with those around them. In relational work it is important to discuss the experiences both past and present of the client and the ways in which those experiences have shaped their relationships. Also, in relational work, the relationship between the client and the therapist becomes another area to focus on, in terms of what comes up within the client/therapist relationship. Both the client and the therapist work to maintain a healthy, fulfilling, and attuned relationship. In this process there may be challenges. Tension is talked about, anger and frustration is disclosed openly. The client and the therapist find ways of working through these relationship challenges together. Sometimes this can be used as support for the client, and in other ways clients use this exercise with the therapist to base their current and future needs in a relationship with others outside of therapy. Within the relationship with the therapist the client learns that it is safe to disclose any aspect of their life with their therapist. By accessing core feelings in therapy sessions, having the support of the therapist present to witness and support those moments the client can gain mastery over their emotional states and build on self esteem, confidence, and learn to tolerate feelings that seemed intolerable before. Great hope and great strength build and become sustainable in the client when this occurs.