This Blog Is About

This blog is about---You! Each and every post is about you. Use it to challenge your usual patterns, as a tool for self-discovery, to stimulate your thinking, to learn about yourself and to answer your questions about others.

Friday, December 30, 2011

Biggest Bang For Your Buck

How to Get The Most Out of Your Therapy Session

 The post I wrote about therapists, called The Imperfect Therapist, has received a lot of attention and continues to attract a lot of readers.   That post discusses what you should expect from a therapist.  However, there are two sides to the story.  How beneficial your therapy is depends, not only on how effective your therapist is but, also, on what you bring to the table.
If you've never been through a course of therapy, it's hard to know how to make the most of it.
How to best use therapy is actually something to be learned.  It is different from  going to other professionals such as a medical doctor or accountant, or tax preparer, or dentist or financial adviser or lawyer since these people usually do something specific to or for you.  For example, a dentist does a procedure to your teeth (oooo, we don't really want to think about that too much, do we!), a lawyer drafts a will, a doctor writes a prescription, and so forth.  So, to these professionals, you simply present your problem and they do something about it. 

The difference in working with a therapist is that it is a collaborative effort.  So the best therapist in the world can't  be very successful with you if you go to them with all your defenses up:  They can't help you move in the most productive direction for you if you lie;  if you are hiding your feelings and restricting what you share, it will be hard for the therapist to make a connection with you.  Your therapist will be trying to begin and build, a trusting, reciprocal, safe, creative relationship with you.

 ~Most therapy effectiveness studies show that the quality of the relationship with the therapist is the most significant determinant of the outcome of the therapy.~
Therefore, the first step is to carefully select your therapist.  Personal referrals are good if you are lucky enough to know someone who has a therapist they like and think would be good for you.  Otherwise, beyond the basic credentials, you want to look for someone experienced, who seems competent to you, and with whom you can feel comfortable.  I don't mean that therapy is always going to be a cake walk, just that you should feel faith in doing your personal work with this particular person.

  • Think about yourself before your session.  You may have a lot of things on your mind, but, try to feel what is foremost.  What has the most charge for you?  Bring that to your session.
  •  Leave your cell phone in the car.  It is a distraction, even on vibe.  Your therapist isn't answering the phone during your session (I hope!), nor interrupting her attention on you to glance at incoming cell calls.  Take the therapy hour as time for yourself; leave your other obligations aside for the session and devote it, uninterrupted, to yourself.              
  • Try to make it to every appointment if at all possible.  There is a psychological rhythm that gets established if you attend therapy regularly.
  • Stay focused in the session.  It doesn't mean that free association shouldn't happen---sometimes insights come up---and it is an off-shoot of your original focus.  That's all right.  In fact, that's good.  Sometimes great leaps of learning take place there.  But what isn't good is if you just go off on tangent after tangent and end up only having poured out your mind contents without achieving any in-depth understanding on any of it.  That can  be frustrating if it happens a lot.
  • Allow yourself to truly consider what suggestions your therapist might offer.  Sometimes the pent up emotionality of a topic will make it difficult for the patient to listen.  If you can't really consider it in the session, try still to take  in what your therapist says and consider it later. 
  •  Have both your feelings and your thinking in gear during your session.
  • Be forthcoming.  Be flowing rather than self-inhibiting.   The more you offer up, the more your therapist and you have to engage with and to consider.  Don't be a tightwad!  Be generous with your inner self and personal information in therapy.
  • Think about what transpired in your session afterwords.  If it is at all possible, take some time right after your visit to digest what has occurred.  It's better not to just put it away and go running off to the next task in your day.  Definitely don't spew it all out to a friend or spouse or relative.  Even if you feel a lot about some of it---excited, stirred up, puzzled, or anything else, it's better to stay with that feeling and see what evolves.  If you immediately share it with someone else, it dilutes the therapeutic effect.
 If you stay in the process, you may continue to move along in your personal growth or toward the resolution of a problem, during the time between sessions; you may have realizations that result from what occurred in the session.  This is ideal as you hope one day, to be able to grow and change on your own.  By the way, therapy does ultimately help you to become more independent and differentiated.  It can take time, and you may feel dependent on your therapist for awhile, but, eventually you will begin to discover self clarification and firmer boundaries,  more flexibility, increased consciousness, and an improved ability to make good decisions for yourself.
Therapy is not only for problem-solving; it can also serve to help you grow and mature.  It even has, sometimes, an effect of improving physical health.                                                                  
Does therapy sound effortful?  Well, yes, it is.  To get the most out of it, you have to put something into it.  But, on the other hand, in an on-going therapy relationship, there is always room for just using a session here and there, for some nurturing and understanding.  If you have been sincere and genuinely sharing with your therapist, the therapist will be able to offer you attentive listening and real compassion.  Now there's a rare and treasured life experience.

Please share your reactions and comments.

Thursday, December 22, 2011

Gift To Yourself

Practice to Nurture Your Well-Being

 "Compassion is a fundamental human trait with deep evolutionary roots.  By creating environments that foster cooperation and altruism, we nurture this positive side of human nature.

 Happiness isn't just determined by our genes.  It also develops from a learned set of skills and habits of mind that can be taught and, with practice, deepened. 

Happiness and altruism inevitably intertwine.  Doing good is an essential ingredient to being happy."

The Greater Good Science Center

Friday, December 16, 2011

Wrong Way Corrigan

How do Most People go About Selecting Their Therapist?

The wrong way, at least in the opinion of most therapists, themselves.  I have heard some pretty hot-under-the-collar declarations by therapists regarding what I am about to describe.
Most people, notably those who have never been in therapy before, seek a therapist in the following manner:  "Hmmm, I think I will call my insurance company for a list of therapists that are on their panel.  Oh, good, here's the list.  Now, let me see, who has an office that is most conveniently located to my work or home."
This isn't how a therapist wants to be selected.
A therapist seeking their own consultant does it quite differently.  (Yes, we do go to therapists ourselves and, by the way, you wouldn't want to see a therapist who didn't.  Someone who already knows it all is not in a growth process).  None of us would ever select a therapist for our own treatment or consultation using this method.

Why is that?  It seems practical, efficient and logical.  Well, because, this is a highly personal matter.  It is even more personal than your relationship with your primary care physician.  A therapist has to provide a number of things for you to be able to flourish in treatment:  They need to match your idea of professionalism, be able to make you feel reasonably comfortable, seem intelligent and knowledgeable enough for your criteria.  And that's just the beginning.  It is a highly individual and personal selection that needs to be made.

It isn't that you are looking for someone perfect but, you are looking for someone with whom you can form a bond and with whom you can think:  "I will probably be able to open up here.  I can imagine myself being able to make the changes I need to make or look at the issues I need to, with this person."  In other words, therapists are not interchangeable.  Be willing to drive a little ways for the right person.  It's worth it.

How Does the Therapist Think About You?
  You are probably more important than you realize.  Most therapists in a solo private practice, do not have more than 20 cases at a time.  They may have more than 20 people under their care as some cases may be couples or families.  But, you can see, we are talking about a range of 10 to 30 people.  So, you are not just a persona passing through.  You receive a lot of attention from your therapist:  Thought, care, planning, concern.  You are individually considered;
you are not in an assembly line.
When you start in therapy with a particular practitioner, they expect to see you on-going for awhile so, they begin by investing themselves in a relationship, in establishing a relationship with you.  This relationship is important as it is the framework within which you will work on your problems.

So, How Do You Find This Just Right For You Person?
If you are lucky enough to get a personal referral, that is ideal.  If you have a friend who is in or who has been in therapy and has someone to recommend, great.   Ask around.  Read profiles on referral services.  If a therapist writes, read what they say; how does it make you feel?  Investigate.  Most therapists in their own practice now have some sort of on-line presence, a blog, a listing, a facebook page, a website; look at these and compare.
Once you've found a few that look interesting, it wouldn't hurt to do a little mini-phone interview.
The last time I sought a therapist for myself, I thought about what were my most important criteria---here I will share those with you---lots of experience, the older the better, someone who had lived a little---these were what I wanted.

I encourage you to think about what you want.  And, also, what doesn't matter to you.  For example, I didn't care if the office was the dingiest ever, if I found someone who could meet me at my level.  But, for some people, the setting is important in feeling comfortable.  I didn't care if the therapist was a man or a woman.  This is important to some people.  Etc.  The point is to try to know what you are looking for---at least what your bottom line must-haves are.
Then I contacted a woman, out of my area, as a matter of fact, who had been the facilitator in some post-graduate training I did.  So, she knew me a little which also helped.  I asked her for recommendations, based on my criteria, outlined above.  She gave me two suggestions.  I picked one and it worked out great.

Using the 1st Discussed- Practical, Efficient Method
Once I had a parent come in with his son.  His son had been seeing a therapist for quite awhile, was connected to her, had a bit of history with her, and felt comfortable with her.   The parents' insurance through their employer had changed and the new one did not have the family's therapist listed.  So, they were looking for a replacement, someone who was on their list and not too far from home.
The son looked so sad.  I tried to say to them that they really should try to negotiate a fee with the former therapist, that the established relationship was important.
I guess you could say I was shooting myself in the foot by not just swooping them up---after all, new business for me, right?  No. Not right. That's not only not ethical, it's unkind.  The boy needed to complete the work he was doing with the therapist he knew.  It was obvious to me.
Unfortunately, the father wouldn't hear of it.  Why should he pay-in this case, the fee was $100. per session-when he could pay a co-payment of $35., he said emphatically.  The last time I talked to them, they were still looking, looking for a replacement.

The Dilemma
Sometimes someone needs therapy, has insurance that will cover part of the cost, the insurance is an HMO (list of their own providers), and they can't afford standard fees.
On the other side is the therapist who earns their living on the payments they receive from a very few patients.
Compromise sometimes has to happen.  Maybe the therapist can lower their fee a little and the patient can stretch their paying tolerance a little and a deal can be struck.  Give it a try.  I wish you the best in finding the therapist who is just right or, right enough, for you.

Your comments are welcome.

Saturday, December 10, 2011

Dialectical Behavior Therapy

Herrick Hospital psychiatry grand rounds, November 14, 2011,  DBT:  An Overview.  Mardell Gavriel, Psychologist, Psy.D. 

A theory of therapy, an offshoot of Cognitive Behavioral Therapy, which has gained some recent renown, was discussed by Dr. Gavriel who uses this method at the mental health services division of the Haight Ashbury Clinic. 
An underlying principle is that if you change one part of the triad---thinking-feeling-behavior, all will change.  This harkens back to family systems therapy theory wherein it was postulated that if one part of the system changed, all parts would have to shift.  It is like a suspended mobile:  If you touch one part, the entire mobile moves (John Bradshaw).
Any kind of emotional dysregulation  can be addressed by this type of therapy.
Goals are:  To do dialectical thinking
.                  To be a flexible problem solver.
                   To find truth in more than one position.
                   To be able to synthesize apparent contradictions.
                   To learn to seek the middle path.
                   To not get caught up in black and white thinking.
                   To learn that ambivalence is possible.
                   One person can have more than one truth.
The DBT therapist uses techniques such as Diary Cards, Homework and Skills Training.
Usually DBT can only be fully utilized in a clinic setting as it requires team strategies (the team is made up of a group of health care providers) who will consult about the patient.  However, individual practitioners can still benefit from some of the ideas and apply them in their practice.

In DBT the therapist and patient work based on a hierarchy of targets, resolving first what DBT considers to be the most serious.  These must be dealt with before moving on to the next target.  The first to be addressed is if there are any dangers-to-self behaviors, on the part of the patient.  The next is therapy interfering behaviors.  Next to be addressed is anything that lowers the quality of the therapy.  And, finally, what DBT calls life interfering behaviors-usually the problems which people come into therapy to work on.
The hoped for outcome for the patient of DBT is:
  • Enhanced capabilities
  • A more efficient life
  • Improved motivational factors
  • Ability to transfer a learned skill from one situation to another
  • Structure the environment to live more effectively
  • Eliminate self-harm behaviors
  • Increase distress tolerance
  • Emotional self regulation
  • Better interpersonal effectiveness
If you, the reader, have ever been able to partake of the therapy process, you will recognize some of the ideas outlined by Dr. Gavriel.   It isn't all new but it is newly organized.
This is not a comprehensive description of this type of therapy; it is a brief rendition of some parts of it.  For more info, see,
Please comment below -

Monday, December 5, 2011

Your Greatest Asset

Reading is brain exercise.  Reading keeps your brain healthy.  If you read my blog, you get double benefits; you get the brain exercise and you get new information and tips for making your life better!

( Anna Ferguson Hall, The Brunswick News, Ga.
Knight Ridder/Tribune Business News)
Nov. 10--Clerks at the Brunswick-Glynn County Library know Evelyn Connell well.
Like clockwork, the Brunswick resident stops by the library every other week, checking out as many books as she can carry. Last week, she signed out 14.
"I can really only carry about 12 or so in my bag, but I just stuff as many as possible in it anyway," Connell said. "There is no limit on how many you can check out, so I take advantage of that, you'd say. I read at least six books a week."
At 71, Connell is an active reader with a sharp mind. She is quick on her feet, clever and vivacious. She loves the TV trivia show "Jeopardy!" and usually knows most of the answers.
She can do several tasks at once and has a mind like a steel trap.
...Her spryness and spunk are likely due to how active she keeps her brain, she speculates.
"I do think that the more active you keep your brain, the longer you hold on to those traits of brain power you have at a younger age," Connell said.
Connell is not alone in that thinking. Overwhelming research has shown that older citizens who keep their minds sharp and active are more likely to retain a higher level of brain power as they age.
Keeping the brain active through exercises like reading regularly is vital to preventing memory loss and reduced brain function, said Janice Vickers, executive director of Alzheimer's of Glynn/ Brunswick.
"There is no question that reading can maintain a healthy brain as you age," Vickers said. "The saying is true: If you don't use it, you lose it."
An estimated 5.4 million Americans of all ages have Alzheimer's disease, the most common form of dementia, according to the National Alzheimer's Association. That's one in eight older Americans.
Vickers said the disease, though prevalent in aging citizens, can be avoided or, at the very least, delayed. Working to prevent the condition at an earlier age is key to ensuring a quick mind like Connell's, Vickers said.
That means flexing the brain as often as possible in a variety of ways.
Cracking a book or other printed work awakens many functions in the brain, including concentration, vision and comprehension, Vickers said.
Reading books, magazines and periodicals aren't the only sources individuals can lean on for stimulating brain function. Doing research online, playing trivia games and even crossword puzzles have been shown as ways to produce more brain function and prevent dementia-related diseases, Vickers said.
Reading also can be a link to diagnosing early stages of memory loss. The ability to read can slip from some patients early in the process of developing the disease. 

(-- Call reporter Anna Ferguson Hall at 265-8320 or e-mail her at to suggest literacy programs or community needs for The Literacy Project.
Distributed by MCT Information Services)