What to Talk about in Therapy Sessions?

For many people who have wanted to benefit from counseling / psychotherapy, not knowing to where to start or what to talk about is one of many concerns.

Over the past few years, I have come across such a question countless times with even patients who had seen me for a while.

They were either worried that they didn’t provide relevant or adequate information for us to work on together or feared judgment or rejection from the therapist if volunteering the “wrong” information.

Thus a lot of them chosen to be “directed” to kick start the session. If you have been to therapy, this probably sounds very similar.

Given their consideration, I usually invited them to give themselves permission to talk about “anything that pops into their mind” and leave their hesitation and worry out of the room.

The result? ALL patients ended up catching themselves “on the topic” by the end of session. Important and urgent matters came up naturally. What’s more important, they always shed light on something deeper to explore.

It never failed. Not even one single case.  

Why?

Due to my clinical training and background, I have strong belief in human potential for positive self-direction that leads to self-actualization. (For those who are interested in reading more, please click here for humanism and existentialism)

Simply put, we human beings have an innate need for growth in all areas to life to strive for becoming who we identified with.

This holds true in all of us. Luckily, we all have this yearning for genuine progress in various areas of life. Still remember the pain when we “feel trapped” and realize that we may not be able to become someone we want to be? How about the joy when you finally have that I-Made-It moment?

Second, our subconscious mind carries way more information than the conscious mind. It is the seat of our feelings, emotions and even patterns. When given permission in a non-judgmental environment, people tend to be amazed by this non-directive approach as to how much valuable but seemingly previously forgotten information was revealed.

I have seen case after case that the more clinical information available, the easier we draw connection between current struggles and previous psycho-social conditioning.

Therefore, with sophisticated skills to facilitate emotional clearance and solid clinical training of your therapist, some deeply seated disturbing issues can be uprooted.

What does it feel like?

Please allow me to borrow my clients’ comments---

“Christine, it feels like something heavy was lifted off my chest/shoulder”.

“I feel light.”

“Finally I feel like I can breathe.”

Or simply a smile with relaxation……

Third, anything, however major or minor in your eyes, can be of clinical importance in your therapist’s ears. Never underestimate any bit of it. A well-trained therapist knows not only how to listen to you but also what to attend to.

Last but not the least, a highly skilled and competent clinician will be comfortable with listening to your feelings and thoughts toward him/her and session work and even encourage you to use that materials (called “transference”) to enrich the counseling sessions.

For example, who did he/she remind you of in your life? How did he/she come across due to certain words/movements? What is it in the session that triggered certain reaction inside of you? etc. Further exploration of these topics helps bring to your attention some patterns that may otherwise remain hidden.

So, next time, are you ready to share “whatever pops into your mind”?

(For those who had gone through this situation, please feel free to share your experience with us. Thanks!)

How To Choose A Therapist For Myself? 

As psychotherapy / counseling services are becoming more and more accepted by our society, a lot of people realized that they can reap many benefits in therapy like emotional clearance, coming to terms with the past, gaining ownership in one’s major decision or even improving relationship with loved ones, etc.

However, before they start this growth-promoting journey, a significant question regarding choice of a therapist concerns them. I forgot how many times people came up to me, asking “Christine, how can I find the therapist that really fits me?”.

Well, as a matter of fact, this is a million-dollar question. Today, let’s decode the matching project step and step.

First, knowledge of your own preference about generic aspects helps narrow down your search. Therapists differ in age, gender, racial/ethnic background, language capacity, religious belief, fees, availability, location, and even physical appearance. It’s no-brainer that a client with limited English proficiency would want a therapist who is fluent in client’s home language in clinical setting. Or a therapist who offers services out of your price range may not be your first choice.      

Second, find out if your therapist’s treating philosophy is consistent with yours. For example, some people would love to move to short term solutions straight after identifying unhelpful thinking patterns ( all-or-nothing thinking; personalization, etc.) while others may be more drawn to sorting out thoughts and feelings for deeper understanding of historic roots of their suffering. 

This is more like one person prefers mowing the lawn regularly while another leans toward uprooting the weed in the garden. Which one is better? Actually, it is fair to say that both approaches have their places and beauty. What matters is that you and your therapist are on the same page about this fundamental aspect of treatment. For more details about various schools of treating philosophy, please refer to my posts in September and October – “What Does Psychotherapy Look like, Part I & Part II?”  

Third, use your gut feelings to determine if your therapist demonstrates professionalism through their interaction with you as a client.  By professionalism we mean whether your therapist can respect your treatment and have your best interest in mind.

Simply put, there are some criteria you can compare your prospective therapist against.

---How punctual is this person to start and end your sessions?

---Is s/he capable of unconditional acceptance without imposing his/her value/beliefs onto you?

---Can s/he sit with your experience, perspectives or even disagreement by encouraging honest and respectful communication without being punitive?

---Do you feel heard?

--- Is s/he willing to put your treatment needs ahead of the need to secure your favor and business?

--- Does s/he uphold professional boundary due to the power differential inherent in therapist-patient relationship? For example, having a personal relationship with a current client is indicative of unethical and unprofessional behaviors on the part of the therapist.  

This list can go on and on. For many first-time users of mental health services, this may sound very cumbersome. Luckily, gut feelings can be our best guide at critical moments as to inform us if someone truly hears and respects us as well as has our best interest in mind.  

All right, I think this can give you some ideas about looking for a therapist of your choice. If you have any ideas or comments, please feel free to share it. I see you next month. J

© Minjun (Christine) Wang 2016 Liberty Psychotherapy Professional Clinical Counselor, Inc.

What Does Psychotherapy Look Like? (Part II)

Welcome back, everybody. As I have mentioned in Part I, today we will cover the two approaches falling between behaviorism and psychoanalysis: Cognitive Behavioral Therapy (CBT) & psychodanymics.

Let's take a closer look at Cognitive Behavioral Therapy (CBT). As everybody can see, Actually, its name is quite self-explanatory by adding new components to Behaviorism. The picture on the

left well illustrates its essential parts : thought, feelings and behaviors. The students of this school of psychology believe that as long as thinking errors (eg. over-generalization, personalization)  are identified and corrected and emotions are in alignment, problematic behavioral symptoms will be alleviated or eventually eradicated. This type of psychotherapy will be carried out in a highly structured manner.

People who are more "symptom-focused" and "action-oriented" than "root-cause-digging" would usually be drawn to CBT. During brief course of CBT treatment, patients will come across activities like thinking errors identification, role playing, guided discovery, behavioral experiments, homework, etc.

Last but not the least, psychodynamics is an equally important and interesting approach to work with mental and emotional conditions. The following chart may help visualize its relationship with the other three:

Compared to Behaviorism and CBT, psychodanymics tend to be more insight-oriented, less structured without homework and longer in duration since like psychoanalysis, it deals with deeper layers of personality of the client.

For those who are not a big fan of therapists taking the lead and setting the agenda for their treatment, or sense that they might respond to treatment better if allowed to "dig deep" with adequate amount of time and space, psychodanymics can create an non-judgmental setting for them to "spill their guts" without being pressed to conform to someone else' schedule to explore both here-and-now and personal history

Please note that the above explanation of each school is merely bare-bones given the need to offer you, our reader, here a sketchy outline. Every one of them can easily expand to volumes for their inner richness and complexities, not to mention many new approaches that derive from them.

As we can see, every single approach has legitimate arguments about their effectiveness, and naturally appeals to different clinicians and clients. I hope this post can bring to your attention which treatment philosophy is a better fit for you.

For those who want to know how to pick a therapist that best meets your needs, please come back later for my next post.  Have a good weekend and I "see" you later. :)

© Minjun (Christine) Wang 2016 Liberty Psychotherapy Professional Clinical Counselor, Inc.

What Does Psychotherapy Look Like? (Part I)

The past few decades had witnessed exponential increase in societal acceptance of psychology /psychotherapy due to the fact that its profound healing effect on human well-being has been repeatedly reported and documented by clinicians, medical professionals, patients and even scientific researchers. 

Psychology, as a term in modern English, can be traced back to late 17th century in modern Latin ("Psychologia"). The more ancient form of psychological intervention, such as Sleep Temple, was recorded over 4000 years in Ancient Egypt. It is safe to say that human beings had had a long history to utilize psychological intervention for treatment of various mental and emotional conditions. Unfortunately, under-utilization of such a powerful tool for restoration of mental health had been a fact in many parts of the world, including well-developed countries because of mistaken beliefs and social stigmas. 

Demystification usually starts with accurate and updated knowledge about the subject. This also holds true for psychotherapy. Today we are going to dissect different major schools of psychology in hopes that this comparison will serve as a clear illustration for our readers. For the ease of writing and reading, I will start from the two on both extremes in the field. 

           Now, let's first look at the behaviorism. The following picture can be a fun way to get the
get behaviorist ​​beliefs across. Behaviorism believes that like animals, human beings' behaviors can be shaped and predicted through stimulus-response conditioning process since introspection / independent thinking does not significantly impact this process.

If you're convinced that human beings are more subject to external stimuli and force of habit than the effect of internal conflicts /unresolved business, or even consider it minimal, you probably see eye to eye with this school of thoughts. In therapy, you can expect to experience relaxation training, modeling, social skills training, behavioral rehearsal, systematic desensitization, exposure & response prevention, and the like.

         Next, please allow me to introduce the opposite of behaviorism--psychoanalysis. Yes, you  

are right------ Sigmund Freud, childhood development analysis, classical couch, therapist sitting behind, controversial topics (psycho-sexuality), seemingly detached "blank slate " / "sounding board" role assumed by the therapists. 

psychoanalytic clinicians believe that insight into unconscious conflicts or long forgotten events in early childhood can help patient "dis-empower" the factors that perpetuate their symptoms and problems. If you suspect that some of your feelings, thoughts, attitudes and behaviors seem to be driven by something vague other than lack of knowledge, skills and awareness, then you can lean more toward this approach (compared to behaviorism). In the sessions, you will likely go through dream analysis, free association (naming things coming up in your mind freely), fantasies, etc. 

       All right, we have outlined the two extreme approaches in the field of psychotherapy. Do some of the practicing therapists use one of them? Maybe.  But the majority of clinicians fall somewhere on the continuum.  In the next post, I will bring up two other major schools that fall in between: Cognitive Behavioral Therapy (CBT) and Psychodynamics. (I “see” you later in Part II)  

     ©Minjun Wang 2016 Liberty Psychotherapy, Inc.