At parties and other social events people naturally ask me about my work. I get all kinds of responses from "Yeah, there're a lot of people out there who need it" to "Oh, that's interesting. Don't you find it hard to listen to other people's problems. I could never do that."
The subject often moves into the personal - without my prompting - and I learn more about why they don't consider psychotherapy a possible source of enlightenment.
Here are my responses to some common misunderstandings about mental health counseling.
You might certainly feel that your psychotherapist can read your mind because she so accurately reflects the emotions you are feeling. This idea reflects the ability of good therapists to be attuned to their clients. This is actually a very desirable quality in a therapist and is not the same as reading your mind.
Therapeutic change occurs when the therapist is finely attuned to what you need emotionally. As you will learn repeatedly on this site it is our connection to each other that helps contain our emotions. The therapeutic relationship offers even more, for counseling can give us a greater capacity to be with our emotions.
From my own personal perspective it is our capacity to feel and manage our emotions that generates the quality of life many of us are searching for.
Attunement means more than just "good vibrations" that is, it doesn't always feel good for some people. For example it can be unnerving for someone who is uncomfortable with "being seen", whether or not this is the reason for going to counseling. And attunement can feel unfamiliar, even strange if you have never had it in a relationship before.
I have had a few introductory sessions with clients during which I felt a good attunement. Nonetheless they never returned, and while it could have been for any number of reasons, I suspect it was for this reason. It is almost as if the attunement in and of itself was overwhelming.
That said, good attunement is precisely the reason counseling can be so effective. It provides a real life stage on which you can safely experience troubling emotions. This provides your emotional brain with the opportunity to develop new neuropathways for feeling or responding differently.
Read more in my upcoming eBook, Choosing a Therapist why the best counseling comes from a therapist who is "attuned".
This is usually said with the same disdain that serious people have for astrology, but it's not true about psychotherapy. The principles you will encounter in these pages are based on extensive research meeting the highest scientific standards. In fact, there's so much research happening now that theory and practice lag way behind today's discoveries.
Rather, it's the practice of counseling that's not scientific. The application of the principles derived from research is an art, because the therapist must create a connection with the client and then skillfully work within it to induce the desired changes.
You could describe it as a dance between the therapist and client, one which follows certain rules (e.g. stepping on toes is not a valid dance step!) yet which allows some scope to improvise, to personalize the expression of feeling.
If you follow the news even now you hear a lot about the science behind counseling and about its long-term health benefits.
So to get you started you might like to take this short tour on The Science of Counseling.
Once you get the general picture, here are the definitions you'll need to understand some of the science behind counseling: Neuroscience of Therapy.
Especially for Psychotherapists
If this topic interests you, you might enjoy a quote from one of my favorite authors, Dr. Allan Schore:
"Although psychotherapy has recently been devalued, or at best undervalued, the art and the science of psychotherapy, the careful study of the inner worlds of a multiplicity of psychopathologies, as well as the necessary self study involved in this profession, are as complex and rigorous as any other discipline in the experimental or applied human sciences... ("Affect Regulation and the Repair of the Self "(2003)).
Dr. Schore's new book "The Science of the Art of Psychotherapy" will continue his interpretation of advances in neuroscience research, and propose a new model of human psychobiological development.
This statement reflects two fears.
The first fear relates to 'psychic power'. I'm only a curious observer in this domain but my guess is that psychic ability is more about an individual's talent to read another intuitively than prescribing or forcing change.
The other is the fear that you can be manipulated into behaving or feeling in a way that you don't want. I'm willing to bet this fear is not restricted to your opinion about therapists…
It is very likely related to your sense of vulnerability to the influence of others. Maybe someone significant in your life has overly influenced you?
Struggling to maintain one's independence of thought and integrity in the face of opposition is a challenging human experience and one that I believe we all face at some point in our lives.
I'm reminded of a scene from Analyze This. The client (mob boss Robert deNiro) tells the therapist (Billy Crystal) that he's decided to go to counseling. And in the next breath he warns the therapist that he's going to kill him if the counseling makes him gay!
If only therapists had that much power!
It can feel like that. One reason is the mistaken belief that every trauma we ever experienced must be re-experienced and worked through. We know from clinical observations of counseling practice this is not the case.
We also believe that the way the brain functions makes it possible for the resolution of one event to psychophysiologically resolve another. (See hypercoupling and kindling & quenching in future updates in Therapy Lingo).
Another reason is related to the way we experience different states. When we are immersed in one state it is difficult to experience or even imagine another. For example for those who are depressed, it can feel like the depression will go on forever. Part of the reason for this is that each time a future event is considered we project our current depressive state upon it. It is impossible to do otherwise.
So in short, don't mistake your current state as a predictor for your future.
Remember too, you are the only one who can set your goals: freedom, healthy relationships, and serenity. Indeed, there is room for growth at any stage of life meaning that the pace and direction of your counseling is for the most part under your control.
Frankly, when you are getting what you want from your counseling, when you are getting results and moving ahead, you just want more of it.
Personally, I don't think that going to counseling is seamless with the idea of suddenly being "cured". I see it as one of the ways--a very important way--of creating a more emotionally secure and happier life.
Most of my friends have been in counseling because they chose to do so, not because they had to - they were managing "just fine". Many continue to go because it helps them enrich their lives, helping them feel more settled and secure both emotionally and physically.
So remember, it's your choice how far you choose to go in your counseling. I bet (I know I'm eternally optimistic!) that once you "get into it" it won't seem so arduous a task.
As an aside, counseling works in incremental steps but this doesn't mean you shouldn't be noticing changes in yourself as you proceed. Tracking your progress in counseling can help you stay connected with shifts you're noticing - or lack thereof. That way, even if you change your mind about continuing or what you hope to achieve, you have a benchmark from which to measure your progress.
This statement comes from the mistaken belief that your counselor is a teacher or that your therapist is going to tell you what to do. If this was what you expected you might be better off simply reading a book.
Quality time in counseling with a good psychotherapist is much richer than any book can provide. We hear everywhere what we "should" be doing to live a healthy, balanced life, and on the surface they seem like simple tasks. However, the reality is that people are not eating more veggies or getting enough exercise. This fact reflects less about a lack of information or a lack of will power than it is about how these avoidance patterns are "laid down" in the brain.
Specifically, these avoidance patterns are implicitly encoded in the nervous system. They do not respond to a simplistic 'just do it' mentality although initially we can certainly push ourselves. Much will depend on the degree to which the nervous system is regulated.
Moments of connection with your therapist are to your brain what exercise is to your body. There is a flow.
No you don't!
In reality, good counseling is about working collaboratively with a therapist. Ultimately the "approval" you need comes from inside yourself. A good therapist recognizes this fact and does what's possible to help you develop the awareness that this resource is within.
If this myth comes up for you when it crosses your mind about giving counseling a try, or when you learn that a friend is seeing a therapist, then consider for a moment what it says about you.
It's my guess that at some level this statement reflects how you experience your important relationships. Perhaps you experience a power imbalance or feel unsure of your own worth?
There are numerous ways to respond to this statement but I'm going on the assumption that it is being driven by fear, lots of fear.
It is natural that you would want to have a reasonable explanation for the way you feel. It is also natural that you might suspect that something awful happened to you to create your present condition.
It is far more likely that several negative experiences combined to establish the amount of fear in your nervous system. While this might not sound like good news hear me out. You may not know the source of your fear but the manifestation of it in your behaviour is probably already well known to you.
What we know now is that it is not necessary to resolve every trauma or negative experience in order to recover normal emotional functioning. In fact there are some events that we will never have verbal recall for. This is due to the way the brain lays down implicit memory in our early years and explicit memory during times of stress.
However, because the brain is interconnected, one event is often hypercoupled with another. (The brain is biased towards association.) This makes it possible to work with issues/events linked to the original in a way that more or less reduces the overall negativity. Indeed, working with the other less negative experiences is sometimes sufficient to resolve the original!
For instance if I have a problem with authority issues, I can do a great deal of work resolving my fears towards my boss without having to deal ad nauseam with emotions and reactions about my abusive father.
Especially for Therapists
Observations from psychotherapy have historically revealed that recovery from a traumatic event sometimes has a reparative effect on the nervous system: Clients report feeling better than before the event. We believe there is an animal model that explains these phenomena.
I have written on this model elsewhere in its application to Self-Regulation Therapy (SRT) and for your convenience it is replicated here:
"The `kindled' limbic amygdala's (Post, 1995) has frequently been cited as a model to explain the effects of trauma at a micro level. … A small amount of electricity (10th of a millivolt) was delivered to the amygdala of laboratory rats. A typical observation is a spike in the frequency and an immediate return to baseline. Over the course of 6 weeks however this baseline actually rises and is maintained at a higher pre-experimental level. This "kindled" brain provides an excellent illustration of the impact of trauma on the nervous system. Symptoms such as agitation, hyperactivity and `in your face' sensitivity to stimulation, may be expressions of a `kindled' brain…
For the clinical work of SRT, the really exciting work with the `kindled' amygdala followed when the stimulation was reduced to 1/100th of a millivolt, a process known as quenching. The baseline not only recovers, but remarkably, to pre-kindled levels! Paradoxically further stimulation has led to a reduction in `kindling'. We believe this may provide one explanation for what we are witnessing in our own practices. When later trauma are resolved in a more resourced manner, it has a reparative impact on earlier trauma."
Good counseling is actually the opposite. Good counseling focuses on your strengths and resources.
But more than that, counseling can help you understand that most of our disordered patterns were adopted at times when they served a purpose. This site is devoted to helping you understand this. Without that knowledge we tend to attribute problematic aspects of our character as arising out of a flawed self. Frankly stated, "we didn't get this way for no good reason".
The strength of these patterns is largely underestimated in our driven 'just do it' culture. However, these brain patterns--entrenched as they are in procedural memory--do not lend themselves to easy modification through simply recognizing them and intentionally trying to change them. When you understand how the brain functions you will see that they require a different kind of re-learning.
I look forward to explaining more about this fascinating subject in future articles on the site.
I think this myth stops many people from entering counseling. They think the therapist is going to try to talk them into making some change they're not ready to make.
Good counseling creates the right conditions for you to change inside naturally, for the change to be embodied. Then the outward expression of that change shows up naturally in your behaviour.
You'll probably find the next topic interesting.
When people think of 'change' they think in terms of specific behaviours that are not working for them. Counseling can change you, but not in the way that you anticipate.
This is how it goes…
People who don't understand what counseling offers come to the erroneous conclusion that they're not ready for therapy.
They will openly acknowledge areas of their life that are problematic. "I drink too much." "I spend too much money on frivolous things." "I'm living with someone who's not right for me". However, if truth be told they are also saying, "I'm not ready to let these things go."
Good counseling is about change but it's more than simply recognizing the obvious behavioural patterns in your life. Most of us are too bright for that. Counseling is about becoming a stronger you. This can be accomplished in a working relationship with a good therapist--which is why good therapy matters.
As you become stronger, your system's overall readiness to make changes in your behaviour grows. Then and only then, can you make choices that endure.
Good counseling is not about forcing you to change specific behaviours. It is about getting you ready for behavioural change. In effect, you enter counseling precisely because the idea of making any change is overwhelming.
Good counseling helps you to recognize and utilize the resources you already have, so that when you want to change fundamentally you can do so…naturally.
I suspect that this attitude represents people who are too fearful to give counseling a try. Counseling is concerned with facing our fears, not shirking them, and it takes courage to do that. And we can go deeper…
To dichotomize people into 'winners' and 'losers' suggests an overly distrustful or competitive view of the world. This perspective is not one that we adopt by just thinking about it or reading it in a book.
Distrustful or overly competitive attitudes--in combination, or as separate traits--are learned behavioural patterns that for the most part become entrenched during our early childhood experiences. These kinds of patterns are laid down in the right brain and are largely unresponsive to the demands of the left (logical) brain (i.e. "just think differently").
Hoping to change entrenched attitudes and behavior patterns through random life experiences can be illusive and exasperating - much like bobbing for apples. Counseling increases the odds for creating life changes. That is, we can be proactive in our desire for change.
The idea here is that some people feel they have to be over the top or on the edge before they feel justified going to counseling. Let me be very clear: You don't need to have a "reason" or be in crisis to consider counseling. Simply wanting to make your life better is more than enough.
Although therapeutic practice has been overly focused on negative symptoms, there is a movement towards "up regulation" or helping clients get more from their lives. Finding the therapist that understands this is crucial.
I have spoken elsewhere how this blind belief stopped me from getting the help I needed when I was younger. The irony is that the very issue I needed to resolve was preventing me from getting the help I needed!
Some people don't feel they deserve the attention and support entailed in going to counseling. They feel guilty about spending the money or using the therapist's time. They just don't feel worth it!
If you are the type of person that more often than not puts yourself second to the needs of others you will find it unfamiliar and difficult acknowledging your own needs. In fact, it may only be when your symptoms interfere with how you meet others' needs that you finally give yourself permission to enter counseling.
That is, you entered counseling so that you could feel better and although you might not be consciously aware…you intend to go back to the same old way of being i.e. attending to other people's problems at the expense of your own needs. Hopefully, a wise therapist will recognize and interrupt this pattern before it gets regularly repeated now and throughout your lifespan.
My Personal Musings
The other dimension that speaks volumes about the statement "My problems aren't heavy enough for counseling" is the fact that therapy isn't just about 'our symptoms'. That is, counseling is much more than a technique to banish anxiety and depression. That would only bring many people back to neutral.
Without the neuropathways for joy, you cannot feel alive in your body or in your life. There are many individuals who, after counseling, are no longer depressed. However these individuals have shortchanged themselves tremendously unless they also achieve joy.
Keep in mind that a good relationship with a partner or caring other offers some of the benefits of a good therapeutic alliance. I believe that through these kinds of relationships change can also occur, and I think we largely underestimate their value culturally. (Not to mention we also completely undervalue the healing potential of community.)
My Personal Musings
It's my impression that unless an individual has had a loving connection fairly consistently over the crucial early years it is difficult to create an intimate bond in adult relationships.
Most embodied change that does occur in our ability to connect with another--that I become privy to--happens after a great deal of heartache and/or remorse.