There are many schools of psychotherapy and, most of us have some preconceived ideas about therapy and how it should work. I have prepared this page to give you a clearer picture of the type of therapy I provide and what you might expect as a prospective client working with me.
"The Therapist" by Rene Magritte (1937)
Basic Ingredients
First and foremost, your therapist has to be someone you can trust, someone who understands you, who genuinely cares about you and provides you with the kinds of information, guidance and feedback that makes sense and produces results. In a nutshell, you should feel comfortable with your therapist, have confidence in him or her and you should expect to see some results, however minor, within the first five sessions. I have seen some patients who were previously in treatment for years, without significant improvement. Some did not expect improvement and were content to have someone to talk to, but most continued month after month, hoping that some day something magically would change. Rarely does a patient continue for months without progress and then suddenly improve. If progress is going to occur, it is usually evident throughout the therapy process. Change is difficult and requires the best that therapist and patient can give.
As Magrite portrays in the painting above, therapists offer clients the opportunity to escape their own personal cages.
"The Beginning" by Cecilia Betancourt www.betancourt-art.ch
Psychotherapy, like good medical care, is both art and science. It is a collaborative effort between therapist and patient. I believe everyone needs a flexible PLAN to guide them toward their goals. In therapy, I help my clients clarify what their primary problems are and what specific results they want to achieve. Then, we identify specific action steps that will enable them to reach their goals.
We all want many of the same things in life: health, loving relationships, confidence, peace of mind, financial security, success, happiness, etc. How successful we are in reaching our goals depends upon having the necessary (1) will or motivation, (2) the knowledge or skills and (3) a well-conceived action plan. My job is much like a coach, to inspire and motivate you, while giving you the necessarytools. Your job is to do the necessary work to implement your plan, and to persevere despite expected obstacles. The results you seek are generally possible and worthwhile, but they will not occur overnight or without sustained effort.
While many patients are able to achieve their goals without medication, and it is better to minimize the use of medications, research has shown that a combination of medication and cognitive behavior therapy produces the best treatment results for many conditions, such as ADHD, Major Depression, Panic Disorder, Bipolar Disorder, OCD, etc. I work closely with a number of primary care physicians and psychiatrists who can provide medication management, if this is needed.
"Diving In" fired stoneware by William Mulligan
Multimodal - Cognitive Behavior Therapy
I trained extensively with Dr. Arnold Lazarus, the founder of Multimodal Therapy. This approach is a comprehensive form of Cognitive Behavior Therapy and can be described as generally:
Shorter-term (takes16 sessions on average, including all types of problems treated, understanding that some clients, who should be seen for a much longer period, drop out after 1 or 2 sessions, while others continue therapy for well over a year; the number of sessions a client is seen depends on many factors, principly the client's motivation and the severity and duration of the presenting problems)
Holistic (concerned with the whole person; recognizing the important interactions of biological, psychological and cultural factors),
Eclectic (using a variety of treatment methods),
Pragmatic (designed to get specific results)
Humanistic (emphasizing conscious awareness and efforts to cope with the real world), and
Educational (providing information and teaching clients more effective coping skills).
Traditional forms of therapy (of which there are many) are less structured and usually require more sessions than Cognitive Behavior Therapy. The therapist is less directive, doing more listening and less educating. A traditional therapist is usually more "non-directive", leaving it entirely up to the patient to decide what will be addressed in each session. Issues addressed are more vague and general, rather than focusing on specific problems, with a plan to obtain specific, measureable results.
The Seven Primary Modalities
In providing a thorough Initial Evaluation and comprehensive treatment, Multimodal Therapists systematically address problems in each of the following modalities:
Behavior (progress is usually limited if the patient does not make changes in action)
Thoughts (success at just about anything requires positive, rational thinking)
Relationships (social skills, communication and conflict-resolution skills)
Health (nutrition, exercise, possible need for medications)
"Female Torso" bronze by William Mulligan
The General Objectives
At a more abstract level, and in keeping with the spirit of the Serenity Prayer, you could say I help clients:
1. Take constructive action to change those things they can change,
2. Become more accepting of the things they cannot change, and
3. Learn how to more skillfullydistinguish those things they can change from those they cannot change.
"Duo" by Cecilia Betancourt www.betancourt-art.ch
Life Transitions
I help clients navigate through predictable and challenging Transitions in Life, such as the following:
Childhood (building self-esteem, family relationships and school performance)
Adolescence (peers and social skills, independence struggles with parents, self-esteem and identity)
Young Adult (transition to greater independence, dating, sex, college and career)
Marriage (Mars and Venus themes, communication and conflict-resolution skills, satisfying individual needs while working as a team to manage family life.
Separation and Divorce (learning and growing from one of life’s most painful crises, while minimizing hostilities...primarily for the children's welfare)
Mid-Life Crazies (change is unavoidable and can be positive, if problems and issues are addressed directly and responsibly, providing more opportunities to learn and grow)
Retirement (have you prepared for your "golden years", emotionally, physically, financially, spiritually?)
Older Age (caring for elderly parents and aging gracefully, as we come to terms with the reality that none of us live forever).
"Attached" by Siri Dehipitiya www.siridehipitiya.com
A Case Illustration
Mrs. Smith, a 34 year old mother of three children requested therapy, complaining of anxiety and bouts of depression. Once rapport had been established, Mrs. Smith's vague, global states of dissatisfaction (e.g., fear and unhappiness) were broken down into specific and discrete problems, such as depressed mood; negative thoughts about herself, her husband and her future prospects; inability to communicate or assert herself effectively; self-destructive, addictive behavior (overeating and excessive drinking); headaches and muscular pains; and insufficient exercise, which in turn were addressed with specific interventions that were largely educational in nature, such as the following: Cognitive restructuring and rational-emotive therapy. Mrs. S. was taught how to replace negative, irrational thinking with more positive, realistic thoughts about herself, the significant people in her life, her future prospects and the world in general. Referrals to her physician and a psychiatrist for medical and psychiatric evaluations to rule out any medical basis for her presenting complaints and to determine if medications might be a beneficial treatment for her anxiety; depressed mood and headaches. Assertion training and Communication Skills Training. Like many women in our culture, Mrs. S was very independent and skillfully assertive with others in many situations prior to marriage. However, over a period of years, she gradually became more and more passive (and unhappy) with her husband. Her passivity was also evident in her interactions with her bright and energetic children, who soon learned that mommy rarely backed up her words with action (consequences). Marital therapy for conflict resolution, parenting and sexual complaints.
Physical exercise, nutritional counseling and relaxation training (with guided imagery) for physical and stress-related complaints. Referral to a community support groupand to other community resources (e.g., a parenting group, couples support group and Weight Watchers) provided specialized help and support from others with similar problems.
