TRANSFORMATIONS - Special Edition
Thank you for taking the time to catch up with us! It's been an exciting year expanding the Palm Springs office, while continuing to work with Robert Linton and Dylan in Los Angeles.
We want to share some of our favorite articles from the first four years of TRANSFORMATIONS.
ACHIEVING MORE EFFECTIVE PSYCHOTHERAPY
By: Dr. Chris Emerson
Article Originally Appeared in:
TRANSFORMATIONS Issue 11,
Many patients, both those who are new to the process of psychotherapy and those who have many years of treatment under their belts, are unclear about how to gauge the effectiveness of psychotherapy.
On the one hand, the positive impacts of psychotherapy are so unique to each individual and so experiential in nature that it's difficult to generalize. On the other hand, a great deal of importance in the field of clinical psychology is attributed to "measurable outcomes;" they can determine which research projects will be funded in the field, the rate at which particular psychological services are reimbursed by insurance companies, and how to most effectively train new clinicians to achieve optimal results.
Here's the good news: over the last decade, a group of researchers tracking the outcomes of thousands of clinicians around the world have found that psychotherapy continues to help around 80 percent of the people who seek the assistance of therapists to deal with their problems (The National Psychologist, Vol. 23, No. 1, January/ February, 2014). But the bad news, according to these researchers, is that psychotherapy has not shown any measurable improvement during the last 40 years in how well therapists deliver their services.
The question of how to make therapy as useful as it can be is of critical importance to me. To that end, I have identified several specific components of the characteristics and behaviors of effective psychotherapists and their patients: (a) Positive Shared Intention, (b) Preparation and Reflection, and (c) Consultation and Collaboration.
People come to psychotherapy for a wide variety of reasons.
Some are seeking symptom relief such as reducing feelings of sadness and hopelessness, or simply to improve their coping skills at work and at home. Some may come to therapy to learn how to more effectively communicate their needs to others, including a spouse or partner.
Some people come with more wide-ranging goals, including increasing their overall self-understanding, addressing long standing relationship patterns, or charting the often difficult existential aspects of entering a new phase of life. This initial reason for seeking therapy is what psychotherapists speak of as the "presenting problem," and often, it opens up and expands into other issues as the process of psychotherapy unfolds.
Regardless of the presenting problem or the subsequent issues and treatment goals, it's important that both therapist and patient have a mutual intention as to what they hope to achieve, and the means by which they will go about it (e.g., an agreed-upon frequency of appointments, a commitment to work together through difficult phases of the treatment, etc.). Another key component of positive shared intention is the mutual understanding that progress is indeed possible, and establishing a basis for working together that includes the patient's reasonable hope for improvement.
The next characteristic behavior of successful therapists and patients is that of preparation and reflection. I find that the patients that benefit most from therapy are those who are able to somehow "bracket" the therapeutic hour from the rest of their busy day, and allow enough time and space to be fully present for the therapy.
It's particularly important for patients who are working through trauma to allow themselves the time and space after the session to come fully back into awareness with the body, their physical sensations, and the powerful thoughts and feelings that can emerge from this work. And the patients who seem to get the most out of psychotherapy also allow for some time to reflect on the issues raised in therapy throughout the week.
Therapists, too, need to allow sufficient time to prepare and to reflect. The previously cited research found that "top performing" therapists spend a good deal of time getting ready for therapy sessions, and a lot of time afterward assessing their work. In addition, it's vital that as mental health professionals we are mindful of our limits, that we do not over-schedule ourselves or take on more patients that we can handle with clarity, energy, and empathy.
This leads to the last characteristic behavior of consultation and collaboration. One of the most effective forums for therapists to assess and reflect upon our work is in consultation with other professionals. I regularly meet with colleagues and former clinical supervisors to review cases and solicit new perspectives and feedback. Giving and receiving consultation takes us out of old, established ways of thinking and practicing, helps to ensure that we are acting ethically and in the best interest of our patients, and that we are practicing good self-care as clinicians.
Another aspect of consultation and collaboration involves the therapist working with other professionals such as psychiatrists and other medical providers who comprise a patient's "treatment team." Patients should expect that such collaboration be made available as a part of their therapist's treatment plan when appropriate, and they should understand that such consultation can take place only with their express written permission.
When we work with the mindset of being a well-functioning, highly communicative team - a team that includes the patient, of course - the probability for positive outcomes is increased exponentially. After all, health is a multidimensional construct, and no one professional has expertise in every area. We really do need each other for optimal success.
By being mindful of these principles, both the therapist and client can better assess the extent to which they are having positive, successful experiences in the shared endeavor of psychotherapy. Perhaps the most important "takeaway" from this article is to remind us that we are indeed sharing in the experience, that it truly is a collaboration, and that only by working well together can we expect to achieve optimally effective psychotherapy.
At A Loss
By: Robert Linton, M.A.
Article Originally Appeared in:
TRANSFORMATIONS Issue 10,
One of the most profound emotional experiences in life is that of a loss and the grief that follows. As common a human experience as grief is, it is not necessarily well understood by most of us, which can leave us unsure and questioning of our own experience. In my work with clients in grief, I address these painful experiences from several aspects, one of which is through an understanding of the myths and truths of the grieving process. Here are five common myths regarding grief:
1. Myth: "There is a right way to grieve." Truth: There are no rules for grieving a loss.
We tend to view grief as something that should be experienced and expressed in certain ways, over some finite period of time, and in a series of ordered phases. But when a person's grief does not occur in these preconceived ways, it can cause feelings of depression, anxiety, and even anger for not grieving the way they think they should. The way one grieves is very personal and can be different for different people. It needs to be allowed to evolve and flow however it naturally does. I have seen people express their grief in many different ways, and I am often surprised and inspired by the unique way clients have found (not always consciously) to work through their grief.
2. Myth: "Grief follows a series of 'stages,' that occur in order, and ends when the final stage is completed." Truth: If only that were true.
It would be comforting to be able to monitor our progress through the painful process of grief by knowing that we no longer have to experience the stages that have passed, and only have a certain number of them left before it is over. But in fact, the well-known stages of denial, bargaining, anger, depression, and acceptance may appear in any order, one or more may repeat themselves, and the process itself might abate temporarily and only to then resume. A grieving person may think they have "relapsed" or feel disheartened if they find themselves back in a stage they have already gone through. Each of these stages will occur as many or as few times as we need in whatever order or non-order we need.
3. Myth: "Grief should only last for a certain period of time." Truth: Grief is not concerned with what "should" be, only what is.
Grief will last as long as it lasts, no shorter or longer. It might seem to us that our grief did not last as long as we thought it should, or conversely that it has gone longer than we expected. We can only look in hindsight to understand how long our grieving period needed to last - because that was the amount of time it did. And another loss we might experience at another time might have an entirely different period of grief that follows.
4. Myth: "I can't handle this." Truth: You already are.
This has a lot to do with re-framing what we mean by "handling it." Loss may feel overwhelming, but it may not always actually be overwhelming. There are times that might be physically and emotionally exhausting, and we feel we are drained and have no energy left. That is handling it. There are times when our emotions are so intense that our daily activities come to a stop. That is handling it. There are times when we want to completely distract ourselves from the pain we have been feeling. That is handling it. Therapy can be particularly helpful in identifying the ways in which someone is handling it and in increasing the effectiveness of their coping skills.
5. Myth: "I need to let go and move on." Truth: Not necessarily, and not necessarily right now.
A common belief is that a grieving person needs to "let go" and "move on." It might be surprising to know that there has been research showing that people who have not "let go" have worked through the grieving process more effectively than others who said they did. That does not mean that it is that way for everyone, but it is another example of how grief is individual to each person. An individual will come to a close of their grief as they are ready, when they are ready, and if they are ready.
Having a better understanding of grief can be helpful, comforting, and empowering in the knowledge that however you experience and express your grief it is the right way - the right way for you.
The Work of Therapy:
Symptom Relief and Meaning-Making
By: Dr. Chris Emerson
Article Originally Appeared In:
TRANSFORMATIONS Issue 8
One of the primary reasons people cite when seeking psychotherapy is a desire for relief from certain symptoms: the presence of anxiety in their daily lives, an ongoing experience of acute sadness and hopelessness, or problematic behavioral patterns that seem beyond the influence and control of ordinary will power.
Others come to address more existential issues, or difficulties related to a particular phase of life: how to separate from the sometimes overwhelming influence of parents and move into a full, independent adulthood, or how to find meaning in challenging life experiences.
Most often, once the work of therapy begins and we probe deeply into the patient's experience, we find a combination of areas that deserve our attention. At that point, the work moves back and forth between achieving symptom relief and meaning-making: that is, we begin to see that the problems in living that we experience are multidimensional. They call out for examination and strategic problem-solving from more than one perspective.
Sometimes the need for a psychopharmacological solution becomes clear; medication is a useful and often necessary part of addressing particular difficulties once an informed diagnosis of certain conditions (e.g., bipolar disorder or attention deficit disorder) has been made.
Patients also use the setting of one-on-one "talk therapy" to revisit old, historical patterns of behavior with the therapist as a willing, interactive partner. Together, we work toward an experience of "repair" so that the patient can move into a future free of unsuccessful and limiting beliefs, behaviors, and patterns of relationship.
Whether one is searching for meaning, symptom relief or a combination of both, psychotherapy is worth considering as a "lever" for change. But psychotherapy is not a panacea, nor is it necessarily the most appropriate approach to every life situation for every individual. It's not unusual for me to work with patients in combining therapy with other transformative activities; for many people seeking recovery from drug and alcohol abuse, for example, psychotherapy is an adjunct to 12-Step work or stays in a rehabilitation facility or hospital.
Because some changes are manifested primarily in the body, exercise regimes, body-focused work, and stress relief strategies are sometimes most appropriate and immediate ways to facilitate change. In these instances, therapy is useful to encourage self-awareness along the way, and to provide a forum for the individual to assimilate the changes that occur.
Not everyone needs or desires psychotherapy; but for those of us who find the project of therapy exciting, challenging and effective, it's worth the struggle and the investment of time, energy and resources.
Change the body... Change the mind
Quote Originally Appeared in:
TRANSFORMATIONS Issue 9,
Rolfing was developed by Dr. Ida P. Rolf, a biochemist and physiologist. She noticed that both physical accidents and emotional upsets tightened the fascial system, and if the fascial tissue continued to hold the posture of fear, grief or anger for any length of time these patterns would become inset. Inflexibility, imbalance and pain are the result.
In my practice I have an array of people who come for guidance. Most wanting relief from pain, some seeking an improved quality of life. What I find most fascinating is working with "trauma". The trauma I am referencing is held in the deep connective tissue called Fascia. Trauma can release in many different ways. One person may have visuals, smells or memories of the traumatic event. Some may have an involuntary shiver or shuttering while the trauma releases. Releasing the pattern of a trauma can bring a feeling of peace, tranquility, and freedom.
The body can feel lightness very much like floating.
One specific client, who originally came in with hip pain, wanted to get back to enjoying physical agility training with her dog. She experienced this type of trauma release during our sessions. As we began our
work, the focus came to her ribs and abdomen. While working to bring freedom to the rib cage, she began to cry saying she was reliving the death of her mother. She realized in those moments that she had stopped breathing in fullness herself. Her emotion confused her as it was extremely out of character for her. I reassured her, asking her to allow the feelings to flow and try not to hold the involuntary shuddering back, even though it felt foreign. It took another session in this area to completely discharge the pain and grief that hibernated deep in her torso. Today, the tightness in her ribcage is finally gone, she has physical freedom to breathe, move and can now speak about her mother without triggering the deep pain and sadness in her chest.
Board Certified Rolf Practitioner.