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Transformations Newsletter Issue 2 - April/May/June 2011

Issue 2 - April/May/June 2011

          Welcome to the second edition of TRANSFORMATIONS.  In this issue, we launch a three-part series, METAMORPHOSIS, based on the transformative experience in psychotherapy of "Laura" (please note that "Laura" is a pseudonym of an independent individual who is not and has never been a patient in this practice).  Dr. Katie Barnes explores what constitutes "clinical excellence" in psychotherapy from both the therapist and patient perspectives, and Victoria Dekovich offers a look at the transformative aspects of group therapy.TRANSFORMATIVE VOICES once again features three inspiring quotes from people in the community with insight into the processes of growth and change in their personal and professional lives.


          If you would like to know more about my practice, please go to my website at www.drchrisemerson.com or contact me by phone at my office: 310-550-4560.  Katie and Eleanor Moreh, M.A. are also currently accepting new patients, and are often willing and able to work on a sliding fee scale. As always, we welcome your thoughts, inquiries, comments, and questions.

Dr. Chris Emerson


Achieving Clinical Excellence:

How patient feedback can dramatically improve therapy's effectiveness

by Katie Barnes, Psy.D.

          As therapists, many of us claim to want to "better ourselves," "never stop learning or improving," and continue to grow as therapists, for our personal sakes and for the sake of our patients. When it comes down to it, if you ask most therapists to rate themselves on effectiveness, we rate ourselves 80% better than we actually are. We are content

with the ways in which we practice, because we have been doing it for years, automaticity has set in, and frankly, we just don't like other people telling us what to do. We did get our slaved-over degrees for a reason, after all!


          In December of 2009 I attended the Evolution of Psychotherapy conference, and was struck by Scott D. Miller's presentation on achieving clinical excellence. As much as I would love to take credit for the ideas and numbers in this article, I would simply like to reiterate what I learned from Scott's valuable presentation on the research he has conducted in his own practice (www.ScottDMiller.com.)


Some surprising numbers:


          Most likely, you are reading this article because achieving Clinical Excellence piques your interest, or as a patient, you are interested in ways to make your investment of time, money, and energy in therapy more effective. Psychotherapy outcome research tells us that the

quality of the relationship between a patient and therapist is the component that has the largest impact on whether a therapy will be effective or not. As therapists, many of us agree. Thus, we are warm, empathic, try to nurture a strong alliance and invite open communication between ourselves and our patients. Whereas the patient's diagnosis only accounts for 1% of outcome variation, it is the therapist

along with the patient's perception of the relationship that determines the therapy's effectiveness. We hate to think it is this simple, and often hate to take on this amount of responsibility. However, in the spirit of achieving excellence and science/research, let's narrow in on what it means to achieve open communication between patient and therapist.


          Open communication requires the therapist not only asking for regular feedback, but accepting and working with it regularly. To accept feedback, we need to be humble, open, and as egoless as possible. We should insist that our patients be honest with us, and that a "10 out of 10" rating does not help us improve as clinicians. Intuitively, we fear this might create conflict, defensiveness on our part, and an inevitable appointment cancellation the next week. Scott Miller has found the opposite. He suggests that regular tracking of the patient's progress, in addition to regular feedback to the therapist, yields a 65% better outcome of therapy. In other words, receiving and incorporating weekly feedback correlates with 65% more symptom reduction combined with overall life improvement for the patient.


          How might we "track" a patient's progress? Scott suggests having the patient fill out a rating scale at the beginning or end of each session. They may do this by paper or online, and the areas to monitor/rate could be the following: 1) Patient's Individual Functioning, 2) Interpersonal Functioning, 3) Social Functioning, and 4) Overall Functioning. In order to do this, a baseline must be measured as early as the first or second session. The idea is that receiving this weekly feedback opens up a discussion between patient and therapist, regarding the patient's perception of their own functioning in relation to the therapist's contribution to each session. This enhances the patient's perception of therapeutic alignment, feeling heard, important, and in control of the outcome of their treatment. In my psychodynamic mind, this simply addresses the relationship dynamics "in the room," which in itself can be therapeutic. *In a study with couples in therapy, there was a 50% less rate of divorce in treatment in which the therapist received the patients' feedback, and this is merely one of the examples given by Miller.


Characteristics of "Superior" Therapists, in short:


          Superior therapists engage in "deliberate practice," or the kind of practice that is cognitively and emotionally demanding, and downright tough to do with a high caseload or lack of adequate breaks in between seeing patients. Superior therapists are egoless, in the sense that they regularly consult with colleagues for advice, regularly ask for feedback, are eager to grow and change their ways of practicing, and are aware of the automaticity that tends to set in with a particular patient after about 50 sessions, or when we start to get non-contingent feedback.


Recommendations to Patients:


          Ask your therapist to address your feedback, if not every session, then every few sessions. If you're feeling up to it, keep track of your own progress or functioning in the areas of your life you are concerned with improving. Keep a journal, and share it with your therapist if you feel unable to convey your thoughts during your sessions. Establish open communication with your therapist early on, and the chances are you will feel empowered and that you are helping to make the most of your therapeutic experience.

Therapeutic Factors in Group Therapies

by Victoria Dekovich, M.S.

            Group therapy is one of many types of psychotherapy systems practiced by today's psychologists. Under this one major type of therapy are a number of subgroups; therapy groups can range from unstructured to highly structured, occur in different settings, and employ various techniques, strategies, and dynamics to achieve therapeutic goals.


            According to Irvin Yalom, a respected researcher and author in the field of group therapy, the different subtypes share certain elements, or "therapeutic factors," despite their diverse approaches. He identifies these factors as: instillation of hope; universality; imparting information; altruism; the corrective recapitulation of the primary family group; development of socializing techniques; imitative behavior; interpersonal learning; group cohesiveness; catharsis; and existential factors. These elements of the therapeutic experience are present in all types of group therapies and in combination, play an important and necessary role in facilitating change.


            Group therapy emerged out of the existential movement of the early 20th century, influenced by Kurt Lewin's T-Group and Carl Rogers's encounter group. Theories about group therapy emerge from research on group interactions, namely how feedback from group members, development of empathy, skill development, observant participation, and the therapeutic relationship influence the group.  Because these components are fundamental to the basis of group therapy, this article will be discussing the therapeutic factors of instillation of hope, group, cohesiveness, and universality.


            In the initial phases of the therapy group, it is important to facilitate motivation to commit to and participate in the group. This is often achieved through the therapeutic factor of instillation of hope. The therapist's communication of his or her expectations of improvement in the group members, also known as "expectancy," is a significant first step in influencing change. According to Yalom, merely pointing out improvements in other group members and the therapist's expression of confidence that the group members will improve with treatment have a substantial effect on increasing the likelihood of a positive outcome.


            Group cohesiveness, the degree to which group members are attracted to the group, is also one of the most essential factors of a positive therapy outcome, but usually comes later in the therapeutic process when members are more comfortable in the group. Just as the therapeutic relationship in individual therapy is necessary for success, group cohesiveness is a necessary mechanism in group therapy.


            The idea of a strong therapeutic relationship has a major presence in all effective therapies, from individual to group. As Yalom points out, "research evidence overwhelmingly supports the conclusion that successful therapy...is mediated by a relationship between therapist and client that is characterized by trust, warmth, empathic understanding, and acceptance." All interventions used must include trust, which is gained by warmth, empathy, unconditional positive regard, and acceptance in order to have the powerful effect of change. This element is a vital part of a group's positive accomplishments.


            A primary reason that people seek therapy is because they are experiencing abnormal symptoms that are interfering with their everyday functioning, and often, many of those who seek group therapy feel emotionally alienated. One goal of group therapy is to help members realize that the other members of the group share many of the same thoughts and feelings; in other words, many of a patient's thoughts feelings are "universal" to others in the group. Learning that one is not alone in experiencing events, thoughts, and emotions that are responsible for the feeling of alienation is an important source of being able to take the steps toward change.


            Even though therapy groups have an incredible amount of diversity in their structure, size, focus, purpose, composition, demographic characteristics, frequency, longevity, and various factors of individual differences among the group members, Yalom's therapeutic factors seem to be present in positive and effective group therapy in general. Among the most prevalent factors are the instillation of hope, group cohesiveness, and universality. The presence of these three particular elements play a significant part in assisting group members to change and improve their social, behavioral, and emotional functioning.

A three-part interview with "Laura"

by Christopher Emerson, Ph.D.

          I recently interviewed a 45-year old woman named "Laura" who agreed to speak in detail about her experience in psychotherapy over the last 25 years.  The transcript of this interview will be presented in this issue of TRANSFORMATIONS and in two subsequent issues. In this first installment, Laura and I talk about her initial experiences in psychotherapy, and the ways in which she came to find the process to be challenging, useful, and ultimately life-changing. ("Laura" is a pseudonym of an independent individual who is not and has never been a patient in this practice).   


DR. CHRIS EMERSON:  Laura, thanks for speaking with me today. Would you tell me about your first experiences in therapy?


LAURA:  I was 19 or 20 the first time I went into therapy; I had left college after my second year. That year, I remember feeling just overwhelmingly tired and sad. There was a feeling of hopelessness much of the time. My grades in school had suffered, and I didn't feel up to maintaining my relationships with friends and family. Those things that had given me pleasure just seemed so far away, like they were part of a past that I couldn't get back to.  Strange to remember feeling so helpless, so lost.  Sometimes I would spend most of the day in bed. I felt so old....  


CE:  How did you find your first therapist?


L:  To tell you the truth, it's kind of hard to remember how I got to her. My parents had become very concerned about me; I had moved back home from college, and I remember that my mother gave me the name of a woman to call. She must have asked her friends or made some kind of inquiry... again, it just seems so foreign to me that I was not able to fend for myself at that time or find the help I needed... but it was like being in some fog that just wasn't clearing up on its own.


CE:  Tell me about that first therapy experience.


L:  I remember the woman I worked with as very smart, very focused. We would talk about my experiences at home, at school, and she would give me assignments - she called them my "homework" - to complete between our sessions. I found this kind of thing interesting - it opened up some awarenesses in me that I hadn't had before, including some of the ways in which my early home life didn't meet my emotional needs, and I discovered a good deal about the impact of my father's drinking on me and on the entire family... but for months and months I didn't actually feel better... I remember wondering when this therapy was supposed to "kick in."


CE: When did you actually begin to feel better?  


L:  It was so gradual and so hard to tell. But the therapist suggested that I consider an anti-depressant and maybe by then I really was doing better, because I was able to think about her suggestion, and resist it.  Funny looking back on that now - probably resisting wasn't the smartest thing I could have done at the time, but I remember thinking, "Wow, at least there's enough of me present to have a thought and a feeling about what I want and don't want."  That alone seemed like progress.


CE: What happened then?  


L:  Around that time I felt good enough to get a job. It wasn't much, just a clerk job at the Old Navy store not far from where we lived. But it got me out of the house and out of my own head.  I remember taking a break from therapy for awhile, and slowly made a decision to look for another person to work with. I was still feeling sad most of the time, but not as paralyzed as before.  


CE:  How did you go about finding another person to work with?


L:  Well, I had started by then to do some research into psychotherapy, and I realized that there were many different approaches. My first therapist got me in touch with some of my thinking and belief systems that hadn't really been serving me very well.  I had come to realize that maybe there really was a connection between my early life and the sadness and hopelessness that I had felt so strongly... by this time, I wanted to explore things in a way that felt deeper, more aligned with the kind of person I was. I've always been introspective, more of a thinker than a social type, and I felt ready to dive into things in a different way.  


CE:  It sounds like your research gave you a sense that you had a real choice about how to take on this next phase of therapy...


L:  Yes, it really did. I had read about psychoanalysis, but I couldn't imagine myself lying on a couch four or five times a week (laughs), and who had the money for something like that anyway?  I found a community-based mental health center on the other side of town that offered low-cost psychotherapy.  It was a training site for newer therapists, but they worked in a different way, a more introspective way, and I decided to give it a try.  


CE:  Did you have any concerns about working with somebody who was still learning, whose experience in the field might have been somewhat limited?


L:  At first, yes. But they assigned me someone who was already a doctor, so I felt that there was at least some training that he had already had. And it was great. We met twice a week for over a year at that center, and things started opening up for me in a new way....


          In the second installment of METAMORPHOSIS in our next issue, Laura talks in more detail about how her therapy "opened up" her world, the relief of her depressive symptoms, and the experience of moving from a patient at a training site for therapists to a private practice setting.


This concludes the second issue of our bi-monthly newsletter, TRANSFORMATIONS. We hope you have enjoyed reading, and remember to check your inbox in May for the next issue!




Chris, Katie, Eleanor, and Victoria

In This Issue
Achieving Clinical Excellence
Therapeutic Factors in Group Theradpies
Transformative Voices



"In 2004, I began thinking about writing a book about crystal meth.  My intention was that the book would be journalistic, covering the escalating use of crystal in the United States from an objective perspective.  However, my publisher, knowing that I was in recovery from meth myself, asked me to write a memoir about both my addiction and journey in sobriety.  To provide immediacy to the book, I agreed to work in a residential rehab as a counselor.  This was something that I had never considered and, in fact, would have avoided had I not been presented with a reason to be engaged with such work.  What began as research ended up being my passion.  Once the book was published, I continued counseling and became certified.  I am now considering going back to school for a doctorate in social work.  This experience was a wonderful lesson for me in allowing myself to take advantage of opportunities for transformation that present themselves, however unexpectedly.  Instead of restricting myself to old ideas about who I am and what I should do, I grow when I just open my arms to what the universe presents."


-Patrick Moore, Author of Tweaked - A Crystal Meth Memoir

"Shame from past hurts can keep people in isolation or addiction, creating loneliness and depression.  Human beings need connection in order to thrive, change, and ultimately flourish.  The psychotherapeutic relationship creates a safe place for our deepest, most shameful secrets to be heard.  The simple act of being seen and heard is a portal for transformation to take place leading us to experience our full potential."


-Alexandra Katehakis, MFT, CSAT, Clinical Director for the Center for Healthy Sex, and Author of Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction  


"The transformation that changed my life completely came unwanted.  I went kicking and screaming, fighting to hold on to a fantasy that wasn't there. 

The change occurred simply by letting go... of control... of memories, of the past, of my most significant identity. 

I had no idea of the beautiful alternative that awaited me.  It was the most courageous thing I have done to this day, learning to let go and free fall into the unknown.  One must let go to move on."


-Jocelyn Cook, M.S., Los Angeles Office of Education School Counselor   





A weekly psychotherapy group for Gay Men


Group psychotherapy can provide unique perspectives and opportunities for personal growth and improving emotional and psychological well-being. An ongoing, closed process group of five to six gay men is underway.  This group was formed in 2008, and several original group members are regular participants.


There are openings for  new group members in 2011.


This group meets weekly on Fridays from 6:30 pm to 8:00 pm for a 90-minute group therapy session, at a rate of $45 per session.


We explore life issues associated with, masculine identity, sex and relationship, spirituality, recovery/sobriety as appropriate, and group process with other men.


The focus is interpersonal and dynamic; the goals of the group include furthering self-awareness through increasing the capacity to give and receive feedback, and gaining access to previously blocked affective and cognitive experience. This group is kept to a maximum of five to six participants to allow for intensive, individualized work.


Participants are asked to be willing and able to make a six-month commitment to regular group attendance and participation.     

There will be an interview process to screen prospective participants. Beverly Hills psychotherapy office location.


Contact Dr. Chris Emerson:




Contact Us...
for appointments and comments
Dr. Chris Emerson:
[email protected]  
(310) 550-4560

Dr. Katie Barnes:
Psychological Assistant
[email protected]  
(310) 684-3605

Dylan Maddalena:
[email protected]  
(310) 550-4560


Christopher Emerson, Ph.D. | 450 N. Robertson Blvd., 2nd Floor| West Hollywood| CA | 90048
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