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I have a large aluminum sculpture in my office that my mother created. It is a useful tool in describing what happens in successful therapy. An artist has an image of what the final result will be. A metal sculpture begins as a large clay block. To create the sculpture she took away the clay that is not part of the image she had in her mind. When she finished taking away all of the clay that was not the sculpture she had it cast in aluminum. I see effective therapy as pretty much the same process. We begin with the image of what we were created as at birth. As time goes on we are triggered by fear, insecurity, trauma, loss, pain, and other baggage that we attach to our original birth image and as time goes on we lose our original form. The purpose of therapy is to remove that baggage that is not part of us but prevents us from moving, sleeping, breathing, speaking, and relaxing; allowing us to be comfortable in our minds and bodies again. It allows us to be able to interact with the world and others as our true selves.

I also use the image of carrying a backpack of rocks that has been accumulated along the way. Each rock represents unnecessary stuff we have collected in life. Visualizing taking off the backpack allows immediate feedback to the body which usually results in noticeable release of tension and sometimes long held pain, particularly around the neck and shoulders.

Effective therapy is not about fixing someone who is broken; it is about pealing away the layers of trauma, negative beliefs, repressed emotions, and fear that builds up over a lifetime. It is okay to leave that baggage behind and become the person you were created to be.

There are a number of obvious assessment indicators for mental health for an individual or couple. For an individual in my opinion the best indicator is the quality and quantity of sleep. For a couple its about the quality of communication. A common indicator of poor communication in the home is if people are always walking on eggshells. One doesn’t feel safe stating their opinion or the truth, fearing the reaction of the partner will be unreasonable. Anger issues often need to be addressed. An environment where everyone is walking on eggshells creates negative stress. If it is in the home, it becomes an unsafe environment rather than the sanctuary that it should be. If the home is not a sanctuary it becomes a household of anxiety and hypervigilance. If you find you are walking on eggshells action is necessary to support mental and physical health of both adults and children. Stress in the home is felt by everyone, including the young.

To be able to be safe saying the truth in a relationship trusting your partner is necessary. You have to trust that you are not going to be emotionally attacked or that the partner is going to shut down and avoid meaningful discourse. There are a lot of barriers to developing trust such as addictions, trauma, and poor coping mechanisms. It takes a lot of intention and commitment to develop trust.

Clients often identify forgiveness as a goal of therapy. During the first session I do an assessment, in which a diagnosis is considered, goals set and a therapeutic plan is discussed. If a client is having difficulty being able to see there is a future and what the outcome might look like I give them possible ideas to consider, such as feeling comfortable in their mind and body. My clients are often dealing with complex trauma; to include significant childhood abuse and neglect, sometimes by a parent or related family member with whom they still have contact. When discussing goals they sometimes identify forgiveness as a priority. My experience is that forgiveness is nearly always am impossible goal to achieve in therapy. It may be an outcome of therapy; however, I would not recommend it as a goal. A child typically learns to repress the anger and fear they experience when they are abused. It is not safe to express it and that learned behavior carries forward to adulthood. The anger, fear, sadness and other distress is carried in the body and mind and is manifested in all kinds of physical symptoms. To try to forgive their perpetrator usually results in repressing those emotions even more. It is usually normal to process the distressed emotions and allow them to be released for progress in the therapeutic process to take place. Forgiveness may end up being one of the outcomes of therapy, but I resist a client identifying it as a goal of therapy.

Western culture, of course, is influenced by Christian doctrine regarding forgiveness. Matthew 6:14 (NIV): “For if you forgive other people when they sin against you, your heavenly Father will also forgive you.  But if you do not forgive others their sins, your Father will not forgive your sins.” I believe that for those of us who are Christians it is an important aspect of our support. As I indicated above forgiveness is often an outcome of processing anger and fear and forgiveness can be welcomed.

It is also my experience that some rare individuals have no filter for their Shadow (dark side), are without a conscience and are truly evil, and that forgiveness for them is not possible .

Having a support network is an important aspect of being mentally healthy. Living in isolation without relationship with others significantly reduces the resources available when challenges begin to become overwhelming. Having a support system is a primary indicator of success in mental health treatment. Knowing there is someone you can trust allows us to spread the weight of responsibility, loss, and frustration. A close friend or spouse provides support and helps us to recognize we don’t have to do it alone and they can affirm that we are taking the right action or that we are on the correct path to overcoming the challenge. It is one of the main reasons having a significant other is such a natural drive for most healthy individuals. Knowing that support is always there is reaffirming and supports taking on newer and more challenging tasks. When working with couples I have them watch the YouTube video “Its not about the nail”. It’s the best couples training video I have seen. Discovering the support network of my clients is an important assessment tool with a new client. To a lesser degree, it is also one of the reasons I ask about pets during an assessment. Unfortunately, a dog is the only support the client totally trusts.

One of the goals of working with anxiety is to feel comfortable outside of the bubble one creates to have a sense of control. Those with obsessive compulsive disorder are the most extreme. Severe anxiety or hypervigilance related to trauma create a sense of fear about what may be around the corner. A typical method of dealing with the triggers of that fear is to try to contain the environment. This severely limits opportunities for getting to know others, exploring the outdoors, moving into new careers, and engaging in needed conversations. Individual growth is stunted. A goal of therapy for anxiety is to process those fears that cause the body and mind to feel stressed so that the client will be able to feel safe in present time. The body becomes more comfortable and the mind becomes quiet. I enjoy watching clients experience this for the first time. It makes it much easier to expand ones comfort zone. Eventually it’s possible to look at life through a new lens with opportunities that were difficult to imagine as realistic. Life becomes easier, requiring less effort, when we are comfortable in the world without having to be on constant guard with shields up inside a bubble.

Many people do not like being in conflict. It is necessary that one be comfortable with conflict to grow in relationships, the work environment, and in the world at large. If it was not okay to be in conflict in the home during development it is typically not going to be okay to be in conflict with significant others as adults and with others outside the home. It is an important ingredient in being successful in relationships, in ones career, and in being comfortable exploring the world.

Noticing how clients deal with conflict in initial assessments is an indicator of resilience. Often those who have difficulty with conflict will be self limiting in their career choices and social interactions.

It makes it much easier for couples to communicate effectively if they are comfortable being in conflict. It allows them to openly discuss issues that may be barriers to being themselves. There is always conflict in a relationship, and almost always at least one signifiant conflict that is not reconcilable, as was pointed out by therapists and researchers Drs. John and Julie Gottman. It is necessary for partners to be able to engage with each other to find a comfortable understanding or compromise.

If there was a lot of anger and overbearing aggression in the home while growing up it can become a trigger to feelings of distress; such as fear or anger that does not have a means of expression, resulting in repression. When in a relationship with an assertive partner I find that conflict often appears to trigger fear and anxiety. When asked about their response to the conflict they often report negative responses that are appropriate for processing. Doing so allows for them to reach a place where conflict is not so frightening.

I often use Maslow’s hierarchy of needs in working with clients to assist them in being able to visualize their motivations and barriers to growth. It is very useful in understanding the primary needs and goals. If a client or couple is struggling with finances, they are going to be focused on the second level of Maslow’s hierarchy of needs identified as “safety”. It increases the level of stress and makes it much more difficult to deal with higher level needs. Clients often find it useful to know that sex or reproduction is at the first level of needs identified as “physiological”. It is such a strong instinct that Freud became stuck on its importance and focused his theory of psychology on sexuality. It is always an important aspect of couples work. And since almost all therapy is about relationship with others it is virtually always comes up in individual work. To focus therapy and to be able to function on the higher level needs of “esteem” and “self actualization” it is important that the lower level needs be fulfilled at some level. Over time and even throughout the day we will typically move between the different levels. If a couple is focused on a different level of need or a different objective within a need; such as, one being focused on sleep and the other on sex within the “physiological” level, conflict with arise. Being able to work with couples to identify and visualize their conflicts within Maslow’s hierarchy of needs is often a good starting point.

If someone has a path forward they have direction in their life. I always insist that clients create their path when beginning their work. This usually includes creating it physically with pencils or paint. The only instructions are to put an “X” where you are currently and to identify your goals in the opposite corner. The object then is to create the path from where you are presently to your goals. If change is going to take place it is necessary to know what that change looks like when your reach it. The goals may change or be refined as you move forward. Using your creative mind to establish your path forward and putting it on paper or canvas is very different than creating it in your mind. After creating your path and finding direction with it you have a compass on what to do when you find yourself lost or challenged by what to do next.

I often use this with clients who are in a dysfunctional relationship with someone who is addicted. The addiction becomes the overriding objective of the addicted and it is impossible for them to get out of it unless they take responsibility for finding a path to new goals. The addicted path is one of chaos that has no future or direction. The spouse or significant other of the individual in chaos has little possibility of finding their partner on their own path.

For those who are goal oriented but have not considered higher level needs other than being successful in a career or basic security needs, their path is often a straight line. This makes it difficult to meet higher level needs such as emotionally fulfilling relationships and balance in life.

The creative process is very useful in bringing about change. I typically have my clients “create their path” after identifying their goals. It sometimes takes minutes and for others it can take weeks. Clients will tell me they have thought about it and created it in their mind. That is very different than drawing it on paper or painting it on canvas. My perception is that actually creating something seems to use a different part of the brain that establishes something more permanent in the individual. It gives them a compass for direction if they find themselves off course. The physical act of creating something sets in place what the cognitive brain has considered. I use their path often during times of difficulty to assist clients in being able to find their way when they are lost and without direction. They soon learn to use it on their own.

Developing the creative process is very helpful in being able to ground oneself and to establish a clear understanding of what one is facing. I have been using the creation of images on paper during sessions to better understand and accept what is true and to motivate clients to take action where they have been resistant to doing so. The use of EMDR helps to create the possibility for change when the need for change has been resisted.

I often hear clients tell me they want to volunteer. Volunteering can be rewarding and an indication of a healthy society; however, it is often the last thing someone needs to be doing if they are challenged by taking care of themselves. If the client is not taking care of himself, but wants to focus their attention on others, volunteering can have a detrimental effect on being able to move forward. They often have difficulty identifying and establishing goals and are not willing to experience the distress that comes with being vulnerable enough to take risks. There is generally a negative belief that they are not worthy of putting themselves first and taking care of their own needs. Instead, they often have a history of spending many hours helping others, but go without themselves. Typically, their defense mechanism is one of shutting down their emotional self, but yet carry the burdens of others. With proper support it is necessary for them to become vulnerable to their own distress and find ways to take care of their personal, emotional, and physical needs and give themselves permission to do so.