Blog

It is not usually one of the identified goals of therapy, however I find that one of the outcomes of therapy is when a client begins to find their voice. When we are comfortable in our environment and with those we interact we are less concerned about how we are viewed and find empowerment in our ability to express ourselves. We repress less of who we are and provide worth to those with whom we interact by providing insight and relationship with the world around us. Finding your voice provides an outlet for our emotions, ideas, values, and beliefs. It allows others to get to know us and be comfortable in our home, work place and community. I particularly enjoy seeing women empowered and more engaged with families and in the work place. This seems to be an outcome in working with women more than men, perhaps because of social and family expectations for sons and daughters. Spouses and family members may find the change that occurs when a client finds their voice to be uncomfortable and distress because of the changing family dynamic. I find clients who have made significant progress much more likely to disagree with me in the therapeutic setting as they find their voice.

Many clients benefit from medication if symptoms are such that daily activities are unmanageable or if stress prevents them from taking care of personal needs. A medical provider familiar with mental health symptoms, medication’s affects, and who has a functional medicine perspective can be very helpful. As a counselor I am not permitted to provide medication recommendations, however an understanding of what medication does, including it side effects is very important in understanding the needs of the client. It is important for the counselor to consider whether the client’s experience is a mental health issue or the effect of medication they are on. Side effects of medication may create the challenges the client is dealing with. Typical complaints I hear from clients that may be caused by their medication are that they can’t sleep, they can’t focus, or manage their weight. Consulting with their medication management provider can be very helpful in reducing side effects when the provider changes medication or the quantity taken. Clients sometimes reflect that they do not believe they can feel “normal” while on several medications because of side affects. They often comment on how much better they feel after getting off of medications for pain that have stopped being effective.

When bringing about change during counseling I have found that going slow is faster than having a time schedule. Individuals change at the rate they are ready for. While the brain is rewiring itself it has to adapt to the changes taking place. Having a goal and trying to make yourself match your expectations for the goal does not work, unless it is a very simple goal like brushing your teeth every night before going to bed, and for some that is difficult. That is another reason why identifying your goals at the beginning is mandatory. There are a lot of steps during your path to change that must be followed, some of them easy and some difficult. Even the easy steps may take time. I have discovered the hard way that having a time schedule does not work. I get a lot of false positive feedback from the client that makes it difficult to assess their needs. The brain has an amazing way of knowing what the next step is and when it is ready for that step if it knows the direction it is moving. That is why it is necessary to learn to manage defenses and allowing them come down at a rate that this allows one to be effective in different areas of life. One’s defenses create resiliency, however a lack of defenses allows the work to go much faster and allows us to be more comfortable in a much larger environment. Knowing the next step in the process of change will move along much faster if the client stays on the path already identified.

I have found that it is difficult for many that I work with to make taking care of themselves a priority. It is often necessary to make it a goal to take care of themselves first. This is particularly difficult for mothers of young children; however clients who suffer from anxiety, sleep deprivation, depression, and other symptoms of high stress make poor providers and care givers. It often appears that if a client can not take care of their own needs they make it their goal to take care of the needs of others. As a result they provide an environment of stress that others are effected by. Children are particularly sensitive to stressful people around them. Those with a history of trauma and a lack of attachment often have low self esteem and negative beliefs about themselves, which brings about a belief that they are not important. To be a positive role model for children and to develop an environment that others want to be part of it is necessary to feel good about ones self and to have healthy habits. This means providing time for self, getting quality sleep, having a support network, exercise and the other normal requirements one finds necessary.

When doing an initial assessment I find one of the most important factors in being prepared for successful change is having a support network that recognizes and supports the change. If that support network does not exist it is helpful to make it one of the goals to develop one. Often times clients live with or have others they associate with who are not supportive of the the change the client is striving for. A support network provides feedback, emotional support, and occasionally basic needs. One of the challenges for those who don’t have their basic needs met is associating with others who share expenses, but a negative environment. Most therapy is about our relationship with others, whether negative or positive. Positive change is much easier if we surround ourselves with a home environment we are comfortable in and friends and significant others the understand and support the changes desired.

The creative process is fundamentally important in bringing about change and I believe it is necessary for some, and perhaps all of us. When working with clients who are stuck I often use it in the form of a diagram or picture to create an image of the change that needs to occur. With most clients I have them create a tree of life and almost always an image of the path that moves them from where they are to the goals they want to attain. I saw the importance of the creative process in my mother who was prolific in her production of art and was not comfortable unless she was creating a drawing, painting or sculpture. Everyone is creative and an artist, even if the end result is not something we are willing to show others. My experience in therapy is that using the therapeutic process provides the client with a means to bypass the normal linear cognitive thinking that gets many clients stuck in false beliefs. It enables possibilities for growth and goals that one does not consider real when viewed from prior experience.

The smoothest path is not always the most productive one for reaching your goals. Whether it is climbing a mountain or bringing about fundamental change in the way we live our life the rockier path can be the less stressful one. While climbing a steep and damp mountain trail this week we noticed the path diverging and coming together further on. One of the paths was smooth. The other was rocky and rooted. We found the rougher trail with rocks and roots provided much better footing than the smooth one. The natural steps they created made footing much more secure. The same can be true for bringing about change in our lives. Going along with what appears the easier and normal habits we live by in our personal lives and in relationships can be frustrating and unrewarding. Having to take the rougher path may be necessary in order to find secure footing for change and long term growth. I know that when someone takes the step to initiate the therapeutic process they are choosing the rougher path.

There are two methods for brining about change. The first is creating tools to manage symptoms. This includes such things as learning relaxation techniques, visualization, creating a safe place, a container to help manage thoughts, and developing a support network, etc. This is necessary in the initial work that is done in therapy. The second method is processing the past to bring about a different perception of the self and your environment. It is possible to process the past cognitively, however it is a very slow method, and I have never known it to be completely effective. I agree with much of current theory that trauma is held in the body as well as in the brain and has a tremendous impact on emotions. By connecting the cognitive process with the bodies memory of trauma and the emotional response one has to the environment it is much easier to bring about effective long term change. This can be done with somatic work, Eye Movement Desensitization and Reprocessing (EMDR), and other methods. I have experienced success using the creative process with exercises like creating a path from where one is to the identified goals as a tool that is often useful in initiating change and in maintaining direction. When processing past memories and the responses associated with them, long term change can occur that fundamentally changes ones relationship with the self and the world around us.

Change can not take place unless one has an idea or image of what that change should look like once complete. That is why one of the first steps in working with clients, and one of the most important, needs to be setting goals. The original goals will be refined and expanded to establish the ongoing change that takes place once one is on the path to change. It is the process of change which is important, and not reaching the goal. I have found that once the original goal a client came into therapy with has been met they will often terminate. This is particularly true with anxiety. Once anxiety has been significantly reduced a client will feel so much better they recognize they can carry on by themselves. However, after several months it is common for the client to return to deal with the much lower baseline of anxiety to further reduce or eliminate it. Life is a path of changing goals and refinement of our goals whether it relates to professional, social, spiritual or developmental growth. Our priorities change, as well as the goals we set.

The first session is an assessment to determine behaviors, beliefs, and emotional status that effect how one interacts with their environment. This will include significant history taking, identifying support networks, resources, and your physical and emotional response to those around you. We will begin to discuss goals and the therapeutic process.
Following sessions will further identify historically significant events in ones life, whether one has a support network, and focus on what the goal of therapy is that motivated you to initiate the therapy. Once goals have been established we will work to develop tools to cope with distress in your life and to contain your response to those events that are disruptive. We then begin to process those experiences that trigger emotional, physical and cognitive responses that bring about distress, with the goal of allowing one to be comfortable in one’s mind and body.
I use Eye Movement Desensitization and Reprocessing (EMDR), Ego State Therapy (EST), visualization, mindfulness techniques, dream work and Cognitive Behavioral Therapy (CBT) in my practice, along with other training I have received in such disciplines as hypnosis and neurofeedback to fit the needs of the individual.