Author: dabarradmin

The clients that move forward in therapy the fastest are typically those who have weak defenses. Those who have stronger defenses take longer, but are more resilient. This is one of the reasons I typically see quick success in clients with high anxiety. They have not learned coping skills to repress the emotional and physical responses to stressors. Those who have strong defenses are able to repress and contain negative emotions and feelings, allowing them to be able to focus on their professional, social, and personal goals. However, this has a negative impact on their bodies and emotional regulation. In therapy clients who have strong defenses must allow them  to come down to access their response to negative stimuli in their lives. This has to be done slowly to maintain their ability to function at a high level in their professional and personal lives and at the same time allow them to experience the risk of being vulnerable. I view it as the difference between creating a sculpture out of soft clay or stone. They clay is much easier to work with and quick change occurs. With stone it has to begin to crack and fracture before it’s form begins to change. Change is much more evident in those who have not been hardened by their environment. The therapeutic work involves identifying changing emotions, physical feelings or sensations and the cognitive thoughts that occur. By connecting these different aspects of self  our perception of the world changes. The end result is the same, being comfortable in a much larger environment.

Often, the first time I get a new client is when they are in despair, feeling trapped and having lost hope. It may occur because of a relationship, job they are in, a manager they work for, because of a mistake they have made, or some other event they have no control over. The primary task is to restore a sense of self outside of the situation and seeing the potential for change. This is done by identifying what is most important (long term goals), recognizing they are separate from the event and that the situation does not contain them. When getting a sense of hope occurs it is evident during the session. They are then able to separate themselves from the event or situation that creates the sense of being trapped and allows them to feel safe in the present and see other possibilities .

My experience in working with clients who are marijuana users is that it is very difficult for them to process experiences in their lives to bring about change. Most clients are typically successful in attaining some of their goals in counseling. I am less successful in working with clients who are marijuana users than any other group of individuals. For those who use marijuana regularly and continue its use, making progress in the therapeutic setting has been minimal. I can not say definitively that it is true for all clients, because there may be some that use it regularly without my knowledge. However, for those who have reported abstaining from it use there has always been a noticeable improvement in their ability to process information, bring about awareness of self, and facilitate movement forward in the therapeutic process.

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.