What A Gift You Are

“What a gift you are”; I remember when I heard these words directed at me after sitting down and sharing with someone the many roles I play in my family and community.  These words stayed with me long after the conversation.  Like a warm blanket, they comforted me.  I began to feel a prodding from God to use the blanket with others…”what a gift you are”.   Imagine for a minute will you, the vulnerability it takes to pick up a phone and reach out for help, drive to an unfamiliar office and sit down and talk to a complete stranger about the deepest darkest places you would like more than anything to avoid talking about.  And then they look at you and extend the blanket “what a gift you are”.

I have learned more about how to see and value God’s people as a therapist than I ever did before.   Sitting with the hurting, confused, scared and offering hope, comfort, companionship.  But until I started looking for “the gift”, I often ended up experiencing what we often call resistance, blocking, stagnancy in the therapeutic process.  In all honesty, I would find myself blaming the client “they weren’t ready”, “that’s an addict for ya”, “they just have a crazy schedule”.   Looking back, they ‘felt’ what I was missing “what a gift you are”.

 In class they called it content vs. process.  I never quite got that concept.  Now I get it…process is seeing the gift.  Process is seeing and understanding the unique gift this person is to this world, and holding that with the understanding of how privileged I am to be allowed to share in their gift of vulnerability.    As a rule, we guard our hurts, disappointments, fears from others; sometimes even our spouse and closest trusted friends.  As a therapist, I now recognize that when a person shares these with me, it is like seeing a rare jewel rarely experienced by anyone else, and I should tread accordingly.  “What a gift you are”.  Learning to get out of the content (paying attention to the specifics and details of a conversation) and into the process (recognizing and highlighting the gift) takes both a shift in mindset and a level of intentionality. 

I call the process of therapy identifying, highlighting and respecting the unique gift of either a person or a system.   

Specifically tending to the process includes listening for the following clues:  

       1. how the conversation is occurring (metacommunications- body language, tone, facial               expressions, etc.),  

       2. underlying emotions heard in content, 

       3. patterns themes in conversation.

How do we get out of content into process?

-        *  Listen for the clues (mentioned above) Some examples: “Your voice tells me that you are really angry about this incident” or “Your body language is telling me that this issue really exhausts you.  It feels really heavy” 

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*  Point out what you are seeing in body language, tone, or facial expressions…ESPECIALLY if it is incongruent to the content.   Ex. “You are telling me everything is fine, however you face is telling me something different.  Tell me a little more about what your face is telling me.” Or “I hear you laughing about this event that took place last week, and I also see tears in your eyes like you are right on the brink of crying.  Would you like to share more about that?”

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        * When a client switches topics or tries to stuff emotions, you take a deep breath and say something like “where we were going is probably really hard and scary, I’m ready to listen when you are ready to talk about it” or “you were about to talk about something really hard, let’s try talking about a little of it today and you can stop whenever you need too and we will pick it back up next time”. 

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*  Ask permission : “I’ve noticed you mentioned loneliness several times in our session so far today would it be okay if we talked more about loneliness today? “ or “This is the third or fourth time I’ve heard you mention _____ it sounds like it’s something that is really got you stuck, with your permission I’d be happy to flush it out more with you”.

Consider thinking of these clues as ‘gifts’.  Client’s way of giving you glimpses into the ‘gift they really are’.  When you are able to catch, highlight, and reflect on the gifts you have done two things in the therapeutic process: 1) you have said “I see you, hear you, and am beginning to really understand who you are” 2) you slow down everything so that client’s experience “what a gift you are” and begin to recognize this truth even for themselves.

Blending Science and Theology

Blending Science and Theology

Seems like a oxymoron doesn’t it…blending science and theology.  For centuries the two have sat on opposite ends of the fence, one exists without the other, no room for inclusion.  As therapists we go through school and learn about the science.  As Christians we go to church and learn about the theology, then we get into the therapy room and the client asks for the theology when all we learned was the science.  Or in the church counseling room the client asks about the science when all we learned was the theology.  Is there room for both?  Can they coexist?  Does one have to be done to the exclusion of the other? 

As a clinician who is committed to excellence in the scientific field of psychology I was met with these questions early on in my career.  My answers surprisingly came through my theology.  As a believer I am committed to living Christ out to the best of my ability, through excellence.  To do that, I have to study, learn, prepare, dig, sit, pray, read, listen.  As I journeyed in excellence in both the sciences and the theology, God showed up in both.  Imagine that!  One way that God began connecting the two for me was through the combination of Bowlby’s attachment model, Eye Movement Desensitization and Reprocessing (EMDR Therapy), and the use of mindfulness based therapies.  Empirical data through the use of science has shown all of these models of therapy to be effective in working with clients who have experienced a history of trauma. 

Click here to read some of this data:

http://books.google.com/books?hl=en&lr=&id=kTrd29tfupIC&oi=fnd&pg=PR9&dq=Dan+Siegel+AND++attachment+Research&ots=YO7hxhNalf&sig=938c1b0e0ySQ56lUbCa6kGuUojk#v=onepage&q=Dan%20Siegel%20AND%20%20attachment%20Research&f=false

 http://online.liebertpub.com/doi/abs/10.1089/acm.2008.0495

http://psycnet.apa.org/journals/ccp/78/2/169/

http://www.traumacenter.org/clients/Intertwining_Nature_of_Attachment_and_Trauma.pdf

http://www.emdr.com/general-information/ptsd-research.html

So much of the information that I was learning was Biblically based.  Attachment theory is written all throughout scriptures.  God’s creation of man for connection then the creation of Eve as connection for Adam, The Psalms, Ecclesiastes, the instructions to the new church in the New Testament, all filled with messages of attachment.  Some of my favorites are:

Genesis 1:26-31

Genesis 2:18

Genesis 2:24-25

Psalm 22

Matthew 22:37-40

As I began to understand they are intertwined I began to find creative ways to use the blending in my work with clients.  One such technique I use is a guided imagery called “The Attachment to Jesus”.  I also add bilateral stimulation to Resource this with EMDR Therapy model, however this technique can be done without the bilateral and used only as guided imagery tool.  This technique is designed with the principles of creating secure attachment (safe touch, eye contact, affirming and calming words) and through guided imagery, allowing someone to experience the creation of an attachment moment to their Savior.   Through the use of this technique, client’s have experienced powerful moments with Jesus that may never have been experienced otherwise.  As always, I am prayerful in my approach to the technique and work to prepare a space that is open and centered on building relationship with the Savior. 

Attachment to Jesus Script

Helping People

Me: “Why do you want to enter this profession?”

Intern: “I want to help people”

Me: “How do you plan to help people?”

Intern: ….blank stare….

The answer to this question is pivotal to the rest of one’s journey into making a career as a therapist. Of course we first think about defining how we help people by the methodology or theory we plan to use as a therapist. The answer is actually much more complicated.  What it takes to ‘help people’ is so much more than what Hollywood would have us to believe, as a simple formula of

 listen + give advice/opinion = helping people. 

To start down the road of ‘helping people’ one must be prepared for the journey.  To be prepared one must know what to pack.  The answer might surprise you.  It has quite a bit to do with the therapist themselves.  The literature tells us that the following are the top factors that determine client success and ultimately satisfaction:

Ø  Therapist participation in own therapy

Ø  Experience as a therapist (years in practice)

Ø  Regular attendance of trainings on latest treatment methodologies

Ø  Flexibility in treatment methodology to target specific client problems

Ø  Availability between intake and subsequent appointments is high

Ø  Expectations about the therapy process communicated beforehand

Ø  Agreed upon central problems

Ø  The use of Client informed feedback at the end of sessions (see link for researched format on Client feedback).

Research tells us, to ‘help people’ we need to care for ourselves by attending our own therapy, learning all we can so we can feel confident in what we do, and take the guess work out by asking the client more about ‘how am I doing?’.  Looking at each of these a little closer here are a few ideas on why these are important and how to accomplish them.

1)     Therapist participation in own therapy- We learned all about counter-transference as we attended school and endured licensure supervision.  In short, this is when our own history and experiences come into the therapeutic process and cloud our judgment or guide us to make decisions in treatment that may not be best for the client.  Therapist participating in their own therapy minimizes this and strengthens the therapists core self so that the therapist can accurately meet the needs of the client.  How to get your own therapy: So our world gets really small when we are trying to find a therapist and realize most of our friends are therapists and cannot ethically meet with us, or we may see our personal therapist at local trainings and conferences.  With this in mind there is a growing population of therapist who solely develop their practice on working with other therapists.  They have specific guidelines they follow to minimize confidentiality breeches and increases comfort of therapist clients.  You may look for clinicians in your area who do this.  Consider asking other professionals if they have gone and who they saw for therapy.

2)     Clinical Experience- This seems self explanatory, however we all have to learn somehow.  What is very important is that as we are learning and getting this experience we are in constant, effective, self explorative, growth developing supervision.  Good therapists get the experience and learn from it.  Some ideas of how to get experience: apply for local community health organizations, volunteer for a local non-profit counseling center, volunteer at a local free health clinic, apply for internships, and consider apprenticeship with local clinician who may allow you to do co-therapy with them.

3)     Regular attendance of trainings- Become a member of your local professional association so that you can be made aware of the most up to date clinical treatments. This will allow you to also get discounts on any trainings they offer through their association.  You can also go to google scholar and type in meta analysis or literature review of best treatment practices in psychotherapy. This will give you evidence based practices to focus your trainings on.  Scott Miller’s website is also a good resource for up to date bestpractice.

4)     Flexibility in treatment modalities- You don’t have to know all treatment modalities, but be well versed and clearly trained in a few best practice modalities that allow you to feel confident in working with client’s that may not fit one particular modality or another.  Consider the population you see the most or get the best results with and find all the modalities with empirical backing and get trained in them.

5)     Availability- It’s great if you are good, and even better if you are booking up your schedule, however it is not good for your client if you squeeze them in for an intake appointment then cannot see them again for 3-4 weeks.  Consider your availability over the next month when scheduling your intakes.

6)     Expectations about the process discussed beforehand- It is hard enough for a client to reach out and make that initial phone call, but what is also hard is arranging your schedule and finances to be able to make the appointment.  If the client isn’t made aware what your regular availability, fees, policies are ahead of time, it could be a very frustrating wasted trip for them.  Consider having an outline of expectations and general policies available on your website or for email prior to the initial session.  You may consider offering a 30 min. reduced rate consultation to make sure you are a good fit with a client.  This would also allow you to review all expectations and get agreement ahead of time.

7)     Agreed upon central problems- To retain clients you must be working towards their treatment goals, which in turn results in client satisfaction.  So first step is to identify what are their goals for therapy.  Most times this is pretty clearly defined by the client, on occasion it is more ambiguous and takes a little more work; either way your first goal in treatment is to identify client goals.  Next, collaborate with the client on identifying which goal should be approached first.  Then work towards that goal until you and the client both identify it has been met.  I recommend some form of measurement be used as a pre and post to help give an objective overview of met goals.

8)     Client informed feedback- The research tells us the more involvement a client has in their treatment process from the beginning, the better their outcomes and overall satisfaction with treatment.  One of the primary ways to involve clients in their treatment is a regular feedback process.  This feedback process can rate weekly symptoms increase/reduction, client satisfaction with clinician, and/or both.  Some examples of how to do this range from a formal process such as the SRS, ORS forms found on the link listed above.  Less formal would be to simply ask clients at the beginning of treatment session about symptoms, using likert scales, and then asking at the end of treatment if they got their needs met.  Some phrases I use “Did you get what you needed today?” and “is there anything you needed that we did not get to today?”

Completing all of the following brings us to what qualitative research tells us truly works in ‘helping people’ and that is “A relationship with a wise, warm, competent professional first….then symptom relief”.

For more information about how to ‘help people better’, see articles listed below. 

More to come:  How do I retain clients?

References:

• Gearing, R. E., Townsend, L., Elkins, J., El-Bassel, N., & Osterberg, L. (2014). Strategies to Predict, Measure, and Improve Psychosocial Treatment Adherence. Harvard review of psychiatry, 22(1), 31-45.
• Goodman (2013) thesis:    https://etd.auburn.edu/bitstream/handle/10415/3899/Goodman.Rebecca_FinalThesis.pdf?sequence=2
• Roos, J., & Werbart, A. (2013). Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research, 23(4), 394-418.
• Swift, J. K., & Callahan, J. L. (2011). Decreasing treatment dropout by addressing expectations for treatment length. Psychotherapy Research, 21(2), 193-200.
• Best Practices : http://www.scottdmiller.com/category/evidence-based_practice/