How the therapy process works

As a therapist I have often been asked some version of the question “how does this therapy thing work?” I received the question again today, in the form of an email, from a prospective client. This helped me to reflect on the process that I tend to use the most.  It goes something like this:

1) Take stock of your life as it is, as it REALLY is, without whitewashing, sugarcoating, exaggerating, rationalizing, justifying, or minimizing.  We have to accurately and thoroughly define reality, both your internal reality (beliefs, thoughts, feelings, affect/body sensations) and your external reality or life situation.  This is the starting point, and we continually look at this as we go along.

2) Identify what your ideal life worth living looks like in detail.  Who is in it, what is in it, where it is, what you and they are doing/not doing, etc..  This vision becomes the long term goal.  With most people, this vision gets adjusted as we go along, as one develops new awareness, new information, new experience, new circumstances.

3) Identify what it is that you presently believe, think, say, and do (both internally and outwardly) that is helping your move toward that life worth living.  The objective is to optimize those things, to do them better and more frequently.  Look at what works. Do more of that.  Build on your strengths.

4) Identify what it is that you presently believe, think, say, and do (both internally and outwardly) that get in the way or prevent you from moving toward that life worth living, or that take you AWAY from that goal.  The objective is to change/reduce/eliminate those things. 

I can tell you from my experience that it is the INNER reality that is the most difficult to access, identify, and change.  Most people have not developed a lifestyle that prioritizes or supports the kind of conscious awareness necessary to confront our own patterns in a manner that is necessary to create significant change.  Therefore, we tend to continue doing the same ineffective things over and over again, expecting change to come because we are doing it more, or less, in this place or that place, with this person or that person, in this way or that way.  When we don't get what we're looking for, we tend to blame the circumstances, or others, and we tend to look to some external source for solace or comfort.  

Some of us have internalized negative messages that we repeat to ourselves in our own voice, not remembering where they come from.  ("You'll never amount to anything", "you can do/be anything/anyone you want", "don't reach too high", "who do you think you are?", "never__________", "always ___________", "expect the worst, hope for the best", etc, etc.).  Some of us have unrealistic expectations of ourselves and/or others.  There are any number of these kinds of patterns that get in the way, many of which are relatively invisible to us.

Confronting these kinds of things is the most challenging aspect of the process for some people.  For others, giving up cherished preferences/patterns that have served them well in some way even though they are no longer working presents the greater challenge.  We all have our unique constellation of things to look at.

So, from a change creation perspective, I tend to advocate beginning, developing, and/or increasing daily practices that:

·        support cognitive flexibility

·        improve self-awareness

·        expand the capacity to tolerate distress and to broaden one's emotional bandwidth

·        increase skillfulness and satisfaction in interpersonal relationships

·        contribute to a felt sense of being comfortable in one's own skin.

In addition to regular individual, couples, and/or group therapy, these practices include:

·        Focused, dedicated mindfulness meditation

·        Written affirmations

·        Intentional observation of self – diary card

·        Daily reflection, journaling

·        Physical Exercise

·        Rehearse / Practice new skills

People often ask, "how long does it take?" My answer is, "It takes as long as it takes.  There are things you can do to facilitate the process and things you can do to retard it. The things I recommend are the things that facilitate it.  How intensely, consistently, and honestly you engage in the process and implement those things is ultimately the deciding factor.  Those who do more get more.  Those who do less get less."

David Llewellyn, MA, LMHC, CSAT