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I approach therapy with a simple question: 

"What do you want out of life, and what is holding you back from that?" 

This question, and your answers, is where we begin the journey. I look forward to hearing from you.

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November 2, 2017

What actually happens in therapy?

The concept of counseling can be confusing because most people don’t know what to expect and don’t know what to ask for.  Remember that you are always in charge of your own experience and you can give your therapist feedback about what is working or not working for you.

There are many different therapeutic modalities that counselors draw from. Counselors select which ones to use based on three main factors:

  • Which ones the research shows will most effectively treat the client’s presenting symptoms/diagnoses
  • Out of those, which ones best fit the client’s preferences and personality
  • And out of those, which ones best fit the counselor’s training and personality

Most adult counseling falls under the category of “talk therapy” because it involves a verbal exchange between the client and therapist.  This is what most people think of when they hear the term counseling.  “Expressive therapies” are often used as well for both adults and children because they can target the whole person more effectively than talk therapy alone.  Some forms of therapy focus on the client increasing insight into their problems, and some focus more on behavioral changes.  Often counseling for children involves “play therapy” because that is a child’s primary language.

Some common modalities/frameworks that therapists use:

Solution-focused brief therapy (SFBT)

This framework focuses on instilling hope and focusing on solutions rather than on the problem.  Instead of spending all of your energy focusing on the negative things dragging you down, you focus on your resources and what you want your life to be like.  By doing so, you change your brain patterns and are able to live into the life you want.

Cognitive-behavioral therapy (CBT)

CBT is one of the most researched therapy modalities and it has proven to be very effective.  Almost every therapist uses CBT interventions to some degree because they are just that important.  The underlying premise is that our thoughts affect our behaviors.  If we change our thoughts, then we can start changing our beliefs about ourselves and the world, and thereby change unhelpful behavior patterns.  CBT can help you recognize ways that thought-patterns keep you stuck, and how to get unstuck.  My post about “shoulds and oughts” is an example of a CBT insight and intervention.  I personally use CBT as a helpful starting place, then move on to other modalities for deeper change and healing.  If you are looking for a therapist who focuses more on CBT, try Regan Hager, LMHC.

Dialectical Behavior Therapy (DBT)

DBT helps clients gain control over their fluctuating emotions and have more satisfying relationships.  There are four pillars of DBT: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.  DBT is focused on helping clients have more stable, satisfying lives through healthy relationship to self and others.  It helps clients find “wise mind,” the balance between the “rational mind” and “emotional mind.”  Many therapists incorporate DBT into their treatment, and a few specialize in it.  If you need more intensive DBT treatment, it is recommended that you also participate in a DBT group setting.  I utilize the principles of DBT in my practice, but do not specialize in DBT.  Many of my clients have reported that my style of approaching these issues makes more sense to them than the individual DBT interventions.  If however, you are looking for a structured framework to regulate emotions and improve relationships, DBT may be just what you are looking for.  I recommend Catherine Jones at Mended Wing Counseling for DBT groups and more intensive DBT therapy.

Acceptance and Commitment Therapy (ACT)

The premise of this framework is that our efforts to avoid the difficulties we experience are actually what create the most distress.  By accepting them without getting lost in them (through mindfulness), it is easier to move through the painful struggles.

Expressive Therapies

Expressive therapies are non-verbal interventions used to supplement talk therapy.  Expressive therapy incorporates art, music, movement, dance, drama, yoga, reading, and/or writing into the therapy process.  The power behind expressive therapies is that they allow you to access and process emotions and memories more effectively than talk therapy alone.  Sandtray therapy helps the client visualize and process what is going on in their life by creating a scene with miniatures in the sandtray.  For excellent sandtray therapy, I recommend Phedra Smith.  Sensorimotor therapy is another framework that focuses on how we store emotions in our bodies through our posture and how we express our emotions in physical reactions.  For example, changing your posture by standing with your shoulders back and head up rather than looking at the floor can help you experience and live into a more confident stance.  Sometimes you know the solution in your head, but your heart and your body have not accepted that reality, and expressive therapies can help you more fully embrace it.  Expressive therapies can address dysregulation and distress experienced in the body more effectively than talk therapy alone.  I enjoy incorporating art therapy and writing regularly in my sessions because it helps clients approach and see things from a different perspective.  It can allow you to both gain insight that's difficult to do through talking alone, as well as express thoughts and emotions that are difficult to put into words.  If you'd like to focus on art therapy, I recommend Anne-Marie Collins at Madewell Art Studio.

Play therapy

Play therapy is the treatment of choice for children because play is the way that they process the world and express themselves.  Children can have difficulty expressing and processing their world verbally because their pre-frontal cortex is not yet fully developed.  Play therapy allows them to use their natural language to process what they are experiencing.  There are many types of play therapy, including one of my favorites, Theraplay.  Theraplay focuses on the here-and-now, which is energizing and transformative for both the child and parent.  Theraplay focuses on structure, engagement, nurture, and challenge.  Theraplay is very effective for attachment issues, early trauma, regression, and anxiety.  I no longer see children in my practice, but recommend the following therapists: Regan Hager, Haley Papajohn, Bree Conklin at Willow Harbor Therapy, and Tiffany Cross.

Trauma-focused therapy

Trauma-focused modalities focus on helping the client establish safety and build coping skills first and foremost.  Once the client feels stable, reviewing the trauma can be helpful in order to make meaning out of the pain, increase a sense of power over the traumatic event, and replace lies the person believed about him/herself as a result of the abuse.   EMDR is one of the most researched and effective interventions for traumatic or disturbing life events.  EMDR helps clear out the intense memories instead of heaping them on.  If you have found that talk therapy seems to just make you feel worse, EMDR may be a better treatment modality for you.  The main goals of EMDR are to decrease the emotional intensity of traumatic events and replace the negative belief you had about yourself as a result of the trauma with the truth.  You can read more about the powerful impact of EMDR treatment here.  Trauma-focused CBT is another well-researched treatment and is effective for treating an isolated experience of trauma, but is often insufficient for multiple experiences of trauma.  I incorporate EMDR treatment as often as is indicated by client's needs, and have found it to be an incredible tool for healing.

Attachment-focused therapy

There are many different modalities within the framework of attachment-focused therapy.  Relational disruptions, especially early in life, can affect how clients connect with others, view themselves, cope with stress, and find support in life.  This is at the heart of how I view the issues presented in the therapy setting, and where I enjoy helping clients find deep healing that impacts both their memories as well as their future.Dyadic Developmental Psychotherapy (DDP), developed by Dr. Dan Hughes is an example of an effective form of family attachment therapy that is focused on healing family relationships, particularly between parents and children.  I have often observed that once this relationship is repaired, the family can come up with many of their own solutions for the problems they are facing.

Family Therapy

When we think of counseling, we often think of individuals meeting with a counselor, but counseling can also involve multiple members of a family.  Family therapy can be especially helpful for counseling involving young children, where parents’ involvement can be critical.  Couples’ counseling is another common type of family therapy.  Even with individual counseling, therapists often make use of frameworks that take family systems into account.  Family-informed therapy targets some of the following areas: creating healthy boundaries so that the family can experience both closeness and autonomy; increasing healthy, direct communication; reducing reactivity; and resolving problems together rather than blaming or attacking each other.

Person-centered Therapy

This approach was developed by Carl Rogers in the 1940's and is a staple of insight-oriented counseling.  It marked a shift from viewing the therapist as the expert to the therapist as a resource.  It focuses on  helping the client find the insight and support he/or she needs in a non-directive manner.  It is a helpful framework, but often requires supplementation with more direct and skills-based approaches.  If you find yourself becoming frustrated that although your therapist is a good listener and provides support, you want more direction and intervention, ask your therapist to incorporate other modalities into your therapy or to explain why he/she believes a non-directive approach is the best fit for you.

Christian Counseling

Christian Counseling encompasses a range of intervention methods, from using Scripture in sessions, to processing the client's views and relationship with God, to incorporating the client's Christian values into the treatment.  All counseling respects clients' personal, religious, and cultural values and supports clients in using them to create healthier lives.  Christian counseling is provided at a client's request based on their values and desires for treatment.

Psychoanalytic/Psychodynamic Therapy

Psychoanalytic Therapy was created by Sigmund Freud, and marked the beginning of the field of psychology.  Psychoanalytic Therapy saw the therapist as the expert, and was a long, time-consuming enterprise to uncover the hidden motivations and reactions of the client.  After going through modifications over the years, the modern-day form of this therapy is known as Psychodynamic Therapy.  It helps people uncover how unconscious processes and what's happened to them in the past may be affecting their behavior.  It increases self-awareness and one's understanding of their patterns, so that they can make choices about what's best for them instead of just reacting.