Introduction
My primary work
is with adults in individual, couples, and group psychotherapy. I
consider myself a generalist working with a wide range of goals and
difficulties. This comes from my training working with people
and with process rather than with particular problems. There
are common threads running through the human experience that make
therapeutic elements such as listening, understanding, sharing depth of
experience, and quality of the interactive therapeutic relationship healing
with most everyone. I believe connection to others, to
community, to spirit, and to oneself to be fundamental in both the problems
people bring to me and in the solutions that people find in working with me.
I also believe that finding meaning in one's life is also fundamental to
satisfying living.
While keeping an
ear to connection and meaning, I also work with people in a very pragmatic
way. I believe in drawing on whatever resources are available.
This can include medication, exercise, nutrition, reading, therapeutic
homework, journaling, art, family research, etc. I also believe it is
often important to collaborate with others (with permission, of course).
I am always glad to talk with primary care doctors, psychiatric
professionals, or anyone else that may be important in understanding and
working with the particular challenges presented.
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Growth, Healing, Recovery, Relief, or Cure?
These are the
broadest terms for the goals set for most coming into psychotherapy.
Which term is most appropriate will depend on the approach of the therapist,
the views of the client, and the nature of the challenge. We often
refer to growth when life is basically going ok yet more is sought. In
healthy human development, growth is continual from birth to death.
Healing is most often used when there has been some identifiable injurious
event, analagous to a physical wound. Recovery emerged from the field
of alcoholism and addiction and has been applied to codepency as well.
Relief might be considered shorter term but not complete or permanent, while
cure would be complete and permanent. Early in the therapy, some sense
of what goal or goals are most appropriate needs to be established.
Another way to
think about differing approaches in therapy is in terms of a growth model
vs. a medical model. If we think in terms of growth, we are taking a
healthy, positive view. A medical model is based on pathology and
diagnosis. A growth model works the whole person while the medical
model works with the psychopathology. Each is appropriate in different
cases. I tend to blend these models. If there is a clear
diagnosable problem, it is helpful to use the accumulated knowledge in the
field to work with the diagnosed problem. The diagnosis works as a
shorthand means of communicating a great deal about the difficulty. On
the other hand, each person is unique. And each person with depression
is unique, as is each person with a phobia. It is this problem, this
person, this time, this context that we have to work with. You will
see how these two models work together in the overviews of some selected
psychological challenges presented below.
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Some Areas of My Therapy Work
This first group
of categories do not necessarily meet criteria for mental health diagnoses.
They are in the range of "normal" life events and challenges that most
everyone faces at some time in their lives.
Grief and
Loss: Grief is the expected reaction to loss. Loss is an
inevitable part of life. The most significant losses are due to deaths
of loved ones, separation, loss of health, or loss of an important job.
For many, grief is painful but natural. They grieve in a healthy
manner and move forward. For others, however, grieving is too painful
to bear or the fear of the pain prevents them from grieving well. The
mainstream western culture contributes to the avoidance of a full grieving
process, particularly for men who have been taught not to cry. When
someone has difficulty grieving, letting go, and moving forward, and their
usual supports are not enough help, a support group or a period of therapy
can be of great help in facilitating this natural and necessary process.
Life
Transition: Significant life changes can often make for a
difficult adjustment. Even positive changes such as a marriage, a
graduation, a move, empty nest, or retirement, contain elements of loss.
Many transitions require a new way of looking at things, a change in habits,
or other changes that all require adaptation and adjustment. Sometimes
these transitions are smooth, sometimes not. Support is almost always
necessary. When a person's usual supports are not enough, therapy can
be of help.
Relationship:
People are relationship oriented. Our relationships are
extremely important to us. When we have difficulty finding or
maintaining relationships, or when we have distress within our
relationships, it can be distressing to us individually. Individual therapy almost always
devotes some focus to relationship issues. In fact, therapy is
a relationship! I view the therapeutic relationship as a core
component of the therapeutic process. It is not exactly a friendship,
not exactly a business relationship. The therapeutic relationship is a
special kind of relationship that works within a safe and consistent context
designed to allow for understanding, healing, and change. When
therapist and client have established a trusting therapeutic relationship,
other aspects of the therapy, such as education, exercises, etc., will be
more effective than when the relationship is more neutral.
Couples therapy
is a mode of therapy that is devoted to working on relationship.
While I concentrate on individual therapy, couple therapy is sometimes more
appropriate and sometimes used along with individual therapy, usually by
different therapists. Couples therapy most often is utilized by partners in a committed primary
relationship, but can be useful to any two people in relationship.
Other examples are brothers or sisters with a significant impasse in their
relationship, a parent and adult child, or even two business partners.
I see couples work primarily focusing on mutual understanding of
differences, needs, and on effective communication. I have found that
most couples are very able to solve their own problems when they learn to
communicate such that both partners feel heard, understood, and validated,
even if disagreement remains. Our unique histories, however, often
lead us to interpret events differently from each other and to have
different needs. Understanding how our histories combine to make a
unique relationship "chemistry" is also an important component of good
couples work.
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This next group
of categories represent some of the traditional diagnostic categories used
in the medical model. That is, there is enough difficulty to assign a
mental health diagnosis and, when considering these diagnoses, we are are
thinking in terms of psychopathology.
Depression:
Depression and anxiety are the most common of the psychological disorders.
Most people will experience problematic depression sometime in their lives.
Whether primarily biological or situational, depression is very treatable.
With severe depression, medication is often indicated. Less severe
depression can still be quite troublesome, particularly if chronic or
recurrent. Some of the questions I ask when someone comes to me with
depression are: What has been lost? What has changed? Is
there a lack of meaning or purpose? One approach is to transform the
depression from something terrible to something productive. This is
most applicable when there has been loss, change, or lack of meaning.
The depression can be viewed as the fertile void from which something new
will emerge.
Bipolar
Disorder: Formerly called "Manic-Depression," Bipolar Disorder
involves mood swings both up and down, though movement towards one end or
the other of the spectrum might predominate. Bipolar Disorder almost
always has a strong biological component and medication is usually
indicated. Psychotherapy is helpful in accepting the reality of the
diagnosis, addressing compliance with medication, learning about one's mood
cycle and early warning signs of changes, skills for coping with the
difficulties presented at individual, relational, and spiritual levels.
Anxiety:
Anxiety can take many forms... phobias, general worry, panic attacks,
obsessive-compulsive disorder, acute stress disorder, and posttraumatic
stress disorder. Some forms are best approached with a
cognitive-behavioral strategy. For example, phobias and panic attacks
can be treated with "systematic desensitization," a method of teaching
relaxation skills, then pairing the relaxation with the anxiety provoking
stimulus until the person desensitizes to the stimulus and the anxiety
response is extinquished. Some forms of anxiety can be seen as
existential problems often involving the fear of loss of control with
intimate ties to confidence and faith.
Posttraumatic
Stress: I prefer to consider posttraumatic stress disorder (PTSD)
as distinct, though it is technically an anxiety disorder. When an
exposure to a traumatic event causes later psychological problems, it is
usually due to the need to protect oneself psychologically from the full
experience of that event when it originally occurred. As a result the
event is not fully integrated into one's experience and memory and can
disrupt day to day living with intrusive memories, nightmares, panic attacks
and other anxious responses, depression, and avoidance of situations that
might trigger these symptoms. The work in therapy is primarily to
achieve integration of the traumatic experience by developing the strength
and ability to confront the trauma, put the dissociated aspects of the
experience together, and to make meaning of what happened.
Personality
Disorders: We all have personality traits that make us
interesting, sometimes bothersome to others, lovable, and always unique.
It is not uncommon for people to seek psychotherapy for a personality trait
or pattern that is problematic. However, it is when these traits
become so inflexible, maladaptive, or distressful to cause social or
occupational impairment that we consider a personality disorder diagnosis.
Work in this area is most productive in regular longer-term therapy that
links childhood experience, current relationships, and the therapeutic
relationship to promote insight into maladaptive patterns and opportunity
for change.
Thought
Disorder: Strictly defined, disorders of thought encompass a wide
range of cognitive dysfunction that can be a part of depression and anxiety
(loss of concentration, catastrophic or unrealistically pessimistic
thinking, extreme self-consciousness, etc.), however, the phrase "thought
disorder" in mental health has generally come to mean the same as
"psychosis." The hallmark of psychosis is hallucinations (perceiving
things that are not there) and delusions (believing things that are not
true). Psychosis can also include disorganized speech and
disorganized behavior. Psychosis generally involves some degree of
loss of "reality testing," or being able to disguish what is real from what
is not. More severe psychosis involves loss of "insight," or the
ability to know that these psychotic experiences are symptoms and not
objective reality. The diagnostic category that is defined by psychosis
is Schizophrenia and its variants though a person might experience psychotic
symptoms during a manic episode, when intoxicated with or in withdrawal from
alcohol or drugs, some forms of dementia, and in severe depressive episodes.
Medication is usually indicated in these disorders. Psychotherapy can
be helpful when there is some degree of insight and the person is organized
enough to participate.
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