Therapy has for most people been associated with something mystical. Before I started to study psychology myself, I also had my mental images of it, and knew about the standard Freudian couch where you simply said whatever you wanted. I`ve heard about Freud, and knew you probably had to talk about your childhood, but had no idea how a typical therapist or patient actually looked.
For people who haven`t been in therapy, it is often still a mystery. A lot of my friend have asked me, isn`t it hard to hear about so many horrible things, every day? But it’s basically what we all do, every day, anyway. We see films, listen to our friends, read books and watch news. Of course, we don´t have the “obligation” to do something about that, so people might feel that it`s different, but for me I feel like a lucky personal coach. We always stand by our patients sides when something needs to be done or untangled, and that feels good.
Even if I am a therapist, I still love to go to therapy or supervision myself. I don`t necessarily respond to the words, but more to the fact that I talk and be seen by a fellow human who wants the best for me. It’s good to have someone there, who just say “it truly sounds like you had a rough time”.
This might still be a bit vague. You might think: Well, that`s fine: But what do you exactly DO during those 45 minutes? To make it more concrete, I will try to write a bit more of what can be done in therapy. Since we can`t talk about patients, I must underline that this is just general, and refers to no specific client of mine. Of course there will be variations in how we work and approach problems, but I always have some basics that I live by: Respect, curiosity and an attitude of “everything is possible”. I truly believe that, no matter how far someone has fallen, with motivation and hard work, nothing can´t be done.
A typical morning for me is getting to work, looking through my calendar and appointments or maybe attending a meeting if its monday or Wednesday. Normally I have about four sessions every day, with people who have a variety of diagnosis. If we have our first meeting, I have to go through some standard questions, but mostly I try to get a description of the problem as they see it. Sometime I also give them some surveys that have to be filled out before the next session, but personally I prefer to not use too much time on those, since I think
people might get a bit annoyed if this is the only focus. I also explain why I use questionnaires: So that we can choose a treatment that fits people who generally score the same. And of course, if they have a diagnosis that might require medications, I can`t ignore that. With depression, bipolar disorder, AD/HD or psychosis, conversations might not be what we focus on the most in the beginning, it might be we also must talk with the doctor so that we can secure basics like sleep. For some people, collecting energy will be the first thing we do. It’s about saying no to people who drain energy, working with attitudes about how perfect everything must be, or simply working in a schedule where they put in healthy food, physical activities and “alone-time”. Some people worry a lot, and then the goal might be to set up experiments where those worries are put to the test. For example, people with panic attacks, might worry about fainting in public, and after a while they start to avoid situations that they feel are dangerous. An example that I actually saw on television, was a woman afraid of hurting kids if she had a knife in her hand.
- Using eye movements to reduce fear
After a while, she stopped using knives, and even made sure to lock them securely in. She also developed a fear where she worried she might accidentally kill someone by not paying not attention while driving. After a while she simply stopped driving, because she didn`t want to take any risks. The therapy for her was rather concrete: She had to expose herself to what she feared, like being in the area where kids could be WHILE she carried a knife, and drive a car where people could potentially be, without turning back to check if she had run over people.
I work mostly with traumatized people and people with personality disorders. I usually follow a model where I first focus on stabilization, before we work with specific traumas that give them flashbacks, nightmares and disrupt them in their daily lives (can`t relax, must always be on “guard”). I often use EMDR for this work, which is basically using eye movements while thinking about traumatic memories. I ask them to bring forward a memory which scare them, and to think about the the worst part of it so that we truly get to the core. Then they keep that picture in their mind’s eye, while following specific movements I do with my fingers. I monitor their discomfort on a scale from 1-10, where 10 is the worst discomfort they have ever felt, and 0 is completely calm, and keep doing the finger movement until they feel calm. I will write more about EMDR later, but it the main point is that afterwards, it`s easier to live with what happened. People have described it as “earlier I lived as the abuse still happens, now it feels like it`s behind me”.
The last part of therapy is saying goodbye. We go through the work we have done, and talk about how it will be to continue their journey without therapy. This is important, because leaving therapy can be tough. I must make sure that people don’t feel abandoned, that they can take with them some part of what they learnt, inside their hearts. I have also been in therapy, and when I feel especially low, I can hear my former therapists voice in my head saying: “Take care of yourself, dear”. I say this to my clients: If I can be with you in just one tiny part, I will gladly be there. I also allow them to contact me later, if they need to. It’s just a way of saying that goodbye is just “now you can continue on your own. I wish I could walk every step of the journey with you, and in my heart, I do”.
A lot of my jobs is
actually about respect and being there. Far too many think they aren`t good enough. It doesn`t matter how many times they have been told or have read that we all have value. Often this simply does not feel. So sometimes I must state the obvious; I give examples of how kind-hearted they are (most people are really wonderful), how hard they try and focus on them surviving horrible times, to show them their strenght. A therapist should also be stable and reassuring.
I truly care about my job and my clients. When they manage to do something good for themselves, I cheer them on and feel real joy in my chest. Its magic, what I do, and it gives me hope, because no matter how many bad choices, relationships or events that have taken place in a life, it truly is never to late
- EMDR Training Update: May 2013 (parkerschlichterandassociates.com)