Begin with the End In Mind
What does successful psychotherapy look like? I would like to begin with what it will feel like at the end of the process. To do so I will start with talking about Group Psychotherapy. Because our original assumptions about ourselves and defenses developed early in life in a group (called our family of origin), the most advanced form of healing and correction also takes place in a group, called simply group psychotherapy.
After being in individual therapy for a period time, I will invite you to continue to grow in a group therapy setting. The power of group psychotherapy lies in the fact that all human feelings, purposes, and behavior originate from the individual's adaptation to other people. The groups that I lead are actively run. Sitting in group for any period allows you to deepen your connection to your self and others with the intention of observing and changing patterns of behavior and dynamics. You are then actively encouraged to practice a new way of relating - whether it is confronting or comforting yourself, setting boundaries with others or taking risks, being vulnerable or learning healthier defenses - with my support and the support of the group behind you.
There are things that will come up for you that are important for you to work through, that sometimes never come up in the safety that exists in individual therapy. Your experience will increase optimism, facilitate change, combat isolation, and help you find your own personal power, your own voice.
Members of the group may come in with differing presenting problems - loss, finding meaning in life, sexual issues, dating, body image, divorce, parenting, depression, OCD - you name it - but the underlying themes, projections and defense mechanisms are universal. While group can initially feel intimidating or overwhelming, it is the most rewarding and effective method for deep personal growth. I would feel negligent as a psychotherapist if I didn't run groups and have my patients progress from individual therapy to group therapy.
"How long will this take?" you might be wondering.... like college it will take struggle, time and money. I consider it emotional grad school. I imagine you know extremely smart, well-off people who are unstable, unhappy and worse. Our emotional well-being determines everything. In 2009, researchers from the University of Rochester tracked the success of 147 graduates. Some had "intrinsic" goals such as deep, enduring relationships. Others had "extrinsic" goals such as achieving fame. They found that intrinsic goals were associated with happier lives and, conversely, those who had pursued extrinsic goals had more negative emotions and suffered more physical maladies.
The successful termination in group therapy looks like this: over time, a member gains clarity about the relational issues that are holding him or her back. Using group feedback and self-reflection, the member gets in touch with a continuum feelings and discovers a freedom of speech to talk about them in the group. By working through these feelings and seeing themselves differently, the person feels lighter but stronger to effectively advocate for him or herself, to seek and gain more successful satisfying relationships, and be able to love and connect to others at a deeper level. The member then carries this over outside of group to have an ease with communicating conflicts or desires or whatever the growing edge is, to others in his or her life. This becomes a new normal that is (hopefully) received well by others and may motivate them to grow, as well.
With progress, it then becomes apparent to everyone that this member is ready to leave the group. The member sets a termination date that allows several weeks (or even months) to review the progress and growth, and process feelings of appreciation for the group and vice-versa. This is a very validating and rich experience, and is critical to the process of change. Being able to give and receive mirroring and compliments is a real gift in life. And it is a gift that you will be modeling to your loved ones, one that has a ripple effect to the generations that will follow.
Migrating Toward the Starting Point
Individual therapy is a mutually participatory process. I will evaluate what you say and develop a "working hypothesis" about who you are and what your presenting problems may be. I will try to give you, as you sit across from me, a framework within which to consider your emotions. I usually give myself at least six sessions to validate that or determine different or additional ones.
I will be elliciting your views always. The more responsibility you take, the better your chances are for a successful outcome. Awareness is not enough. Once you have named all your issues, expressed all your disappointments, vented all your rage, and have felt mad, sad, bad and glad, you still have the task of changing. Often there is a difference between what you want and what you need. I will try to help reframe your questions so that you may come up with new solutions, and I will ask you to replace self-judgements with curiosity.
I will ask you to talk about what brings you in, and over the course of several sessions, we will weave around to get your life story from both a positive and negative perspective. Why go back to childhood? As children we are too vulnerable, unskilled and insecure to confront our parents about repetitive mishandling. This leaves behind a considerable unprocessed archaic legacy of fear and anger. And it take a lot of psychic energy to keep all these pains and fears locked down in what I call "the vault of your psyche." Often, people come in and don't know why they are depressed. Your inner child knows why....You may find that you've been looking at yourself in a distorted mirror, the kind you find at a carnival, for quite some time.
I may impart my interpretations, but in the final analysis, the only truly illuminating insights about personal destiny are self-generated. Theories will only take us so far. You also will be unaware of what it is that needs confronting or at least be unwilling to achnowledge it and deal with it. Receiving initial confrontation is usually a surprise or shock. However, this is necessary for consciousness-raising. You want to wake up to something that is critical to your own well-being and the well-being of others, yes?
In terms of confronting, I don't believe in either cream puff or sledgehammer approaches - one side is degenerative of power and the other is lacking love and sensitivity. And in each case, care and wisdom are missing. Neither are necessary when our process is approaching the target. And yes, I'm presuming to judge what it is you are not aware of - but it is in your best interest. If I get it wrong, then you get to correct me and add to the picture so that it comes into focus. Your level of honest disclosure hastens this process immensely.
I believe it is my duty to carry this critical part of the therapy out without my own residual anxiety in the mix. We therapists have our own emotional (at times unfinished) business having to do with a thousand experiences from our pasts, particularly those from our own childhood. I have spent many years in the chair across from my own therapist and in group settings, as well as supervision groups, advanced training groups, and as a member of the Ethics Board for the American Academy of Psychotherapists. I would love to say that my issues are all wrapped up in a neat package, and yet I'm always amazed, as I continue my own work, at what surfaces or re-surfaces. As I get older, I find the new feelings and insights around things that I've already processed to be both astounding and relieving. I hope I get to collaborate with you to experience this healing awe.