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Archive for the ‘about me’ Category

It is easy to lose focus in therapy.   Therapy can become a meandering journey, a bit of a boat adrift in the sea of life struggles — tossed and turned with each new week.

Or therapy can set a clear destination – a goal, a distant shore towards which each session in it’s own way is heading you closer.

There are several ways I like to help my clients (and me!) make sure we all know where the boat is headed and that the course we are charting will take us towards that destination.

1.  Early in treatment articulate a clear goal.  Sometimes this will be a vision of what “better” might look like.  For other people a laundry list of concerns that will be resolved.  In other situations it may be relief from symptoms like depression, anxiety or marital tension.  Every so often is a new skill set– parenting skills, marriage skills, boss-management skills.

2.  I review this goal before each session to make sure that the course I am charting is heading us towards our destination.

3.  I often encourage clients to pursue treatment in blocks of about 5 sessions.  Move towards the goal for a handful (or handful plus) of sessions, then re-group.  Sometimes the re-group is a pause in treatment.  Sometimes it is just a few moments in a session to look at where we’ve been and where we are going.

I find being clear about the destination to be particularly important to keep right at the fore when working with people who come to therapy with a broad range of things that just aren’t working in their lives and/or longstanding history of depression, anxiety or other mental health challenges.  There can be so many directions to explore, so many different ports that one might go calling in.  However, by visiting them all, one risks losing momentum.  Better, I think to pick a destination, sail to it, savor it.

And then one can always pick a new port to go calling next!

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Making it to a first therapy session takes guts.

Really, it is an odd thing to sit in a waiting room wondering about this person, this random therapist you found on the internet or heard about from a friend,  with whom you are about to share the intimate details of your life.  If you’re like most people, these are thoughts and feelings which few people, if anyone, in the world knows about.

I hope this post can alleviate some of that waiting room anxiety.

So what does happen in a first session?

For me, a first session actually starts before the first session.  I encourage my clients to complete a comprehensive welcome packet.  In addition to telling my clients about myself, I have them fill out a pretty long questionnaire about their concerns, past experiences with therapy, recollections of themselves as a child etc.    Why?  Simple.  Because this way I don’t have to spend precious minutes during the first session asking all these questions.  Instead, by the time a client walks in my door, I at least know a little bit about them and why they are coming to see me.

The first thing I, and every therapist, talk about during a first session are the legal and practical details of therapy.  I explain what confidentiality is and its limits.  I make sure that I have explained my fee structure and cancelation policy.

And then it’s time to roll up our sleeves and get to work.

Often, the next thing I like to do is to create a laundry list— that is a list of all the things that, if they all were fixed, would tell us all that it was time to end therapy.   With couples and with parent/child combos, I’ll be the note taker while the two talk together about what goes on the list.  This gives me a chance to see where their skills are at the same time as we’re making the list.

As we have a pretty comprehensive list, I generally shift to talking some about what it will take to get from here to there.  I might ask how long a client thinks it would take them to resolve everything on the list if they had great help doing so.  Or, we might explore how if magically everything on the list was fixed when they woke up the next morning, how would my client know that everything had been fixed.

Sometimes with couples or parents and children at this point I also like to give each person a few minutes alone with me to check-in if their are any pieces they would like to add to the list which they weren’t comfortable talking about with their spouse/parent/teen in the room.

While many therapists like to use the first session for a lengthy history taking, I prefer to jump in and geting working.  I already have the critical historical pieces on the paperwork.  I’ve found that details relevant to therapy will come out on their own.  And those that aren’t relevant– well, why would someone pay to tell me about something that isn’t going to help solve their problems or leave them feeling better.

“So, which item on the list do you want to start with?” I’ll usually ask.  At this point, I may also have a something to put on the “agenda” for the session.  Perhaps it’s teaching a skill where I noticed a glitch, or perhaps it’s infusing some optimism into what looks like an impossible situation.  With an agenda laid out that incorporates what everyone wants to use the session for, it’s time to get to work.

By jumping in like this by the end of the first session not only have we created a clear road-map for treatment — fix everything on the list — we’ve also actually started helping things. Ideally, I’ve learned a lot about my clients and they are going home hopeful, not on blind faith, but because we’ve actually succeeded in moving forward on something from their list.  Hopefully, as well, clients leaving from a first session are as clear as I am about what we’re going to do together, about how long it’s likely to take, and how this whole process is going to help them.

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Back at Last!

After graduating with a Ph.D. in Clinical psychology nearly 4 years ago, I am so excited to finally open the doors to private practice.  Why so long?  For the past 4 years I have been directing a $2.5 million grant from the US Department of Health and Human Services to create online tools for relationship and marriage education.

It’s been a rewarding project, and one which I continue to work on part-time.   When we started back in 2006, it was often hard to convince people that maybe, just maybe, the internet could be a powerful medium for helping couples to build stronger, more loving, and more satisfying relationships.   Well, with 4 years of hard work, and four more years for the internet to blossom, we have succeeded.  Power of Two Online (poweroftwomarriage.com) is here, and IT WORKS!  Yes, we just completed a random assignment, wait-list-controlled study, in other words the gold standard study design from a scientific standpoint, that shows, without question, that Power of Two Online does transform marriages.

Likewise, we’ve launched a membership model service so that couples everywhere can reap the benefit of this inexpensive and effective resource.

How does all of this connect to this blog and my therapy practice?  Well, as Power of Two Online has stabilized, and I’ve enjoyed hearing stories from our members, I realized how much I missed actually sitting with real people –coaching, teaching, and exploring with them the in-depth pieces of how to build a happy, satisfying life.

Likewise, while my training included extensive work with teenagers, children and their parents, while I had young children, it was good timing to put helping others with parenting concerns on hold.  As my three boys are all independently off to school everyday, I am so pleased to be able to share my expertise again with clients.

If you are reading this blog wondering if I am the correct therapist for you, I hope you’ll give my office a call.  The secretaries are wonderful at helping people to figure out which of the therapists I office share with would be a good match for them.  303 388-4211.

All the best,

Dr. Abigail Hirsch

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