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Posts Tagged ‘therapy’

So, if my postings have been a bit sporadic the past few months, it’s with good reason. Much to our surprise, after 8 years of unsuccessfully trying to add child #4 to our family, I seem to be very much pregnant (due in March if you’re curious).

What’s the connection between that and a flutter of anxiety? Imagine my surprise when, instead of feeling overjoyed with the discovery, I instead promptly had a massive panic attack.

Dr. Heitler, my office-mate (and yes, my mother) has a very helpful technique for figuring out what was going on that triggered that anxiety — and where my husband and I needed a pow-wow to get on with being excited about this new development.

Dr. Heitler posted a blog this week at PsychologyToday with a very nice description of the process I found so very helpful. The one sentence summary — trace back to find the “butterfly” thought that in some sub-conscious way, triggered the anxiety.

Curious what my “butterfly” was?    Seeing our camping gear ready for a weekend’s adventure “butterflied” me to concerns that a new baby would mean we would no longer be able to do this kind of family adventure. The solution — lots of fun ideas for how to tote a baby along on family outdoor adventures — and plans for leaving baby-to-be with the Grandparents as well!

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I had a wonderful session with a couple today where we talked about the hallmark of truly first rate listening. Here’s what we arrived at.

First rate listening transforms THE LISTENER.

Yes, it’s wonderful to be listened to and listening is a gift to do for anyone you care about.

And, the real halmark of great listening is that every time you really do it well — that is listen to learn from your spouse — it’s a chance to become a more open, more understanding and more educated you.

So, next time you’re listening, notice if it’s changing YOU.

Want more on how to do this kind of listening? Watch a video of me teaching about listening here.

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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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Affairs are horrible painful.  They are painful for the couple.  They are miserable for children who find out what happened.  And, for the most part, they also end up being terribly painful for the “third leg.”

And, at the same time, affairs are one of the most preventable causes of marital distress.

How?

Four simple rules:

  1. Save conversations about anything intimate, revealing, special, exciting etc for your spouse.
  2. Know your family history.  If your parent(s) cheated, you need to be particularly alert to avoid making their mistakes.
  3. Try to be home with your family for dinner.  If you have to travel or do business dinners be very careful!
  4. Stay away from ex’s and old friends of the opposite sex– especially if you just rediscovered them.
  5. Be open and honest when either of you have situations that start to feel uncomfortably charged or concerning.
  6. Keep your marriage strong, intimate and loving.

Want to test you savvy?  Click on the picture or here for a fun interactive quiz.

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I’m not a big fan of homework for kids.  Actually, I’m a big anti-fan of homework for kids.  School is long enough.  When kids finally come home it’s time to play sports, read, draw, talk with friends and just chill on the couch.

Homework after a therapy session, however, is a completely different matter.  In some ways, this is the most important part of the whole project.

Why is giving and doing homework between sessions so different from homework from school?  Here’s my list.

  1. School lasts 7 hours or so a day.  Therapy is 1 hour a week (or so).  That’s not enough time to learn, practice and do.  Thus, practice and do homework.
  2. The goal of school, in many ways, is to learn to do school well.   However, the goal of therapy is to learn to do LIFE well.  So, bringing therapy home is key.
  3. Changing habits is hard.  It takes a lot of practice to do one’s life differently.  Therapy homework is a way to structure this practice.
  4. Therapy is expensive.  Homework is a way to get the most out of each session so you can use the least sessions possible!

What makes for good therapy homework?  Good therapy homework is decided on as a team with both therapist and  client(s) deciding what the assignment will be.   Good homework feels do-able so that it’s a way to succeed.

And, perhaps most of all, good therapy homework, all-in-all makes time instead of taking time.  It makes time by fostering healthier, happier ways of doing this project called life.  Because, it’s not just our kids who deserve a break at the end of the day!

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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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