Thursday, September 14, 2017

Why Should I Pay to Talk to You?: Reflections on the "Process" of Psychotherapy

A recent conversation prompted me to revisit this question. This post is an edit of a 2013 post on "Content vs. Process" in psychotherapy.  

When meeting new clients (and others), I encounter a variety of comments that reflect common misconceptions about psychotherapy.  One is that the focus of therapy is for me to evaluate the client and tell them what to do.  Many people start their therapy a bit defensive because they are fearful of my judgment or correction.  Some people have mocked the process of therapy by saying that therapists never tell you what to do and only “Listen”.  Others have said to me, “Why am I paying you to listen to me when I could just be talking to a friend or family member?”  The difficulty with all of these assessments is that they assume over-activity or inactivity on the part of therapist.  People have experiences with other "advisers" in their life in which they seek advice and receive a plan on what to do for their particular problem and they expect therapy to be like that.  There are also distortions of the therapeutic process portrayed in film and television that perpetuate misconceptions.  Unfortunately, there are also a number of people in the world practicing some type of counseling who contribute to these stereotypes by their methods of practice.  The very terms we use for this type of care are also confusing – counseling, therapy, psychotherapy, psychoanalysis, etc.   (In a previous post, I commented on the technical differences in these various terms).  Many people think that seeing a therapist is helpful because the therapist is supposed to be a neutral third party.  However, what makes the process of psychotherapy different from talking with a friend or other type of helper is the attention to the process of therapy. Because this part of the relationship is often managed in subtle ways, people often perceive that the therapist is not doing much, but the reality that is that the process is rich with reflection.
Fundamentally, what makes any type of counseling or psychotherapy beneficial is the quality of the established relationship and this is true regardless of the therapist's theoretical orientation.  However, attention to this "process of therapy" is particularly meaningful to those who practice psychoanalysis, psycho-dynamic psychotherapy, and traditional Pastoral Psychotherapy. In these types of therapy, the therapist is mindful of the dynamics of the relationship, monitors these things, and uses them (hopefully) for the client’s benefit.  These types of dynamics can exist in other relationships with friends, etc, but it is more rare.  Psychotherapy is, by definition, a relationship between two (or more in the case of couple or family therapy) people for the benefit of one of them.  Everything the therapist does or says should be for the benefit of the client.  In order to do this, the therapist must be aware of many dynamics that are simultaneously at work in the counseling office.  Friendships are generally more mutual in nature.  

What is the "Process" of Therapy? 

When a person comes to therapy, the issues they wish to discuss and the struggles they have with these issues constitute the “content” of the session.   However, the forces that motivate a person’s behavior are also important.  The therapist should be reflecting on the selection of material presented and the content of the material.  After a particularly painful session of dealing with something like grief, a client may come in the next session and talk about more mundane or superficial issues.  The therapist’s job is to note the shift in tone and help bring to awareness the change.  When a client presents a memory of events, the therapist is focusing on how the person was affected and how they behaved in the events presented, but he or she is also focused on how the person seems to be feeling as they are presenting the material.  The therapist should not make assumptions about what the client felt, how they are feeling, or why they behaved in a certain way.  The job of therapist is to note that such feelings and motivations exist and to ask questions to raise the client’s awareness.  This is why it has become cliché for a therapist to ask questions like “How did you feel when that happened?”

The Therapist should monitor his or her own feelings during a session

Completely out of the awareness of the client (at least it should be) is the therapists’ reflections on another set of dynamics in the room – his or her own.  As the client is sharing, the therapist is also monitoring his or her own feelings about what is being shared.  He or she is monitoring the experience of the person and noting what they observe and hear.   The therapist is monitoring how his or her own story is connected to the client’s story.  The goal for the therapist is to be able to separate his or her own experiences from the experiences of the client.  In order to do this effectively, the therapist should have done sufficient therapy for their own personal issues and to receive adequate supervision and/or consultation on their work. The therapist becomes less effective when he or she assumes what the client will or should feel instead of allowing the client to discover what they actually feel.

Therapy is meaningful when the therapist is NOT giving advice

While the therapist may provide some education on common dynamics of interaction or personal development, their primary goal is to allow the client to discover how he or she plays out these dynamics in their own life.  Any intervention or action on the part of the therapist should be in the service of this self-discovery or to help provide an environment that contrasts the clients’ previous hurtful experiences.  By observing the clients actions, monitoring feelings, and dealing with the dynamics of the client’s relationship with the therapist, the therapist creates the opportunity for growth and healing.  The client’s experience of the resulting relationship between therapist and client can then grow beyond the walls of the therapy office to the other parts of the client’s life.  The goal for the therapist is to create independence for the client and not to foster dependence.  Advice-giving and such activities, while helpful, only keep the client dependent on the counselor.  When the therapist helps the client discover his or her own ways of dealing with things, then they are able to apply that understanding to novel situations.  The experience of this growth within a therapeutic relationship is generally experienced by client and therapist as deeply meaningful.  In pastoral psychotherapy, this growth and self-reflection will often include reflections on faith, God, and spiritual development and the process of the therapy itself can be experienced as quite spiritual or holy. 
So, far from doing nothing or doing everything for a client, the therapist works with the content of the client’s issues while monitoring the internal and relational process of therapy. The therapist should maintain a calm exterior, but should always be actively reflecting internally.  I have found this process personally, professionally, and spiritually enriching.  For most events in life, the support of a good friend or trustworthy family member is invaluable.  A good friendship can have wonderful therapeutic value and can be very helpful in many of life's difficult situations, but for me, there is no true substitute for a meaningful therapeutic relationship.

Wednesday, February 22, 2017

Easy Answers

The members of the Sunday School class I teach and other friends that know me, know that when it comes to my faith, I do not accept easy answers for tough questions.  I am a skeptic by nature and faith does not come easy to me.  I have lived enough life to have suffered a little and struggled a lot.  The seemingly trite explanations of suffering or the traditional answers to biblical questions are not always easy for me to accept.  When I sit down with my Sunday School Class on Sunday mornings, I want us to wrestle with meaning of difficult passages.  I don’t want to skip over the unpleasant or difficult passages of the Bible.  When it comes to the familiar passages, I want us to slow down and not just accept traditional understandings.  In short, I take the bible and faith seriously, but it is not “easy”.

On a recent Sunday Morning, one of my longtime class members asked, “Just out of curiosity, is there any “easy answer” that you accept?  The class laughed and I blushed a bit.  I did not think of an answer right off, but the question stayed with me all week.  I reflected on the basic tenants of our faith.  I thought about various “truths” I have been taught through the years.  Ultimately, I came to the answer that I usually come to when thinking such thoughts – God is Love (I John 4:8).

I was eating lunch with a new friend this week and we were sharing the respective stories of our lives and how we came to be the people we are and do the work that we do.  I was struck, as I often am in hearing other’s stories, that though my friend’s story was nothing like mine on the surface, what we shared was an overwhelming experience of God’s love.  In my own story, I talk about a time in my life when I felt unloved and unloveable and a friend reached out to me and offered me love.  This act was followed by other friends demonstrating love to me – not wholesale approval of where my life was, but love and acceptance in the place that I was.  I have also experienced incredible love from my wife, Lynda.  This love demonstrated to me by friends has become an internalized experience of what I had previously professed as God’s love, but did not truly understand.  This love has become a living reality for me and the experience has been so profound, I want only to help others have such an experience. 

In a training I recently attended, I heard Richard Rohr say, “I am better at talking about love than doing it.” That sentiment immediately resonated with me.  Having had an experience of transforming love and having done study on the power of love, I am woefully aware of the times that I fail to provide it to others.  At times when I am tired, insecure, frustrated, hurt, anxious, fearful, among other feelings, I can let those other emotions cover and smother the desire to be loving.  Each day I pray that God would make me more loving; that I would live out in my life the love that I have experienced from God through others. 

All of that to say, while I may have questions about some of the fundamentals of my own faith tradition, I cannot just walk away from my faith because there is an experience of love that I have had that literally changed my life.  When I read the bible now, I see that love in the pages.  I desire to love others because I have experienced the love of God.  I desire to be an embodiment of that love for others.  There may be one or two others, but I know that the one “easy answer” that I accept is that God is love and God loves me (and you).  The journey to understanding that and learning to live that out in every circumstance of life is not all that easy, but I can imagine no other truth that is greater for me.  

Wednesday, September 21, 2016

I'm Probably Doing This Wrong Too

Several years ago I relinquished one of my email accounts to the realm of spam, newsletters, and sweepstakes.  I pretty much only use that email address to “Sign Up” for things.  I check that email often though just to make sure I don’t miss something that I want, but that account gets A LOT of spam.  I have noticed a trend over the past few years that is really starting to annoy me.  There seem to be a number of emails that declare I am doing something the wrong way.  I am drinking wine, eating sushi, cooking my steaks, wearing my underwear or any number of things…the wrong way.  Someone somewhere has proclaimed that there is a proper way to do something that is different than many or most of us (or maybe just a few of us) are doing it.  I hate these emails for a number of reasons.  

Such emails either make me feel self-conscious about the way I eat, wear, drink, etc. and/or they make pretentious others even worse as they get to sit with me at dinner and look down their nose at me and proclaim how they saw an article online the other day saying the “proper way to…” is this.  Why do I need another thing in this world to help me feel self-conscious?  We already have commercials that make me second guess the car I drive, the medications I take, or the clothes I wear.  I really do not need another person telling what I should and should not do with my sushi?  We are governed too much by trying to get things right.  We are ruled too much by fear and guilt.  Such articles just reinforce our performance-driven society. 

These types of emails and the mentality behind them also assume that there ought to be some kind of uniformity in how everything is done and that there is some kind of standard of taste that controls what is good and what is not.  Certainly, I am not suggesting a free-for-all in everything.  Of course, we want to be mindful of the feelings of others.  Certainly, we don’t want to do things that are dangerous to life and limb for us or our neighbor.  However, to suggest that there is only one way to eat a steak or one way to enjoy fruit, is to deny the variety of human taste and experience.  There is a cultural expectation that all people will conform to a particular norm.  However, that norm is set by a dominant culture that is not always mindful of others' norms and it does it often express interest in learning.  So, the pressure to conformity kills the individual spirit and nurtures the “isms” of our world (sexism, racism, ageism, etc.)  Conformity may make us feel safe in that it does not raise a question about whether what we are doing is right or not, but if there is freedom, why does it matter? 

What makes life so interesting is that there is a variety of tastes, beliefs, traditions, stories, and idiosyncrasies.   If we approach life with more curiosity than rules, we have such better conversations and deeper relationships.  To share with another about your interests or traditions while listening and exploring theirs is so much more enjoyable than judging another’s actions as wrong or bad.  Again, I make the exception for issues of criminality or abuse, but in so many things in the world there is a rich diversity that we miss if we claim a false sense of superiority and go judging others' likes and dislikes.  

I don’t like black coffee.  I am more a frou-frou coffee drinker.  I am sure there is some coffee connoisseur somewhere who would consider a latte or mocha an abomination.  Am I drinking my coffee “wrong”?  No.  No, I am not.  I am drinking it the way I like it.  If you are drinking your coffee black, are you drinking it wrong?  No.  You are drinking it the way you like it.  A friend of mine once shared that he was criticized by a neighbor not cutting his grass exactly 4 inches.  The lawnmower people might even suggest that is a good height for grass, but then why does the lawn more adjust lower than that?  Cut your grass as high or as low as you like your grass.  Don’t let someone else tell you can’t eat your steak or drink your wine the way you want.  Don’t allow yourself to feel guilty because someone else doesn’t like the way you ice a cake.  Let grace abound.  Let love rule.  Let relationships be ruled by curiosity and acceptance.  We could all use a bit richer conversation and lot judgement in our lives. 

Sunday, August 7, 2016

A Long Journey and Time to Catch My Breath

Reflections on my years at Insight Counseling Centers & 
A Time for New Beginnings

(This entry is more of a personal reflection on my professional journey.  It is longer than many things I have written.  I wanted it to be shorter, but I wanted to honor the journey that has led me to the new beginnings I have entered this month.)

In December 1993 I had finished seminary with a sense of call to pastoral care and counseling. I did  some training as a hospital chaplain.  In 1995 I started a job as an alcohol and drug counselor in high school north of Nashville.  Also in 1995 my wife and I were in marriage counseling at the Brentwood office of the Pastoral Counseling Centers of Tennessee (PCCT) (Now Insight CounselingCenters).  I was not a great client, but over the next several months, I learned a lot about myself and I learned a lot about my wife.  As a couple we made tremendous progress and I loved the patient, caring, and thoughtful way our therapist had dealt with us – or more specifically with me.  As we were moving towards terminating our therapy, I asked my therapist one day in session, “If I wanted to do what you do, how would I do it?”  

My counselor told me of his own path towards becoming a pastoral psychotherapist and told me of a training program at Pastoral Counseling Centers that I could apply to.  I met with the Executive Director and prepared my materials.  I was interviewed later by the Executive Director, Jim Coffman, and training faculty member, Dick Bruehl.  I do not remember who else was there that day, but I remember those two.  The therapist I had seen, Bruce Vaughn, Dr.Jim Coffman, Dr. Dick Bruehl, along with Dr. Evon Flesberg, Dr. TomKnowles-Bagwell and others all became part of my training.  For two years I did clinical work at the Pastoral Counseling Centers, I had lectures and supervision by the faculty at PCCT.  These people challenged me personally in ways that made me learn about myself.  They challenged me professionally to become a better therapist with the clients I encountered.  I remember when I first sat in a room with these mentors on a Friday morning for case consultation and how intimidated I was by the quality and depth of the conversations.  I was sure that they had made a huge mistake by allowing me to enter the training program, but I also was amazed by the way that the group reflected on the theological themes of the clinical material presented and how they reflected psychologically on the religious material presented.  My life experience had been that I could not separate one part of myself from another and I could not talk about anything going on with me without reflecting on what it meant for my faith and my relationship with God.  Here I heard people doing this in a professional and profound way that was both inviting and amazing to me. 

In 1999, I was hired to the full-time staff of PCCT.  I served the organization as a site Coordinator for offices in Manchester, Tullahoma, and Franklin, Tennessee.  I later served as Clinical Director.  In 2004 I earned a Master of Marriage & Family Therapy, became a Fellow in the American Association of PastoralCounselors (AAPC), and was licensed in Tennessee as Clinical Pastoral Therapist.  In 2005, after Jim Coffman left the organization and again in 2007, I served as interim Co-Executive Director and focused on the clinical and training aspects of the work while my Co-Executive Director, Chrissa Jennings Walsh, focused on Finances and Development for the organization.  We had some very difficult years from 2007 to 2012.  By the end of 2012 the organization had stabilized financially and the staff that had been there through the difficulty had become a close and supportive family.  

At the end of 2012, Chrissa Jennings left PCCT and I moved into a position of sole Executive Director.  The organization hired a new Development Director.  I took on more of the administrative and financial roles that Chrissa had filled.  Somewhere in there I managed to become a Diplomate in AAPC, but there were new challenges as the organization was ready to move from surviving to thriving.  The Board of Directors undertook a process of strategic planning and adopted a new name (Insight Counseling).  The organization became more visible through events and programs that highlighted the services during Mental Health Awareness Month in May of 2016.   However, through all of this growth, there were many personal losses for me. 

We had lost some key therapists from the staff.  We had lost some long-time board members from the board of directors.  I had cut my own counseling to a minimal caseload.  Somewhere in those years between 2013 and 2016, I began to lose a sense of myself.  I did not feel as grounded in the work as I once had.  I was dealing with challenges I had not had to deal with in past years.  I began to tell people that I felt “off balance” and “insecure in my identity.”  This feeling of unrest grew in me until events in early 2016.  

 In early 2016, I attended two ordination services at my church.  One for Brandon Owen and one for ShannonMeadors.  I was surprised to find myself tearful through both of these services as I recalled my own ordination and the work of pastoral care and counseling to which I originally felt called.  I began to feel I wanted to just return to that work.  In June of 2016, I resigned as Executive Director at was then Insight Counseling Centers and in August I began work with the group practice of Sage Hill Counseling in Nashville.  The desire to embody the work of pastoral psychotherapy that I had been trained in has become of upmost importance for me.  Working at Sage Hill as a PastoralTherapist offers me the opportunity to focus on the counseling and care work that I had originally felt called to in seminary and later refined as I sat in our marriage counseling.  I have described this to people as a desire to return to “breath”.  Just as in mindfulness practice when a person becomes distracted by thoughts or surroundings, one might instruct them to just return to their focus on their breathing.  Pastoral Care and Counseling is the core of my professional identity.  I do not know what other opportunities might arise or where the work at Sage Hill might lead, but for now, I want to rest in my ministerial identity as a provider of pastoral care and counseling and just breathe for a while.