Revamp: Uncomplicated Considerations for Therapists

Atlas Concepts LLC | Rock Hill SC | Mental Health

Regardless of your experience as a therapist, you should well know there is value in both consistency and flexibility. Like most professions, the field of counseling is ever-changing. Conversely, the acknowledgement of the impact consoling words and encouragement have on humans is well-known; a conservative historical reference dates back to at least ancient Greece. So while digital software, phone apps, advancements in neuroscience, as well as, electro this-and-that keep things fresh, it is difficult for therapists to be confident they are doing all they can to provide any given service. Arguably, there is always a better, more efficient, or more innovative way to provide therapeutic healing. On the other hand, somewhere in the middle of my degree pursuit I concluded a great counselor can perform effective therapy inside a cardboard box. While I still believe this statement (and share it with others often) I am not without understanding the weight of social constructs on myself and my clients. In that light, the following will address some of my thoughts on engaging therapy outside of the box.

Consider the wave of holistic treatment. An effort similar to self-actualization of which achievement lies in understanding of the insolubility. In our plight as helping professionals we push through the marring of our ego to eventually find we can make a difference. We discover in the moment we work with a client we are best served by leveraging the skills, tools, and environment we are allotted in that instance. Moreover, we harness the capabilities and capacities of our clients. Within ethical and legal borders, there is something to be said for simply a method or an approach that works. So while you continually hone your craft, I hope to offer a few uncomplicated considerations that may bolster your effort. At the least the following points may serve as a periodic self-check or perhaps a starting point for your next self as the therapist remodeling.

The Traditional Five Senses

You don’t have to be an ecotherapist to harness the power of the environment; however, many therapists overlook ways to integrate stimulation of all the five senses and create a healthy space.

Ever run across the term biophilia? As I understand, the term is used in reference to human connection to nature. While there is a perception the use of natural products in any environment reduces toxins, these statements may often be reduced to bold claims grounded mainly in marketing. In truth, natural toxins exist as well. The difference boils down to selecting natural non-toxic materials in lieu of manufactured off-gassing materials (Kennedy, Smith, & Wanek, 2015). What is more important are the benefits of being connected to nature such as positive emotional experiences and increases in overall well-being (Lumber, Richardson, & Sheffield, 2017). Items such as wood, silk, wool, and cotton are easily integrated. Living plants add a number of benefits and offer great metaphors related to growth and life. A low maintenance indoor planting of lavender may be a great starting place.

If you have the latitude to change the wall, ceiling or floor colors in the place you provide mental health services, do so with some level of insight on the effects of color on human emotion and cognition. A discussion with an art therapist may be worth your time. Beyond the color of the more permanent aspects of the room, colors can be integrated in several ways including pillows, rugs, therapist clothing, pictures and other decorations, etc. Keep in mind that various shades and tones may hold different meanings.

A bottle of water, healthy snacks, candies and mints are options to intrigue the sense of taste. This effort must be minded carefully as clients may be dealing with shame related to body image, have emotional eating tendencies, or allergies. Being mindful of the issues clients are facing is critical, as there is a difference in supporting a bad habit and giving a client an opportunity to choose a healthy alternative. Keep in mind organic or natural foods have sensory and emotional appeal and can create feelings of tradition, comfort and safety (Franco, Shanahan, & Fuller, 2017).

Diffusing essential oils is becoming increasingly popular in therapy and healthcare settings. The trick here is to know both what you’re buying and the impact. Quality matters as the benefit is not simply fragrance. The effects of essential oils are driven by chemical makeup and concentration (Cardia et al., 2018). A bit of knowledge goes a long way in this area; for instance, some oils which promote stress relief and relaxation also promote sleep. Unless you’re a hypnotherapist this may not be an intended result. I mentioned lavender earlier regarding live plants; lavender is also a popular essential oil. In both cases, there should be caution when using lavender as allergies and skin irritation are both possible (Cardia et al.). By many accounts, the jury is still out on the effects of essential oils as much of the information available is conflicting though the evidence is chiefly anecdotal (Franco, Shanahan, & Fuller, 2017).

I would be remiss in not mentioning lighting. Especially considering the success (however short-lived or debatable) light therapy has evidenced concerning Seasonal Affective Disorder (Moscovici, 2006). In general counseling offices, I don’t suggest anything near the 10,000-lux associated with light therapy, but there is science behind “good lighting.” It’s safe to say the age of fluorescent lighting is nearing its end in most settings. But what of the amount of light? Studies suggest dimly-lit therapy settings result in a more positive experience for clients, increasing disclosure as well as feelings of safety and comfort. While low lighting can cause your eyes to tire/strain, it’s not linked to permanent harm.

We’ve all tried those noise makers outside of our doors at one time or another. In many cases they work well. Most people will believe if they can hear someone else, they themselves can be heard and if this occurs during your session it’s a problem. Aside from keeping the session private and without distraction, there are other ways to mind the auditory sense. Have you ever asked a client if you can play a musical request? Perhaps disrupt the monotony of your voice with a relevant and insightful video. Additionally, a simple internet search can offer relaxing sounds of nature which may also be leveraged in a session. In fact, a great deal of evidence supports human preference of natural sounds such as wind and water over industrial noises and sounds related to traffic (Franco, Shanahan, & Fuller, 2017).

What about a quote of the day? These have been inspiring people for ages, but are easily overlooked by therapists as a tool in practice. Sure if a client mentions a quote or cliché they thought of during their long day at work that helped them push through, you’ll acknowledge it. But what if you put your own quote on a dry erase board or easel each day or week? The avenues this tactic opens are endless. Before you know it, you’ll have clients offer you quotes and those same clients will be validated when their quote ends up on your wall. If there’s no room for an easel, or you don’t want to tie up your only dry erase board, quotes can be printed on small slivers of paper and given to clients.

These “practice boosters” can be truly refreshing to you and your practice. Your clients recognize both your consistency and irregularity in addition to your flexibility and rigidity. Modeling is an age-old technique; however, it doesn’t have to occur in a rehearsed or traditional sense and likely works better when it’s simply a display of who you are. If you aren’t willing to change, don’t expect your clients to be.


References

Cardia, G. F. E., Silva-Filho, S. E., Silva, E. L., Uchida, N. S., Cavalcante, H. A. O., Cassarotti, L. L., … Cuman, R. K. N. (2018). Effect of Lavender (Lavandula angustifolia) Essential Oil on Acute Inflammatory Response. Evidence-Based Complementary & Alternative Medicine (ECAM), 2018, 1–10.

Franco, L. S., Shanahan, D. F., & Fuller, R. A. (2017). A Review of the Benefits of Nature Experiences: More Than Meets the Eye. International Journal of Environmental Research and Public Health, 14(8).

Kennedy, J. F., Smith, M. G., & Wanek, C. (2015). The Art of Natural Building : Design, Construction, Resources (Vol. Second editon, completely revised expanded & updated). Gabriola Island, BC: New Society Publishers.

Lumber, R., Richardson, M., & Sheffield, D. (2017). Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. Plos One, 12(5), e0177186.

Moscovici, L. (2006). Bright light therapy for seasonal affective disorder in Israel (latitude 32.6 degrees N): a single case placebo-controlled study. Acta Psychiatrica Scandinavica, 114(3), 216–218.


Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is the CEO for Atlas Concepts, LLC. Additionally, he is a Licensed Professional Counselor Associate and Certified Life Coach.

Advertisements

Caregivers, Therapists, and Race Cars

“Tires will smoke when you reach the point of volatility or vaporization of the materials in the tread compound,” says Goodyear race-tire engineer Robert Bethea (as quoted in Huffman, 2011).

I know where all the statistically genius minds went but never mind the association of standard deviation and variance with volatility.  This isn’t a composition on research and evaluation, so for the other 98% of you out there, keep reading.  This is actually your invitation to take a vacation this summer.

Why?  To avoid the smoke.  After all, one thing caregivers, therapists, and race cars have in common is the potential for burnout.

There is often a distinction made between burnout and compassion fatigue.  Burnout is recognized as being more predictable, as it occurs over time, and is less treatable.  Marked by chronic stress, irritability, low self-esteem, and exhaustion, burnout symptomatically resembles depression and anxiety.  Compassion fatigue on the other hand, can happen suddenly and is associated with a shock or stress reaction to helping or desiring to help others.  However, similarly, compassion fatigue can result in chronic physical and emotional exhaustion, depersonalization, somatic complaints, irritability and difficulty sleeping.  Both burnout and compassion fatigue occur in situations where the susceptible individual is caring for or desires to assist a person who has experienced trauma or is experiencing emotional distress.  Therapists, lawyers, and nurses are among the individuals who should be concerned with self-monitoring for burnout.

Essentially, in a mental health setting, therapists are subject to burnout if they are affected by their clients’ stories outside of work.  In order to prevent burnout, workloads must be manageable, vacations and time-off must be observed, and sleep should be monitored; journaling as well as exercise are also preventative measures.  As a medical or helping professional, it is necessary to collaborate with peers, mentors, and supervisors throughout one’s career vice simply when a problem is identified.  These long-standing relationships in themselves may very well be the best preventative measure against burnout.  Isolated environments such as private practice increase susceptibility to the aforementioned and other ethical hazards.  Simply put, notwithstanding your experience, or how well you do your job, a level of vulnerability exists.  No matter where you are in your career, it is always a great time to assess the measures you have in place to protect yourself and those you serve.  The less supervision you require, the further removed you become from your formal training, and the more isolated you are from peers—the greater the risk.

So before your office is filled with smoke and you completely breakdown all of your grey matter, take a moment to evaluate the conditions—your condition and those around you.  Be encouraged to create and sustain an atmosphere that is conducive for your work, and concerning the signs of burnout, remain vigilant.

Reference

Huffman, J. P. (2011, February) Burnouts: An Appreciation. Retrieved from http://www.caranddriver.com/features/burnouts-an-appreciation-feature


Jordache Williams

Jordache Williams is currently based in Rock Hill, SC, and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach and holds a Master’s Degree in Human Services.

 

The Improbable Therapeutic Relationship

Jordache Williams | Therapy | Fields of Knowledge

How does a therapist appear inviting, even friendly, when they don’t know who you are?  When you don’t know them?  How do they encourage you to tell them every single deep, dark secret in your life?  How can you tell them things you have never told anyone else?

MYTH: If I see a therapist, I will have to tell them things I don’t want to share with anyone.

TRUTH: Effective therapy does not always consist of digging into your past.  If this is something you are worried about, it’s simply not a valid excuse for avoiding counseling services.  However, since this is a common practice in several models of therapy, it is best to share your concerns with any potential therapist early in the process.  This allows the clinician to determine if they are skilled to work within your comfort zone.

For more myths, take a look at Margaria Tartakovsky’s Therapists Spill: 11 Myths About Therapy.

What things effect you prior to your first therapeutic encounter with a particular therapist?

Past experiences with therapy.  “I’ve tried this before and it didn’t work.”  Whether you have bad, or even good, recollections of past therapeutic encounters, these expectations may prove to be obstacles in your current effort.

Baggage being brought to therapy.  The intensity of the presenting problem(s) at the time you arrive is likely heightened.  The final straw has landed on the camel’s back, so to speak.

Starting over.  You may feel like you already know your problems and having to relay information about them requires starting back at step one.

The journey to the office.  Most people experience anxiety in some form or fashion—bad traffic, you’re running late, or the simple fact you’re missing work (i.e. “Things are going to pile up before I get back” or “I need that money”).

Paperwork.  The amount of paperwork you fill out beforehand and how much or what type of information is requested may leave an impression.

Fees.  You are anticipating paying for a service in some form or fashion, which you are not entirely sure is worth it.

So what happens when you see the therapist for the first time?

You’re looking to be wowed.  You’re evaluating the environment, the therapist’s clothes, and the way they present themselves.  You expect their presentation to be on point, and you expect to see several framed degrees perfectly positioned on the wall.  In a way, you want to feel better by simply being in their presence.

You’re looking for them to be relatable.  You make judgements based on things you perceive: race, ethnicity, mannerisms, and level of attractiveness.  You’re looking for any religious symbology in the office, a golf bag in the corner, maybe photos of their family.

Ultimately how do you know if you and a particular therapist are a match?

The therapist’s experience.  It is your right to ask the clinician if they have experience working with clients of your race, gender, and general perspective.  It’s a good idea to ask if they have experience assisting others with issues similar to yours.

Observation.  Evaluate whether the therapist appears to show genuine concern and a willingness to be present in the moment.  Understand that therapists must inform you of their experience and credentials but they are not required to pontificate.

Are they “working?”  Oftentimes, therapist don’t work by doing all of the talking.  In most settings, if therapy is going well, you are the one doing the majority of the work.  Therapist work may include: enabling you to express yourself openly, asking questions you can’t answer with one word, using words you have introduced into the session, and asking how you feel about certain things you describe.

You leave with a shopping bag.  When you walk away you may leave some things behind, but you should also exit understanding what you should be doing prior to your next appointment.  Whether or not the counselor has specifically told you to do something (i.e. homework) or you’ve gained a certain clarity, you should feel like you have work to do.

Here are a few things you may have to get over—they may not mean what you perceive them to mean.

The therapist doesn’t stand to greet you, they don’t walk you out, they don’t shake your hand or hug you, they don’t open doors for you, they sit beside you, they don’t sit beside you, they offer you drinks or snacks, they look at you over the top of their glasses, they write notes while you talk, or they type on a computer during the session or intake process.

The point is, that it’s okay to not like everything about a therapist.  While most clinicians have been trained in some form or fashion on cultural competence, you must understand that each client is different and most of the time a counselor is just being themselves.  Many times, if you ask about a particular nuance which bothers you, the clinician may be able to make accommodations for you.  If things aren’t adding up for you as the client, express yourself, and make a determination on whether you would like to continue seeking the services of that particular therapist.

The more important point is that you should not write-off the mental health industry because of one bad experience (or several for that matter).  For more information on how therapists may differ, take a look at Therapists Differ and so do Their Approaches.

Finally…

It is an expectation of therapists to establish trust.  Many do this well which creates an unrealistic view of the splendor of its accomplishment.  Factors exist outside of the control of the clinician, but others they do direct: the physical environment, the way they dress, talk, act, and present themselves, and sometimes the administrative processes.  As interaction increases, the use of “I” statements, being present in the moment, active listening, rapport building, joining, and even the manner they orchestrate therapeutic transitions can all affect trust.  It’s difficult in itself to build someone’s trust in you, because trust is a personal process—they’ve just met you.  Trust is more probable over time and through shared experiences.  If there are barriers to trust based on superficial things such as gender and race, these barriers can only be overcome through conversation—conversation which is relatable.  Finding common ground may be an effective way, in the early stages of counseling, to achieve trust.  This can be done through acknowledging similarities and the clinician proving motivational.  Establishing individualized and agreeable goals as well as serving as a beacon of hope, also assist the formation of a therapeutic alliance.  When you land across the room from a therapist for the first time, understand the number one objective may very well be the establishment of a relationship between the two of you.  Engaging this process with an open mind is one of the best things you can do to get the most from the experience.

Additional resources:

Rosen, D. C., Nakash, O., & Alegría, M. (2016). The impact of computer use on therapeutic alliance and continuance in care during the mental health intake. Psychotherapy, 53(1), 117-123. doi:10.1037/pst0000022

Smith-Hansen, L. (2016). The therapeutic alliance: From correlational studies to training models. Journal of Psychotherapy Integration, 26(3), 217-229. doi:10.1037/int0000012

Wiarda, N. R., McMinn, M. R., Peterson, M. A., & Gregor, J. A. (2014). Use of technology for note taking and therapeutic alliance. Psychotherapy, 51(3), 443-446. doi:10.1037/a0035075


Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

The Racial Identification Development Model (R/CID)

The purpose of the Racial/Cultural Identification Development model is for therapists to provide the foundation for an individual of a specific culture to positively progress toward their own cultural identity.  The desired end state being that they foster an appreciation for their own cultural lineage while developing their own personal set of beliefs and values.  Clinicians use the R/CID model to distinguish a client’s current stage of cultural identity, and then provide objectives and guidance that the client can use throughout their journey to understanding and accepting their own culture and evolving their personal identity within their culture.

The stages of the model are comprised of the conformity, dissonance, resistance and immersion, introspection, and integrative awareness stages.  The series of stages represent every possible mindset of an individual from the extreme negative to the final acceptance and appreciation of one’s culture.  In the case of African Americans, extremes of their cultural views would include either a complete disregard or shunning of their minority culture, or the opposite, in which they would display a total unacceptance of the majority (White) culture, displaying a significant level of racism toward the majority culture members.  The stages are definitive, and the ideal is for an individual to progress through them; however, it is not required that an individual be in the first stage before they can begin their advancement toward the desired end state.

Although the first stage of the R/CID is the conformity stage, it is not necessary for an individual to be present in this stage to seek and proceed with therapy.  This stage is identifiable in a person by their overt rejection of their own culture.  This occurs by the individual attempting to adopt and uplift the values of White culture, while simultaneously demeaning the value system of their cultural group.  African Americans would depict their presence in the conformity stage by their attitudes regarding themselves.

In my personal life, I have witnessed quite a few instances of this; most notably was a twenty-four year old African American friend of mine who harbored a hatred of all people and things attributed to be African American related.  He was also excessive in his acceptance of all things related to White culture.  He would only wear clothing brands typically associated with Whites, only date White or Asian females, and refused to have any African American friends; and this type of behavior is common in African Americans who are present in this stage.

As an individual, an African American would adopt White cultural aspects such as mannerisms, speech pattern, dress, and goals in an attempt to not only mimic these attributes, but also to make themselves more attractive to the members of the dominant culture.  If their individual “acceptance” is gained, then they can prove to the other members of their minority group that they are “better” than they are.  In this stage, an individual’s perceptions involving the other members of their minority group would include their overall shunning of these persons as they operate on the views of the majority culture.

African Americans, in this instance, would view themselves as the exceptions of their racial group.  To them, they supersede any African American typecasts because they hold differing views than the other group members.  For example, a college-educated, employed black male would hold himself in a higher regard than other members of his group because he is not “lazy, ignorant, unemployed and criminal.”  They would view the members of other minority groups a similar way—as if he were in the majority culture.  In the conformity stage, a minority individual would either rank other minority groups on oppression level, or view them all as equally “below” him.  For instance, an African American’s thought process may be that he is in competition with an Asian American individual to gain majority approval because, “White’s already know an Asian is smart.”  Finally, persons functioning in the conformity stage view the majority group as the ideal culture.  They hold the majority culture in a superior light, and view full acculturation to the majority group as his or her ultimate achievement.

The stage of dissonance is defined by just that, a period of time in which a previously conforming individual is now faced with a disagreement between his or her self-concept and the attitudes of his culture.  It is typical for an event to delegate one’s shift from the conforming stage to the dissonance stage, and this event usually appears in the form of overt racism or discrimination.  An African American male in a professional environment could be participating in a work-related event among White individuals he perceives to be his equal colleagues, and while at the event could be faced with a discriminatory comment (aimed at him) that could immediately begin to alter his views regarding his place in his minority culture group.

In this stage, one’s views regarding themselves would entail a great deal of questioning in reference to why they even desired to be acculturated into White culture since there are clearly aspects of it that are not as positive as they once thought.  Their attitudes towards members of their minority group will begin to take the form of acceptance, and the realization that their views are not as negative as they previously perceived.  It is likely that this individual would experience shame and regret at the thought of their repelling all of their minority group’s values, simply to adopt all White culture ideals.  Their views regarding other minority groups would shift as well, although not as significantly as it would among their own minority group; however, this individual would gain a new sense of acceptance among other minority groups.

Another significant change would be the one between the individual and how they now view the majority culture.  This adjustment would surface in the form of the depreciating value of the majority culture’s ideals.  The dissonant individual now realizes that they were never completely accepted as a member of the majority culture, and that race remains to be a contributor of discrimination, no matter how educated or accomplished the minority culture individual may be.

Resistance and Immersion is the next stage in the sequence.  While in this stage, it is noted that individuals experience a strong gravitation toward their minority culture and begin to dissolve any connection to their previously upheld views of, in this case, White culture.   The individual also dissipates any validity of the majority culture.  The person’s guilt and shame surface as they understand their role of oppressive enabler of the majority culture.  Their reflective attitude regarding their personal role encourages them to begin to seek knowledge regarding their own culture with ferocity.  And by obtaining this new knowledge base, these individuals increasingly experience a sense of pride for their own cultural group.  Their opinions regarding their same minority group shifts in the sense that they now focus on unraveling previous doubts and identifying a sense of connectedness among its members.  This begins the process of upholding their own cultural group’s values as opposed to the majority group.  Among other minority groups, individuals in the resistance and immersion stage begin to seek similarities within the other groups, typically in the form of joining together in a united front with opposition of the racism and oppression exhibited by the majority culture.  For example, African Americans may seek out likenesses between themselves and Hispanics, attempting to forge relationships based on the commonality that they have both experienced a great deal of discrimination from White America.  Their views toward the majority group change significantly in that distrust, anger, and disdain emerge as the individual reasons that the source of discrimination lies in White culture.  Henceforth, the individual vows to function in total opposition to majority culture.

The therapist attempts to guide persons in the Resistance and Immersion stage toward understanding their own functionality, emotionality, and level of differentiation.  This is achieved, in part, by the therapist aiding the individual with creating their own objectives and ideals.  Once this framework is established, one can transition into the Introspection stage.  It is during this stage that a minority individual acknowledges that the energies they have been delegating towards being angry and distrustful of the majority group are futile.  They begin to understand that these emotions are a hindrance to the efforts that could be allocated toward gaining knowledge regarding their own cultural group.  It is during this stage that individuals aspire to create their own autonomy, and are discouraged from defining themselves based specifically on a cultural group.  Their attitude toward their own cultural group changes in that they begin to understand that total immersion or resistance to a certain group may not be the appropriated route.

While gaining a more neutral position, the individual’s allegiance to his own group will begin being questioned by its members.  The introspective person will understand the importance of gaining knowledge regarding other minority groups.  It is in this stage that their focus will not be on oppressive likenesses, but instead will be on the differences.  The individual will be interested to learn more about other minority groups’ discriminatory experiences.  For the African American, the attitude toward White culture would still remain greatly underdeveloped.  In the introspective stage, the individuals are continually seeking more information to validate their acceptance of any White values.  Their disdain for White culture dissipates to form a more curious, knowledge-seeking, and general questioning of the reason for many of the ideals that White culture upholds.

In the final stage of the R/CID model the minority group individual has progressed significantly toward establishing his or her own autonomy within their cultural group, as well as in relation to the majority culture.  In this Integrative Awareness stage the individual possess the ability to identify the benefits as well as disadvantages of the ideals of the majority culture, without concentrating on solely the oppression aspect of, in this instance, White society.  They harbor no discourse with their own minority culture, nor do they hold any disconcerting feelings toward the overall values of the majority culture.  From this point forward, the individual possesses an increasingly strong feeling of empathy toward the cultural group in which they belong, as they have absorbed it’s belonging values and delineated which values they choose not to abide by, without the feeling of discouragement that they are not all-absorbed in the entirety of the culture.  Individuals in the Integrative Awareness stage tend to welcome forging relationships among other minority cultures.  Adhering to the mindset of multicultural awareness, they continue the aspiration to obtain more knowledge regarding other minority cultures as well as the oppression experienced by each group.  They have also evolved into an appreciation of the positive aspects of the majority culture, and have created an inviting attitude toward understanding and identifying with individuals in that culture.  This stage involves finding the likenesses and benefits of multiple aspects of the majority culture.

The potential implications for clinicians involved in using the Racial/Cultural Identity Development model includes the unpredictability regarding when a client is actively transitioning from one stage to the next.  In this light, it is difficult to understand or estimate when a client is emotionally and psychologically prepared to advance from one stage to the next.  This is when the importance of cultural competence and the therapist-client relationship peaks.  When the therapist is functioning at a high level of cultural competence, there is an increased likelihood that the client’s transition between stages becomes seamless.  As the therapist increases his or her own awareness they can identify the client’s culturally objective status, and then proceed to guide them throughout their next transition fluidly.

Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

 

 

Therapists Differ and so do Their Approaches

In the most basic sense, therapy is a form of treatment for disorders.  However, not every person that seeks therapy meets the full criteria for a clinical diagnosis, thus therapists are often engaging a client regarding presenting problems.  These issues may or may not lead to diagnosis, but more often than not, are affecting the individual’s overall functionality.  So, while you as a client may feel that you need therapy, understand that you may not be receiving treatment for a disorder. In many cases, at the request of the client, therapists seek to assist the client with restoring or increasing the client’s level of functionality (often recognized by the client as balance, happiness, meaning or fulfillment).  This process typically includes a clinical assessment of the client’s level of functionality, and a determination on whether or not the client’s thoughts or actions meet the criteria for diagnosis.

In order to provide therapeutic assistance, therapists use their experience and expertise, which may be derived from a variety of tools, techniques, theories and models.  Because of the vastness of the research, experiments and studies that have occurred over time, there are an abundance of valid (proven) approaches to therapy that may be chosen by a given practitioner.  While there is no identified “best” approach to therapy, the client’s situation and the therapist’s competence play a large role in determining which model the therapeutic engagement will follow.  If you are interested in seeking therapy, it may prove helpful to understand what specialties potential therapists claim, as well as what approach(es) to therapy they practice.  Below is a comparative look at a few popular therapeutic models.

Reality Group Therapy versus Structural Family Therapy

While applying the Reality Group Therapy method, the therapist focuses on the individual’s control of their behaviors.  The clinician aides the client in performing a self-evaluation in which they identify the quality of their behaviors, then determines what the contributors of their failures are.  The therapist’s role is to guide the client through the process of developing a plan of action to eliminate these behaviors, and then hold them accountable throughout the execution of the devised plan by confronting them and identifying any possible deterrents or reasons for any incapability of completing the plan.  The therapist and client work closely together to formulate the plan of action for the client to modify the behaviors causing their negative emotions in order to reach the desired outcome.  Whereas, in Structural Family Therapy, the therapist emphasizes the dysfunctions of the family as opposed to strictly the individual’s control of the issues.  Abiding by the Structural approach limits the therapist’s overall involvement as he is not used to establish intensive reparative for the family members, but to simply outline the framework, develop the foundation for reframing, and then encourage the family to continue a positive progression of growth.  The Structural therapist’s role is to be an active agent in the process of restructuring the family, emphasize clear boundaries, facilitate the unearthing of hidden family conflicts and then outline the manner in which the family can modify them.

Person-Centered Therapy versus Strategic Family Therapy

The Person-Centered therapist is one who is congruent, removing all sense of authority and de-masking of professionalism.  To be an effective Person-Centered therapist, it entails revealing personal information if it is an accelerant to the progression of therapy.  Typically therapists have the general understanding of the limitations when involving self-disclosure; however, in Person-Centered therapy the clinician is transparent.  Person-Centered therapy is client-guided as they explore their life experiences, and with the aid of the therapist, analyze their history and the result is the client resolving their own issues.  In this approach, it is vital for the therapist to exude unconditional positive regard, providing no criticism, guidance for behavior, or discouraging them from any behaviors.  In opposition, Strategic Family Theory requires the therapist to employ guidelines and directives, no matter how ambiguous.  The Strategic therapist pays extreme attention to detail and accepts only the positive, whereas the Person-Centered therapist must accept all aspects of the client—positive as well as negative.  Therapists abiding by the Strategic approach also develop a distinct outline for treatment involving defining the problem, investigating all solutions, defining clear change to achieve, and formulating strategy for change.

Rational Emotive Group Therapy versus Psychodynamic/Bowenian Family Therapy

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences.  In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally and inevitably reducing the conflict.  In a group setting, the therapist takes a lead role in attempting to change the minds of the clients.  The therapist can accomplish this without fostering a “warm” relationship with the clients.  In a group setting, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience.  Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational, and both preserving and destructive.  Therapists must promote clients to confront their behaviors as well as accept their faults.   Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructure their way of thinking.  In this light, the therapist must continue to encourage self-discipline as well as self-direction.  The primary similarity between Rational Emotive Behavior therapists and Psychodynamic therapists is that the principle focus of both is essentially for the client to reach full self-reliance, and operate at a high level of differentiation by exploring and developing their own autonomy.  The Psychodynamic therapist accomplishes this not through confrontation, but through examining the client’s family of origin, constructing and dissecting a multigenerational diagram, and guiding the client to remove emotionality from their family system and begin approaching it from an objective approach in order to identify its highest level of functionality.

Because these comparisons are very general it may prove helpful to conduct further research regarding any approaches that are of interest.  Additionally, understand that there are a multitude of other approaches to therapy as well and the best interpretation for you to have regarding any approach is the interpretation used by your therapist.  Understand that even though some therapist’s practices are based on the same principals, each therapist will inevitably approach therapy in their own manner.  This is to say that just because a certain therapy model was unsuccessful in the past with a specific therapist, you should not necessarily avoid seeking help from others utilizing a similar approach.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Therapy Models That Work

Atlas Concepts LLC_Fields of Knowledge Blog_Therapy ModelsDespite a therapists’ ability to categorize issues, disorders and presenting problems, it is largely agreeable that all clients are unique. There are a plethora of reasons why a therapist may seek to gain familiarity with a specific therapeutic approach. Sometimes that reason is based simply on the therapists’ effort to best serve a local service population.

Herein are a few examples of how various therapeutic models may be used in particular instances. If you find yourself working with clients whose presenting problems are similar to the issues described in the examples, it may be beneficial to take some time to learn a little more about the model presented in that example.

Several approaches to therapy are very broad-based and may be used in a variety of contexts. It is possible for a therapist to become comfortable in such an approach, most likely because it works. Yet it is critical to understand that it is your responsibility as a helping professional to continually educate and professionally develop yourself.

The most basic benefit of researching other approaches is to build your knowledge-base.

However, through new understandings you are actually afforded opportunities to increase your level of experience. This process enables you to become a better therapist…efficiency via competence. While you don’t necessarily need to change your “style”, a new tool or technique may come in handy. Perhaps, take a look at some of the “classics” for inspiration…

A husband and wife are unable to agree on how to discipline their two small children. The wife grew up in a family where there was violence and child abuse. The husband’s father had a very demanding job and his mother was socially engaged.

Due to the distinct family of origin issues described, Bowen Family Therapy may be a viable approach to assist this family.

Using Bowen therapy, both parents should be assessed to discern if they have a healthy level of differentiation. Because they are having difficulty disciplining their children (a process in which the children are likely involved), they may run the risk of perpetuating the lineage of negative multigenerational transmissions. The conflict between the parents in regard to disciplining the children can result in triangulation as well as cutoffs.

In addition, because there are two children involved, therapy may include dealing with sibling position; in the event that this concept is budding while the children are “small” it would be prudent to address the issue in a timely manner.

Having the parents construct a genogram of their respective family of origin may prove helpful in a reasonably short amount of time. Through assisting these clients in dealing with unresolved issues, I believe that they would also find the disciplining of their children more agreeable and, in effect, they would be empowered to control their family’s multigenerational patterns.

An 8-year old girl has been wetting her bed for the last four weeks. Her parents began to argue frequently several months ago concerning the family budget. They are both frustrated by the bed wetting and desire an immediate solution.

Behavioral Family Therapy has its origin in parent’s modification of children’s actions. Not only does it appear at a glance that the parent’s discourse is responsible for the child’s bed wetting, but it seems that they have a problem with it as well. The parents need to know that they harness the ability to foster an environment for change, and, through training and empowering the parents, the therapist can allow the parents to take credit for working together to resolve the bed wetting issue.

By simply defining the problem behavior and then explaining the behavioral patterns to the parents, both the therapist and parents can monitor that behavior and as well monitor the child’s bed wetting habit as a means of marking progress.

It is foremost irrational that the parents believe that their child’s behavior can stop immediately; however, when concentrating on the dyadic parent relationship they will find that the family in its entirety will benefit.

A 12-year-old boy began displaying temper tantrums around the time his divorced mother announced she was going to remarry. She and her new husband are having a difficult time dealing with the situation.

One may lean upon the experiences of Minuchin (Structural Therapy) to assist the family in this scenario. By observing the patterns in this family, the therapist would hope to gain knowledge of the family’s structure. As well, it may be important to determine what may be different about the family structure once the mother remarried.

It is apparent that the divorce and second marriage were stressful times for the child. The child’s outcry could be in part due to the demolition of a coalition with his father. Though the family underwent a marital (or legal) restructuring, it may be necessary to restructure the “living” system in an effort to make the family stronger.

It may be plausible to address any incumbent boundaries caused by the marital shift. Due to the new “executive” system that is in place, it is necessary to evaluate the cohesion of that system and examine any residual effects. Additionally, this parental union may have to be alerted of the signs of triangulation as well as the methods for its avoidance.

The structural approach involves the technique of reframing, which can also be useful in assisting the child with coping with his “fits”. In short, there is a basic need for this family to redefine its boundaries to deal with the relevant stage of development. If appropriately applied, the Structural Approach may prove to be of assistance to this family.

A 34-year old female physician began getting anxious in elevators about 7 months ago. She became progressively more anxious in a variety of situations. Now she cannot cross bridges or go out to crowded places.

Cognitive-Behavioral Therapy, having roots in the social learning theory, would be a solid approach to this scenario. Cognitive restructuring may be a beneficial technique to accomplish modifying the client’s behaviors.

It is plausible that the client is dealing with issues regarding her beliefs and reasoning in a fashion that has affected her behavior. Through desensitization the client may be able to overcome the unnecessary anxiety that is associated with the situations described in the vignette.

By enhancing the client’s problem-solving and behavior-change skills she may be empowered to overcome her anxiety through a self-renown confidence. Additionally, a specific technique such as shaping could be employed, as it appears that the client has reached an extreme level of anxiety. It may require the client to take gradual steps towards such goals as crossing bridges and going into crowded places before she can achieve these feats.

A 43-year old male, recently unhappy with his career, sees himself as a failure and has begun to isolate himself because of a lack of confidence.

In dealing with this man’s career issue, one may employ the Strategic approach. In the vignette there is a clear problem that needs to be resolved or removed. It is beneficial to begin by defining the problem and then moving towards evaluating what the client has done to fix the issue.

By defining the necessary change and implementing a strategy for achieving that change, the client could be propelled to a more virtuous cycle. Additionally, the client could benefit from the reframing techniques practiced in Strategic Therapy.

By emphasizing positives and assisting the client through encouragement and direction, he may also begin to see his career in a different light. It seems the issue is rooted in his malcontent with his employment. In this instance I believe the lack of confidence may be a residual effect of his job situation. However, through combating his isolation through actions, he may be able to perpetuate his own confidence and gain a new awareness of his ability to acquire a job that may be more conducive to his happiness.

Another way the Strategic Approach may prove helpful is by utilizing the ordeals technique; in this instance the client may discard his isolated ways as he realizes that this behavior is not constructive.

A 24-year old male who is high functioning with no obvious diagnosis is confused about his goals in life.

Due to the over-functioning nature of the male depicted in the vignette, I believe that Experiential Therapy may be of most benefit, especially considering that there is no “obvious diagnosis”.

The Experiential approach is helpful because it relies on the personality of the therapist more so than that of the client. In this case, there is not much known about the client thus, the Experiential approach allows for the therapist to guide the therapeutic environment in an effort to learn more about the client. One manner in which the therapist can begin to assess the client is by evaluating the client’s level of individuality. An Experiential therapist can achieve this by fostering a warm climate in which the client feels respected and accepted.

As well, it is important for the client and therapist to work towards determining the nature of the client’s confusion (i.e. what about his life goals is confusing). The therapist has the ability to help the client see his confusion as meaningful. The client should be led to understand that it is productive to have goals and that his confusion pertaining them may only be a result of his personal growth.

By utilizing alternatives to reality, the therapist can allow the client to assess whether or not his goals are feasible, thus eliminating goals that are too vague or nested in improper judgments. The more excitement the therapist shows for the client’s progress, the greater stimulation the client is likely to experience, in turn providing the client opportunity for personal existential encounters.

While I may not be able to teach you more than you already know about these approaches, my effort is simply to remind you of the validity and importance thereof. If graduate school is the last time you encountered one of these models, consider this written for you.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Finding a Good Therapist

Fields of Knowledge_Choose a Therapist

Though they have dissipated in the last decade to a degree, there are still stigmas regarding the world of mental health. Of those exists the thoughts that therapy is for “crazy people”, “individuals who need medication” or “those who have way too much to say and no one else to talk to”. The reality is that therapy may or may not be for any of those individuals and likewise may be effective for those who are often considered normally (mentally) healthy. Growing up in South Carolina I am very familiar with the phrase, “if it ain’t broke, don’t fix it”. While this maxim has proven very true in many instances, there are times when it doesn’t necessarily apply. I believe therapy to be included in this list.

Let’s switch gears for a moment and think about a scenario involving an automobile mechanic (pardon the pun). You speak to a mechanic over the phone and discuss with him the fact that your headlights do not work. The mechanic schedules you an appointment. When your car is returned to you, you are told that the issue with the lights has been repaired, so you render thanks (i.e. $). Before you leave you ask the mechanic what the issue was and he tells you that the problem was corrosion in your car’s fuse box.

Hold on a minute…you came for your headlights and he spent the last hour working on your fuse box? The point here is that while there are common issues that arise with individuals and families, those “in the mix” may not clearly understand the root of those problems. The mechanic could have changed the light bulbs, installed new wires and even changed your tires, but until he fixed the actual problem with the fuse box, the headlights would have never operated properly.

Yes, as a client, therapy at times may seem like a process that involves “going around your hip to get to your elbow.” So how do you find a therapist? In all actuality, many people go about it very similarly to how they arrive at finding “their” mechanic. People often consider items like location, reputation and cost(s). And while this process is understandable, it may not be inclusive. All therapists are not created equal.

The mechanic analogy is a great one, because it applies in so many ways. Another example is that many auto mechanics have specialties, whether it’s a specific make of vehicle, a specific component, etc. This holds true for therapy as well, though there are some “jack of all trades” out there, therapists may be better suited to work with clients with certain concerns or issues. When seeking a therapist, I encourage you to conduct some amount of research pertaining to the specialties of the practitioner. This may include contacting them directly.

Some therapists have the ability to utilize objectivity and empathy with a nearly artful balance, allowing “hard truths” to descend at the rate of the feather on Forest Gump (1994). Therapists can be practical, eccentric, rigid, playful, exotic…you name it. A therapist’s “style” is typically a mixture of their personality and the model(s) of therapy they practice. As a client, it is critical that you are comfortable with your therapist but you must understand that while personable may be comfortable, it does not necessarily mean therapeutic.

Let’s face it, a person seeking therapy is looking for something which they perceive they cannot offer themselves. The client’s goal going into therapy is, to at the end of the session or through the course of therapy, feel better…BE better. Unfortunately, the best understanding a client will get of what a particular therapist can offer is to participate in the process. This means paying for something that may or may not work. Here are a few tips for narrowing your options through conducting research, telephonic inquiries or attending a consultation.

  1. Trained – Often you can learn a great deal about a therapist’s level of training from the internet. Company websites, business review pages, LinkedIn and other social media sites may offer insight into the level and type of training a therapist has attended. Consider the scholastic reputation of institutions of which the therapist is affiliated. Programs which are evaluated and accredited by notable organizations and entities may elude to the quality of the educational and training experiences thereof. In general, therapists are required to participate in continued education annually in order to maintain licensure. Because these educational experiences are chosen by the therapist, such experiences can reveal some of the therapist’s recent interests and/or concerns.

 

  1. Experienced – Not to be confused with how long a therapist has been in the profession. Time and experience can often be uncorrelated concepts. To determine the type of experience a therapist has consider what they claim as “specialties”. Experience in itself does not make a therapist suited for all clients; however, it may allude to a level of comfort and proficiency with their work, an ability to adapt and generally represent their “brand”. Therapists are as diverse as their experiences, a key to aligning yourself with an appropriate therapist is to discover their success with issues similar to your own. Experience is a progressive step from the training environment which leads to the next topic…

 

  1. Competent – Very easy to agree with but possibly not as easy to identify as one would imagine. Competence can initially be masked by accolades, fast talk and promises of success. While a clean and inviting office environment, polite administrative staff, short wait times and a nice business suit may allude to a professional environment, these may not necessarily be clues of therapeutic competence. Competence speaks directly to the therapist ability to use therapeutic intervention to assist a client with attaining goals. Testimonials and reputation are great gauges of competence.

 

  1. Culturally appropriate – While it is incumbent for therapists to be attentive to ethnic and multicultural diversity, the truth is that some therapists are more suited for a specific gender, race or ethnic group. This is not to say that you should strive to find a therapist who is similar to you because that is not necessarily the best fit based simply on racial identity. There are indeed individuals who are not “of” the group of which they work with best. Go beyond the surface when looking for a therapist, the best therapist for you may not look like you and may not be located on a side of town you frequent.

 

  1. Ethical – There is no greater must in therapy. The ethical considerations of the therapist should be outlined and discussed as a part of an informed consent process which precedes therapy. Though your personal ideals may not be directly aligned with those of the therapist, it is the therapist’s responsibility to conduct therapy in a manner that is not offensive or harmful to you (the client). The counseling professional you choose will likely be affiliated with a licensing body based on the credentials they hold. These licensing and professional organizations set the minimal standards for ethical conduct. Find more on ethics from the American Psychological Association, the American Counseling Association and the American Association of Marriage and Family Therapy.

 

  1. Credentialed – Often mistakenly equated with competence, in actuality, credentials more closely relate to training. I am adding a note regarding credentials because the list of acronyms associated with many of these professionals can be confusing. The truth is that the credentials of a therapist are more relevant to other counseling professionals than they should be to clients. These credentials essentially align counselors with specific governing agencies and/or organizations. As a client, you are protected by the organizations with which licensed and credentialed therapists are affiliated. Don’t be confused by credentials, or get bogged down trying to sort them all out. For clients, the most relevancy of a therapist’s credentials may be the limitations regarding insurance coverage or reimbursement. Additionally, clients should understand that they may contact relevant credentialing bodies to report unethical conduct of a therapist.

Atlas Concepts, LLC_Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Therapist Self-disclosure

The matter of self-disclosure in the professional therapeutic setting is one that can be daunting to understand.  Foremost, disclosure in therapy is most identified as originating from the client.  Many of us picture a somewhat small, dimly lit office where the client is lying down with their eyes closed telling their personal secrets.  In many instances, however, this is not so.

Therapy has become so diverse that a generalization such as this can be very far from the reality a client faces when they enter the therapeutic setting.  So aside from not really knowing what to expect regarding the physical environment, clients are also leery about the process of therapy.

It is helpful for clients to understand that therapists have also undergone similar thought processes, such as the internal debate regarding how much of themselves they are to share.

Therapists teeter between disclosing too much and not enough about themselves to clients.  As a therapist, where do you draw the line? As a client, what are your expectations?

In general, self-disclosure should be used at the discretion of therapists with the intention of promoting wellness while avoiding harm at all costs (i.e. primum non nocere).  Self-disclosure is a natural (or promoted…or even integral) part of several models of individual and group therapy, thus for therapists practicing such models it is necessary in many cases.

Other models of therapy do not require therapist’s self-disclosure, and may even work more effectively if such disclosure is avoided.  So for therapists, the answer is to understand your model, and work within that frame…be comfortable and be authentic.

Hint: As a client, if you have the opportunity to research and select a therapist, you should consider what you perceive to be your presenting problem and evaluate the approaches of the potential therapists.

Not all therapists are created equally and some therapeutic models have been evidenced to work well with specific issues.  You also want to consider qualifications, credentials and reputation, but this will be covered more extensively in another blog.

As a client, you should expect therapists to be forthcoming with their particular intentions regarding the progression of the therapeutic experience, which may or may not include their intentions regarding self-disclosure.  At any case, therapists’ disclosure should be in keeping with the intent of the therapeutic experience as outlined during the process of informed consent.

The process of therapist self-disclosure is unique to each therapist, and clients who may have had previous experiences must understand that their own expectations can make their experience more or less productive.  If, as a client, you were forced to change therapists (e.g. because you relocated), you may be jaded.  If you discontinued seeing a therapist in search of a better experience, you may be disheartened by having to start over again (i.e. the administrative processes and the initial “introduction” sessions).

If you are completely new to therapy then your understanding of the uniqueness of therapists will prove helpful.  You are making an important decision in your life, and, in that regard, being informed is a process which you can directly influence…being informed is also something you should expect during the course of therapy.

In other words, be informed going in and be even more informed coming out.

Atlas Concepts, LLC_Jordache Williams

 

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  He is a Certified Life Coach, holds a Master’s Degree in Human Services, and is an aspiring therapist.