How Do I Know If I Need Therapy?

How Do I Know If I Need Therapy?

“So about how long should it take until I feel better?” “How long do you think I’ll need therapy?” “How many sessions should I expect to attend before my problem is solved?” I have asked all of these questions during time spent on the other side of the couch. I know what it’s like to want concrete answers and expectations met. Everyone wants a sure thing in the face of so much uncertainty.

Therapy is not exactly a sure thing. Surely, it can and does help, but it’s not as simple as basic input of time and results yielded. Results depend on client honesty (with themselves and the therapist), right fit with a therapist, client’s commitment to the work both in and out of the therapy office, and right fit with whatever therapeutic modality is used.

Therapy is almost never a quick fix, but there are quicker-fix type/brief therapeutic modalities available. Whether or not these protocols are right for someone depends on a lot- personality, history, diagnosis, whether or not a person has experienced complex trauma. Even in the best of scenarios, it still requires the practice of skills through time to maintain results.

Under the psychotherapy umbrella, there are five really (really) broad categories we use to organize treatment strategies:

Psychoanalysis and Psychodynamic Therapy:

Makes the unconscious conscious, insight oriented. Emphasis on client-therapist relationship. Brief therapy model (20 session maximum) is not the rule, but is available for single-incident trauma like an attack, rape, catastrophic event, targeting a single life shift.

Examples of Psychodynamic Therapy: Jungian, Dream Work, Attachment-based

Often used for: Increasing self-compassion, improving self-concept, self-actualization, mood disorders, relational problems, trauma, developing insight to identify and manage internal conflict, shifting external locus of control to internal locus of control, couples, families,

*Psychoanalysis: Multiple times per week. The therapist is a blank slate onto which client projects their beliefs and experiences. Relies heavily on free association.

 

Behavior Therapy:

Focuses on conditioning new behavior. Uses brief therapy model.

Examples: Applied Behavioral Analysis, Aversion Therapy, System Desensitization

Often used for: Phobias, Addiction, Anger issues, Impulse control problems, self-injury

 

Cognitive Therapy:

Focuses on changing thought pattern. Uses brief therapy model.

Examples: Rational Emotive Behavioral Therapy, Cognitive Behavioral Therapy

Often used for: Phobias, Addiction, Schizophrenia, Bipolar Disorder, Suicidal ideation, Anxiety disorders

 

Humanistic Therapy:

Focuses on cultivating personal accountability and reaching highest potential. Emphasis on free will. Uses both brief and long-term therapy models.  

Examples: Gestalt, Client-Centered, Transpersonal, Solution-Focused, Adlerian  

Often used for: Improving self-concept, self-actualization, improving communication with others, cultivating self-awareness, shifting external locus of control to internal locus of control, couples, families, existential crises  

 

Integrative or Holistic Therapy:

Often referred to as “Eclectic Therapy.” (Some practitioners will basically fight to the death in disagreement over whether or not Integrative is also Eclectic.) Uses various modalities depending on what is indicated for each client. One therapeutic modality combines various features of the previous four categories. Uses both brief and long-term therapy models.  

Examples: EMDR, Narrative, Cognitive Behavioral, Dialectical Behavior, Internal Family Systems, Gottman Method, Transactional Analysis

Often used for: All of the above

 

Some people prefer to see the same therapist for various issues they’d like to target while others seek out a different specialist to treat each issue. There’s no right way to do this, just whatever feels like it’s working for the client. Some clients come with an agenda and leave when their goals have been reached. Some stay for a while after because they like having a professional to talk to who’s all about them. Plenty of people try therapy and find it difficult to give themselves over to the process, take a more passive route to treatment, get frustrated and give up. Sometimes this is because traditional psychotherapy is not a good fit for them right now, maybe ever. There are so many other great therapeutic options. Traditional psychotherapy is not the only way to heal or feel better.

 

I know it’s overwhelming to look for a therapist and decide which kind of therapy would be best for you, especially when you’ve been dealing with a problem for years, and you’ve finally decided to take the plunge and ask for help.

 

If you describe the issue and a little bit about yourself, many of us will be able to direct you in the right direction. There are plenty of therapists who won’t do this because they are sure that they can handle it regardless of their training and orientation. While I would like to believe that this is mostly the exception rather than the rule, it happens. If you feel too overwhelmed or busy or exhausted to educate yourself on various therapeutic tools and modalities, remember that you can interview multiple therapists at a time to see who feels like the best fit for you. (You can also do this regardless of your stamina to self-educate.) Once you start seeing a therapist, you can audition us. If you’re not feelin’ it for some reason, you can switch. It’s ok not to like your therapist or to like them, but feel like they’re not actually helping you. Therapy is an investment, and you have the right to switch providers at any time for any reason. If you’re feeling like you need to discontinue treatment, I usually recommend addressing this with the therapist; sometimes it just takes a little direct communication to shift things. Even if you don’t plan on continuing your work with the therapist, honest feedback is good for both sides.

 

If you’d like to talk more about this, please email me or call and I would be happy to answer any questions. This is one of my favorite subjects!

 

Love and Be Loved,
Natalie

If You Want to Be Heard, Start Listening

If You Want to Be Heard, Start Listening

A lot of couples seek therapy looking for help with their communication. They want to feel seen, heard, and understood. Pretty much all of us want to feel this.

 

Often, what ends up happening is a lot of talking and explaining and scrambling but not a lot of listening. We want to be heard before we hear. We want to be seen before we see. It becomes a rigid bartering system with the understanding that “If you listen to me and understand what I’m saying, I’ll listen to you and try to understand what you’re saying.”

 

And it’s understandable. When an intimate relationship is fraught with miscommunication and misunderstanding, there are wounds. There is pain. Most of us don’t know how to navigate our pain and the pain we’ve caused our loved ones. We are defensive when confronted and quick to point out what the other has done to hurt us. It’s hard to forge ahead together with this strategy.

 

If we’re unsure of how to navigate our hurt, we usually use anger as a secondary emotion. During an intense discussion or argument, we become angry enough that we forget we love the other person. Our stance becomes adversarial, and in a minute we say something deliberately hurtful. This kind of defense amplifies our communication problem and is a devastating hit to emotional intimacy.

 

In the heat of the moment, it’s hard to slow down. It goes against everything our nervous systems are telling us to try hear and see the other person’s experience. But if we want to deepen and maintain our bonds, we have to learn how.

 

When we’ve experienced trauma, hearing and seeing while regulating our emotions is especially hard. Fatigue, hunger, and loneliness also stack the odds against us.  There are a million reasons that contribute to the challenge of hearing and seeing. And there is one big reason to keep trying- increased peace and understanding within ourselves and our relationships.

 

To be proficient in inquiry of others’ experience, it’s helpful to start to with ourselves. It’s also helpful to start by being pretty basic about it. Initially, try it when you’re feeling relatively calm. Pause and see what you notice. What’s happening? What do you hear? What do you smell? What do you notice in your body? Then, try it when you’re feeling slightly irritated. The more you practice it (or anything), the more available it will be to you when you need it. Eventually, you’ll try this when you are really struggling whether on your own or in relationship. If you’d like to talk more about this or have any questions, feel free to reach out.

 

Love and Be Loved,
Natalie

There Is No Way to Avoid Pain

There Is No Way to Avoid Pain

There is no way to avoid pain. The human brain has evolved to avoid pain, but there is no way to avoid it. So we find ourselves in a bind.

 

We make concerted efforts to protect ourselves from pain. We try to minimize it or hide from it, trade one type of pain for another. We try to protect loved ones from their pain. And mostly it comes from a loving place. But when we try to protect ourselves and others from something so inevitable as pain we are doing a disservice.

 

We are reinforcing the belief that pain is something to fear, that we cannot handle it, that we should go to any length not to experience it. So we don’t take risks. We numb. We deny ourselves. We micromanage. We hide. We lie to ourselves. We stay in relationships that don’t feed us. We stay at jobs that don’t serve us. We silence our voices. We don’t get off the couch. We make excuses, and we rationalize. We do not live fully.

 

The worst thing about pain isn’t that it hurts or that it’s scary; it isn’t even pain itself. The worst thing about pain is our fear of it. We’ll do anything to put a wide berth between us and pain.

 

But what would it be like if instead of avoiding it, we learned how to interpret pain? What if we learned how to understand what it is telling us and how to manage it, how to soothe ourselves?

 

Because sometimes it’s telling us to move away from something. Sometimes it’s telling us to slow down or rest. Sometimes it’s telling us to move toward or into something. And sometimes it’s telling us that we’re on the right track.

 

How can we hear the messages that only pain can communicate and learn from this teacher if we don’t attune to it?

 

When we are willing to listen to our pain’s message, we find our limits and our limitlessness. We explore unseen capabilities and gifts. We become less afraid to live our lives. We experience intimacy. We trust ourselves. We stop asking for permission and start living in our authentic space. We stop people-pleasing. We explore what it means to be groundless. We explore what it means to live as embodied consciousness.

 

Love and Be Loved,
Natalie

Black Lives Matter

Black Lives Matter

As a practitioner in the helping profession, it is my job to help people thrive. None of us can truly thrive if groups of us are being singled out, mistreated, attacked, harmed, and killed. The Black members of our communities continue to experience this.

 

It is my responsibility as a member of this community, health practitioner, and white-presenting person to use every platform I have to address issues of injustice and inequity in my community to communicate that this community cares about what happens to you and we will fight alongside you for your rights and your lives. Racism oppresses, harms, and kills.

 

Yes, all lives matter, but here in the United States, Black lives specifically are historically and consistently undervalued. It does not devalue anyone’s life to say that Black lives matter. If it offends you or is uncomfortable for you to hear the phrase, “Black lives matter,” consider the reasons why a group of people in our community feels like they need this movement. Consider why this movement is criminalized. What must their experience be like if they are so vocal about this movement? One group is saying, “All lives matter,” while another group is saying “Stop abusing and killing us.”

 

White people are often afraid to talk about racism. Many of us feel uncomfortable around it and silence ourselves. Our silence is unacceptable and is a very real, harmful symbol of our agreement that some lives are more important than others. It is a clear sign of our privilege that we are afraid to have uncomfortable conversations about race while Black people are afraid for their lives. As people who hold privilege, it is our responsibility to talk openly about racism and how we can work to eradicate it. It is our responsibility to keep learning and unlearning, growing and changing, and to be better for our community members who deserve our respect, our voices, and our solidarity.

Know Your Demons

Know Your Demons

Have you ever watched a thriller about demon possession? Kind of off my usual beaten path, I know, but you’ll see where I’m going with this. I promise. Anyway, I like them sometimes. Every so often, I’ll check around for a good one to watch and see what piques my interest. I’ve found that sometimes I’m drawn to thrillers that make demonic possession of someone their central plot. (Which is surprising to me because I’m not usually interested in seeking out super dark stories about evil, especially when there’s more than enough of it to be found in the news). About once every three or four years, one of these dark plotlines pulls me in and I find myself watching an unsuspecting upstander begin the struggle of (and for) their life.

 

When I find a good possession thriller, I like almost everything about it. I like the journey the character takes from being ok (or pretty ok) to decompensating to being pretty possessed most of the time to being fully possessed all the time to finding progressive healing to being stronger and more conscious than when their story started. I like the tension over “will this character we’ve all come to love make it through this?” I like the research and deep inquiry that the other characters employ in an effort to find out more about the demon that is in possession of the victim.

 

What I am particularly drawn to, what I appreciate most is that there’s always ample time given to the journey taken by the characters in finding out the particular nature of the demon and its name. When the demon is called by name, its possession breaks. The demon always gives clues as to who they are, but they’re usually abstract and steeped in about a million layers of epic composition of poetry and require a doctorate in theology. At some point, to the rest of us, it pretty much seems like a lost cause. Just in the nick of time, someone puts all of the pieces together and discovers the name of the demon. Then we feel that surge of renewed hope.

 

What I’ve noticed is that, in all of the stories that I find most gripping, there are at least five commonalities:

 

  • There is a specific name of the demon, which when finally discovered and uttered face-to-face to the demon is the only defense against it.

 

  • The possessed or loved ones of the possessed enlist help.

 

  • The demon seems to have limitless ways of manifesting itself.

 

  • Someone, whether the possessed or loved ones of the possessed, experiences self-doubt, retreats, somehow finds the motivation to throw themselves into the metaphorical fire of terror and uncertainty, and contacts the demon for a head-on battle.

 

  • The demon never really goes away. It’s still there lurking around, but now the characters have more strength, courage, willingness, and awareness to deal with it.

 

I appreciate the symbolism because darned if that just isn’t that just how life is.

 

Whether it’s depression or anxiety or addiction or a particular pattern of behavior or thought pattern or chronic pain or the fear of fear or general dispiritedness, we all go through periods of life when we feel utterly possessed by pain and completely out of control. And many of us have found release through inquiry about the name of our experience or feeling and asking for help from loved ones, peer groups, and professionals.

 

Many of us have realized that our demons never completely go away, but that our relationship with them changes, and that with each bout with and experience of those demons, we learn to sit with whatever they bring. Through this long, uncomfortable process, we’re learning that our demons have many, many ways of manifesting themselves in our lives. We’re learning to coexist in a world where demons can’t be extinguished but instead faced with self-compassion, willingness, and courage. We’re learning to stop believing the bullshit they spew in an attempt to maintain their control over us. We’re becoming more connected with ourselves and with others, with life.

 

Keep on keepin’ on.

 

Love and Be Loved,

Natalie

There is Enough.

There is Enough.

Experiencing deprivation is painful. Whether we’ve experienced deprivation in a neglectful or abusive relationship, financially, or otherwise; the lived experience of “not enough” hurts. Even when we are no longer in that same situation where we experienced the deprivation we often find ourselves in the same mindset. We can be in a totally lucrative career, making plenty of money or in a healthy, stable relationship with plenty of love and affection and still feel like there’s “not enough.”

And that scarcity mindset is a harsh landscape. It prevents us from allowing ourselves to really enjoy what we have and keeps us stuck in fear of losing it. We want to feel gratitude and excitement for how far we’ve come and where we’re at now, but we won’t allow ourselves to experience it for fear of jinxing the whole thing.

I find that, for myself, whenever I’m coming from a scarcity mindset it feels so much more dangerous to take a risk, put myself out there and get what I want. I think to myself, “Don’t rock the boat, man. You’re lucky to have what you have.” It feels safer to hold back.

It can almost feel like we’re getting away with something when we find ourselves in a good place. Any second it could all come crashing down, and we’ll lose it only this time we’ll end up worse off because we know how much better life can be. We end up holding ourselves back. Some of us protested against the deprivation we experienced in the past and got burned. The person we wanted more from rejected or abandoned us. The boss we confronted fired us. It taught us that it really is too risky to rock the boat, that we should just shut up and take what we’re offered if we know what’s good for us. So we stay stuck. It makes us more fearful and resentful. Years pass and it feels like life is just happening to us.

Often, I post about a subject and then write about some helpful tips to try. I won’t do that this time. For some reason, it seems like it would be somehow misleading. There’s no quick fix for overcoming a scarcity mindset. (I mean, there’s no quick fix for anything.) It’s a process of very deliberate practice. Some might find strength in cultivating a mindfulness practice. Others will find it in a therapeutic relationship. Some might find it using a combination of tools.

I will encourage you to try this, though. See what it’s like to notice whatever it is you’re afraid of losing. Notice how much you like having it in your life, what it does for you, how it nurtures you. Whenever the panic shows up and tells you that these are the exact reasons you’re afraid of losing this aspect of your life, acknowledge it with compassion. Remind yourself again how grateful you are to have whatever it is at the focus if this exercise.

I’ll be honest. It will be hard at first, and you’ll freak out about losing whatever it is you’re afraid of losing. You’ll probably feel anxious and irritated. When I first started, I would think, “Whatever. This is stupid.” Sometimes I’d cry, filled with anxiety about losing what I loved. It’s fine. There is no right way. You’re only job is to notice that part of yourself with compassion and remind yourself of your gratitude. Maybe you’ll only feel like you can do it for a few seconds. That’s enough. Maybe you’ll be able to do it for a minute and a half. That’s enough, too. It’s enough because there is enough.

 

Love and Be Loved,
Natalie

Fear, Depression, and Hope

Fear, Depression, and Hope

Most of the time you are not consciously thinking about what is at the core of what scares you.  You might not know what’s at the core. Maybe you don’t spend a lot of time thinking about the impact of being afraid, the impact of fear on your wellbeing. Whether or not you have given it a lot of thought, for some, fear can seem as though it has infinite power. It can feel paralyzing, isolating, and uncontrollable.

It can feel as though there is an endless supply of fear, that it can be turned in any direction- fear of the unknown, fear of rejection, fear of being alone, fear of failure, fear of economic instability, fear of “being found out.” Most of the time you want to feel good. (Who doesn’t?) To do that you probably tend to act in a way that you believe will allow you to avoid pain.  You try to predict what will cause you pain by using experience from the past and making assumptions about the future. Fear can be pretty motivating.

It’s possible to go to incredible lengths to avoid or control fear- intense preoccupation with details, intense preoccupation with outer appearance, addiction, aggression, are a few examples.

When there is so much fear telling you what you need to avoid to feel ok, it doesn’t leave much time to sit productively with what is happening in the present. You probably find that you enjoy your relationships, jobs, families, and hobbies much less. You are not as productive when you are distracted by fear, however; if you use your productivity to defend against fear, you might find that you get a lot done, but still feel incredibly anxious.

At some point, there is a circumstance that encourages you to stop avoiding whatever it is you fear. Perhaps you make a conscious choice to face it because you have renewed resolve. Maybe you find yourself in the dreaded situation and begin to see that you are already getting through it and that it has not overtaken you. Or maybe you have decided that so much avoidance is exhausting so you begin to take slow, small steps toward a courageous shift.

Fear is a pretty compelling emotion. It’s why some of you stay in relationships or jobs long after you want to be there. It’s why some of you suffer from addiction. It can drive you to lead completely inauthentic lives by denying who you are and what you want, and you begin to live for someone else, what that person wants, who that person wants you to be. This can cause depression and anxiety which feeds addictive behavior; it can be tough to extricate yourself from this cycle.

That small step toward a courageous shift I was talking about earlier is essential for getting yourself out of this pattern. On another hand, when you are in this cycle, it can be hard to see that you have any choices. Maybe you feel like you don’t have any choices at all. That’s a normal feeling. When you have been experiencing the same behavioral and emotional cycle for a length of time, it can be difficult to remember a time when things were different. Maybe things weren’t ever different, and your hope for change is slim. But if you’re here, you have found some amount of hope somewhere within you. Together we can increase that hope.

 

Love and Be Loved,
Natalie