People can gather and mobilize their own inner resources, when they have the opportunity to talk to an understanding professional who can provide them with support, acceptance, and a listening ear. An effective approach to counseling and therapy always includes this empathy and understanding, whatever theoretical approach the therapist uses. The helping relationship is the basic foundation of counseling and therapy.
How I Approach Counseling and Psychotherapy
I view psychotherapy and counseling as collaborative efforts designed to help people feel better, function more effectively, and enhance their relationships. There is no magic technique that works for all people. The helping process begins with building a comfortable working relationship and helping people to feel heard and understood, while they have the opportunity to talk things out. This may take several sessions or may happen more quickly, depending on the person’s situation and emotional state.
Once that foundation of comfort and trust has been established, the process of guiding the client toward useful insights can provide the groundwork for self-correction and goal-setting. Sometimes it is enough for a client to realize what they have been doing wrong and why, which often involves understanding how coping strategies that worked in the past are no longer effective.
Finally, change efforts may involve setting goals and plans, and working to change behaviors, interactions, and thoughts; in ways that result in improvements in feelings and relationships (as well as work or school effectiveness).
Psychological Assessment and Treatment Planning
In many cases, clinical interviews (taking from 1-3 sessions) can be the basis for setting goals and a treatment plan. Short assessments (for depression, anxiety, or other issues) may help with this assessment process. Some of these may be sent prior to the first session, using the client portal.
Occasionally, more structured psychological assessment tools may be used to help draw attention to underlying personality patterns and ways of handling life situations.This can serve as a springboard for collaborative discussions about how best to set goals and work to change these patterns. Some of the tools that I use include the Millon Clinical Multiaxial Inventory, 4th Edition (MCMI-IV) and the MMPI-2. The Adlerian Life Stye Inventory (see below) may be used alone or in conjunction with other assessments in treatment planning.
Adlerian Life Style Inventory
One tool that I have long used with individual clients (as well as couples) is the Adlerian Life Style assessment, originated by Alfred Adler himself and further formalized by other Adlerians, including Bernard Shulman and Harold Mosak at the Alfred Adler Institute in Chicago. This can be a relatively brief yet effective method for understanding your own self-defeating beliefs. When used in couples counseling, it can point to inconsistencies in family background that may have led to inconsistencies in a couple’s beliefs about family and relationships. The process usually takes from 3-4 sessions, and can be used to help arrive at goals and work on changing attitudes or behavior.
A combination of the Adlerian Life Style process and cognitive-behavioral techniques can be helpful in learning to change the “basic mistakes,” or self-defeating perceptions that we all have.
I have been trained in Eye Movement Desensitization an Reprocessing (EMDR), a technique developed by Francine Shapiro, Ph.D. a number of years ago, to treat post-traumatic stress symptoms. It can be helpful when past events seem to be “stuck” in a person’s mind and they don’t seem to be able to get past them.
Solution-Focused Therapy and Short-term Problem Resolution
Many problems in living, including relationship problems, work burnout, and life transition issues, can be helped with a combination of problem-solving and skill development. Some common skills that people work on are communication style, listening, assertiveness, time management, relaxation/meditation, values and goals work, and acceptance and mindfulness techniques.
Solution-focused therapy looks at “what’s already going right” and helps people to use more of what is already working. It encourages people to examine their assumptions about the way that things “should” be, and about how they should try to make them better. This approach also makes use of people’s ability to imagine how things would be if the problem were suddenly solved. Solution-focused therapy may be used as one form of short-term problem resolution, but it is not the only problem-solving approach that a counselor can use to help people deal with difficult situations.
Collaboration with Physicians
It is important for behavioral health providers to work collaboratively with a client’s other health care providers, including physicians. Many primary care physicians have been prescribing medications for depression, anxiety, ADHD, and other behavioral health conditions. In many cases, this works out well, and it is helpful for a therapist to get permission to communicate with the PCP to share impressions and progress. In some cases, especially where symptoms are more severe or persistent, a referral to a psychiatrist for a medication evaluation is a good idea. Coordination of care is also important in those cases.