Category Archives: treatment theory

Defining Success

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I used to work in a university Career Services center. There, I learned that one of the toughest job interview questions was, “How do you define success?” It’s time I answer that question myself.

From my experience, productive counseling meetings incorporate three main therapeutic skills:

  • I provide concentrated attention: capacity to listen, presence, and track the main points from our prior conversations
  • I help someone expand their story: exposing & exploring additional layers
  • I offer concrete options, alternative actions, and resources

Healing Body Memory of Trauma

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I took a recent training with Yudit Maros called “Brief, Solution-Oriented Trauma Resolution.” This training specifically focused on troubling sensations in the body that may periodically resurface after the trauma. The BSOTR protocol helps a client attend to and correct the aftershock disturbances in the nervous system and one’s negative self-identity. Here are the most basic steps:

First, the therapist helps the client identify and practice a resource state called grounding. I can guide you through a visualization exercise that depersonalizes the pain and provides more comforting imagery, which tends to regulate the nervous system. We identify and develop comfortable imagery that helps you reset. Then, I ask you to scan your life history for anything that feels pleasurable and safe. We detail key components of the experience and you practice re-experiencing the positive experience and people. Later, we scan your life history again for an unpleasant or traumatic experience. I interview about what you would have preferred to experience. Then, I facilitate your current, grounded self attending to and taking care of your younger, distressed self through a series of self-care invitations, visualizations, and self-dialogue. When it appears that you have been a loving guide to your younger self and you have nothing left unattended about the chosen difficult experience, I invite you back to the here and now of the therapy room.

If you are interested in experiencing this BSOTR process or have any questions, please let me know.

Shame Shields

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I took a webinar with Brene Brown called Shame Shields. Dr. Brown is mostly known for her research on shame, worthiness, and healthy vulnerability. Her research reveals these core tenants about shame:

  • We all have it
  • No one wants to talk about it
  • The less you talk about it, the more you have it
Shame and addiction are interlinked. Addictive behaviors are an attempt to numb, or shield the shame. However, their effectiveness is short-lived and the shame resumes.
Dr. Brown, and separately–researchers at Wellesley College Stone Center–discovered there main subtypes of these shame shields:
  • Moving away — Avoiding, leaving the room, spacing out, daydreaming, distraction
  • Moving towards — Hyper-appeasing, over-flattery, buttering up, sucking up
  • Moving against — Attacking other people, inducing shame in other people
All three shields are an attempt to deflect shame away from the person. Here’s Dr. Brown’s recommended alternatives for shame resilience:
     1) Recognize triggers
     2) Reality check messages
     3) Reach out
     4) Speaking shame
I know these four prescriptions are easier said than done so I am happy to help be a part of the process.

Science of Trust

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I took a webinar with John Gottman of the Gottman Institute called “The Science of Trust.” Perhaps Gottman is most famous for his “four horsemen of the apocalypse” theory–that contempt, stonewalling, criticism, and defensiveness poison intimate relationships–and that the long-term success of a partnership can be calculated according to the frequency of these problematic dynamics. This particular webinar about trust explored active, healthy alternatives to repair interpersonal wounds.

Essentially, cognitively-based repairs (appeals to reason, logic, and problem-solving) aren’t as effective within intimate relationships as emotionally-based repairs. For example, empathy, self-disclosure, and investing extra attention/participation into the partnership all work at the emotional level. Emotional interventions help relax someone in distress, thereby encouraging them to make any decisions outside of duress. Within an intimate relationship, logic and “fixing” other’s problems can be experienced as dismissive, shallow, or intrusive.

Many people are not taught intimacy skills–it’s not a formal study in primary school. Some of us learn from family and community role models–other people don’t have this access or experience.

After an interpersonal or developmental trauma, a person is likely to experience hypervigilance–fight/flight responses–and/or avoidance–flight/freeze responses, even within more moderate conflicts. Effective conflict resolution within a healthy relationship requires active participation, deliberation, and transparency from all involved parties. Often, a partner can facilitate a step down the scale of hypervigilance. Gottman and others use the acronym ATTUNE to describe this stance in more detail: awareness, turning towards, tolerance, understanding, non-defensive responding, and empathy. For a great video on empathy, click here: Brene Brown on Empathy.

Does this mean everything has to be hearts, puppies, and sunshine? NO! If people interrupt their conflict or trauma processing, something like the Zeigarnik Effect is likely to happen–people will remember (often at inopportune times) experiences they haven’t ATTUNED to in a healthy relationship. If we haven’t ATTUNED to a partner’s distress, we are most likely telling a negative fictional story about our partner’s abilities.

People who avoid relational conflict have a tendency toward infidelity and and other betrayals, which likely create more (internal) conflict and avoidance.  People who address conflict also practice relaxation and co-construct viable creative solutions, over time, with additional input & information.

Transgender Assessments

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I work with many clients who suffer from gender dysphoria. During any given week, I host several conversations regarding clients’ gender expression as related to their sense of self and well-being. There are several means, depending on the situation, to bolster client efforts in synchronizing their gender expression (cues visible to others) with their gender identity (their self-experienced gender).

Some people seek an official assessment for potential hormone referral therapy. These assessments include an intake of the client’s life history including child & adolescent development; transition goals; coping resources; and any co-occurring problems (such as depression or trauma histories). During later stages in the process, I may invite clients to bring family members into the meetings for increased social support (this part is required earlier for adolescents).

Other clients, such as gender non-conforming people, benefit from deconstructing any unhelpful gender associations & roles they internalized from developmental and social contexts. Then, therapeutic techniques such as assertiveness training help privilege their own unique identity and facilitate choices & empowerment.

Internal Family Systems

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I enjoyed a webinar with Richard Schwartz, developer of the Internal Family Systems therapy model. The IFS model grew out of other family therapy models that examined “roles” each family member inherits in reaction to each other & the family’s overall needs. The IFS model examines various “parts”, or roles, within a person, often developed within confusing family dynamics. For example, an individual is likely to develop various “protector” parts and other parts that are “exiles”–parts that express impulsive or other unwelcome behavior. In the IFS model, healing occurs as each part is attended to with curiosity and awareness. When the parts are understood, they relax and trust a well-informed leader–the “self.”

Schwartz’s IFS website: Center for Self Leadership

Daring Greatly

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I am currently re-reading the wonderful book Daring Greatly, by Brene Brown. If I only had a single therapeutic tool or paradigm, Dr. Brown’s work may be the one. Dr. Brown examines yucky problems like scarcity, shame, and defense mechanisms with finesse and humor. For those of you who have not seen her first viral video, here it is: vulnerability .

Trauma and Restoration

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When you experience a negative memory, do you experience an inability to move or take action? These “stuck” or “frozen” states are indicative of trauma. The trauma may be related to a single overwhelming event and/or it may be from a developmental disturbance, like childhood abuse or neglect. Trauma is about powerlessness, not being able to DO something helpful within the original situation. A traumatized person’s challenge is to re-train their mind AND body to take calm action when they are triggered into these states. Sometimes, traumatized people over-react to situations, understandably not wanting to be revictimized. Some interventions that help relieve (rather than re-live) trauma are: meditation (noticing disturbing mind/body cues while regulating breathing and heart rate); identifying and using self-soothing stimuli (perhaps a comforting smell, texture, visualization); and articulating the trauma experience within a safe and responsive context.

I recently completed a continuing education training with Dr. Bessel van der Kolk, author of The Body Keeps the Score.

Consultation Form

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Clients who would like me to consult with another service provider–for example a psychiatrist, school counselor, judge, previous counselor, or medical doctor–are welcome to complete this Release of Information form. It enables the client to describe what type of information they would like shared and to specify the consultation dates. In some situations, consultations boost the effectiveness of one or both practitioners. Clients are welcome to discuss specific consultation considerations with me.

Feedback Informed Treatment

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I am enlisting two new tools to build collaborative client relationships! The Outcome Rating Scale measures a client’s life satisfaction–and any positive or negative trends during the course of treatment. At the end of each meeting, clients use the Session Rating Scale to provide feedback about the meeting’s topics and methodology.  These tools are associated with the International Center for Clinical Excellence. This evaluation process encourages transparency, accountability, and “custom-fit” rather than “cookie-cutter” therapy.