Tuesday, September 22, 2015

Five Essentials of Transformative Psychotherapy

A few weeks ago I had someone ask me, “How can you see client after client and not be exhausted?  Don’t you feel drained after?”  My short answer to her was that I don’t.  As a matter of fact, I feel exhilarated and full of life after a good therapy session.  If I had more time to think about it, I probably would have told her that there are times, though, when I do feel exhausted and drained.  However, those are times when I was not at my best in the session. 

Later, as I thought more about this conversation, I had an epiphany regarding what makes for good therapy and what makes for true healing and transformation.  I quickly pulled out my phone and recorded what I consider the five essentials of transformative psychotherapy:

  1.      The right mindset within the therapist
  2.           The right skill-set
  3.        The therapeutic relationship
  4.      The client’s own resources
  5.      God / Higher Power / Holy Spirit


I want to expand on each of these here.  This is my list.  Another therapist might have a different list.  My main inspirations for this list are my own years of experience, my studies in Rapid Resolution Therapy and A Course in Miracles, and counseling theory in general.

The Right Mindset

It is important that I be in the right mindset if I am going to be of help to my clients.  As a matter of fact, being in the wrong mindset will assure that the session will be of no benefit.  The wrong mindset will occur if I am distracted, tired, or mentally confused.  Also, the worst thing for me to do would be to see my client as flawed, unworthy, separate from me, or as defined by their presenting problems or diagnosis.

A Course in Miracles says that the one responsibility of the miracle-worker (the one the Holy Spirit works through to heal someone’s mind) is “to accept the Atonement for himself.”  This means that the miracle-worker or therapist will have to know (even if briefly) who she truly is as God’s creation and have a healed mind before she can be of help to others.  This knowing might be fleeting for the therapist.  It might come and go.  The point is to come from this healed, whole, holy mind as much as possible as we work with our clients.  Another term used for this mindset in the Course is “right-mindedness.” 

I often will use a prayer from the Course to help me get into this mindset before a session:

“I am here only to be truly helpful.  I am here to represent Him Who sent me.  I do not have to worry about what to say or what to do, because He Who sent me will direct me.  I am content to be wherever He wishes, knowing He goes there with me.  I will be healed as I let Him teach me to heal.”

In Rapid Resolution Therapy and in A Course in Miracles we learn the importance of having a clear goal for our client at the outset.  This is a vision of the client with their mind restored and healed – where they are operating at the highest level their mind would intend for themselves.  This is another important part of the right mindset that is needed for true healing and transformation to occur.

Finally, Carl Rogers also spoke about three qualities that are needed in the therapist for good results in therapy (sometimes called the core conditions): 1) unconditional positive regard, 2) empathic understanding, and 3) congruence / genuineness / authenticity.  These are core conditions that all therapists will want to work at cultivating within themselves – no matter their theoretical orientation.  They are the building blocks of the right mindset.

The Right Skill-set 

The skills of the therapist must be honed and practiced.  It is a rare thing that a person has such skills without extensive training, modeling, feedback, and practice, practice, practice.  However, such skills are rarely taught in graduate school and are even hard to come by in workshops for clinicians.  It is my experience that therapists have to be proactive in making sure they get the training they need to be effective at their craft.

Anyone can be a “rent-a-friend” (a phrase Dr. Jon Connelly likes to use).  This is a therapist who simply allows their clients to vent about their problems and offers some support and occasional words of wisdom.  The client might leave the office feeling better (let’s face it, venting with a friend does help us feel a little better).  However, they have not learned what they need to do to actually get and stay better.  The therapist has not set the session up in a way that true healing and transformation can occur.  In other words, the therapist either doesn’t have or is not using the right skill-set.

In my opinion an effective therapist is going to have a combination of 1) relationship / interpersonal skills, 2) non-defensive communication skills, 3) rational / cognitive skills, 4) mindfulness/contemplative skills, and 5) hypnotherapy skills.  The needs of the client at the time of the session will determine which skills are called upon.  The most transformative therapy sessions will utilize all skills in a seamless flow.  A therapist also needs to be a great communicator and teacher.  They also need to be a model for the client – demonstrating what they are teaching. 

I have had training in or have studied extensively the following therapies and techniques to acquire the above listed skills.  I recommend all therapists seek out similar training for themselves – no matter the cost.  As a social worker, I have an ethical obligation to make sure that I am competent and trained well in the interventions I use with clients.

Imago Relationship Therapy and the Imago Dialogue
Interpersonal Process Psychotherapy
Rogerian / Person-Centered Therapy
Motivational Interviewing
Nonviolent Communication / Powerful Non-Defensive Communication
Rational Living Therapy and Rational Hypnotherapy
The Work of Byron Katie
Mindfulness-Based therapies like DBT, ACT and others
Mindfulness Meditation
Centering Prayer
A Course in Miracles, Buddhist psychology, Yoga, Christian Mysticism and Theology, and other diverse spiritual / religious paths
Integrative Restoration (iRest) Yoga Nidra
Rapid Resolution Therapy
Memory Reconsolidation

The Therapeutic Relationship

There has been much research on the importance of the therapeutic relationship and how it is the relationship itself that is one of the biggest factors when it comes to therapeutic results.  This relationship has been described in various ways.  One of the best descriptions comes from Carl Rogers and has already been described above under the right mindset.

This relationship is very different from the ones that the client is used to.  They might come to therapy with a history of unstable, abusive, unhealthy relationships.  The therapist’s job is to remain present, maintain the right mindset, and to give the client a very different experience from all other relationships in their life.  It is this new experience that has the potential to heal the client.  I actually like to describe therapy as “a relationship that heals.”

Dr. Jon Connelly (developer of Rapid Resolution Therapy) teaches that many things have happened to our clients before they come to see us – sometimes very bad things.  Our job as therapists is to “happen to them” in such a way that healing occurs.

A Course in Miracles would call this relationship a “holy relationship” or “holy encounter.”  A holy relationship is one where both members of the relationship give up their separate interests and join together with a common goal.  This joining then allows the Holy Spirit to enter into the relationship and use it for healing.

In Rapid Resolution Therapy we also come up with a shared goal with the client (that the therapist leads them to with feedback and input from the client).  Having this shared goal means that the client’s and therapist’s energies are now joined, and this energy can’t help but to expand.  This energy is also power and fuel to bring about the shift from how things have been for the client to how things are now intended.  This therapeutic relationship (this healing / holy relationship) with a shared goal sets the process of change and transformation in motion and keeps it going in that direction even after the session is over (For more about this see my last entry on “Goal-Powered Synergy”).

The Client’s Own Resources

The client has within them what is needed for true healing and transformation.  There is nothing uniquely special about the therapist.  The only difference is that the therapist is temporarily more aware of the truth of themselves and of the client.  The therapist knows that the client has resources that have been unused and knows how to guide the client to find and use them. 

There are times when true healing and transformation happen without any interventions by the therapist.  Oftentimes change comes about from factors outside of the therapy setting – from resources that the client has and brings to the table.  These can be inner or outer resources.  Examples of inner resources are: insight, faith, awareness, talents, skills, past coping mechanisms that were forgotten, etc.  Examples of outer resources are: family support, getting a new job and increased income, “chance” encounters with someone who says just the right thing at just the right time, spiritual support systems, etc.

Another important part of the client’s own resources has to do with what the client does between sessions.  I always tell new clients that one of the main factors in them getting better is what they do between sessions.  Sometimes they are given homework assignments.  Sometimes I ask them to practice certain techniques.  Those who actually follow-through with such instructions are the ones who usually progress much faster.  I always tell my clients that it is essential they do their part.  

God / Higher Power / Holy Spirit

In my opinion true healing and transformation comes from a power much greater than anything of our own making.  The above factors – when combined – can act as a channel for the Divine to do its work.  The therapist, the interventions, the relationship, and the client are all used by the Divine to bring about true change. 

Not all therapists have a spiritual orientation.  And, the therapy sessions themselves do not have to be overtly spiritual for them to have a spiritual component.  It is not necessary that the therapist has a spiritual belief system or that the sessions have a spiritual component to them.  The Divine can still operate through us without us even being aware of it.

Other terms or phrases that can be substituted for the Divine are: grace, mystery, love, synchronicity, power greater than ourselves, energy, creative power, spirit, the universe, etc.  We are all spiritual beings having human experiences whether we realize it or not.  Those of us who are spiritually oriented can be very intentional in “opening the space” for God to work through us.  We can also ask about the client’s own spiritual orientation and encourage those who have one to utilize the practices of their path.

Conclusion

For me, when the above five factors are in place, my job as a therapist is very fulfilling, very effective, and very energizing.  I do not feel tired at the end of the day.  I actually feel “in-spired” – filled with spirit.  There is no doubt that, for me, being a therapist is my calling – my vocation – or, as A Course in Miracles would say, my “special function.”    


I am curious to hear what others think about these five essentials for transformative psychotherapy.  Are there others that you would add?  Do you have a different take on the five I listed? Maybe your list would be totally different from mine.  I look forward to hearing from you.

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