The following section is a detailed explanation of my theoretical orientation. While it is written primarily with colleagues and referring practitioners in mind, potential clients may also choose to read this information as well. If it feels too technical, try reading the sections on individual, couples, group psychotherapy, and hypnosis. They are more practically written, and are designed for individuals with minimal backgrounds in therapy or psychology.
My theoretical orientation integrates several different perspectives into a cohesive approach. I draw most heavily on the principles of my field of counseling psychology; the theoretical perspectives of self psychology and interpersonal process theory; and the experiential techniques of clinical hypnosis. I incorporate principles from each of these areas into my therapeutic approach.
Counseling Psychology: A Focus on Strengths
Counseling and clinical psychologists have a great degree of overlap in their training experiences. One historical difference has been that counseling psychologists have traditionally focused on human strengths, or what allows individuals to be successful. This difference was due to the fact that clinical psychologists used to focus more heavily on pathology, or problems. This historical difference has gradually faded over the years as all psychologists have become more interested in human strengths (the "positive psychology" movement). As a counseling psychologist, my field's emphasis on wellness influences my work and treatment philosophy in profound ways. No matter how damaged or defective an individual may feel about her or himself, I believe that there are always strengths that can be tapped. While I maintain a sense of realism about an individual's problems, I also believe that each person has a lot to offer, as well. I seek to identify individual strengths and incorporate them into the therapy. By enhancing what is going well we can minimize what is going wrong.
Self Psychology: A brief background
Self psychology is a modern, relational approach to psychoanalysis. Without getting into all of the specific details, this theory focuses on the role of relationships in influencing our development. According to this theory, we need a combination of idealizing and mirroring. Idealizing involves having a stable, secure figure(s) to look up to, one who provides with a sense of comfort and security, a feeling that everything will be alright. Mirroring involves having someone who validates the child, who supports the child's growing sense of self. According to this theory, with adequate idealizing and mirroring over the course of a child's development, the child eventually internalizes these idealizing and mirroring functions for her or himself. Thus, the individual is able to reassure her or himself during times of stress, as well as feel comfortable about who he or she is. The reality is that all of us have times where are unable to soothe ourselves or feel shaky in our sense of self (e.g. our identity). However, for those with a lack of consistent proper idealizing and mirroring, the internalization process does not fully take hold. As a result, these individuals often look to external relationships (friends, partners, colleagues) or objects (food, alcohol, drugs, etc.) to provide these soothing and validating processes that they are unable to provide for themselves. Examples include narcissism, low self-esteem, and anxiety, amongst others. Essentially, these people are engaging in a distortion of their relationships. While there is a part of these relationships that are real, there is also a part that is distorted, in that the other person is serving a self-regulating function to the individual (helping her or him calm down, feel safe, feel good about her or himself, etc.). The above description is a simplification of this theory. In reality it gets more complex. For example, we can get too much of these functions growing up ñ an example would be the child who is always praised ñ to the point that we become self-critical because we do not know whether the feedback we are receiving is real.
Implementation of Self Psychology in the Treatment
I incorporate self psychology principles in my work in several ways. First, I believe strongly in the concept of empathic attunement. Empathic attunement builds off of the word empathy and involves stepping in the other's shoes as if I was that person. I strive to deeply understand that person's worldview, thoughts, emotional experience, while simultaneously maintaining my own perspective as a therapist and individual. The emphasis of empathic attunement is on understanding. I want to understand the individual's experience, what it is like to be her or him in any given moment. As a result, I work hard to track this moment by moment experience. I may interrupt someone's story in any given moment and ask her or him to clarify a particular detail or experience. Tracking is an important part of my work because it allows me to follow and understand the client's experience, while simultaneously aligning myself with her or him.
In considering some of the concepts raised in the earlier description of self psychology, it becomes easier to see why empathic attunement and tracking are so important to my work. Many clients comment to me that they are not used to having someone listen to them so closely. They say it allows them to feel heard in a new and deeply satisfying way. I raise these points not to boast, but rather to point out the process that is occurring. Through this therapeutic style of empathic inquiry, I am working to establish the idealizing and mirroring functions with the client in a more lasting way. The therapeutic relationship becomes a holding environment, a containing experience where self-soothing and the development of self-esteem and identity can begin and take hold.
The Importance of Observing and Experiencing
One of my principle goals with clients is to enhance their observing and/or experiencing functions. Many clients, as a result of their developmental backgrounds, are too immersed in their experiences. They can become flooded with emotion, and often lack the ability to step back and observe themselves. Self observation is an essential component of self-awareness, growth and change. By slowing the client down through the tracking process, I work to facilitate their ability to observe themselves and be more reflective in the moment. Other clients, again as a result of their developmental backgrounds, may have the opposite issue. They are overly observing and analytical. They observe themselves to a fault; so much so that they are unable to fully experience emotion in a given moment. With these clients, the tracking serves a different function; in these cases I try to follow and draw out their emotional responses to varying experiences and cues. Oftentimes, the experiencing of repressed or buried emotions is an essential part of the growth process.
The "Here and Now" Interpersonal Encounter
Thus far, I have described the importance of tracking and relating to my clients' experiences. I believe that this process of being able step in and connect with their inner worlds is a healing one. However, to do so exclusively risks missing out on an important element of therapy, one which can also be very beneficial to clients' growth: the "here and now". What exactly is the "here and now"? It is whatever is happening in the moment between two (or more) people, everything from the verbal to the non-verbal interactions. I always have my "here and now" radar on and operating during sessions. How are my clients experiencing me? And I them? Exactly how are they expressing their statements? With energy? Apathy? Humor? Anger? Sadness? Being able to catch these rich interactions (between myself and a given client) as they occur in the moment lends to greater awareness. As we observe and understand these interactions, clients start to develop greater awareness and appreciation of their interpersonal behaviors. This new understanding allows us to work on changing these interpersonal behaviors as appropriate.
How Clinical Hypnosis and Experiential Techniques Fit Into My Treatment Approach
At first glance, one might see little in common with hypnosis and an approach that appears to focus on empathy, insight, and the therapeutic relationship. Actually, hypnosis integrates wonderfully with these concepts. I enjoy using hypnosis with my clients because it is an experiential technique that can be learned in session, and then practiced and applied individually outside of therapy. Many individuals seeking treatment want to see immediate results. While this is not always possible, experiential techniques such as hypnosis can allow them to experience change more rapidly than they might through regular talk therapy.
In addition, I see hypnosis as another format for implementing the therapeutic principles that I have been describing in my treatment philosophy. For example, earlier I mentioned the importance of empathically tracking my clients' experiences. Through empathic attunement, I am stepping into their shoes and getting a sense of what it is like to be in their inner worlds. By doing this, I am observing them and working to enhance their own sense of self-observation. As hypnosis is a state of focused attention, clients in a hypnotic trance are concentrating their attention inward. Hypnosis involves absorption, or focusing on internal cues. As we go deeper into hypnosis, we become more in tune with our internal experience. Our breathing becomes more rhythmic, and our perceptual senses become sharper. Put another way, when we enter hypnosis, we become more in tune with ourselves. We increase our mindfulness and our awareness of our mind-body interaction. Basically, we are observing and empathizing with ourselves! Thus, through the utilization of hypnosis, I can help enhance clients' self-observation abilities, something I seek to do as well during therapy.
Also, I've written about the important process of internalization that develops over the course of therapy, where the client begins to internalize the soothing capacities of the therapist. As this occurs, the client becomes better at being able to soothe or comfort her or himself. Another wonderful aspect of hypnosis is that it allows the client to directly self-soothe, and in a potentially more rapid manner than the typical therapeutic process. When an environmental stressor affects us, we can become "flooded" by a rush of emotions (anxiety, anger, fear, etc.). This is because our "fight or flight" system has kicked in. As a result, we become physiologically aroused (shortness of breath, increased heart rate, sweating, indigestion), cognitively aroused (racing thoughts), and emotionally aroused. In these moments, it is really hard to self-soothe. It is at times like these that we need a "reset" button. Hypnosis can be that "reset" button. Hypnosis serves to induce an altered state, one in which we focus our attention inwards and slow everything down. Absorption occurs; we also dissociate, or drift away from all of the external stressors. Thus, by the time we are finished with a hypnotic exercise, we have often experienced both an affective and physiological "shift" from where we were at before the hypnosis. We feel in a much better, more relaxed state ñ physically and mentally - than we did initially. I believe very strongly in teaching my clients self-hypnosis, so that they can practice and utilize hypnosis on themselves outside of therapy. With self-hypnosis, it is possible for clients to utilize hypnosis in the heat of the moment, as a stressor may be activating them. Thus, they gain the ability to self-soothe and self-regulate at all times. This is a very empowering experience, and one of many reasons why hypnosis is an important part of my work.
Although I have chosen to focus on hypnosis in this section, these same principles can be applied using other experiential techniques, such as deep breathing, guided imagery, and progressive muscle relaxation. I prefer hypnosis because I think it is more extensive, and can be used to greater effect, but this is not to say that the other techniques cannot be beneficial in the same manner as described above.
Although this is an extensive document, it is meant to provide a sense of how I work with clients. Because I have somewhat of an eclectic treatment approach, I believe in tailoring it to the particular individual with whom I am working.