Therapy has evolved quite a bit since the 1970’s and ‘80’s. Even at that point psycho-analysis no longer had a monopoly on therapy. While John Bowlby had already introduced his work regarding parent-child attachment, its significance was not yet recognized. Back then, behavioral therapy and CBT had come to dominate the field. The assumption was that by rewarding positive behavior or using logic and rational approaches it was possible to get people to change their behavior and thinking. While this had an effect on more superficial cases, there were many clients who did not benefit from these approaches.
However over the years, the importance of Bowlby’s work became more evident as to the impact of attachment and disrupted attachment (aka: trauma) had on influencing child development. We now understand that untreated trauma does not simply go away, but rather influences the personality into adulthood. As a result our awareness of trauma related issues, the underlying question in therapy is no longer "What's wrong with you?" but rather "What happened to you?"
Fritz Perls of Gestalt Therapy recognized that blockages in people’s daily lives were caused by early forms of trauma. He called these blocks ‘unfinished business’. In today’s podcast we will discuss what needs to be done to address unfinished business and how far we need to dig.
Everyone knows that therapy is serious business. We help people from broken families with broken dreams to put back the broken pieces of their lives. So suggesting that there is a place for ‘joking and absurdity’ in therapy may seem a bit counter-intuitive. However, ultimately it is the client’s ability to integrate his trauma and suffering that will determine how quickly he heals. Part of this process often depends on the clinicians’ ability ‘lighten up’ the dark cloud the client carries. Of course, showing the absurdity of the client’s situation must be done with caring and empathy. But when done correctly it often can provide a new perspective and a ray of hope to move beyond the burden of their dilemma.
A humorous remark can sometimes reveal the thin line between laughing and crying as a way bring a person to the next level of his healing process.
The problem with teenagers is that they are neither here nor there. Sometimes they act like adults and sometimes like children. For therapists’ this can be challenging because we don’t always know who will show up. On the positive side, teens have a lot of energy, that when channeled in the right direction, can overcome difficult obstacles. On the negative side, teens often try to assert their independence and believe they can run things better than their parents. When parents’ sense that their authority is being questioned they feel they need to be more strict and controlling. This often triggers a reaction in the teen to further assert his independence, thereby perpetuating a parent-child power struggle. As you might imagine, this often leads to a stale-mate where everyone is miserable.
When these families end up in family therapy, the usual assumption is that parents need to be taught communication skills, and learn techniques to retain control, while responding in a calm way. This type of therapy is tedious, time consuming, and requires constant monitoring.
Paradox therapy has a different idea. Rather than engaging in power struggle with the teen, the therapist acknowledges that the teen is indeed ‘in control and in charge’ of the family. At first, the teen is thrilled that he gets to be the ‘authority’. He can’t believe it!
But after 10 minutes, when he realizes that he is responsible to make all the decisions, he suddenly has a change of heart and doesn’t want this ‘job’ any more. At that point, when he admits that he is really still a child in the family, he willingly surrenders control back to his parents.
Therapists often seek to learn about new modalities and gain innovative skills designed to improve their practice. While searching for new methods is certainly important, what often goes unaddressed is the ‘other side of the coin’.
This ‘other side’, refers to the therapist’s ability to trust his personal awareness or ‘use-of-self’ in the therapeutic process. In this manner, the therapist is conscious of himself as a ‘tuning fork’ to gauge his ability to connect and empathize with the client. This means engaging and trusting the flow of treatment on a non-verbal level. Within this non-verbal interaction, the therapist is sensitive to the client’s needs combined with the ‘right timing’ to introduce a promising intervention or technique.
In therapy, ‘timing is everything’. While it is surely possible to learn new techniques, the timing aspect of use-of-self is an abstract idea that cannot be learned by reading a book. Use-of-self means that the therapist is in touch with his own feelings, and uses this awareness as a way to strengthen his flow with the client.
Therefore the use-of-self is not a ‘one-way street’ designed to only influence the client, but rather encompasses a broader perspective toward a ‘two-way’ interactive bond. From here we recognize that the implementation of new and various techniques are actually secondary to the main function of developing a trusting and healing alliance. When the therapist is able to balance the ‘inside and outside’ of doing both, he becomes a catalyst for change.
People often enter therapy because they experience emotional or psychological ‘suffering’ in their life. As therapists’ our goal is to relieve suffering. However, what does ‘suffering’ actually mean?
Is ‘suffering’ based more on behavior, emotions, thoughts, or trauma from childhood? Often the hope is that therapy can correct the above symptoms, merge ‘parts’, or roleplay the client toward different solutions to help the client get beyond their suffering. Clients who suffer, but are motivated to get beyond their pain are easier to work with. .
But what if the client’s suffering is so great, that they do not even know the degree and depth of their emotional pain? Is it possible to reach even those who avoid or are unmotivated to cooperate in therapy?
In this podcast we will explore the central aspect and underlying dynamic that leads to suffering. We will also identify what therapy needs to accomplish in order to bring true relief to both motivated and unmotivated clients.
Video: Carl Rogers with Richie who is ‘coasting through’
Roleplay – I want to stop eating cake…
As part of therapy it is common to hear therapists looking for ways to get the client to ‘buy in’ to the treatment process. Some try to convince the client that it to their benefit, some offer rewards, and some will warn of the negative consequences. But essentially the hope is to figure out how to get the client to cooperate and accept our therapy agenda… And of course, once the client ‘buys in’, then with a little more cooperation the therapist will surely feel successful…
But hold on…. Am I missing something here?
It seems to me that pushing for a ‘buy in’ basically is asking the client to do the therapist a favor?! And as you might imagine, for the savvy client who fakes a ‘buy in’ to treatment, this may be an easy way to get a lot of perks and privileges.
There’s gotta be a better way!
Many therapists get overwhelmed even just thinking about doing couple or family therapy. Offhand it seems much easier to do individual therapy where the therapist can focus all his attention - without distraction - on the client. However, the problem with individual therapy is that we are hearing only one side of the story. When doing individual therapy we do not have access to the dynamic interchange between the client and the other ‘players’ that are part of his system. The advantage of couples and family therapy is that we get to see a more whole picture of the ‘real world’ that the client is functions within. As strange as it might sound, in some ways working with couples and families is easier than individual treatment. The reason is because even if just one person changes in family therapy, this influences everyone else. Please join us and check out ways of widening your practice and learn exciting ways to engage with families.
Bed wetting and Encopresis are common problems in childhood. Many times a child may just grow out of it. However, sometimes parents become concerned depending on the age of the child, or how long the issue persists. Some parents resort to medication, and some try behavioral techniques. There are also sleeping mats that are designed to wake the child up using alarms if he starts to wet the bed. However, many of these methods seem to have a ‘behavioral’ or ‘shame’ based quality to get the child to stop. Pdxi has a short-term, unique, and counter-intuitive way of addressing the issue. Interventions tend to challenge the child to utilize his subconscious free-will to control his bladder. As a result, the process often raises the child’s self-esteem as he takes free-will control of his bodily functions. This video included is called the Puppet Dance. It highlights how pdxi often encourages clients to exaggerate spontaneous movements and thereby become more aware of energy patterns they may tend to dismiss or suppress.
Therapists must be very sensitive in handling suicidal ideation and threats. The main and primary factor in working with such ideation is taking away the person's underlying experience of being alone. In order to help people with suicidal ideation, it is important to quickly convey a personal connection. Our approach toward the person should be non-threatening and avoid any kind of power struggle. Sometimes the goal is to 'buy time'. With a client who is 'standing on the ledge', I might acknowledge that he certainly has the ability to end it all now, however "Is there a reason it has to be right now. Let's talk it over, and see if we can resolve it. If not then you can always end it tomorrow." It is also helpful to remind the client that suicide is a "long term solution to a short term problem." National Suicide HOTLINE phone # is: 988
DeCarte said, “I think, therefore I am”. As a result, many people have tried using their internal process of thinking through ‘self-affirmations’ to think differently. Some work very hard to convince their mind to change negative beliefs and thought patterns. Inevitably such affirmations don’t work because their underlying sense of isolation and aloneness remains the same. However in pdxi, the goal is not to change thinking directly. Instead we want to offer the client a change in perspective. Sometimes this might mean even encouraging or exaggerating an old behavior, thought, or emotion. Suddenly the client becomes aware of his old behavior in a new way. It is from this perspective that he is able to make the necessary changes. While it is true that his thoughts will also change, this is the result of a spontaneous shift and not the result of self-affirmations.
In the video, we see how the wife tries to ‘litigate’ the husband to think differently.
Many therapists get overwhelmed even just thinking about doing couple or family therapy. Offhand it seems much easier to do individual therapy where the therapist can focus all his attention - without distraction - on the client. However, the problem with individual therapy is that we are hearing only one side of the story. When doing individual therapy we do not have access to the dynamic interchange between the client and the other ‘players’ that are part of his system. The advantage of couples and family therapy is that we get to see a more whole picture of the ‘real world’ that the client is functions within. As strange as it might sound, in some ways working with couples and families is easier than individual treatment. The reason is because even if just one person changes in family therapy, this influences everyone else. Please join us and check out ways of widening your practice and learn exciting ways to engage with families.
As therapists, we all want to be 'competent'. But it sometimes our very desire to be competent that gets in the way of allowing the client to grow and discover their own solutions. At times the direction the client needs to go is obvious to us. However by giving the client OUR answer, we take away the clients' ability to search and discover solutions that work for them. When the client is able to make choices and take responsibility for their OWN solutions, this is when true healing and growth happens. Therefore in counter-intuitive fashion, it is often the therapist who is ‘incompetent’ by not giving the client the ‘right answers’ – but is able to guide him in the right direction – that ultimately makes the therapist competent. In the video, the client wants the therapist to confirm her BPD - Borderline diagnosis, but the therapist unexpectedly turns the tables on her.
In 1965, Gloria (a patient) met for a half-hour session with 3 well known therapists of that time; Carl Rogers (Client Centered Therapy), Fritz Perls (Gestalt Therapy), and Albert Ellis (Rational Emotive Behavioral Therapy – REBT). In this podcast we get to explore a shortened video version of these 3 meetings. We explore and comment how the originator of each of these therapies demonstrates their technique.
Rogers outwardly projects warmth, empathy, and genuineness. Gloria was relaxed and receptive as Rogers tended to mirror Gloria’s words and thoughts. However with Perls, Gloria is already defensive from the start. Perls remained relaxed and kept the session in the ‘here & now’. His focus is more on her ‘non-verbal’ expression and how she defended herself. Ellis tended to focus on Gloria’s thinking and unrealistic messages that she may be giving herself that prevents her from moving forward.
t is important to be aware of transference and counter-transference. Transference is when the client projects on to the therapist emotions and perceptions they may have experienced earlier in life. Often a client may see the therapist as having similar qualities to that of a parent. At the same time, the client may also bring up feelings and emotions in the therapist that is related to his personal history. For the therapist in particular, he should try to work out these type of conflicts in supervision so that it doesn’t muddy the session. For the most part, the therapist should approach the client in a centered and neutral way. The videos show 2 therapy clips. Roger demonstrates an accepting and neutral approach with no evident power struggle between himself and client. Linehan however acknowledges that she has an agenda of what she expects from the client. As a result the seeds of a power struggle are sown.
Here we explore a direction in which Artificial Intelligence (AI) technology is being used to advance therapy. A brief video showed how a computer avatar could be used to help people diagnosed with schizophrenia, and who had been previously paralyzed by critical and debilitating voices in their head. By using the computer to generate an avatar voice with face image, the client could finally have a conversation with that ‘other voice in their head’. Apparently this method has shown to be very effective with people experiencing this condition. In the podcast group we discussed how such technology could be used in other areas of therapy including individual, couple, and family therapy.
In this podcast I do a 20 minute roleplay with a regular participant to the podcast. Although he tries a few attempts to get me ‘off track’, I remain in the ‘here & now’ and coach him how to better avoid ‘being responsible’. After the roleplay, I and the participant review the ‘session’ and discuss what he learned from it. He noted that it helped him discover that he was working harder to get his client unstuck than the client was for himself. As a result, he was looking forward to the next session with his client to try some ‘new ideas’.
The Grand Illusion refers to the fact that while we each experience our ‘reality’ as being a separate individual, in truth we are all included as part of the greater unified universe. So in essence our existence in the world is to overcome the Grand Illusion that we are separate and alone. This means that the work of therapy is not so much to change the finite limits of behavior, thinking, or emotions, but rather to expand a person’s ‘infinite’ perspective of being part of something greater than themselves. It is therefore through the process of therapy that we hope to change and remove or undo a person’s sense of isolation and aloneness.
In the video mom complains that her son manipulates her to stay home from work. My response is to praise the son for his ‘manipulation skills’. At no point do I tell him to stop. However in the next visit the son informs me that he decided to stop. The video demonstrates the power of joining and strengthening the therapeutic alliance as a way to influence a person toward gaining a more infinite perspective.
Many of us have gone for various training and learned techniques designed to move the client forward. However if the focus of the therapy gets wrapped up in perfecting the technique, then we can often get stuck in the skill or tool and lose sight of the person in front of us. In this podcast we offer that the therapist should try to address the client from a position of caring and empathy. We should recognize that skills and tools will best serve the therapeutic process when they are generated from a heart-centered place. In addition, a heart-centered approach means that the therapist is better able to maintain a position of neutrality in order to enter client system. By maintaining a position of neutrality it allows the clinician to enter into the family or individual ‘system’ in a manner that allows him to be a catalyst for change.
In the video, in the middle of the couple quarreling, Dr. Kaplan asks “How am I doing?!” With everyone’s agreement that their quarreling has not changed, Dr. K scolds the couple. But he does so from a heart-centered place that is caring and neutral.
Most people assumption that the process of therapy is ‘hard work’ – that inevitably takes a lot of time and a lot of effort. The analogy of ‘pushing a car up a long hill’ is often used to describe how therapy works. If the client keeps pushing and pushing, then eventually he will reach the top of the mountain. The conventional wisdom is that with months and years of constant effort, he will eventually reach the pinnacle of success.
However in pdxi, we see it differently. The high mountain top represents high stress and high tension. Therefore the true work in therapy is to gently guide the car toward a gradual slope that leads to the bottom of the mountain. When done correctly, the car will start to slowly roll. At that point, the client is asked to jump into the driver’s seat and check the steering and step on the brakes. Since the natural force of gravity is present, the car’s movement (change & growth) will automatically occur. Without much effort from the client, his job is to simply guide the car down the mountain in a responsible and safe way. When the car reaches the bottom, the client will have spontaneously let go of stress and tension and will enter a new place that Is relaxed and stable.
The video by Rabbi YY Jacobson reminds us that as therapist's it is important to continue our own personal growth to work out internal conflicts that could get in the way of connecting with those he is dedicated to serving.
For the most part, the field of psychology has attempted to change patterns of behavior by targeting the behavior itself. This is the focus of Behavioral therapy through rewards and punishment, as well as rational or cognitive approaches that appeal to linear logic to influence a change in behavior. And even psychodynamic approaches will delve into one's history to identify the root cause of a behavior with the hope that new insight and understanding will undo negative behaviors and encourage more productive behaviors. It is relatively only more recently that John Bowlby's work in the 1950's on 'attachment' has begun to resonate and gain traction. It is becoming increasingly clear that initial attachment bond with parents and caregivers has a huge impact on childrens' later behavior. In this podcast we will see a video demonstrating both secure and insecure attachment in toddlers. The nature of pdxi is to expand the premise of attachment in the form of the therapeutic alliance. The pdxi process literally has no interest in influencing behavior. The nature of pdxi is to simply strengthen the alliance with the understanding that this in-and-of-itself will have a secondary effect to influence an automatic shift in rigid patterns of behavior.