(Originally written April 22, 2015)
Psychotherapy often gets a bad rap. Whether due to social stigma, shame of needing help, or a negative experience with it, the word ‘psychotherapy’ leaves a bad taste in the mouths of many. Meanwhile, those who haven't developed an aversion to it find the investment of time, money, and faith to be too much of a gamble. To me, the need for therapy always made sense when I considered the complexity of both the human brain and society. But, having tried eight different therapists over the past twenty years, I never realized how beneficial therapy could be until one of them truly empowered me. What sets my current therapist apart has changed my life and opened my eyes to what good therapy looks like. In the past, I had no rulebook or goal other than to feel like less of a mess; now, I have a virtual playbook of pointers to help others on their way to getting good therapy, relatively risk-free.
It's an exciting time to be in therapy. The last 30+ years of research in fields such as trauma, brain development, and vulnerability, have revolutionized the field of psychology and armed new generations of therapists with far more knowledge and tools than their predecessors had at their disposal. In our increasingly stressful world this is good news, and yet too few people know enough about how to get good therapy. For instance, do you know that there are different approaches to psychotherapy, and that factors like education, clinical supervision, and, hopefully, personal experience in therapy establish a therapist's style? Do you know the difference between an M.F.T., L.C.S.W., and Psy.D., and that these labels may change from state to state? When considering a new therapist, do you remember that they are people, too, and that you may not vibe with each one?
Like any sort of meaningful progress, therapy is a process, and understanding this is the first step to getting the care you need. In this entry I describe how I stumbled upon emotion-oriented therapy, demonstrating how the slow and steady path of personal transformation can unfold even when there's a shortage of time, money and faith.
a stormy past
For 20 years I tried to forge a healthier path, but the only pattern that emerged was one of inconsistency and crisis. Events like quitting jobs, breakups, insufficient funds, med changes, and breakdowns, derailed any healthy activity I was engaged in. In other words, yoga, hiking, and meditation went out the window as soon as my stress level increased. As I grew older, this pattern of crisis derailment became more pronounced, making it increasingly difficult to get back on the healthy horse. Fear of future crises and disappointment fostered a pervasive sense of doom that hung over me like a black cloud.
With the help of an exceptional therapist named Alison, I've come to understand the roots of my struggle in two parts:
- Stress triggered previous trauma, and without the right tools to successfully manage it, I either froze (got stuck in depression or obsessive-compulsive loop), fought (self-abuse or relationship conflicts), or fled (quit jobs, classes, relationships, or moved);
- My problem-solving abilities were limited by false beliefs, such as: Once I'm making good money and have some stability, I'll be able to eat better, meditate, and see a therapist, consistently. I was always waiting for something outside myself - money, a job, a man, friends - to solve my problems.
Alison helped me see the truth - that, actually, the only way to reach my goals was to develop a healthy, personal routine especially in times of crisis, while understanding that it's about practice, not perfection. Perfectionism can be as problematic as addiction, and therapy helped me tame mine.
ALISON SMITH, LMFT (Licensed Marriage & Family Therapist)
I found Alison online in 2008, after googling Los Angeles-therapist-body image-sex-sliding scale. It was three years after being diagnosed with an O.C.D. spectrum disorder called body dysmorphia, and I was recovering from a psychiatric breakdown that robbed me of my apartment, the love of my life, and, temporarily, the city I call home. But I was in a new relationship, and I felt ready to start reclaiming my body and my sexuality. I was also hoping to lower the high doses of anti-depressants I was taking, even though my psychiatrist said they'd be a lifelong habit given the severity of my condition.
Alison’s website exhibited a clean layout, expressive logo design, and succinct copywriting, and it was these elements more than anything that prompted me to call and inquire. I earned a B.F.A. in Graphic Design two years earlier (because there are advantages to being obsessive), so I could tell a lot about Alison by how her online info was organized. It didn't matter that someone else designed the site; she had a clear description of her services, and she chose to hire a professional who could execute a pleasing visual representation of her brand with a tidy display of text. Why is this important? Because it told me that Alison had considered how others will receive the information - that she cared about her audience and valued the art of communication.
Because I was one of the many unemployed Americans during the Great Recession, I was only able to visit Alison occasionally in the beginning, thanks to a sliding scale arrangement. But even though our sessions were scarce, several qualities stood out:
- I felt comfortable because there was no power trip in her professionalism, no perceived distance between us.
- She drew links between current stressors and past experiences.
- She recalled details about me and my past, even when considerable time had lapsed between visits.
- Her explanation of addiction and emotional avoidance, and its impact on relationships (since I was involved with an addict). I wouldn't fully understand my own emotional avoidance mechanism until I started seeing Alison weekly.
I would come to realize that Alison well fit the description of an "existential therapist", as explained by Dr. Stephen A. Diamond of the Existential Psychotherapy Center of Southern California in a Psychology Today article:
"The existential therapist is not confined to the passive, neutral, anonymous and interpretive role of the psychoanalyst. The courage and commitment to truly and genuinely encounter each unique patient is required by the existential therapist, who must not avoid his or her own anxiety by hiding behind a rigid professional persona or rote therapeutic technique. In existential therapy, the human relationship between patient and therapist takes precedence over technical tricks, and, as now corroborated by research, is the basic healing factor in any psychotherapy."
In June of 2012, four years after my first meeting with Alison and one year after receiving a breast cancer diagnosis, I underwent my first major cancer-related surgery. Alison further reduced her fee so that I, with the help of loved ones, could carry the cost of therapy, and I was able to begin weekly sessions. There was a lot to work on. I was 41 years old and penniless, living alone with cancer. I was stressed about managing medical appointments, insurance, and post-op complications by myself, while trying to control a mind that was prone to panic, darkness and dysfunction in the face of crisis (i.e., I had to tend to the roots of my mental illness while constantly pruning new stems). Plus, I had spent the prior two years slowly weening off of psych meds, and I was determined to kick them for good.
Over the past few years, I've developed greater mental and emotional resilience thanks to numerous therapeutic modalities (sensory work, Buddhism, and more recently, Transcendental Meditation), but weekly psychotherapy has been my primary resource. Consistent therapy is essential for those of us with deep, toxic grooves in the record players of our brains. If we want to alter decades of unhealthy thought patterns, it's only logical that reversing them will require dedicated time and energy. Good therapists create space for us to understand old habits and nurture new ones; they also engage us in a process that can help turn a victim of cancer and mental illness into a more empowered and integrated individual.
The intermittent early sessions with Alison were impressive, but my experience of weekly therapy has been transformative. I've thought a lot about what makes Alison different, why friends envy my experience, and what about her practice has helped me to not only cope with O.C.D. and stress, but actually begin healing it for the first time after nearly two decades of effort. Alison was not the first therapist that I had seen on a regular basis, so what was it about our sessions?
The answer is emotional work. Alison was the first therapist who brought awareness to the connection between my physical state and feelings.
It is ironic that feelings are what many people associate therapy with, and yet few seem to be dealing with emotions in therapy (or in A.A. for that matter). I certainly wasn't. Prior to Alison, I had worked with 7 different therapists: MFTs, psychologists, social workers, and interns; some long-term, some short-term; some interactive, some quietly inquisitive; all C.B.T.-oriented.
"C.B.T. (cognitive behavior therapy) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping." (National Alliance on Mental Illness)
Until Alison, whose practice integrates multiple psychotherapeutic approaches, my experience of C.B.T. lacked attention to the emotional component. It seemed that my former therapists thought that if they could just change my thoughts and alter my behaviors, I would stop feeling bad. Past therapy went like this:
- If I discussed feelings of depression, worry over dwindling bank account, anger regarding inconsistency pattern, compulsive mirror-checking,
- the therapist would try and understand my financial circumstances, point out my irrational beliefs, offer tips to help diminish mirror-checking.
- In the short term I left feeling lighter having talked; I implemented suggestions; I checked mirrors less. In other words, I thought it was working.
- In the long term money continued to be an issue and depression cycles worsened; I replaced mirror checking with other compulsive behaviors. In other words, it wasn't working.
The Latin root of the word emotion is the word mot, which means to move. I learned this in a college class taught by Theresa Larkin, Ph.D., and it stuck with me. Emotions are meant to move - not clog up our bodymind. With Alison, I still examine my thoughts, behaviors, and current stressors. But after I describe what's on my mind, she often brings focus to my physical state - Am I holding my breath? Clenching my fist? Are my shoulders up by my ears? Once my awareness is brought down into my body, I begin to breathe more, and feel. Emotions surface, flow, and release while Alison holds space.Holding space [ideally] happens when someone is in pain and they need to let it out. To hold space for that person, you let them know that you are listening by 1. making eye contact, 2. actually listening, and 3. letting their feelings move your own (empathizing). You don't try to quiet them, change the subject, or tell them it's not so bad/things could be worse; you muster up your strength and love and hold space until the storm passes. Not many humans know how to hold space, but all therapists should be able to do it, and do it well. Alison was my first to rock it.
In the beginning of our weekly work together, I was so stuck in my head I didn't even know there were feelings going on inside my body. When I described a stressful event to Alison, she would ask me what the emotion was and my mind would go blank. I'd lose my train of thought. This is when I learned that the experience of certain feelings, like grief or shame, were traumatic for me, and that I had a strong coping mechanism in place to avoid them - unacknowledged painful feelings brewed inside my body, taxing my immune system, and the O.C.D. loop of cerebral process and compulsive action was how I repressed them.
Over time, Alison gently interrupted the O.C.D. mechanism by guiding me through emotional discomfort. She spoke of a healthier way to experience and regulate through painful feelings that I had never learned (nor have most people in our culture), and she schooled me on research about "highly sensitive persons" (H.S.P.) - people that experience stimuli and emotions more intensely. She also explained how most of our stressors are not life-threatening, but that the lower center of our brains perceive them that way, especially if an event is triggering a past trauma. Let's say someone cuts you off in traffic, and, as a child, a bully embarrassed you daily by cutting the lunch line in front of you; if no one taught you how to deal with the painful feelings that bully caused you, you might have repressed them - hiding them, in shame or denial - only to have them surface as an adult experiencing road rage. Now your body is in fight/flight mode, pumping out stress hormones, but there is no lion in your midst, no bully at the door.
Good therapy is a sort of re-parenting that, on the one hand, provides the nurture, attunement, and emotional validation that so many of our stressed-out, working parents weren't equipped with; on the other, it helps us understand our stress and better manage it. Eventually, we integrate what we experience in therapy and develop compassion for ourselves and others.
Good therapy creates meaning and provides tools for growth. It turns weekly stressors into opportunities to better understand our issues (with our bodies, intimacy, money, authority), while the resultant insights foster growth that affords us an ever-improving life experience.
Good therapy prompts one to truly know thyself. It arms you with knowledge. It goes beyond coping; it empowers the victim. I am 44 years old and still living with cancer. Disability checks cover only the barest of essentials, so every month my faith is tested. The question is always the same: Am I going to trust the process? Can I regulate my emotions through the discomfort or do I need outside help? Will I shift my attention and give energy to what I have, what I appreciate, what I want to give? Or am I going to let fear reign? This is the test every month. Sometimes I give into fear and freak out, but thankfully it's no longer my routine. Because of the work I've done with Alison, I can often disrupt my panic response by applying self-regulation techniques and opting for trust.
trust the process
I sometimes help clients find a good therapist and get the most out of their sessions. Whether interviewing therapists or working with them, there are specific criteria one can look for or ask for, in order to know if someone is a good fit and/or get the most out of therapy. But whether I collaborate with you or not, I encourage you to Trust The Process - the supported process that unfolds when we take even the tiniest steps toward our healing. Maybe it's the process of finding the right therapist, of therapy itself, or in the process of building your personal growth and transformation practice, day by day.
Trust process, stay with process, and get out of the way. In other words, allow the space for what is happening without suppression and with trust. Don't suppose that a particular socially-conditioned way of life is the only correct way of being, and then define that, rather arbitrarily, as 'health.' (Esalen Institute cofounder Dick Price explaining three keys of his Gestalt Practice method)
The sooner you can accept that there is no quick fix to your troubles, and that we are all in the same dualistic boat, the sooner you can jump the ship of Denial and set sail for a wholehearted horizon. Think of healing and true happiness like yoga - as a rewarding, lifelong practice. Actually, don't "think" of it, apply the wisdom and find out for yourself.