My Approach to Therapy

My Approach to Therapy

My approach to therapy begins with the understanding that it is our beliefs and thoughts about ourselves, others, and events that determine how we feel and how we act. This approach, called Cognitive-Behavioral Therapy, CBT, teaches us to become aware of what we are telling ourselves is true, examine those beliefs, and through awareness and behavioral experiments in new ways of coping, replace dysfunctional thinking patterns, such as self-critical and discouraging thoughts, with patterns of thinking that are self-supporting, encouraging, and productive of positive feelings and behaviors. We used to think that changing in this way was hardly possible. But because we now know that our brains are constantly learning, every day strengthening or modifying old connections and building new ones, we know that it is possible to change, and we understand why it is so important to take charge of our own thoughts.

I like to teach people to give up the question, “What’s wrong with me?” and view their problems as learning problems. When we have trouble coping with life, it’s because we haven’t learned how to do it better–yet; and when we turn our focus to how to do it better, we’re already moving forward.

To learn the most effective ways to regulate our own feelings and behavior, and strengthen our ability to tolerate and cope with stress, CBT incorporates mindfulness techniques for present awareness and self-soothing; body-based awareness and calming techniques such as exercise, relaxation, and bilateral stimulation; and dialectical behavior therapy techniques for distress tolerance.

This treatment approach has proven in research and clinical work to be effective for depression, anxiety, panic attacks, phobias, obsessive-compulsive disorders,
and impulse disorders–substance abuse, dysfunctional eating, anger dyscontrol, and addictions. It is also helpful in the treatment of posttraumatic stress disorder, and for the psychological management of pain and chronic illness. For more severe disorders, the research is clear that a combination of medication and CBT is usually most effective.

I think of the kind of therapy I do as “psychodynamically-informed CBT.” Psychodynamic therapy provides awareness of how our earliest experiences have shaped our personalities, our relationships, our coping strengths and weaknesses. It focuses attention on how these things play out in the relationship between patient and therapist, and how that relationship can be healing.

Humanistic and Gestalt approaches have also emphasized the importance of the relationship for growth and change, focusing on awareness, authenticity, and nonjudgmental positive regard.

Newer therapies include EMDR, a method developed for the treatment of posttraumatic stress disorder. Trauma stops the normal processing of events into the past in our memories, and EMDR facilitates that processing. It is used to help speed the changes in our brain necessary for letting go of past pain, for healing, and for further development.

Beyond therapist competence, the most important component of therapy that works is an approach that has recently become its own system, Positive Psychology. For many years, psychology focused on healing weaknesses, pain and suffering. Positive Psychology focuses on strengths; on growing self-esteem, self-confidence, and resilience; on learning attitudes that facilitate happiness, vitality, and well being–optimism, compassion, gratitude, hope. In Positive Psychology the focus of therapy is not simply on how not to suffer, but on how to flourish–how to fill life with positive emotions, positive relationships, engagement, meaning, and achievement.

Therapy that works changes your focus from the life you don’t want to the life you do want. It helps you turn wishes into intentions, criticism into accountability, helplessness into action. It gives you hope, and supports your strengths. It mobilizes you to make the changes you need to create the life you want.