Even before we have met, I have ideas about you.
These are not universal truths, these are my beliefs and assumptions. Let me share these ideas with you
as they may give you some idea where I stand and from where I will start therapy
You are not a disorder
People should never be reduced to their diagnoses. While you may have been
diagnosed with Major Depressive Disorder, Generalized Anxiety Disorder, PTSD, or
Alcohol Dependence, your identity should not revolve around these labels. How
much would I know about you if all I knew was your diagnosis? Not much. You are
a whole person. Like every person, you have strengths and weaknesses, admirable
and less admirable qualities, and more or less helpful tendencies in your
thinking and actions. During our meetings, we will examine your problems in the
context of your whole life. It is undeniable that our personal histories shape
who we are today. We will review events from your past that continue to “show
up” and influence your current life. However, we will spend much more time on
your present life in the here-and-now—and the future life you would like to set
in motion. We will re-discover your strengths and values and use them—both to
set a direction and to get you moving in that direction. If, like many people,
you have already become very identified with your problems or the roles they
seem to force you into—let’s change that, and soon.
You are not sick
While our culture tends to favor medical and disease models over all others,
there are serious limitations to using such models with psychological problems.
It is certainly true that many psychological problems have biological or
physiological components, such as inherited vulnerability (genetic) or gross
differences in brain chemistry compared to others without similar problems.
However, these differences alone are very unlikely to provide an adequate
explanation for any difficult life situation you may be in. More importantly,
these differences alone provide very little direction for you, especially if you are
ready to take active steps to change your situation. The whole truth is that
most persons suffering from depression, anxiety, problems with stress, or other
common emotional health problems, are facing problems that are much different
than the flu, cancer, or diabetes. Even if your problems are, in fact, rooted in
a medical problem, you are not only or merely sick. You also have significant
wellness and health in you. By promoting your emotional and physical health, we
can help you move forward with your life.
Q: My physician says that I have a psychiatric problem that
is rooted in my biology and neurochemistry and is a disease. Are you
saying that my physician is wrong? No. Many disorders, such as
bipolar disorder (manic-depressive disorder) and schizophrenia, for example, are
generally understood to be rooted in biological and neurochemical dysfunction.
Many others are understood to be strongly influenced by biological factors.
The difference here is one of emphasis. My stated assumption that "you are
not sick" is simply saying that over-identification with this illness is
unlikely to empower you to change. No one is solely or merely
ill, we all have much health and strength in us. Identifying as "sick"
leads many people to have mistaken beliefs about being unable to change or
beliefs that medical treatments are the only or best course for change. While medical treatments are often necessary or
beneficial, they are often best used as one component of a comprehensive
strategy for change. For most disorders, the existing research strongly supports this
view. It is likely that the best "whole package" strategy for change should
address your behavior,
your thinking, your lifestyle, your responses to stress, your relationships with
others, and your struggle with difficult private content (thoughts, feelings,
You are already whole
Many people fear that they are incomplete or “bad” because of unhelpful
programming from their past. Consider this: What are some of the judgments you
make about yourself? During your worst moments,
what do you say to yourself or
call yourself? Now consider this: Are these judgments, labels, and harsh names
new? Have you just started to think about yourself like this recently? Chances
are, the answer to these questions is “no.” In fact, if you are like most
people, these internal criticisms and judgments are probably very old and
probably have been there in some form since you were quite young. How many times
have you thought “I am my harshest critic” or “I am my worst enemy?” There is an
element of truth in these thoughts, isn’t there? Now, it may seem like you need
to get rid of this programming, this unhelpful internal voice, before you can
move forward with your life. But there is a trap here. How long have you already
been trying to get those judgments to go away, to stop, or to ring “false”
instead of ring “true?” Apparently, the way to get unstuck and away from those
harsh inner critics is NOT common sense, obvious, or easy. That is the bad news.
But here is the good news: You can begin to move forward now, with this
programming still intact. Rather than changing those voices in your head, let’s
work on changing your life. The place to disprove these ideas (if we must) is
NOT in your head, it is in your day-to-day life, in your actions, and in your
relationships. This is what your therapy can be about. Many of the most profound
moments in therapy occur when people realize that they already have what they
need to begin to move forward with their lives.
You are already good
Many people will react negatively even to such a simple statement: you are
already good. Others believe this statement but will hear a quiet “yes, but…” in
the background even as they agree. So, what does this mean? Briefly consider
your values—what matters most to you in your life. Below are a few questions to
help you identify some of your values.
What is most important to you?
What would you like your life to be about?
If _______ [your problem] were to disappear overnight,
what would you do?
If you could freely choose your direction in life, where
would you go?
If your _______ [pick a problem area, like your
relationships with others, your role as parent, your health, your job, your
spiritual life] suddenly started working for you, what would be
Your true values are perfect
What was it like to consider these questions? Yes, there sometimes is some pain
in reviewing our values—we often do not live up them, and realizing this can be
painful. There is a lot more that could be said about this. Right now, let’s not
lose the focus: Underneath our complicated lives, many of us retain clear and
clearly good values, unblemished from our life experiences, bad choices,
unfortunate life events and trauma, mistakes, and struggles. Moving forward
often has more to do with re-discovering our values, polishing them up, and
beginning to move in accord with them again. Even if this is painful at first,
this way usually reveals a more vital and workable way of living over the
long-term. I often compare this to finding a compass, long-lost in the back of
some junk drawer, but still completely functional.