MacFarlane Psychology Group - A psychologist's' Blog about being a theraapist in Copenhagen

Therapeutic alliance research

A recent article in Psychotherapy, again indicates very strongly the utility of the alliance in the therapeutic process. Negotiation around the goals of therapy, and tasks we may use to reach those goals, is very important to the outcome of therapy. Reaching agreement and clarity on what you would like to get out of therapy, and how you may get there, is directly related to how succesful your therapy will be. As a current or new client, it is in your best interest to engage in this process with your therapist.
Click here for access to the article. It's a great read for both clients and practitioners. Though I am not sure the tables etc. are that interesting to most, the introduction (the first several pages) and the last part about therapeutic practices may be.
- Peter

Anxiety

In my therapy practice I think and read a lot about anxiety. Anxiety is many things, but perhaps it can be useful to think of it as a mechanism developed through evolution, to keep us alive when we are in danger. It works by making us anticipate that something is going wrong, and then to make us try as hard as we can to figure out what that something is.

Severe anxiety, such as what is experienced during a panic attack, is so strong that some clients have reported to me that they would prefer the physical pain of chopping off a finger if they could only stop feeling the pain involved in the panic attack.

That much anguish, coupled with the mechanism developed by evolution to keep us alive are the motivating factors that drive the worry, the fear, the negative anticipation so common in anxiety; It is little wonder that our minds work so hard to try and figure it out, and to make it stop.

- Peter

What you look for you will find

In other words, if you look for the negative, then you are more likely to find it. Here's an example of this phenomena. If, when considering buying a new car, you are particularly interested in getting a Jeep. Then I can almost guarantee that Jeeps will suddenly start to pop up everywhere. Similarly, it may seem that bad luck is out there in abundance. And sometimes you will find exactly the opposite if you can look in a different direction.

A negative inner dialogue is often at the core of depression and anxiety. When we have a negative focus, we miss out on the very things that could potentially begin to thaw a depressive episode or that could wrestle the focus away from debilitating anxious thoughts. When grappling with depressed or anxious mood, this might feel overwhelmingly difficult at first, but as Martin Luther King said: you don’t have to see the whole staircase, just keep taking one step and the rest will gradually appear.
- Hanne-Berit

Concerns in Romantic Relationships

According to John Gottman, the most important foundation for a couple is friendship. If two individuals who are in a loving relationship are friends as well, then it becomes easier to resolve conflicts and survive the strain. However, there are some alarming behaviors that could potentially harm any relationship. These include:

Harsh communication
Criticism
Contempt
Defensiveness
Stonewalling
Flooding

These are just a few of the warning signs. Couples therapy is about finding a more useful and constructive way of communicating so that the other person feels seen, heard and understood. The two underlying corner stones of every successful relationship are understanding and acceptance. In order to understand our partner, we need to know them well. Once we know them, we need to allow them to be who they are while they allow us to be who we are. This is the process of acceptance. Having a third person, such as a therapist, observe the couple interact and guide the couple through the process can often be beneficial and help strengthen the relationship.
(From: The Seven Principles For Making Marriage Work By John Gottman and Nan Silver)

Aims in therapy

Insight – the ability to understand the origins and development of emotional difficulties, leading to an increased capacity to take rational control over feeling and actions.
Self-awareness – becoming more aware of thoughts and feelings that had been denied or blocked, or how one is perceived by others.
Relating – becoming better at understanding others and being able to maintain healthy and satisfying relationships.
Cognitive change - the modification or replacement of irrational beliefs or thought patterns.
Self-acceptance – accepting areas that had previously been subject to self-criticism and rejection.
Behavior change – the modification or replacement of maladaptive or self-destructive behavior patterns.
Self-actualization – moving in a direction of fulfilling potential and integration of oneself.
The therapeutic relationship is used as an arena for exploration, where the therapist creates a safe and flexible enough space for you -the client- to explore whatever dimension of life is most relevant to your wellbeing.
(From An Introduction To Counselling by John McLeod)

How does therapy work?

Many components play into effective psychotherapy treatment, from specific techniques like identifying and challenging self-defeating and self critical thought patterns, to emotionally processing difficult circumstances or traumatic events. These techniques take place within the therapeutic relationship that you, the client, develop in collaboration with the therapist.

Research has made it very clear that one of the most effective causes of positive change in psychotherapy is something called the therapeutic alliance. The alliance has to do with how you and your therapist work together.

There are three areas:

Identification of and collaboration on goals
Identification of and collaboration on tasks to reach those goals
The relationship in which tasks and goals take place

The relationship between you and your therapist is therefore very important. It is therefore very important to find a therapist you feel you can communicate with, and who can communicate well with you. For instance, when minor disagreements or misunderstandings arise in therapy, it is critical that these are discussed and dealt with in the context of trust and respect.

As you progress in therapy you may find that your goals change, either through solving problems or through new understanding that allows you to reconsider what your goals really are. As these shift, it is again important that the therapist is transparent with you about the processes you are engaged in, and that he or she communicates about potential treatment directions. In other words, that client and therapist continue to discuss and agree on tasks and goals, also as they change over time.

(You can read much more about this in an article we wrote, here.)

Does therapy really work?

"Averaged over all mental health professionals, of the 426 people who were feeling very poor when they began therapy, 87% were feeling very good, good, or at least so-so by the time of the survey." (Seligman, 1995.)

"Of the 786 people who were feeling fairly poor at the outset, 92% were feeling very good, good, or at least so-so by the time of the survey." (Seligman, 1995.)

"Long-term therapy produced more improvement than short-term therapy." (Seligman, 1995.)

"The advantages of long-term treatment by a mental health professional held not only for the specific problems that led to treatment, but for a variety of general functioning scores as well: ability to relate to others, coping with everyday stress, enjoying life more, personal growth and understanding, self-esteem and confidence." (Seligman, 1995.)

"Alcoholics Anonymous (AA) did especially well." (Seligman, 1995.) (NOTE: there is an english speaking chapter in town.)

"Active shoppers and active clients did better in treatment than passive recipients (determined by responses to "Was it mostly your idea to seek therapy? When choosing this therapist, did you discuss qualifications, therapist's experience, discuss frequency, duration, and cost, speak to someone who was treated by this therapist, check out other therapists? During therapy, did you try to be as open as possible, ask for explanation of diagnosis and unclear terms, do homework, not cancel sessions often, discuss negative feelings toward therapist?")." (Seligman, 1995.)

So yes, Therapy works! 87 to 92% of those seeking treatment, improved significantly. Long term is better than short term, but short term works pretty well too. Furthermore, therapy works beyond the specific problems to include stress, life enjoyment, self-esteem, etc. And, finally, active participation in your therapy will yield better results.

Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974.

Consumer Reports. (1995, November). Mental health: Does therapy help? pp. 734-739.

How to find a good therapist

How does one go about figuring out if a therapist is going to be a good fit or not? These are mostly thought of as questions you can ask the therapist during an initial phone call or during your first session.

What is the psychologist's experience and training regarding my problem?
How long has the therapist been practicing?
How long has it been since the therapist has sought continuing education, training, or attended relevant conferences?
What is their theoretical background and how does this background influence how they interact with the client?
What is their relationship with research in the field?
How able was the therapist at answering the above questions?
And finally -- and this is important -- though the answers to the above questions and how the therapist answered them would weigh in my decision, I would also highly value someone who was easy to talk to and who manages to ask questions that begin to clarify my concerns, especially during the first session or two.

Finding just the right therapist is very important. You might think of a good therapist as someone who is both well trained and practiced (technical skills) and who is easy to have a helpful relationship with (interpersonal skills).

Depression

People with depression experience their symptoms in unique and individual ways that often are very personal. This can not be overstated. People with depression should not be treated as medical problems. People with depression often think of their symptoms as personal shortcomings or weaknesses. This tendency towards self-blame is further a core part of the way depression can cause the person to think about themselves.

Psychologists often use a list of symptoms to help diagnose depression. These include:

Depressed mood (feeling sad or empty)
Loss of interest or pleasure in things you used to enjoy
Weight loss or gain not attributed to other things
Difficulty sleeping or suddenly sleeping more than usual
Feeling tired or slow, or feeling restless
Feeling worthless or guilty
Difficulties concentrating
Difficulties making decisions
Thinking about death or dying, thinking about ending it all (If you or a loved one is in danger, then please seek immediate help through the emergency room or medical doctor.)

A person does not need to have all of these symptoms, but if they are significant enough to cause distress or loss of ability to work, live, or play, then it is time to seek treatment. These concerns are very treatable, however, with research suggesting psychotherapy as the first choice of treatment. You can read more about my approach to treatment in the other pages.

Anxiety

Psychologists often think of anxiety as a group of different problems including

Generalized anxiety
Social anxiety
Panic disorder
Panic attack
Agoraphobia
Obsessive compulsive disorder
Posttraumatic stress disorder
Health anxiety disorder

The nervousness may include the following:

Restlessness
Feeling keyed up or on edge
Difficulty controlling the nervousness
Fear
Irritability
Easily fatigued
Muscle tension
Sleep difficulties (waking up or not getting good sleep)

Additionally, the experiences that set off anxiety can be many things such as tests, presentations, performing in front of other people, open spaces, heights, or even remembering a bad experience.

It is important for the treatment of these concerns that an accurate diagnosis is made. People's experience of anxiety is personal and real. Each person's experience is unique,few have all the symptoms, and each symptom is often presented in unique ways.

Just as with the depression symptoms, you do not need to have all these symptoms, but if they are troubling you or getting in the way of you being happy and productive, then there are things we can do to help you.

Depression and anxiety are treatable, with research suggesting psychotherapy as the first choice of treatment, occasionally in collaboration with medical treatment (anti-depressants).

Therapists' Blog