Motivation: Start Lifting Yourself Up and Stop Beating Yourself Down

Motivation, non-judgment, authentic life
Listen to the Audio Version of Dr. Bando’s Article.
Often, clients or prospective clients approach me for help with motivation. We all want to live vibrant lives and maybe increase exercise, change the foods we eat, stop eating late at night, make that health care appointment, or countless other important things. Today passes, then tomorrow, then a week goes by, and we realize we haven’t made that change we wanted at all. We can’t seem to find that Motivation, so we get frustrated and feel defeated. Our self-talk becomes harsh: “Ugh, I am so bad at this!” “Why can’t I just do what I’m supposed to?! It should be easy!” “I’m hopeless.” “I’m an idiot!” We give up for the moment and throw in the towel, abandon our goals, and try to accept things as they are, giving up hope that we will ever make that change.

Finally Fed Up?

Maybe we finally decide to get serious. We are disgusted enough with ourselves that we make a strict plan to ensure we adhere to the behaviors we “should” be doing. Then one day passes, then another, then a week, and then here we are: still stuck, still without change.

Perhaps we even make the change for a brief time. Maybe we start eating in a way that makes us feel nourished and energized while helping to reach a target weight. Then, time goes by, and we are sick of being restrictive and “depriving” ourselves, so we give in and “indulge,” feeling stuck in old behaviors, staying unmotivated, and continuing the cycle.

It’s Time to Get Motivated!

MOTIVATION happens when our goals align with our values, then the behaviors we take to move toward our goals link closely to our values, and we reinforce those behaviors. I know from personal experience that the key factors in staying Motivated are reinforcement, which inspires and ignites Motivation, and punishment, which extinguishes Motivation. When we narrow it down to these two simple principles, we begin to realize how straightforward it is to start down a path to lasting change. By reinforcing yourself with simple things like clear goals, being in tune with what is truly important to you, and staying passionate (by focusing on what works and reinforcing the hell out of it), you are guaranteed to break yourself free from that cycle.

Audio Meditation for Motivation:

Listen to Dr. Bando’s Audio Meditation
To stay motivated and moving toward goals that you value, you must build the muscle of Reinforcement. Finding what you are already doing that is working, or taking very small steps forward, and then rewarding those actions creates sustainable motivation for change. Think of it this way: punishment extinguishes motivation and reinforcement creates, ignites, awakens and maintains motivation. Where you have reinforcement, you can create motivation.

Let’s practice building this muscle:

Start with noticing your breathing. You do not have to change or alter your breath. Simply notice that you are inhaling and exhaling. Pay attention to where in your physical body you feel your breath.

Now, for the next three to five breaths, pay attention to where you feel your breath in your physical body and when your mind wanders away or zones out, gently bring your attention back to your breath.

When you notice yourself wander and bring you attention back to your breath, you can think of this as a weight lifting rep, or an exercise to build your ability to put your attention where you want it.

Now, let’s go further. Using this idea of placing the mind where you want it to be in the moment, recall one thing you did in the past day that was effective. Unless you achieved a huge goal in the past day, this exercise requires you to let go of judgments and find where you were effective. Do not dismiss anything for not being “good” enough or “big” enough. If you were tired and you got up on time, that is an accomplishment. If you felt depressed and did not want to get out of bed but you took a shower, perhaps that was effective. It does not matter how big or small you think this action was, take a moment and pick one effective action you engaged in over the past day.

When you have that behavior in mind, reinforce it. You can reinforce this behavior a number of ways: you can reinforce with self-talk, such as, “Good job,” or “I did it,” or “Nice!” Remember, your focus is on what you did well and reinforcing it. If your mind wanders to telling you that it wasn’t good enough, your practice is to gently bring your focus back to what you did well and reinforce it. You may also reinforce your behavior through soothing touch. Maybe if feels soothing to place your hands over your heart center and notice the warmth, or one hand over the other hand, or gently cup your face with both hands. This is touch that feels loving and sweet. Again, when your mind wanders to you or your behavior not being good enough, gently bring your attention back to what you did well and reinforce it.

This is the practice of increasing your motivation in a way that is sustainable and reliable. You can practice this every day – find one thing you did well and practice turning your mind toward noticing what you accomplished and reinforcing it. When your mind goes toward judgments about you or your behavior not measuring up, this is punishment. It will extinguish your motivation and ability to move forward. It’s not wrong, this is just what minds do, they wander, and they come up with judgments. Your task is to calmly notice when this happens and bring your attention back to reinforcing your accomplishment. Practice, practice, practice this and you will notice your motivation grow and your ability to take more steps toward your goals increase.


Feeling Over-“stuffed”: 2 of 4

How to Focus on What Matters During the Holidays (and Keep Yourself Feeling Merry).

Part 2 of 4 of the Holiday Stress Survival Guide

 

The holiday season is here, and along with this time of year comes a lot of “stuff”! Yes, “stuff” can come in the form of things, objects, presents, toys, etc., but there is also a lot of emotional “stuff” that gets stirred up this time of year. If you are feeling over-“stuffed” and want to loosen the button on your emotional pants, read on for ways to cope. Part 2 of this four-part Holiday Stress Survival Guide focuses on relationships.

 

RELATIONSHIPS DURING THE HOLIDAYS

The holidays are a time when relationships come front and center. We often spend more time than usual with family members or those who are like family. We can find ourselves in a cocktail of a lot of face-time with people with whom we have a lot of history, and high stress, all while feeling rundown during these cold months and at the height of cold-and-flu season. Maybe not a mixture we would like to order often, but during the holidays, this is what we have on our plate.

California Online Therapist, holiday stress, relationships

 

SKILLS FOR INTERPERSONAL CONFLICTS

Dialectical Behavior Therapy (DBT) is a well-researched therapy offering lots of skills that you can put into practice in real-time to get true results. There is a whole module in DBT focusing on Interpersonal Effectiveness. Here are some quick tips for applying some of my favorite Interpersonal DBT Skills to ward off (or decrease the likelihood of) interpersonal conflicts during the holiday season.

 

Be skillful, and ask for what you want, DEAR. DEAR is an acronym used in DBT that gives us a template for what to say when we would like to ask for something we want. It goes like this:

 

D – Describe just the facts, without judgment. This orients the person to what you would like to discuss.

Example: I’d like to talk about who is making each dish for Christmas dinner this year.

E – Express how you feel about the situation. Explicitly tell the other person how you feel. They may not know if you don’t say the words!

Example: Nobody has committed to bringing a dish yet, and since I am hosting, I’m feeling overwhelmed.

A – Assert what you want. Say precisely what you are asking. Don’t leave it up to guesswork. Be specific, direct and clear.

Example: I would love if you could tell me two dishes you will bring and let me know by this Friday.

R – Reinforce the person in advance for giving you what you want. Here, you are answering the question, “What do they get out of giving me what I am asking for?”

Example: If you tell me by Friday, you can choose whatever is your favorite to bring, and I will be much less stressed the next time we talk! (Don’t be afraid to use a little humor and an easy manner to loosen up the conversation.)

Practice writing out your DEAR ahead of time and then rehearse a few times before you deliver it. The beauty of this skill is that only four little sentences are needed to ask for what you want in a direct and assertive way. You can also use this skill to refuse a request, like a dinner invitation. Use the same steps but instead of “Asserting” a question, say “no” to the request. Try it!

 

VALIDATE (yourself and others)

Validation may be the most powerful interpersonal skill. Use it wisely! When used effectively, validation opens the doors of communication and closeness. Make sure that is what you want and you’re ready. I have seen validation break down walls that have taken years to build. It may be the most potent tool to affect change.

 

People often misinterpret what “validation” means. Validation is not a compliment, agreement, or approval. Telling someone you like something about them or think they are “right” is not validation. Validation is exhibiting that the other person (or yourself) makes sense. We display validation in many ways: paying attention, nodding, asking questions to clarify, making statements such as, “I understand why you feel that way,” or, “That makes sense.” In other words, validation is treating someone as though they make sense whether or not you agree with them or like what they are saying.

 

Validation of either ourselves or others is a mighty technique in diffusing conflicts. Once any of us feel understood and like we matter, we calm down and are less defensive. If you’re interested, check out my quick steps and worksheet for practicing self-validation. You can use the same steps on someone else.

 

Happy Holidays! Please remember, life is too short just to survive. Use these practices to help you THRIVE!

Read the whole series

Feeling Over-”stuffed” Part 1: Holiday Stress

Feeling Over-”stuffed” Part 2: Navigating Relationships

Feeling Over-”stuffed” Part 3: Loneliness

Feeling Over-”stuffed” Part 4: Overeating

 

If you use any of the practices suggested, please feel free to share your experiences and send your comments to contact@drbando.com. While Dr. Bando will not answer personally, your comments and feedback help inform future posts.


Telehealth vs. In Person Therapy: Which is Better?

You may be familiar with the image of counseling taking place in a psychologist’s office, client and therapist sitting opposite each other, or perhaps the client lying down on a couch. While this model is well known, our current-day communication technology makes it possible to access psychological services in the comfort of your own space.

Therapy has changed over the years, as has the consumer. As more information about psychological health has become readily available, those seeking treatment have become savvy customers. You value your time, money and energy and want gold-standard care. In therapy, this translates to more people looking for skills-based treatment delivered efficiently. Replacing the tradition of a therapist asking you to lie on a sofa and talk about your childhood, are therapists who view themselves as expert consultants, able to teach you the techniques and strategies needed to get what you want out of life. Therapy has become solution-focused and results-oriented, making video sessions an ideal platform for counseling.

In today’s busy world, many people find it difficult to schedule an hour plus commute to their therapist’s office on a weekly basis. Others do not want to sit in traffic, add another appointment to their day, or may want to see a specialist who is not located in their neighborhood. Telehealth provides a convenient solution.

Telehealth can provide greater ease and flexibility, and research shows it can be just as effective as traditional therapy. So which option should you choose?

How is Telehealth different from In-Person therapy?

In-person therapy means face-to-face in the same room or office with your therapist. The therapist provides the office space for your therapy session. Telehealth services are provided remotely, meaning that you and your therapist could be miles apart. Your sessions are assisted with HIPAA-secure technology, such as phone, video conferencing, email, online chat platforms, and even texts. In this model, you are responsible for making sure your space is private and confidential, and you feel comfortable enough to speak freely and be able to benefit from the session in the environment you have created.

Telehealth offers the advantage of making therapy services accessible to anyone, anywhere. This makes it easier to access the treatment you need. If the distance to travel to a therapist or the desire to see a specialist who is not in your area has held you back from therapy before, Telehealth might be a viable option to explore. If you want clear, directed, results-oriented therapy this can be easily delivered over Telehealth and help you reach your treatment goals quickly and effectively.

Teletherapy session, Telemedicine therapy, telehealth appointement

Who can benefit from Telehealth?

Anyone who is looking for results-focused treatment, in which the therapist serves as a teacher to help you gain the skills, techniques, and confidence to apply new strategies to your life and see the changes you want, can be a good match for Telehealth. In short, treatments focusing on helping you build skills to effect change are easily delivered via Teletherapy. Treatments such as Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help you with anxiety, depression, emotion dysregulation and interpersonal problems in an online format.

Clients who succeed with Teletherapy have the ability to provide a private, confidential space that allows them the focus needed to gain the benefits from their online sessions. Practical considerations such as having a strong internet connection, making sure your space is soundproofed enough so that you can express yourself freely, and having pen and paper handy, will ensure you get the most from your Telehealth treatment. With an online session, you do not have to lug your notebooks, writing materials, etc., to your therapy appointments. Everything you need is already at your fingertips.

Telehealth also allows you the luxury of sitting in your space, taking notes, and thinking or processing after the session has ended. Many people who have experienced face-to-face counseling know how abrupt it can feel to end a session after exploring vulnerable topics and then head out into the busy world again. With Telehealth, you have the opportunity to slowly absorb what you have learned, perhaps make a plan for optimizing your week ahead, and at your pace, slowly transition back into the outside environment.

Telehealth can also help people utilize counseling when they otherwise could not access services. This is especially true for people that live in rural areas or overseas, where they may not be able to find a therapist in their area with the expertise they need. People who have limited mobility due to health problems, age, or chronic illness can also find Telehealth helpful. Busy professionals and parents who may not have access to childcare can find Teletherapy an ideal choice. The goal is to access help with more convenience.

Does Telehealth really work?

When Telehealth was very new, there was some initial concern that it might not work as well as traditional therapy. However, research has found that remote therapy can be just as helpful as in-person treatment, with equivalent patient satisfaction scores. The benefits of convenience and accessibility make Telehealth the ideal solution in our increasingly busy and technology-driven world.

To find out if Teletherapy could be the right fit for you, speak with a therapist who specializes in Telehealth services and start shifting from surviving to thriving today!


How To Prevent Seasonal Depression This Winter

seasonal depression, seasonal affective disorder, SAD

 

Many people find it hard to get going on a gloomy day. The covers feel extra cozy and that cup of hot coffee or tea, extra warm and inviting. The urge to stay in your pajamas and curl up indoors beckons you.

You may notice the weather can influence your mood. You might feel more tired or even down and blue. It might be hard to motivate yourself to get much done. Feeling subdued is nothing to concern yourself with if it happens for a day or two. Relax and put your feet up (as much as your schedule allows) and give yourself permission to chill out and indulge. The key is to soak up the laziness and enjoy, without shirking your responsibilities or feeling pulled farther and farther into hibernation.

This may be easier said than done. For some, seasonal depression is an experience that lasts all winter long.

What is Seasonal Depression?

Seasonal Depression is sometimes called “the winter blues” and psychologists give it the more formal title of Seasonal Affective Disorder (SAD). It is a set of depressive symptoms that occur with a seasonal pattern, typically emerging in the Fall, when the weather gets colder, and remitting in the Spring, with the more frequent sunshine. Occasionally, people experience the opposite, with symptoms during Spring and Summer.

Typical symptoms include having low energy, feeling tired, sad and sluggish, losing interest in activities, difficulty concentrating, and sleep/appetite changes. Additionally, with seasonal depression, you may experience irritability, agitation, anxiety, hypersensitivity, and conflict in getting along with others. Frequently, symptoms start out mild and can become more severe.

What causes Seasonal Depression?

A major cause of seasonally-based depression is biology. Your biological clock (or circadian rhythm) may be partly to blame.  Changing patterns of sunlight and less daylight affect your biological clock. Reduced sunlight can also cause decreases in serotonin, a neurotransmitter (chemical in the brain) which affects and regulates mood. Finally, the body’s balance of melatonin may be disrupted, which also affects mood and sleep.

Another cause of seasonal depression is vulnerability factors. In Dialectical Behavior Therapy (DBT), vulnerability factors are described as circumstances that make you more vulnerable to experiencing intense, unpleasant emotions. These factors may include environmental stress, a diet that isn’t supporting your needs, sleep irregularities (lack of or too much sleep), lack of exercise (or too much or the wrong kind for you), and physical illness. During Winter, as the weather and winter colds and flu make you feel tired, worn down, and depressed, you may become even more vulnerable, less equipped to handle stressors and feel greater amounts of unpleasant emotions more frequently.  When vulnerability factors are high, intense emotions can follow, making you even more vulnerable.

How to prevent Seasonal Depression?

A gold-standard and evidence-based treatment (research shows it works) for any cause of depression is called Behavioral Activation. In short, this means that as soon as you suspect depression may be on its way (or has arrived), you make a plan to get active. In DBT, this is called Opposite Action.

Specifically, identify all of the depressive behaviors you might want to engage in (e.g., call in sick to work, stay in all weekend without socializing, watch more television). Then, identify their opposites (e.g., show up early to work, make plans ahead of time with friends and keep them, have your shoes and jacket by the door ready to go for a walk after work). Next, get busy doing the opposite behaviors that you feel like doing when you are depressed.

The key is to be clear and specific about what Opposite Action you are going to take (make plans with Joe to see a movie on Sunday afternoon, not vaguely: make plans this weekend), and then throw yourself in all-the-way. Don’t expect it to be easy. Combating depression is exactly that, combat. And, do not be discouraged. It is a battle you can win with persistence and encouragement.

When engaging in Opposite Action, do not suppress how you are feeling or your desire to stay home and put your head under the covers. Instead, allow yourself to feel how you feel AND, at the same time, throw yourself all-the-way into the Opposite Action you have identified and let the skill do the work. (Do not wait until you feel like doing Opposite Action. That day may never come, and it allows Depression to take even more of a hold.) Then, do it again and again until you have gone through your list of Opposite Action tasks and Depression has been sent on his not-so-merry way. If you find it hard to get started, pick one very small step you can take, and take it! Last (and definitely not least), remember to reinforce yourself for taking each step. Reinforcement is a powerful change agent. The more you use it immediately after engaging in desired behaviors, the easier those behaviors will become.

Another way to prevent seasonal depression is by managing your vulnerability factors. Identify what is making you more vulnerable to intense, unpleasant emotions. Although this step may seem obvious, we often do not realize the number of stressors present until we say it out loud to someone else or give it some intentional thought. Once you’ve identified your vulnerability factors (e.g., not sleeping well, feeling under the weather, nutrition has been off the past week), you can brainstorm some ways to attend to them and give yourself really good cold-weather care. For example, if you know that you need extra sleep during the winter and without it, you become quite irritable, see if you can brainstorm some ways to get even just a little bit more sleep each night. Your body and emotions will thank you.

Other treatments for seasonally-based depression address the physical causes. To help combat decreases in natural light, you might use Light Therapy. This works with specially designed light therapy boxes, and research shows it can help. Some people also elect to try vitamins and supplements (in consultation with their health provider) as an alternative to psychotropic medications, such as anti-depressants.

If you have noticed that your mood shifts as the season changes, you may find it helpful to seek out therapeutic support in learning to manage it. Therapists can teach you how to send depression into remission, and then prevent or drastically reduce the likelihood of a relapse. Dialectical Behavior Therapy (DBT) is one helpful approach. DBT offers techniques to help you identify your unique vulnerability factors, engage in self-care to reduce and manage them, and notice earlier when they may be affecting you so that you can take steps to mitigate depression. If you think DBT may help you, contact a qualified therapist and start shifting from surviving to thriving today!

 


Where Does Anxiety Come From?

We’ve all experienced stress, worry, and anxiety from time to time. For some of us, or at certain times in life, it occurs frequently and can feel overwhelming. At its worst, anxiousness can even impair daily functioning. A lot of factors work together to cause the experience that we call anxiety. Let’s take a look at some specific ways that it develops:

From Chronic Stress Conditions 

Most of us equate stress with anxiousness, and oftentimes, these two do go together. However, when we talk about anxiety as opposed to a passing stressor (a stressful life event that comes and goes rather quickly), there is a lot more to it than just feeling stressed. Some people grow up or live in incredibly stressful environments (e.g., low-income households, experiences of neglect and abuse), and these long-term stressful conditions can make people more vulnerable to anxiety, and in some cases, weaken their ability to handle stress. If your system is already taxed by dealing with chronic, daily stress, your ability to manage more stressors thrown your way will very likely be compromised. A buildup of chronic stressful situations that do not go away quickly can lead to an experience of anxiety.

From Reinforcement

Have you ever heard someone say, “You don’t need to worry,” and you want to answer with, “I do need to worry!”? When we are experiencing anxiety, we often believe it’s helpful, because it gets reinforced. When we feel anxious about something and spend time ruminating and worrying, often everything turns out just fine. We can then believe that anxiety helped achieve the desired outcome. There is an old quote by an unknown author that goes, “Worrying works! 90% of the things I worry about never happen.” We continue to feel anxious and sometimes become almost fearful that if we are not anxious, things will not work out. Most of the time, this isn’t even a process we choose. The cycle gets reinforced, and the brain keeps it going without our intent. Reinforcement is brain food; when a behavior is reinforced, it is likely to occur again.

 

Anxiety, anxious, anxiousness, worry

 

From Avoidance

One function of anxiety is that it helps us to avoid other issues. This can be the most puzzling reason for anxiety. Most of us hate the experience of anxiety, and at first glance, it does not make sense that we would use anxiety to avoid anything. Rather, we want to avoid anxiety! Think of it like this: Anxiety gives our mind something to chew on. We may not like it, and it may not feel pleasant, but it occupies us, nonetheless.

Anxiety tells us that something is wrong and we need to fixate on it, wring our hands, figure it out, look up facts, check out others’ opinions, etc., and it keeps us very busy. Sometimes it keeps us so busy that we can’t focus on much else. If we are having an uncomfortable emotional experience or find ourselves in a painful situation that cannot be solved (e.g. a job we cannot quit, the death of a loved one), sometimes we are so overwhelmed that anxiety jumps in to try to give relief. We may prefer (on some level) the experience of spending our time figuring out an unfixable problem than sitting with the feeling of grief or helplessness.

 From Other Emotions

Another function of anxiety is its ability to hide other, more difficult emotions, because it is a secondary emotion. Anxiousness (or any secondary emotion) happens when the primary emotion is not sufficiently experienced and processed. In other words, your anxiety serves as an avoidance (see above for more explanation on this). When we experience it, we don’t feel the underlying emotion. Our way out of anxiety is to feel this primary emotion. When we resolve a primary emotion, the secondary emotion regulates.

 From Itself

One of the most unpleasant aspects of anxiousness is that once we are aware of it, we can start to feel anxious about our anxiousness. The more we work to avoid it, ignore it, fight it, or self-criticize it, the more space it takes up in our mind. We end up feeling anxious about having anxiety and sometimes anxious about the rare times we do not feel anxiety. We may also experience additional concern about others noticing or criticizing our anxiousness.

If you struggle with anxiety, consider seeking therapy. Therapy can help you safely address and resolve unrelenting anxiousness. A therapist who practices Dialectical Behavior Therapy (DBT) is a good choice. DBT can help you build skills to address any vulnerabilities you have, to identify and cope with primary emotions, and to make more effective choices than avoidance. They can also teach the skill of Radical Acceptance, which is learning how to accept things that cannot be changed, rather than adding to your suffering by fighting it or feeling more anxious. If you could benefit from these skills, contact a qualified therapist and start shifting from surviving to thriving today!


Name that Emotion

We’ve all got things to do and people to see. Who needs unwanted emotions slowing us down? Just ignore them, and maybe they’ll go away. Right?

Here’s the hitch: emotions are hard-wired into our human experience. In other words, emotions are part of us and the more we push them away, the louder they become. When we deny and try to block out emotions, we starve them until the emotional hunger pains are so strong, we become overwhelmed with unruly, overbearing, unable-to-control feelings.  You know, that moment someone asks you something harmless like to pass the salt, and you completely lose your cool? When we suppress or don’t acknowledge emotions, they bubble up, and like water boiling in a covered pot with the burner on high, eventually they’re going to blow.

The solution? Don’t ignore the monster!

Emotions grow to become monsters when we ignore them, push through them, judge them and just plain do whatever it takes to try not to feel them. There is a better way! The next time you feel an unpleasant emotion, try noticing it and putting a name to it.

Scientists call this affect labeling. It goes something like this:

  • I am noticing a feeling of butterflies in my stomach. I’m nervous.
  • I feel a lifting, light feeling in my chest and shoulders. I’m happy.
  • I feel like it’s hard to move. I notice that I’m slumped and don’t feel like doing anything. I’m sad.
  • I can’t believe that guy just cut me off. I’m irritated.

When we give our emotion a name, it starts the process of calming it down. Instead of pushing the feelings away, we pay attention and engage our intellect to give it a name. Once emotions are acknowledged and paid attention to, they start to digest and let go of their grip. Relief can get his foot in the door, and we initiate the process of regulating emotions and feeling more in control.

 

Brain imaging studies explain the science behind affect labeling: When we experience an emotion, a part of our brain called the amygdala, gets activated. When our amygdala is very active and fired up, it is hard to access the reasoning part of our brain, the frontal lobes.

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

 

When we use techniques like affect labeling, we begin to activate our frontal lobes (the organizing, planning, thinking-through part of the brain) and de-activate the amygdala (the “OMG!” emotional part of the brain).

 

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

 

PRACTICE:

The next time you are “freaking out” or “stressed” or just “feeling off,” try getting specific. What emotion are you feeling? Can you put a label on it?

How to become Happy, Breaking through an Obstacle, Orinda Psychologist, Lafayette Psychologist, Berkeley Psychologist, Oakland Psychologist, Moraga, Alamo

Now, reinforce yourself by checking out the Reinforcement Practice Sheet and get some suggestions on how to reinforce yourself. You’ve just taken the first step toward processing and letting go of that unpleasant emotion.

LIFE’S TOO SHORT JUST TO SURVIVE. THAT’S WHY I HELP PEOPLE THRIVE!


HOW TO FIND A RESULTS-ORIENTED THERAPIST

Maybe you have never been in therapy. Perhaps you have been in therapy, and it hasn’t gotten you the results you’d hoped.  This time, you want to try something a little bit different. You may even have a particular goal(s) and know what it is that you want to change. Now come the questions, “How do I get the results I want?” and, “Who is the best person to help me?” Despite the consumer-savvy world we live in, there is little information on how to find a therapist, let alone how to find a therapist who will truly help you achieve real results and change your life in the way that you want.

Here, you will find a five-step process to help you find a therapist who will help you achieve the goals you want to reach. Stop wasting time, money and effort with treatment that doesn’t work. Set yourself on the path to success today!

 

  1. Get COMFORTABLE. – Going to therapy can be a hard process, requiring courage to step outside of your comfort zone and ask for help. At times, therapy asks you to be quite vulnerable, talking with another person about your deepest, most private experiences. Treatment often requires you to be super uncomfortable, and even want to temporarily squirm out of your skin or run for the door. After all, you are in therapy to get help with areas that are likely challenging and possibly, quite painful. To venture to feel this awkward and uneasy, you must first be comfortable! It is so important that you are at ease in the presence of your new therapist and feel understood and not at all judged. In other words, think about whether this is a person to whom you would want to open up.
    • Ask for a PHONE CONSULTATION to get a feel for the therapist. Most therapists will agree to talk to you for a free, 10-15 minute phone consultation. During this meeting, you can give the therapist an idea of what you want help with and hear his or her response. It is important to ask questions and leave time for the therapist to talk so that you can start to assess your feel for this clinician’s competency and ability to help you. Trust your instincts. The therapist should give you a choice (or you can ask) whether you want to schedule an in-person appointment right then and there, want time to think about it, or do not believe that this therapist is a good fit for you.
    • MEET IN PERSON with the idea that you are still evaluating whether this professional is a good fit for your needs. During the first session, the therapist will likely ask you questions about why you are seeking therapy and many other detailed questions about yourself and your treatment goals. The more open you are will help you to experience how the clinician responds to you and gives you the opportunity to evaluate your comfort level with this person. Their response will provide valuable information about whether you would like to proceed or seek another’s help instead.

 

  1. Ask for a CASE FORMULATION. – A results-oriented therapist will be able to discuss their conceptualization of your problem(s) and what is currently missing for you to reach your goals. Likely, this won’t be obvious information that you already know. Rather, it should add more information to your understanding of your stuck point(s) and show you that this person has the education and experience to understand your particular problem area(s) expertly. Think of the analogy of visiting a medical doctor (M.D.). You may report your symptoms (e.g., poor digestion, feeling light-headed) and the doctor will not simply repeat your symptoms back to you: “You have poor digestion and feel light headed. That must be hard.” They will tell you, based on their evaluation (e.g., examining your vitals, blood tests), what is wrong (e.g., “You have high blood sugar.” “Your thyroid is malfunctioning.”). You can expect this same kind of expert information regarding your psychological and emotional health as well. A results-oriented mental health professional will not only repeat your complaints back to you; they will add information to fully conceptualize what is contributing to the problem and why you need help in solving it. For example, you may report repeated over-eating and sudden emotional outbursts. The results-oriented clinician may suggest after their assessment (e.g., conversation with you, standardized questionnaires), they believe these problems come from deficits in understanding how to change behaviors and regulate emotions successfully.1 The results-oriented therapist will explain this to you in detail and discuss precisely how this affects you. This explanation will be in language you understand, and the conceptualization should make sense to you. If you think the therapist is off-base, does not accurately comprehend your problem, or cannot communicate in a way that you understand and agree with, openly discuss this with him or her. If you still cannot come to an agreement, it may be time to interview another therapist for your treatment needs.

 

  1. Ask for a TREATMENT PLAN, including TREATMENT GOALS, prognosis, and length of therapy. – Just as your general medical practitioner will give you an idea of your treatment options, likely results, rate of recovery, and time needed to achieve these results, you can also expect this from a results-oriented therapist. For example, a clinician may tell you that in the first three sessions2, the two of you will collaborate to reach a case formulation. At that point (by the third session) the therapist will make a treatment recommendation. They will talk with you in detail about how the treatment he/she is recommending addresses your particular problem(s), will help you reach your goals, and the time you should expect to devote to attain this outcome, including frequency and length of sessions, and expected length of time in therapy. Alternatively, at the third session, the therapist may refer you to another professional with the expertise to help you meet your goals if you and the clinician have determined that is what is needed. Again, think of the M.D. If blood tests reveal you have a thyroid problem that is relatively simple and straightforward, the doctor may express this to you and lay out a treatment plan. If, however, the problem seems more complicated, the M.D. may then refer you to an endocrinologist or another specialist to help you achieve your health goals. Defining treatment goals in therapy is important because these goals will help you know if you are making progress and whether the therapy is working.

 

  1. Understand how you and your therapist will MONITOR TREATMENT PROGRESS and ask for HOMEWORK. – How will you know whether you are moving toward your treatment goals and making progress? This is a question a results-oriented therapist will be able to answer with clarity.
  • Together, you and your therapist may choose to use standardized measures of symptoms or progress and chart them on a graph, making sure your symptoms are decreasing, and skills needed are increasing. You may also choose to track behavioral markers, such as how often per week you are engaging in a particular behavior or have the urge to do so. Successful treatment would show a decrease in those behaviors (and possibly urges) the therapist has agreed to help you decrease (e.g., over-eating). You will also see an increase in the behaviors moving you toward your treatment goals (e.g., taking three breaths before a meal, stopping eating your meal when you experience a feeling of satiation regardless of the quantity of food left). Your therapist may ask you to chart each time you have the urge to or actually engage in these behaviors in between sessions to track your progress.
  • PRACTICE, PRACTICE, PRACTICE, and then, you guessed it, more PRACTICE is needed to make changes and reach your goals. Homework will always be present in results-oriented therapy. Homework doesn’t mean that you will be sent off to write a 5-page paper about what you learned. Rather, therapy homework is a way for you to put into practice what you are learning in therapy. Typically, therapy sessions last about 50 minutes once per week. What about the other six days of the week and 24 hours each day? 50 minutes is not going to change your life in the way that you want. A results oriented therapist will send you home with something to practice (e.g., filling out a worksheet about a skill you learned at your session, practice saying “no” and noticing in detail the thoughts that come into your head or sensations in your body). If you want results, you must practice. Change does not happen in our thinking. Change happens when we do things differently over and over and over again. If you want results, ask for homework!

 

  1. CONTINUE TO EVALUATE, on an on-going basis, whether your treatment is helping you move toward your goals and achieve the results you want. A results-oriented therapist will regularly review treatment progress with you using the techniques described in Step 4. Therapy is not meant to be life-long. Remember, you are hiring a professional to help you reach specifically-defined treatment goals. At some point, if therapy is working (as you are carefully monitoring), you will have achieved those goals and will either want to develop new treatment goals or decrease the frequency of your contact with this clinician or terminate your treatment.

 

Therapy can be an enriching, life-changing experience if you choose an effective treatment. Use the five steps above to help you get the help you need and deserve, and start shifting from surviving to thriving today!

 

NOTES

 

  1. This is provided as an example only and does not imply that all causes of over-eating or emotional lability come from the same source. These statements are meant to clarify the topics addressed in this article, not to assess or diagnose.

 

  1. Not all clinicians assess within one to three sessions. This is meant as an example only. Please check with the therapist you plan to see about their individual policy and of course, ensure that it makes sense and is reasonable to you.

Frequently Asked Questions:

  • What is the difference between a Ph.D., Psy.D., LMFT, LCSW, MFTi, etc., and will it affect the quality of my treatment?

A Ph.D. and Psy.D. both have doctorate degrees in psychology. LMFTs and LCSWs have a  master’s degree. A Psychological Assistant (someone with a doctorate who is not yet licensed) and MFTi (Marriage and Family Therapist intern) indicate this person is still in training and under supervision before they can become licensed. While the degree itself may show different types of training and specialties, what is usually more informative is how the therapist works with their clients. I have results-oriented colleagues with LMFT and LCSW licenses who work similarly to myself and other contemporaries who have doctorate-level training. I also have met professionals with doctorates who are not results-oriented and do more of a supportive-type therapy. In my opinion, if you follow the five steps laid out in this article, you will significantly increase the likelihood that you will work with a therapist who will help get the results you want, regardless of their type of license. Trainees can also be good options. I personally would choose to work with a Psychological Assistant or MFTi if they met all of my requirements in the 5-steps to finding a results-oriented therapist. The quality of work a therapist demonstrates to me is more important than where they are in their education and whether they have a master’s or doctorate degree. One caveat: if your problem is quite complicated and you have been to several clinicians before who haven’t helped, you may need a skilled and seasoned eye and choose a therapist who has some years of experience under his/her belt.

 

  • Should I look for a therapist with a particular theoretical orientation?

Some of my results-oriented colleagues may argue that it is imperative to receive treatment from someone doing “evidence-based therapy,” such as cognitive-behavior therapy (CBT). I like to be careful about making this generalization. There are certainly CBT practitioners who are results-oriented, and there are those who are not. Because someone professes to work under a particular modality is not an assurance that they do. More relevant is whether the therapist helps you develop treatment goals, assigns homework, monitors your progress, etc. I am less inclined to be concerned about the modality and more interested that the therapist can give you evidence that their treatment recommendation(s) works (has been researched to be effective) and the way the therapist is applying the treatment to your problem makes logical sense to you.

 

  • What if my therapist tells me that being uncomfortable with him/her or wanting to leave therapy is as a result of my problem(s) and I should not act on this?

This answer is not a straightforward “stay” or “leave.” Rather, it is a more nuanced answer: Use your WISDOM. On the one hand, if this is a new therapist, it is important to be comfortable and feel at ease in his or her presence right away. (See Step 1.) You will already be challenging yourself to grow in various ways throughout your treatment; no need to do this with the relationship with your therapist. I have talked to countless people who have stayed with a therapist they didn’t like or felt uneasy around because they assumed they (the client) were at fault and there was something wrong with them that they felt this way. I previously had a personal experience visiting a therapist with whom I was uncomfortable. I told her so, and she stated that she thought this meant I had significant problems with intimacy and needed to sit physically closer to her than I was comfortable with and work through the problems in my relationship with her. At that moment, I felt ashamed and unsure of myself. After leaving the session, and discussing it with a loved one, I determined that the only relationship in my life that I was having a significant problem with and wanted to get out of was the one with my therapist. I left, found a new therapist who I was immediately comfortable with, and therapy was successful. I have heard some version of this story from many clients about their past therapy, and often, once they remove themselves from that clinician, they find much success moving toward their goals with much more ease. On the other hand, it could be useful to ask yourself if your therapist has a point. Does this reaction toward your therapist happen in many other relationships? After visiting a few therapists, do you feel this same way about each of them? If so, you may want to consider whether this is something you want to target (work on) in therapy and may decide to stick with this therapist. You may want to consult with a trusted loved one and get some help tuning into your WISDOM to make this decision. Also, remember Step 5 and to continuously evaluate whether this treatment is helping you.


© 2017 Amanda Gale Bando Phd · Designed and Developed by D-Kode Technology

Dr. Amanda Gale-Bando

Dr. Amanda Gale-Bando