In an old Greek myth, a host named Procrustes had a peculiar fetish for making his guests fit their bed at night. Instead of trying to “fit” a person’s needs into one school of therapy, I do my best to make sure my therapeutic approach fits a person’s needs. While my techniques are varied, my style does lean in one direction. I have a reputation among therapists for being extremely active and direct in the form of an “active advocacy”. Many clients have found themselves dissatisfied with prior therapists who have merely been passive and emotionally supportive. My style is more ambitious. The first thing I do is to help the person clarify goals and get an agreement about what we are trying to accomplish. From then on, I direct focus and energy toward whatever will be most helpful toward reaching those goals. Very often, a person’s history is relevant in understanding how certain emotions or beliefs became conditioned to their current state. However, I find that insight and understanding alone are usually insufficient to produce most emotional changes. To bring about changes in emotion or emotionally determined behavior, a well-designed plan of intervention is necessary. When I make recommendations for a course of intervention, I always explain the principles of psychology and emotion behind it.
In the course of therapy, I do a fair amount of personalized teaching. One way that I do rely on insight is to teach a person how to influence their emotions. Our emotions follow a somewhat different set of rules than ordinary behavior. Usually, we can immediately choose how we want to behave. With emotions, we can’t. Our feelings are learned in a different way than what we think of as ordinary learning. We learn to feel certain ways through either powerful or repetitive emotional experience. The technical term is called “conditioning.” My style of therapy has been influenced by my years of study of psychophysiology and how emotions are “conditioned.” My theoretical orientation incorporates Russian research on perception and conditioned reflexes as well as western research on the brain circuitry of attention, perception, emotions and learning. I have found that while our emotional conditioning can’t be immediately changed, it can be gradually altered if we learn to use the correct tools. Very effective therapists will use tools like these and people can make dramatic changes in their feelings. So the paradox is this: feelings can be changed but you just need to learn some new rules about how to influence them without trying to control them.
These are some of the different therapies I do:
Adjustment counseling & stress management
This type of therapy is the most simple and entails what people refer to as “counseling.” It usually involves a lot of teaching and prescribed exercises at home. A significant part of counseling is to teach clients about human nature so that they have realistic expectations of themselves. Clients are often taught how to more effectively relax, how to fashion realistic goals from their own needs and desires, how to journal to promote emotional growth, how to compartmentalize grief, how to confront and replace automatic irrational beliefs, how to use autosuggestion for shifting emotions, how to manage situational cues to influence their emotional states, and many other self-management strategies. My style of counseling has a reputation for being very direct and friendly.
Intensive trauma reduction therapy (EMDR)
This is a very technical form of therapy that is evidence-based effective for treating trauma and post-traumatic stress disorder (PTSD). I employ this technique along with other strategies when treating compound PTSD and dissociative disorders such as multiple personality disorder. Auto-hypnotic and somatic experiencing techniques are especially useful to combine with EMDR. (Read more about how I use EMDR here.)
Marriage Counseling-Relationship Therapy
Many therapists employ a communication model for couples work that assumes that most couples’ problems derive from dysfunctional communication. The assumption seems to be that teaching better communication should resolve their difficulties. Unfortunately, most well-controlled studies show that only about one-third of the couples going through marital therapy are reporting significant post-treatment benefits after one year. After two years, the benefits shrink another 50 %. Those are not impressive statistics and they do not give much support for a simplistic communication therapy model. I find that a couple’s communication usually breaks down because of more complex emotional dynamics. Those dynamics can involve historical shame issues, personality deficits, knowledge deficits, and boundary interactions. These issues can be quite complex but are still understandable. Much of my couples work involves clarifying the emotional dynamics and then working with the couple to design a strategic intervention. The necessary intervention will depend upon the needs of the couple. My philosophy of treatment is to try the simplest feasible intervention first. When we’re lucky, we can be successful on the most superficial level through mere education. I’ve had some couples who merely needed 2 to 4 sessions to correct their problems. This might involve educating the couple regarding the care and feeding of emotional needs within a relationship. Assigning intimacy exercises would be a part of this type of intervention. Teaching skills for managing mood states and conflict strategies would still operate on the educational level. However, more time is usually needed, especially for learning conflict management strategies.. Three to 4 months is the norm for these types of cases.
What people don’t like to admit is that communication and affection frequently break down due to issues of personal incapacity. By personal incapacity I mean the inability of either individual to engage in certain mood states within their relationship. These emotional states include the following:
- The ability to become curious about and to draw pleasure in exploring the mind of their partner. This constitutes the highest form of loving because the mind of each partner constitutes their truest self. When both partners love and relish each others minds, then both of them will feel “close.”
- The ability to express their desire within the relationship for various forms of fun and pleasure. Unless this is happening, then one or more of the partners will feel “trapped” in the role of constant responsibility. They may even begin to state that “they don’t know who they are” anymore.
- The ability to energetically confront their partner to prevent their partner’s desires from completely ruling their life and eclipsing their own desires. Unless this confrontation takes place, the feeling of being dominated will usually result in losing sexual desire for their partner and even possibly displacing it outside of the relationship in the form of an affair.
- The ability to sooth themselves with a sense of higher emotional priority when their partners feel angry or hurt. Unless a partner has this capacity for momentarily switching to a higher emotional priority, they cannot approach risking c) or possibly b) if it might lead to conflict. They won’t be able to risk intimate exposure.
The model that I use for relationships is that both parties must have the emotional resources for dynamic balancing between the states of nurturance/connection and autonomy/self-reliance. Decades of work have shown me that the best model for predicting the quality of relationship is the dynamic balancing between these two emotional states. You can read alot more more about this relationship balancing in the book chapters provided in the Marriage Problems First Aid Kit.
When either individual lacks the emotional capacity to engage in any of the 4 emotional states above, then marital or relationship counseling needs to shift to a deeper level. This usually involves individual or group therapy to establish the missing capacity. Group therapy is useful in training in a “theory of mind” so that the individual can become more empathetic and curious about what their partner is experiencing. If a person’s background involves emotional trauma, then their anxiety may need to be reduced via EMDR therapy. Anxiety reduction may be necessary before they can relax enough to become sufficiently curious about their partner. When shame issues block a partner from expressing (or knowing) their desire, then individual hedonic inhibition therapy will be necessary for the individual to avoid feeling eclipsed in the relationship. If a person is blocked from using healthy anger in the form of assertiveness, then EMDR may be used to reduce their sense of helplessness. (Read more about EMDR here.) If a person is too fearful of feeling guilty about their partner’s anger or disappointment in any potential conflict, then conflict inoculation training may be necessary. And if a person fears their own rage in potential confrontations, then conflict inoculation training again is the likely requirement. In other words, personal incapacity can take many forms. The necessary intervention can take many forms as well.