Below are a number of the therapeutic/healing models I integrate into my clinical work. I tend to draw on a mixture of these approaches depending on the particular needs of each client and which approaches seem to work best for the person’s particular needs.
Attunement and Attachment Oriented Approaches
Have you ever felt like someone really understood and cared about you? Have you shared something vulnerable or personal and another person listened carefull and responded in just the way you needed? I remember one day when my neighbor and I arrived home from work at the same time. We greeted each other and paused to talk. He shared how he had had a rough day at work and was feeling frustrated. I deliberately resisted my all too automatic reflex to jump in with advice and just listened and reflected back what I was hearing in a very simple way affirming that that I could see why he was so frustrated. After about three minutes we parted ways and went to our respective homes. I wondered whether I had been any help at all since there seemed to be nothing I could do or recommend that would be of help in the situation. To my surprise the next day he shared with me how deeply he had appreciated our conversation. He said that after our talk it was like his frustration just washed away and he was able to walk into his home and be fully present and enjoy his evening with his family. I could hardly believe such a simple interaction could have been so helpful. Central to the positive transformation that resulted in my friends brain from this interaction was my ability to attune to him with no agenda.
Attunement is a fundamental skill which we can all improve through deliberate practice of being able to “tune in” to another person such that they feel seen, heard, understood, and that their feelings are real and matter. I write more about attunement in a separate post, but for now suffice it to say that it is a central skill in the success of basically every relationship from babies to spouses to friends and even to rivals trying to come to an understanding. Many people of faith I talk to even report that a highly important aspect in their ability to relate to and trust God is the experience of God being attuned to them.
Attunement is a central aspect of virtually every effective form of therapy even if it is not explicitly named. The capacity of the therapist to attune to the client and of the client to attune to their own varied emotions and internal experiences are critical to the client feeling safe, heard, and valuable. Attunement may not be the only thing a person needs which is why I also draw on other approaches, but it is usually one of the first things a client (or any person) needs. It is also the first step in identifying what more a person needs in a given moment so that we can work together to address those needs.
Cognitive Behavioral Approaches
The contributions and research of the longstanding cognitive and behavioral approaches to psychotherapy are very important to me and I incorporate knowledge and interventions from cognitive and behavioral approaches and from Cognitive Behavioral Therapy (CBT) which combines both of these fields. Helping clients to recognize and adjust maladaptive patterns of thinking and acting and to increase healthy adaptive patterns of thought and behavior is a very important part of the counseling process. As long as one remains attuned to the client these approaches can be helpful for a wide variety of needs including improving executive functioning, improving top down regulation of the nervous system, adjusting and reframing one’s perspective, and coping with the effects of painful memories that have not yet been processed.
Strengths Based Approaches
We assume that all clients have a great deal of strengths and gifts that they may or may not yet be aware of. Part of the work of counseling is to help people become more aware of their own internal and external sources of strength. Often we simply need someone to reflect back to us the strengths they see in order to begin to recognize them in ourselves. Remembering to help people recognize their strengths helps balance out the simultaneous work on challenges and growth areas that is also an important aspect of counseling process.
EMDR (Eye Movement Desensitization and Reprocessing)
Andrew Ross is trained in EMDR and incorporates it into his work especially for processing unresolved past experiences. EMDR was first developed by Francine Shapiro in the late 1980’s. Shapiro discovered this approach quite by accident one day as she was walking along thinking about a nagging somewhat distressing experience and then suddenly realized that for some reason it did not feel painful any more. She traced back the details of the previous few minutes and discovered that she had been moving her eyes back and forth in a diagonal motion rapidly as she thought about the experience. She tried the same combination of thinking of another nagging thoughts while moving her eyes in the same way and discovered that the distressing thoughts reduced. In chapter two of her book Getting Past Your Past she tells of her chance discovery and how she then began experimenting with friends and discovered the same combination of thinking of a painful memory and bi-lateral eye movements often seemed to resolve their painful memories. She gradually discovered ways to adjust things when a memory seemed to remain stuck and developed a protocol for how to work with traumatic memories using sets of back and forth eye movements. Since the 1980’s EMDR has grown into its own therapeutic modality with thousands of practitioners and over 20 randomized controlled trials indicating its efficacy at reducing the symptoms of Post Traumatic Stress Disorder (PTSD) and other clinical symptoms. Studies by Bessel Vander-Kolk seem to indicate that EMDR is more effective if PTSD symptoms are from one or a few traumatic incidents and to be somewhat less effective if a person has a long history of childhood abuse and neglect involving years of large and small traumatic experiences.
No one knows exactly why EMDR works to resolve traumatic experiences. One important aspect seems to be that it promotes dual awareness that one is both safe in the present and merely thinking of the painful memory in the past rather than actually being back in the experience. Another likely theory is that it activates our brains natural system for processing information which Shapiro calls our Adaptive Information Processing system. Traumatic memories seem to be those our brain was not able to process or metabolize at the time and so EMDR is a way to target those specific memories and help the brain finish the work of processing them in an adaptive way. EMDR can be very helpful with processing and removing the charge from both large and relatively small painful experiences. There are also cases where EMDR is not recommended such as if a person’s system is highly guarded to prevent directly accessing certain memories. In my opinion it is important to look at the big picture of a person’s life, internal system, and clinical goals to decide whether, when, and how often to include EMDR as part of the clinical work. I have both level one and level two EMDR training through the EMDR International Association (EMDRIA).
Internal Family Systems
Internal Family Systems was primarily developed by Richard Schwartz a recognized leader in the world of family therapy. He developed this model through careful attention to how his clients described their internal experience. Schwartz’s key insights include 1) that our minds are actually better understood as a system of differentiated “parts” that work together (or fail to work together) much like a family than as a single unitary mind. In other words our mind-brain system is so complex and intricate that it may be understood as multiple minds which work together in an integrated way than as one mind that only thinks/feels/experiences one thing at a time.
2) A second key insight by Schwartz is the concept of what he calls “self” which proposes that our identity is not simply a collection of parts but that at the center there is a “core self” which is different than the “parts” and is always capable of relating to the various “parts” within a person and to the outside world in a curious, gentle, compassionate, connected way. Schwartz describes being surprised to discover that this core self seems to exist with all of these capacities even in the most traumatized clients who had never received or seen modeling of this kind of care and compassion from caregivers.
3) Finally, Schwartz proposed that basically everything we know from “systems theories” about how family systems and larger social systems tend to function can be applied to the “internal family system” within each person. For example, polarization seems to be a common phenomenon in many systems where two sides have different opinions about what is the best course of action and become polarized and unable to see any common ground or creative way to collaborate. When this happens internally it can often leave a person feeling unsure how to move forward due to competing internal perspectives about what is needed.
At first glance these concepts may seem odd to the reader as they did to me but as I have experimented with them I have found that they have tremendous value both for counseling work and ordinary daily life, and that they are actually quite compatible with most everything else we know about health and well-being. Many people are relieved by the notion that they are not crazy because it seems that part of them wants and feels one thing while another part wants and feels another, such as the part that still longs for a parent’s affection and the other part that wants nothing to do with the parent. It is also incredibly valuable to people to find ways to connect more to their core self where they feel genuine compassion, care, and curiosity toward themselves and those around them. To learn more about IFS you can read Schwartz’s book Introduction to the Internal Family Systems Model
Approaches that Seem to Promote Memory Reconsolidation
Can painful and traumatic experiences actually be healed? Or is coping adequately well the best one can hope for? Scientific research into the phenomenon of memory reconsolidation seems to suggest that yes, traumatic experiences can be healed. Memory reconsolidation is the idea that memories that have already been “consolidated” into short or long term memory storage in the brain can be made labile again and re-consolidated in a new, more adaptive way. The result is that the person still remembers the event, but it no longer feels painful and no longer stirs up all of the same negative beliefs and emotions, and no longer seems to be happening to them all over again every time it is remembered. Ecker, Ticic, and Hulley’s book Unlocking the Emotional Brain provides a helpful explanation of the process of memory reconsolidation and proposes that a wide range of therapeutic approaches can accomplish the same goal of activating and reconsolidating large or small traumatic memories such that they no longer feel traumatic to the person. In reading many case studies and experimenting with various approaches in my own work I am in agreement with the concept that many but not all approaches are able to accomplish the goal of memory reconsolidation. In my personal experience, memory reconsolidation seems likely to be occuring in EMDR, during certain aspects of Internal Family Systems work, through Coherence Therapy, through The Immanuel Approach, and through numerous psychodynamic interventions. As I start to become more aware of somatic approaches such as Somatic Experiencing it seems likely that at least part of their efficacy is their ability to create a space where the brain can reconsolidate painful unprocessed experiences into adaptive, more fully processed experiences. In my experience the time it takes to enter the processing phase of therapy and to accomplish the goal of reconsolidating particular memories varies depending on many factors including client readiness and capacity. Processing painful memories is not the only purpose of therapy and needs to be balanced with other concerns such as skill building and addressing present challenges, etc, but it can be a very helpful and transformative part of the therapeutic process.
Faith Informed Approaches
For many people their faith and spirituality is a very important part of their lives and they are often eager to learn that faith can be thoughtfully, responsibly, and beneficially incorporated into the counseling work. I (Andrew Ross) draw specifically on faith based approaches which are grounded in findings from the field of neuroscience and compatible with more widely used and cutting edge approaches for working with trauma and personal growth. The Immanuel Approach to Emotional Healing developed primarily by Dr Karl Lehman is an approach which incorporates a client’s faith and spirituality as a resource in the counseling work. I make deliberate efforts never to impose faith beliefs on anyone. I only recommend approaches that incorporate faith and spirituality if clients explicitly indicate that faith and spirituality is something they would like to include in their work and if the approach is compatible with their religious and spiritual worldview.