How do I choose a Therapist?

Are you the right one?

How do I choose a therapist? This is a common question. How do you pick the person that you're going to open your wounds and spill your guts out? A person that you will establish a close relationship with?

After talking to some of my clients I've heard some factors that stick out as important in choosing: 1. How quickly the potential therapist responds to their inquiry. In such a technically accessible and convenient world, most clients feel a response in less than 24 hours is warranted; whether it's by text, email, Facebook, phone, etc. The quicker the better.

2. Google! Staying on the technical subject, many clients have reported doing Internet searches to see who comes up in their area. Thanks to www.psychologytoday.com, clients can look for therapists specifically in their area and also see the profiles of therapists and how and what population they work with. Many clients say they have an idea of how the therapist might be just by reading profiles or looking at their personal websites.

3. Friend or Family Recommendations This can be tricky for therapists because of confidentiality, however some clients report that they've sought out therapists based on a personal recommendation. The therapist can never confirm this, but the family or friend that comes in may have more confidence in the process knowing someone close to them is being helped.

4. The Very First In Person Meeting! This is the scary part. There is a consensus with clients, that they really make their final decision after the first meeting. Most clients say they "know" immediately after this first meeting their comfort level and whether they'll continue or not. You may be wondering why Experience is not one of the four listed? This factor does come up and has been asked: "How many years have you been in practice?" or "How long have you been working with couples?" Ultimately after meeting with the individual, if it is determined we're on the "same page" with treatment plan and goals, we can work together to gain distance from their problems, and the years of experience requirement becomes less of a priority.

In Veritas Libertas -Heather Cotsenmoyer, MA, MFT

Letter Writing & Therapuetic Declarations

The Power of Letter Writing & Therapeutic Documents

There are many ideas of what the therapy process is like, and with Cognitive Behavioral Therapy (CBT) so mainstream, many clients expect to receive “homework” from their therapist. CBT employs the use of homework to “allow” the client to practice skills that they’ve been working on in therapy sessions in everyday life. Some researchers (Fehm & Morse 2008) have shown that clients who complete homework have better outcomes in therapy and homework helps facilitate incorporation of these skills in everyday life. I believe that homework is beneficial for many of my clients, but not one of my requirements. 

My foundational training is in Narrative therapy which involves “re-authoring” or “re-storying” conversations. www.narrativetherapycentre.com 

The idea is to “de-construct” the stories we’ve been living by that have been affecting us, and get back to a “preferred” way of living. Narrative therapy, unlike CBT, does not focus on behavior modification, but more on the therapeutic conversation itself. However, I do use a combination of these two ideas when suggesting the letter writing exercise to my clients. Most times, the end result is more of a “declaration” to the Problem and terms and conditions from the client on how they’ll be moving forward with or without the Problem.

Here is an example of a conversation about the “assignment”:

    1. What would you call the Problem/s that brought you into therapy? 

        ex: Depression, Guilt, Shame, Addiction, etc.

    *This is naming the problem, getting a better understanding of how the client experiences life*

    2. “How has the Depression been controlling your life?” “What kind of person does the         Depression tell you are? “ 

    * This helps externalize the Problems and help the client set up their terms and conditions*

    3. “Between now and our next session, write a letter to Depression. Talk to Depression         about your current relationship. Let Depression know exactly how you feel about it’s affects on your life and how things are about to change”

    *This sets the Problem (Depression) apart from the client and allows them to remove the label of “I’m a depressed person” and move towards “I have a relationship with Depression I can manage”.

This is just a brief example, and this usually happens after a few sessions with the client. I have been privileged to hear some beautiful, powerfully moving, and emotional letters. My clients have said things like, “the experience was initially difficult but worth it after completed.” They have been mostly thankful for the “assignment” and appreciative of the therapeutic support. The beauty of this is that this can be a lifelong tool. Letters and declarations can be written to Problems, Family or Friends, and I have even written letters to clients about our work in session. 

If you or anyone you know is interested in therapy, feel free to contact me. 

www.therapywithheather.com 

Roles in Relationships

What is your role in a relationship?

Most of the time we take on multiple roles. For example: wife, mother, friend, etc. These roles can and must change in a split second according to life's demands, and healthy relationships come down to how we maneuver through these roles. 

Roles navigate us through daily living by "requiring" certain specificity when we commit to them. As a therapist, I see the strain on the relationships where a role has been taken on inappropriately. The best way to describe this is to use myself as an example. In a therapy session, I take on the obvious therapist role; this requires professionalism, collaboration, and empathy for my client. I never want to switch over to the "Friend" role with any of my clients because this can cause confusion and cross boundaries. A person would not be coming to a professional for help if they could just get what they "needed" from a friend.  A client may not always have immediate access to me as their "Therapist" as they would a "Friend". This is not a limitation, in fact is an important part of the therapist client relationship. It empowers the client to independently think through and process the situation and then be able to come back and collaborate ideas at their next session. 

In couples therapy I hear about inappropriate "self-assignment" of roles and sometimes have had it modeled in session as well. There are times when instead of working together for example as husband and wife on an issue, there is husband and mother, or husband and child working against each other. This often time happens when there is Emotions in the room, and there is no real hearing of the other person any more.

This is not to imply that we must always be and act a certain way, it is merely a suggestion to be more aware of oneself. How do you interact in your relationships, and how do you allow your relationships to interact with you? 

The Truth Shall Set You Free......

In doing work with couples, the issue of infidelity unfortunately comes up quite often. Fortunately, I have been privileged to witness relationships heal and move forward stronger. I am not trying to fool anyone, this is an arduous process with many facets. 

When looking at the statistics, for heterosexual couples, it is close to 50/50 (husband/wife) on who has the affair. And a common misconception of the word "affair" is that is always sexual. While this does happen at a higher percentage, in our digital age there is sexting, online chat, Facebook, etc. 

The person who has had their trust broken can mirror a grieving person that has lost a close love one. A way to understand this process is to become familiar with the Kubler-Ross model of the 5 stages of grief. The stages are: Denial, Anger, Bargaining, Depression, and Acceptance. These usually never go completely in order, and will cycle back and forth between stages. 

The person who has broken the trust can also go through the above stages, but it all depends on what he or she decides is their "agenda" for their relationship. Most of the couples I've worked with have an "agenda" of repairing their relationship and the unfaithful partner ultimately does not want to leave their relationship for their paramour. 

As scary as telling the truth to your partner may seem, it can set you free from the unrealistic "smoke and mirror" world you've been in. 

If you are having trouble in your relationship or need support to "come clean" to your partner. Please contact me to schedule an appointment. 

Heather Cotsenmoyer, MFTI 

Recovering.

Recovery; A Second Thought.

In the many conversations that I've had with clients, it seems apparent that there is a preconceived notion and seeking of "recovery" from problems. And according to societal standards,  if one is not able to to do this in a short period of time, then they have failed. 
Here is society's mathematical calculation:  pressure with the client to FIX things, and pressure from the therapist to FIX things eventually = recovery.

The dictionary definition of recovery is "a return to a normal state of health, mind, or strength." Just the fact that the definition contains the word normal, makes it easy to understand how pressure exerts all its power on someone. It is also understood that there are processes involved in recovery. It is the therapist's job to question the process and assist with better understanding of the person's  relationship with the problems. There should not be an attempt at making the person more normal.

When we hear about the recovery process, it is common to assume there may be "issues" centered around what can be referred to as substance abuse. I will use alcohol as an example. I meet with a group of wonderful women on a weekly basis and we have rich conversations around their past and previous relationships with alcohol. I attempt to collaborate a shift in thinking and examination of the relationship between the person and the alcohol. We look at all sides of the relationship and "renegotiate" this relationship with alcohol. (Madsen, W. 2007 Collaborative Therapy with Multi-Stressed Families) This is done with questioning and curiosity, rather than concluding and advising for example, that if she just STOPPED drinking and being an ALCOHOLIC, than she'll be able to recover.
 I know that some clients may in fact need to focus on abstinence in the short term to survive, but as a clinician I realize that in the long term, moderation can be a viable option in the process. Risks should always be taken into account, but focus should be on the person's strengths and not their deficits.