Therapy is a plan that takes someone from a problem to a solution. It should not be any more complicated than that. Therapy should be organized, and it should not have too many moving parts. It should not add more confusion to someone’s life. I often hear therapy described as a “struggle.” I cringe when I hear this. Therapy is not a gladiatorial event. It is a process. In many ways it not that different from consulting with an attorney or a CPA. You are seeking knowledge from a highly trained professional. The patient, really is a customer, and should be treated with respect. Therapy is a process. Let’s talk a little bit about what that process should look like.
I begin by taking a very thorough history which includes previous mental health treatment and medical history. If the patient is an adolescent I request that the parents arrange for a complete internal medicine review with all standard laboratory assays including a thyroid panel. This is to help rule out any potential organic source of an emotional issue. When I receive the medical information, I will sit down with the parents to see if any follow up is indicated, such as a pediatric neurologist or a pediatric endocrinologist.
I ask the patient to tell me in 1 or 2 sentences why they are here. That will be the working or provisional diagnosis. With more information, the diagnosis will sometimes be modified. In my practice I use behavior modification, and cognitive therapy. Both are helpful, and it is now common to weave them into what is called CBT, cognitive behavioral therapy. There is one more technique that I use called “Patient-Centered” therapy. Each of these techniques are easy to understand, and have a long history of success. I will discuss each one briefly
Behavior modification is not new, and mothers have been practicing this technique for thousands of years! It is simply rewarding the behavior you want. I have always been attracted to its simplicity. There is nothing hidden. Indeed, it can be announced to every member of the household.
Cognitive therapy is another powerful tool to treat adolescent depression. It is based on a simple idea—we become what we think. In some sense the world is neutral, until we assign a meaning to it. Isn’t it interesting how two people can experience the same event, and respond differently.
Surely the reality was the same for both. What was different was the way they processed the event. So, in a manner of speaking, each person actually did experience a different reality.
In cognitive therapy I teach my adolescent patients “don’t believe everything you think.” There is a relationship between feelings, thoughts, behaviors, and physiology. When an adolescent is depressed or lonely, it can be very difficult to see the connections between a thought and an emotion.
A lot of sadness is generated by thinking about something in the wrong way. In cognitive therapy I ask my patients to challenge the accuracy of their thoughts. This can take time, because many inaccurate
thoughts have been living rent free in a teenagers head for years. They become, in an odd way, comfortable with these maladaptive thoughts because they know them so well. It is a kind of “Stockholm Syndrome” where they become friends with something that is tormenting them.
When an adolescent begins to challenge and discard inaccurate perceptions, it can be like walking through the Narnia closet—they discover a whole new world.
Cognitive therapy allows the patient to become their own therapist. It is less directive than it is collaborative. This is especially helpful for a teenager who is seeking to master his or her own life.
There are two other clinical philosophies in my practice that I wish to discuss. The first is something developed by Carl Rogers called the “Patient-Centered Approach.” The second one is “Positive Psychology.” Both the Patient-Centered Approach, and Positive Psychology, are actually two distinct forms of psychotherapy. However, I use these two techniques in a slightly different way—more as a foundation upon which I build the cognitive-behavioral therapeutic treatment. The Patient Centered Approach and Positive Psychology are like background music that I use to help build the relationship that is a necessary of personal growth. I will explain each one briefly.
The Patient-Centered Approach is non directive. It states that a person is part of a constantly changing and dynamic environment and that each of us is striving to reach the “real self.”
The real self is distinguished from the “ideal self” which is the one That society is trying to impose on us. The main feature from this therapy that I use frequently is called “Unconditional Positive Regard.”
A lot of therapies in psychology assume that the patient has a few missing parts, and that it is the goal of the doctor and patient to find these missing pieces or create new ones. What I really like about the Patient Centered Approach is that it assumes that the individual seeking therapy is already fully constituted and whole. The patient is a flower looking to bloom with all the petals intact.
The main feature from this therapy that I use all the time is called “Unconditional Positive Regard.” This gets misunderstood a lot, so I want to explain it. It does not mean that I smile, nod my head, and agree
with everything that a patient says. Rather, it means that I value, respect, and support the person in my office as an individual. In therapy, the patient frequently tries to conform to the way the doctor sees
the patient. Thus, the patient really never fully develops into his or her authentic self. Client-Centered Therapy puts the patient in the drivers seat, and the therapist becomes a coach. It transfers the power from
the therapist to the patient. There is a certain magic in that transfer.
The other technique that I weave into all of my therapy is called “Positive Psychology.” I view positive psychology as a style of delivering therapy rather than a therapy in itself.
