How well does CBT work in therapy?
I never did CBT like a class, as if the client were a student, with the lessons and the worksheets, following a manual. That’s psychoeducation, possibly helpful and interesting, but absolutely not psychotherapy. But if you’ve got a good working relationship with a client, based on trust and commitment, CBT-type interventions can be great.
Are therapists supposed to tell clients they deal with emotions wrong?
Therapy is a deep, unique relationship that allows full expression, exploration, and resolution of any and all emotions and a lot more. It’s about an approach tailored specifically to you, the whole you, not some convenient label or diagnosis.
How many appointments does it take to know if a therapist is a good fit?
Unlike dating, therapy is a relationship for a carefully managed, well-boundaried single hour every week or so, with a person who’s trained and who has experience in doing what they’re doing, probably for thousands of hours, without getting into too much trouble.
Is therapy supposed to be this incredibly important relationship that shapes the rest of your life, or is it actually not that deep?
Both, or either one. It can be an incredibly important relationship if you have a lot to reframe and repair, or not as deep when you just need help stopping smoking or deciding whether to retire now, etc.
How can a therapist help a client safely externalize pent-up anger?
I think that might be the wrong question. “Letting it all out” doesn’t work and can be dangerous.
How do therapists help depressed clients who struggle to engage because everything is bad and nothing is ever enough?
The client showed up for therapy. That is huge. They keep coming. That is more huge. I’d say the client has engaged, plenty.
Still, they keep saying everything is bad and nothing will ever be enough?
OK. Then that’s where we start, supporting the client as they find ways of expressing it fully and in different ways, all the feelings and the thoughts.
How is attachment to my therapist a sign of healing when it hurts more than my original pain?
Ah, the pain thing. Therapy can be painful and often is. You’re letting go of some of the maladaptive defenses, and the avoiding, and the self-kidding that cushioned you from pain but stopped your growth. That hurts.
Do people cry in front of their therapists?
They often do, and they should, and it’s a good thing... There’s just about no better place in the world than a therapy office, where you don’t have to hold back tears or any expressions of feelings, because you have this special, highly private relationship with another human who is fully there for you, and you see only for that 50 minutes, once a week or so.
Can therapists give clients gifts and still stay ethical?
I gave gifts to clients. Once. Not unethical, but also not very bright of me. One year, long ago, I saw a picture of a paper white narcissus and thought it was beautiful. I’m no botanist and don’t know much about flowers, but I really liked that one.
What is your opinion of a therapist who tells you what to do?
If you’re having a panic attack in front of me, I know what to do to help stop the agony, but you’ll need to follow my instructions and let me help, which is up to you. I will always ask your permission before jumping in.