Why your therapist won’t tell you what to do

One question us therapists often hear from our clients is, “What should I do?”

It makes sense that a client would want our advice. After all, we are often the only people in our clients’ lives who know all of the intricate matters of their hearts. We sit with the ambivalent feelings, desires, and conundrums our clients find themselves encountering. And, because we aren’t interwoven in our clients lives in the way that a friend or family member is, we aren’t directly impacted by the decisions our clients make. In short, we get the full picture without being in the picture. So, why shouldn’t we give them advice? 

Let me answer this question by painting a picture of a hypothetical client scenario. In this situation, a client has been dissatisfied with her relationship for quite some time. She feels that her partner cannot connect with her on an emotional level, and their sex life has been lackluster for the past year. She explains the full details of her situation to her therapist and asks, “What should I do?” Her therapist says, “Well, it sounds like this may not be the best relationship for you. I think you should leave.” 

What are the possibilities coming out of this? Let’s consider a few. 1. The client leaves her partner but later feels she has made a mistake. 2. The client leaves her partner and is thrilled about making the decision, but she is robbed of her confidence in her ability to make her own decisions and relies on her therapist for all future major decisions. 3. The client stays in the relationship and no longer trusts the therapist's opinion. 4. The client finds that she actually resents being told what to do and ghosts her therapist, losing faith in therapy and never getting the therapeutic help that would have helped her confront her deeper underlying reasons for seeking help in the first place.

As you can see, there is no winning when we provide advice to our clients.

In fact, this can do more harm than good. When providing an opinion, we may also fall into the unethical trap of imposing our own beliefs and values onto our clients – a direct violation of our ethical code. We also strip our clients of the very empowerment they come to therapy to build. While providing an answer to our clients’ problems may temporarily provide relief from uncertainty, it also reinforces reliance on the therapist to provide a sense of certainty. We want our clients to stand in their own power and trust in themselves – and to believe that no matter what the outcome of their dilemma, they will be able to handle it. 

So, what do we do when our clients ask us, “What should I do?”

We have several approaches we can take. We can help our clients to think through the pros and cons of each choice. Through this process, we may collectively uncover possibilities our clients had not thought of before. We might even go deeper than the surface level questions, challenging catastrophizing, black-and-white thinking, and other cognitive distortions. Perhaps we’ll find that the situation is not as bleak as it seems. If a client seems to be intellectualizing a choice, we might focus on expressing feelings and underlying needs. Contrary to popular belief, feelings and needs play an important role in decision-making and should not be ignored. Finally, we might explore how similar situations in the past are connected to the client’s emotions and beliefs about the current situation – or even confront the concepts of uncertainty and control more abstractly. 

We therapists are certainly flattered that our clients think our opinions are worth seeking on-high stakes decisions. But we also care about our clients enough to not tell them what to do. What we can do – and what is ultimately far more helpful – is  help them gain more insight into themselves. And this in itself is so powerful. Because when our clients know themselves better, they can make better-informed decisions that are aligned with their own goals, values, and beliefs.  

Book with Author Kaitlin Lowey: https://SouthTampaTherapyBOOKAPPT.as.me/KaitlinLowey

How to get unhooked from difficult thoughts and emotions with ACT

By: Kaitlin Lowey, MHCI

You’ve likely heard the phrase uttered by Benjamin Franklin, “...in this world nothing can be said to be certain, except death and taxes.” As a mental health professional (and fellow human being), I would add one other inevitability: experiencing uncomfortable thoughts and emotions. 

“I’m not good enough.” “It’s breaking my heart.” “I totally freeze.” “Something feels off in my gut.” “What is wrong with me?” “I feel depressed.” “I’m so scared.” “What if I get it wrong?” “Do they actually like me?” “Why did I say that?” “What if I fail?” “What if I end up alone?”

Our difficult thoughts and emotions are 100% normal.

Many psychologists and counselors, especially those practicing Acceptance and Commitment Therapy (ACT), would argue that experiencing such thoughts and emotions is just part of being a human. In fact, emotions like anxiety serve a purpose – they protect us from threats (like a charging lion or a dimly-lit alley). Uncomfortable emotions only become a problem when they show up in non-adaptive ways and stick around long past when they’ve served their purpose – in other words, when the degree of emotion we feel outsizes the actual threat. Our emotional responses are both innate (such as fear of snakes) and learned (such as fear of touching a hot stove). Some emotional wounds experienced in childhood, particularly those related to relationships, can continue to impact our emotional responses well into adulthood. 

So, what do our minds do when we experience these emotions? They view the emotion as a problem to be solved – to be gotten rid of. Again, the mind’s problem-solving nature is normal. It’s how humans have survived and adapted for thousands of years. For instance, humans built homes to shelter us from animals and the elements. We created the wheel to transport objects more easily. We even invented the remote control to save us from the inconvenience of having to move to turn up the volume on the TV. Our brains are hard-wired to problem-solve, and that’s usually a great thing! However, it’s not so great when our brains’ well-intentioned but ill-fated attempts to get rid of uncomfortable feelings only makes those feelings stronger. 

So, what happens when our emotional response and our problem-solving are both operating on overdrive? Russ Harris, the author of ACT made simple: An easy-to-read primer on acceptance and commitment therapy, describes the effect as getting hooked. Getting hooked means our brains automatically label the thoughts as a threat, something we have to act on, or something requiring all of our attention (what ACT theorists call cognitive fusion). We may do everything in our power to get rid of them (what ACT theorists call experiential avoidance). In addition, we might start to fuse these thoughts with our self-concept (e.g., If I keep thinking I’m bad, then I must be a terrible person.) We can also lose contact with the present moment, instead narrowing our focus on the thing that’s making us uncomfortable, disconnecting from our experience, or disengaging. Ultimately, we can lose sight of our values (what we care about and want out of our lives) and instead attempt and reattempt the same ineffective strategies to gain control over our thoughts and feelings. In other words, we use just about every strategy we can to banish our discomfort. This might look like denial, obsessively ruminating on whether or not our thoughts and feelings are true, procrastinating, engaging in addictive substances, and other attempts to control and escape. 

The problem with these strategies is that they are not likely to work. Not only do they not solve our emotional discomfort in the long run – they actually move us away from the kind of life we want to lead. And to top it all off, they often result in a spiral of shame and self-loathing. It’s a vicious cycle. 

At this point, I want to pause and remind readers that it’s not our fault our brains are wired this way – it’s extremely normal and entirely human! And, once we accept this, we can begin to make changes that help our minds work for us, instead of against us.  

So, what’s a human to do? And how can ACT help?

ACT proposes an alternate strategy (with many concepts borrowed from Yogic and Zen principles) to deal with our emotionally uncomfortable thoughts and feelings: accepting them. What if, instead of fighting our emotions and accompanying thoughts, we accepted them for what they are: our bodies’ and minds’ attempts to protect us? What if, instead of living our lives constantly running away from our discomfort, we were able to view our discomfort as separate from ourselves, accept that feeling discomfort is normal in the situation we are in, and make choices that are workable and that move us in the direction we want? In other words, what if we were able to get unhooked?

Several tools from ACT can help us unhook from uncomfortable thoughts and feelings. For instance, mindfulness strategies work to reduce emotional intensity by enabling us to attend to our emotions and the present moment with compassion and acceptance. They can also get us into the habit of viewing our thoughts and emotions as things we are experiencing in this moment, rather than the absolute truth or indicative of who we are. 

One of my favorite ACT tools involves the concept of workability versus absolute truth. As Harris states, ACT isn’t interested in whether thoughts are true – the concept of truth could be endlessly debated. Instead, ACT is interested in whether our thoughts and what we do with them are workable. If a thought or a behavior is workable, it has worked for us in the past and/or is likely to work for us in the future. It will move us closer to our long-term goal. This is a simple question we can ask ourselves when we find ourselves getting hooked and in auto-problem-solving mode: is this thought or behavior workable? Or will it be ineffective or cause other problems? 

Finally, ACT asks us to get really clear on our values. What kinds of concepts (such as love, compassion, resilience, integrity, and authenticity, for example) do we want to guide our actions? If our problems did not exist, how would we operate? Once we know our values, we can endeavor to live in alignment with them. And living in alignment with our values results in less emotional discomfort, improved self-concept, and greater fulfillment. 

Who can benefit from ACT? 

Evidence shows that ACT can be effective for a myriad of mental health problems, including anxiety, obsessive-compulsive disorder, depression, stress, phobias, chronic pain, addictions, and adjustment. But I believe that just about anyone can find usefulness in the approach. As Harris writes, 

“Who wouldn’t benefit from being more psychologically present; more in touch with their values; more able to make room for the inevitable pain of life; more able to defuse from unhelpful thoughts, beliefs and memories; more able to take effective action in the face of emotional discomfort; more able to engage fully in what they’re doing; and more able to appreciate each moment of their life, no matter how they’re feeling?” (Harris, p. 36) 

There is much more to ACT – more than can fit in this article. But I hope this post provides a basic understanding of how ACT can help us humans get unstuck and live a more meaningful, fulfilling life. 

By: Kaitlin Lowey, MHCI

Kaitlin joins her clients as they find relief, healing, hope, clarity, and transformation. She has helped individuals experiencing struggles with anxiety, stress, relationships, life changes, obsessive-compulsive disorder, intrusive thoughts, grief and loss, fertility and postpartum, motherhood and parenthood, athletic and career performance, perfectionism, identity, and self-worth. As an integrative therapist, Kaitlin collaborates with her clients to identify goals and choose research-supported therapeutic approaches that fit best. She offers in-person and online appointments.

Book with Kaitlin Lowey, MHCI here: https://SouthTampaTherapyBOOKAPPT.as.me/KaitlinLowey

The Power of Listening in Communication

Why do we communicate? Communication is the key to understanding. Understanding helps to create a quality of connection sufficient to work together and collaborate, and to attend to our needs. 

“The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention….” -Rachel Naomi Remen. 

Listening can be a powerful tool to help get to a place of greater understanding. Listening depends on silence. The ability to let go, even temporarily, of your own thoughts, views, and agenda for the conversation, in order to be fully present and listen to the person in front of you. 

Listening can help build trust and good will between two people. 

There are three basic ways to listen: 

The first is silent, present listening. This entails letting go of your own thoughts and agenda, in order to be fully engaged with the person you are communicating with. Try to get curious about what the other person is communicating. Think of yourself as an eager student listening to an exciting lecture. Your role is to listen and gather as much information and understanding as possible. Try to come from a place of wanting to connect and understand through listening. 

The second way to practice active listening is to utilize one of two skills: paraphrasing or summarizing. Paraphrasing is to restate what the person just shared with you, exactly in their own words. There are no additional words, meanings, or questions attached to the paraphrase. 

Here is a simple example: 

Speaker: “I have been feeling sad and lonely this past week”. 

Listener: “You have been feeling sad and lonely this past week”

Summarizing is something you can utilize AFTER you have listened to the speaker share their full story. A summary is a more condensed version of what you just listened to, but it still includes all the main points that the speaker just shared. Think of a summary as what you would find online about a book or movie that you are wanting to understand the meaning of- it has the gist of the story and the main themes, without all the specific details. Utilizing the skill of summarizing allows the speaker to see that you were truly listening and trying to understand what they shared. It also allows the speaker a chance to correct or clarify anything that may have been misunderstood. A good summary shows that you are a good listener. 

The third way to practice intentional listening is to utilize a skill known as empathetic reflection. This is very similar to the paraphrase skill; in that it mirrors what the speaker just shared with you. However, the key difference in an empathetic reflection is that it must include both the feeling the speaker is experiencing, as well as the reason for that feeling. 

Here is a simple example: 

Speaker: “I’m feeling really anxious about tomorrow. I have my big annual review with my supervisor.” 

Empathetic reflection: “You feel anxious because you have your annual review with your supervisor tomorrow.” 

Notice how the sentence includes the feeling word: anxious; as well as the reason for that feeling: an upcoming annual review with a supervisor. Empathetic reflections are so helpful because it allows the speaker to see that you are not only actively listening to what they just shared, but that you are willing to understand how they feel even if it is uncomfortable for you. Think of empathy as feeling into or feeling with the other person. You do not have to share the person’s feelings in order to empathize with them. It’s best to utilize the same words that the speaker shared in your empathic reflection. Keep it simple and remember that if you are actively listening, you will hear clues as to how the speaker is feeling, and the reason for that feeling- which are the 2 pieces you need for your empathic reflection. 

People thrive and grow when they feel understood. Which is why active listening can be one of the most powerful healers for difficult conversations. Practice utilizing the 3 basic ways to listen and see how it can transform your conversations to create more understanding and connection. 

Written by: Jamie Rudden 

https://SouthTampaTherapyBOOKAPPT.as.me/JamieRuddenMFTI

“Words are Windows

(or They’re Walls)

I feel so sentenced by your words,

I feel so judged and sent away,

Before I go I’ve got to know

Is that what you mean to say?

Before I rise to my defense,

Before I speak in hurt or fear,

Before I build that wall of words,

Tell me, did I really hear?

Words are windows, or they’re walls,

They sentence us, or set us free.

When I speak and when I hear,

Let the love light shine through me.

There are things I need to say,

Things that mean so much to me,

If my words don’t make me clear,

Will you help me to be free?

If I seemed to put you down,

If you felt I didn’t care,

Try to listen through my words

To the feelings that we share.”

— Quote Source—Ruth Bebermeyer

Why I Only Accept 50% of Insurance Clientele & 50% Self-Pay In My Private Practice (50/50/❤️ MODEL)

WHY I ONLY ACCEPT A FEW NEW INITIAL INTAKE INSURANCE APPOINTMENTS

USING MY MORAL COMPASS AND COMPASSION FOR HUMANITY, I’M CHOOSING TO CREATE A 50/50/❤️ MODEL:

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Sliding Scale Fees help advocate for affordable mental health care and create an opportunity for highly qualified INTERNS to counsel clients in need. I interview interns extensively, decide selectively, and supervise very closely and yet very trustingly. I will be an active participant in each session.

I initially started accepting insurance 15 years ago when I felt a strong need to support my community, who needed financial support, to get consistent help. Despite hearing horror stories from colleagues about insurance paperwork and clawbacks, I joined a few insurance panels. I loved every minute of being a therapist! I hated everything about the administrative process when it came to dealing with insurance companies. Don’t get me wrong, I love my insurance peeps! We have connected over the years and I will continue to support my clients who choose to use insurance as they should!

I too, have health insurance. I get it, we have health insurance for a reason, pay high monthly premiums, and should be able to use insurance when we need it!

Regardless, I will show-up powerfully for ALL of my clients.

I feel good about my choice to create a 50/50/ ❤️BALANCE in my Private Practice!

As a healthcare member and a private practice provider, I’ve had the unique experience of seeing both perspectives of the healthcare system in the US.

As my specialty has continuously evolved, I have realized that mainly accepting insurance no longer make sense for the advanced work that I do. Ultimately, my decision came down to acting with integrity and practicing what I preach to my clients.

Here are some key points to help you understand my decision to create this model for my Practice:

LACK OF PRIVACY & CONFIDENTIALITY

When insurance companies pay for your treatment, it also means that their employees (clinicians or not) will audit my treatment plans and read what we talked about in my session notes. These employees are paid to save the insurance company money by searching for fraud and determining whether you're overusing your insurance coverage. In turn, the insurance company may decline authorization of additional sessions because you're not progressing fast enough; our work in psychotherapy does not qualify as "a medical necessity": or because my treatment approach isn't recognized by the insurance company as an "evidence-based treatment" (that's code for short-term, as in 6-8 sessions).

Hell, some insurance providers don't reimburse for 60-minute sessions anymore!

This doesn’t seem right.

I recently got audited by an insurance company. This audit took me countless hours, staying up late at night, time away from my family, unnecessary stress and scrutiny to provide tedious paperwork and specific details to prove that my clients needed the services provided. This is just not okay in my book. I totally understand documentation for integrity but demanding extra proof during a pandemic when I am already submitting the necessary information and feel overwhelmed and overworked helped me create the awareness and opportunity for me to reflect on MY CHOICE to accept insurance.

At first, I reactively felt angry resulting in thoughts and hopes that the insurance company would fire me! However, when I pause and feel to respond intentionally, I honestly and truly feel honored to hold space and care for ALL of my clients and I would feel disappointed if I were unable to offer insurance as an option.

In conclusion, I believe that everyone has a right to confidentiality of your medical records. You also have the liberty to progress through treatment at a pace that's best for YOU - one that allows you sufficient time to process everything that you're experiencing. Things unfold differently for each person, especially when our world seems chaotic (Global Pandemic)! If the insurance company fires me, they rip the therapeutic relationship apart that my clients and I have securely built over the years. Emotional injuries and attachment issues can be easily re-traumatized within seconds.

DIAGNOSIS OF ILLNESS

Insurance companies operate on a medical model, which means they require a diagnosis to establish that you have "a medical necessity" to seek services in order to pay providers. To justify that you have a "medical necessity" I have to assign you a diagnosis to be reimbursed for our work together when there may not be one that really fits what you're going through. The vast majority of insurance companies don't consider relationship issues like couples or family therapy, developmental/attachment trauma, existential issues, life-transitions, personal development, or self-improvement as "medical necessities" because there are no diagnoses for these in the DSM-V.

And even if there are appropriate diagnoses, there are some diagnoses that insurance companies don't consider debilitating enough to pay for. So, if I know what diagnoses are and are not paid for, l'd have to label you with a more severe diagnosis they will pay for, but one that may not really reflect your situation. I am not ok with this either!

You're probably wondering, "What's the harm in that? A little truth-bending never hurt anyone." Well, that's just it - it can. It can come back to bite my clients in the ass... your medical record. While that might not be such a big deal right now, it may become one later on if you want to: get life insurance, work in the financial sector managing other's assets, regularly handle firearms, or seek employment in any sector in which your decision-making might be called into question due to your emotional state. Call me crazy, but I feel that people should get the help they need without fear, stigma, or reprisal for making their mental health and personal growth a priority.

FRAUD

If I engaged in the aforementioned truth- bending, I'd essentially be committing insurance fraud. There are providers out there that are willing to walk this fine line and take this risk. In my opinion, the penalties and professional consequences of insurance fraud are huge, and frankly, not worth it. I have a strong need for peace of mind that comes with integrity.

LOW RATES

In order to be "in- network" with an insurance company, I have to agree to accept a lower fee in exchange for the insurance company listing my practice in their directory of providers and sending me referrals. In the spirit of transparency, most of my clients find me through friends, family and through searching online. And each year, insurance companies continue to cut the rates they pay therapists for their work.

Here's an example with real numbers and real circumstances of how this happens: My fee is $170 per session. But I joined XYZ Insurance Co.'s network because I had a client in need of services. I chose to help and chose to agree to the insurance reimbursement rate of $60 per session. My client would also be responsible for a co-pay of $0-$40 per session depending on his plan, bringing the total to $60-$100 per session. That means I'm waiving at LEAST $70-$110 for each session. As a healthcare professional, I want to help! I have made these types of choices for the 20 years that I have been in private practice. I will keep choosing to advocate for my clients who have insurance because I also have insurance for myself and my family.

Would you be willing to forgo ~65% of your salary?:-/

I will also continue to set boundaries with ALL of my clients and companies that I choose to work with. If you no-show as a self pay or insurance client, I will treat you the same and ban you from being able to book an appointment until we have a meeting. I get it. I want to understand one another and use empathy. Life happens. I want to turn toward these curveballs

Additionally, insurance companies have been increasing their members' premiums, deductibles, and co-pays in the last few years claiming rising costs of care. You'd think that that would translate to higher reimbursement rates to care providers, but it doesn't...at least not in the mental health fields. In fact, insurance reimbursement rates have actually decreased over the same period of time. You're probably wondering, "How do the therapists and psychologists that take insurance afford to?

For such insurance-based practices, taking on more clients than is clinically prudent is the only way to make up the difference and keep their doors open. This then leads to another problem...

BURNOUT & EXHAUSTION

Here's the reality, many providers that accept insurance overbook their schedules in order to turn a modest profit after rent, utilities, malpractice, and other expenses.

Additionally, these providers often only offer a 30-50-minute session to maximize the number of clients in a day (10 vs 8) and the chances of insurance reimbursement (remember, most insurance companies don't pay for 60-minute sessions anymore). Also, if you use the 60 min codes, you are flagged for audits which take hours and hours to complete.

DELAYED (OR NON) PAYMENTS

Despite the insurance companies agreeing to a set reimbursement rate, these companies require therapists to jump through a bunch of hoops to get paid. It is common practice for most insurance companies to reject submitted paperwork to delay payments. When they're not seeing clients, these therapists are drowning in insurance paperwork and resubmitting billing claims in order to get paid, or spending hours on the phone contesting unpaid claims.

On average, it takes an additional 1.5 hours of UNPAID work outside of the session to get paid for sessions. And remember, the therapist is already making less by agreeing to take insurance. (In my previous example, it would cost $255 of my time ($170x1.5) to get paid my $60 reimbursement rate from XYZ Insurance Co.)

The alternative is to pay a medical billing company 8-10% of the claims' costs to do the aforementioned, but that increases expenses and cuts into that modest profit I mentioned before. But let's say that I or my medical billing admin ARE able to see the claim through the labyrinthine insurance payment process, the payment will finally arrive in my bank account anywhere between 3-6 months after the session took place IF everything goes smoothly.

RETROACTIVE CLAIM DENIALS (AKA CLAW BACKS)

Now imagine that, after all that trouble, that insurance company asked you to give the money back, even years later. Yep, this really happens and, unfortunately, it's a common practice among insurance companies. They'll audit your claims and paperwork for several years back. If they find any mistakes or inconsistencies in the therapist's paperwork they missed when they originally approved the therapist's claim, the insurance company will request that the therapist return the fees she was paid.

Pretend that your employer sent you a bill requesting that you repay the income you'd earned 3 years ago. Would that seem fair to you? I didn't think so. Claw backs can amount to thousands of dollars that can bankrupt a small business like a private practice. Many insurance- based clinicians live in fear of such retroactive audits.

Before reflecting and reassessing the insurance-based private practice I founded, I recently heard from a friend and colleague that a major insurance company requested thousands of dollars be returned by the end of the month. Talk about stressful!

All together that's a recipe for a tired, overworked, and stressed out therapist.

This may have been the problem if you've ever been to therapy that you felt didn't "work" with a provider from your insurance company. I should know. I started to experience the symptoms of burnout after two years of insurance-based practice. And that's when I realized, "Crap! I'm doing the things I tell my clients not to do!" Talk about incongruence!

So I changed my business model for the sake of the well-being of myself and my team to preserve the quality of care we want to provide every client. It breaks my heart to REDUCE ACCESS to care for people in need, but I realized early on that we can't help anyone if we're stressed/burned out or have to close our doors. I am choosing the 50/50/❤️ MODEL to advocate for mental health and well-being for all!

This makes sense to me!

WHAT ARE THE BENEFITS OF PRIVATE SELF-PAY AND/OR A 50/50/❤️MODEL FOR MENTAL HEALTH CARE?

No Labeling - You don't have to carry an unnecessary diagnosis on your medical record. Although, if you’d like to create awareness and assess for diagnostic criteria, I would invite this curiosity and self exploration.

Confidentiality & Privacy - You and your psychotherapist are the only people that will know you're in therapy. You get to choose who you disclose this information to. Session notes are private records so there won't be intimate details to “prove medical necessity/ diagnosis info”.

I am highly confidential and keep minimal notes. I naturally remember our sessions together because I truly care and our therapeutic relationship is genuinely important to me.

Self-Determination - You get to work with a psychotherapist that is free to use the best therapeutic approach to help YOU meet YOUR goals. You and your psychotherapist are the only people involved in the decision about the length of your care. You won't have to seek additional authorization to continue your work or return to psychotherapy, if you have new goals you'd like to explore.

Quality Care & Attention - You'll get a psychotherapist that's alert and engaged during your session, remembering the details of previous conversations. You'll have the help of a professional that's invested in your process of growth because they've taken the time to do the same for themselves. She will be able to use the healing methods that are most appropriate for you.

You might be thinking that this is just one therapist's rant against insurance companies. Don't take my word for it. Feel free to do your own research!

If you tried psychotherapy and were disappointed with the results or the treatment didn't seem to "fit" after working with a provider from your insurance company, I hope you have a better understanding of what might have been happening behind the scenes. We urge you to reconsider getting some support now that you do. There are great providers in the healing professions on both sides of the insurance divide that can help you.

I HOPE YOU HAVE A BETTER UNDERSTANDING ABOUT WHY I HAVE DECIDED TO CHOOSE THE 50/50/❤️ MODEL!

50/50/ ❤️= 50% SELF PAY 50% INSURANCE ❤️SLIDING SCALE FEE

Call or TEXT with any questions:

📱#813-240-3237 or ***Book Now: —> ❤️

The Empty Chair

The term gestalt refers to a whole that is greater than the sum of its parts. Gestalt therapy, formulated by Fritz Perls (1893-1970) is based on the idea of a whole being as connected with their environment, loved ones and memories. Therapy works toward creating full awareness of the here and now, both within the client and between client and therapist. The empty chair is one of many interactive techniques used to help engage the client's feelings, thoughts and behaviors.

The ol' empty chair has had quite a tongue-lashing over the years. Clients have given a piece of their mind to innumerable spouses, bosses, best friends and dead relatives thanks to this simple tool. But the chair is none the worse for wear, and millions of people have a greater understanding of feelings and communication as a result.  

1. When would a clinician use the empty chair technique?

The empty chair technique is characteristic of some styles of gestalt therapy. It is often effective at facilitating clients' integration of different aspects or "disowned parts" of their personality in order to further psychotherapeutic insight. It is one of a variety of interventions that help people move from talking about something towards the fullness of immediate, present experience - sensation, affect, cognition, movement. The less people are "in touch," or "verbalizing," or abstractly thinking, the more likely therapists are to use this as an expressive technique. It is not used for clients whose emotionality is already dramatic and who may be already subject to emotional "flooding."

2. What does it look like?

As first popularized by Fritz Perls, one of the founders of gestalt therapy, an empty chair faced the client. The client imagined someone (or himself, herself, or parts of him or herself) in it, and spoke, gestured, or otherwise communicated to the "empty chair," which was now not so empty. The client then sat in the chair, continuing the conversation, this time reversing roles. Variations of the "empty chair" developed over the decades in order to fit the clinical needs of the situation - and as gestalt therapy evolved. The client might participate in this technique without the "prop" of an actual empty chair. Importantly, the technique today always includes attention to the relational dynamic between the client and the psychotherapist.

3. How does it help the client?

This technique often brings clients into present or immediate experiences. Abstractions or verbalizations become enlivened moments. Clients may be able to experience different aspects of their own conflicts in a new manner through empty-chair dialogue. Gestalt therapy is more than a collection of techniques, despite the notoriety of the empty chair. This technique is one of the many interventions within gestalt therapy, all with the common purpose of facilitating discovery and psychotherapeutic insight.

4. In your opinion, what makes the empty chair a cool intervention?

Any intervention that challenges the passivity of the clinician and turns psychotherapy into a creative collaboration is a cool technique. Further, if the empty chair is a new approach to the clients, it offers a new perspective on the therapy process.