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 Psychotherapy Retrains the Brain to Expect (and Feel) Better!

People enter psychotherapy with the desire to feel better, but they are often unsure how therapy will help them accomplish this goal. A common refrain from people hesitant to enter therapy is, “How is talking going to help?” People are used to talking to other people to get practical solutions to problems, and while problem-solving does have a place in therapy, change also occurs on a much deeper and unconscious level. This process has to do with the way the human brain is programmed and cannot easily be mimicked outside of a relationship with a psychotherapist.

Our brains are always evolving unconsciously through our relationships. People who experienced painful relationships growing up have been trained to expect hurtful experiences with others. It takes a new type of relationship—in particular, a therapeutic relationship—to retrain the brain to expect more positive experiences, which is a big part of ultimately feeling better. 

WHY CAN’T A THERAPIST JUST TELL ME WHAT TO DO?

To understand why the therapeutic relationship can be so valuable and cannot be mimicked by, for example, advice in a self-help book, it is instructive to look at how the human brain has evolved. Broadly, there are three parts of the human brain that represent different phases of evolution: There is the reptilian brain, which evolved first and is responsible for the automatic control of vital bodily functions such as breathing; the limbic brain, which evolved second and is responsible for the regulation of emotion and behavior; and the neocortex, which evolved last and is responsible for higher-order functions such as symbolic thought, language, and reasoning.

When a person asks their therapist or a friend what they should do about something, they are essentially asking for a neocorticol solution—something that is rational and can be consciously implemented. Often, however, their problems are a result of hurtful experiences in their earlier relationships that have caused changes in their limbic brain, and only a new type of relationship can alter their limbic brain to produce fewer negative emotions and more positive ones.

BRAIN WIRING IN OUR YOUTH: HOW EMOTIONAL ISSUES BEGIN

Our emotions are meant to help us survive in a world in which we need the help of others. Over time, our limbic brains evolved to automatically create emotions, such as anger and sadness, that are meant to help us navigate the social world. When someone mistreats us, evolution has programmed us to become angry to try and change their behavior. When someone rejects us, we feel sad so we can mourn the loss of what we wanted with them and move forward with our lives.

However, when we are young and particularly dependent on others for survival, whether our emotions actually help us navigate the world has a lot to do with how other people—our parents in particular—respond to them. A child who responds to unfair or disappointing experiences with anger and is further punished for doing so may, over time, come to unconsciously pair the expression of anger with pain. As this occurs, rather than directly experiencing anger at times of unfair treatment or disappointment, they may instead experience anxiety about having anger because their brain has been trained by their social environment to expect that anger will hurt rather than help. Their limbic system is in effect attempting to prevent further emotional pain in the form of being punished, but the cost is another type of emotional pain in the form of persistent anxiety. This can be particularly problematic when people enter into new relationships (friendships, romantic relationships) where there would not be the same costs associated with the open expression of an emotion like anger, but earlier experiences still create anxiety and inhibit its expression.

RETRAINING THE BRAIN WITH PSYCHOTHERAPY

A psychotherapy relationship allows a person to essentially retrain their limbic system to no longer expect negative reactions to the expression of certain emotional experiences, and in doing so can alleviate the anxiety and unconscious emotional suppression their earlier experiences programmed into them. The therapeutic relationship does this in part because the parameters of psychotherapy recreate the type of relationship in which a person was first forced to suppress their emotions: one where they are dependent on another person to meet their needs.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships.

Just as a parent has a daunting task in meeting all of a child’s needs, so too does a psychotherapist, especially since many people arrive to therapy wanting a conscious, rational solution to their problems when such a solution often does not exist. Therapy presents a unique opportunity to heal and feel better by the way the therapist solicits and responds to feelings such as disappointment, anger, and sadness that emerge over the course of treatment. Rather than punishing a person for having these emotional experiences in the same way that may have occurred when they were younger, a therapist can actively solicit, explore, and normalize their feelings. This helps to retrain a person’s limbic system to no longer pair the expression of those emotions with punishment. As this de-coupling unconsciously occurs, the person becomes more easily able to tolerate the experience and expression of emotions.

THRIVING IN ADULTHOOD

This shift in tolerance for emotions naturally causes a person’s anxiety level to diminish because their mind is no longer fighting to ward off their innate emotional impulses. In addition to symptom relief, the beautiful part of this process is it restores a person’s ability to constructively access their emotions for their original purpose—as a way of helping to navigate the social world. It is hard to thrive in relationships when we have been programmed to believe we must accept the mistreatment of others or that we cannot show others when we are hurting and in need of care. As adults, this is often no longer the case, but our early experiences may make such underlying beliefs unconsciously feel true.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships. The result can be genuinely transformative, and studies suggest people who have been through therapy show less activity in the areas of the brain responsible for creating negative emotions. Talking, it turns out, can help quite a bit when the person you are talking to is a skilled and compassionate therapist.

If you’re struggling, reach out to a therapist in your area for help.

References:

1. Bowlby, J. (2005). A secure base: Clinical applications of attachment theory (Vol. 393). UK: Taylor & Francis.

2. Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain. New York, NY: W.W. Norton & Company.

3. Damasio, A. R. (2006). Descartes’ error. New York, NY: Random House.

4. Grecucci, A., Theuninck, A., Frederickson, J., & Job, R. (2015). Mechanisms of social emotion regulation: From neuroscience to psychotherapy. In Emotion regulation: Processes, cognitive effects and social consequences, pp.57-84.

5. Karlsson, H. (2011). How psychotherapy changes the brain: Understanding the mechanisms. Psychiatric Times, 21.

6. Lewis, T., Amini, F., & Lannon, R. (2007). A general theory of love. New York, NY: Vintage.

7. MacLean, P. D. (1990). The triune brain in evolution: Role in paleocerebral functions. Berlin: Springer Science & Business Media.

The Miracle Question!

The Miracle Question – an old standby for many different types of therapy! This question can be used in individual therapy as well as couples therapy, and it can be applied to a wide range of situations, issues, or problems.

The general idea of this technique is to both help the client (or couple) explicate their needs or desires and help the therapist better understand what his or her client(s) is hoping to achieve in therapy. It is especially helpful for those who have never really taken the time to clarify what they want out of their relationship, either for themselves or for their partners.

This question can generally be worded as such (Howes, 2010):

“Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you would notice that would tell you life had suddenly gotten better?”

Even if one or both clients give describe a scenario that is absolutely impossible to achieve, their answer can still be useful for understanding their goals. In the scenario of an impossible ideal future state, the therapist can dig deeper into the couple’s “miracle” by asking, “How would that make a difference?” (Howes, 2010).

This question helps the couple believe in a more positive future for themselves, a future in which their problems are solved. This exercise can result in greater motivation to work at improving their relationship, enhanced confidence in the efficacy of couples therapy, and even instantaneous (but incremental) improvement in interactions between the two people.

Solution Focused Therapy (aka Brief Therapy) emerged in the 1980's as a branch of the systems therapies. A married therapist couple from Milwaukee, Steve de Shazer and Insoo Kim Berg, are credited with the name and basic practice of SFT. The theory focuses not on the past, but on what the client wants to achieve today. By making conscious all the ways the client is creating their ideal future and encouraging forward progress, clinicians point clients toward their goals rather than the problems that drove them to therapy. 

The Miracle Question fits perfectly with this model. Imagining an ideal future and connecting it to the present immediately actualizes the work. Clients are challenged to look past their obstacles and hopelessness and focus on the possibilities.

It's cool because it's a relatively simple intervention that can have a powerful impact. Just take a look at the question (response #2). You're probably crafting your response already. It's creative, bold, healing, a bit mysterious and definitely has a cool name. The Top Ten designation is well deserved. 

Don't just listen to me, hear it from an expert. Linda Metcalf, Ph.D. is founder of the Solution Focused Institute of Fort Worth, Texas and author of ten books including The Miracle Question: Answer It and Change Your Life. Beyond writing and therapy, she speaks internationally to schools, agencies and universities. She was kind enough to share her wisdom with us today. 

1. When would a clinician use the Miracle Question?

The Miracle Question is a goal setting question that is useful when a client simply does not know what a preferred future would look like. It can be used with individuals to set the course for therapy, with couples, to clarify what each person needs from each other and with families, who too often see one person as the culprit. By using the Miracle Question and asking each person what a better life would look like, it is apparent, perhaps for the first time, what others need from each other.

2. What does it look like?

"Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you would notice that would tell you life had suddenly gotten better?"

The therapist stays with the question even if the client describes an "impossible" solution, such as a deceased person being alive, and acknowledges that wish and then asks "how would that make a difference in your life?"  Then as the client describes that he/she might feel as if they have their companion back again, the therapist asks "how would that make a difference?"  With that, the client may say, "I would have someone to confide in and support me."  From there, the therapist would ask the client to think of others in the client's life who could begin to be a confidant in a very small manner.

3. How does it help the client?

It catapults the client from a problem saturated context into a visionary context where he/she has a moment of freedom, to step out of the problem story and into a story where they are more problem free. But, more importantly, it helps the therapist to know exactly what the client wants from therapy...and this is what makes Solution Focused Therapy so efficient and brief.

4. In your opinion, what makes the Miracle Question a cool intervention?

It helps the therapist see where the client wants to go. Too often, therapists assume that a client needs to grieve, leave their spouse, quit their job, after the client describes why he/she has come to therapy. The Miracle Question helps the client and therapist to address exactly what the client wants, not what the therapist thinks is best.

WHAT IS SOLUTION-FOCUSED THERAPY AND HOW DOES IT WORK?

Photo by egal/iStock / Getty Images

Most types of psychotherapy involve exploring feelings, being validated, finding explanations, exploring wishes and dreams, setting goals, and gaining clarity. Every therapist has unique ways of working with clients, based on his or her personality, training, and views of how people change.

A solution-focused therapist is likely to do the following:

1.    Instead of going over past events and focusing on problems, the therapist helps you envision your future without today’s problems.

2.    During the course of therapy (often as few as 3 to 6 sessions), the therapist helps you discover solutions.

3.    The therapist encourages you to identify and do more of what is already working.

4.    The therapist guides you to identify what doesn’t work and to focus on doing less of it.

5.    The emphasis is on the future, not the past.

6.    SFBT therapists believe that the client is the best expert about what it takes to change his or her life.

7.    The therapist’s role is to help you identify solutions that will remove the barriers to having the life you want.

Solution-Focused Brief Therapy (SFBT) is a process that helps people change by constructing solutions rather than dwelling on problems. This type of therapy tends to be shorter-term than traditional psychotherapy. Steve de Shazer and Insoo Kim Berg of the Brief Family Therapy Center in Milwaukee are the originators of this form of therapy.

The SFBT therapist helps the client identify elements of the desired solution, which are usually already present in the client’s life. The client learns to build on these elements, which form the basis for ongoing change. Rather than searching for the causes of the problem, the focus is on defining the changes and making them a reality. The two key therapeutic issues are: (1) how the client wants his or her life to be different, and (2) what it will take to make it happen.

Creating a detailed picture of what it will be like when life is better creates a feeling of hope, and this makes the solution seem possible. The therapist helps the client focus on the future and how it will be better when things change. It is important to develop a set of specific, detailed goals. These goals drive the therapy process and keep it focused and efficient.

Why SFBT Is Usually Short-Term

SFBT therapists don’t set out to artificially limit the number of sessions. A good brief therapist will not focus on limiting sessions or time, but rather on helping clients set goals and develop strategies to reach those goals. Focusing on the client’s goals and the concrete steps needed to achieve them usually takes less time than traditional therapy, in which the client typically spends many sessions talking about the past and explores reasons and feelings. SFBT therapists aim to provide clients with the most effective treatment in the most efficient way possible so that clients can achieve their goals and get on with their lives. As a result of this focus, the counseling process often requires as few as six sessions.

Types of Problems That SFBT Addresses

Solution-Focused Brief Therapy is an effective way of helping people solve many kinds of problems, including depression, substance abuse, eating disorders, relationship problems, and many other kinds of issues. Since it focuses on the process of change rather than on dissecting the problem, more serious issues do not necessarily require different treatment. The SFBT therapist’s job is to help clients transform troubling issues into specific goals and an action plan for achieving them.

In The Miracle Method, authors Scott D. Miller and Insoo Kim Berg describe how to create solutions with these steps:

1.    State your desire for something in your life to be different.

2.    Envision that a miracle happens and your life is different.

3.    Make sure the miracle is important to you.

4.    Keep the miracle small.

5.    Define the change with language that is positive, specific, concrete, and behavioral.

6.    State how you will start your journey rather than how you will end it.

7.    Be clear about who, where, and when, but not why.

Signs That You Should Consider Seeing a Therapist

There are several ways to know when you would be doing yourself a favor by finding a licensed, professional therapist to work with.

1.    You’ve tried several things on your own, but you still have the problem.

2.    You want to find a solution sooner rather than later.

3.    You have thoughts of harming yourself or others.

4.    You have symptoms of depression, anxiety, or another disorder that significantly interfere with your daily functioning and the quality of your life. For example, you have lost time from work, your relationships have been harmed, or your health is suffering. These are signs that you need the help of a trained, licensed professional.