Some ways I work with clients

 

 Below are concerns which clients may have and examples of my counselling approaches.

Self-concept, self-talk and self-esteem

How we think and feel about ourselves and how we attend to what is going on in our minds and bodies can be a very helpful avenue to pursue in therapy.  If, for instance, our parents or caretakers were critical and shaming, we may internalize those attitudes and be critical and shaming in the ways we talk to ourselves inside.  We may have a “script” running in the back of our mind which says, for example, “I’m not good enough; I don’t measure up.”  We may have a history of trauma and wonder why it happened to us.   Such difficulties can create a lot of pain and detract from our pleasure in living.

 

We can improve our sense of self by finding ways to be gentle, compassionate and encouraging to ourselves.  We can learn to appreciate our accomplishments and growth. This frees up vitality and energy.  Nurturing our self-esteem is a form of healing, not just of ourselves but of others. A tolerant and loving attitude to self seems to attract others; perhaps they sense that we will have the same attitude towards them.

Anxiety and depression

Anxiety and depression are related conditions.  Fear and sadness are natural emotions we all have, but when they expand into chronic anxiety or depression then support is often very important.  Both can suck the colour and joy out of living.  A thorough evaluation is important.  There is much that can be done to treat both conditions and relieve suffering.  While drugs are available to treat both conditions, there are many non-pharmaceutical approaches, such as activation, changing thinking patterns, improving self-care, mood boosting with exercise, and being heard, understood and cared for by a therapist.  

Interpersonal conflict

Nothing stirs us up like conflict with someone we love or with whom we have to interact, at work for instance.  Anger, sadness and fear are likely to arise and can be troubling to manage.  If we are to communicate well in a period of conflict, managing our feelings is critical – because conflict negotiation, boundary setting and conflict resolution require a thoughtful, present and calm approach.  A therapist works by helping clients vent emotion in a safe place, by listening and understanding, and by exploring ideas and strategies to resolve the conflict.

Managing Stress

It is a cliché to say we lead complicated lives, but we do.  We have so many choices that we may feel overwhelmed. Managing stress is often successful when we let some things go rather than add more.  We may need to develop ways of saying no to demands on our time and energy, while keeping the needs of others in mind.  We don’t always need a medication or a new activity to release stress.

 

Stress can overwhelm our pleasure in living and pull us away from what nourishes and restores us.  Feeling stressed is also profoundly physical; it does affect our health.  Sometimes we're stressed by internal processes such as being perfectionistic.  Or we may make superficial comparisons with others’ accomplishments instead of measuring ourselves in terms of our own growth.  Therapy provides a safe place to explore solutions.  Reducing stress should involve working with our whole self – mind and body.  

Addiction and Substance Use Concerns

We can become addicted to substances (alcohol and drugs) or to processes (pornography, gambling, work, etc.)  Addictions  can cause a great deal of suffering, both to the person who has the addiction and to those he or she is close to.  Some people are more vulnerable to addiction (whether substance or process misuse) than others. Often, people with addictions suffer from other difficulties such as depression, a history of trauma, or a troubled family background.  Therapists need skills in identifying and treating these while maintaining a focus on recovery from the addiction itself.  Addiction and substance misuse can bring isolation and loneliness.  Part of recovery can be peer support and the social opportunities provided in various recovery groups.

 

In B.C. the many resources for the treatment of addictions can be bewildering to someone seeking help.  There is often a wait for various community-based supports such as detox, outpatient and inpatient treatment, relapse prevention and education. The counsellor or therapist needs to be knowledgeable about resource availability and quality, and must provide consistency and encouragement throughout the process of recovery from addictions.   

Codependency and personal boundary setting

Being involved with someone who has an addiction, a mental illness, or a chronic physical illness can cause the relationship to become unbalanced.  Little by little, the big needs and emotions of the other person flood us until we lose our sense of ourselves.  A simple working definition of codependency is that another person’s emotions are in the centre of our life. 

 

Therapy for codependency starts with an acknowledgment of our right to our own emotional sphere and its expression, protected by boundary setting and reconnection with our own goals and desires.  The therapist’s deep interest in you can be healing in itself.  

Adjusting to change

We vary greatly in our ability to tolerate and embrace change.  Changes may be positive – a promotion, falling in love, relocation, the birth of a child; it may also be negative – the loss of a loved one, an illness or loss of ability, aging.  Interestingly, we seem to react to positive and negative changes in similar ways:  loss of the familiar can result in a period that feels like “limbo”.  Therapists help by supporting you through a change that has left you with difficult thoughts and feelings.

Recovering from trauma and abuse

Traumatic experiences as well as being exposed to people who were physically, emotionally, spiritually or sexually abusive may leave us with shame, guilt and confusion and a deeply shaken sense of ourselves.  Abusers commonly say things that make healing more difficult, for example, enforcing secrecy through threats.  The effects of trauma can be worse if we didn’t have support and care after it happened, if we had to keep it secret, or if we told and weren’t believed. 

 

Trauma and abuse can leave “undigested” chunks of memory and feelings.  The therapy environment needs to be safe, carefully paced, deeply accepting and affirming.  Then those chunks can, over time, be “metabolized” and integrated as part of our story.  

Improving communication skills

For better or worse, we bring habits of communication from our families and caregivers, and sorting through those habits to find out what works and what doesn’t can be very helpful.

 

Life can present us with new circumstances in which our communication skills don't work as well as we'd like.  At those times a therapist can help us practice in a safe place and supply ideas for communicating effectively.

 

How we communicate (which includes the non-verbal) is the key. When that process is safe it is more likely that difficult content (what we communicate) can be discussed without resentment, defensiveness, withdrawal or punishment.  Listening carefully to the other person is just as important as what we ourselves have to say.  Therapy in this area focuses on having a range of skills to suit various circumstances.  

Responsible assertiveness

How do we balance our needs with those of others?  How can we advocate for our own needs and wants clearly so they will be understood?  Do we agree to things before we’ve asked ourselves if they’re right for us?  Does our “yes” mean yes, and does our “no” mean no?

 

Gaining assertiveness skills is a lifelong process, as is the ability to communicate and listen effectively.  Finding the right zone --  being neither aggressive nor passive when we need to assert ourselves can take practice. Even so, we may find that some people tend to overwhelm our assertiveness skills and roll right over us.  Understanding why and having new strategies helps.  

Couple counselling and family communication

In communicating with those close to us, we frequently focus on what we’re discussing (the “content”).  But how we communicate is much more important (the “process”).  In couple work it’s important to encourage a return to or the development of a process of communicating that is non-defensive, acknowledging, tender and balanced.  If the process is right, any content can be discussed more productively. 

 

Additionally, we all want to be loved in a certain way, and our partner may want to be loved in a quite different way.  Discovering, respecting and nourishing these wants and differences can be a revelation.

 

Our families of origin and caregivers have taught us things that may or may not work in our current intimate relationships.  We want to keep the tools which work and gain new ways of relating and expressing emotion. 

 

Some couples come seeking a deeper and more satisfying closeness, and some wish to end a relationship on good terms.  Some come because of disagreements about parenting, others come to heal from a relationship’s emotional hurts and mistakes.  There are many reasons, and the couple’s own goals are what count. 

 

Therapy needs to create a safe zone for exploration and be accepting of various relationship formats: traditional, gay, lesbian, polyamorous and open.  

  

Gay, lesbian and bisexual concerns

While strides have been made in the acceptance of sexual orientations, it is still true that there are many difficulties faced by gay men, lesbians and bisexuals (GLB) that heterosexuals do not have to face.  One example is that every situation must be evaluated by GLBs to determine how “out”  (if at all) he or she can be and how safe it is to be open about self.  Many GLB folk struggle to find role models and develop life goals when guidance is still scarce or generated by heterosexuals.  A therapist must provide a deeply accepting and caring environment to offset and begin to heal the many psychic injuries, large and small, which gay men, lesbians and bisexuals endure.  

Alternative relationship models

If we choose a relational model that is not the traditional heterosexual one, it’s important to have a therapist who is familiar and comfortable with the many ways people find emotional and sexual fulfillment.

 

Such ways could be “friends with benefits”, gay, lesbian or bisexual bonds, polyamory, open relationships, or being content with singlehood and having close friends.  Meeting our relational needs in mutually satisfying ways is central to our happiness and who we are as humans.  Traditional roles suit some, others can’t make them fit.  All relationship styles have their challenges and joys.

Grief and loss

While grieving is often described as a process that happens in stages, few people experience it that way.  How we grieve losses is highly individual.  Grief is one of our most profound emotional processes. 

 

We attach to people, places and things.  Loving them and the changes that losing them brings can make us feel we’re in a whirlpool of emotion -- sometimes with conflicting feelings at the same time.  It can feel as if it will go on forever, but grief does indeed have a beginning, middle and end. It ends when we become interested in re-investing in new activities and connections.

 

Therapy for grief involves the safe expression of emotion as the process of grieving unfolds.  

Anger management

Anger is the most difficult emotion to manage because of its dynamism and energy.  If channeled poorly, it can hurt those around us and hurt us too. 

 

The common anger issues brought to therapy include:

  • Being unaware of or unable to express anger.

  • A suspicion that other feelings are involved which complicate the anger.

  • Wanting to understand gender conditioning in anger expression.

  • Anger as a stage of grief.

  • How to stop “acting out” anger destructively.

  • Learning to self-comfort and self-calm.

  • Understanding how the role models we were exposed to when younger can influence our anger expression.

  • Feeling safe to say how you’re feeling, including being angry.

  • Responding to the anger of others effectively.