Group Ketamine-Assisted Therapy: A Therapist's Musings

Group Ketamine-Assisted Therapy From The Perspective Of A Therapist

 

When I first started bringing up the idea of group ketamine therapy to my patients as a potential option, I did so somewhat timidly, often prefacing the conversation with “ok, now hear me out” or “I know it sounds strange…group therapy but with ketamine”. This was in part because the idea and execution of it was new to me, my hopes for positive outcomes were still a hypothesis and in part, because the patients I spoke with about it were immediately incredulous and skeptical, not only of group therapy work, but also of throwing a consciousness-altering medicine into the mix. After seeing firsthand the positive outcomes of group sessions that my co-facilitator and I have led, and working closely with facilitators of other groups with similarly outstanding results, I approach the group ketamine conversation differently: with confidence and earnest convictions of the benefits for those who bravely enter this space.

I will say here what I say to my patients who I think are a good fit but who are skeptical of this model: healing happens in groups. Yes, individual work is important, and for some people that individual work needs to happen first before entering a group space, but for generations across time, across cultures, and across the world, healing has happened in communities, when we witness and are witnessed in this process and we begin to embody the sense that we are all connected in more ways than we ever dreamed.  

During the medicine sessions, this is not group talk therapy, although we are together in the same room each person is having their own experience with the medicine. Typically, everyone is wearing eyeshades and music is playing while at least two facilitators carefully watch over the group, providing support when needed, but mostly leaving participants to explore their own innate ability to heal themselves, with support from others. All are welcome in this room, laughing, crying, and complete silence, it is all ok and requires no explanation.  

When we have shared experiences of transcendence, of entering the depths of sorrow, of embodying joy and playfulness, of connecting deeply with those around us, we find that we are better able to do those things in our everyday lives: with our families, our friends, and our community. We are able to bring these learnings back to those we love, facilitating a deeper connection with others, and ourselves.  And for those who feel they lack those relationships in their lives currently, practicing this kind of vulnerability opens the door of possibility that community is not only possible but accessible. Connection often doesn’t just happen in the culture we currently live in, it's not a given - it must be sought out and practiced. Coming together in a group with a shared purpose gives each of us the opportunity to practice vulnerability and connection with others in ways we are not often afforded in our everyday lives.  

I know I keep referring to “we” and “us”.  I have done this because we come into this group together. The group is not a service we as therapists and medical providers are giving to you. We are in this place together, learning and growing along with you, and for that we thank you for taking this leap.  

 

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If you're interested in learning more about our Group Ketamine-Assisted Therapy sessions, visit our webpage. 

If you're in the Utah area, we are leading Group Ketamine-Assisted Therapy sessions focused on chronic and serious illness at our Murray Clinic starting October 9th. One-on-one intake visits are currently open until October 4th. To learn more or to book your spot email INFO-UTAH@NUMINUS.COM or call 1 (801) 369-8989.

 

 

Episode 40: Dr. Robert Grant on Internal Family Systems Therapy

“What’s healing is the self to part relationship. And that relationship gets built based on the part being able to tell its story without repercussions.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Robert Grant. Dr. Grant is an Internal Family Systems (IFS) therapist, a ketamine-assisted psychotherapist, a pulmonary physician, a professor of medicine at UCSF, a former researcher in HIV prevention and treatment, and a cofounder of the Healing Realms Center. The Healing Realms Center is a clinic specializing in ketamine-assisted psychotherapy.

Dr. Grant is especially well known for his work as an IFS therapist specializing in ketamine treatments. IFS was developed by Dr. Richard C. Schwartz. It is a therapy based on the notion that the human mind is made up of inner parts. And healing involves the cultivation of harmony among these parts. It is commonly used in the treatment of post-traumatic stress.

 

In this interview Dr. Joe and Dr. Grant explored:

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Dr. Grant from the interview:

 

“It was the human connection that was curative. And the mescaline was helpful maybe because it facilitated that connection.”

 

“Other people may trigger different parts of us that give us an opportunity to learn about our inner processes.”

 

“‘Self’ is the part of us that can see our own trauma without being re-traumatized.”

 

“Healing is a process of hearing out that inner dialogue. So we can really develop a relationship with our parts.”

 

Sometimes spaciousness actually fosters connection because it allows us to see each other more clearly.”

 

“Parts are still there after the healing process. You’re not trying to get rid of them. You’re just trying to allow them to be seen and to play healthy roles that are playful, pleasant, and productive to a certain extent.”

 

Here are some highlights from their conversation:

 

Let’s talk about healing. That’s where I wanted to go next. You said things like, ‘this part needs to tell their story.’ And you gave the example earlier about, maybe someone coming to therapy because they feel confused about whether to stay in or leave a relationship. And that the purpose of the therapy is not to arrive at a conclusion, but to create space for these stories to be heard. Can you tell me what’s healing about having these parts express themselves?  

It’s the beginning of the healing process. So I think that what’s healing is the self to part relationship. And so that relationship gets built based on the part being able to tell its story without causing a reaction or without having repercussions. So creating a connection between the self and the part by listening to their story is an essential step in the process of building those relationships.

We have a number of heuristics which are actually helpful. And if I can digress a bit, the founder, Rick Schwartz, in his most recent iteration of his book with Marta Sweezy, said that IFS could be conceived of as a psychodynamic theory. And so it is in this lineage of psychodynamic process. And because it does embrace the multiplicity of the mind, it allows for conflicting, psychodynamic relationships within the person.

What I like about IFS is that it goes one step in the direction of giving us tools for uncovering exiled or subconscious material. And so a classically trained psychoanalyst might expect to spend hours or days or years listening to the client on the couch, and eventually the subconscious material will bubble up, either in terms of dream interpretation or day time fantasies or behaviors that create ambivalence within them. I mean, they’ll just wait for it. And I love that idea of just waiting, witnessing. And so I have great respect for thoroughly trained psychoanalysts.

And IFS does give us some tools that allow us to move pretty quickly toward uncovering subconscious or exiled material. And so it has a toolbox that allows us to be expeditious. But I don’t think the process is very different from what a psychoanalyst would do. It’s just a little more guided and a little more intentional.

So one of the heuristics that IFS has is called the 6 F’s, and so I can walk us through those. You want to find parts. So whatever part we want to find, we want to see what’s up for the person. It might be that a single part has very strong feelings that need to be heard out. Or there may be a pair of parts that want to stay in or want to get out, a polarized pair of parts. So you want to find the one or two or three that you’re going to work with on that day. And then you want to focus on them, let them know that you’re here to listen to them. And when I say you, it’s actually the client ‘self; is there to listen to them. Now, the therapist’s ‘self’ energy is also very important in this process, so that the therapist ‘self’ and the client ‘self’ are there to listen to the parts. So, you know, it’s intuitive that that’s reassuring. I mean, if you’re wanting to make friends with someone, what do you do? You focus on them. You look them in the eye and you focus and then you flesh out.

So that’s the third F. ‘Tell me more about that. Tell me what that was like for you. Tell me what was the worst part of that or the best part of that? What did you do with that?’ And then there’s this phrase that we use is, ‘how do you feel toward the part?’ And that’s actually a key step because, you know, if you asked me, Bob, ;how do you feel toward that part that’s carrying shame?; And if I say something like, ‘well, I actually dislike that part, it’s annoying. It bothered me my whole life. Why would I be ashamed of it?’ Those are not self qualities. So what that tells you when I answer that way is that it’s not a self to part relationship with being developed. You’re hearing from another part of me that is trying to exile that part carrying the shame. And so you would at that point having asked me how I feel toward the part, but having not heard from self, you would say, ‘okay, can you give attention to the part that wants to get rid of that shame and let’s find out about it. What is it trying to do? What is afraid will happen if we heard  about the shame? What would it rather do if we didn’t have to suppress that part that had all the shame all the time?’

And, you know, and so we change the focus to the part that came up in reaction to the other part, and we continue to do that. And then we’ll ask, ‘how do you feel toward that part that wants to get rid of the shame?’ And, you know, at some point I’ll say, ‘well, I’m curious about what is it trying to do? And I want to know more. And  that’s self energy. And so then that’s our green light to start doing the real work of developing self to part relationships. So the feel toward is one of 6 F’s.

And then and then you want to unblend as much as possible. You want the part to be able to see the self, and the self to see the part and and parts don’t like doing that. They like being connected to self. They like being connected to self so much that they stick to self, like a glove. And so one thing that I like to say is, ‘can we ask the part to give us some distance and spaciousness so that you can see it better and so it can see you better?’ So one of the beautiful things about connection is whether it’s between people or within our parts, within ourselves. Sometimes the spaciousness actually fosters connection because it allows us to see each other more clearly. And then, you know, that can be healthy and relationships as well. Sometimes that relationship I mentioned earlier, ‘do I stay and do I go out?’ Maybe there is a middle ground. It’s, you know, let’s just take some space and, you know, we don’t spend  every day of our lives together. But we think we can walk and have some spaciousness. And that may be all the relationship wants or needs.

And it’s the same way within parts within ourselves, but sometimes asking them to unblend, they’ll say, ‘no, no, I cannot unblend.’ They’re desperate for more attention. But they said, ‘Well, no, it’s if you just give us some space, then I can see you better. You can see me better.’

So there’s unblending and then there’s befriending, just continuing to say, ‘it’s so great that I’ve been trying to protect Bob from feeling shame. You’ve done such a great job. And look how well he’s done in school and that has led to a career. And that’s so great.’ But do you really want to keep doing that all the time? And often they’ll say, ‘No, I’m exhausted.’ I’d rather that Bob, if there were a way for Bob to deal with his shame without me having to work all the time, I would like that, but I don’t think there is a way to do that. That’s why I’ve constructed this job. So the part may say that. You could say, ‘well, you know, I think there is a way to help Bob with the shame without you having to work all the time.’ Sometimes the part would say, ‘I’m not sure that’s possible, but I would want that. So, you know, let’s give that a try.’ And then you can ask, you know, that protective part to rest and it can stay close and watch if it wants, just in case something comes up that makes it afraid. It can step back in if it needs to. But that then gives you an opportunity to go back to that exile, which initially caused the protected part to come up. But that part now is befriended and it’s willing to rest. And so you can work with the exile material.

And then ultimately you would want to get to a point where whatever caused the burden of shame to come to that exile part, then that part can have a chance to leave that situation and unburden that shame. And then the whole system can appreciate that , ‘Yeah, there was a way to deal with the shame that didn’t involve having to compulsively work all the time.’

So the healing process is really one of befriending the parts and airing them out and ultimately giving the exiled parts a chance to be retrieved from the hard situation and then to unburden the beliefs that were important to survive that hard situation. And then to have the rest of the parts come back into the situation, and ask them, ‘did you see what happened there?’ And some of them will come back in and say, ‘oh, yeah, wow, I’m impressed. I didn’t think there was a way to solve that problem. But yeah, there was.’  So great.

And some of them may come back and be a little frightened. Like the example I gave might say, ‘you know, I spent my whole life working obsessively to do well in school. And now what do I do? I don’t know what my job is.’ ‘It’s okay. You know, I’ll work with you. There’s lots of jobs that you could do. Maybe you can work on writing a book or something other than school.’ Maybe oftentimes the job that the protectors want to do has nothing to do with what they were doing. The part of me that wanted to do well in school might want to take up finger painting or, you know, writing poetry like I was doing in college. Maybe they want to go back and do that or, you know, like, hey, who knows? But letting them do what they want, it’s an important part of being a good self for them, a good self leader for them.

I mean the parts are there, they’re still there after the healing process. You’re not trying to get rid of any part. You’re just trying to allow them to be seen and to play their healthy roles, which are roles that are playful and pleasant and productive to a certain extent.

 

Connect with Dr. Robert Grant on the Healing Realms Center website.

Connect with Dr. Joe on FacebookTwitter,LinkedIn and Instagram

Follow Numinus on FacebookTwitterInstagram, and LinkedIn.

Episode 34: Dr. Devon Christie on Psychedelics as a New Paradigm for Medicine

“As therapists and guides, we’re holding that space for the location of healing to be intrinsic to that person.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Devon Christie. Dr. Christie is a family physician with a focused practice in Multidisciplinary Pain Management and the Senior Lead of Psychedelic Programs at Numinus. She is also a clinical instructor with the UBC Department of Medicine, Kundalini Yoga instructor, Mindfulness-Based Stress Reduction (MBSR) teacher, Relational Somatic Therapist and MDMA-assisted and ketamine-assisted psychotherapist.

She also has first hand experience recovering from chronic pain, traumatic brain injury, PTSD, bulimia, anorexia, and depression. These experiences have served as the foundation for her work.

Dr. Christie and Dr. Joe spoke about:

Connect with Dr. Joe on FacebookTwitter,LinkedIn and Instagram

Connect with Dr. Devon Christie on Facebook and Instagram.

Follow Numinus on FacebookTwitterInstagramLinkedIn, and YouTube.

 

Here are some highlights from their conversation:

 

I think you and I both believe that psychedelics have the potential to bring about very, very meaningful change in our health care systems, maybe even more broadly than that.

Why do you think there’s so much promise here in mental health or maybe even health more broadly?

There are a lot of ways I could go in answering that question. I mean, the first thing that comes up is just this notion of a paradigm shift where, in my view, what psychedelic assisted psychotherapy proposes, is that we can have the intention of helping individuals to heal, to deeply heal from mental health conditions, from chronic illness in that the location of that healing is inside them.

We talk about this concept of an inner healing, inner healer, or innate healing intelligence as part of preparation for people going into these experiences to trust that that’s there and to allow that to guide the process. And that is as therapists and guides, we’re holding space for that, the location of healing to be intrinsic to that person. Like you cut yourself and then you keep the conditions clean and dry and your cells know how to knit themselves back together. There is an intelligence there.

But I think what our broader system has sort of conditioned us into perceiving is that we need to be fixed somehow by external people or modalities or surgeries or drugs, people that know more than us. And there’s this almost like a victim–there’s just less empowerment. It’s much more passive. And I think the way our system is set up almost kind of encourages that.

So it’s this active–you’re the source of healing. We’re going to create the optimal conditions. Do our best to do that. And so that to me is really powerful, empowering, and I think will lead to a lot of support for motivation and health behavior change. And so that’s just one aspect of the paradigm shift.

Another is, as I mentioned, with respect to how much I respect Gabor and his work is just this breaking–quitting this view that comes from biological reductionism that the mind and the body are separate. And that it’s all like–Western medicine is very materialistic and there’s a lot of benefit from that. We’ve learned so much. It’s amazing how much we understand our cellular biology and yet it sort of parses things apart and creates silos of specialties.

For example, where this doctor treats this system and this doctor treats this system and it’s all very focused on the physical. So there’s all these kinds of discrete categorizations, and people get many different diagnoses and go to see many different specialists for each of those separate things.

Yet when you really zoom out and take this more systems approach–which I actually didn’t mention as well, I’m a certified functional medicine practitioner, which is a systems biology view. It’s like, actually, no, it’s all interconnected. We’re alive ecosystems, and mind and body are absolutely intricately simultaneously co-arising. They can’t be separated. I have a thought that is producing chemicals that are influencing my state.

So I really see that psychedelic assisted psychotherapy is going to really support this awareness–approaches that are targeting our emotional well-being and our nervous system regulation and our what we term mental wellbeing will translate into physical, like positive physical outcomes.

Because we know and this is again in Gabor’s work. The stress response is just this common underlying factor between a multiplicity of different expressions of illness, whether we call them mental or physical.

So I’m really excited for that and for the ways that as we continue to research different applications of psychedelic assisted psychotherapy that we’re going to see and learn how much more broadly, this type of intervention may be applicable.

And the final tag on that is to actually support more systemic funding for psychotherapy in general. You know, psychedelics aside, right? We already have evidence for that. We already know that if people have access to psychotherapy, they visit their family physician less.

Psychotherapy as opposed to pharmacotherapy for mental illnesses. The research shows that it likely has much longer term benefits, more impact on quality of life for people rather than just symptom management, and that people prefer it and there are less side effects. So even if psychedelic assisted psychotherapy can also just usher this change in our system to bring parity to approaches that support individuals mental well-being, that would be a win, in my perspective.

Teletherapy and Cyber Security

Important Disclaimer: This document is for informational purposes and general guidance only and is not advice on any specific regulatory or legal matter. Always consider getting qualified advice on the facts of any matter before proceeding.

In a world in the midst of the COVID-19 pandemic, therapists have had to adapt rapidly to continue offering psychotherapy. The main form of adaptation has been to transition to delivering  remote therapy, whether via telephone or video conferencing. Existing bodies of research have shown online therapy to be effective, but clients and therapists often still have concerns about privacy and security. Now is the time to directly address those concerns and it has fallen on me, as Numinus’s Clinic Manager to take on this challenge. My background as both a therapist and information technology professional helps me to understand and explain our approach to the delivery of remote sessions in the province of Quebec.

Numinus has always had a few therapists providing remote sessions to their clients; now it is the entire team. We have always abided by the rules governing the practice of teletherapy in our jurisdiction and will continue to do so. The Ordre des psychologues du Québec (OPQ), the governing body for psychologists and psychotherapists in Quebec, has produced several documents outlining the ethical and practical guidelines for remote therapy (in French only). I will briefly summarize these documents:

OPQ Guidelines for Psychologists/Psychotherapists practicing in Quebec

Encryption, End-to-End Encryption, and You

Encryption is a way to obfuscate the contents of a message, or video, so that only someone with the proper decryption key can undo the encryption and see the contents of the encrypted communication.  End-to-End (E2E) encryption adds an extra layer of security so that even the provider of the tool or service cannot decrypt the contents of communications, even if compelled to by law, or hacked by a malicious actor who inserts themselves as a “man in the middle” at the corporate level (e.g., at a software company’s servers that offer the teleconferencing solution).

The most common questions that arise from these guidelines relate to encryption. Does your therapist use a tool that encrypts your communication, preventing casual electronic eavesdropping by unsophisticated attackers? Good odds that the answer is yes, and at Numinus, we definitely do. All the tools listed by the OPQ use some form of encryption in order to prevent electronic eavesdropping.

PIPEDA, HIPAA, and Quebec’s “substantially similar” legislation

You may have heard people talking about various names for electronic privacy legislation passed in various jurisdictions and how they relate to remote practice. In the United States, there is HIPAA, in Canada there is PIPEDA. In Québec’s there is An Act Respecting the Protection of Personal Information in the Private SectorAn Act to amend the Act respecting health services and social services, the Health Insurance Act and the Act respecting the Régie de l’assurance maladie du Québec, all of Québec’s privacy laws relating to health records. The most important things to know about all of these laws, from Numinus particular perspective:

What you can do to help ensure that your sessions remain confidential

When it comes to security, you are more likely to have your remote session’s privacy violated by a person physically listening in from a nearby location than by a sophisticated state actor capable of breaking encryption or inserting themselves as a “man in the middle” attacker (e.g., the National Security Agency in the United States). The corporations offering these communication services have a vested interest, both legal and financial, in maintaining the privacy of these communications, so unless compelled by court order, they will not intercept any remote communications or turn over any recordings (which they all state that they do not even make in the first place). One could argue that you are as likely to have an in-person session bugged by law enforcement as to have a court order issued mandating that a session be captured and decrypted. If this is a real concern of yours, due to your work or other factors (e.g., you are a high level government official, famous actor, or crime lord), then online sessions might be best avoided! If you are not generally at risk of being a target of a state-level actor or law enforcement, you can also do some basic things to best assure your privacy:

  1. Make sure you are initiating sessions from a place where you can monitor, and ideally control, your environment to prevent someone from physically listening in.
  2. Do not use public WiFi networks when engaging in remote therapy unless there is absolutely no other choice. And if you must use public WiFi, then you must use a Virtual Private Network (VPN) software solution to provide an additional layer of protection to your communications.
  3. Regularly run virus and malware scans of your computer, or use your mobile device for your remote session, as they are far less prone to viruses and malware.

I hope this helps to inform you and address any concerns you might have, whether as a therapist delivering remote sessions, or a client on the receiving end!

Mental Health Services Transition to Online Care

The coronavirus pandemic is wreaking unprecedented havoc on our healthcare system, economy and communities. The combination of high stakes, uncertainty, lack of control and limits on social connection is creating a perfect storm for psychological distress. Undoubtedly, there is a mental health crisis lurking underneath the public health and economic crises unfolding before our eyes. And this, while everyone is forced to stay home.

The one bit of good news is that psychotherapy works online. Numinus has been offering virtual sessions for many years. But in the last week, we managed to transition our entire clinic operations online. While the virtual therapy session takes some getting used to—for clients and therapists alike—the results have been positive. Clients are grateful that they continue to have access to services. Sarah, one client said “I still had a real connection with my therapist, still able to make progress on issues that I have been working on for a while, and reduction in anxiety from what’s going on today.” Therapists also report that they are having positive experiences despite the remoteness. Jessica said “I’ve been pleasantly surprised by the quality of the connection I’m making with my clients despite the distance.” Julien even found some clinical advantages to virtual sessions: “I also find that there are advantages to meeting clients in their natural environment.”

The research on virtual psychotherapy supports these experiences. A 2012 review paper by Backhaus et al. concluded that virtual therapy is “feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy.” Surprisingly, according to Simpson and Reid (2014), meeting a therapist online does not seem to compromise the quality of the client-therapist relationship, which is an important ingredient in successful therapy. So good quality mental health care is available online.

This mental health crisis is affecting organizations as well, as they rely on the sustained performance of their people to adapt to sudden, tectonic shifts in the business landscape. Virtual psychotherapy may be an essential ingredient to maintain employees health and functioning at work. Many organizations try to support employee well-being by offering extensive health insurance benefits. In this post-COVID world of social isolation, the primary headwind to employee wellness are feelings of anxiety and disconnectedness that arise from suddenly being thrust into working from home in an uncertain world. Psychotherapy is typically covered under these policies, but often not sought out. Alayacare, a Montreal-based health tech company contributing to COVID-19 solutions, is encouraging employees to make use of these benefits. CEO Adrian Schauer says “we are aware that some of our people are having difficulty coping with the current circumstances, which is totally understandable. We feel like working with an organization like Numinus to give our people access to licensed mental health professionals just makes sense.”

The insurance companies providing mental health coverage are just as motivated to facilitate services. For one, like many of us, they are often looking for ways to make meaningful contributions to their communities in this crisis. They also fundamentally want their customers to get good value for their policies, or else organizations won’t renew their policies. For example, SunLife’s  indicates: “We want to ensure plan members continue to receive the health care they need. Now, we’ll cover virtual services for appointments where they do not need direct physical therapies.”

Do you work with or represent an organization looking to support its employees through this crisis? Have a look at Numinus comprehensive offering for organizations during the COVID-19 crisis.

Acceptance and Commitment Therapy: 6 Skills to Living a Richer and More Meaningful Life

Acceptance and Commitment Therapy, or ACT (pronounced in one word), was developed by Dr. Steven Hayes and his research team and has, in the last decade or so, become one of the leading mindfulness-based interventions. One of its biggest strengths is that it is an evidence-based psychotherapy, with literally dozens of peer-reviewed research articles being published every month investigating its effectiveness in a wide range of contexts.

Although based on a cognitive-behavioural framework, it is heavily influenced by mindfulness concepts. Like other mindfulness-based interventions, ACT is not focused on changing unpleasant events or reducing symptoms, but rather to learn how we can make room for them and live a good life in spite of them. However, unlike other mindfulness-based therapies that involve long hours of formal meditation, ACT targets specific skills that can help cope with distressing events through brief exercises. This is especially helpful for those who are having difficulty meditating for long periods of time. These skills are based on the premise that distressing experiences are inevitable so learning how to cope with them is important, and that doing so allows us to live richer and more meaningful lives. The therapy consists in learning 6 skills, some of which focus on how to cope with unpleasant events, and others on how to live a meaningful life by making wise decisions.

1. Defusion

The first skill targets the destructive potential of thoughts. Being fused with thoughts means buying into them, or taking them literally. Conversely, being ‘de-fused’ from them means perceiving thoughts as simply thoughts, no more, no less. Defusing ourselves from thoughts that we have allows us to create some distance between our troubling thoughts and ourselves. This doesn’t mean getting rid of them but helps remove the emotional impact that they have on us. There are plenty of defusion exercises, for instance, a distressing thought such as “I’m a loser” can be repeated very rapidly until it loses its meaning, or can be tagged on after the stem “I am having the thought that…”, which also helps realize that it is just a thought passing through awareness and is not necessarily an accurate representation of reality.

2. The Observing Self

After some practice defusing oneself from unhelpful thoughts, we begin to notice that there are thoughts and there is an awareness of these thoughts, and that they are not the same thing. It soon becomes experientially apparent that while experiences continuously come and go, the awareness of these transient experiences itself is consistent and unchanging. Redefining oneself as the observer of experiences rather than as the experiences themselves, allows us to feel less directed by thoughts and thus freer to act volitionally. To facilitate understanding of this unusual concept, certain metaphors are used, such as comparing the self as a chessboard and thoughts as the pieces on the chessboard.

3. Acceptance

Having a range of experiences, even bad ones, is normal and part of being human. What creates distress is resisting these experiences and trying to avoid them. Another skill that is taught in ACT is being willing to allow all experiences, even unpleasant ones, to co-exist with us in every moment. Accepting unpleasant events is easier said than done but becomes easier the more it is practiced.

4. Contact with the Present Moment

Ultimately, life is always unfolding right now. So to live a rich and full life we have to be here now for it. By practicing accepting one’s experiences as they are, it becomes easier to remain for extended periods of time in the present moment. By doing so, not only are we enriching our life experience, we are also no longer avoiding troubling situations but learning to live with them.

5. Values

In order to live a meaningful life, it is essential to identify our deepest values and subsequently behave according to them. Identifying values requires taking the time to ask ourselves what is truly important to us.

6. Committed Action

Knowing what is important to us is not enough to live a meaningful life. The important last step is to commit to acting in accordance to these values despite the many obstacles that life regularly throws our way.

In essence, ACT is a means to become more aware or what we are experiencing from moment to moment, and more aware of what we truly care about. By no longer getting caught up in automatic (and often unhelpful) thoughts and actions, we develop the ability to become more flexible in the decisions we make and ultimately the way we chose to live our life. Our actions are made more consciously and are guided by what is deeply important to us.

Want to learn more about ACT? Many of our psychologists have trained in ACT for individual therapy, and we also offer group therapy programs based on ACT, as well.

 

This is an updated version of an article originally published on July 19, 2015

Episode 24: Love, Attachment, and Couples Therapy with Dr. Sue Johnson

 

“Relationships are the keystone of our lives. They are as important to us as our next

breath.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Sue Johnson. Sue is a pioneer in the field of couples therapy. Alongside Dr. Les Greenberg, Dr. Johnson developed emotionally focused couples and family therapy (EFT), which is a couples therapy based on the newest research surrounding relationships: attachment theory. She is also the author of many books like Hold Me Tight, Created for Connection, and Love Sense and is the founder of the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT), which offers training to therapists in EFT.

Dr. Johnson and Dr. Joe spoke about:

If you’d like to seek services in couples therapy and EFT, please visit our site for more information.

Connect with Dr. Sue Johnson on FacebookTwitter, and her website.

Connect with Dr. Joe on  FacebookTwitter,LinkedIn and Instagram

Follow Numinus on FacebookTwitter,LinkedInInstagram.

 

Here are some highlights from their conversation:

Could you take us through the basics of attachment theory and how that informs emotion-focused couples therapy? 

One way of thinking of what EFT is about and capturing it very fast is that EFT–you could think of EFT as a model, as a conversation between Carl Rogers, which is my basic training as an individual therapist. It’s a conversation between Carl Rogers who believes that it’s the therapist’s job to believe in people’s ability to grow. Who was dedicated to non-pathologizing and to listening to people and believing that acceptance and a powerful safe connection was healing in itself.

So it’s a conversation between Carl Rogers who invited therapists to listen to their client’s experience, to take it seriously, and to reflect that back in a way that allowed their client to continue to process it and engage with their experience in a different way, to create corrective emotional experiences.

And then you have Salvador Minuchin who would come in and say that you have to look at people in the context of relationships. And that you have to look at the dance, the drama in people’s relationships and how those dramas take over people’s lives and define them. You have to find ways to understand these powerful feedback loops that you see people caught in throughout their lives. Where they almost create the interpersonal problems that they have.

‘My only way of dealing with my emotions is to shut down and shut you out. When I shut you out, I alarm you.’ Because you are a bonding mammal, your brain is designed to be alarmed by the person you count on shutting you out. So when I shut you out, you become alarmed and you become angry with me. And then I hear everything I’ve ever been afraid of, which is you’re going to reject me. I’m not good enough. So I shut down more.

And this kind of feedback loop that I’m talking to you about–some folks who are trained just in individual therapy don’t really think in this sort of systems, process oriented level.

So it’s a conversation between Carl Rogers, Salvador Minuchin about how to intervene. You’ve got to look at the relational systems people are involved in and the pattern of interactions, the drama in their–how people move their feet in the dance. And you’ve got to look how people put their emotions together, their emotional life. And you got to look at it in a non-pathologizing way. But that’s still not enough.

If you’re going to work with close relationships in couples and families, and even individual therapy, you have to have this awareness if you’re going to be effective.

You have to listen to John Bowlby who basically said, ‘we’re bonding mammals,’ and gave us a map to our basic needs and basic fears. He basically said–and this has been borne out now by so much science in our world–emotional isolation is traumatizing for human beings and evokes pretty dysfunctional responses because when you’re afraid, your whole world narrows down, and your response repertoire usually narrows down, your ability to explore and open up narrows down. And many, many of us then get completely stuck.

So Bowlby said that we have to understand ourselves as bonding mammals and how these relationships with others are the keystone of our lives. They are as important to us as our next breath.

John Bowlby basically said that all the dysfunction that you see–if you want to call it that–in your clients, all the places that people get stuck, are distortions of things that in other contexts would be perfectly reasonable, healthy responses. I think Rogers would have agreed with that.

Bowlby said that when people feel safely connected, they are able to be expansive and learn and grow. People need safe haven, secure base relationships. They need safe haven people to go to with their vulnerability where they will receive comfort and reassurance and get their emotional balance. We give clients emotional balance in EFT. They need their loved ones to provide a secure base to go out from.

What we understand now is that as adults, there is something called constructive dependency. The strongest among us and the ones that are able to grow and change and be resilient can turn to other people in our minds, and also in our lives, and use those other people as a resource. And that’s constructive dependency.

 

I’d love to hear you talk about these sorts of patterns of disconnection that happen–I believe you called it the tango. Maybe you could just give us examples of the tango. 

Patterns of disconnection in couples in our society–the most popular show in town is that one person starts to tune into the fact that there is emotional disconnection. They’re asking the question: Are you there for me? And somehow the answer comes back ‘No’ or ‘Maybe.’ So they start pushing to change the dance, to change the relationship. So they became more anxious, more demanding. They start sounding critical. ‘Why don’t you…’ ‘You never…’ ‘How could you?’ ‘Can’t you see that…?’ And they start pushing.

The trouble is that neither partner is not often very clear about what they’re pushing for. They might say, ‘I just want you to do chores.’ But when you really hear it, it’s not about chores. It’s about, ‘I want to know if I say something to you that matters to me that you care. I want to know that my pain matters. I want to know that my happiness matters. I want to know that I matter to you.’

So we see this pattern of pursue, withdraw–I get angry with you and more desperate, and you reason with me or don’t become emotionally available. You turn away. You shut me down. You shut down and shut me out. The more you shut down and shut me out, the more desperate I become. We’re obviously reducing a complex phenomenon to something simple. But that’s the most popular dance that creates distress in relationships.

So we help people see that dance. We help them see how it leaves them both desperate and alone. And then we help people move into being more open and connected with each other.

And the tango that you talked about, which is the thing that we do in almost every session across the stages of therapy, whether we’re trying to help people see the negative dance they’re caught in in stage one. Or moving into stage two, helping them create new moves in their dance like really open up to each other and help each other with their fears and needs, help each other so that their feelings of vulnerability have a solution. And the solution is the connection with the other person. The connection with the other person is the solution to the problems.

Once people are connected safely, they can deal with almost any of the other problems they come in with like sharing chores or parenting or finances or what to do in bed. You can’t talk about any of those things effectively if you don’t have some sort of team.

The way the therapist does this is that they do something called the EFT tango. I dance Argentinian tango. So that label is mine [laughs]. But the reason I called it the EFT tango is because most people think of tango in terms of ‘Dancing with the Stars,’ which is horrible. Real tango–which you can see in any city in the world right now–is all about attunement. It’s not about the steps at all. The steps can be amazingly simple. It’s about tuning in, being able to stand up with a perfect stranger, listen to some beautiful music, and tune in to that stranger’s signals, that stranger’s intention, that stranger’s body moves and emotional tone, and then come together and move together with this music as the structure. So that’s why I called it the tango.

If I were to describe it for you very simply, the EFT therapist, whether they’re working with individuals, couples, or families–move one is that you stay in the present moment. You stay in the present moment and you look with your attachment glasses on at the patterns that are happening in front of you. You look at the emotional patterns and the patterns between people if you have more than one person in the room or even if you have an individual person who’s talking about their relationship with mother, etcetera.

Episode 11: The Science of Personality & Philosophy of Well-Being with Professor Colin DeYoung

 

“I think that we can boil down well-being to two basic questions: How successful are

you in moving towards your goals? And how well integrated are your various goals?”

– Colin DeYoung

In this episode of the Numinus podcast, Dr. Joe speaks with professor Colin DeYoung. The purpose of the Numinus podcast is to inspire well-being: to help us all move toward a healthier, more joyful, and more meaningful life, for ourselves and our communities.

We are convinced that a scientific understanding of well-being provides a strong foundation for this pursuit and Colin is an exceptional guide to this area of science. Colin DeYoung is an Associate Professor in the Department of Psychology at the University of Minnesota. He specializes in the study of personality and its biological bases. He is well-known for his Cybernetic Big Five Theory, which provides a unifying theory for personality psychology and personality neuroscience. More info on Colin’s research can be found at deyoung.psych.umn.edu/.

This episode is particularly relevant at this time of the year – it’s the beginning of 2019 and for many of us, it is a period of reflection – a moment to clarify our hopes and dreams for the next 12 months. The podcast today should align nicely with this state of mind as Colin talks a fair bit about the philosophical bases of well-being science.

The conversation also addressed the impact of the following variables on well-being:

Colin and Joe speak about the Big 5 theory of personality and how it has surpassed the Myers Briggs approach to become the dominant model in personality science. If that discussion makes you curious about your own personality, you could get a report on your Big 5 profile by filling in a simple questionnaire: Big 5 Personality Inventory

Finally, if you are inspired to improve your well-being, Numinus could help. You could make an appointment with one of our therapists or coaches, you could register for one of our mindfulness programs, you could join our meditation community at Presence, or you could bring Numinus to your workplace.

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Here are some highlights of the conversation with Colin:

2:54 Who are you and what do you do?

3:32 How do you do this kind of research?

4:43 What about the fact that personality is sensitivity to context?

8:17 Are some people’s personalities more dependent on context than others?

11:05 Tell us about the Big 5 model of personality

17:54 How is the Big 5 different from the Myers-Briggs model?

25:01 How did you get into this kind of research?

 

28:50 What does the personality literature say about who experiences well-being and why?

So I guess a good place to start with this would be to talk about what do we mean when we say well-being? It turns out that philosophers and psychologists tend to come at this from pretty different perspectives.

Again, this is partly because of the challenges of measurement. We talked about the difficulty of how you measure people’s personality as well. It also turns out that it might be difficult to measure well-being depending on what you think well-being means.

If you think that well-being is simply of somebody’s satisfaction with their own lives and how happy they are, then it’s actually pretty easy to measure. So this is how psychologists understand well-being probably because precisely it is easy to measure.

In psychology what we do is just ask people how satisfied are they with their lives. How much positive relative to negative emotion do they experience. And some psychologists say that is a little too limited.

So now there is also a tendency to think about other types of well-being like how meaningful their lives are, whether people have a sense of purpose in their lives. Of course these are all very important things in terms of people’s experience of their own lives.

But nonetheless you’ll notice that they’re all still completely subjective. They’re just about how people feel about themselves consciously. So it turns out that most philosophers wouldn’t take that to be an adequate foundation for well-being. The school of philosophy that get closest to that view would be the hedonists.

So there are essentially three general types of theories about well-being and philosophy and I know about this under my tutelage from my friend Valerie. Hedonism essentially says that the balance is really what constitutes somebody’s well-being. You can talk about whether that’s important from the moment to moment or whether there’s some long run balance between pleasure and pain that we should have to establish somebody’s well being. But at any rate that is the only philosophical school that thinks subjective experience is the primary or crucial foundation for well-being.

There are two other general types of theory. One of them is known as list theories and the original one comes from Aristotle. So they are also referred to as Aristotelian approaches to well-being and they basically argue that there is some objective list of qualities that you have to achieve to have well-being. And that can be with the sense that you have to fulfill some kind of human nature. That you have live up to some potential for human nature and that is what true well being means. So if you have those kinds of things, whether they are–well, that’s the thing, different philosophers within this school will come up with slightly different lists of what are the qualities that a person should have like wisdom and temperance and good judgment or whatever else it is that once that somebody has that, you can say objectively that they have a high level of well being.

Then the third type of theory I usually call preference or satisfaction theories. And these basically state that people have certain desires, certain goals, and the degree to which they are actually achieving those goals or successfully meeting those desires is what really constitutes well-being.

There is obviously a subjective component there because what people’s goals and preferences are are going to be at least in part subjectively determined. But there is thought to be a real potentially objective question in many cases about whether people are actually moving towards their goals or not. In other words, somebody who was delusional, who thought things were going really well in their lives and had a strong sense of satisfaction and felt like their desires were being met even when if we can identify in truth that they weren’t. That they were failing in most of the things that they themselves profess as their goals and they’re heading to some kind of calamity, we might say that they’re actually be mislead or deluded about their own well-being.

Valerie’s theory is kind of a sophisticated version of a preference or desire satisfaction theory. It’s called Value Fulfillment Theory. It basically says that people have well-being to the extent that they are moving toward, fulfilling a set of values that they have. And those values have to be appropriate.

That’s the word that she uses. What that means is essentially is that people’s conscious judgments about what they want are well integrated with their emotional lives and basic motivations and these other things about themselves that may not be always fully conscious, but we can try to have some kind of insight into and to pay attention to.

It turns out that that idea that you have to have well integrated goals that are viable. In other words, they have to be realistically possible for you, that are sustainable, that are going to be things that work for you in the long term. Or at least notably long term because of course people can change their goals. And then also have this quality of being well integrated across our various different goals, both in our conscious and unconscious experience of the world or our relation to the world. That fits really well to the kind of approach I take to how personality works in which goals are really important.

 

35:57 What about Eudaimonic well-being – the notion that we experience the deepest well-being from the process of facing and overcoming adversity? How does that fit into your theory?

I do think it is important. People’s subjective sense of–we’re not claiming that people’s subjective sense of well-being whether it’s happiness or meaning or purpose is irrelevant. That’s obviously very important. But it’s just not the whole picture.

I think that in order to have a sense of purpose or meaning in life, you have to have what Valerie calls appropriate values. What that means is that you are motivated by some kind of larger, longer term goals.

I should probably say a bit about this contrast between values and goals. So I tend to use goals in a sense of the word that comes from a field called Cybernetics. We can talk a little bit more about it too because that’s the basis of my own personality theory. So Cybernetics is the study of systems that are goal directed and that manage to self-regulate via feedback. So they have some way of monitoring what the state of the world is and they also have some kind of representation about the way the world should be. And they are capable of comparing those things and then engaging in various kinds of strategies or actions or cognitive processes to try to transform the way that the world is into the way that they think the world should be.

And so these representations of the way that the world should be are goals. And goals can be as simple and straightforward as, ‘I want a sandwich because I’m hungry’ to something like, ‘I should always be an honest person’ or ‘I think that war is bad and that we should be trying to eliminate it from the world.’

What people often refer as values I think are in an important sense just some of these relatively broad abstract goals. That gives us a way of thinking about what it means for people to say that they have meaning or purpose in life.

 

41:36 What is the role of goals and values in well-being?

 

43:36 If well-being is so tied to goals and values, what do you make of the approach, exemplified by the secular mindfulness movement, that encourages letting go of the past and the future and appreciating what is already present?

I think that is a really great point. And I think that it’s actually compatible with the way that I think about well-being.

It actually raises some really interesting questions. I think that probably the right way to think about that–I think that we can boil down well-being from my perspective to two basic questions. One is how successful are you in moving towards your goals. And by that I’m not just including your concrete goals like getting a raise at work. I’m also including these much more abstract goals like being an honest person or kind or having fulfilling personal relationships. These kinds of things that people view as their ideal self or ideal future or the way the world to be.

And so the first key component are people actually making progress towards those things. And the second key component is how well integrated are their various goals? We can think about people’s goals as a hierarchy because some of our goals are broad and some of them are more narrow as we have already said.

And typically to achieve broad goals, there are subgoals, where some of those narrower goals that need to be met. Let’s say I am in college and let’s say I have the desire to have a fulfilling career and thinking about what my future is going to be, maybe I decide I have this feeling that I really want to help people. And so I think that, well, being a doctor would be a good way to do that. Suddenly I have this very broad goal. Which is to help people. Then I picked a somewhat more concrete subgoal. Which is to be a doctor.

So that’s a way in which I’m going to be able to help people. And that subgoal of being a doctor itself needs a whole bunch of different subgoals. So that means I have to successfully get into medical school. That means I need to take pre-med. There are sorts of things that one has to do in order to achieve these broad long term goals and they too are narrower goals.

So we have this whole complex set of goals and the problem is that they don’t all necessarily fit in together with each other very well. Let’s imagine this person who wants to be a doctor and let’s imagine that they always really enjoyed music. Let’s say they’re an excellent musician, studied music as a child, really enjoyed it. But now they feel like that music is good, but I’ll keep doing that on the side. I got to get into med school and be a doctor, so maybe I don’t have as much as time for it as I used to. Now that might work out. Maybe for this person music works fine as a side hobby. But maybe it turns out that they a lot more attached to making music than they realized.

What they’re finding is that they’re not enjoying organic chemistry or these various other things that they’re taking in order to be a doctor. There is essentially no time for music. These classes are hard. That’s out the window. They really start to suffer because of that. Because they feel there’s a detriment to their well-being.

And now there’s an interesting choice to make. And sometimes people make these choices without consciously realizing that they’re doing it. It’s like things just drop off or conflicts between different goals that people have, people make compromises. Sometimes without even paying attention to the fact that they’re making compromises. So a lot of what we have to deal with in life, and a lot of what leads to poorer quality of life or lack of well-being has to do with goal conflict.

We have some need that is not being met because a need is just another way to talk about a goal. To me a need is basically like a goal that is built into the human being by evolution. There are certain goals that are not optional for most people. You can’t escape them. And so there are often these tensions between fulfilling our different needs or goals or values.

And I think, if I can bring this back around to where your question started out, that these traditions that emphasize the importance of mindfulness and non-judgment and letting go of our attachments, what they’re doing is basically providing us a tool with figuring out what are really our important goals. Like they don’t usually use those words.

That’s partly because I’m using goals in a more general and abstract way. But you might think that they help us figure out what our important values are. What do we need to be attached to? What do we not need to be attached to?

Now you might say, ‘hang on, hang on. If you’re going to be a good Buddhist, you don’t need to be attached to anything. You have to have complete non-attachment.’ But interestingly I think that’s like one of the things we were talking about earlier like one of these values that maybe works for some people to work toward, but is not actually something that you can achieve. You cannot cease to be a Cybernetic system.

n other words, you cannot cease to be an organism and organisms are goal directed by their very nature. That is essentially what makes an organism what it is. You will continue to need to eat and to sleep. You will continue to care about your interpersonal relationships. You will continue to have goals, no matter how good of a Buddhist you are.

 

50:03 Do you think it’s possible to achieve freedom from our attachments?

 

56:57 How is your meditation practice these days? Does your experience with meditation align with your theory of well-being?

I wish I could say that I have a good meditation practice still. But the fact is that at this point I am meditating only very rarely. And it would be great if I were doing it more.

I thought about why it’s hard to maintain meditation practices. I think that if I look back over my life for the last let’s say almost 20 years, at least 15, when I took that class with you, and that’s when I really started meditating.

What I got out of that–and I had a very regular meditation practice for probably about 5 years let’s say. That was hugely important for my development. And for what I would say is my well-being even through to today. And a lot of what I learned with that practice still influences the way I experience life all of the time even though I don’t sit very often anymore.

So what happened was that there was a period of a few years where I was meditating less often, and since then it’s kind of dropped off. I always thought about it a lot. Even when I was meditating often, I was having a hard time making the time to sit and meditate and that was weird to me as a psychologist because of the fact that when I did, I found it so rewarding.

Some people talk about really struggling and of course everyone if they have had a really regular meditation practice has had the experience of really struggling with their practice and feeling like that sometimes the mind wandering is worse than usual and it can get frustrating.

I didn’t have that experience too often. I certainly have had plenty of experience of having an unruly monkey mind. I generally thought it to be a really positive experience in the moment while I was sitting there, like it was emotionally positive for me.

And so then like a good psychologist I thought that this should be conditioning me. this should be making it really to be motivated to do this. And I started to think about why that might be.

When I started to learn about some of the ways that the brain’s reward system works and in the way that dopamine works and the way that the endogenous opioid system works, I kind of developed a hypothesis–I haven’t tried to test it yet–about why that might be the case.

Basically what you’re doing when you’re meditating is that you’re trying to free yourself from desires, from trying to pursue things, from being judgmental about things, from being caught up with a certain goal, whatever it is. So I think one of the things that you’re doing in typical meditation is that you are really trying to turn off the dopamine system. Give yourself some freedom from wanting things in order to have this greater clarity and perspective.

Out there in the popular press, dopamine gets presented sometimes as a feel good chemical as what makes you happy. That’s not true. If you take a dopaminergic drug, it will often induce euphoria and that’s why people like cocaine and amphetamines which are acting directly on the dopamine system. But it turns out that that feeling of pleasure is actually due to a different set of neurotransmitters those that are related to the opiate system.

But what dopamine is doing is making you motivated. It’s making you want things. It’s really more a chemical about wanting than it is about liking things. I think that what you’re doing when you meditate is that you are temporarily trying to deactivate your dopamine system.

And the interesting thing about that is that dopamine creates learned motivation. I think that’s what is happening, one of the reasons why it’s hard to maintain a meditation practice. Even though you kind of have the liking and enjoyment of the behaviour, but you are intentionally suppressing the process that would normally make the behaviour addictive, that you were really motivated to do, and that you had the desire to do in a way that manifested in your behaviour.

So I think that there is something interesting about the way that meditation works by its very nature that makes it inherently harder to train yourself into a habit with it.

That would really explain a lot if it is true because this is something we face at Numinus. And everywhere I go trying to inspire people to meditate, almost everybody recognizes that it would be beneficial and valuable and a useful thing to do. But it’s just so hard to make it stick.

One of the things that for probably millennia people have understood about maintaining a meditation practice is that community is a hugely important component. There’s the Sangha and there are the people you sit with and I wonder if it’s a question of reward of introducing reward into the routine. I think it’s not even just reward.

Although of course people are rewarded by social engagement often in community. But it’s also just building a pragmatic structure, so that you have the organization. And it’s not just up to you and your whims whether you pursue the practice or not. You have obligations to other people. You got all these other motivational systems that are now coming into play that help you organize your behaviour, other than just whether you feel like doing something or not.

 

1:05:17 How does personality fit into your well-being theory. Do our personalities lock us in to a pre-disposed level of well-being?

1:10:02 What are “characteristic adaptations”?

1:12:35 What are the best tools for changing “characteristic adaptations” to improve well-being? What are the obstacles?

Attachment Theory and Why it Matters in Psychotherapy

British psychoanalyst John Bowlby is the man behind Attachment Theory. His theory revolutionized how we think about love, relationships and our human “attachment” needs for emotional connection, consistency, and security.

In 1969-1970, Bowlby published a famous trilogy of papers describing an innate network of psychological, biological and behavioural processes that he called the “attachment behavioural system.” Compared to other mammals, human babies are born quite helpless.

These processes ensure that bonding occurs between babies and parents– and thereby increasing babies’ chances of having their early needs for safety, nourishment, and love satisfied.

Bowlby wrote that the quality of attachment between an infant and parent (or another caregiver) depends whether or not the child sees the parent as a source of security, comfort and understanding–or in other words–as a source of love.

Since Bowlby’s time, psych research has since shown us that attachment experiences shape kids’ sense of self and later experiences in intimate relationships.

Attachment styles are categorized as secure or insecure: securely attached kids think of themselves as lovable and think of others as trustworthy, consistent and responsive.

The picture is slightly more grim for insecurely attached children: they are more likely to view themselves as unlovable and to see others as insensitive, inconsistent and unresponsive.

The good news is that research shows that most of us are securely attached!

Unfortunately, reality and experience are always more nuanced and complicated than scientific research would have us believe.

My view is that attachment styles exist on a continuum, are adaptable, and depend on the relationship. For example, I might be securely attached to my father and insecurely attached to my mother.

Alternatively, I could be insecurely attached to my mother as a child but then build a strong and secure attachment to her in adulthood. Because I see attachment bonds as dynamic rather than stable,  I believe that relationships with parents, friends, grandparents, or lovers can provide corrective attachment experiences.

That is, our adult friends and partners provide the opportunity for us to change our attachment style. Beautiful.

In individual therapy, the client/therapist relationship can provide a corrective attachment experience; in couples therapy, I help clients address their attachment needs in the relationships.

No matter your attachment style(s), we all have a basic need for safety, belonging and love. Seeking connection is a fundamental part of being human–and often a central part of healing in therapy.

How to Choose a Therapist

This year, you’ve resolved to get help: to learn tools for managing panic attacks, to explore the issues underlying your relationship fiascos, or to decrease your drinking. You’re ready to seek therapy. But now what?

 

Choosing a therapist isn’t like choosing a new dentist or dry-cleaners. Your therapist is someone you’ll entrust with your personal experiences and vulnerabilities. You’ll share private information with your therapist and partner up with him or her to identify the triggers and maintaining factors for your problem behaviour.

It’s in your interest to find a therapist you’re comfortable with, and who meets your needs. Here are a few guidelines to help you make a good choice.

Consider therapeutic approach

Your therapist’s approach must be consistent with your therapy goals. If your objective is to decrease your compulsive shopping habit, or manage your panic attacks, it may be a case for cognitive-behavioural therapy. If your inability to experience or express emotion is wrecking your relationships, it may be a case for emotion-focused therapy.

If you have no specific pressing issue but your intense stress level prevents you from feeling present, it may be a case for a mindfulness approach. Don’t be shy to ask your potential therapist which approach(es) he or she uses.

Consider credentials

In Quebec as of 2007, the title of psychologist requires a PhD in psychology. Psychologists licensed in 2006 or earlier have a masters degree in psychology; certain guidance counsellors, sexologists, social workers, nurses, psychoeducators, and occupational therapists may be accredited as psychotherapists.

A PhD means six years of psych coursework, research, and internships; a masters degree means two or three years. Licensing as a psychotherapist requires a master’s degree in a different mental health field and training in psychotherapy. Don’t be shy to ask your potential therapist about his or her background. (Click here for a review of the differences between psychologist, psychiatrist, and psychotherapist.)

Consider experience

A therapist who recently completed his or her training may be proficient in the latest tools, techniques, and evidenced-based practices. However, an older therapist may have the wisdom of decades of experience (and may also be proficient in evidence-based practices). When choosing a therapist, consider whether or not this factor is important to you.

Consider fees

Psychologists in Quebec charge anywhere from $60 per session to $200 per session, with an average of about $100. Many insurers will cover the costs of psychotherapy with a psychologist (but not other types of therapists), and many therapists have a sliding fee scale. When researching potential therapists, consider your budget.

Consider location and availability

Psychologist A charges $100 per hour but her office is a 45-minute drive away and she only sees clients between noon and 5pm. Psychologist B charges $130 per hour, but his clinic is in the building next to your office and he can see you at lunch or after work. When researching potential therapists, consider location and availability.

Consider age, gender, and culture

If you’re an older person, you might believe that a young therapist wouldn’t understand your perspective. Alternatively, you might prefer a young therapist who could offer you a fresh perspective. If you’re younger, you might prefer a therapist close to your age; alternatively, you may be seeking a maternal or paternal figure.

Similarly, you may prefer a therapist of your gender or of the opposite gender, of your culture or of a different culture. When researching potential therapists, consider your age, gender, and culture preferences.

Finally, consider the possibility that age, gender, culture, experience, and credentials might not matter as much as you think.

The most important indicator of client-therapist fit is your global feeling of comfort or discomfort. Even if you find a therapist who meets all of your criteria based on the factors listed above, if you feel like your therapist doesn’t get you, if you feel uneasy in her office or unable to open up, it could be a poor fit.

Similarly, even if your therapist is the wrong gender and younger than you expected, if there’s a nice ‘click’ between you and a feeling that working together could be constructive and gratifying, it could be a great fit.