What Really Works in Therapy

What really works in therapy? I have observed that the following system works very well:

1. What does the person want in a given situation? What is the desired outcome, congruent with this person's strongest needs and unique personal values? Clarify that.

2. Examine WHY in a given context the person is experiencing a mix of thoughts, emotions and behaviors that are causing distress and dysfunction. This means uncovering the originating trauma that caused a specific set of negative associations – a “schema”. This IS useful to know, because otherwise you are attempting to effect change with no link to the deeper fears the person has! There is a loss of context without this understanding, and that can get in the way of real change.

3. Become aware that a given mix of emotions, trains of thought and objective circumstances triggers these old fears, resulting in self-defeating behaviors.

4. The real work comes in CHANGING THE SELF-DEFEATING BEHAVIORS. Until the person consciously chooses to be aware of, but no longer “get stuck in” the system of associated disabling thoughts and feelings, AND most importantly consciously chooses specific behavioral responses more likely to get their needs met, their lives will be a cycle of self-fulfilling prophecies and nothing will really change.

I would argue that this method technically combines Rational-Emotional, Behavioral, Schema, and Acceptance and Commitment therapies. It really is Cognitive-Behavioral Therapy fully applied as it was intended. The bottom line is, you have to replace unproductive behaviors with effective behaviors, regardless of your cognitive or emotional states (as meditators tell me, “you are not your thoughts or your feelings”). What you DO defines your experiences down the road. However, an awareness of very old and powerful negative associations is helpful, to put the NEED for behavioral change in a context the person can understand, within the framework of their own life experiences. Thus, we have a WHY for change, as well as a HOW. If you just try to act differently without fully understanding the reasons for doing so, or if you simply “get lost in” the relived emotional chaos of the traumatic response (a close friend called this “emotional bulimia”), results will come slowly, if at all.

In summary, what is helping me the most is 50% brief psychodynamic, and 50% behavior modification. Once the psychodynamics are revealed to me, it all comes down to me repeatedly practicing more effective behavioral habits no matter how loudly those old fears scream in my ear.

Practising new ways is hard isn't it. It's like trying to knit fog at first. Than when out of the blue you see You've actually knitting a successful item, the fog lifts

What really world in therapy is honesty and courage.