Designing a therapeutic approach that is appropriate for the client

         The therapeutic frame of containment: a hermetically closed encounter
In order for therapy to achieve psychological depth it must of necessity take place in a closed container.  The confidentiality of sessions, the fact that I am forbidden (by law) to share the content of our discussions with anyone other than my client is the basis of this closed container. In addition to the requirement of discretion and secrecy, I maintain privacy of therapy sessions by making sure that there are no interruptions, no phone calls or other disturbances.

  1. Time and frequency of sessions

          The length of a therapy session is usually 50 minutes. On occasion I have a double session with an individual client. When I see couples I prefer to see them for a double session; but I have seen couples for a single hour with very good results.
The frequency of sessions depends on the needs of the client. There are some clients who have sessions every other week, and at the other end of the spectrum clients who have daily sessions.
Similarly, some clients gravitate to a fixed regular weekly hour while others prefer a different time every week.

  1. Face to face or on the futon

          I see most of my clients face to face as we sit opposite each other with no furniture between us. Some select clients prefer the classical psychoanalytic arrangement, lying on the couch, and they make use of the futon while I sit in back of them out of their line of sight.  This arrangement enables them to go more deeply into fantasies and primary feelings.
(The futon is my contribution to psychotherapeutic furnishings. It serves as a comfortable seat or as an ersatz couch, and is also the venue for my daily nap.)

  1. The empty chair

           The empty chair is a technique that I learned in Gestalt therapy and has proven extremely useful in certain cases. An empty chair is placed in front of the client and he is asked to imagine a relevant person sitting on it. A dialogue ensues with the client alternating between the positions. This can be a powerful tool in helping clients withdraw their projections. When we withdraw our projections we are empowered.

  1. Recording sessions

          Certain clients find that recording our sessions is helpful and I generally record the session on a tape cassette which I give them at the end of the hour. Others prefer to bring in their own recording device. The only stipulation that I have about recording sessions is that nobody but the client listen to the recording.
          I encourage these clients to listen to the recording of our session with pen and paper in hand and to make notes, focusing on the music of the session; the pace, pauses, hesitations, inflections and modulations of voice; all of which add a significant dimension to the experience of therapy.

  1. Process notes

          Some clients find it useful to write a process note after sessions, which include after-thoughts, additions and emotional reactions that they did not express. The client e-mails me the process note and I read it prior to our next session.

  1. Dreams – by e-mail

          Dreamwork is a central focus of my psychotherapeutic approach (see, Dreams, Dreamers and Dreamwork) and often it is most efficient for the client to send me his dream by e-mail and that way I can peruse it and get a general impression of the dream prior to our session. This is also an excellent way to make sure that a given dream has a reserved place on our agenda.

  1. Homework assignments

           From time to time I may suggest homework assignments to deepen and intensify the psychotherapeutic experience. I may suggest that the single adult client who is having trouble separating from his parents stop taking his laundry home to his mother. I may suggest that the client who is suffering from blocked mourning visit the grave of the loved one in question. Or, I  may suggest that the client who has a ‘score to settle” write a letter to the person against whom he has the grievance with the stipulations that he write the letter without censorship, but that he withhold sending it for a few days; and in this manner discriminate between the writing of the letter and actually sending it.

  1. Verbal Judo

           Being a Gemini I am keenly aware of communication patterns and have discovered over the years that there are certain patterns of speech which institutionalize alienation of the speaker from his feelings and immediate experience. I try to neutralize these forms of linguistic alienation and to help the speaker connect with his feelings and immediate experience, and making this connection immediately empowers the speaker.

    1. Questions become statements.

           Under every question there lurks a statement, a ? always hides a !.  When we phrase our thoughts in the form of a question we dissipate and disperse the power inherent in what we say, and when we access the underlying statement our communication is more forceful and we are empowered.
          For example, when someone asks me “Have I been too nice to X?” I encourage him to make the statement “I have been too nice to X”!; and when someone ends a session asking me “Did I make any progress in this session?” I encourage them to make the statement “I did not make progress in this session!”

    1. No “no” in the unconscious.

         Sigmund Freud taught us that the unconscious does not contain the term “no”, and that most statements with the word “no” are examples of denial rather than true negation. This is most apparent in statements like “I cannot say that I was angry, insulted, hurt, offended, etc.” These are blatant denials of being angry, insulted, hurt or offended, and my typical response to this denial is “you already said it!”. And, you can be sure that when someone says “Don’t be angry (insulted, hurt, offended) by what I am about to say” that they are for sure going to anger (insult, hurt or offend) you.

         As a corollary to this, when someone protests that they don’t know something, I point out that the issue is not knowing but imagining, and that they should imagine rather than trying to know.  Therapy is about enhancing the imagination. Knowing is for courts of law, imagining is for therapy. “I don’t know” is one of the all time great cop outs in therapy.

          c. “Either or” becomes “and”.

          Phrasing a dilemma in terms of “either or” is a way of detouring around both sides of the problem, and by making the two options exclusive of each other the speaker avoids identifying with either side.  I encourage rephrasing of the “either or” statement into an “and” form, which enables the speaker to connect first with one side and then with the other. This may lead to a logical inconsistency, such as the statement “next year I want to go to university and to travel in the Far East”; but as Oscar Wilde pointed out, consistency is the last refuge of the unimaginative.  Fritz Perls, the developer of Gestalt therapy, taught us that we need to go deeper into each side of the conflict in order to achieve resolution.
         When a client says: “I don’t know if I love X or I don’t” I suggest that the best way to find out is to look me in the eye and say the statement “I love X” as if it were the absolute truth, and after a moment or two to look me in the eye again and say the statement “I don’t love X” as if it were the absolute truth, and for the client to pay attention to how s/he feels making each statement, and invariably the feeling truth will be readily apparent.

          d.   Correct person – 2nd person discourse becomes 1st person discourse.

          One of the most frequent forms of linguistic alienation is using the 2nd person “you” instead of the 1st person “I”; and this is a way of avoiding owning one’s experience. I correct people who use the alienated “you” instead of the personal “I”, whispering “I” audibly to their every “you”.

          e. The use of “like” or in Hebrew “Ke’eelu”

          The use of the word “like” or the Hebrew equivalent כאילו  indicates a false statement. “Like” or כאילו  is not the real thing but an approximation, and although it is a common form of speech (especially among adolescents) it is always an indication of a forgery or something counterfeit; not the real thing.  The use of this form of speech is prevalent among adolescents because they are involved in establishing their identity, and by necessity “try out for size” false or counterfeit identities. Careful attention to speech patterns reveals that the use of “like” or כאילו  is selective in terms of content and rarely uniform for all subjects.

        f.  The use of " that’s it ” or  “ זהו  “

         People tend to insert “that’s it” or "זהו" in their speech as an artificial halt in their associations, a blockage; and when I hear “that’s it” or “זהו ” I point out that frequently “ that’s it” or “זהו ” comes just before the most important part of what they have to say, and then they often continue to the heart of the matter.

  1. Notes on all sessions

         I write a note to myself after each and every therapy session, and I don’t start the next therapy session until I have read my note from the previous session. These notes help me conceptualize the process with a bit more perspective and also enable me to expel some of the pain that I have absorbed. Also, when I feel stuck with a client I review my notes of the previous months for insights with regard to the location of the impasse.

        Needless to say, all of my client notes are kept in password protected files that are open to me only.

how does it work

How to be good at therapy

23 Harakevet St  Baaka, Jerusalem 93502 Israel Tel.972-2-6734360  Cell. 054-6912360   Fax. 972-2-6713032

john@bezeqint.net
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