From the very beginning, I ask my clients what they hope to achieve from counseling with me. Without knowing what a client wants, how would I know whether what I do would be helpful? If I do believe I do can be helpful, I apply strategies supported by research.
Cognitive Behavior Therapy (CBT)
I use elements of Cognitive–Behavior Therapy because research proves that it works. CBT teaches and trains clients to think in new ways and behave differently, so informed hopes and dreams are closer to realization. It stimulates creation of new brain networks that increase mental and behavioral flexibility. For this reason, my counseling is directed toward teaching and training to augment positive changes in my clients’ brain.
I became aware of Behavioral Medicine research findings when I was working on my dissertation about how feeling anxious or feeling personal control affect the experience of pain. I learned that when people have a perception of personal control and believe a support system is available to them, they feel less pain and inner calm, resulting in better overall health and increased hardiness. These powerful findings are why my counseling focuses on and augments clients’ perception of personal control and development of a reliable support system. I should also mention that Alfred Adler, a colleague of Sigmund Freud, almost a century before behavioral medicine came into being, conceived of “inferiority complex,” which essentially referred to a person who lacked a perception of personal control!
In traditional coaching for performing artists and athletes (not the new kind of coach such as a life coach, etc.), giving instruction or advice about how to improve performance is expected. From my point of view, if clients knew what to do to solve their problems or achieve their goals, they would, without a counselor. Therefore, if they don’t remember ever having been effective in the area(s) for which they’re seeking help, I believe my counseling should first, brainstorm new options for thinking, feeling and behaving, (based on their goals), and, second, teach and train toward effectiveness in achieving those goals. Moreover, when asked what I would do in their situation, I answer the question, without hesitation.
Maryland and DC laws do not allow psychologists to prescribe medication. However, since there are mental illnesses that respond well to the appropriate medication, when I learn that a client’s thoughts, behavior or emotional experiences cause significant distress and daily dysfunction, I teach about the medications that may be helpful. Some mental illnesses respond best to a combination of medication and counseling. Therefore, I do what I can to help clients find a physician who can prescribe psychotropic medication.
With the client, at our visits, I monitor and discuss changes and reactions to medication. Progress toward goals is enhanced and hastened when medication is really needed.
On-going Re-Evaluation of Progress
I want counseling with me to be effective and efficient. I want what I do with clients to be targeted toward achievement of stated goals. I want anxiety or depression or ADD or other conditions’ features to decrease as soon as possible. The client and I will regularly assess whether my interventions and the client’s experiences are moving in the right direction. If needed, I’m happy to modify what I do, when better results are likely.