I recently had a chat with a fellow I knew since childhood. When we talked about our careers, he asked me what I do as a psychologist. Obviously, that question was hard to answer on a phone call in which we had not connected in several years. But in attempting to summarize, I told him as a cognitive-behavioral therapist, my focus is to help my clients change their irrational disturbing beliefs to more rational ones, that is change the way they think about things. After speaking to him, I decided to write about two aspects of therapy that, to some, might seem apparent, but still, often have been a good starting point in helping my clients.
These important methods in affecting change in my clients take place through the use of education. If my clients do not understand how I am trying to help them, much of my efforts will be in vain. Speaking in the client’s language is strategic in behavioral change. Depending on the client and the issue at hand, I may start the therapeutic process by illustrating how the process of change occurs by defining two terms, used on a daily basis, emotions and thoughts. I let them see that an emotion relates to an expression of a feeling in one word, such as anger, depression, anxiety, love and hate. But the thought that they have generally takes the form of a sentence or a group of words. This distinction is crucial in understanding what is causing a client’s discomfort.
As higher primates, humans have the ability to think and it is this same characteristic that can boomerang on us resulting in emotional pain and hurt. But as I tell my clients it is the emotion, that though not the root of their problem, can act as the clue to uncover their irrational beliefs or thoughts. A therapeutic intervention that has served me well in my many years of practice is to have clients search for the thought through the pain of their feelings. Just as a fuse will go off to break an electric circuit if the current exceeds a safety level, a negative feeling such as depression or anxiety signals a fundamental problem in our underlying thought processes. By employing this analogy, clients can identify more easily the thought that is producing their negative emotion.
Because couples’ therapy is not the same as individual counseling, I employ the use of education in a different way. For example, the majority of the couples I see in therapy come in with a mutual sense of not being able to communicate well with one another. Once I have each partner define what poor communication means in more specific language, the therapeutic process is facilitated. Problems become much more tangible when each partner avoids name-calling and labeling that have a pejorative connotation. When clients can explain more clearly what it is that they find bothersome about their partners, much confusion and bad feelings are avoided.
I have employed the above examples of what I do in therapy as mere starting points and not solutions to the problems my clients may have. Psychoeducation serves as only one component of the therapeutic process but, nevertheless, can play an important role in counseling. Because my clients are all different, I tailor the treatment I provide to them to their set of unique needs. Whereas some individuals may require little psychoeducation, others may need more, but then this is really what the experts refer to as the practice of therapy not only being a science, but also an art.
Dr. Bernard F. Natelson 