How to Win at Therapy

How do you know you are doing well in therapy?

If you are trying to get an “A,” you’re doing it wrong. Mental health treatment uses a different system when it comes to helping people become better versions of themselves. While you might be used to grades systems applied in primary education, or job evaluations, counselors evaluate progress differently. So, how do therapists determine progress?

Different viewpoints of treatment exist. Which one does your therapist use?

Psychotherapists use a variety of models in their case conceptualizations. Most rely on the biopsychosocial model of healthcare.

The medical model approach to health views objects as broken systems or parts that need to be fixed. This perspective does not take into account the environmental factors that influence a person’s life. It negates our complexities as humans, and leaves many unaddressed areas that can impact someone’s mental health. Your body is seen a broken object in need of repair.

Alternatively, the biopsychosocial concept encompasses the interconnected biological, psychological, and social causation of distress. While both have served us to treat the human condition, the biopsychocial model provides a wider frame through which we view people with behavioral or mental health challenges.

Counselors utilize the biopsychosocial model for treatment of one’s disorders. There is no grading system. Having a mental health disorder does not mean that you are broken, irreparable, or damaged goods. Nor does it mean you are failing at life.

People experience problems, on a spectrum. Every person has periods where they struggle. We lose people we love through death, location change, or relational fracture. We undergo life changes, and experiences stress. People function differently, in various environments.

We all have character strengths and weaknesses. They are simply characteristics that cause negative consequences in some environments, and positive ones in others. Workaholism is great in your job, but terrible for home-life. The key is to know when, where, and how to use them.

Unlike the medical model, the world of mental health counseling vastly differs. Behavioral health professionals and doctors utilize both approaches. However, counselors typically view you through the biopsychosocial lens, where your world is considered, not just broken parts.

You Are Normal

I don’t know about you, but I have yet to find out what normal  is. Especially today, normal is a fantasy for those who believed in the long-extinct American Dream. You define what is ordinary versus unusual through your own observations.

This norm is always changing. Our society’s definitions of what constitutes as acceptable is fluid, and usually changes for the better. What isn’t normal is abuse. You can be a victim of abuse, but that does not mean you are abnormal. You did not choose to be victimized. You might have reactions to this, or life circumstance. That does not make you broken or different and less than others. You are human, with wounds, just like everyone else.

What isn’t normal is hurting someone, then dismissing their pain. It isn’t seeing a person you “love” fight through a battle for their life with addiction or depression and telling them just to “get over it,” or making them feel inadequate in any way for having these difficulties. These are trauma responses in some cases, and poorly learned behaviors in others. Making others feel less than human in order to make yourself feel better about yourself is definitely not normal. It’s sad.

Like Cory Taylor says, our society is broken. We value things, not people- including the people who fight to protect us. Money comes first. This level of denial America‘s “normal.”

Letting our veterans die with no mental healthcare in the midst of their crises, putting them on years-long waiting lists for any type of medical treatment happens regularly. From 10/2017 to 11/2018, 19 veterans killed themselves in the parking lots of VA hospitals. Horrid mismanagement, purposeful pushing out of appointments, and not following up, people get lost in the system. Their crises cannot be resolved when their appointment that is scheduled 6 months out or more comes around. 22 veterans die by suicide daily. The United States spends the most on healthcare, yet has the highest rate of suicides when compared to other nations.

The health care system in America is broken. People cannot afford to stay alive, quite literally. Insurance denials of life-saving procedures, unaffordable copays and policies, mental health is the last priority. The health care system has had these issues for decades.

The US ranks first with the highest suicide rate and lowest life expectancy. According to the Child Welfare League of America (CWLA), “The Well Being Trust believes that the alarming number of deaths is due to a lack of inclusive policies, limited affordable access to care, food, and housing insecurity, and systemic bias. To further highlight the lack of accessible care, Well Being Trust shares that approximately 50% of patients drive at least one hour for mental health treatment and that 50% of counties do not have a psychiatrist.”

Merriam-Webster defines the term disorder as an abnormal condition that is physical or mental. Nowhere does this define a person as being abnormal, just parts. I encourage people to change the story they tell themselves. You are not your behaviors. The fusion of identity with one’s mental health challenges distorts reality.

Like in addiction, people commit atrocities. Their minds are altered not by their choice. Addiction is a disease, caused by maladaptive coping mechanisms to trauma or horrendous circumstance. While the argument of whether the choice is made to use substances to cope, we spin our wheels disagreeing about the technicalities and spend it shaming those who are in the fight for their lives. This does not solve the problem and adds to these high death rates.

We don’t get paid to judge you.

This is the first thing I tell my clients. Therapists chose this field for a reason. We have been there and done that. We understand and we do not think about you the same way you see yourself.

I will tell you what I am thinking and explore that with you. When I begin any counseling relationship, I let that person know that I do not use shaming tactics nor rely on character judgement in my work. Rather, I approach their case with curiosity and the knowledge that every person has a unique situation. We all have different experiences, physical makeups, and environments with unique characteristics, values, and perspectives. To assume that mine are superior would not only further damage my clients, it would cause loss of personal relationships everywhere. I don’t see life in such black and white terms. Rather, I approach them with a curiosity and look for possible areas to build upon their existing skills.

Psychological safety is the single most important factor in a therapeutic relationship. The New York Times discusses the effectiveness this makes in the workplace. Likewise, mental health efficacy relies on the rapport. If the person does not feel safe in my office, we will not get very far. This is one of the first lessons taught in grad school.

I point out people-pleasing behavior because this is a survival mechanism, and usually a sign that the person has some level of codependency and/or emotional distancing. This is the result of childhood trauma, where the child learns to please and care-take others in order to survive. This is how the child learned to get acceptance, nurturing, and attention. Likewise, defensiveness comes in many forms, such as gaslighting or passive aggressiveness. These defense systems keep the person safe. I highlight such areas and question how these serve them.

We also don’t get paid to like you, or to dislike you. These factors have nothing to do with your time in my office. Rapport is different than friendship. I cannot be your friend for this very reason. It gets in the way of doing good work in an ethical manner. Rapport is the building of mutual understanding and empathy in order to make communication easier. Friends give each other passes. Counseling relationships depend on professionalism and trust.

So, How DO You Win at Therapy?

Be yourself. Put in the effort, and become open-minded. Rigidity is the symptom for something deeper. If nothing changes, you will get exactly what you’ve gotten.

Tell your therapist about all of your problems. In order to get better, we need to know what it is you are dealing with. What cards did life give you, and how have you played that hand? I want to understand how you think, and why you make the decisions that you do. I need to know if you cannot sleep, keep a partner, or are drinking or using drugs to handle life. Are you finding it hard to keep a job or pay bills? These are all common areas that people experience extreme shame about. You cannot just over them. It takes help.

There is a reason that we suggest what we do, also. You will hear us therapists say “trust the process.” This is because we know the difficulties of change, the skepticism, the hopelessness, and impatience. We get it. We are always happy to talk about it with you. True change does not happen overnight. It is a process that is long, often times hard, and sometimes painful. Change is never easy, but usually intensely desired.

There is no magic pill. You have to do all of the work if you want better. The more effort you put in, the more you will get out of your time.

Resources:

1. “medical model .” A Dictionary of Sociology. Encyclopedia.com. 26 Aug. 2022 <https://www.encyclopedia.com>. 
2. “Medical Model.” The American Psychological Association. Accessed September 15, 2022. <https://dictionary.apa.org/medical-model>
3. “Biopsychosocial Model.” The American Psychological Association. Accessed September 15, 2022. <https://dictionary.apa.org/biopsychosocial&gt;
4. Barbara J. Lehman,Diana M. David,Jennifer A. Gruber. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass. First published: 03 August 2017: https://doi.org/10.1111/spc3.12328.
5. “Disorder.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/disorder. Accessed 16 Oct. 2022.
6. Montero, A ; Kearney, A.; Hamel, H; and Brodie, M. “Americans’ Challenges with Health Care Costs.” 2022. http://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/
7. “Suicide Rates Are the Highest in the U.S. Compared to Wealthy Countries.” John Sciamanna. CWLA. Accessed October 16, 2022. https://www.cwla.org/suicide-rates-are-the-highest-in-the-u-s-compared-to-wealthy-countries/
8. “The Parking Lot Suicides.”  Emily Wax-Thibodeaux. Feb 7, 2019. https://www.washingtonpost.com/news/national/wp/2019/02/07/feature/the-parking-lot-suicides/
9. “Rapport .” A Dictionary of Sociology. Encyclopedia.com. 26 Aug. 2022 <https://www.encyclopedia.com>. https://www.merriam-webster.com/dictionary/rapport
10. “High-Performing Teams Need Psychological Safety: Here’s How to Create It.”  Laura Delizonna. August 24,2017. Accessed October 16, 2022. https://hbr.org/2017/08/high-performing-teams-need-psychological-safety-heres-how-to-create-it?utm_medium=social&utm_campaign=hbr&utm_source=LinkedIn&tpcc=orgsocial_edit
11. DeAngelis, T. (2019, November 1). Better relationships with patients lead to better outcomes. Monitor on Psychology, 50(10). https://www.apa.org/monitor/2019/11/ce-corner-relationships