Therapy with David
From your perspective, what is therapy?
Therapy is a designated time, space and relationship that supports the client in looking at the full spectrum of their process - how they go about meeting their needs in the world, how they make meaning of the various components of their lives and relationships, maybe working on a pattern or reoccurring situation that is problematic - and using that awareness to get to a greater sense of agency, acceptance and well-being.
Please share 2-3 anonymized examples of how the work can play out and/or look in the room so that I can form a visual or narrative of what to expect.
-A client feels threatened by their grief over the end of an important intimate relationship. I ask the client to describe their experience. I ask them to pay attention to their process while they do that - what are they thinking, what are they feeling, do they notice sensations in their body as they contemplate their grief? I pay attention to what the client is expressing, and how, and share what I observe. Perhaps they started wringing their hands or clenching their shoulders. Maybe their voice got really quiet all of a sudden, or they looked lost to me. When I notice something like that, I ask them to describe what just happened to cause that action or expression. I suggest pausing at certain points, in order to let the client take in some of what they are sharing, staying with their process. Sometimes we circle back to things that seem important or got interrupted.
I encourage the client to explore their feelings in this present moment - not only the grief itself, but how they feel about grieving, and subtly different, how they feel about themselves, grieving. What meaning are they making of their experience? As it turns out, no one ever talked about feelings of sadness or helplessness in the client’s family. I share my appreciation for the client’s capacity to engage with the feelings and beliefs. I ask them to stay with the feelings and to take in what that is like for them. Uncomfortable! I help them organize the conflicting aspects of the experience by remembering and reflecting back what they share with me. I repeat back some things the client describes, and ask the client how those words feel. Sometimes they feel correct. Sometimes the client changes them. Through this process, we figure out what feels true in the present moment and what effect that has on the client.
A lot of the information about feelings comes from paying attention to sensations in the client’s body. Fluttery feelings in stomach, tightness in jaw or chest, hand movements, posture, etc. If the client is quiet for a long time, I ask them if they can share what is going on in. I may ask them to describe how they are feeling toward me as we work with the material of the session. Can they identify if there is something that they need - from me or from the situation?
As the session closes, we check in to see how the client is feeling in the present moment. What happened for them in the session? What are they leaving with and how does that sit with them? I express my appreciation for their work. I suggest that we take a second to reorient ourselves as the client anticipates re-engaging with the world outside of the office.
- A couple who are trying to juggle adult responsibilities and parenting their demanding 3-year old, find themselves at odds and arguing all the time over everything. They come in for their weekly session. They describe feeling like things are going better between them, less fighting, they had a good weekend, etc. I notice that they are sitting close together on the couch and holding hands. They acknowledge that. We sit quietly.
After a minute or so, one of them takes away their hand and moves to the far end of the couch. Actually, there is something that they would like to talk about. Something did happen….and it has to do with the way that the dishes were put away. The client describes looking for something in the kitchen, but being unable to find it when they needed it. They acknowledge that it isn’t that big of a deal, but that it is something that has continued to kind of eat away at them, and they don’t know why. I ask how they are feeling, bringing this up. They describe being frustrated when they couldn’t find what they needed and why it is important to them to be able to find what they need, when they need it.
I ask the first client to go back and tune into the feeling that they had, looking for the thing that they couldn’t find. Can they remember what that felt like - either emotionally, or maybe a physical sensation? They remember feeling angry. Anything else? Yes, angry and abandoned. We sit with that a moment. I ask the client to try an experiment: if those feelings had a voice, what would they say, to whom and how? Can the client try to be those feelings, and give them a voice? The client can’t do that, but they do realize that they are thinking about their mother. Can they tell us more? The client describes how their mother, a single parent, ran their family as a very tight ship, all by herself. I ask the client to take a moment and see what comes up, tuning in to their mother as they are remembering her. That it is important to do things the right way. I ask the client to tell us more, and to pay attention to what comes up, remembering their mother and how she kept the household. Is there a phrase or statement that comes up? Yes, that if you don’t do things the right way, everything will just explode. Explode? The client doesn’t have the appetite to go much further. I comment that this feels like important information, and it seems like it is difficult material for the client to stay in contact with. They agree, adding that they feel exhausted.
I turn to the other member of the couple and we process what they just experienced, and how they are feeling, in the moment. I ask them to share that directly with their partner. I ask the other partner what that was like. We continue to process what is happening in the moment between them.
Are there any philosophies or values that inform your work that I should know about?
I use Gestalt psychotherapy, which is focused on an exploration of the full spectrum of one’s experience, as a starting point. What are your needs and how do you meet them? I find narrative therapy useful as well, paying attention to what stories/meanings you may have absorbed from your environment or created yourself, and how do they impact how you navigate any given situation? I approach the therapeutic relationship as co-created and have a lot of respect for how each of us navigates our given circumstances to the best or our abilities. And how complicated that can get.
How much do you share about yourself during our time together and why?
I am always paying attention to my own emotional response to what you share in the session, and may offer that as something for you to react to. Something like, “You describe being frustrated with the way your parent doesn’t acknowledge what you are going through. Listening to you, I am aware that I am feeling very sad. I’m wondering if that is also true for you.”
In terms of other information about myself, I usually keep that to a minimum. Not to present as some mysterious authority, but because the focus is on supporting the client’s experience.
How participatory are you during sessions?
It varies from session to session and client to client. My responsibility is to engage with the clients, and facilitate their process. Sometimes that means more participation on my part, and sometimes less. Also, I think that I am participating even if I’m not saying or doing anything besides paying close attention to the client and maintaining a space and openness in which they can have and get in touch with their self/process.
Do you assign homework, activities, or readings for me to do between sessions? Why or why not?
It depends on our therapeutic relationship and process. If you use our time primarily as a supportive context in which to explore your experience and make meaning, assignments, besides paying attention to your process, probably don’t seem useful or relevant.
If, on the other hand, you are trying out new ways of being, I may assign a tiny, manageable action to try out, or ask you to pay attention to a particular type of situation in order to help figure out what happens. For example, if you are someone who was conditioned to meet other people’s needs and automatically say yes to requests, I may suggest trying “let me get back to you on that” as a response that gives you space to take your own needs into account and decide what you want to do.
How will our relationship be different than relationships I have with friends/loved ones?
Unlike a personal relationship, the therapeutic relationship is one sided. It’s all about you, your needs and how you uniquely go about your life. You are the valid starting point. My only expectation is that you engage in the work.
Is there ever a time when you would encourage me to leave or graduate? Or how do I know when it’s time to end or move on, or time to stay and explore more?
Yes. That would be a conversation about whether we were engaged, if it felt useful, how therapy supports (or doesn’t) your life. What is working, what isn’t. Maybe something has changed? I don’t think that everyone needs to be in therapy all the time.
Where did you work before going into private practice?
I was an oncology social worker at a not-for-profit.
Have you received any particular training beyond your post-Bachelor’s training?
I received 3+ years of training in Gestalt psychotherapy at Gestalt Associates for Psychotherapy in New York. I also got a certificate in Meaning Centered Psychotherapy from Memorial Sloan Kettering.
Do you have experience (5-10 years+) working with any types of obstacles or people in particular?
Yes, people dealing with cancer, including patients, caregivers, family members, intimate partners and the bereaved.
What led you to become a mental healthcare practitioner?
It is endlessly fascinating and valuable work. I also like how working with people’s intensely personal and unique experiences feels like a good balance to what I view as an increasingly brutal and commercial social environment.
What is the best part of the work for you?
Showing up as a fellow human being and facilitating a person’s growth and emotional development.
What is unique about the work you do, or how have you found your work to be different than your colleagues’?
That’s hard to say, because all the work is so unique and private. Other practitioners who have been clients have shared an appreciation for the sense of openness and respect they experienced in working with me.
How do you approach diversity in the room or working with clients who may come from a different background than you?
As always, I start where the client is. What are they facing? How are they making meaning? What is their environment and how do they navigate it? Those questions are fundamental, no matter what background a person has.
How can you tell if I am benefiting from working with you?
When I observe some relief, growth, sense of aliveness, etc. Clients often provide examples of how they have navigated something differently, based on something that has come up in therapy.
How can you tell if I am feeling stuck, unseen, or unheard?
By checking in and paying attention to the interpersonal process on an ongoing basis. “What is going on with you right now?” or “What is going on between us right now?” is how we do that. Whatever is happening in the therapy space has a correlation to what happens in the world outside of therapy and how one navigates that, so it’s vital information.
How long should I commit to being in therapy, at least in the beginning?
First, you should get a sense of whether or not the therapist feels like a good fit. If not, let them know, and move on. If you find someone that you think you can be comfortable working with, give yourself a couple of months. It takes a while to feel safe, develop the relationship, and get an idea of what is going on.
How should I prepare for my first session with you?
Just prepare to be open and pay attention to as much of your experience as possible.
Do I need to bring anything with me?
Do I need to be mindful of anything in particular while commuting to your office?
No, it’s easy.