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Graduation: The Goal of Therapy


It is a bittersweet moment when a client graduates.  I am happy to see their hard work pay off yet sad to see them go.  But, of course, the goal of therapy is healing and that means letting go when the time comes.

From the first session, my goal is to help clients heal to the point of graduation.  Some people come at a turning point and want a course correction; others want a major overhaul.  Their lives are out of control and they are feeling hopelessly caught in a downward spiral.

Imagine a client at a turning point.  She needs to make a decision about her marriage.  She comes to me when she finds herself spending too much time on the computer to avoid making the hard decision.  She feels numb.  Not surprisingly, she is anxious and depressed.

By the time she graduates months later, she has put limits on her computer time and decided to work on her relationship with her spouse, basically to wait-and-see.  Her depression has lifted and she is again enjoying activities she had abandoned.  She describes herself as mostly happy with more frequent glimpses of joy.  What happens in between is hard work.

My approach to therapy is behavioral.  When people identify what’s not working for them and change the underlying behaviors, their lives get better.  When their lives get better, their thinking about the past and future changes. The future looks brighter and the past is just that, past.  They can cope with unpleasant emotions more easily.  In short, they have the skills to handle life’s inevitable ups and downs more effectively.

In individual therapy, my client and I look at cause and effect.  She brings a situation that went wrong to our weekly session, maybe an argument with her spouse.  We look at what went wrong when the argument escalated.  We identify how her actions might have contributed to the outcome of her sleeping in the guest bedroom.

Then we analyze each step in the causal chain, identifying her thoughts and emotions along the way.  We assess what she gains and loses from handling the situation in the way that went wrong.  Then we identify skills – some familiar and others new — she might use to achieve a different outcome when she is faced with a similar situation in the future.

Repeated analysis of cause and effect enable us to identify patterns of behavior that lead to the situation that brought her to therapy (e.g., not listening which leads to misunderstandings which leads to arguments which leads to yelling which weakens the relationship).  With these patterns in mind, she experiments with different ways of doing things and new ways of thinking about her problems.

She practices applying the same skills in a variety of situations (e.g., with her spouse, her children, at work, with friends).  By noticing when she uses newly acquired skills, she learns to intentionally use them more and more effectively, which ultimately leads her to achieve her therapy goals.  With time and diligent practice, the skills will become almost as automatic as the self-defeating behaviors that brought her to therapy.

I’m not saying therapy is easy or quick.  It takes time and patience.  Some clients come when they have already figured out they have to take responsibility for their own actions and they are willing to make changes in their own behaviors.  These clients generally progress relatively quickly.  Other people come when they have a vague feeling something has to change but they are not ready to change themselves.  In these situations, it takes time to help clients accept that they can’t change anyone or anything but themselves.  This acceptance is fundamental to begin the process of change.  There is no “right” time to start therapy.  Wherever people are on this continuum, we start where the client is.

I’m also not saying people cause their own problems.  I am saying they have to solve their problems whoever caused them.  If a person steps off the curb and is hit by a drunk driver, the injured person has to do all the work to heal even though she didn’t cause the problem.

Nor am I saying causal analysis and skills development are the only things we do in sessions.  Rather, analysis of cause and effect coupled with skills development are the foundation on which we build.

This evidence-based approach to therapy is called Dialectical Behavioral Therapy or DBT as many people know it.  Read more about DBT on our website.

Sandra Miller, MSW, LCSW and sometimes blogger, sees clients four days a week at St. Louis DBT, LLC.  She uses DBT to address couples’ and families’ relationship problems and individuals’ depression, anxiety and borderline personality disorder. 

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