Effective termination of therapy

Psychotherapy is a life-long, ongoing process for the client. The client feels the effect of therapy long after the sessions are over.

It is a fact, that at some point, the therapist and client will part ways. Notwithstanding sudden disability or death of either party, the process of termination is a very important part of the client’s therapy.

Norcross, in the interview below, explains the process succinctly. Like him, I would consider termination a form of “graduation” for both therapist and client. The client attains new learnings about the self, and the therapist achieves an abundance of professional knowledge.

Norcross state the following steps for good termination:

  1. Proper preparation for termination.
  2. Reflection on the gains and consolidation of the gains.
  3. Processing of feelings about the therapists and client.
  4. Discussion on future functioning .
  5. Generalization of skills, etc. achieved.
  6. Anticipation of future growth.

Norcross reminds us that termination may not mean ending of the relationship. In fact the therapeutic relationship does not change. Termination or graduation means that a phase of the work is ended. It is not uncommon for clients to resume therapy with the same therapist when they reach a new phase, and when they feel that they need to reconnect with the previous therapist.

My experience is that when time is allowed for the process of termination, the process goes more in-depth. As a consequence, the client gains far more insight from the consolidation of learnings, and is able to take home a valuable resource that lasts a lifetime.

Trauma: Symptoms of Dissociation and Treatment

The DSM describes main feature of dissociation as a disruption of memory, consciousness and identity or perception. Dissociation is a protective mechanism. Human beings have at their disposal to survive traumatic events.

Abusive painful experiences and memories are put away into isolated compartments in the mind, and separated from regular memories.

Read also: Traumatic and Non-Traumatic Memories

Dissociation is a way the mind organizes information

Dissociation refers to a compartmentalization of experience: elements of an experience are not integrated into a unitary whole but are stored in isolated fragments (van der Hart et.al., 1998).

Exposed to trauma, the mind splits. The part of the brain that continues with the daily functioning of life (the left brain), and the emotional part of the self that holds the traumatic memories (the right brain) and its survival impulses of the moment of trauma becomes unintegrated with each other. This leaves the person with a split sense of self.

In trauma, the left and right hemispheres of the brain becomes more split and less integrated.

Experiencing a split sense of self can be disturbing. To notice the phenomenon as it happens is to gain agency.

The disruption of integration of the hemispheres of the brain leads to the experience of feeling something and “not making sense” of the feelings. The feelings come in the form of emotions, perceptions or physical pain.

The experience of not making sense of what one feels, can be disturbing. As human beings we need to make meaning and understand things about ourselves to feel safe. When such splitting occurs, the trauma survivor experiences blankness and confusion. This contributes to more insecurity. Oftentimes the need to make meaning results in thoughts that are paranoid in nature, intrusive and/or obsessive.

In therapy, clients are guided to 1. first identify the feelings and sensations that make no sense, 2. accept these feelings without making meaning. 3. observe the nature of thoughts that arise from attempt to make meaning, and 4. allowing these sensations to pass (through relaxation or somatic exercises). Each of these steps are tedious and challenging, needing full attention of both therapist and client. This is also solid mindfulness work. The result is the client gaining of agency of the self.

Splitting leaves the client fragmented into parts of personality. As different times the person’s right brain may trigger experience in him/herself a part that is raging and wants to fight or take revenge, a part that is terrified, a part that is ashamed, a part that is needy and/or a part that wants to run away. When these parts are traumatized, they feel out of control.

The left brain engages the other parts of the person that wants agency. These parts manage daily function, the part that is sociable, and the part that is responsible.

Noticing split-off and traumatized parts

One can notice that splitting has occurred through phenomena like experiencing chronic inability to make decisions, continually relapsing into addictive behavior, having intrusive emotions that seem to arise out of nowhere, intrusive thoughts, shifts in mood or behavior, going numb, getting hyper-aroused, collapsing, feeling suicidal, hearing voices, loss of ability to connect with others, difficulty communicating, withdrawal from society, feelings in the body and somatic symptoms that are not based on medical logic.

There are different severity levels of dissociation

Dissociative symptoms can be severe in some people to a point of rendering them incapacitated. Many individuals, however, experience dissociative symptoms, and are still able function and be successful in life.

Treatment of dissociative symptoms with therapy in functioning individuals is a measure to keep the person healthy and functioning. While we can cope with dissociative symptoms, these symptoms do not disappear on their own. Symptoms get worse with age, and are exacerbated by crises in life. This is why and how some seemingly functioning people experience sudden psychological breakdown.

Signs to look out for in functioning individuals

It is clear that severe dissociative symptoms require professional attention. Less obvious or hidden signs of dissociation are worth noticing: 1. difficulties putting things together, not being able to remember conversations, forgetting appointments, or inability to recount coherently what happened in certain situations, 2. experience of doing things that does not seem to add up, like having sexual relationship with someone one finds unattractive, 3. having unexplained chronic pain or somatic symptoms, 4. chronic experience of stuck in life, 5. experience of identity confusion, 5. experience of self-harming or suicidal thoughts.

Therapy that focusses on mindful observation of these symptoms, its triggers and the trauma underlying lead to successful outcome in providing clients with agency over his/her life.

Bibliography

van der Hart, O., van der Kolk, B. A., & Boon, S. (1998). Treatment of dissociative disorders.

Psychological Trauma: Types and Symptoms

Psychological trauma is a person’s experience of one or more events that is too overwhelming for the person to emotionally, physically and intellectually react to, and integrate into his/her memory and sense of self. The experience is that of as sense of threat to life, integrity or sanity.

Psychological Trauma is not only PTSD

Traumatic events are varied. It can be one major event (as in the case of PTSD), a series of events or living conditions that persists. In traumatic events the person is vulnerable and loses sense of agency or control. Since vulnerability is the feeling, young children and babies are more prone to being traumatized than healthy adults.

Symptoms of Psychological Trauma

Sufferers of PTSD tend to be more aware that they suffer from trauma than individuals who suffer developmental trauma or complex trauma.

Symptoms of trauma are often experienced as: irritability, depression, numbness, fogginess, lack of concentration, sleeping disorders, nervousness, panic disorder, chronic pain, addictions and addictive behavior, self-harm and suicidality, and eating disorders.

Symptoms of psychological trauma
Diagrammatic Symptoms of trauma

Trauma-focussed psychotherapists would check childhood experiences of individuals with these symptoms for sources of traumatic experiences.

It is not unusual for such clients who are not suffering PTSD but complex or developmental trauma to be baffled at the idea that they are manifesting symptoms of trauma, since these experiences are either forgotten, or because the memories in themselves are not recorded as traumatic.

Traumatic experiences that happen in infancy and early childhood lead to what is termed developmental trauma.

Developmental Trauma

The younger the child, the more dependent they are on their caretakers for survival. Children get traumatized by neglect, separation and abandonment, exposure to domestic violence, parents fighting, witnessing violence, fearful caregiving, threats to them (meant or not), medical crises and accidents, death in the family, especially of parents and siblings.

Developmental trauma are more insidious than adult onset trauma because young children are not able to process the memories of the event(s) fully.

These memories are not integrated into learning experience, and remains out of awareness. As the child develops these memories become physiological and psychological symptoms.

Developmental Trauma presents itself also as generalized symptoms. Patients experience difficulties in areas like : 1) affect dys-regulation, 2) having a deep sense of self devaluation, 3) having difficulties forming relationships, and 4) dissociating from experiences.

“Getting Triggered” in the present as sign trauma

Since memories of traumatic experiences are not adequately integrated, the body remembers the traumatic experiences without the brain understanding what they are about. Such memories of traumatic past experiences are called implicit memories, or memories without language.

Implicit memories are sensed. These are memories of the past. However, in the present, harmless events can happen that are similar in feeling to these traumatic past memories. The body reacts to these harmless present events like it did during the traumatic event. The individual is unaware of the past memory hijacking the present moment and gets triggered.

When the dust settles, the sufferer and those around him/her cannot understand how or why the person over-reacted to the present event in such an exaggerated manner.

We may all be familiar to getting triggered or witnessing someone being triggered. It can be disturbing and sometimes destructive.

Understanding that these triggered states of emotionality, fear or rage are rooted in past traumatic experiences can provide for some relief to all involved, because this condition can be treated with psychotherapy.

Psychotherapeutic Treatment of Psychological Trauma

Psychotherapeutic treatment for trauma is an individual process. The condition of the patient and the extent of trauma first needs to be understood. Since traumatic experiences involve a deep sense of threat to life, the therapist needs to create a safe secure setting for the patient.

Trauma therapy can take months to years, depending on the condition of the patient and the trauma. There are five main phases involved:

  1. The first phase of trauma therapy is to establish security for the patient in the session as well as in the patient’s daily life outside therapy.
  2. The second phase would be to work with the client to build resilience, self support, orientation and self awareness. This phase requires the moment-to moment tracking of sensations and emotions that occur in the body before, during and after triggers.
  3. This third step includes psycho-education in which the client learns the nature of his/her traumatic experiences and how his/her symptoms align with the theory underlining. Though this learning he/she learns to dis-identify from his/her symptoms.
  4. The fourth phase is trauma memory processing. This step is only done when the patient has his/her agency and can see his/her triggers as they happen. EMDR is a technique that can be applied in this this phase.
  5. The fifth phase is about integrating the memories and experiences. The patient learns to move on, make new affirmations and begin to live a life that is more in the present and not held back by the trauma symptoms.

Trauma therapy has its contra-indications. Patients can get re-traumatized if the groundwork of phases 1 and 2 are not adequate. The building of the therapist-client working alliance is thus very important to ensure safe, effective trauma treatment.

Complex Trauma: 12 basic concepts of somatic experiencing in healing Trauma

Traumatic events happen in a variety of circumstances. Incidents that happen to us which suddenly shocks us, leaving us overwhelmed, and sometimes frozen, can lead us to experiencing life-long psychological and physiological effects of trauma.

Exposure to traumatic experiences affect us in very individual ways. The consequence of being traumatized, concisely explained, is the effect of our nervous system sensing the danger of the past traumatic experience as if the danger is happening in the present. Harmless situations can trigger feelings of anxiety as a result of trauma.

“The great thing then, in all education, is to make our nervous system our ally as opposed to our enemy.”

William James (1914, Habit)

Since danger and anxiety are buzzwords in trauma, healing trauma in psychotherapy requires big doses of trust. Trust that the suffering from traumatic experiences can be healed. Trust that the psychotherapeutic alliance is a working, trusting one. Trust that, whatever the outcome may be, that the work is worth doing.

This article features part of the very inspirational work of Peter Levine (1997), whose work is a guide for my professional attitude towards trauma.

Importance of Slowing Down during Trauma Work

When working with trauma, it is necessary slow down. Traumatic events and subsequent trigger reactions happen at split second duration, often out of awareness. In the treatment of trauma, the sensory events, feelings and thoughts that arise need to be witnessed with the time slowed down with guidance of the therapist.

Many trauma patients, frustrated at their symptoms, want speedy resolution. Therapists are best advised to reassure their patients, that slowing down is the safer, more effective road to healing.

Traumatic triggers happen out of awareness. The act of slowing down during therapy brings the sensations and thoughts into awareness. It is through awareness that the client gains sovereignty of his/her experiences — and ultimately nervous system.

12 Basic Concepts of Trauma Work

Levine’s work stipulates 12 basic points of trauma work and experiencing. Some clients benefit when theses points are shared with them. I use this as a map in my work, for effective tracking of the patient’s process and progress.

  1. The phenomenon of being riveted. During an overwhelming traumatic event, the shock causes the body to stiffen up. The muscles tense up. The body can get frozen and stuck in this state. The energy is locked up in the body. The state of being riveted is experienced in each patient uniquely. In the therapeutic session, each patient displays his/her own unique symptoms of this phenomenon.
  2. Feelings of defeat and helplessness. During a traumatic event, the sense of being overwhelmed and trapped, leads to the profound feeling that one would never escape. There is overwhelming helplessness. After the traumatic event, this feeling of defeat resides in the body of the traumatized person. People may become unable to work, play or do daily tasks as a consequence of this body memory of the traumatic experience of helplessness. It may be helpful for patients to know that this is happening to them, to allay fears or self judgment for not being able to function as society would like them to.
  3. Tracking with Awareness. in-tunement of inner landscape. feelings, sensations, thoughts. We are not lost in the experience, or disassociated, but looking and tracking it from a close distance. Pendulate between comfortable and uncomfortable situation.
  4. Pendulation between Polarities. To be able to move between expansion and contraction; to having feelings of past memories at one instance and then coming back to the present reality. To feel anxious at one moment, allowing the feelings to pass, taking a break from what one is doing, and slowly breathing towards calm. Pendulation is an exercise of acceptance, and allowing of oneself to move between emotional states, without hinderance.
  5. Resourcing. The process of resourcing is to deliberately take stock of anything of value in one’s life. Resources can come in the form of relationships, material wealth, work, interests, hobbies, vocation and religion. Resources, no matter how little, add foundation to ones sense of stability.
  6. Uncoupling feelings of excitement with experience of fear and trauma. Take time to check in with oneself, and learn to mindfully differentiate between feeling of excitement (pleasant surprise, nervousness about a job interview or performance in public, excitement over positive events, butterfly in the stomach feelings) and fear. Take time also to differentiate between fear of actual fearful stimuli of the moment, and fear that arises out of traumatic memory.
  7. Grounding & centering. Grounding and centering involves mindfully feeling the weight of one’s body pulling itself to the ground. .Gravity is the helper that helps the body rest and center itself. Grounding exercise is usually done by sitting comfortably on a chair and putting two feet flat on the ground. One can also lie flat on the floor and feel one’s weight on the floor. In fear and panic we loose our ground. The earth seems to disintegrate from under our feet. When we are aware of our ground, we can feel more secure.
  8. Strength & resiliency. Building emotional, intellectual, physical strength in whatever form adds to one’s agency. Going for psychotherapy to build emotional strength, learning or studying anything to build intellectual strength, and doing muscle building exercises to gain physical strength adds to the alleviation of the dominance of the trauma symptoms.
  9. Restoration of natural aggression. Get support from a competent therapist or an understanding friend, who is able to listen to the feelings of anger and hate that are related to the traumatic experiences. Traumatic events render the victims helpless, trapped and immobile. Coming to terms with the natural aggression that is locked up in this immobility resets the nervous system. Expressing the anger releases the aggressive energy and restores vagal tone. The body as a result feels the relief.
  10. Running. Similar in the reasoning to restoring of aggression, running is what the body needs to do to escape from the condition of being trapped. One can experience running in the therapy session. One can also simulate running through mindfulness activity, like imagining sprinting to a safe place (even by moving arms and legs quickly while seated) every time one feels trapped. Important is for us to have a mindset that running away from the traumatic situation is actually a positive action.
  11. Orienting. Taking the time to orientate oneself while in different situations is good practice. This sharpens one’s skills in being present in the moment. Orienting, grounding and centering enhance physical stability.
  12. Completion of self regulation. With the support of a psychotherapist who works with emotions, one learns to experience a full repertoire of emotions, energies and perceptions. Traumatic experiences cause our senses to shut down, leaving us incapable to completing our natural self-regulatory cycles. Completing these cycles of self-regulation releases energy and brings calmness to the body.

Psychotherapists who work with trauma know that trauma is locked in the body. Being aware of, and checking into the somatic experience of the client is essential to the work. This is possible when a trusting, therapeutic alliance is already established.

Do seek professional advise if you or someone you know suffer symptoms related to trauma. It is a safer approach to healing than ignoring the symptoms or trying to treat the symptoms unprofessionally.

Bibliography

Levine, P. A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. North Atlantic Books.

Physiology of Physical Fitness

The articles in this page provides information on exercise and fitness. The motto behind the principles embedded in these pages is that exercise should be done mindfully. The goal of exercise is to achieve long term gains for the person as a whole.

Having good exercise habits releases hormones that affect positively one’s psychological health.

I hope this page provides information on the physiology and endocrinology of exercise that is easy to understand.

Download Article in ENglish:

exercise

Download article in German:

DE-exercise

Is psychotherapy for me?

Ask yourself these questions to decide if you need psychotherapy.

This article is for the people have landed on this site looking for psychotherapy, and are wondering if psychotherapy is what they need right now.

Here are some questions (in no particular order) to ask yourselves. If one or more of your answers is a “yes”, it is probably a good idea for you to speak to a psychotherapist.

  • Your doctor / psychiatrist / teacher or other professional advises you to get therapy.
  • Your loved ones encourage you to seek therapy.
  • You are looking for answers about your inner experience.
  • You are experiencing a difficult milestone in your life: leaving home, getting married or divorced, having a child, being diagnosed with illness, migration, etc.
  • You find yourself in a difficult or abusive relationship at home or at work.
  • You experience physical reactions that you cannot understand: like panic attacks, crying attacks, rage.
  • You are having thoughts that are churning in your mind.
  • You suffer anxiety: social anxiety, phobias, paranoias.
  • You’re not sleeping well: not able to get to sleep, waking up in the middle of the night and not getting back to sleep, not able to wake up, sleeping all day, having nightmares.
  • You have an overwhelming feeling helplessness.
  • You have an overwhelming feeling of guilt. You blame yourself for many things.
  • You harm yourself physically.
  • You have suicidal thoughts and/or plans.
  • You are addicted to substance.
  • You are addicted to a behavior: working, shopping, internet use, porn, sex.
  • You are on antidepressants, anxiolytics or antipsychotic medication, and are thinking of reducing these.
  • You obsess over certain activities. These activities preoccupy your life, affecting your work, and family life– like work, sports, collecting certain things, hoarding things.
  • You have problems eating: obsessive thoughts about eating or not eating, bingeing, throwing up after eating, thoughts of starving yourself, feeling anxious around food, not able to enjoy food or the eating process.
  • You have issues having sex.
  • You suffer pain and aches that your doctors cannot find physical cause of.
  • You are having problems working or studying, and feel like you’re about to burnout.
  • You are socially isolated and / or feel very lonely.
  • You have lost a parent / family member or two for over a year and have not got over the loss.
  • You had had difficult childhood experience of abuse, neglect or abandonment.
  • You have been sexually abused in your life, and have not worked through this experience with anyone.
  • You have difficulty remembering parts of you childhood, and you suspect trauma.
  • You’ve encountered a traumatic event that was threatening to your life or the life of someone else.
  • You cannot feel or identify your emotions.
  • You see, hear of feel things that are not there.
  • You or a loved one suffer chronic physical ailments or disability.
  • You or a loved one have been diagnosed with terminal ailment.
  • Your children are suffering from poor grades, ADHD, stress or are suicidal.

This is not a comprehensive list, although it does cover issues that I deal with in the psychotherapy practice.

Gabor Mate: On Cannabis use, Addictions and Healing with Psychedelics

Understanding cannabis use, it’s effects, addiction and trauma.

Gabor answers questions regarding the use of Marijuana (Cannabis). He discusses addictions to some drugs, and how these are relative to the effects of legalized narcotics like tobacco, alcohol and prescription drugs.

Important point he made is on the effects of drugs on developing brains of young children and adolescents, putting a spotlight on prescription of drugs to children.

As a therapist, I fully appreciate his emphasis on psychological trauma as the root cause of addictive behavior. He tells us that the medical profession should be more aware of trauma.

Maté: Denial of own emotional needs and its connection to chronic illness

Do unto yourself, what you would do for others.

This lecture is presented in this site because it is a good argument for going to psychotherapy sessions that involve working through emotions and childhood traumatic experiences.

Gabor Maté’s message is an important one. As I write this reflection article, I am myself experiencing being in a situation which is teaching me an important lesson: I am forced to take a 5-day unexpected break from a hectic schedule which I had created for myself. I had an accident. I fell from a deep flight of stairs, and escaped with injuries that could have been much worse. Sitting at home nursing a swollen brow and black-eye, I am reflecting on how, for the last couple of months, I had wanted this time off but did not have courage to put appointments aside. I did not want to disappoint other people.

This accident was no accident, but a warning. A therapist myself, I knew what was going on in me, but I really thought that the rest could wait. Wrong I was.

It is so easy to fall into the trap of self denial, because we are programmed to be so. Maté’s lecture, “When the body says no — caring for ourselves while caring for others”, hits the nail in the head.

On premature aging due to stress of taking care of others

2:30 DNA studies show aging in people who live under stress.

Preoccupation for the needs of others, while neglecting the self as a risk factor for chronic illness.

4:20 A story of the personality of a woman who has breast cancer. How she worries about her husband’s emotional state rather than dealing with her own illness.

5:31 He reads obituaries of people who died too soon, to illustrate the self-sacrificial and self-denying behavior of people who have died from chronic illnesses.

Dealing with Anger

7:50 The dangers of suppression and repression of healthy anger leads to autoimmune disease and cancer, while going into rages, which is the polar extreme leads to heart disease.

The healthy way to deal with anger is to notice it, accept the feeling and talk to someone who is willing to listen about your anger feelings. Healthy way to deal with anger is crucial to health.

9:55 Mate describes a study from Australia of married women. Those that were unhappy in their marriages and could articulate them were better off physically than those who suppressed their unhappiness. The issue was not about happiness of the marriage but the ability to express the anger underlying.

Hanging on to roles society imposes on you, trying to please everybody, while forgetting to take care of your health can cause deterioration of health and death.

We cannot separate mind from the body.

14:05 Mate explains to us about chronic illness and the current medical attitude towards these illnesses.

We cannot separate the individual from the environment

16:11 We are shaped by the environment. Environment is not only physical, but also the psycho-social environment. This means that the environment includes the people we live amongst.

To illustrate this, he cites studies where children whose parents are stressed are more likely to get asthma in polluted environment and other illnesses. This is known to be directly as a result of stress since asthma drugs are stress hormones themselves.

We cannot separate ourselves from the mental states of others in our society.

Talking about anger to someone is important reliever of stress

19:10 Studies of breast cancer patients in Australia found that having a stressor in life AND being socially isolated made the subjects 9x more likely to have cancer. Mate explains that connection with another person, talking to others about feelings of anger is instrumental to maintaining healthy life.

Stress from anger is not only mental, stress is also felt in the body. In short term, stress hormones help to escape, long term stress causes chronic ailments.

Amyotrophic lateral sclerosis (ALS)

23:20 Maté explains the possible cause of ALS .

ALS is a neurological motor neuron disease, which strikes usually healthy people, and is fatal. Mate found these patients to have a personality tendency of denying their negative feelings, denying the experience of the self, while having the overwhelming need to always be there for others-

27:03 He talks about the story and personality of Lou Gehrig. Gehrig’s name is the name for ALS. His personality of selfless ambition and helpfulness is typical of what Mate considers a personality that is typical of patients wit ALS. Lou Gehrig had childhood trauma from growing up a child of an alcoholic.

These are caused by unconscious patterns. Not the fault of the patient’s themselves.

Unconscious self-denying behavior is learnt from infanthood.

19:30 Mate tells us his own story of how unconscious factors affect how he too has a tendency of self denial while trying to protect his mother.

Infants pick up on the stress of the mother and other caregivers. Infants learn to suppress their own pain in order to maintain a relationship with its care-giver. This infantile suppression becomes a memory that is recorded by and stored in the body. It is called trauma.

Making oneself lovable is done by suppressing feelings and denying own needs.

Mind and body are inseparable.

Personality patterns are learnt from infanthood. These patterns translate into physical illness.

36:00 Newborn need to establish these patterns to maintain attachment to adults.

Emotional centers of the brain are attached to the hormone system, and nervous system are connected to the immune system. These systems are connected.

38:40 Mate explains the phenomenon of “gut feeling.

How and why we give up our authentic selves as children

Children read and respond to gut feelings intuitively. Children are born with ability to intuit body language of adults accurately. As we get older, we begin to suppress this gut feelings, and rely on intellect.

41:40 There are 2 great needs of children. One is attachment to the care-giving adults. The other need is to be authentic. This is a need in order to function as an individual human being. In situations where we, as children have to sacrifice our authentic self, because this authentic self endangers the attachment to our parents, leads us to a pattern of having lost touch with our needs and feelings.

Our problem as adults is that we still stick to this need for attachment.

42:48 The Heart-brain Connection predictive activity.

Hence our emotional states is connected to our physical health.

Healthy anger is about knowing your boundaries and expressing it

44:45 Mate demonstrates what boundaries are and how boundaries can be breeched. He explains that healthy anger is necessary for us to communicate to the other that our boundaries have been crossed and to back off.

Immune system is linked to our emotions

The role of our emotions is boundary integrity. To keep out what is unhealthy, and let in what us enriching. The job of the immune system has similar roles.

Autoimmune disease is a way of the body attacking itself.

To prevent illness or overcome illness, we need to exert who we are and to say, “no”.

Saying “no” may trigger fears about attachment, but we have to remember that we are adults.

If you are caring for others, you must demand support also for yourself.  Ask yourself and reflect on this question: in what situations in your life is it difficult for you to say, “no”.

How a therapist can tell the progress of the patient

Psychotherapeutic change is observable. Noticing the progress of the client is an important aspect of therapy.

An important aspect in the work of the therapist, is to track patient progress. In my practice, even if I do not mention to the patient, I look for signs at every session.

The healing process in psychotherapy is often a subtle one. Meeting the patient every week, it is possible for the therapist to overlook these changes. Therefore, I give special attention to looking out for the signs.

Importance of looking out for the patient’s progress and change during therapy sessions

It is important for the therapist to be alert to change. Patients are normally oblivious to the subtle changes in their own personality. Left on their own, individuals may start doubting their new sense of being (due to persistent introjects / resistances).

Noticing the client’s change and progress is helpful to him/her. The therapist, in bringing attention to the development of the patient, helps the patient to integrate fully with this new attitude or behavior, through:

  • acknowledgement of the perceived change,
  • appreciation of how the change is impacting the life of the client,
  • understanding of how the change is developing and meaning making,
  • assimilation of the experience, i.e. how it feels to exist with this change.

Some signs of change observable in the patient during the course of therapy.

There are many signs of change. Here is a brief description.

  • Change in how the patient makes eye contact, makes facial expressions.
  • Change in posture, dressing, hairstyle — not the usual change of styling, but when the client comes in, and his/her aura feels different.
  • Change in topics brought up in session — most individuals bring up a kind of focus topic (like work or kids…). I’d notice a change when the topic is suddenly no longer interesting to talk about, or when another becomes figural. Generally, when the topic becomes more about the experiences of the self, it is progress.
  • Change in the client’s emotional vocabulary.
  • Client’s own account of perceiving new feelings or losing anxiety . Especially after holidays, the client reports that certain old feelings of anxiety around the festive season is no longer felt.
  • Client making new decisions. This applies to clients who have difficulty doing so.
  • Client reducing medication (esp, meds that have been long time prescribed), or reports having alleviated physical symptoms.
  • Client reports that children / spouse, etc are “doing better” (usually relationshipwise).

Note that these changes may not mean that the goal of therapy is reached. Change indicates that the therapy is in progress, and the patient can look forward to more enrichment from the sessions.