How do we know if we actually need therapy?
You should consider therapy when:
- Your frustration, sadness, anger, or other difficult emotions are beginning to interfere with other areas of your life.
- You and your spouse have fallen into a pattern of: frequent conflict; poor communication; criticism and contempt; lack of intimacy; and/or grown apart.
- Your teen is consistently: making poor choices; disrespectful; underachieving at school; and/or displaying a bad attitude.
- Your child is: misbehaving at school or at home; frequently out of control; consistently sad or angry; and/or not getting along with his/her peers.
How do we choose the right therapist?
Many prospective clients ask their friends or associates whom they might recommend. That’s fine, but it is also very important to find a therapist who is a licensed mental health professional in the State of Washington. In addition, the therapist should also be trained and credentialed in the particular kind of therapy you are seeking. For couple and family problems, it is important to select someone who is an experienced, licensed marriage and family therapist (LMFT) and a Clinical Member and/or Approved Supervisor of the American Association for Marriage and Family Therapy (AAMFT).
Why use a Marriage and Family Therapist?
According to the American Association of Marital and Family Therapy (AAMFT), research studies repeatedly demonstrate the effectiveness of marriage and family therapy in treating the full range of mental and emotional disorders and health problems…
Consumers report that marriage and family therapists are the mental health professionals they would most likely recommend to friends. Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent.
After receiving treatment, almost 90% of clients report an improvement in their emotional health, and nearly two-thirds report an improvement in their overall physical health. A majority of clients report an improvement in their functioning at work, and over three-fourths of those receiving marital/couples or family therapy report an improvement in the couple relationship. When a child is the identified patient, parents report that their child’s behavior improved in 73.7% of the cases, their ability to get along with other children significantly improved and there was improved performance in school.
What should clients expect in therapy?
Since our primary focus is couple and family relationships, all members of the couple and/or family should expect to participate whenever possible. During the first session or two, we will ask each person present in the session to express their view of the problem and later help them establish treatment goals. However, therapy has both benefits and risks. While it has been empirically demonstrated that therapy has substantial benefits for those who invest themselves in the process along with commitment and realistic expectations, it also has risks that may include experiencing uncomfortable feelings, conflicts and/or struggles. It is not unusual for things to get worse before they get better. Moreover, the process is not predictably linear such that even when clients are improving, periodic setbacks do occur. These should be expected and are a normal part of the healing process. Change is frequently possible, but usually not easy. As a rule, therapy is most effective when clients are open, actively engaged, and willing to work collaboratively with their therapist toward mutually agreed upon goals.
The primary focus of couple or family therapy is relationships. In contrast to traditional psychotherapy, we assume that all members of the couple or family system plays a part in creating and maintaining any conflict or problem. However, this also means that all family members can play an essential role is resolving the difficult.
What if my spouse refuses to come to couples therapy?
When one spouse refuses to come to therapy, it is often advisable for the willing spouse to come alone. Your therapist can provide you much needed support and help you strategize about ways to get your spouse involved.
What if my child/teen refuses to come to therapy?
Many children or teens who are having problems would rather go to the dentist for a “root canal” than go to therapy. Typically, children and teens know very little about what therapy is. They cannot see how “talking about a problem” can actually do any good. Moreover, they often feel that “somebody has to be “crazy” to need therapy and they are not “crazy.” If a child or teen is having serious problems, we believe that these are also a family problem.
If your child/teen is under 18 years old and you, as their parent, believe they need help, then it’s often better to frame therapy as an opportunity to work on family relationships rather than “fix them.” This focus on relationships de-pathologizes the child/teen and re-frames the issue as a family problem, rather than just their problem.
How long does therapy last?
Since problems have typically been developing over months and often years, expecting a quick fix is unrealistic. For most relationships change comes neither fast nor easy. But, change is often possible.
Depending upon the nature and complexity of the problem, therapy typically lasts anywhere from several weeks to several months. Typically, we begin with a 6-8 week contract that fully assesses the problem; establish treatment goals; and begin making inroads into solving it. At the end of that period, we, in collaboration with the clients discuss how therapy is going. (e.g., What’s been working? /not working? Have we made progress toward our goals? Does it make sense to continue? If so, how?)
What about confidentiality?
All client information will be kept strictly confidential within BCFT unless you give written authorization. Except in emergencies, verbal authorization will not be sufficient. We practice along with other mental health professionals and administrative staff. All mental health professionals and staff are bound by the same rules of confidentiality. However, there are certain conditions under which confidentiality may be breached:
If a client threatens to harm himself/herself we may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.
If it is disclosed that a child or elderly person is being sexually or physically abused, we are bound by law to report it.
If someone is a danger to themselves or others, then we are bound by law to protect you and/or the other person. The other person would be warned and the police notified.
In legal proceedings, the courts usually respect your rights to confidentiality. However, a judge could order us to testify in certain situations, such as a contested custody proceeding in a divorce, and, under these circumstances, we must do so.
If a government agency is requesting the information for health oversight activities, we may be required to provide it.
How do we maximize our chances for successful therapy?
Take responsibility for your part in creating and maintaining the problem and be open to hearing constructive feedback even when it’s difficult to hear.
With the help of your therapist, begin to deconstruct your dysfunctional interactive/communication/emotional patterns. Recognize that changing the patterns of interaction begins to shift not only the way you relate, but the relationship itself.
Entertain the notion that it is not only possible, but even likely, that both you and your partner can both be simultaneously right and wrong. It all depends on your point of view.
Be patient and let the therapeutic process evolve (even though it’s often expensive and frequently gets worse before it gets better). Therapy has far less to do with the actual facts than the interactive process (communication and behavior), interpersonal relationships, and your feelings about all these.
Establish clear, realistic therapeutic goals and work collaboratively toward achieving them. This is the essence of good therapy.
Trust your therapist to do what they are trained to do. If you have questions or disagreements with the way therapy is going, discuss it openly with them and try to work it out. Don’t just stop coming to therapy because that simply doesn’t solve the problem.
Understand that couple relationships work best when both partners are giving 90% to the relationship and taking 10%.
Homework assignments are carefully conceived to enable you to continue the therapeutic work outside the session. Most therapy occurs between sessions, not within sessions.
If your couple or family relationships are strained or tenuous, it is essential to avoid stepping on any land mines between sessions. This will only set you back.
Criticism is like pouring battery acid on the relationship. Given that you may well have justifiable anger for past wounds, work with your therapist to determine how you can deal with these constructively rather than destructively.
Therapy and change are synonymous. People may come to therapy to be vindicated and proved right, but an essential part of therapy is changing your beliefs, attitudes, and behavior. Would you rather be right or be in the relationship? If you would rather be right, then you probably don’t belong in therapy. Sometimes you will be right, but don’t make your partner consistently wrong as this will only alienate him/her and drive a wedge between the two of you.
Learn how to compromise and negotiate. Be willing to discuss, reconsider, and possibly adjust your expectations and attributions to your partner. If you are a couple, then cognitive distortions are invariably going to be in play on both sides.
Everyone brings emotional baggage from their family of origin (FOO). Be open to exploring the influences of yours and your partner’s family of origin on the marital relationship. Remember that the marriage of two individuals truly is the marriage of two families (even though you had not intended to marry your mother-in-law). There is an entire body of literature that suggests people get married in order to work through unresolved family of origin issues. Begin to work at differentiating emotional reactivity based in your FOO from emotional reactivity to your spouse.
For therapy to work effectively, you need to be as open and honest as possible (even though this may be painful and difficult at times).
Regular appointments ensure that the therapeutic process can proceed effectively. (otherwise, the therapy process loses focus, momentum, and continuity).
Therapy is hard work and it will get worse before it gets better.