What Do You Expect?

One of the questions I ask during an initial consultation centers on the client’s expectations for both treatment and the therapist.  Clear expectations about therapy go well beyond problem-solving and goal-setting—important distinctions to make.  When both client and therapist can develop clarity about what therapy is and what to expect, the work will proceed at a reasonable pace, with fewer “bumps in the road.”  The foundation of the therapeutic relationship is likely to be more solid, and goals will be shared—critical when it comes to life-changing work!

Some questions to consider and to talk about with your therapist:

·         What will your life look like once the problem is resolved?

·         What will progress look like?  How will you know you’re making progress?

·         If you’ve been in treatment before, what worked for you?  What didn’t?  How will you communicate these dynamics to your new therapist?

·         What is the therapist’s role in helping you?  What does support look like?  What kind of feedback do you welcome?  

·         What does a collaborative relationship look like?  How collaborative would you like your therapist to be?

·         How do you expect the therapist to communicate with you? 

·         How will you communicate to the therapist when you feel dissatisfied or when you feel you are not making progress?  When you feel you are making progress?

I encourage clients to engage me with these questions.  Talking about your expectations will illuminate the issues you are facing as well as the dynamics that are likely to emerge between you and your therapist.

Indeed, having clear expectations about therapy and your therapist can go a long way toward creating a meaningful helping relationship where deep, life-transforming work can be done.  

Step Back

On September 13, 2001, I boarded one of the few subway trains running in NYC and tried to get to work from my apartment in Brooklyn.  The mostly empty train left Brooklyn and was on its way to the Wall Street station when the train suddenly lost power and lurched to a stop in the tunnel.  The lights went out, and emergency lights flickered on, eerily illuminating four other passengers spread throughout the car.  From my seat in the second car of the train, I could hear explosive popping sounds several cars away.   Memories of the towers collapsing flashed in my mind’s eye, and I quickly began to feel very anxious and uneasy.  I could feel my heart racing faster and my blood pressure rising.  I looked across the car to the other passengers and sensed that we were all having similar thoughts:  another terrorist attack; we’re going to be blown up or drowned under the river.  My thoughts careened ahead, and I began thinking of how I might escape, wondering exactly how far we were from Wall Street. The more I entertained these catastrophic thoughts, the harder my heart pounded, and the more anxious and panicked I became.

But then, I caught myself, and saw how crazy my thinking was.  I became aware that my anxious thinking was making the situation much worse.  With effort, I was able to step away from the story, back into the present moment. 

I had created a story about what was happening and what might happen. By doing so, I no longer accurately perceived what was actually occurring.  I did not know what was taking place several cars away. I was speculating, imaginatively filling in the blanks to make sense of what I was hearing.  And the story I wrote in my head created suffering.  The reality was this: the train stopped in the tunnel, the lights were out, there were sounds—the origin and cause of which were unknown to me—and I was alive. Nothing bad was happening in the car where I sat.  For the moment, I was OK.

I consciously decided to stay focused on what I knew at that moment, and what I knew was that I was OK.  Being OK was enough.  The awareness of being OK was followed by a second thought:  there was actually nothing more to do. There was no action to take, given the knowns and unknowns of the situation.  If some new development arose that demanded a response, I would take action then.  But for the moment, I simply held to one thought:   ”Right now, I’m OK.”  Doing anything else would be foolhardy and unnecessary—and potentially disastrous.  Waiting with alert awareness was the best choice. 

Although it seemed an eternity, the train’s conductor soon announced that the train had lost power, and that the sounds I heard were caused by the train trying to generate power.  He stated that he would try to power up the train and get us to Manhattan.  After a few more moments, the train began to move and we soon safely arrived at Wall Street. 

I’ve thought about that morning a great deal over the years.  I’ve shared my experience with many people to illustrate how our minds can generate potent but unnecessary stories that distance us from the truth of the present moment and create anxious suffering.  We create stories during moments of uncertainty that, in turn, can generate powerfully aversive feelings.  Aversion then generates an incredibly strong impulse to flee the situation. Indeed, we may react prematurely, creating more discomfort and distress. 

Although stories tend to arise in stressful situations, self-generated stories ultimately have deeper roots.  They arise from unexamined, dysfunctional beliefs about ourselves—beliefs about one’s sense of agency and power, beliefs about our ability to tolerate uncertainty and strong feeling states.  Too often, dysfunctional beliefs and the stories that arise from them lead to the adoption of dysfunctional coping behaviors.  Addictions and other compulsions often have their roots in dysfunctional beliefs about one’s self and the world.

In any event, the stories we create about situations (and the feelings that arise with the stories) filter and distort our experience of reality.  And we conflate the feelings that arise in response to situations with reality itself.  A vicious spiral of anxiety and dysfunctionally reactive behavior may ensue. We make ourselves miserable as a result.

It need not be so.  Indeed, when you can step back from the stories, you can have a new experience.

Identifying the stories you tell yourself is an essential part of therapy.  Taking a critical look at the stories, how they function in your life, understanding their purpose, evaluating their utility are all aspects of therapeutic work. 

Stories and feelings will arise in any given situation.  Such is life.  Life unfolds; feelings arise and fall.  Feel the feelings.  Let the feelings be, but do not add to them by creating stories about them.  Be aware of the stories that might be generating feelings.  Learn to step away from the stories.  Step back into the reality of the present moment—with all its knowns and unknowns.    Your responses will be freer, clearer, and life-affirming.