Psychological Approach

Board Certified Clinical Psychologist & Certified Group Psychotherapist

The psychological approach that I have found most useful and use most of the time is based on the empirically-based theory called Systems Centered Therapy® (SCT), developed by Dr. Yvonne Agazarian, with whom I have studied for 23 years. SCT® theory itself reflects an integration of psychodynamic theory and systems thinking (see www.systems-centered.org). On the one hand, in SCT® it is understood that our patterned ways of relating to ourselves and others which cause trouble and distress now, reflect roles that we learned in early relationships. We needed these roles at the time because they somehow served to elicit the best care our caregivers could offer. On the other hand, our focus will not be on the past, at least not at first, but primarily on how you and your relationships operate in the present.

Defenses

If we think of the optimal internal system as one which can respond fully to whatever life presents, without the interference of defenses, we would look for a balance between thinking and feeling in which the information contained in fully-experienced emotions provides emotional intelligence and good decision-making ability. We would have our feelings about whatever context we are in, and then we would go on to the next context and experience. Most of the symptoms and suffering we have (such as anxiety, depression, and psychosomatic disorders) come from our defenses against our natural experience. The defenses we all developed to protect ourselves from pain that felt unbearable growing up, tend to become like monoliths that dominate our lives and waste our energy. When we defend, we also miss knowing what we would otherwise have experienced, and the important emotional information contained in that experience.

As a system’s-oriented therapist, I work systematically and actively to help my clients recognize and learn to undo these costly defenses, and to then explore the feelings underneath, until they regain access to the full range of human experience. When we are familiar and comfortable with all aspects of ourselves, neither afraid nor judgmental, we are less likely to defend against whatever experience is aroused. For example, the first defense we learn to undo in our work is symptomatic anxiety (as compared to the normal mild anxiety we have whenever we face something we don’t know, which is often). Problematic anxiety is usually caused by the way we are thinking, such as when we tell ourselves things that are made up, and don’t stick to the facts. When an anxious client can describe what is really true in the present without making negative predictions, imagining what others are thinking or feeling, or putting interpretive spins on things, anxiety usually drops back to normal. Staying in reality makes relationships much easier and more satisfying, as the conflicts we get into with others often start with anxious thoughts about the other person that are not accurate. When someone does something we do not like, we naturally feel frustration, irritation, or anger, but we won’t “fan the flames” if we stick to the facts of what really happened.

Steps In Treatment

Through her clinical research, Dr. Agazarian found that there are stages of work which build on accomplishing the work of the previous stages. Reducing anxiety comes first. Second, we undo tension which masks feelings and makes experience in the body inaccessible to exploration. Third, we address the defense of discharging feelings rather than containing and exploring them (frequently this means attacking others or turning aggression on oneself and creating depression). After one can undo these beginning defenses, one is capable of undoing more complex defenses that involve roles (like victim, rebel, compliant, dictator) and role-locks with others (when two people induce each other to play the reciprocal role to the one they’re playing, such as aggressor and victim). As one has experience undoing these defenses, one learns to claim one’s authority (as opposed to having problems with external authority figures and blaming them for one’s unhappiness), and to feel increasingly empowered to create the life one wants. It is only then that one is ready to explore issues of intimacy, closeness vs. separation, merging vs. alienation. In this phase we learn to stay fully present with others in closeness and in conflict, both when we’re similar to and when we’re different from others.

Group

Most of my clients in individual systems-oriented therapy choose at some point to join a group. A group gives one practice undoing defenses and creating the space to explore oneself. I think of group as similar to a language lab when studying a language. At first it is helpful to have individual attention in learning to work, but as skill increases, defenses can be undone more quickly, and more time is dedicated to exploring. This exploration is greatly enriched by a group. Not only are feelings aroused that can then be explored, but members can team up to explore a similar feeling and this sub-group can usually go deeper, with less shame or taking personally what you discover, than one member could go alone. In a systems-oriented group, members learn at a deep level that whatever they find in themselves is a “voice for the group” – it’s getting aroused because of group dynamics, and it is more about the group than about themselves. We could say “a voice for the human race,” which reflects the fact that we all have the potential to feel anything any member discovers, even if we don’t have access to it at the moment. Our experiences are “normalized” to us when we understand that they are in response to a context – not about something being wrong with us. This concept can be difficult to grasp (convinced as we are that we are flawed), but we are tremendously relieved when we are finally able to not take things personally.

Working with Trauma

With many patients, there is some aspect of the treatment that touches on small to major trauma. Trauma refers to any experience that overwhelmed the nervous system and has not yet been integrated. I have found two very useful systems in working with trauma: EMDR (Eye Movement Desensitization and Reprocessing) and SE (Somatic Experiencing). I have used EMDR, in conjunction with my other approaches, with about a third of my clients for at least 20 years. I am still in the process of learning SE and am finding it a wonderful addition with most of my clients. I expect to finish the three-year training in 2014.