Now that I am working full-time in private practice I notice more freedom to become the therapist I want to be. And the biggest thing that’s surfacing for me is recognizing my basic job is to help my clients in Expanding Awareness.
What does that mean?
When clients start therapy for the first time ever, they usually think that therapy is problem solving: they tell me their problems and I come up with solutions. Sometimes their model is that of a doctor: he asks enough questions or runs enough tests that he can diagnose the problem and recommend treatment.
And there are certainly times therapy is like that. With new clients I may give them my checklist and help them identify which type of overeater they are. Then, sometimes, I can offer them specific advice. For example, most overworked overeaters don’t eat breakfast or don’t eat enough of one, so I may suggest they add a protein-rich breakfast and see what difference it makes.
For medical doctors, that is often the extent of what they do. They diagnose you, you do the treatment, and then you move on.
But for therapists, that is just the beginning.
Therapists differentiate solution-focused therapy (much like the MD model) and depth work.
There is certainly nothing wrong with solution-focused therapy and most therapists do at least some of it, because it’s a good place to start. But I believe that people are able to overcome overeating when they understand why they are eating when they’re not hungry. And that requires depth work. Which requires Expanding Awareness.
For example, a client comes in to work with me and I suggest a protein-rich breakfast and they are able to make time to eat one. As a result, they notice they are more energetic and focused at work and don’t reach for their usual 2 p.m. sugar fix.
In order for compulsive eaters to stick with their new eating pattern for the long haul, they need to understand the feelings and motivations that created their old pattern. Otherwise, they may continue to eat breakfast for a few weeks or even a few months, but will eventually backslide into their old way of eating once again.
And in order to reach this understanding, they will need to gain some new skills.
I may start by teaching them The Body Scan or The Bubble Exercise, which I have outlined in previous blogs.
But, mostly, whatever they talk about, I start asking them questions to probe deeper. They may list their difficulties of the current day, and I will ask them specifics. Say they are struggling with a decision. I may ask when it came up, the background that led to the decision, their feelings about it, or how they have thought through their choices.
This gives me some background on them and points to areas in their life where they get stuck. Most of us have parts of our lives where we function quite well and, in other areas, not so much.
I may begin to ask them about their past and explore the things that they didn’t learn in their childhood that effect their life today. Sometimes this is not at all obvious at first. They report a wonderful childhood with few problems. Sometimes the dysfunction in their family is quite severe, but they haven’t realized until we talk how it remains with them still.
I help my clients get a bigger picture of themselves and what makes them tick. Sometimes this takes a while, because they are not used to thinking about themselves, what they are feeling, and why they do the things they do.
When I first entered therapy at the age of 23, I realized how afraid I was all the time and how it got in my way. Over time, I became more aware of when I get scared, why I got scared, what I tended to do when I was scared, and how I could begin to think and act differently about life.
This wasn’t something that happened once and I instantly knew what to do about it. I have been developing my awareness over my entire life since, and I have a lot more self-understanding now than when I was in my early twenties.
In solution-focused therapy, the work happens much more quickly. In depth work, therapy happens slowly and gradually unfolds over time. Some sessions are murky and it isn’t clear what my client is really addressing. But, with time, the inner awareness accumulates, and my clients become much more able to understand who they are and why they do the things they do (particularly compulsive overeating.)
It takes time, but the work lasts. And the changes in eating habits stick in ways they didn’t before.