Help Me!: A Psychotherapist’s Tried-and-True Techniques

Source: Richard B. Joelson used with permission of the author

What drives most people to therapy is the nagging belief that they are not good enough. Why, they wonder, do they treat others better than they do themselves? Chances are they engage in “personal propaganda.”

What is the single question you get asked most often by patients?

New patients who are veterans of psychotherapy often wonder why, after so much treatment over so many years, they do not think, feel, or function much differently than they did before therapy—this despite reports of successful therapeutic experiences with previous therapists. Patients new to therapy frequently wonder why it is that they regard and treat others so much better than they do themselves. The disappointments or failures occurring in their lives are often responded to with harsh and punitive self-condemnation, as opposed to the tolerance, understanding, and compassion that they may have for others.

Do you find that most people have a good relationship with themselves, and if not what is/are the trouble spot/s?

In general most people have a reasonably good relationship with themselves, characterized by self-acceptance and tolerance for personal vulnerabilities and limitations. The average psychotherapy patient, however, may not enjoy a good enough relationship with him- or herself, and this may be why they seek psychotherapy. The struggle is usually related to ongoing and entrenched negative beliefs about one's self. "I'm not good enough" is probably the single most troubling belief that often brings someone into therapy.

How are we often our own worst enemy?

By striving for perfection rather than for excellence. This frequently leads to frustration and disappointment and, worse, self-condemnation. If one's goals and expectations are reasonable and realistic, then a sense of accomplishment and self-esteem are more likely to result.

What are the key elements of a good relationship with oneself?

Acceptance and self-compassion. By accepting our imperfections and personal difficulties and handling them with self-compassion, good mental and physical health is much more likely. According to recent research, people who score high on tests of self-compassion have less depression and anxiety and tend to be happier and more optimistic. Another element is to be very aware of what I call "personal propaganda," which refers to the self-defeating ideas and beliefs that we sometimes use to justify ourselves when we have fallen short in some way. We have to be willing to confront and challenge ourselves to function at a high level rather than excuse ourselves for not doing so.

What’s wrong with feeling sorry for oneself?

In moderation, sympathy for oneself can be soothing and helpful in one's efforts to overcome the pain that life events and experiences can cause. However, if someone is so wedded to their despair that they find it hard to focus on anything else or to improve their situation by developing better coping skills, then it is detrimental. When feeling sorry for oneself becomes extreme and reaches the level of chronic self-pity, it is likely to have significant personal and interpersonal consequences.

How does self-blame trip us up and what is the alternative?

Self-blame often arises when adversity occurs that does not have an easily identifiable cause or explanation. "It must be something about me" or "I must have done something wrong" are frequently easily accessible  and unfortunate conclusions, but they can contribute to depression and anxiety. An alternative way of handling such situations is, at the very least, to stay neutral or give one's self the benefit of the doubt. If one wishes  to investigate causality, it can hopefully be accomplished without prematurely assuming blame for something that may not at all be one's responsibility.

What are the most important things you want readers to know?

Change is difficult but possible even if the path to achieving it can be time-consuming and frustrating. It is possible to become more understanding and patient with oneself and to parlay that into greater life satisfaction. Relationships can actually improve and deepen over time, especially when both parties work out their personal difficulties as well as their interpersonal ones and pay attention to the needs of the relationship, which at times are different than their own needs.. Negative beliefs about the self can be exorcised and replaced by healthier, more positive ones. Being a good listener who is empathically attuned to others is one of the key components toward being a more successful person and a good partner. By being more thoughtful and reflective about our thoughts, attitudes, and behaviors, we are better able to achieve self-improvement and meaningful change.

What makes for relationship success that others have not identified or emphasized enough?

Learning the techniques to resolve differences and conflicts without escalating tension and anger. Too many couples report recycling the same arguments for years without any benefit—in fact, often making things worse—so they avoid addressing issues and simply store resentments for future arguments. Productive dialogue that accomplishes something is a major ingredient of a successful relationship. I define productive dialogue as one that ends with both parties pleased with the outcome, perhaps a little closer to each other, and satisfied that the issue in question is no longer a source of conflict. Another is the ability to say, "I'm sorry." I have seen heated conflict dissolve into warmth and appreciation when these simple words are sincerely uttered as a necessary and justified response.

How does one move from insight to change?

Many people come to therapy in a state I refer to as "insight-rich and change-poor." It’s captured by one person's opening comment in session one: "I know a great deal about what makes me tick, but I still feel like the same run-down, broken clock I have always been." The translation from insight to meaningful change is a key theme of any psychotherapy. It must be a focus in the treatment, continuously emphasized, often by helping patients identify ways that they can apply their new insights to change their problematic behaviors. This also involves helping people to understand their worries and fears about making change despite their expressed wishes to do so.                          .

What does it take to go from living to thriving?

This has a great deal to do with the extent to which someone believes that they are primarily responsible for most of what occurs in their life. People who believe in their ability to influence the outcome of events and circumstances in their lives—and act accordingly—seem to be able to prosper and flourish more than those who believe that external factors and forces ultimately determine what happens to them. Thriving, as opposed to simply living, also involves being able to cultivate healthy and deeply satisfying relationships so that one has support, feels safe in the world, and feels valued.

If you had one piece of advice, what would it be?

When one is under stress of any kind, it is important to avoid resorting to dysfunctional ways of coping such as procrastination, excessive worry, and negative thinking.  Whether achieved as one of the goals of therapy or developed some other way, it is necessary for one to develop the belief—based on acquired skills, confidence in one's self, and a solid coping repertoire—that pretty much any difficulty or challenge can be handled competently. We are capable of this.

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Help Me!: A Psychotherapist’s Tried-and-True Techniques

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