I entered the field of clinical psychology because I wanted to make a meaningful and helpful connection with people who are struggling and wanting to grow. The improvement or resolution of a person's presenting problems or the attainment of personal goals are the context and purpose of therapy. What is exciting in this process is the dialogue between myself and others that leads to new self-awareness and the opportunity for change.
I help those I am working with develop present-centered self-awareness. Being in the present moment is a simple and obvious concept yet it is elusive to most of us, in it's truest sense, because we are conditioned to be anywhere but in the present. Becoming more aware of our thoughts, feelings, and bodies (i.e., posture, muscle contraction, and quality of breathing) in the moment helps us to see with greater clarity how we interrupt our natural self-regulation. With healthy self-regulation we are free of paralyzing conflict, suppressed feelings, and natural behavior can flow in an unrestricted manner.
I help individuals to make healthy contact with others. If the boundary between ourselves and others is disturbed, we cannot function in a healthy and effective way. Three examples of boundary disturbances follow. When we unconsciously place our thoughts, beliefs and feelings onto others (projection), our perceptions of others become distorted. When we swallow whole the thoughts and beliefs of another in a reflexive and involuntary manner (introjection) we lose the recognition of what is ours and what belongs to someone else. When we cannot establish any boundary between ourselves and others (confluence) we are unable to say "no" and we become trapped by the will of others.
I emphasize the importance of dialogue in the psychotherapy relationship. We do not heal simply through monologue. We need interaction with another person to affirm a sense of ourselves and to heal through meaningful relating. Psychotherapy is the only relationship, by nature and purpose, where we are not only relating with another but talking about this process as well. The awareness that develops from the therapeutic relationship is invaluable to our understanding of how we relate to people in our life outside the therapy office.
I also value experimenting with new behaviors and the experiential learning that follows as a necessary component of change. We ultimately learn and change by doing.
From my experience as a clinician I have learned the importance of the link between how we formed as young people and our present difficulties. I guide people to see the impact of parents and important people during our development on our self-experience. I help people understand how each person has had to navigate his or her development to both maintain vital connections with those on whom our psychological survival depends and at the same time achieve necessary separateness, autonomy, and individuality. When we learn that we had to make shifts in our functioning in the past in order to progress, we have a fuller appreciation that we can make shifts in the present to function in a healthier way.
In terms of our emotional life, I do not make a distinction between past and present. If a painful experience or feeling from our past has not been addressed, it is in the present in that it is currently drawing emotional energy and impacting us even though we may not be fully aware of this process. In therapy we become aware of these feelings and have the important opportunity to express them safely and constructively. This work is necessary in the development of our healthy emotional integration and self-regulation.
Human beings have four essential developmental needs: the need to acquire a distinct sense of self that is separate from others, the need for a parent or caregiver to provide consistent and reliable emotional and physical safety, the need to feel loved and special for who we are, and the need for at least one other peer to feel close and connected to. When these needs have not been met in a reasonable fashion, we do not acquire a fortified sense of self and a range psychological problems often develop including difficulties with assertiveness, anxiety, depression, impaired self-esteem, and problems with relationships. A central task of therapy is to understand unmet developmental needs and to mend a lack of self-cohesion.
We are all psychologically organized in a unique way based on our life experience. In my work, I am attuned to the unique organization of each person and what is called for from moment to moment. The excitement of good therapy is that it is continually on the growing edge or cusp of something new; whether it is a new perspective on a relationship or predicament, the discovery of a conflict within us, a more clear awareness of how we feel about and treat ourselves, an emotion we were unaware of, or a new strength and capability.
While each person's therapeutic work is different, the process of therapy has three general areas of focus. When and how each of these areas becomes foreground in the work depends on each individual.
One component of therapy is our thinking or belief systems. What beliefs or convictions do we have about ourselves? Are our beliefs about ourselves healthy in that they promote psychological self-support and confidence in how we work and relate to family, friends and partners? Do our beliefs about ourselves promote personal expansiveness, creativity and striving for excellence? On the other hand are our beliefs about ourselves and the world unhealthy leading us to be self-critical and feel shame, inappropriate guilt, or fear? The origin of our unhealthy beliefs need to be understood so that they can be challenged and modified as they are not an inherent part of our core and true being; we are not born self-critical or feeling guilt or shame. Healthy beliefs need to take their place and this process is discussed below.
A second focus of therapy is our relationship to the spectrum of emotions that are a core part of our human constitution and how we experienced ourselves and interacted with the world well before our ability to think abstractly. Do we have awareness of our different feelings and the ability to express them or has this connection and skill been derailed? Derailment occurs in two general forms: suppression and emotional reactivity.
Suppression happens when a feeling is either unacceptable or has never been present in the emotional range of our parents or caregivers. If a feeling (i.e., joy, sadness, or fear) is never modeled or permitted by caregivers, we make the reasonable determination that it is not okay to feel and express this feeling. Feelings that we have lost or never developed a connection with need to be rewoven into our psychological functioning for personal effectiveness and enrichment. Suppression also occurs in response to injurious interactions with parents or caregivers. As a result, we block awareness and suppress these emotions because they are painful and because their expression might threaten necessary ties with parents or caregivers.
Emotional reactivity are feelings that surge forth reflexively and with intensity well beyond what a situation calls for (i.e., road rage, catastrophic fear). This occurs when parents or caregivers have modeled or treated their children with an excessive level of emotion, and/or other injurious behaviors. I work with individuals to understand the primary sources that drive emotional reactivity and with therapeutic work, reduce or dissolve it.
The third arena of treatment focuses on our behavioral life. Unhealthy beliefs or thinking and suppressed or reactive painful feelings often lead to unhealthy behaviors such as social avoidance, passivity, inappropriate anger and hurtful behavior toward others, and compulsive or addictive behavior. Addressing old injuries, painful feelings and unhealthy beliefs alone does not always bring change in behavior. We often need the successful result of new behaviors to galvanize the process of change. Through experimenting with new behaviors we learn that we can function differently in the world without our feared consequences becoming reality.
An example would be an adult who, as a young child, was pushed into a swimming pool before he or she was able to swim, enduring the terror that he or she were going to drown. As a result that individual becomes terrified of going into a pool. Therapy will promote an understanding of this fear and provide the opportunity to express the emotions from this trauma that may have never had a voice. However, it will be unlikely that this individual will be able to go into a swimming pool until he or she has had the opportunity to experience directly and incrementally that the pool is safe; that there are steps to support one's feet, a shallow end in which one can stand, and sides to hold onto. The above behaviors become experiential learning and the success we achieve is what solidifies enduring change.
Experiential learning is necessary not only with overt trauma as exampled above but with any repetitive psychological injuries that have left us feeling (i.e., fear, guilt, or shame) and have prevented us from asserting ourselves, or expressing a need or vulnerability to a partner or friend. As with the swimming pool, discovering there will not be the catastrophic consequences that we feared or experienced as children is where we truly learn that we can function differently. At this point the process of change is underway.
Experiential learning allows to see that others will respond differently than we expected. Should that not be the case, we also learn in therapy that we have new strengths and resources to support us. As adults, we are not dependent, impressionable and vulnerable in the same way we were when we were young. As adults we have a greater capacity to both assert ourselves and to understand other people in the context of their own struggles and limitations.
One of the most important principles that guides my work as a psychologist is that emotional pain comes through relationships, therefore, the healing must also come through a relationship. Being a part of this healing relationship is a meaningful process that is enriching and gratifying to the person or couple I am working with as well as myself.
Copyright © 2010 Bruce A. Howard, Ph.D. All rights reserved.