Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / Conversational Depths in Therapy #210 ⭕️

Transcript

Conversational Depths in Therapy #210 ⭕️ · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

• 0:00
  SPEAKER_00: Words matter.
• 0:03
  SPEAKER_00: They are the medium to connection, ideas and emergent realities.
• 0:09
  SPEAKER_00: As the legendary social work professor turned TED Talk superstar Renee Brown says, language is praxis.
• 0:18
  SPEAKER_00: Praxis refers to the process of putting what you know into practice.
• 0:23
  SPEAKER_00: We are taught a lot about the theories of human development,
• 0:26
  SPEAKER_00: psychopathology,
• 0:27
  SPEAKER_00: and theories of psychotherapy,
• 0:29
  SPEAKER_00: but we rarely get into the details that is exchanged in the four very private walls
• 0:35
  SPEAKER_00: of therapy.
• 0:36
  SPEAKER_00: Conversations.
• 0:39
  SPEAKER_00: The word conversation is made up of con, with, and verser or turn.
• 0:47
  SPEAKER_00: Conversation is taking turns.
• 0:51
  SPEAKER_00: Musicians describe a good improvisation or performance as a good conversation.
• 0:57
  SPEAKER_00: If we resist the urge to overcomplicate things with our elaborate theories,
• 1:02
  SPEAKER_00: We must learn to be the midwife of good conversations.
• 1:07
  SPEAKER_00: More, it takes practice to develop the skills required to handle difficult conversations in therapy.
• 1:14
  SPEAKER_00: Yes,
• 1:15
  SPEAKER_00: some clients are harder to engage than others,
• 1:18
  SPEAKER_00: but the burden of responsibility should not fall on the shoulders of the client.
• 1:22
  SPEAKER_00: It's on us.
• 1:25
  SPEAKER_00: We are not the experts of their lives, but we should be skilled enough to guide them.
• 1:30
  SPEAKER_00: The aim of the following framework is to allow you to appreciate which level of the
• 1:35
  SPEAKER_00: conversation is taking place between you and your client.
• 1:39
  SPEAKER_00: So now let's take a look at each of the five levels of conversation as we described
• 1:44
  SPEAKER_00: in the previous episode called We Are Hungry for Death in Frontiers Friday 209.
• 1:52
  SPEAKER_00: So the five levels are informational level,
• 1:56
  SPEAKER_00: emotional,
• 1:57
  SPEAKER_00: confessional,
• 1:59
  SPEAKER_00: experiential,
• 2:00
  SPEAKER_00: and activational level.
• 2:04
  SPEAKER_00: The first, informational.
• 2:07
  SPEAKER_00: We need enough information about the client in order to understand their presenting
• 2:11
  SPEAKER_00: problems and the context in which they are experiencing them.
• 2:15
  SPEAKER_00: But don't go digging around for true but useless information.
• 2:21
  SPEAKER_00: Our urge is to gather all the necessary facts about the person.
• 2:26
  SPEAKER_00: We have to ask ourselves, at that given stage, have we earned the license to pry?
• 2:33
  SPEAKER_00: If information is all we need,
• 2:35
  SPEAKER_00: everyone would have been billionaires with perfect six-pack abs,
• 2:41
  SPEAKER_00: says writer and entrepreneur Derek Sivis.
• 2:45
  SPEAKER_00: In other words, information is not equals to transformation.
• 2:50
  SPEAKER_00: Nevertheless, at the informational level in therapy, clients want us to know what they want us to know.
• 2:57
  SPEAKER_00: We gather, we listen, we suspend judgment, and we take notes.
• 3:02
  SPEAKER_00: To facilitate conversations at an informational level, there are three things.
• 3:09
  SPEAKER_00: One, gather enough information to be on the same page.
• 3:13
  SPEAKER_00: You can ask questions like, tell me about you, what you like doing, what you do for fun.
• 3:19
  SPEAKER_00: In light of the issues you raised, I'd love to know what usually occupies your mind.
• 3:26
  SPEAKER_00: What would you like me to know about you that we haven't had a chance to talk about?
• 3:31
  SPEAKER_00: Is there anything I've happened to ask you that you actually would appreciate if I did?
• 3:37
  SPEAKER_00: Two, provide relevant information.
• 3:41
  SPEAKER_00: As we gather information as therapists, our clients too may have stuff they want to know more about.
• 3:49
  SPEAKER_00: Like, what's wrong with me?
• 3:51
  SPEAKER_00: Is this normal?
• 3:53
  SPEAKER_00: Am I going insane?
• 3:54
  SPEAKER_00: Is there a book that you recommend to help me in this area?
• 3:58
  SPEAKER_00: What to expect is number three.
• 4:02
  SPEAKER_00: Clients may not necessarily know exactly what to expect in therapy,
• 4:08
  SPEAKER_00: what the therapist's role is and their role too.
• 4:12
  SPEAKER_00: This is an invitation for clients to be an active agent of change.
• 4:18
  SPEAKER_00: Therapy is not done onto them, but with them.
• 4:23
  SPEAKER_00: The second level, emotional.
• 4:27
  SPEAKER_00: At this second level of conversation,
• 4:29
  SPEAKER_00: clients enter beyond the realm of the logical and begin to share what's going on at
• 4:35
  SPEAKER_00: a felt level.
• 4:38
  SPEAKER_00: As mentioned in my previous post, we are hungry for depth.
• 4:42
  SPEAKER_00: At the informational level, head speaks to head.
• 4:46
  SPEAKER_00: At the emotional level, heart speaks to heart.
• 4:52
  SPEAKER_00: The therapist's task at this level is to listen carefully and provide dynamic
• 4:56
  SPEAKER_00: empathy that facilitates a deepening of what they are saying,
• 5:00
  SPEAKER_00: while also implying that you can go further and I'm with you.
• 5:07
  SPEAKER_00: The world of affect often requires a guide to go deep.
• 5:11
  SPEAKER_00: Feelings can be present just beneath the surface of our conscious mind.
• 5:16
  SPEAKER_00: We can create a climate to welcome them into the therapy room.
• 5:22
  SPEAKER_00: The sort of guidance to go further requires climate control, not command and control.
• 5:28
  SPEAKER_00: Do we create an invitational climate in the room, in the conversation for the client to go deeper?
• 5:36
  SPEAKER_00: Carl Rogers famously said,
• 5:38
  SPEAKER_00: in my early professional years,
• 5:41
  SPEAKER_00: I was asking the question,
• 5:42
  SPEAKER_00: how can I treat or cure or change this person?
• 5:47
  SPEAKER_00: Now I would phrase the question in this way.
• 5:50
  SPEAKER_00: How can I provide a relationship which this person may use for his own personal growth?
• 5:59
  SPEAKER_00: Even the use of the voice,
• 6:02
  SPEAKER_00: our primary instrument in the conversation of music,
• 6:05
  SPEAKER_00: can be used to facilitate going deeper into the emotional realm.
• 6:11
  SPEAKER_00: A simple statement like, how are you, can be asked in so many affective ways.
• 6:17
  SPEAKER_00: How are you, an upbeat kind of greeting.
• 6:22
  SPEAKER_00: How are you, a matter of fact way of asking.
• 6:26
  SPEAKER_00: And
• 6:27
  SPEAKER_00: How are you?
• 6:27
  SPEAKER_00: A softer, slower intonation.
• 6:33
  SPEAKER_00: All of the above suggests that we have a facilitative role to play,
• 6:37
  SPEAKER_00: especially in helping a client to go deeper.
• 6:40
  SPEAKER_00: As one of my intellectual heroes, anthropologist Gregory Bateson would say, it takes two to know one.
• 6:49
  SPEAKER_00: To facilitate conversations at an emotional level, there are three things.
• 6:55
  SPEAKER_00: One, focus on going inward.
• 7:00
  SPEAKER_00: Here's some questions that you can ask.
• 7:03
  SPEAKER_00: As you were hearing the arguments between your parents, what's going on for you on the inside?
• 7:11
  SPEAKER_00: What is an inner struggle that you are facing?
• 7:16
  SPEAKER_00: Two, focus in the moment.
• 7:20
  SPEAKER_00: Here's some questions that you can ask to a client who seemed to be reporting
• 7:24
  SPEAKER_00: traumatic events matter-factly to you.
• 7:28
  SPEAKER_00: Can we take a moment here and slow down?
• 7:31
  SPEAKER_00: As you were talking about all the hurts, how are you feeling right now in your body?
• 7:39
  SPEAKER_00: And to an anxious client at the start of the first visit,
• 7:42
  SPEAKER_00: what is it like to finally be here at this first appointment in this room?
• 7:48
  SPEAKER_00: 3.
• 7:49
  SPEAKER_00: Differentiating primary and secondary emotions I see that you are very angry for
• 7:58
  SPEAKER_00: what your friend did to you,
• 8:00
  SPEAKER_00: though you didn't show it to him.
• 8:03
  SPEAKER_00: And underneath it all, what feelings are stirring or bubbling beneath anger, if any?
• 8:11
  SPEAKER_00: In this situation,
• 8:13
  SPEAKER_00: anger is framed as a potential secondary emotion and the target of the emotion was
• 8:19
  SPEAKER_00: actually to the friend,
• 8:20
  SPEAKER_00: but he did not show it.
• 8:22
  SPEAKER_00: And the primary emotion is something we're trying to get to or assess or help to
• 8:28
  SPEAKER_00: make clear for the person,
• 8:30
  SPEAKER_00: which potentially could be about hurt,
• 8:33
  SPEAKER_00: disappointment or sadness.
• 8:37
  SPEAKER_00: We must not be afraid to go there.
• 8:43
  SPEAKER_00: The third level is confessional.
• 8:46
  SPEAKER_00: Therapy is not exactly a confessional booth at the church,
• 8:49
  SPEAKER_00: but we could do well to open up the door for people to speak what has been buried
• 8:55
  SPEAKER_00: in their hearts for a long time.
• 8:58
  SPEAKER_00: I'm not exactly sure how to account for this, but in the first 10 years of my clinical practice,
• 9:05
  SPEAKER_00: With some exceptions, I don't frequently hear people speak at a confessional level to me.
• 9:12
  SPEAKER_00: In the last decade, I seem to hear more and more people speak the unspokens, for some reason.
• 9:19
  SPEAKER_00: And the effect of such a conversation is unshaming, unhiding, and is welcoming.
• 9:27
  SPEAKER_00: This seems to have a profound impact.
• 9:31
  SPEAKER_00: If the emotional level is deep in the sea,
• 9:35
  SPEAKER_00: Confessional level disclosures are like uncovering stuff buried under the ocean floor.
• 9:41
  SPEAKER_00: As mentioned in the Fool Circles essay previously, shame is an innocent emotion.
• 9:48
  SPEAKER_00: It is afraid of being judged, unloved and made small.
• 9:54
  SPEAKER_00: It seems to me that those with clinical levels of symptoms are more likely to
• 9:58
  SPEAKER_00: present with old ghosts that haunts them,
• 10:01
  SPEAKER_00: often in the form of painful,
• 10:03
  SPEAKER_00: traumatic and intrusive memories or guilt-ridden deeds.
• 10:08
  SPEAKER_00: A core pain exists deep within.
• 10:12
  SPEAKER_00: Thus,
• 10:12
  SPEAKER_00: to not only give voice to these psych aches,
• 10:16
  SPEAKER_00: but to be received by another in a caring manner,
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  SPEAKER_00: can be transformative.
• 10:23
  SPEAKER_00: But especially at this confessional stage, we must not think that we need to fix or solve anything.
• 10:29
  SPEAKER_00: It just needs to be wholeheartedly received.
• 10:34
  SPEAKER_00: I've listened to hundreds of hours of therapy recordings,
• 10:37
  SPEAKER_00: and one of the common mistakes that practitioners make is that we move to the
• 10:41
  SPEAKER_00: activation of stage,
• 10:43
  SPEAKER_00: i.e.
• 10:44
  SPEAKER_00: behavioral activation of SMART goals and
• 10:46
  SPEAKER_00: when the client is still raw from opening up to you.
• 10:50
  SPEAKER_00: I've unfortunately made this mistake too.
• 10:53
  SPEAKER_00: It is worth reiterating the following points.
• 10:57
  SPEAKER_00: At the informational level, we say what we will say.
• 11:01
  SPEAKER_00: At the emotional level, we say what we won't say.
• 11:06
  SPEAKER_00: At the confessional level, we say what we can't say.
• 11:12
  SPEAKER_00: When your clients start to speak to you what they typically can't say, learn to be still.
• 11:19
  SPEAKER_00: Be a withness.
• 11:21
  SPEAKER_00: Be with the person.
• 11:23
  SPEAKER_00: Let them speak of their demons.
• 11:26
  SPEAKER_00: No need to be afraid.
• 11:28
  SPEAKER_00: Co-regulate with them moment by moment.
• 11:32
  SPEAKER_00: Soon we can learn to dance with our demons.
• 11:36
  SPEAKER_00: To facilitate conversations at a conversational level, there are three things.
• 11:42
  SPEAKER_00: Invitational.
• 11:43
  SPEAKER_00: Here are some questions.
• 11:46
  SPEAKER_00: Is there anything I haven't asked you that you actually would appreciate if I did?
• 11:52
  SPEAKER_00: What are some things that have been left unspoken in your life?
• 11:58
  SPEAKER_00: Is there some things that are hard to speak about?
• 12:02
  SPEAKER_00: And you also have every right not to go there if you don't want to.
• 12:07
  SPEAKER_00: Second, receiving the person.
• 12:10
  SPEAKER_00: And here are some questions.
• 12:12
  SPEAKER_00: As I hear you speak about these painful memories, it must be hard to even give voice to them.
• 12:18
  SPEAKER_00: I see that you are not trying to blame others, but you were left on your own device to fend for yourself.
• 12:27
  SPEAKER_00: The intent is empathic resonance and speaking of the further unspokenness.
• 12:33
  SPEAKER_00: Another question.
• 12:34
  SPEAKER_00: I really appreciate you sharing this.
• 12:36
  SPEAKER_00: I have deep respects for you for doing so because you're taking courage to address
• 12:42
  SPEAKER_00: this as well as countering the urge to hide from all of this.
• 12:47
  SPEAKER_00: The intent is explicating respect for the client.
• 12:53
  SPEAKER_00: And another example.
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  SPEAKER_00: I'm deeply moved by what you are telling me.
• 12:59
  SPEAKER_00: I can see that you are working hard to make sure this doesn't get passed intergenerationally.
• 13:05
  SPEAKER_00: And you're doing this for the sake of your children.
• 13:09
  SPEAKER_00: The intent is some form of emotional disclosure and affirmation of client's intention.
• 13:17
  SPEAKER_00: Finally, the third one is processing.
• 13:22
  SPEAKER_00: And here are some questions that you can bring up.
• 13:26
  SPEAKER_00: What is it like for you to speak about X with me?
• 13:30
  SPEAKER_00: How are you feeling right now?
• 13:34
  SPEAKER_00: The intent is regulating in the moment affect.
• 13:39
  SPEAKER_00: Is this feeling foreign for you?
• 13:42
  SPEAKER_00: Do you feel too raw or vulnerable at this point?
• 13:46
  SPEAKER_00: And another direction you could take when it's relevant.
• 13:50
  SPEAKER_00: Do you have any unexpected fears that come to the surface after talking about what
• 13:56
  SPEAKER_00: you've just talked about?
• 13:59
  SPEAKER_00: Now, this is a note.
• 14:01
  SPEAKER_00: Sometimes clients may have some nagging feelings of confidentiality,
• 14:05
  SPEAKER_00: even though this was previously discussed.
• 14:08
  SPEAKER_00: Assurance might be helpful at this point, especially at the confessional level.
• 14:13
  SPEAKER_00: In addition,
• 14:13
  SPEAKER_00: some clients might begin to project and experience a feeling of being judged by you,
• 14:18
  SPEAKER_00: even if you're not doing so.
• 14:20
  SPEAKER_00: This needs to be addressed so that they are experiencing you as you.
• 14:26
  SPEAKER_00: within the interpersonal dimension that you have with your client.
• 14:32
  SPEAKER_00: The fourth level is experiential.
• 14:37
  SPEAKER_00: At this level,
• 14:38
  SPEAKER_00: through the improvisational nature and emergent reality of therapeutic conversations,
• 14:44
  SPEAKER_00: a new experience is found.
• 14:48
  SPEAKER_00: The client feels a qualitatively different experience of the self.
• 14:53
  SPEAKER_00: The client may feel inspired by the dialogue that just occurred.
• 14:58
  SPEAKER_00: Such experiences can happen spontaneously.
• 15:01
  SPEAKER_00: More often than not,
• 15:02
  SPEAKER_00: it is the therapist's responsibility to facilitate an experiential level of
• 15:07
  SPEAKER_00: conversation when it's called to fall.
• 15:11
  SPEAKER_00: After more than 12 sessions with Sophie, my client's outcomes seemed to have plateaued.
• 15:17
  SPEAKER_00: We've covered a lot of grounds on helping her with a fear of traveling away from her hometown.
• 15:22
  SPEAKER_00: She now has the tools and strategies to deal with the anxiety.
• 15:26
  SPEAKER_00: But however,
• 15:27
  SPEAKER_00: I had a suspicion she was still avoiding the inexperience of complex emotions,
• 15:33
  SPEAKER_00: which bubbles into anxiety.
• 15:38
  SPEAKER_00: Taking an affect phobia perspective,
• 15:40
  SPEAKER_00: which is fearing to experience feelings within,
• 15:44
  SPEAKER_00: I spoke to my concerns for her.
• 15:47
  SPEAKER_00: While she was not exactly avoiding to drive out of her comfort zone,
• 15:51
  SPEAKER_00: which she did on few occasions,
• 15:53
  SPEAKER_00: I worried that she was actually dissociating from the inner experience or inner feelings.
• 15:59
  SPEAKER_00: In other words,
• 16:00
  SPEAKER_00: though she was doing so-called exposure therapy on the outside,
• 16:05
  SPEAKER_00: she was still evading the feelings on the inside.
• 16:09
  SPEAKER_00: The proper exposure for her might be affect exposure.
• 16:14
  SPEAKER_00: Oh boy, Sophie responded and we both laughed.
• 16:19
  SPEAKER_00: I brought up a symbol that most of us have seen before on ambulances or in hospitals.
• 16:25
  SPEAKER_00: The rod of Cepheus is a single serpent entwined around a staff.
• 16:32
  SPEAKER_00: It's a symbol of healing.
• 16:35
  SPEAKER_00: That is, the very thing that is poisonous from the serpent now is a source of healing.
• 16:42
  SPEAKER_00: If she is volitionally choosing to approach what she fears on the inside and not
• 16:48
  SPEAKER_00: just do the exposure work on the outside.
• 16:51
  SPEAKER_00: With Sophie's will on board, as well as knowing that she is physically able to, I begin to set this up.
• 17:00
  SPEAKER_00: I was scratching my head on what might be the best way to induce the emotional experience.
• 17:06
  SPEAKER_00: The simplest one came to mind.
• 17:09
  SPEAKER_00: Hyperventilation.
• 17:11
  SPEAKER_00: Immediately, just based on this suggestion, I could see a change of expression on her face.
• 17:16
  SPEAKER_00: Really?
• 17:17
  SPEAKER_00: Are we really doing this?
• 17:19
  SPEAKER_00: She said with some nervous laughter.
• 17:22
  SPEAKER_00: Only if you are on board with this and no one can force you to.
• 17:26
  SPEAKER_00: Okay, she said.
• 17:31
  SPEAKER_00: I added, don't worry, I will do it with you and we can stop at any given point in time.
• 17:38
  SPEAKER_00: Okay, it's now or never.
• 17:42
  SPEAKER_00: With my stopwatch at hand, we did a 60 second burst of shallow and fast breathing.
• 17:49
  SPEAKER_00: If anyone walked past my office at that point in time,
• 17:52
  SPEAKER_00: others might have thought the client and therapist had gone hysterical.
• 17:57
  SPEAKER_00: Okay, I know your heart rate is up.
• 17:59
  SPEAKER_00: The point is not just that.
• 18:01
  SPEAKER_00: The point is that this triggers all sorts of internal fears of not being in control.
• 18:07
  SPEAKER_00: Don't fill it up.
• 18:11
  SPEAKER_00: Feel it.
• 18:12
  SPEAKER_00: Don't fill it.
• 18:15
  SPEAKER_00: Feel it.
• 18:17
  SPEAKER_00: I suggested for Sophie to augment with some cognitive approach on top of that.
• 18:22
  SPEAKER_00: Now imagine you are riding an elephant.
• 18:24
  SPEAKER_00: The elephant is a massive beast of energy, but the rider can still guide the direction it is heading.
• 18:31
  SPEAKER_00: As Sophie sort of catches her breath and recomposes herself.
• 18:38
  SPEAKER_00: I met Sophie three weeks after.
• 18:42
  SPEAKER_00: She said she slept like a baby that night and seemed to make a turn around the
• 18:46
  SPEAKER_00: corner in relations to her fear of travelling outside her comfort zone.
• 18:52
  SPEAKER_00: She now enjoys the drive.
• 18:55
  SPEAKER_00: To be clear, I'm not giving this as an example of here's how to do therapy.
• 19:01
  SPEAKER_00: I'm trying to highlight the following point.
• 19:04
  SPEAKER_00: We are most persuaded by our own experiences than explanations.
• 19:10
  SPEAKER_00: When the time is ripe, we can facilitate that.
• 19:15
  SPEAKER_00: To facilitate conversations at an experiential level, here are three suggestions.
• 19:23
  SPEAKER_00: Evoke in the moment emotions.
• 19:26
  SPEAKER_00: Instead of talking about the client's relationship with their parent,
• 19:30
  SPEAKER_00: have them picture that particular parent on an empty chair and speak to them as if
• 19:37
  SPEAKER_00: they were there.
• 19:38
  SPEAKER_00: And instead of gathering information about who is special in one's life,
• 19:43
  SPEAKER_00: get the client to picture them in their mind's eye.
• 19:46
  SPEAKER_00: Vivify the image of that person right here, right now.
• 19:52
  SPEAKER_00: Second, experience.
• 19:54
  SPEAKER_00: Don't tell.
• 19:57
  SPEAKER_00: Instead of trying to get parents to empathize with their child,
• 20:00
  SPEAKER_00: get the parents to speak as if they are their child,
• 20:04
  SPEAKER_00: i.e.
• 20:05
  SPEAKER_00: in the first person.
• 20:06
  SPEAKER_00: And note it's not so much as a role play,
• 20:08
  SPEAKER_00: but to get them to experientially feel what it's like to be their child in the
• 20:14
  SPEAKER_00: presence of that parent.
• 20:17
  SPEAKER_00: Follow up by getting perspective if they have an inaccurate view of what the child is experiencing.
• 20:24
  SPEAKER_00: Or you could use photos of loved ones to evoke memories, get them to bring it into session.
• 20:30
  SPEAKER_00: This can help form a more coherent narrative in one's history or even in grief work.
• 20:39
  SPEAKER_00: 3.
• 20:39
  SPEAKER_00: Beyond words.
• 20:42
  SPEAKER_00: Sometimes some experiences are beyond words.
• 20:46
  SPEAKER_00: Don't be too quick to get clients to name it.
• 20:49
  SPEAKER_00: Let them know that they can sit with the inner experiences as they unfold while you
• 20:54
  SPEAKER_00: are right there with them.
• 20:57
  SPEAKER_00: And some notes that these suggestions doesn't do justice to the vast and wide array
• 21:02
  SPEAKER_00: of possibilities at the experiential level.
• 21:05
  SPEAKER_00: Readers can look up further on areas such as somatic therapy,
• 21:09
  SPEAKER_00: emotion-focused therapy,
• 21:10
  SPEAKER_00: hypnosis,
• 21:11
  SPEAKER_00: play therapy,
• 21:12
  SPEAKER_00: etc.
• 21:15
  SPEAKER_00: And at the fifth level, activational.
• 21:20
  SPEAKER_00: Since this article is addressed to psychotherapists,
• 21:25
  SPEAKER_00: I'll say this regarding the fifth stage, activational level.
• 21:31
  SPEAKER_00: A client who is not ready or keen to take action based on what you suggested does
• 21:36
  SPEAKER_00: not mean that they are not ready for change.
• 21:39
  SPEAKER_00: A client would be activated if it's something that they truly care about,
• 21:45
  SPEAKER_00: something that they feel they can do and is meaningful to them.
• 21:50
  SPEAKER_00: A client did not do your thought diary homework is not because they are resistant to change.
• 21:57
  SPEAKER_00: Perhaps because they don't see any meaning in that exercise or it's either too easy or too difficult.
• 22:05
  SPEAKER_00: In other instances, we might have been premature in trying to get our clients into an activational level.
• 22:11
  SPEAKER_00: The client may have stuff that they have not yet told you as they are getting to
• 22:16
  SPEAKER_00: know you and feeling if they can trust you with some of the not yet spoken about stuff.
• 22:22
  SPEAKER_00: What we need to keep in mind is this.
• 22:25
  SPEAKER_00: Is what we are hoping for them to do,
• 22:28
  SPEAKER_00: leaving them into their learning zone or panic zone or even pointless zone?
• 22:34
  SPEAKER_00: If we're not mindful of their limits, overstretching their LZs can tip our clients into panic zones.
• 22:41
  SPEAKER_00: You know you are in PZ when they are overwhelmed or flooded with strong emotions.
• 22:48
  SPEAKER_00: If you're not cognizant of the impact of their history,
• 22:52
  SPEAKER_00: being emotionally unregulated in the PZ can at times lead to re-traumatization.
• 22:59
  SPEAKER_00: Panic zone materials are usually either too far a stretch in terms of the content
• 23:04
  SPEAKER_00: to be learned or the topic at hand might have triggered ghosts of the past that
• 23:09
  SPEAKER_00: have not been addressed.
• 23:11
  SPEAKER_00: The learning zone is the sweet spot between the comfort zone and the panic zone.
• 23:16
  SPEAKER_00: Not too little, not too much.
• 23:22
  SPEAKER_00: To facilitate conversations at an experiential level, hear three suggestions.
• 23:28
  SPEAKER_00: One, one thing.
• 23:31
  SPEAKER_00: Near the end of a session, ask your client, what is one thing that stands out from today's conversation?
• 23:38
  SPEAKER_00: A task can be suggested based on the client's response.
• 23:42
  SPEAKER_00: If a client says that he was surprised how much he had missed painting,
• 23:46
  SPEAKER_00: that is,
• 23:47
  SPEAKER_00: if you inquired about what he cares about in the informational level,
• 23:51
  SPEAKER_00: you might suggest for him to park aside one evening before the next session,
• 23:56
  SPEAKER_00: to put aside his phone,
• 23:57
  SPEAKER_00: refrain from Netflix,
• 23:59
  SPEAKER_00: and set up his painting equipment.
• 24:03
  SPEAKER_00: Therapy homework can be potent,
• 24:05
  SPEAKER_00: which stretches beyond the therapy hour,
• 24:08
  SPEAKER_00: but only if it's imbued with meaning for the client.
• 24:13
  SPEAKER_00: 2.
• 24:14
  SPEAKER_00: Know the direction.
• 24:16
  SPEAKER_00: At any given point in time in your work with a client, be clear on these three things.
• 24:23
  SPEAKER_00: Where are we?
• 24:25
  SPEAKER_00: Where are we going?
• 24:26
  SPEAKER_00: And why?
• 24:29
  SPEAKER_00: This not only provides a sense of structure, but also a sense of directionality.
• 24:34
  SPEAKER_00: When north is clear, clients are more mobilized and willing to walk the hard mile.
• 24:41
  SPEAKER_00: 3.
• 24:42
  SPEAKER_00: Experiments with truth.
• 24:45
  SPEAKER_00: Sometimes a client might not be at a stage to take action simply because they
• 24:50
  SPEAKER_00: aren't clear on where to go just yet.
• 24:54
  SPEAKER_00: In such instances, the goal is to figure out the goal.
• 24:59
  SPEAKER_00: Instead of going on an exploit mode,
• 25:03
  SPEAKER_00: that is focusing on using existing knowledge and direction to maximize benefits,
• 25:08
  SPEAKER_00: take an explore mode,
• 25:11
  SPEAKER_00: which is focus on discovering new options and possibilities.
• 25:17
  SPEAKER_00: Be unwedded to results at this stage.
• 25:20
  SPEAKER_00: The aim is to try things out.
• 25:23
  SPEAKER_00: For example, a client might not have a clue on what career to pursue.
• 25:27
  SPEAKER_00: Provide a framework to your client to aid their exploration.
• 25:32
  SPEAKER_00: Personally,
• 25:33
  SPEAKER_00: I might draw up this event diagram,
• 25:35
  SPEAKER_00: true,
• 25:36
  SPEAKER_00: useful,
• 25:36
  SPEAKER_00: beautiful,
• 25:38
  SPEAKER_00: and I would ask clients to initially see where they find a natural gravity towards
• 25:43
  SPEAKER_00: and then explore possible jobs in that realm.
• 25:48
  SPEAKER_00: In the true,
• 25:49
  SPEAKER_00: useful and beautiful Venn diagram,
• 25:52
  SPEAKER_00: true stands for someone who values truth would be inclined towards domains related
• 25:58
  SPEAKER_00: to justice,
• 25:59
  SPEAKER_00: philosophy,
• 26:00
  SPEAKER_00: science,
• 26:01
  SPEAKER_00: and the pursuit of what accurately represents the world and the way it ought to be.
• 26:07
  SPEAKER_00: Think of lawyers, social activists, journalists, research scientists, et cetera.
• 26:14
  SPEAKER_00: Useful.
• 26:15
  SPEAKER_00: Someone who values youthfulness will gravitate towards work that helps others,
• 26:20
  SPEAKER_00: adds value,
• 26:21
  SPEAKER_00: and makes the world a better place.
• 26:24
  SPEAKER_00: Think of social workers, nurses, doctors, people in the helping profession, etc.
• 26:30
  SPEAKER_00: Beautiful.
• 26:32
  SPEAKER_00: Someone who values beauty,
• 26:34
  SPEAKER_00: who is moved by aesthetics and wants to create and bring that experience to others.
• 26:40
  SPEAKER_00: Think of artists, musicians, designers, and architect.
• 26:45
  SPEAKER_00: And naturally,
• 26:45
  SPEAKER_00: some of these can overlap as well,
• 26:48
  SPEAKER_00: depending on what particular slant or domain a person is in.
• 26:54
  SPEAKER_00: Misalignment Now that we have covered all the five levels of conversation,
• 26:59
  SPEAKER_00: it is worth stressing that when we are speaking at different levels,
• 27:04
  SPEAKER_00: there is likely to be a disconnection between both parties.
• 27:09
  SPEAKER_00: A client who is wanting to take action,
• 27:11
  SPEAKER_00: activational level,
• 27:12
  SPEAKER_00: but because of your psychodynamic neo-Freudian orientation,
• 27:17
  SPEAKER_00: you think it would make sense to dig deeper into the past,
• 27:21
  SPEAKER_00: which is more on an informational and emotional level,
• 27:25
  SPEAKER_00: you might experience a lion's rupture.
• 27:28
  SPEAKER_00: A client who is wanting to talk about stuff that is difficult to bring up,
• 27:32
  SPEAKER_00: that is at a confessional level,
• 27:34
  SPEAKER_00: but because you are anxious about where this is going,
• 27:37
  SPEAKER_00: your attempt to get clients talking about SMART goals,
• 27:41
  SPEAKER_00: plus the evidence says that it's good to do so,
• 27:44
  SPEAKER_00: you might inadvertently make the client feel invalidated.
• 27:49
  SPEAKER_00: Misalignments are risk factors for premature dropouts.
• 27:54
  SPEAKER_00: Remember, it's not what happens.
• 27:57
  SPEAKER_00: It's what we do with what happens.
• 28:00
  SPEAKER_00: Every therapeutic conversation moves to different levels as immersion possibilities arises.
• 28:07
  SPEAKER_00: Every chance of realignment and repair is a chance to not only be on the same page,
• 28:13
  SPEAKER_00: but also to truly be with each other in a deep way.
• 28:19
  SPEAKER_00: Our clients yearn for a deeper connection.
• 28:23
  SPEAKER_00: It is on us to create the appropriate climate for that to happen so as to touch, move and inspire them.
• 28:35
  SPEAKER_00: Thanks for listening to Frontiers Radio based on Frontiers of Psychotherapist Development.
• 28:41
  SPEAKER_00: You can also read this in Substack and the link is darylchow.substack.com.