imageOther people wrote my blog for the past five months. I suppose it's time I got back to work.

They didn't write everything, but the 14 interviewees for the Seven Questions Project did the heavy lifting. These influential figures in policy, theory and popular psychology donated their time to help clarify theoretical and personal differences between therapeutic approaches. I'm honored to spread their wisdom to clients and therapists alike.

The interview format was a self-imposed change for me. I invited them, researched biographies, wrote intros and included links, but that means thinking like a journalist, not a therapist. I've been interviewing for so long I need to ease back into my role as a psychologist writing a users guide for psychotherapy. I'll start by answering the questions I've been asking.

I'll keep my own intro brief: here's my bio, here's my book (now in Danish!), here's my website. My therapeutic orientation is a psychodynamic amalgam, but I stubbornly resist the label eclectic (the term should indicate expertise with several theories, but too often means: "I didn't study any theory in depth"). My views on psychotherapy are influenced by Freud, Heinz Kohut, Irvin Yalom, Murray Bowen, Althea Horner and Stephen A. Mitchell. Essentially, when I work with clients I'm thinking about the significance of the early environment, the development of the self and the power of the therapeutic relationship. Without further ado, here are my responses to the seven questions:

Seven Questions for Ryan Howes:

1. How would you respond to a new client who asks: "What should I talk about?"

"I could probably think of topics for you to discuss, and I will if you insist, but I'm afraid doing so would make today about my interests instead of yours. If you're having a hard time knowing what you'd like to address in today's session, maybe we can sit a minute while you collect your thoughts. When something comes to mind, let's talk about it."

That's how I'd like to respond, but I'd probably say: "Anything you want!"

2. What do clients find most difficult about the therapeutic process?

This question addresses the central issue of my blog. I think therapy poses several problems for clients.

Therapy doesn't work like other relationships. It's a strange association that looks frustratingly similar to others, but isn't a complete match. The standard rules of etiquette and friendship don't necessarily apply, but warmth and empathy are central elements. There are strict boundaries where some things are concerned (sex, time, money, confidentiality, roles), but unlimited personal disclosure is encouraged. Therapists say healing comes through the relationship, but clients may never know if their therapist is married, when her birthday is or what kind of car she drives. And many clients never learn why therapy is structured this way.

Complicating matters further, therapy varies from therapist to therapist, leaving clients with questions like: Does she give homework or not? Will our work focus on thoughts, behaviors or emotions? Will he provide advice, coaching, emotional support or some combination? Is the therapist going to "fire" me if I don't progress fast enough? Why does she answer questions with questions? Why can't this work more like a visit to my physician? When does therapy end?

Therapy is called the talking cure because clients get relief and insight through verbal communication. It's frustrating that many therapists don't take the time to clearly verbalize the roles, rules, boundaries, processes and limitations of their work. Time and money are wasted because clients simply aren't taught how therapy functions.

3. What mistakes do therapists make that hinder the therapeutic process?

Therapists need to be aware of their countertransference; how their own issues influence their view of their clients. I wish all therapists had a supervisor, a consultation group and/or their own therapy throughout their career. This introspection and feedback is essential for discerning between their issues and those of their clients. For example, many therapists treat issues that hold personal significance, which can help them truly empathize with their clients; but they also run the risk of becoming personally involved and losing objectivity. Others may have difficulty looking beyond particular symptoms and diagnoses to see the person. And some may simply feel burned out. Therapists in isolation might not even be aware they're in danger. Consultation can help with this.

4. In your opinion, what is the ultimate goal of therapy?

Of course, the goal is treating the problems my clients present. But in a broader sense, I see therapy as two people collaborating to help the client gain a greater understanding of self, increased self-efficacy, higher capacity for intimacy and acceptance of limitations.

5. What is the toughest part of being a therapist?

Triangulation. I'm cool with most issues that arise between me and the client, but dysfunctional triangles present an extra challenge. I'm talking about any entity outside the room that has negative power or influence over us. Examples might include insurance companies who limit or restrict our sessions, outsiders who undermine our work or issues in either of our lives that draw away our focus. Global recession, swine flu, natural disasters and unexpected traffic jams also qualify. Of course, it's important to learn to adjust and cope with these inevitable intrusions, which can lead to great work in therapy. But when it comes to the toughest part of this work, I find direct communication empowering and triangles draining.

6. What is the most enjoyable or rewarding part of being a therapist?

When a client tells me: "I've never told anyone this before, but...." The statement means we've built trust, created a sacred space and we're about to have a therapeutic breakthrough. Equally powerful is the statement: "I just realized something..." because it means insight is coming. I enjoy any time I see positive change happening. Like the compliant, conflict-avoidant client who suddenly feels safe enough to confront me. Or the emotionally detached client who lets his anger or sadness show. Or when our hunch about something proves true or leads to a deeper insight. The time and effort is validated any time our collaboration creates a lasting change.

7. What is one pearl of wisdom you would offer clients about therapy?

Take risks. Say honest things to your therapist you'd never say in the outside world. Have a sudden flashback memory? Say it. Feel an urge to run, kick, laugh or scream? Say it. Don't want to be here today? Say it. Have a question about the therapist or therapy? Ask it. Afraid that your thoughts are too heavy, too "crazy" or demand too much from the therapist? Say it anyway, these thoughts can help us understand you on a deep level. Therapy is the one place you can come and let the odd thoughts out. Take advantage of it.

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