Therapy Basics

The Art and Science of Psychotherapy

There are many schools of psychotherapy and, most of us have some preconceived ideas about therapy and how it should work. We have prepared this page to give you a better understanding of the type of therapy we provide and what you might expect as a prospective client working with us.

The Therapist

“The Therapist” by Rene Magritte (1937)

Basic Ingredients

Therapy is about CHANGE. Therapy is about solving problems to make your life better. Change is not always easy and the initial catalyst for change is often unwelcome. Some people want to change because they are passionately committed to excelling at whatever they do, whether it’s athletics, work, relationships, health or the enjoyment of life. More often, unfortunately, it is pain that motivates us to change. We seek therapy when we are unhappy about something that we cannot solve by ourselves. Often, wives, employers, parents or physicians are the ones who “encourage” us to get professional help. Usually, when children and adolescents have problems, the parents are more motivated to seek change than the children. Similarly, when couples have problems, one spouse is usually more motivated to seek therapy than the other. While it is best if both parties come in to address marital problems, we routinely urge one party to come in alone, if their partner is initially unwilling. One motivated and determined person can be a powerful catalyst for change; and, the resistant partner usually becomes more curious/interested as the first partner starts changing. Most of our patients express regret that they did not come sooner.

It is often difficult to decide what treatment is best for your specific problems and who is best qualified to provide that treatment. Should you seek treatment from a Clinical Psychologist (PhD or PsyD), a Clinical Social Worker (LCSW), or a Professional Counselor (LPC), all of whom are licensed to provide a wide range of “talk therapies”. Or, do you need the services of a Psychiatrist (MD), who is likely to rely on medication as the primary treatment modality. Our bias is to start with a therapist who is trained in Cognitive Behavior Therapy (CBT), because research has shown CBT to be both efficient and effective. After an initial evaluation, we may refer you to a physician for medications, to supplement your therapy with us. However, if your condition is severe and urgent (severe depression, homicidal or suicidal ideation, hallucinations, uncontrollable rage, etc.), we recommend you seek assistance at the closest hospital emergency room or from a psychiatrist.

In searching for the right therapist you need to find someone you believe can help you and someone you trust. A good therapist isn’t always going to say things you like to hear, but you need to believe your therapist is someone who is knowledgeable, understands you, genuinely cares about you and provides you with the kinds of information, guidance and feedback that makes sense and produces results. Within the first 3-5 sessions, you should know if you can work with your therapist and you should have confidence in his or her ability to help you realize positive results. If you don’t, you should discuss this with your therapist and consider switching if things do not change. Sometimes it is simply not a good match.

We have seen patients who were previously in treatment for years, without significant improvement. Some eventually gave up. Others made a switch, but were frustrated after hoping for too many months that some sudden insight would magically produce change. Some had chronic conditions and were unable to change. Others were (1) too comfortable with their therapist, content to have someone to talk to, (2) reluctant to do the hard work of self-examination and change, or (3) believed others were the cause of their problems and were waiting for them to change first. There are many different reasons why change may not occur, having to do with the therapist, treatment methods or the patient. The main point here is that rarely does a patient continue for months without progress and then suddenly improve. If progress is going to occur, it is usually evident throughout the therapy process. Slow, steady progress is just fine. Change is difficult and requires the best that a therapist and patient can give, but good results make the effort worthwhile.

As Magrite portrays in the painting above, therapists offer clients the opportunity to escape their own personal cages.

The Beginning

“The Beginning” by Cecilia Betancourt

Psychotherapy, like good medical care, is both art and science. It is a collaborative effort between therapist and patient. We believe everyone needs a flexible PLAN to guide them toward their goals. In therapy, we help clients clarify what their primary problems are and what specific results they want to achieve. Then, we identify specific action steps that will enable them to reach their goals.

We all want many of the same things in life: health, loving relationships, confidence, peace of mind, financial security, success, happiness, etc. How successful we are in reaching our goals depends upon having the necessary (1) will or motivation, (2) the knowledge or skills and (3) a well-conceived action plan. A good therapist is much like a good coach; you can expect him or her to inspire and motivate you, while giving you the necessary tools. Your job is to do the necessary work to implement your plan, and to persevere despite expected obstacles. The results you seek are generally possible and worthwhile, but they will not occur overnight or without sustained effort.

While many patients are able to achieve their goals without medication, and it is better to minimize the use of medications whenever possible, research has shown that a combination of medication and cognitive behavior therapy produces the best treatment results for many conditions, such as ADHD, Major Depression, Panic Disorder, Bipolar Disorder, OCD, etc. We work closely with a number of primary care physicians and psychiatrists who can provide medication management, if this is needed to supplement your therapy with us.

Diving In

“Diving In” fired stoneware by William Mulligan

Multimodal – Cognitive Behavior Therapy

Dr. Mulligan trained extensively with Dr. Arnold Lazarus, the founder of Multimodal Therapy. This approach is a comprehensive form of Cognitive Behavior Therapy and can be described as generally:

  • Shorter-term (takes 16 sessions on average). Consider the fact that we treat all types of problems. Some clients, who should be seen for a much longer period of time, drop out after 1 or 2 sessions; while others continue therapy for well over a year. The number of sessions a client is seen depends on many factors, primarily the client’s goals and motivation, along with the severity and duration of the presenting problems.
  • Holistic (concerned with the whole person; recognizing the important interactions of biological, psychological and cultural factors),
  • Eclectic (using a variety of treatment methods),
  • Pragmatic (designed to get specific results. We address specific problems in the present, rather than focusing extensively on your childhood)
  • Humanistic (emphasizing conscious awareness and efforts to cope with the real world), and
  • Educational (providing information and teaching clients more effective coping skills).

Traditional forms of therapy (of which there are many) are less structured and usually require more sessions than Cognitive Behavior Therapy. The therapist is less active, doing more listening (reflecting back what you say) and less likely to recommend that you do specific things. A traditional therapist is usually more “non-directive”, leaving it up to the patient to decide what will be addressed in each session. Issues addressed are more vague and general, rather than focusing on specific problems, with a plan to obtain specific, measureable results.

The Seven Primary Modalities

In providing comprehensive treatment, Multimodal Therapists systematically address problems in each of the following modalities:

  • Behavior (progress is usually limited if the patient does not make changes in action)
  • Emotions (anxiety, anger, guilt and depression)
  • Physical Sensations (stress-related, psychosomatic symptoms)
  • Imagery (visual pictures)
  • Thoughts (success at just about anything requires positive, rational thinking)
  • Relationships (social skills, communication and conflict-resolution skills)
  • Health (nutrition, exercise, possible need for medications)
Female Grace

“Female Torso” bronze by William Mulligan

The General Objectives

At a more abstract level, and in keeping with the spirit of the Serenity Prayer, you could say I help clients:

  1. Take constructive action to change those things they can change,
  2. Become more accepting of the things they cannot change, and
  3. Learn how to more skillfully distinguish those things they can change from those they cannot change.

“Duo” by Cecilia Betancourt

Life Transitions

I help clients navigate through predictable and challenging Transitions in Life, such as the following:

  • Childhood (building self-esteem, family relationships and school performance)
  • Adolescence (peers and social skills, independence struggles with parents, self-esteem and identity)
  • Young Adult (transition to greater independence, dating, sex, college and career)
  • Marriage (Mars and Venus themes, communication and conflict-resolution skills, satisfying individual needs while working as a team to manage family life.
  • Separation and Divorce (learning and growing from one of life’s most painful crises, while minimizing hostilities…primarily for the children’s welfare)
  • Mid-Life Crazies (change is unavoidable and can be positive, if problems and issues are addressed directly and responsibly, providing more opportunities to learn and grow)
  • Retirement (have you prepared for your “golden years”, emotionally, physically, financially, spiritually?)
  • Older Age (caring for elderly parents and aging gracefully, as we come to terms with the reality that none of us live forever).

“Attached” by Siri Dehipitiya

A Case Illustration

Mrs. Smith, a 34 year old mother of three children requested therapy, complaining of anxiety and bouts of depression. Once rapport had been established, Mrs. Smith’s vague, global states of dissatisfaction (e.g., fear and unhappiness) were broken down into specific and discrete problems, such as depressed mood; negative thoughts about herself, her husband and her future prospects; inability to communicate or assert herself effectively; self-destructive, addictive behavior (overeating and excessive drinking); headaches and muscular pains; and insufficient exercise, which in turn were addressed with specific interventions that were largely educational in nature, such as the following:

  • Cognitive restructuring and rational-emotive therapy. Mrs. S. was taught how to replace negative, irrational thinking with more positive, realistic thoughts about herself, the significant people in her life, her future prospects and the world in general.
  • Referrals to her physician and a psychiatrist for medical and psychiatric evaluations to rule out any medical basis for her presenting complaints and to determine if medications might be a beneficial treatment for her anxiety; depressed mood and headaches.
  • Assertion training and Communication Skills Training. Like many women in our culture, Mrs. S was very independent and skillfully assertive with others in many situations prior to marriage. However, over a period of years, she gradually became more and more passive (and unhappy) with her husband. Her passivity was also evident in her interactions with her bright and energetic children, who soon learned that mommy rarely backed up her words with action (consequences).
  • Marital therapy for conflict resolution, parenting and sexual complaints.
  • Physical exercise, nutritional counseling and relaxation training (with guided imagery) for physical and stress-related complaints.
  • Referral to a community support group and to other community resources (e.g., a parenting group, couples support group and Weight Watchers) provided specialized help and support from others with similar problems.