What is My Therapist Thinking?

Therapist Thoughts

Do you ever wonder what your therapist is thinking? What is behind that note pad, pen, and concerned look? There is a lot more than processing, analyzing, and theory application that goes on in a therapist’s mind during a session! After reading “If I was your Therapist” (http://loveandlifetoolbox.com/if-i-was-your-therapist/) by Lisa Brookes Kift, LMFT, I decided to add a few more to the list to share just what goes on in the minds of therapists!

We are often humbled …

We are always very humbled by the practices of the families we see. Many families or parents come in thinking there are doing a terrible job, or that their family is so dysfunctional, but that is certainly not the case, or the whole story. We see many families that, despite some of their challenges, do or practice some amazing things. No matter who is sitting in the office, there is always one positive thing we learn from them, that we try to practice more of ourselves.

We are emotionally touched…

Many people come in to therapy thinking that their therapist is annoyed by their thoughts or that the therapist is bored, but this is quite the misconception. As therapist, we are truly touched by your stories, and so much so that we are often left feeling a bit emotional. We hold back tears, we form sincere smiles, and we feel real pain.

We are rooting for you all the time…

We don’t just think of you in our allotted time in session; we think about you outside of the session as well. Our hopes and concerns travel outside the 50-minute session and into our weeks, as we are rooting for you all the time. And when successes are made, we are ecstatic. Even if it is just a small realization that was had, we are ready to throw up confetti and start dancing, because your progress is always on our mind!

We know your care…

No matter how many damaging things you tell us about yourself or how broken you may feel, we know that deep down inside you are a good person, with the best of intentions, and you care. Despite feelings of inadequacy or immorality, we see you just as you are: human. We know you care, and that is enough for us.

We appreciate your dedication…

Therapy is work, and it is a team effort. The best progress made is when both parties are actively working towards goals, and we notice when our clients are working hard outside of session.

We do not think your stories are weird, and you are not broken…

Therapists are the first people to understand that there is no such thing as normal, and no one is perfect. There is never a point in session where we are shocked or surprised at what we hear. We are all human, and everyone has challenges in life to face. We do, however, feel compassion, understanding, and empathy in what we hear, and that is the truth!

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Vanessa Lemmingnessaer M.A., LMFT 53937
Marital and Family Therapist

© Vanessa Lemminger, M.A. Marriage and Family Therapist LMFT53937, 2015. Unauthorized use and/or duplication of this material without express and written permission from this author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Vanessa Lemminger, Marriage and Family Therapist LMFT53937 with appropriate and specific direction to the original content.

This blog (https://vanessalemminger.wordpress.com/) is for informational and educational purposes only. No therapist-client relationship arises. The information provided and any comments or opinions expressed are intended for general discussion and education only, even when based on a hypothetical. They should not be relied upon for ultimate decision-making in any specific case. There is no substitute for consultation with a qualified mental health specialist, or even a physician, who could best evaluate and advice based on a careful, considered evaluation of all pertinent facts. Likewise, it is understood that no guarantee or warranty arises from the information provided or discussed on this (https://vanessalemminger.wordpress.com/) blog.

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Some Bunny to Talk to: A Story About Going to Therapy

Check out this fantastic book resource for kids in therapy! Some Bunny to Talk to: A Story About Going Screen Shot 2015-02-25 at 1.38.04 PMto Therapy by Cheryl Sterling, Paola Conte, and Larissa Labay (Illustrated by Tiphanie Beeke) provides for a gentle and easy to understand introduction to therapy. Filled with colorful illustrations, the book covers feelings of worry, sadness, anxiety, while also explaining who a therapist is, what they do, and how they can help. Some Bunny to Talk to does a great job showing how therapy can be a positive and helpful experience. In addition, the book has a section at the end that provides notes to parents and caregivers on how to pave the way for a positive therapy experience. The book can be found at your local library, or it is also available on Amazon.com here: http://www.amazon.com/Some-Bunny-To-Talk-Therapy/dp/1433816504

Bunny Collage

Expectations for Therapy

Expectations for Therapy

            Coming to therapy can often be intimidating.  The treatment you receive from a therapist is much different than going to an appointment at your family doctor or the dentist, but the treatment is just as important.  To get the best out of your experience, it is helpful to know what to expect from your therapist, and what not to expect as well.

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What you can expect:

Informed consent. The first thing your therapist should do is provide an informed consent form to review and sign.  This form details your participation in therapy, and covers areas such as confidentiality, reporting laws, and your fee agreement.  If you are not asked to sign an informed consent form, this should be a red-flag.

Review of confidentiality.  Every therapist should review the limits of confidentiality, and how it applies to you specifically.  There are different laws and ethical guidelines surrounding confidentiality that differ depending on whether the client is a child under the age of 12, a child 12 years of age or older, an adult, a couple, or a parent.  It is important to know how confidentiality works, and what the legal exceptions are.  If your therapist has not reviewed this with you, ask him/her to right away.

Clear understanding of fees and scheduling. The therapist should review and confirm with you their fees and scheduling policies.  It should be clear exactly what you are paying, how long the sessions last, the policy for going over the designated session time, and any cancellation or rescheduling policy.  It should also be clear as to what methods of payment are accepted, and if you are able to use your insurance.  Often times this information is listed in the informed consent form, but if you have any questions or are not clear on everything, do not hesitate to ask your therapist for more information.

Right to end treatment.  You should never feel forced to go to therapy or that you have to complete a certain number of sessions.  A therapist will certainly recommended a desired number of sessions that would be necessary to complete your specific treatment goals, but you are never obligated to, nor should be forced to complete a set number of sessions.  Each and every session is voluntary and you should never feel pressured to continue treatment if you are not comfortable.  The only exception to this is with court-mandated treatment or treatment of a minor.

Setting goals.  It is important to set goals at the beginning of therapy, and define what it is you want to work on.  Depending on the therapist’s theoretical orientation, goals may be more specific or more general.  If you have a preference as to how you would prefer to set goals and how you want your therapy experience to feel (more concrete and structured, versus more abstract and introspective), ask your therapist what his/her theoretical orientation is, and how that affects his work as a therapist.  Some therapists are more involved and work more as an agent of change, while other therapists take a more collaborative role, working side by side with the client.  This is also dictated by the therapist’s theoretical orientation.  Find out what type of therapist and theoretical approach you are more comfortable with or that matches your style.  Often therapists work from several theoretical approaches and have a more eclectic style.  Let your therapist know what works well for you, and they can use the theoretical approach that fits best with your style.

Support.  In the therapy room you can expect to find support through the challenges you are experiencing.  Coming to therapy can help reduce feelings of isolation.   Therapy goals almost always include increasing support systems as well, as it is important that the client receives support as they work through the challenges they face.

Empathy.  Therapy is also a place where you can expect to receive empathy.  Everyone experiences challenges and seeking help does not make you weak or damaged.  Therapy provides a non-judgmental space to address your challenges, while also providing feelings of validation and understanding through the process.

Expect to work.  Part of the therapeutic process involves making changes, and to do so requires work from both you and the therapist.  Reaching your goals is going to require you to make changes, put plans into action, and require you to step outside your comfort zone.  Some therapists, depending on their theoretical orientation, will also assign homework in addition to what is worked on in therapy.  This homework works in conjunction with what is done in session.

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What NOT to expect from therapy:

Answers. Unless your therapist takes a very direct and authoritarian-type position, you should not expect to get “answers” to your problems in therapy.  Your therapist is not going to tell you whether you should stay with your partner or separate, nor whether you should quit your job or not.  Therapy is a process that results in personal growth, something a Magic 8 Ball cannot do.

Quick fix. Therapy is not a quick fix either.   One or two “power sessions” are not going to work out your marriage conflict.  The minimum amount of sessions to expect for almost any goal is at least 4, and longer for more complex relationship concerns.  If you are not quite ready to make a commitment, consider attending a workshop.  Many therapists offer a wide variety of one- or two-day workshops that address a variety of different themes: communication, intimacy, confidence, etc.

Tips and tricks.  Often parents come to therapy looking for tips and tricks to fix their “problem child”, and they are often disappointed.  The “problem child’s” behavior is almost always the result of the entire family’s dysfunction.  A more realistic expectation for parenting concerns or behavior management in therapy would be developing positive parenting strategies and reducing family conflict.

Change your partner. Therapy is not a place to find an ally to take your side during arguments with your partner, nor is it a place to “change your partner.”   Coming to therapy will not “fix” your partner or make them “see it your way.”   A more realistic expectation for therapy would be to learn how to appropriately mediate arguments, improve communication, and clarify expectations for your relationship.

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Having a clear understanding of what therapy entails, what to expect from therapy, and what is not likely to happen in therapy, will make scheduling an appointment much less distressing.  Therapy is a place to feel relief from stress, experience empathy, and find support.  Having a clear understanding of the therapy process will help maximize those feelings and move you close towards your goals.

   nessa

    Vanessa Lemminger M.A., LMFT 53937
Marital and Family Therapist

 

© Vanessa Lemminger, M.A. Marriage and Family Therapist 53937, 2013. Unauthorized use and/or duplication of this material without express and written permission from this author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Vanessa Lemminger, Marriage and Family Therapist 53937 with appropriate and specific direction to the original content.

How to Make the Most of a Social Outing

How to Make the Most of a Social Outing

A child’s learning does not just stop at school or the therapy session.  Providing opportunities for your child to learn and practice their social skills is a great strategy for continued learning.  Setting up a play-date or social outing for your child is a great start, but there is more you can do to help facilitate appropriate social interaction and social skills while allowing the natural peer interaction to take place.

Children age 2-6

For parents with younger children, it is important to take time and observe the children’s play.  Children at this age can have unique styles of play, and do not always use logical play.  Instead of immediately joining the children in play, spend time observing first.  Watch how the rules of the play are established, and what the object or goal of the play is.  Study how they transition between play, and what themes they frequent (Do they always play some version of house, or do they lean more towards adventures?) Once you’ve taken some time to understand their style of play, join in, but let the kids take the lead.  Asking questions is a great way to engage more conversation in play while still leaving the control to the kids.  As an example:

Three kids are pretending to cook in the sand box, and you join.  Questions you can ask: “Can I play?” “Who can I pretend to be?” “What are you making?” “What should I make?” “Who is going to eat the food?” “Where should we take the food?” What do we cook next?”

Another great technique to naturally model appropriate social play is to think out loud.  Narrate everything you are doing while playing.

“Hmm… I want to dig a tunnel, but I need the blue shovel and Jared has the blue shovel.  Maybe I could ask him to take a turn with it.  Jared, can I take a turn with the blue shovel?”

“Oh no! I want to play on the swings, but everyone is playing in the sand.  I really wish I had someone to swing with.  Maybe I could ask someone to come play with me! Caleb, do you want to play on the swings with me?”

Remember, when working with kids, less is more.  The goal is to create natural social interaction, and it’s important not to over-pathologize your child’s behavior.  Children do not always say “thank you” after every single toy exchange, and do not compliment their peers on everything they do.  It is also typical for children at this age to play alone or have moments of parallel play (children playing adjacent to each other).  Don’t feel like you need to be maintaining constant dialog.  When the environment is relaxed a child will feel more comfortable going beyond their typical boundaries.

 Children age 7-12

Parents with middle-aged children should focus on building self-esteem and competency during social outings.  This is the age where children develop of sense of self, which makes modeling appropriate social behavior important. A great way to do this is to be overly socially appropriate yourself.  For most, social skills come naturally so we do not even realize the different social behaviors we are exhibiting.  As a parent modeling appropriate social behavior, the goal is to expand these interactions and amplify them.  To provide an example:

Two individuals, John and Gary are at a bowling alley.  John sees Gary pick up his ball and start walking towards the lane.  This triggers John to think, “Oh, it must be Gary’s turn.”  John then glances up at the screen to confirm his thought that it was, in fact, Gary’s turn.  After Gary sends his last ball down the lane, he casually tosses a hand up, which John meets with his own.  Without checking the screen, John walks up to the lane for his turn.

A child with ASD may not see all these subtle social interactions that take place, and deciphering when it is okay to approach the lane, who’s turn it is, or what to say to a friend may not be so obvious.  This short interaction can be amplified and expanded by being curious, asking questions, and making observations.  For example, to prompt a child to look at whose turn it is or stay focused on a game, a parent could ask the child, “Whose turn is it? Do you know whose turn it is, Molly?” A child at this age will be more receptive to the former approach versus, “Molly, it is your turn.  Make sure to pay attention to the game.”  Using observational statements also helps narrate some of these interactional patterns.  A parent could say, “Wow, Molly! Sarah hit 2 pins on her first try, and 6 pins on her second try.  She did a great job. I’m going to give her a high-five!”  Expanding your language beyond “Good job!”, “Great work!”, and “Nice try!” is also helpful.  Try to compliment and appreciate a child’s specific behavior and achievements.  Some example of this phrasing include:

“Andrew, you put your lunch box away by yourself!”

“When you put toys away, that helps Ms. Smith.  She appreciates your help!”

“Carissa, thank you for giving Ella an extra turn.  That was showing great sportsman ship!”

Children at this age also like to have a sense of control and independence.  It’s important for all parents to establish boundaries, but allowing your child to choose some of the rules and boundaries for play will give them a sense of control and create a less restriction environment.   When feeling in control and relaxed, a child will feel more comfortable opening up and exercising their social skills.  Giving children some control of their environment and boundaries will also lead to less resistance or less focus on the “rules”, which will allow the child to be more productive during their social play.  Language and approach makes all the difference when talking to children.  For example, which of the following phrases sounds [approachable?]:

“Well, we could play [game X] or we could also play [game Y].  What do you both want to do?”

“Well, that is not an option.  You can pick [A] or [B].  Which one?”

The words “could”, “also”, and “want” provide a softer approach that appears to be giving all the choice to the child, when in fact you as the parent set the parameters.

Teens 13-18

Working on appropriate social skills with teens during play-dates or outings can be tricky.  First off, it is probably best if you refrain from using the word “play-date” with your teen.  Instead, use “hanging out”.  All teens have an increased self-awareness and are very sensitive to being embarrassed.  Working with your teen is all about being natural and playing it cool.  No teen is going to want their mom or dad lurching around them while their hanging out with their friends, and especially not if they are going to point out things they are doing wrong.  The first key to working with your teen in social situations is to blend in.   As much as you despise that video game with exploding zombie heads, act like you love it! Maybe they are playing a game that makes absolutely no sense at all to you: act excited to learn how to play! Every teen has liked something absolutely silly at that age, but if you are not receptive to their interests, they are not going to be receptive to yours (working on the social skills).  Try your best at refraining from saying as many “Eww!”s or “What?!”s as possible (if you are really brave, try using some “Cool!”s and “Awesome!”s), and instead ask questions about the game or activity they’re playing.  You can ask what the rules are, how to play, what happens if someone does X or does Y, and the object of the game.  Remember to ask in an excited voice and not with a concerned tone. This will not only clue you in on the parameters of their play, but also show that you are interested in their world.  Once you have established this common ground, you can start modeling appropriate social interactions.

When modeling social skills with your teen, it’s important not to draw attention to him/her or single them/their behavior out.  You can still provide correct social responses without having to point out the error.

As an example: Your son/daughter walks in the kitchen, with his friend following behind.  Your son/daughter grabs a soda from the fridge, shuts the door, and starts to leave without offering his friend one. Don’t: “Benny, you need to ask your friend if he wants a soda too. That was rude.” DO: “Chris, would you like a soda as well? If Johnny is thirsty, I’m sure you are too!”

The correct response here allows you to demonstrate to your teen that if he is thirsty, others may feel the same as well.  It provides an example on how to be polite, without making the child feel like he is being scolded in front of his friend.  You can also redirect the focus from your teen by focusing instead on the emotion present.  As an example:

You and your teen are at the beach with a friend and his/her teen.  Your teen skips up to you, unknowingly knocking over their friends sand creation in the process.  DO: “Chris (the friend), you look upset because your castle got knocked over.  You were working hard on that, and I can tell you are upset. Maybe we can help you rebuild it!”

In this example, the emotional context is still being addressed, an appropriate action is still being offered, but there is no blame or focus on someone’s mishap.  Using “we” when offering to help rebuild the castle also allows for another opportunity to work as a team together, and shifts the focus from a blame (“you need to fix his castle”) to working together on the solution.

Lastly, parents can practice their social skills at home.  Practicing with partners or relatives can be very effective modeling.  They are many instances when adults use very subtle cues to express what they are feeling, that may be missed by a teen with ASD.  Compare these examples:

Example 1:

Mom: “Dan, we are almost out of milk, eggs, and we don’t have anything for lunches this week.” Dad/Dan shrugs his shoulders.  Mom: “Well, Dan, I got the groceries last time, and the time before that”.  Mom then stares at Dan/Dad with her hands on her hip and a scornful look on her face.  Dad/Dan is silent for a moment.  Dad/Dan: “I’ll go tonight …” with a huff.   

Example 2:

Mom: “Dan, I’m feeling frustrated that I have to get groceries every time, and I think it would be fair if we took turns and shared the responsibility.” Dan/Dad: “I’m sorry that you’re frustrated and I apologize for not helping out more.  We should be taking turns and sharing the responsibility.  I will go get groceries tonight since you got them the last few times.”

Example 1 uses a lot of emotional cues, body signals, and gestures that may not picked up, where as Example 2 provides a narrative that better describes what each partner is feeling and what the appropriate social rules are.  Of course this change in language is hard to do all the time, and that is not expected.  But recognizing the more subtle emotional language used, and taking time to expand it to provide more clarification can provide great modeling examples for your teen when at home or with family.

Final Note:

On a final note, if you need more help knowing what to do, reach out to your child’s therapist, or behavioral interventionist.  What techniques do they use? What patterns have they seen? What are they currently working on in regards to social skills.  You can even ask to shadow a session.  Working on the same goals and using the same approach will help create consistency, which helps both your child and the therapist or interventionist working with them!

Vanessa (16)

    Vanessa Lemminger M.A. LMFT 53937
Marital and Family Therapist


    


© Vanessa Lemminger, M.A. Marriage and Family Therapist 53937, 2013. Unauthorized use and/or duplication of this material without express and written permission from this author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Vanessa Lemminger, Marriage and Family Therapist 53937 with appropriate and specific direction to the original content.