The Person Is Not the Problem


“The person is not the problem; the problem is the problem.”

This quote was first used by Michael White and David Epston, the founders of Narrative Therapy, to describe one essential aspect of the narrative approach. It is an attempt to make the client see that he is not identical with his problems in order to recognize the ways in which those problems have dominated and impaired the way the client sees himself.

Coming out of postmodern and social constructionist critiques of human behavior, narrative therapy asserts that each person can choose to be who she wants to be through retelling the story of her life. We all have stories that we have told ourselves and others for our whole lives about who we are and how we got the way that we are. While these stories have aspects of truth, they also leave out aspects of ourselves that don’t fit into the narrative very neatly. When distressed, people tend to focus on their problems and forget to include memories, actions, and values that are positive or contradictory to the “problem narrative.” Narrative therapy attempts to draw out the positive story that has been lost in the client’s self-narrative.

The lynchpin of narrative therapy is the belief that the stories we tell ourselves about our lives have a profound effect on how we feel about ourselves. They organize our sense of ourselves and turn the messy raw material of memories, dreams, and emotions into a coherent and causal biography.

Narrative therapy is a strengths-based approach which helps a client explore his or her strengths and values in collaboration with a therapist. While some therapists believe that simply telling one’s version of a personal problem is a way to take action and make positive change, a good narrative therapist will help the client to objectify problems, frame them within the larger context of cultural expectations and social norms, and invite in other, less prominent personal stories. In this way, the therapist helps the client to write a new script for herself, one that sees the problem and the person in a new and preferred light.

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy, or DBT, is an off-shoot of Cognitive Behavioral Therapy (CBT), with some additional assumptions and techniques to complement cognitive-behavioral interventions. The first difference, obvious from the name of the treatment, is that DBT is based on a dialectic, which means that it attempts to integrate two opposing tensions. In this case, those opposites are the need to accept oneself despite one’s faults and the effort to change oneself and one’s faults.

DBT was first developed by Marsha M. Linehan in the late 1970s when working with patients with Borderline Personality Disorder, but it has since been shown to be effective for many other conditions and complaints, including substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

The technique consists of four particular aspects: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Mindfulness means learning to be aware of oneself and one’s feelings in the present; distress tolerance is learning to tolerate distressing or uncomfortable emotions and situations; interpersonal effectiveness is learning to behave in and experience relationships in a productive and affirming way; and emotional regulation means learning to regulate one’s emotions to avoid the extremes of negative emotional experiences.

Through building each of these skills, the therapist helps the client to accept and validate him or herself while at the same time setting goals for behavioral and emotional change.

For more information on DBT, see the Linehan Institute.

Is mindfulness just a fad, or can it help you live a fuller life?

Mindfulness has become a trendy word recently. It seems like everyone, from business executives to exercise gurus, is using mindfulness as a way to improve performance and reduce stress. But what does it really mean to practice mindfulness, and can it really do what everyone says it can?

History

It may be trendy now, but mindfulness has a very long history. Mindfulness has its roots in ancient Buddhist practices of meditation, used for millennia to cultivate spiritual awareness. It wasn’t until the 1970s that Western thinkers, such as Jon Kabat-Zinn and Marsha Linehan, started realizing the psychological benefits of such practices and bringing them into Western psychology.

Today, mindfulness is an important aspect of several different therapeutic modalities, including Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, and Mindfulness-based Cognitive Therapy. However, many therapists use it on its own as a general practice designed to reduce stress and bring the client into greater self-awareness and present-focus.

What is Mindfulness?

Strictly speaking, mindfulness simply entails taking the time to focus on the present moment. This can be done through meditation practices, but it does not have to include meditation. Many therapists use mindfulness to help clients focus on the feelings, thoughts, and behaviors that they normally don’t recognize, but that have a negative impact on them anyway. Slowing down and paying close attention to one’s actions and reactions is one way of preventing people from getting caught in the same old habits and patterns that unthinkingly keep them from living a successful or fulfilling life.

One of the most important components of mindfulness is non-judgment. A therapist can help a client to learn to observe her emotions without immediately judging herself in a negative way because of them. Learning to find this emotional distance from one’s own habitual self-punishment can be an important way to intervene when a client is spiralling out of control emotionally, experiencing depression or anxiety, or contemplating self-harm.

More generally, learning to be in the present, instead of worrying about the future or ruminating about past mistakes, can help people to appreciate the positive aspects of their lives and move past places where they have become stuck. Such present-focus can be helpful for managing chronic pain, depression, anxiety, addictions, and many other conditions that rely on habitual patterns or seemingly-intolerable sensations.

Do I have to Meditate?

As noted before, meditation is only one of the ways that a person can cultivate mindfulness. Other techniques might include focusing on physical sensations, breathing exercises, or guided imagery. All of these techniques help the client to learn to turn his attention away from the noisy thoughts that often crowd our minds, observing but not getting caught up in the many negative reactions that can increase stress and impede happiness or relaxation.

The Strengths-based Approach to Counseling


A strengths-based approach to counseling has become a common therapeutic tool over the past decade. The model is just what it sounds like: a way to focus on a person’s strengths, rather than on his or her weaknesses, to help facilitate healing. Instead of looking at a client through the eyes of an expert diagnosing a disease, the therapist considers herself a partner in helping the client draw on his or her own resources of character and support to improve his or her situation.

The key to a strengths-based model is in seeking out the strengths one possesses to cope with life problems. No matter how difficult the challenges, each person has character traits, life goals, deep knowledge, and social support networks that he or she can draw on to feel empowered to work through the difficulties that life presents. Therapists will generally begin a strengths-based session by focusing more on what a client wants to achieve in his or her life than on what is going wrong. This shift in perspective allows the therapist to assist the client in seeing him or herself as a capable and valuable person who has much to offer.

In addition, a therapist using a strengths-based approach will consider him or herself a collaborator with the client, working together to find solutions, rather than telling the client how it is. The client uses the therapist as a strong and conscientious support for the client’s own self-improvement. It requires that both therapist and client be active collaborators, working together toward the client’s goal.

Empirical research has begun to show that a positive attitude will result in a healthier outcome. After all, if you believe that your situation is hopeless and that you are broken, you are unlikely to be able to improve your sense of well-being. A therapist using a strengths-based approach will help you to discover what strengths you possess and how to use them to find a sense of hope and optimism in your struggle to live a full life.

Psychoeducational Assessment for Kids

It can be distressing for parents when their kids are having problems at school. Maybe your child is facing difficulty finishing schoolwork or keeping up his or her grades. Maybe your child has problems making friends or feeling socially comfortable. Maybe you’ve noticed something different in your child’s behavior lately — a loss of appetite, irritability, or a tendency to be withdrawn. If these behaviors are interfering with your family life or your child seems unhappy, don’t throw up your hands in despair. By seeking the help of a psychoeducational assessment, you can get to the bottom of what’s happening with your child and help him or her to be successful despite his or her struggles.

There are many possibilities when it comes to behavioral and mood issues. Here at IHC, we have two clinicians, Dr. Britania Latronica and Dr. Ninfa Neuser, who specialize in psychoeducational assessments. Assessments are a series of questionnaires and tests that a clinician can administer to sort out what’s really going on. What might seem like a learning disability could turn out to be a mood disorder like depression or anxiety. What might seem like a behavioral problem could turn out to be a learning disability like AD/HD. Dr. Latronica and Dr.Neuser use standardized questionnaires combined with years of clinical expertise to help differentiate mood disorders from learning disorders, determine if your child faces any neurocognitive problems, and develop a treatment plan to address them.

If you’re concerned about your child’s actions, thoughts, mood, or behavioral changes, don’t hesitate to call IHC Associates at 503-740-1971 and set up an assessment with Dr. Latronica or Dr. Neuser today.

Using Cognitive Behavioral Therapy to Improve Mood

What is cognitive behavioral therapy?

cognitive behavioral therapy

Cognitive Behavioral Therapy, or CBT, is a therapeutic technique used to combat depression, anxiety, and many other conditions. CBT practitioners believe that our emotions, thoughts and behaviors all affect each other in both a positive and a negative way. This means that if you have negative thoughts about yourself, it could cause you to have negative behaviors, and ultimately to feel bad about yourself or your life. This is why thinking positive thoughts, or doing things that feel good, can help to ease depression and other negative feelings.

Is CBT effective?

CBT has been in wide use for over thirty years, and thus far the evidence strongly suggests that it can be as effective as medication, often more so, in helping people to break destructive habits, depressive or anxious thinking, and difficult or unwanted behaviors.

What does a typical CBT session look like?

CBT is goal-oriented and focused on your present predicament, not on an analysis of your childhood. In a typical CBT session, your therapist will ask you to identify the negative thoughts that accompany unwanted behaviors. CBT therapists often assign homework, asking you to keep track of feelings, thoughts, and behaviors by using a checklist or a daily journal entry. This kind of self-tracking can help you to become aware of thoughts and feelings that you usually take for granted and don’t really notice. Once aware of these scripts in your head, you can then work on countering the negative narrative you have been telling yourself, and thus change the destructive behaviors that thwart your ability to live a happy life.

CBT at IHC Associates

Because Cognitive Behavioral Therapy is the latest and most effective intervention psychologists have yet developed, all of our practitioners are trained in and make use of the methods of CBT. For more in-depth information about CBT, see the following resources:

  • National Association of Cognitive Behavioral Therapists
  • Beck Institute
  • PsychCentral
  • IHC Adds New Clinicians

    IHC Associates would like to welcome many new clinicians to our practice! Britania Latronica, Ph.D will be joining us at the Parkrose Clinic, while Theodore Askwith, Psy.D will be serving patients at the Cherry Park clinic. In addition, Claudia James, LCSW will start soon at the Gresham Troutdale Clinic, and Gillian Scott, LCSW at our Creekside location. Welcome to all our new clinicians!

    Help for Insomnia

    IHC Associates and Dr. Rocky Garrison are offering a new class:

    Promoting Good Sleep: Applying the Science of Sleep

    IHC provider Rocky Garrison, PhD, will teach this ongoing three-session class, using the science of sleep to help participants cope with insomnia and other sleep problems.

    Each session of this class includes:

  • A relaxation/imagery experience
  • Education on one or more of the factors influencing sleep
  • Self-assessment and monitoring of progress
  • Setting and review of individualized goals related to healthy sleep practices
  • This class meets every other week and new members can begin at any session and then continue through the remaining sessions. The classes are billed to the patient’s insurance: there may be a copayment for each session, and a sliding scale fee is also available.

    To join this class, call IHC Associates at 503-740-1971and ask for an initial assessment for the science of sleep class with Dr.Garrison.

    Compassion Fatigue Lecture

    This month the Cedar Hills Continuing Education Series features our own Jennie Sullivan Vernier, LCSW, discussing compassion fatigue.

    This lecture will focus on all the ways that healthcare professionals can improve personal well-being and professional satisfaction while at the same time becoming better providers for their clients and patients.

    Focusing on the differences between compassion fatigue, burnout, PTSD, and other work-related conditions, participants will complete self-assessment tools in order to ascertain their levels of professional health. The outcomes of these assessments will inform the creation of a personalized self-care plan.

    This lecture will be on March 6, 2015 at the Doubletree Hotel,
    1000 NE Multnomah St., in Portland. The lecture is from 9 am-12 pm, and offers 3 CEUs. Click here to register for this lecture.

    Dr. Rocky Garrison, Ph.D Offers Sleep Class

    IHC Associates and Dr. Rocky Garrison are offering a new class:

    Promoting Good Sleep: Applying the Science of Sleep

    IHC provider Rocky Garrison, PhD, will teach this ongoing three-session class, using the science of sleep to help participants cope with insomnia and other sleep problems.

    Each session of this class includes:

  • A relaxation/imagery experience
  • Education on one or more of the factors influencing sleep
  • Self-assessment and monitoring of progress
  • Setting and review of individualized goals related to healthy sleep practices
  • This class meets every other week and new members can begin at any session and then continue through the remaining sessions. The classes are billed to the patient’s insurance: there may be a copayment for each session, and a sliding scale fee is also available.

    To join this class, call IHC Associates at 503-740-1971and ask for an initial assessment for the science of sleep class with Dr.Garrison.