PHILOSOPHY OF CARE
After more than thirty years practicing psychotherapy, I have come to realize that therapeutic outcome is largely hinged on five factors.
The first factor (necessary, but not sufficient) is the relationship between the therapist and the patient. Good rapport, collaboration, and trust are necessary before the patient will completely share his or her struggles with the therapist. Strong confrontation is often called for in therapy and this is most helpful when the patient has developed a degree of trust in the “good intent” of the therapist. Without a strong therapeutic alliance, very little change comes from therapy.
The second factor is the hope or level of expectancy of the patient. The therapist can do much to increase this or to instill it when absent. The professionalism and expertise of the therapist (and an appropriate communication of those qualities) is a determining factor in the level of hope/expectancy with which the patient imbues the treatment. Prior treatment experiences impact the expectancy of the patient. It is often important to address issues that have arisen in previous therapy.
The third factor is the therapy structure, model, or technique. It is important to have a wealth of training and a plethora of techniques. However, these are most effective when the above two factors are in place. The appropriate treatment is most often based on the “theories of change” the patient brings to therapy. Finding these and responding to them will enhance effectiveness in therapy. An effective therapist can respond to a wide variety of personal and cultural theories.
The fourth factor is medication. Appropriate medication is an effective part of treatment and medication issues should be monitored closely by the psychologist and addressed with the physician. A working knowledge of biochemistry, biochemical models of pathology and biochemical properties of medications is a necessary part of responsible patient treatment.
The fifth factor is extra-therapeutic. In other words, situations in the patient’s world outside of psychotherapy can be extremely helpful or detrimental to the therapeutic process. A focus on “learning” is important and it is helpful if the therapist uses these real-life experiences to enhance and strengthen the learning of the patient.
That being said, I believe that optimal treatment in almost all cases is outpatient. This begins with good assessment, accurate diagnosis, thorough treatment planning, informed consent of the patient, and conference with other medical providers.
Effective treatment occurs on several levels that build upon one another. The specific diagnosis, resilience of the patient, level of functioning, and childhood history often determine the necessary level of therapy.
Cognitive and behavioral restructuring, education, and skills enhancement are necessary components of almost all therapy. It is important to teach skills the patient may not have learned and to challenge unhealthy thinking and behavioral patterns. For many patients, this may be all that is needed.
If the diagnosis is rooted in interpersonal problems, interpersonal therapy or interpersonal process work may be a modality of choice.
However, for those who have experienced trauma, neglect, abandonment, and/or abuse, various experiences/techniques of emotional processing and release are likely necessary. Insight into the impact of trauma on present neurological and psychological functioning as well as guidance and exercises to alleviate the negative results of trauma is necessary treatment for most trauma and abuse survivors. Process work and EMDR and have proven helpful adjunctive modalities for releasing emotional wounds, restoring neurological balance, and restructuring beliefs at a deep level.
Education and LicensurePh.D. in Counseling Psychology, University of Utah, Salt Lake City, UT, August 1988.
M.S. in Clinical Psychopharmacology, California School of Professional Psychology, February, 2007.
Licensed Psychologist, State of Utah, since 1989.
Clinical ExperiencePsychologist in Private Practice since 1989.
Supervisor of Psychology Students since 1992.
Past Director of Psychology & Clinical Director at two local hospitals.
Professional AffiliationsAmerican Psychological Association:
Division 55 (Association for the Advancement of Psychopharmacology)
Utah Psychological Association
Eye Movement Desensitization and Reprocessing International Association
International Society for the Study of Trauma and Dissociation
Listed: National Register of Health Care Providers in Psychology
Area of SpecialtyDepression
Post-Traumatic Stress/Abuse and Trauma Resolution
Relationship Conflict/ Strengthening Healthy Relationships
Lesbian, Gay, Bisexual, Transgender Issues