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Talk therapy is talk. When people complain it’s “just” talk, they mean if therapy doesn’t lead to some kind of change then therapy is useless. It might feel good and it might be “interesting,” but if the person doesn’t create or experience any change then how was therapy effective? So how does “talking the talk” become “walking the walk”? The central features of good talk is that it’s focused on two goals: firstly, it creates a functional, connected relationship, and secondly, it moves towards gradually resolving the client’s problems. In this post I’ll address the issue of problem-solving; in my next post I’ll address the relationship issues. There’s a common saying that once you understand a problem, you’re halfway towards solving it. Albert Einstein said “If I were given one hour to save the planet, I would spend 59 minutes defining the problem and one minute resolving it.” My own sense is that every situation is unique; sometimes understanding a problem is 99% of the solution, and sometimes understanding a problem is 0% of the solution. In terms of therapy, although people come to change, there are always forces working against change (environmental, relational, motivational, biological, psychological). If change was easy, no one would need therapists. It’s vital for a therapist to grasp the various forces working against a person’s change, so as to understand what isn't working. To be a good problem-solver, therapists must look at A) the contexts for behaviors, and B) the consequences of the behavior (this is often called “Functional Analysis”). What’s the history of the problem? Under what circumstances does it show up? When does it go away, or decrease? What makes it more or less intense? What consequences does the behavior somehow lead to, such that the person

continues to engage in the behavior? On this last note, it’s crucial for the therapist to empathically understand the subjective position of the client - I remember once an anguished parent telling me “There’s no reason for my daughter to cut!” to which I replied that there certainly were reasons (from her perspective), even if we could agree that some of those reasons led to negative health consequences. Using these kind of questions (and a Functional Analysis approach) not only identifies possible solutions, they also help the person see their problems as not intrinsic to who they are, but rather, as a behavior they’re trying to change. Oftentimes we identify with our problems, and our problems become our identity, which leads to a diminishment of the goals we might have for ourselves, and a diminishment of our self-respect. I’ll say more about this in my next post, but I have found that many clients engage in behaviors so as to reduce the emotion of shame, even when the behaviors themselves create the emotion of shame. Being non-judgmental is therefore crucial, to slow this shame-rooted vicious cycle. Understanding a problem also means understanding what solutions have already been tried and failed. This is especially important because people frequently make their problems worse by fixing them ineffectively - using short-term “coping skills” like alcohol, drugs, anger, avoidance, or passivity. When I meet a client the first time, I often ask them what they’re doing to make their problem worse, because those behaviors are often the easiest to stop (and, usually clients haven’t thought about this). Relatedly, it’s important for a therapist to ask what solutions the client wants to try - what they’ve thought of, heard of. If the therapist becomes the “expert” and takes over the job of problem-solving, those solutions likely won’t work, and the client will feel in some way disrespected, or treated as less-than-capable. There’s also in some cases a danger for a client to learn dependency on a therapist, if the therapist isn’t pushing the client to solve their own problems. A personal anecdote: a few months ago I told an acquaintance I was tired (I was driving them to a class we were both in). They spent the next ten minutes telling me how they’d solved the problem of being tired (they accepted being tired). The thing was, I already knew how I was going to solve my problem (a cup of coffee) and mostly felt irritated that he hadn’t asked me about my ideas before launching into his (this kind of thing is a pet peeve of mine). The most common solution people use to solve problems is negative self-talk - judging themselves for their problems. This kind of talk almost never works. Beating yourself up, harassing yourself, abusing yourself in your mind generally leads to more negative emotions, and more desires to use problematic behaviors (like the ones listed before). One of the central skills of a good therapist is non-judgment. The therapist attempts to see the problem in a way that offers compassion and understanding, while also being realistic. This skill functions as bridge - it not only helps to create effective problem-solving, it also works to create the relationship. More on that in the following post! If you have any questions or thoughts about this, or any other blog post, please email me! I’d love to hear from you.

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