Individual psychotherapy — as soon as you enter my office I will ask you what you are hoping to get out of therapy and what has prompted you to seek services at present time. I will listen to and together with you thoroughly try to understand the problem-areas of your life. My role is to listen carefully and understand your situation fully — your priorities and the changes you envision. As you tell me your story I will not only listen to what you are saying but also to what you are not saying, or saying indirectly; I will look at what is going on with your feelings, anxiety, and how you are relating to me and to yourself.
As I begin to see patterns emerge or as I am having thoughts about what I am seeing and hearing, I will actively share them with you in real time in a way that I think will be helpful to you. I will share my observations and invite you to weigh in with your opinion and response to my observations.
I will aspire to hold up a mirror so that together we can be conscious and clear about the nature and meaning of what you are struggling with. If I am off or only partially right about an observation, I will ask you to correct me so that we can have the same vision and be on the same page about what is taking place. Part of what I will be pointing out and sharing with you is my view of what you are doing in real time to impede your own progress.
As for my observations of what I see in you:
In couples and family therapy, a similar process takes place, but there is an added emphasis on pointing out and addressing your interactions with each other (and with me), and I will comment on how your interactions are either furthering or impeding collaboration and emotional intimacy between you. In these forms of therapy I often focus a good deal on modeling effective communication strategies and teaching you important interpersonal skills.
Again specific to couples and family therapy: when there is common ground among everyone in my office on what needs to change, we will work towards those changes. When there is no common ground and shared agreement around a given issue, I will point that out and clarify that the issue is not likely to change and that we cannot work on that issue in the absence of a shared agreement that the issue is problematic for everyone involved.
Because I am and expect to always be a work in progress, I have found that inevitably there are times when I will not see what is really going on for you, times when I will be less attuned to you than I would like to be, and when this happens I make it a habit to let you know that I see how I have fallen short. This can lead in different directions, but more often than not these discussions tend to further the therapeutic work. Being open with my observations, even when they include insights about where I failed to recognize something important in your experience – and then seeing where that takes us – is central in my approach to psychotherapy.