Strategic Counseling
by David Gersten, MD
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Introduction
How do you begin to overcome emotional distress? If the pain is severe enough that you require professional help, how do you decide on a particular clinician or healer?
In this article, I will share my model of psychotherapy, psycho-spiritual counseling. The umbrella of all my work, as a holistic physician, is in Integrative Psychiatry and Nutritional Medicine. Half of my treatment approach involves nutritional medicine and half involves strategic counseling. I want to make this clear because total healing is most likely to occur when people address body, mind, spirit . . . and even more dimensions of life. By only addressing nutritional deficiencies and other body-level issues, we only see part of the picture.
Strategic counseling
I do not present my approach to counseling as the one-and-only or the 'best' approach. Rather it is my approach, forged out of 30 years of working with a vast array of human experience. What I know is that there is no single psychotherapist who is suited to work with all people, and there is no one particular treatment modality that will work for all people.
Like all relationships, work with a therapist/healer is a relationship. No matter how eloquent your therapist's words may be, if you don't click, if you don't feel understood, or if you leave that first session feeling worse than before the session, you are probably in the wrong healing relationship. The relationship is built on mutual understanding, hope, trust, and a shared belief in what causes illness and what can cure it. However, from the therapeutic side of the relationship, the healer himself is the most important ingredient, and not his beliefs, techniques, or credentials.
Here are my goals when I meet a client for the first time:
1. Connect,
2. Listen at a profound, non-judgmental level,
3. Inspire hope,
4. Decide if I believe I can help this individual, and
5. Map out a plan of action, which includes an explanation of the chances of success, the duration of therapy, and an explanation of why I think that person is in pain, and what strategies are most likely to be beneficial.
The tools of Strategic Counseling that I use include: empathic listening, re-arranging the puzzle, re-framing, cognitive approaches (not full-fledged cognitive therapy), strategic pattern intervention, meditation, mental imagery, mood words, breath work, affirmations, paradoxical interventions, practical problem solving, and Body-Centered Trauma Resolution (BCTR).
Within the flow and context of this work, emotional releases often take place, but I do not deliberately promote these. I find that buried emotion surfaces in a natural way. My approach in this area is more like Tai Chi, whereas powerful emotional release work therapies are more like boxing or karate. They utilize a lot of force. Force, being a quality of mind rather than soul or higher mind, is not in the level at which I seek to work.
I almost always have a very clear idea at the end of the first session about the problem, the treatment, and the likelihood of success. However, it is important that I don't consider my opinions to be fact. I have worked with people who, at the beginning, appeared unlikely to benefit much. But they proved me wrong. These people did go through a phase of resistance to change, but once they were able to work through that resistance, they did phenomenally well. So, I am careful not to make preliminary assessments that are etched in stone. Rather I make educated "projections."
All clients are required to complete a comprehensive, 7-page form that I developed, the Health and Wellness Assessment Form (HWAF) before their first session. , The same form is used for those with mental/ emotional problems and those with physical symptoms. The HWAF provides an enormous amount of information. In addition, the HWAF is actually set up as a healing tool in itself so that the individual filling out the HWAF has learned a tremendous amount about herself before she has even met me. ( Click here to download a .pdf copy of the HWAF.) There is a clear set of principles that helped me determine the questions, the tone, and the timing of the HWAF. I developed a simple process called Psycho-Spiritual Assessment (PSA), which has four steps: 1) What is your Main Concern (which may be a problem, illness, experience, or goal)? 2) How do you feel about your Main Concern?, 3) How has my Main Concern affected my sense of meaning in life?, and 4) What action steps, if any, can be taken given what I have clarified in the first three steps?
The HWAF weaves PSA in and out. The HWAF is intended not only to gather information but to help my client begin his healing journey. The first two questions of the PSA are at the beginning of the HWAF. Question 3, about "meaning," is the very last question on the HWAF. The fourth question of PSA, action steps, is what is left for counseling to help my client discover. Later on in this article, you will read about a Sanskrit phrase, "Sathyam vada dharmam chara," which means "speak the truth and practice powerful right action." The PSA expands on this Vedic principle.
Re-designing the life puzzle
To illustrate part of the approach of strategic counseling, when I first meet my patient, metaphorically she is a 20-piece puzzle. In that first session, I take in a huge amount of information, using both analytical skills, intuition, and psychic ability. At the end of that session, I am holding a 1,000-piece puzzle, and I have had to expand my consciousness to contain all of these pieces, to hold the entire life story within my mind. Some of those pieces we can simply discard. My patient can just toss some of the pieces out of her life after our initial consultation. There are other pieces that I help her move around, so that a particular piece is occupying a different place in her total puzzle at the end of the session. We are able to re-frame some of the pieces. We have not made these pieces (problems or symptoms) disappear, but we have looked at them in a radically new way that transforms the problems and the individual. During the first session I will take in more information at once than during any other session. I hold the whole puzzle in consciousness during the first session. At no other time will my patient open up their entire life in the way that the process occurs at the time of our first meeting. Our work begins to zero in on specific issues during the second session.
After that first session, the 1,000 pieces of the client's life puzzle re-assembles into a different shape, and things come together in a more whole way, a more peaceful way. My clients usually do not think that anything has happened at all, until they come in for their next session and they tell me that they feel different, that things have begun to shift in their life for the better, but they are not quite sure why they feel better. That is okay with me. They don't need to understand how the puzzle re-assembles Here is how this process works. My intention is to raise consciousness, and not simply to remove symptoms. I put a great deal of effort into raising my own consciousness as well as the vibration of the office itself. By so doing, the beginning of this healing relationship takes place within a resonating field of higher consciousness in which truth and dharma (powerful right action) are the two most important ingredients. By holding a person's entire life in my expanded field, with the express goal of raising consciousness, the pieces of that puzzle are going to shift and re-assemble at a higher level of consciousness.
I often explain to my patients the Sanskrit phrase, "Sathyam vada dharmam chara," which means, "Speak the truth and practice dharma." The entirety of the Vedas is summed up in that one phrase. Dharma means, "powerful right action or super integrity." It means, "Doing the right thing no matter what." In order for a person to improve or recover, they must have a true hunger for personal "truth" and also for spiritual "Truth." Once they know their truths, dharma, right action, starts to become clear. Without knowing truth, or wanting to know truth, it is impossible to know what one's personal dharma is. In changing one's life, there is a third requirement to truth and dharma, namely "courage." Once you know your truth, and you know what you must do, all that is left is to find the courage to follow your dharma.
Part of the shift in consciousness involves assisting my clients in becoming the Witness of the workings of their mind, and to begin to disengage from the false idea that they "are" their mind. The simple practice of meditation (which is my main 'medication') helps people shift from thinking they ARE the mind to being the Witness of their mind. The shift to being the Witness is a rise in consciousness.
The first session begins a shift in consciousness. During the second session, which I call the "Initial Mental Fitness session," I teach them mantra meditation, and help them create their own mantra. "All" sessions strive to continue to expand consciousness, but during the Initial Mental Fitness session, I bring their awareness to their mind. Their mantra is created by having them sit silently for 30 seconds, after which we review every thought, feeling, image, and sensation that they experienced during those 30 seconds. Through this simple process, the client is made aware that they can "watch" the activity of their mind. Therefore, they "are not" their mind.
Beliefs that Heal
It is most helpful if healer and healee share similar beliefs about why people suffer and how suffering is relieved. If these beliefs are not shared, the healer's job is to explain his model in clear terms so that the work he is doing does not seem like hocus-pocus. There is no treatment model that is so complex or elevated that the healee/ patient would not be capable of understanding it. If the model is so complex that it cannot be explained, it is highly unlikely to be a valid method. Here are some of the beliefs that guide my work:
1. My job is to inspire hope.
2. There is no false hope. There is only "false no hope," to quote Dr. Bernie Siegel.
3. My job is to create an environment in which healing can occur.
4. Everyone has the inner resources for healing within. I serve as their guide, their teacher, their confidant, not just the person that they must come see once a week for 6 months or 6 years. My goal is to teach tools of self-empowerment and help my patient recover as fast as possible.
5. Problems, symptoms, goals, and experiences are important to me. Formal diagnoses are far less important, with the exception that I must know if the individual has schizophrenia, true mania (vastly over-diagnosed) or true biological depression. I have written one new order for anti-depressant medication in the last five years although if people come to me who are already on medication, I will continue prescribing if they wish, and if I think it is indicated. Most people who come to me who are taking anti-depressants want my help in getting off meds. Usually we can succeed at that goal, but sometimes this is not possible.
6. Lasting change can be instantaneous. I have already explained, in part, why this is true. I began to observe instantaneous change more than 20 years ago. By this I mean that by the second session, my patient's work was done, her pain was dramatically relieved, and she truly did not need to see me anymore. From a financial standpoint, this evolution in my work was not helpful. From a moral and spiritual standpoint, I simply knew that if it were possible to help people change incredibly quickly, then that was my job . . . and it was God's job to send me a lot of new patients, because psychotherapists ordinarily make a living by seeing a few patients for a very long time. This is my deal with God and She has been cooperative.
7. Change does not need to be painful. It is quite American to say, "No pain, no gain." It is also incorrect. If you think that you must yell your guts outin order to change, you are wrong.
8. In marriages and families that are having problems, there is almost always one core misunderstanding. After I have listened to layers of emotion, mistrust, betrayal, and the like, if there is genuine love, the core misunderstanding will become clear by the end of the first session. No wailing of tears NOTE: is is correct. It refers to wailing, which is singular) required although these certainly may come up in the work I do.
9. Those with strong spiritual faith and connection will do much better than those without.
10. What is required for deep, lasting change is courage - courage to discover one's truth, the right course of action, and courage to take action, no matter how scary that might seem. The very act of taking powerful right action, or dharma, in-and-of-itself is healing. You become stronger when you practice dharma, and weaker when you do not.
11. What you believe about change has a lot to do with how quickly you will change. [Creating positive expectations is an important aspect of therapy.]
12. Creative outlets need to be fostered. Those who are artists or musicians who have given up their art MUST pick up their paintbrush or musical instrument, and are strongly encouraged to do so when they get home after their first session.
13. Search for your fears. They are the doorways to your power.
14. Focusing on one's passion, mission or goals is extremely important, and is more important in the healing process than focusing on one's weaknesses. Those without a passion need help in finding their passion because without that, I cannot make life meaningful for someone else, no matter what I do, no matter what techniques I use.
15. Healing and curing are different. I may help heal someone, but they may still die from terminal cancer. In 'healing into death' they will have died feeling healed and whole.
16. It is my job to find the Divine in the individual sitting in the chair facing me.
17. It is not possible for me to understand fully why a person is suffering, especially if the suffering has gone on for a long time. There are invisible, spiritual and metaphysical factors, especially karma, which can play a heavy role in illness. Karma is the law of cause and effect. Our current situation, whether painful or pleasurable, is the effect, the reaction to actions taken earlier in this life . . . and in prior lifetimes. Karma must be played out, lived out, survived, and transcended. The idea of karma, on the face of it, appears simple. For example, one might think that certain difficult challenges are due to "wrong action/negative action" in a past life. That idea is overly simplistic.
18. There are no limitations to the growth that my patientsmay attain. I help them to transform limitations and fixed ideas about what is possible and what is impossible. If I believe my patient can only go just so far, he probably won't exceed my expectations. Because I believe that, periodically I will be delightfully surprised by a person's radical transformation, I see miracles. While I hold a space for unlimited growth, people dive into the healing process with different levels of intention, drive, commitment, and dedication. So, I do not always see miracles or dramatic change. However, I create the healing space within which miracles and dramatic transformation are more likely to occur.
The second session is the Mental Fitness Training session, in which I teach the core mental fitness techniques (meditation, use of the breath, mental imagery, and mood words) and help develop a foundation of mental fitness. This is a powerful program of tools that my client takes home and practices for the rest of her life (ideally). It takes ninety minutes to build the foundation of Mental Fitness. However, of the six core Mental Fitness Techniques, some people require one hour just to create their personal mantra and explain its use. These people require a second Mental Fitness Session of 60 - 90 minutes to complete their Mental Fitness Foundation. Of course, this is not a one-size-fits-all process. When I next see my patient, she has re-worked the mental fitness program we set up so that it fits her life. I want this program to fit like a soft, velvet glove, and I want it to make my patient feel better, more centered and peaceful - immediately.
Beginning with the third session, I will begin to move in a wide variety of directions, based on individual needs, after the foundation has been laid. The foundation is the Mental Fitness Program as determined in the second session, with mantra meditation at the heart, serving as mental home base, around which we might eventually add up to 50 other techniques. The average number of counseling sessions is seven or eight.
Here are some examples of these modalities.
Strategic Pattern Intervention
Every habit is part of a complex pattern. The act of lighting up a cigarette is part of about 20 separate steps.
'Tom' had smoked for 30 years. I analyzed the pattern of his smoking, and simply asked him to smoke only with his left hand. Tom was right-handed. This suggestion created a 'pattern interrupt' and he had given up smoking before the next visit - permanently.
Re-Framing
By re-framing, I do not mean, 'changing the picture.' I merely suggest that my patient see the situation in a new light and put a new frame around it. Many people now are walking around with alphabet diagnoses pinned to their mind by their psychiatrists.
'Brent,' a bright 16 year old, told me he was suddenly developing OCD (obsessive-compulsive disorder). Indeed, for reasons that are not clear, he became extremely compulsive, had to check the door five or ten times when he left home to make sure he had locked the door, and a number of other compulsive behaviors.
I chose to take a broad view of his life, new relationships, and a "vision" he had begun seeing in his bedroom. I explored all the possible explanations for the vision. And I told him that he had the choice not to label himself as OCD, and that by buying into a label he was condemning himself to a lifetime of mental illness by self-definition and was regarding OCD as if he had caught pneumonia or some other terrible infection. I said, "I suggest you delete those three letters, O-C-D, and replace them with the word "Anxious." You are young and anxious about a lot of changes occurring in your life, but if you continue to buy into the labeling process, you will become that diagnosis. Don't do it." And then I taught him mantra meditation as a way of helping to create "mental home base," and to decrease stress and anxiety. At the end of the first session, he had let go of "being or having" OCD. I saw Brent one week later and virtually all of his compulsions were gone. Equally profound is that the simple act of learning mantra meditation opened a window for Brent. He began researching a variety of mantras on the Internet, and chose to re-design the one he had been working with. He had chosen a Tibetan Buddhist chant. Far from plunging into a lifetime of OCD, Brent skyrocketed in his personal life, school, and spiritual evolution. There is not room here for the details except to say that within one year of learning mantra meditation, his spiritual growth was palpable and noticeable to family and friends.
Mental Imagery
Mental imagery, representing most of what I do, has universal applications. Imagery is how I help people go deep, far, and wide. Our brain/ mind thinks, feels, perceives, and images. Cognitive therapy was born out of the mental process of thinking. Guided Mental Imagery emerged from the normal mental process of imagery.
Imagery involves a conscious process in which we engage all five senses to help solve an infinite number of problems and to attain an infinite number of goals. People often confuse imagery with visualization. Visualization is imagery in which only one sense, that of sight, is being engaged. In interactive guided imagery, we guide the patient and help him experience through sight, sound, touch, taste, and smell. There are thousands of imagery techniques. There are also three or four major meditation techniques that I teach.
Mental imagery is the language that allows your brain/mind to gain access to your body. It is the key that turns the lock to the body. Imagery is also the key that allows you instant access to your unconscious mind. Mental imagery is not simply about visualizing yourself healthy or wealthy. That approach is useful, but is kindergarten level mental imagery. Guided Mental Imagery is such a powerful and complete field of expertise that it has become one of three CAM (complementary and alternative medicine) treatments that Blue Shield of California will pay for, depending on your particular insurance policy. (Acupuncture and chiropractic are the other two.)
I use the 'Cutting the Ties' imagery to help people free themselves from the restraining chains of relationships, past and present. What is required is one imagery session per person in your life. When one commits to cutting all the ties, within 8 months or so, one is largely free of a lifetime of entanglement. Cutting the Ties accomplishes what 10 years of talk therapy does not and cannot accomplish. The Cutting the Ties imagery was created by Phyllis Krystal around 1950. Two weeks of preparation are required prior to the "cutting session." During those 2 weeks, the individual practices a "Figure-8" imagery, visualizing the person they are cutting loose from sitting in a circle facing them. The Cutting the Ties session takes about ninety minutes. It is a systematic, lengthy process with dozens of separate steps. The essence is that my client is asked to allow his sub-conscious mind to show him "ties" that connect any part of his body to any part of the person with whom the cutting is taking place. In twenty-five years of doing this work, I have found that there are never fewer than seven ties to cut when working with a parent, spouse, or anyone who dominated the client or whom the client dominated. The ties that are visualized can be made of any substance, including, but not limited to: ropes, chains, string, wire, vines, leather, wood, smoke, mist, light, or plant-life. During the Cutting the Ties session, systematically, the ties are cut, one by one. At the end of this one session, the universal response is, "I feel lighter." Within days, changes begin to take place within the person who did the cutting exercise in relationship to the person with whom the ties were cut. Changes also occur that generalize from the specific cutting. A person in an abusive marriage, after a cutting imagery, will find it much easier to cope with the marriage and make a decision about whether or not to stay. In addition, my client may find that he is developing clearer boundaries throughout his life, has recognized other abusive relationships, and made changes regarding those relationships also. The effects on the interactions in the relationship, as well as more global change may not be noticeable for weeks. It is a process of unfolding. The effects of one single Cutting the Ties session can unfold over the course of an entire year.
One 65-year old woman recognized the reality of her marriage to an alcoholic after cutting the ties. A few months after that, she left her husband, moved to a new city, bought a new condo for seniors next to a golf course... and changed her identity from real estate to painter/artist. Within a year of the cutting, she had paintings showing in more than a dozen galleries in San Diego.
The greatest power of imagery lies in 'symbolic imagery.' One can allow an image to emerge that represents virtually any issue, problem, or goal.
I recently was interviewing candidates for an administrative assistant position. I tend to really like people and therefore being a great judge of someone's future performance has not always been my strong suit as an employer.
I had zeroed in on 'Lisa,' as the best choice. The morning before I hired her, I did the "scales imagery," visualizing a scale calibrated from 0 to 10. At noon I 'saw' the scale at 4. By midnight, the scale read 7, meaning I was now 70 percent positive and confident about hiring her.
I awoke, still unsure about what to do, and so I asked my subconscious mind to show me a symbol. My analytical brain already knew that Lisa would be great, and that she would treat my patients with incredible care and empathy, understanding, knowledge and wisdom. But I still needed to know in my heart, so I asked to see a symbol. What appeared was a graphic symbol I had recently created, which is a fleur-de-lis with wings. Symbolically, "wings" mean "to live by faith." I gave the symbol a voice, which is how one begins to dialogue with a symbol. This may sound silly, but it's how my mind or your mind can respond to questions. We can ask our symbols to talk to us. The winged fleur-de-lis said to me, "She will give you wings to fly."
The exercise took five minutes and gave me total clarity and peace of mind. I immediately called Lisa to hire her before someone else could. The use of symbolic imagery gave me vital information, removed virtually all doubt, and helped me make a decision in which my right and left brain were in equal agreement. Head, heart and soul were in full agreement and the final decision was clear, and effortless.
In summary
I hope this article has provided an understanding of my psycho-spiritual counseling. My way is not 'the right way.' It is my synthesis of thirty years' experience as a medical doctor, and twenty-seven years as a psychiatrist. I have not bought into any dogma and I am not part of any particular school of thought, other than 'Life University.' I have worked with hundreds of techniques, integrating these with belief and attitude. Through practice, along with trial-and-error, I have created my personal role as a healer. Just as my patients engage on a healing journey, my journey as a healer is never complete. Of all the techniques, attitudes, great books and great teachers I have examined and studied with, my patients truly have been my greatest teachers.
David Gersten, MD practices nutritional medicine and integrative psychiatry in Encinitas, CA. He built the 1,800 pages at www.aminoacidpower.com, and the 800 pages about mental imagery at www.imagerynet.com and http://www.imagerynet.com, which explores the healing power of barefoot contact with the earth's bioelectrical fields. He has served as the mental imagery consultant to Rodale Press/Prevention Magazine on 18 books, published Atlantis the Imagery Newsletter for seven years, consulted to the White House; and authored "The POW Survival Guide" and "Are You Getting Enlightened Or Losing Your Mind?" dgersten@imagerynet.com 760-633-3063 Return to Master Table of Contents
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