Types of Therapy, the Importance of Trauma-Informed Care, & the Role of Sin in Therapy
Episode Notes
Today, Cindy and I are tackling your questions about therapy, shedding light on research, common challenges, and insights to help you on your own healing journey! Here's what we cover:
Here’s what we cover:
1. Which modality should I use (DBT / CBT / IFS / EMDR)?
2. What is the most important factor in getting results?
3. What is trauma-informed therapy?
4. How do therapists deal with getting triggered by a client?
5. What if I feel like I'm “too much” for my therapist?
6. Do we take the role of sin too lightly?
Resources:
- Episode 67: The Link Between Faith & Emotional Healing—Gen Z, College Life, & A Hidden Search for Meaning with Cindy Gao
- Find Dr. Alison on Facebook and Instagram
- Sign up for my weekly email at dralisoncook.com
- Episode 70: Mastering the Art of Emotional Intelligence—How to Harness the Power of Your Emotions to Improve Your Relationships
- Episode 23: Am I wounded or am I sinful?
If you liked this, you’ll love:
- Episode 113: A New Vision of Human Flourishing—A Christian Approach to Mental Health with Duke University Psychiatrist & Theologian Warren Kinghorn
Thanks to our sponsors:
- Go to www.organifi.com/bestofyou today and use code BESTOFYOU for 20% off your order today.
- This episode is sponsored by BetterHelp. Give online therapy a try at betterhelp.com/BESTOFYOU and get on your way to being your best self.
- Go to thrivemarket.com/bestofyou for 30% off your first order, plus a FREE $60 gift!
- Whether you're exploring distant lands or enjoying a staycation at home, Cozy Earth has your back. Visit cozyearth.com and unlock an exclusive 35% off with code BESTOFYOU.
Music by Andy Luiten/Sound editing by Kelly Kramarik
© 2024 Alison Cook. ALL RIGHTS RESERVED. Please do not copy or share the contents of this webpage without permission from the author. While Dr. Cook is a counselor, the content of this podcast and any of the products provided by Dr. Cook are not specific counseling advice nor are they a substitute for individual counseling. The content and products provided on this podcast are for informational purposes only.
Transcript:
Alison Cook: Hey everyone. And welcome back to this week's episode of The Best of You Podcast today. We're closing out this current series, “Therapists on Therapy” with something special, a Q&A session featuring your questions about this very series. Joining me today is someone you might recognize–my incredible media coordinator, Cindy Gao Higgs.
We absolutely love hearing from you. And today, Cindy and I will dive into some of the questions you've sent our way. Now, for those of you who might be new or who have missed Cindy's appearances before, let me reintroduce Cindy. She's not only a vital part of my team, but she's also a Masters student in counseling at Denver Seminary, where she is in training to become a counselor.
She also has a powerful story of coming to faith in Jesus during the pandemic while she was a student studying remotely at Harvard University. It's an incredible story. And if you haven't heard it yet, I highly recommend you go back and check out my interview with Cindy on Episode 67, where we discuss Gen Z and a hidden search for meaning. It's one of my favorite episodes, and it really highlights the intersection of faith and emotional wellbeing.
Be sure to stick around until the end of today's episode where Cindy and I get pretty fiery talking about the relationship between sin, compassion and boundary setting. I always enjoy these conversations. Before we jump in, a quick note. Several of you have been asking about specific diagnoses or diagnostic categories like neurodivergence, autism, addictions, and other topics.
I'm excited to share that we're planning a future series with specialists to dive deep into some of these areas. So please keep an eye out for that. And to make sure we're covering what matters most to you, I will be running some polls in both my weekly email and on social media.
So if you're not already connected with me, please make sure to follow me on social media. You can find me on Facebook and Instagram. It's @DrAlisonCook. And you can sign up for my weekly email at dralisoncook.com. It's free. It goes out every Friday and I send out additional resources in that email–books that I'm reading, conferences I'm aware of that you might be interested in.
I'm always trying to include that in my weekly email, bonus resources that I think might be helpful for you. And that's where I'll also sometimes do some polls and surveys to find out what you want me to cover on the podcast. All right. So without further ado, please enjoy today's episode where Cindy and I are answering your questions all about therapy.
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Cindy: So the first question we have from Bernadette is, how do I know which therapy modality will best suit me? There seem to be so many different approaches like CBT, DBT, IFS, EMDR. How do you choose one?
Alison Cook: Oh, that's a great question. All the acronyms can make your head spin , it's a great question. I would love to hear a little bit from you, Cindy, from the perspective of how you're being trained in some of the modalities and how they're talking to you guys about it as up and coming therapists.
I would say, first and foremost, that each modality has some real strengths, and some fit with different people more than others. So I don't tend to be someone who prescribes only one modality. I think there are real strengths in each one, and I think we can all benefit from different emphases and each approach to therapy.
So number one is to do a little trial and error, maybe do a little bit of reading on some of these different approaches. And then see what kind of speaks to you. So for example, if we're talking about IFS, internal family systems, that's the one I talk about the most is the one I'm trained in the most.
It's more experiential. It's more where you're really connecting to a part of yourself from inside of yourself. You're experiencing what it feels like to be present to a wounded or hurting part of your soul and what it is like to differentiate from that part. And for some people, that is really powerful and it brings healing in a way that others don't, but some people don't really like it.
They want something a little more pragmatic. Something maybe a little bit more like CBT, Cognitive Behavioral Therapy, which is more, here's what I'm thinking. Here are the thoughts, and a therapist helps you disentangle facts from fiction, things you're telling yourself that aren't very helpful, helping you replace those thoughts with reality, more constructive thinking, which leads to different behaviors and different habits.
It's a little bit more pragmatic. Some people really benefit from that. So a lot of it really depends on your own personality, your own disposition, a little bit of trial and error, and understanding what each one emphasizes.
Now in this day and age where you can get a lot online, you can even sometimes find videos where folks are showing what each modality looks like and notice what kind of draws you in.
Cindy: Yeah. I think it's a really good question, and I'm wondering if listeners would be interested in a potential series where we can go more in depth a little bit into all the different approaches. So if you're a listener and you're interested, you can email info@dralisoncook.com and let us know if that's something that you'd want to know more about.
Alison Cook: That's a really good idea. We'll do a little survey and see how much interest there is in going through more systematically, what each of those modalities is about.
Cindy: I would say, before I started my master's program, training to become a therapist, I was so confused about all these different acronyms. It felt overwhelming to be like, oh my gosh, how do I pick the right or the best modality for me? And through my training now, as I've been learning about all the theories and the different techniques, I totally agree with you that different modalities can work better for different types of people.
But at the end of the day, it really struck me that in all these modalities, there are common elements that therapists use that kind of make up the therapeutic “magic sauce”. You can use different techniques, but who you are as a therapist, what your relationship is between therapist and client, that really is arguably more important.
It’s the concept of the person of the therapist. You can have all this knowledge and use all these techniques, but if you don't really care about your client, that's not really going to help. So I hope that's encouraging to people who maybe feel anxious about figuring out the best approach. I think regardless of the approach, you can find healing in a therapeutic relationship.
Alison Cook: It's actually interesting that you say that, Cindy, because that's what the research shows. The research shows that it's the therapeutic alliance, the relationship that you build with the therapist, that brings about the most effective results. And it's interesting, you think about that even biblically.
We are created to heal in the context of relationships. What I'll find oftentimes is folks will come to me because we have a great relationship. They want to keep seeing me, but maybe we reach a point in our relationship where they really should try EMDR and I'm not trained in EMDR.
At times in the past, for example, I'll be working with a client and they'll go seek EMDR from a therapist for a specific period of time, and then maybe they'll come back and see me after that. We incorporate that into our relationship.
So there are a lot of ways to do this, but I agree with your point that you find someone that you really respect. Again, they're not perfect, but it's a relationship that feels restorative to you. And that's really the most important ingredient.
Cindy: Yeah. So the second part of this question from Bernadette is, how is a trauma-informed therapist different from any therapist?
Alison Cook: Yeah that's a really great distinction because I was thinking that some therapeutic interventions/approaches are more suited for trauma work than others.
So a trauma-informed therapist is somebody who's going to understand the unique impacts of trauma. And what that means is that they understand that, first of all, there's a really important emphasis on pacing, that when you come in to therapy, often your baseline concern is, oh, I'm experiencing anxiety in this relationship, or I'm experiencing friction in this relationship, and it might seem like it's about the here and now, but there's really a long tail to the past, and there's a lot underneath that that's really painful and that's going to be hard to unpack.
And if a therapist moves too quickly into, let's dig in to all that deep stuff, it can almost re-traumatize someone because they're not ready. Their system is not ready. They've learned to cope through some of these survival strategies.
You've learned to cope through pleasing other people. So all of a sudden, if your therapist is really attacking that and trying to use behavioral interventions to get you to stop certain things, you don't know how to cope because that's the only way you've learned to cope.
So a trauma informed therapist understands the connection between our current behaviors and our past wounds and understands that pacing is a big part of that. So for example, in IFS, we always talk about getting permission from the protectors, which means we don't go for the big, deep, overwhelming, exiled emotions, all the pain before those protector parts of us understand that the system can tolerate it.
And what that means in practical terms, for example, I'll even use myself as an example. There were years where I had deep anxieties rooted in the past that to open up the lid on that all at once would have flooded me. I would have become more anxious. I wasn't ready. I didn't have the coping in place for that.
I had to chip away a little bit at a time over different years and different junctures until finally, I can go into those deeper areas of my life without feeling so anxious. We have to be really sensitive, and that's what primarily a trauma informed therapist does.
EMDR does a lot of work around containment, building safety, building trust, before you go into those deeper areas of wounding, those really painful memories. It's really important if man, in my history, I've got some really tough stuff that I've never really looked at.
When we say they're trauma informed, they understand that they're going to work with you to build up your reserves, build up your tolerance, build up safety, build up trust, so that when you do dig into some of that, you're ready. You're ready, and you're not going to have a worse reaction than you would before.
I think about it sometimes in the medical model. Maybe you need surgery, but your overall body isn't yet healthy enough to tolerate what it will take to go through that surgery. You first have to build up the overall health of the system before you can have that procedure.
Cindy: That's super helpful. Yeah. There's been a lot of research that has come out on how trauma affects the body, the brain, the way we relate to others. And I would say that for all therapists, it's a necessary part of our professional role to understand that research because that will inform the way that we see our clients and help us be more effective.
I think it's really a way of understanding the human condition and understanding why we think, feel, and act the way we do. And it's not its own modality, it's something that you bring with you regardless of what acronym you practice with.
Alison Cook: Yeah. A behavioral therapist, and when you talk about behavioral, this is someone who's going to really focus on modifying behaviors or modifying thoughts. They're not going to dig into past memories, and can still be trauma-informed in the sense of, maybe in the initial inquiry, making sure, okay, let's look at some of these thoughts. It's like a trauma informed CBT therapist. Someone who specializes in CBT might say, man, I think it might behoove you to go do some trauma work.
To go look at the past, because we're not making any progress making behavioral changes. So to be trauma informed might not mean you go out and get certified or you get an expertise in trauma work, but it means you understand there are different reasons why folks might not be able to make the changes in their life they want to make.
Cindy: So we'll move on to the next question. This is from Julie. What do you do as a therapist if you yourself get triggered during a session?
Alison Cook: Oh, that's a good question. Therapists are humans like everybody else. So that's the first thing that I would say. Like anybody else, when you're in a conversation with another human, we notice reactivity within ourselves. So that first step of noticing, oh I'm triggered by what this person is saying.
There's some reactivity inside of me. That self-awareness is the baseline. We all have to have that, whether you're a therapist or in two-way relationships, you're learning how to, first of all, recognize, I'm feeling a little frustrated. Oh, that's making me want to check out. I'm wanting to detach.
That can happen in any relationship and emotional intelligence–we did a whole episode on emotional intelligence–is learning how to even be aware of that. So that's number one. Therapists really have to have that good self awareness.
I'm sure you're doing a lot in your training, Cindy, about growing that self-awareness. Noticing is number one. Oh, I'm anxious about this. Isn't that interesting? Okay. So then part two for the therapist is, how do I regulate that while staying present to my client?
Because it's not the nature of this relationship for me to bring that in. And one of the things I really like about IFS, I don't mean to always go back to that, but I think one of the things IFS gives us as clinicians is that framework of thinking about it as a part of me.
Isn't that interesting. I can be curious inside of myself. A part of me feels a little anxious about that. Or part of me feels a little annoyed right now. Can I honor that while staying present to the client? And it can really reduce stress inside. Because it's okay. Two things can be true.
I can feel really compassionate toward you and want to be present with you while simultaneously being aware that gosh, later on, after this appointment, I'm going to need to take a look at that. I'm noticing I feel a little scared.
I've noticed, years ago, I would notice if clients had angry parts and they'd come in with anger, a part of me would get really triggered because I was really uncomfortable with anger. I noticed that, okay, isn't that interesting? And then I do my work outside of that session. And that's why as therapists, we grow through the work of providing care, because then I have to go, isn't that interesting? What is that bringing up in me from the past where that kind of reminds me of someone in my life who used to get mad at me and now I'm afraid?
And how do I work through that with my supervisor and in consultation with other therapists in my own therapy so that I'm not bringing it into this relationship? We get to do our own work as a part of showing up for others, which is really powerful.
Cindy: Yeah, for sure. In my program, so much of the training is this continuous facing of our own stuff and processing it through essays, in our class discussions, with supervisors, in group supervision, individual supervision. There's so much of it because that's part of what will enable us to be good therapists.
We have to be self-aware, because our own stuff cannot get in the way of helping our clients. So that's something I think therapists should take pretty seriously in their development. And I also think about the concept of the wounded healer from Henry Nouwen, which I think is so beautiful. Because, as you said, all of us are human.
All therapists are human. We all have our own wounds. But it's not something that has to get in the way. And it can even empower us, as we've faced our own stuff and really been aware of the ways that we struggle and our own pain points, we can harness those experiences and it can help us be more effective.
We can empathize more. We can connect better with our clients. We can see the world differently and really honor the sacred space that we have with our clients because we've done that work to really see how raw and vulnerable and truthful and special the work is.
Alison Cook: To your point, Cindy, the other thing I love about the work of therapy is sometimes you repair with a client. Sometimes a client has to repair. There's rupture and repair within a therapeutic relationship. I've had that happen where I'll say something or we'll have a session and the client will come back and be like, hey, that didn't land very well with me. I didn't like that.
And we talk through it, which can become a restorative experience because that's a part of a normal human relationship. We don't always get it right. I would encourage the listener, if you have a therapist where there's been a disappointment, sometimes it's not a good fit, but sometimes it might be worth trying to raise that and say, hey, this isn't landing right with me or this isn't helpful to me.
Or when you said, this was hard for me, see what you get back. Because therapists are also human. Sometimes they'll defend themselves. Sometimes they won't make it better. And if that happens, then that might be a cue to switch therapists. But in a lot of cases, you bring that up and you actually have a really helpful understanding of what it looks like to work through a repair with a therapist.
We are very much wounded healers and I think all of us, every single one of us is a wounded healer as well. These skills that we're learning within the context of a therapeutic relationship are the same life skills, essentially, that we're learning to go out and enact with other people too.
We're trying to discern, is this something I need to try to repair with this person? And where is this person not a good fit for me?
Cindy: Yeah. Something else I'm also hearing in this question is a potential fear of, what if what I'm experiencing or feeling is too much for a therapist even? Because it feels so overwhelming for me internally. What if my therapist can't handle it?
Alison Cook: Wow. Yeah.
Cindy: What would you say to address that fear?
Alison Cook: It's a great question. I think what I would say is to test it out, because we don't know. So this is where I love the “name, frame, brave” work. You've done a great job of naming it. I notice I'm a little bit nervous. I think my emotions might be too much for this person. We've named it, but we don't know how to frame it yet.
The framing might be, I'm afraid of my big emotions. My therapist actually is dying for me to get a little more raw. But the frame sometimes might be, actually they're not tracking with me for whatever reason, they're not able to keep up with me. And I have had both experiences in my own personal therapy where I notice I'm holding back cause I don't think they're gonna get it. And sometimes I've been right. I've been holding back out of holy discernment.
And sometimes I've been holding back and parts of me were afraid. What I would say is, test it a little bit, maybe name that very experience with the therapist. Hey, I'm noticing this. What do you think? You are always trying to, especially at the beginning of a therapeutic relationship, you're trying to discern if this person is trustworthy and safe for you. You do not want to assume that because they're an expert, they are safe for you.
Cindy: Yes, that is such a good point. Just because they're a therapist and they have all these letters after their name doesn't mean that they're gonna be a good fit for you and that you're gonna feel comfortable with them.
Alison Cook: That's right. So test the system a little bit, test it out and notice and see how they respond and see how they respond. If you feel like, ooooh, they really got it. Or see if they bypass or sideline or make you feel worse. And notice those cues like any relationship. We talk about the red flags and the green flags and the yellow flags.
The same applies as you're discerning about whether or not to work with a therapist and whether or not to reveal certain things to a therapist.
Cindy: Great. So we're gonna move on to our final question for this episode. This one's from Carrie. In this series, Therapists on Therapy, as we've talked about the wounds that might bring people into therapy, Carrie is wondering, are we taking the role of sin too lightly in our understanding of woundedness? And what are your thoughts on balancing self-compassion versus taking responsibility for our actions without making excuses?
Alison Cook: Great question. We have a podcast episode, I think from about a year back called, Am I wounded or am I sinning?
Cindy: Yes. That's Episode 23. We can link it in the show notes.
Alison Cook: There is a definite theme with most of what we talk about on the podcast, that we change in the context of compassion, baseline. We change in the context of compassion. We get compassionate about whatever emotions we're feeling. We get compassionate about whatever the reason is behind a behavior, that we're going to change in the context of compassion versus the context of beating ourselves up or shaming ourselves.
When we're shaming ourselves, when we're criticizing ourselves, when we're berating ourselves, we're actually ratcheting up the nervous system. We're actually moving ourselves out of that calm, clear homeostasis, that place inside that makes us more equipped to make wise and constructive decisions.
So when we shame and beat ourselves up, it rarely helps us toward the end of healthier, more constructive choices. I think that is definitely a theme. Does that mean, I guess the question is, does that mean we're being easy on sin?
Cindy: Yeah, I totally agree with the importance of that compassion. In my own life, I don't think it's a “compassion” versus “taking responsibility for sin” dichotomy. I think in my life it was very much, I had to become a Christian, and that meant receiving compassion and love from God, and that's what empowered me to actually look at the behaviors I'd done, and some things that I realized I wasn't proud of, but I was too ashamed to ever face, so I pushed it aside.
I never admitted it and could never apologize because I would become so overwhelmed with shame that I would deny it. I probably have gaslit people in that period of time because it was too much for me to handle. And it was actually learning, okay, there's a God who actually loves me, who accepts me even though I've done all these things I'm not proud of.
And once I was able to receive that compassion and extend that compassion towards myself, that empowered me to start taking responsibility and owning the decisions I'd made in my life.
So I think they actually feed really well together. I can see the perspective of, we don't want to stop at, oh, I'm compassionate towards myself and everything that I've done is okay and I can keep acting in this way that might be hurting others.
But it starts with self-compassion, and I think taking responsibility for the way that we act and our actions and how we treat others is really important. But that flows out of an acceptance and a compassion that we have for ourselves.
Alison Cook: Yeah, I love that, Cindy. Thank you for being so honest about that because I think there's a lot of truth in what you're saying. I could say the same thing. There's times when I've acted out and I was doubling down on it and I didn't want to be called out for it. And you do the things, the gaslighting and the justifying and the rationalizing and the defending that is hurtful.
It's an interesting question and I think that question tends to come from two different places. The first place is in ourselves, am I justifying sin in my own life? But the second place I noticed that question can come from is folks who've been really hurt by abusive people, by narcissistic people.
By people who are really doing harmful, cruel activities, which also happens. That question can come from, hey, are we being easy on that? Are we being easy on some of those folks that are really being cruel out there? And there's some justification for that. I get that. And then there's also the angle of, am I being too soft or too easy on myself from that first angle?
I couldn't agree with you more in my life. The more there's that sense of my own belovedness, the more there's that sense of that healthy, and I don't even want to call it shame, but that healthy oh, that's so hard to admit, I hate that I do that, but I do, and I need to take a look at it.
The more I lean into my belovedness, the more that that little tinge of shame becomes constructive and moves me toward change versus destructive doubling down on more toxic strategies. So I 100% agree with that.
To those of you listening where you've been really harmed by somebody, and there's this, why are we being so compassionate towards folks who are doing terrible things, which can also be at the root of that question. In my years, some of my work was with addicts who had, through the course of their addiction or to support their addiction, really done some pretty harmful things to family members, to other people, to their kids, even, to spouses.
And what I've noticed is that number one, for those folks to even ponder that when they're in sobriety, when they're trying to change, that there is a God who actually is compassionate for them, it's so radical that to actually maybe even taste that would lead them on the path of, how would I not change for this guy who would love me even after I've done these horrible things?
So it doesn't lead to oh, let's be soft on this. It actually leads to this paradoxical, dramatic, how could I? This almost paradoxical, I have to completely change. And I noticed that the enemy doubles down on the shame, the “you are rotten”, which doubles down on the toxic behaviors. It's fascinating. So I've seen it from that side.
That being said, if you are someone who's been hurt by somebody who's really toxic or really abusive, I have no problem saying to clients, that is toxic. That is abusive. That is evil. I'm not necessarily saying that about the person, but I am naming that pattern of behaviors for what it is.
And we will set a boundary with that. We will not let those behaviors harm you. We will not let those behaviors near you. We're going to do what we have to do to set boundaries around that so those behaviors are not hurting you. They're not coming anywhere near you. You may have to take extreme measures to shut those behaviors down.
But that doesn't necessarily mean, even with those strong boundaries, even that strong naming of this is toxic, this is wrong, you do that so that you get to safety, at the end of the day, you are still releasing judgment of that individual to God.
Your goal is to do that to free yourself from the ongoing damage of harboring anger and resentment against that person. Even when we set really strong boundaries with sin, whether in somebody else or in ourselves, sometimes in ourselves, if we've got patterns of sin and we have to be like, listen, this is wrong. I cannot step across this line.
That's very different from hating ourselves, from beating ourselves up, from shaming ourselves. That's saying, this is a clear line I cannot cross. That's a boundary and boundaries are not inherently condemning. They're based on practical realities and facts. This behavior cannot stand.
I like to distinguish between really strong boundaries, either with the behaviors of someone else or with ourselves, and this sort of self-condemning or other-condemning emotional posture that doesn't really bring health to anyone. In ourselves or in other people, we can be compassionate.
Compassion says, man, I've had a really hard day. I am so tempted to go do something really stupid right now because I'm mad at my loved one and I've had a really bad day. Compassion says, I've had a really bad day. It doesn't say, I can go do that thing. It saysm I've had a really bad day. How can I care for myself in a healthy way through it?
How can I get more support for myself? It doesn't say I've had a really bad day. It's okay. I can justify, I can rationalize doing this thing I know I'm not supposed to do. It can feel like a fine line, but it's an important one.
Cindy: Compassion does not justify harmful behaviors. And to your point at the beginning of your answer, compassion is what helps us calm that nervous system. If we've had a bad day and we're way overwhelmed, compassion can bring us down, to actually have the resources to make better decisions. Whereas if you feel completely overwhelmed, you will be more vulnerable to making an impulsive decision that might hurt yourself or others.
Alison Cook: Exactly. Yeah. So well stated. Compassion is really powerful. It's not soft in that sense. It can really transform that moment, that pause between an impulse and a choice.