How Therapy Works

Our second episode highlights the Affect Avoidance Model, a universal and nondenominational way to look at the problems treatable with psychotherapy. Key Points The affect avoidance model views any psychological dysfunction that can be addressed through psychotherapy as the result of the mind’s automatic tendency to avoid the conscious experience of negative affects. Avoidance of affects appears to be a guiding principle in the mind’s built-in strategies for adapting to life. This leads to unhealthy avoidance but also leaves opportunities for facing and detoxifying painful feelings long held out of consciousness. Avoidance patterns in the form of EDPs are triggered by recognition of a circumstance associated with anticipated negative affect. The emotional approach to resolution is to prevent this system from activating avoidance strategies. EDPs embody three types of avoidance strategy: dysfunctional patterns of behavior, helpers aimed at biasing free will toward implementing the dys- functional behavior, and involuntary symptoms like anxiety and depres- sion, that also serve to avoid affects. The behavioral approach to treatment seeks to change these patterns of thought and behavior. Helpers include primary emotions like fear, conscience-based emotions including shame and guilt, automatic thoughts, and impulses. In addition to dysfunctional behaviors designed to avoid affects directly, the mind may seek to implement childlike plans to influence the therapist in the hope of solving unfinished business from early life. In doing so, the aim is to avoid the pain of disappointment. All therapies exhibit the same structure consisting of tension between the desire to change in positive ways and the nonconscious problem solver’s efforts to avoid change. This tension becomes the backdrop against which issues are revealed and affects come to the surface where they can heal. The affect avoidance model unifies different therapies by focusing on change processes. In doing so, methods from different therapies can be chosen pragmatically and put to work in a cyclical alternation between emotional healing and behavior change.

Welcome to our Podcast, How Therapy Works, a nondenominational guide to psychotherapy. In this first episode, Amelie Southwood asks questions and Jeffery Smith, MD shares a new way to think about psychotherapy. We begin by focusing on the problems clients bring to therapy using a framework common to all therapies. Link to a 3 min. Video Introduction:    https://www.youtube.com/watch?v=kPURh0ZHZOw Link to Dr. Smith's Website and Blog: http://www.howtherapyworks.com/ This podcast is a companion to Dr. Smith's textbook of psychotherapy, Psychotherapy: A Practical Guide (2017), available on Amazon and through http://www.howtherapyworks.com/books Key Points in this episode: Problems treatable with psychotherapy can be seen as layered modules with each one originally "designed" to shield from appraised or anticipated harm. These problems can be divided up into distinct modules called entrenched dysfunctional patterns or EDPs. All EDPs are triggered by the anticipation of experiencing a painful, over- whelming, or uncomfortable emotion and consist of a pattern of thoughts, feelings, and behaviors designed to avoid the dreaded emotion. Any EDP can be visualized as unit with the triggering circumstance and its associated feeling on one side and the pattern of avoidance on the other. In between is the invisible mental processing that creates and implements an avoidance strategy. Multiple EDPs can be visualized as stacked in layers starting with the ear- liest at the bottom. Emotions anticipated to escape from one layer are what trigger the next. For a given EDP, psychotherapy can approach by detoxifying the trigger- ing feeling or by helping the patient change thoughts and behaviors. Integrated, modular therapy is usually targeted at the most accessible EDP. It can approach via the emotion or via the avoidant thoughts and behaviors and can be chosen for the precise job at hand.

To whet your appetite for an efficient new way to improve your therapy skills, regardless of orientation, we are offering this way to guide your sessions by cycling through just four questions. Enjoy! And if you want more, the same content is available with slides on Youtube on my channel, Jeffery Smith MD. 

In this fourth episode, we explore details that are true of all dysfunctional patterns, then we turn to a catalog of all the different types that are encountered in a psychotherapy practice. This is part 1 of two that relate to Chapter 4 in the book.

In this fifth episode, Part 2, we build a catalog of all the different types of dysfunctional patterns encountered in a psychotherapy practice. Having a matrix with just so many possibilities makes it easier to clarify just what kind of problem you are dealing with now. This is part 2 of two that relate to Chapter 4 in the book.

In this episode, we explore recent neurophysiology about how painful affects can be "detoxified," or healed, to the point where they are no longer threatening and no longer trigger avoidance. In particular, we look at how exposure therapy works and the recently researched mechanism of reconsolidation.

Paired to chapter 6 in Psychotherapy: A Practical Guide, we delve into just how connection leads to mindfulness and mindfulness leads to the healing of painful emotions, especially from loss, trauma, and neglect. See Dr. Smith's website www.howtherapyworks.com and tell us about your experiences.

Motivation from within and without is a very important factor affecting every therapy. In this episode, a companion to Chapter 7 in Psychotherapy: A Practical Guide, we explore all the ins and outs of this critical factor.

In this episode, corresponding to Chapter 8 in Psychotherapy: A Practical Guide, we give therapists a concise guide to those developmental periods and steps where problems are most likely to affect clients in their adult lives and where understanding has an important role in helping clinicians make sense of what they see.

This episode is the beginning of part II, focusing on what therapists actually do, and how to go about it. The companion chapter of the book presents ideas and principles regarding the first session. We use an approach that is generic and adaptable to any kind of talk therapy. 

In this episode, we discuss how to begin sessions, how to follow the flow, when to intervene, and when not to in a generic form of psychotherapy adaptable to any style or orientation. 

We continue with a look at the cycles and phases of therapy and how some change processes take place over a longer time course than others, (before moving on to the next episode on the therapeutic relationship).

We explore the therapeutic relationship and how best to manage it, corresponding to Chapter 11 in the book, Psychotherapy: A Practical Guide.

Why Dr. Smith has traded the concept of transference for that of the inner child, and how to work with this alternative approach. Accompanies Chapter 12 in Psychotherapy: A Practical Guide

This is the last of the "how to" chapters and covers issues like how much to talk, how to work with different attachment styles and how to decide about homework. The next chapter begins the final section on what different kinds of problems you will encounter as a therapist and how to work with them.

This is the first of our final series describing all the problems you are likely to encounter that psychotherapy can address. In this companion to the first half of Chapter 14, we look at voluntary avoidance, nonverbal schemas, reenactment and acting out. With each type of problem, we discuss some of the challenges and solutions that will help make the therapy clear and successful.

This episode covers "hidden agendas," "guilty quests," and avoiding painful feelings by avoiding experiences altogether. Each of these behavioral patterns can lead to real suffering and loss, and working with them is an important aspect of our work as therapists.

All about addiction, what it is, why it happens, and how to help individuals and their families deal with the devastating effects of the compulsion to use mood altering chemicals and other compulsive behaviors. This is one of Dr. Smith's specialties. Follows Chapter 15 in the book.

Companion to Chapter 16, this podcast looks at how emotions can mean different things and how to work with them in your sessions.

In this episode we explore what some call automatic thoughts and others call free associations, and how to work with them. In parallel with Chapter 18 in the textbook we look at the purpose they serve and how to work with them. And we finally ask listeners to comment! Please!