This article discusses our approach to psychotherapy from a technical perspective, as it applies to therapists. For a discussion of the same topic as it applies to therapy clients, please visit: How therapy works
At Psych Lab, our approach is fundamentally developmental and relational, rather than symptom-oriented and skills-based.
Starting from a foundation of attachment theory, we understand problems of mental health as stemming from adaptation to less-than-ideal social environments in early life. The result is a lack of flexibility and resilience created by incomplete development of:
Since we are starting from the idea that people are held back from their full potential by the learned constraints of early life, we hold that the role of the psychotherapist is to provide a social context which stimulates patients’ own natural developmental capacity.
Research has demonstrated that the social learning system is only activated in the context of a secure and collaborative relationship. But the very thing holding our patients back is the limitations in their ability to relate to self and others. So we can teach them skills to mitigate symptoms, but those skills will only be enacted consciously and forgotten as soon as attention wander. This is why studies on skills-based therapies show a tendency for benefits to diminish over time.
Instead, we identify and challenge the habitual strategies our patients used to preserve their insecure attachments in early life, which now interfere with their ability to attach securely. We create experiential learning by helping patients encounter and accept aspects of themselves which they had to hide. Only then can the patient truly learn and grow in therapy.
Whereas many therapy models such as CBT, MBCT, ACT, DBT, CPT, and ERP are used as techniques to be applied to patients, we draw interventions from these models only as quickly as we are able to ensure that they are taking place within a truly mutual and collaborative healing relationship (otherwise they don’t work.) We use techniques in the service of the relationship, rather than in place of it.
Because our first task is to create a relationship that is secure in ways the patient has previously not been capable of experiencing, this also means that every interaction we have with them, including those outside the therapy hour, need to be thought of as interventions. Everything we do, from our posture and tone of voice to how we handle scheduling and billing, communicates something to the patient.
We must become acutely aware of our own emotional reactions to our patients, and address them reflectively instead of allowing them to provoke us to act in ways that may unconsciously re-enact patients' early schemas (or our own.) A major part of our task involves working directly in the here-and-now of the therapeutic relationship: noticing, verbalizing, and drawing the patient into collaboration about how to understand the relational events unfolding between us in real time. By acknowledging small therapeutic ruptures as they happen and engaging the patient in a process of mutual understanding and re-attunement, we help our patients come to know themselves more fully by more fully understanding self-in-relationship.
We believe that the aim of psychotherapy is much more than reducing or even simply managing symptoms. Just as a physician should check your blood pressure and cholesterol even if you’re coming in for a flu, we strive to help our patients attain overall wellness whether their presenting problem is anxiety, depression, PTSD, OCD, loneliness, or grief.
To this end, it’s helpful to think about what it really means to be psychologically healthy. Nancy McWilliams proposed 10 “vital signs” of mental health:
Most of these are not the sort of things that a person types into a search box when they are looking for psychotherapy. Many are not things that the client will ever ask you for help with, or even necessarily have insight into the fact that they can benefit significantly from improving. But they are markers of health, well-being, and good functioning. They describe aspects of enjoyment in life or of the basic capacities that allow people to fully enjoy their lives.
In contrast, a solution-focused, skills-oriented approach to therapy involves focusing narrowly on the client's stated problem, helping them resolve that problem to their satisfaction in a manner that is as expeditious as possible, and telling them to come back if they think of anything else they want to work on.
In our integrative, developmentally-informed model, we look instead at the developmental tasks needed for emotional maturity and ask if they have been achieved, or traumatically frustrated. Is the patient healthy, in all the ways listed above?
The patient won't know to tell you that they're still not letting themselves experience closeness, or staying present in their lives, or reflecting on their experience — their learned compensation for these lacks is the air that they breathe! The patient's reported symptoms are only the shadows of these basic injuries. Solution-focused therapists aim to remediate those symptom shadows; we aim to resolve the injury by facilitating developmental growth.
Since we consider the therapeutic relationship to be central in psychological growth, and we consider that type of growth and change to be the central focus of our work, we must therefore structure therapy in a way which facilitates that relationship.
Meta-analyses have shown a strong relationship between psychotherapy outcome and frequency of sessions. Increasing the frequency of sessions from one per week to two per week nearly doubles the effect size of therapy, while decreasing session frequency leads to a more chronic course of illness (Tiemens et al, 2019).
The relationship must continue at that pace for a sufficient duration that developmental learning is completed. For more than half of patients, that takes longer than one year (Shedler & Gnaulati, 2020).
Therefore, we must strongly resist our patient's flight into health upon first experiencing some symptom relief. Instead, we must keep in mind the total picture of their mental health, and use their relief as an opportunity to inspire hope that they can gain effectiveness and life satisfaction which they have never even imagined would be possible for them.
At Psych Lab, we offer a unique opportunity for therapists who are passionate about integrative, relational, developmentally-informed therapy. Our approach allows for deep, meaningful work with clients, supported by:
We believe in nurturing not just our clients, but also our therapists. By joining Psych Lab, you'll be part of a team dedicated to continuous learning and growth, both professionally and personally. Our commitment to this integrative, relational approach sets us apart and provides a rich, rewarding environment for therapists who want to practice depth-oriented psychotherapy.
For current opportunities to join our team,
visit our hiring page.
Provides psychological assessment & treatment planning. Specialties in complex trauma, psychanalytic therapy, and clinical hypnosis.
Manages facilities, hiring, patient census, chart audits, and runs our weekly Monday staff meeting!
Helps keep billing & insurance authorizations on track.
Helps people work through trauma, identity issues, & tough life transitions.
Expert in military and sexual trauma, psychosis, and supporting folks along the spectrum of gender and sexuality.
Skilled in working with complex trauma, severe & chronic mental illness, autism, and ADHD.
Experienced with trauma, disabilities, chronic pain, domestic violence, and relationship problems.
Focused on healing trauma and social anxiety, and facilitating personal growth.
Helps people regain hope in spite of the most difficult circumstances.
Helps people learn to value themselves & their experiences.
Promotes mindful living, self-compassion, and emotional resilience.
Specializes in helping people work through grief and trauma.
Focuses on psychodynamic approaches for deep healing.
Experienced with DBT and attachment-based approaches to trauma and addiction.