Interview with Natasha Collins, Marriage and Family Therapist in San Francisco, CA

7.) What are the primary treatment approaches you use and how do they help clients?

Natasha: In that last example, I talked some about cognitive behavioral tools I use, like the thought record.  My approach is most informed by cognitive behavioral therapy, solution focused therapy, and interpersonal therapy.

With Cognitive Behavioral Therapy (CBT), the central belief is that there’s a direct interplay between our cognitions or thoughts, our behaviors and our feelings. The way we think about things has a direct way impact on the way we feel and the way we behave. We are able to exercise some control over the way we think about things and the choices we make about what to do or not do, so when utilizing CBT, the work is to make changes to how we think about events and experiences.

It takes some training and work to shift cognitions, but it is possible. If we’re able to shift the way we think and perceive situations or life events, then that has a direct impact on the way we feel and how we respond behaviorally. There’s a lot of research and data to support this type of approach, especially in addressing depression and anxiety. It can also translate to other types of mental health symptoms as well.

CBT is a very structured and directed modality, so there are lots of tools, exercises, and homework assignments involved to facilitate the change process.  It’s a very dynamic treatment style and it requires a lot of active participation by both the therapist and the client.

With Solution Focused Therapy, simply put, the name says a lot about the approach.  The underlying assumption is that all people have the ability to identify what would make their life better, although they may need support developing the skills to make those changes happen. Using solution focused approaches, there is generally a clearly identified challenge or problem that an individual may be struggling with, and the work of the therapy is to structure conversations that can guide an individual to articulate their vision of a solution to a given problem.

A lot of time and energy is spent on exploring how the individual has solved similar problems in the past and is encouraged to utilize strategies that we know have worked before. It’s a pretty fast-paced therapeutic approach and I think a lot of clients appreciate it, especially since there’s a very discrete or specific challenge to focus on. This approach can help the client avoid getting stuck in a lot of problem talk or a problem narrative, because really the focus is on how to find a solution, by exploring the strengths that they can draw on, helping them develop new skills, and learning from what has been successful in the past.

KP: So, with the Solution Focused Therapy it sounds like you are drawing on people’s strengths and really encouraging them to think about and start taking action on the solution versus just dwelling on the negative of the problem.

Natasha: Yes, exactly.  Another technique used in Solution Focused Therapy is called the “Miracle Question.” The miracle question asks that you imagine that you go to sleep tonight and while you are asleep, a miracle happens and all your problems are solved.  You are then asked: When you wake up the next day, how will you know that the miracle has really happened?  This type of questioning allows a client to begin envisioning the types of solutions that they may be hoping for and can work towards in therapy.

Lastly, the Interpersonal Therapy approach recognizes that issues and challenges occur within interpersonal contexts and effect relationships. Emphasis is placed on how the symptoms one is experiencing are related to the relationship. The therapeutic work focuses on how to make adjustments to someone’s interpersonal relationships that will have a positive impact on them, and ideally on the relationship as well.  I really like this approach because it recognizes the interconnectedness of us all.  We are not just treating symptoms in isolation, but we’re looking at how the interpersonal aspects of someone’s life are impacted by or impacting their current struggles.

KP: I could see how the three approaches you mentioned would blend well together.  Can you give an example where you have combined all three?

Sure, I worked with an individual who felt depressed and was having problems with their primary relationship.  Over time, it became clear that an inability to resolve conflict was underlying the depression and the relationship troubles.  Using a solution focused approach I prompted the individual to generate goals for therapy based on positive changes this individual wanted to see in the relationship.  Using a cognitive behavioral framework, I taught conflict resolution techniques and skills so that problems in the relationship could be more effectively addressed and explored some of the thoughts and behaviors that contributed to feelings of depression.

Natasha: I do really think that these approaches do lend themselves to being blended together quite naturally and most often in working with clients, I’m generally pulling from all three of these at any given time, it’s rare that I’m only using one of these modalities.

Next Section: 8.) From your perspective, what are the most important factors that contribute to the healing and change process?

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