Updated: Dec 4, 2019
If you've ever gone to counselling, or perhaps if you've considered going, you may have experienced the anxiety of wondering what you should talk about with your therapist. You recognize that you are in need of some kind of emotional/psychological remedy, but where do you even begin? Especially if you're going to pay for the session out of your pocket, you want to make sure that the time spent in therapy is as meaningful and helpful as possible.
There is a framework for mental health treatment that is piquing the interest of many in the field and even stirring up a bit of controversy. It is called the Power Threat Meaning Framework. Its purpose is to provide a way of describing unusual behaviour and emotional distress that is an alternative to the current, more medically focused, diagnostic model. Whether or not you buy in to this new model I think it can provide some meaningful points from which a person can launch their introspective journey toward wholeness and wellness.
While the current medical model tends to focus on figuring "what's wrong" with a person, the PTM framework aims the focus on what has happened to individual, how they interpret these events, and how they cope, whether through adaptive or not so adaptive means. In my experience, many people will feel that something is not right and ask me, the "expert," to tell them what is wrong. While there are theories that helps enlighten the conversation around pathology and its causes, I prefer to look at context before categorizing someone with a diagnosis.
I think that by applying some of the core questions of this framework, anyone could get a solid head start on their self-exploration and come up with some salient fuel to bring to therapy. Here are some questions you could start asking yourself now:
What has happened to you? And more particularly, in what way does power operate in your life? In what contexts do you feel empowered and in which do you feel powerless? There are power dynamics in every interaction and relationship we have and some of the most troubling and traumatic experiences will often have to do with a power differential or a perceived abuse of power.
How did it affect you? You've taken inventory of what has happened to you and now it's time to consider what kind of threats these events pose on you. For example, your significant other was unfaithful and now your sense of emotional safety and your prospects for continuing intimacy are threatened. Quite often the event itself may not be the most traumatic event. It's the impending and residual threat to your reality that causes distress.
What sense did you make of it? Different people experience the same events in different ways, depending primarily on how the event is interpreted at the time and in retrospect. The meaning that you derive from your experiences will dictate the level of distress involved. One child loses a soccer game and another loses his self-worth. To one child it's a test with only a few marks on the line, to another her entire future is on the line. The cognitive filters that interpret our life events play a significant role in the psychological stress felt.
4) What did you have to do to survive? In other words, how have you responded to these threats. Do you escape with alcohol, excessive work, pornography, or do you avoid social situations altogether? Do you lash out in your meaningful relationships almost as if to test your significant other's loyalty or ability to "handle you" at your worst? Does it present as nervousness, anger, depression, or compulsion? Given what has happened to you, its affect on you, and the way in which you have interpreted the threat, your reaction may be completely rational. Perhaps there is less of a need in this case to diagnose you with a disorder. Maybe as you self-reflect on your survival strategies you will have more clarity as to why you feel and behave in ways that you know aren't helping you. Now you have something concrete to present to your therapist in terms of a goal or direction you want to pursue in therapy.
What are your strengths? What access to Power resources do you have? Don't forget to give yourself and your resources some credit. You may feel like the whole world is crumbling around you but you have made it this far and if you really think about it you have had daily successes in managing your distress. Who and gives you strength? Who has your back? What role do you play in the world? How did you survive the last time you felt this angry, anxious, or depressed? You are far more capable than you give yourself credit. By identifying your strengths and resources your therapist will be better informed on who you are and how you are going to work through your distress.
What is your story? This is the fun part that may require an astute, non-judgmental observer in the form of a therapist. But to prepare for the construction of your life story you could reflect on meaningful memories and how they interact with your current situation. Looking at the big picture narrative of your life provides context and history to your present concerns.
I want to be clear that I'm not suggesting that answering these questions to yourself is some kind of substitute for therapy, although I do believe that self-reflection is a valuable practice for anyone whether you receive counselling or not. By pondering these questions you are more likely to have a more fruitful session with your therapist.
In addition to these questions, The British Psychological Society also released in its PTM Framework Publication a list of core human needs according to evidence gathered in their research. I thought I would add them here as well, perhaps as a checklist for you to consider before heading into a therapy session.
I've listed the core needs in question form for your self-evaluation:
Do you experience a sense of justice and fairness within your wider community?
Do you have a sense of security and belonging in your family and social groups?
Are you/were you safe, valued, accepted and loved in your earliest relationships with caregivers?
Can you meet the basic physical and material needs for yourselves and your dependents?
Have you formed intimate relationships and partnerships?
Do you feel valued and effective within family and social roles?
Do you experience and manage a range of emotions?
Are you able to contribute, achieve and meet goals?
Are you able to exercise agency and control in your life?
Do you have a sense of hope, belief, meaning, and purpose in your life?
In theory, if you are able to answer in the affirmative to this checklist you should also then have "the conditions for [you] to be able to offer [your] children secure and loving early relationships as a basis for optimum physical, emotional, and social development and the capacity to meet their own core needs," thus starting or continuing an inter-generational legacy of wellness.
If you show up to my office with answers to these questions we are ready to dive right in!