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Brief Therapy with Single Mothers: The Transformational Alchemy of Metaphor

Posted on September 6, 2023March 3, 2026 by Psychotherapy.net Team

Psychic Schemas and the Phenomenology of Being a Single Mother

There are over 9 million single mothers in the USA. Therapists working with these women hear stories of abandonment, disempowerment, loneliness, hopelessness, victimization, rage, and unrelenting stress.

Disturbing perceptions and emotions such as these, and the distorted interpretations that result, may, but more likely and typically, solidify into psychic schemas characterized by deeply embedded patterns of distorted thinking, dysfunctional reacting, and compromised coping.

Psychic schemas, themselves free of valence, can be understood as internal vehicles serving as repositories for what the individual notices, perceives, and catalogues — including feelings, thoughts, sensations, actions, experiences, and the ever-changing states of the Self. The way these phenomena of living are perceived — through thought, memory, imagination — and the linguistics of the internal narrative, provides the personal schema with its phenomenology, its valence, and its meanings.

As with any individual, what gets introduced and accepted into a single mother’s schema will affect how she thinks, what she feels, how she continues to live her life, and how she views herself. Her existing schema will influence content that continues to be incorporated. The phenomena that become absorbed will affirm or refute negative cognitions, support or refute distorted thinking, validate or dissipate painful emotions, increase or decrease stress, and affect choices of action, including decisions about the mother’s parenting — and about her sense of self.

Through listening to the single mother’s stories, and recognizing her interpretations about them, the therapist can become aware of and assess the possibilities for creatively crafting metaphors that can elicit cognitive shifts, emotional transformations, and behavioral change.

The Transformational Alchemy of Metaphor

The unconscious mind embodies a powerful potential to transform negatively charged schemas into more positive ones that embody uplifting themes and hopeful interpretations. The quiet mind, combined with the evocative and rhythmic language of hypnosis, can fuel a subconscious shift that can reduce stress, increase ego strength (including parenting skill), transform confusion into clarity, decrease stress, and increase a sense of strength and wellbeing.

Used in conjunction with trance, the mother’s personal metaphors become powerful tools that can reach beyond the didactic to tap the unconscious mind’s potential for reframing and restructuring the phenomenology of the single mother’s psychic schema. This potential to redirect focus, shift internal states and create change in the bio-psychosocial-emotional substance of the patient’s psychic schema constitutes the transformational power of metaphor.

Metaphors (and their cousins, simile, allegory and parable) contain rich sensual imagery that can gently and poetically focus attention to perceptions that can shift self-states and move patients toward changes they desire. When used with techniques of trance, such as tempo and attunement, metaphors drawn from patients’ stories constitute a power-filled therapeutic tool for anchoring change and growth in the body-mind with stability and durability that can successfully lead to increased resilience and coping strength.

Using brief, simple, and effective techniques, therapists can assist the single mother in imaging and identifying with new metaphors drawn from her own personal story. In trance, this “sympathetic identification” with new and transformed metaphors can lead to increased confidence, more solid self-esteem, greater ego strength, and a more integrated core of Self. When this positive enhancement becomes incorporated into the psychic schema, the psychosocial-emotional benefit to the mother can also benefit the health of her children.

In the following narrative, my work with “Queen Esta” demonstrates the way in which a carefully crafted metaphor has the power to shift the meaning of a personal and create a stronger sense of Self.

Queen Esta’s Story

“I just left my husband of 30 years!”

That was how Esta introduced herself, at the age of 83, knowing that she could have a future. Esta wanted to understand why she had spent thirty years with a second husband she did not love. To Esta’s credit, she had the wisdom to realize that at this critical turning point, it was important for her to understand the greater span of her life in order to accept her choice to leave her marriage.

As Esta’s story unfolded, it became clear to both of us that Esta’s acceptance of her current choices had everything to do with looking at a different piece of her story. Long before there were social supports and the stigma had faded, Esta had been a single mother. Esta soon came to realize that understanding the impact and meaning of her single motherhood would hold a key to the answers and comfort that she was seeking.

I discovered that Esta had married her first husband in the early 1940’s, shortly before he went into the service and, “when I was too young to know what love was.” The new husband had come home on leave and had left Esta again, pregnant. Esta’s husband was not pleased with the news. When he told her that he wanted her to have an abortion, she agreed it was a very good idea. “I did have one,” she enjoys saying triumphantly — “and it was him!”

After dismissing and divorcing her husband, Esta found herself a single mother of a very young son. In the mid 1940’s, widows, especially war widows, had some acceptance, but single motherhood was not as socially integrated as it is today. How had Esta coped? What had been her resources? Even so many years later, Esta did not fully comprehend how strong she must have been to grapple with the social context of the day and the great difficulties and isolation that single mothers faced.

As single mothers in every era must, Esta had to deal with her own fears and insecurities and raise her child at the same time. Esta had done both successfully, but she did not see the strengths she had drawn on or realize that they could add to her resilience in the present.

During her son’s early childhood, Esta had called upon her inner and outer resources. She had relied on her parents to take care of her little boy while she worked long hours, often traveling alone overnight. She remained mindful and grateful for the help she was getting from her family, feeling fortunate that she had this support. In this way, Esta did not see herself as a victim, but rather cultivated an attitude of acceptance that gave her strength to keep going.

“Esta,” I asked her, “Wasn’t it terribly hard to be a single mother in those days?”

“Yes, it was.” She assured me. “I did what I had to do, but there were others harder up than I was, with no families to help.

“What is the secret of this positive attitude you had?” (She still has it into her 90s!)

“I believe in God.” she said unhesitatingly. “This was the path he chose for me, and I had to accept that. I felt grateful to have my son. He was so precious, and my mother and father loved him as if he was their own. I accepted my decision to divorce and trusted that this was what God wanted for me. So, you see, I was lucky.”

As Esta continued to examine her life story, she came to realize that more than luck had been at work. She was able to see her courage and the intuitive wisdom that gave her the courage to banish husband number one. Finally, she could entertain the idea that there was also deep wisdom in her choice of husband number two. At a point where she no longer had family support, was weary from her grueling job, and had no financial base, Esta had married a man who could, and would, support her and her son.

Esta was now able to make sense of her past and present choices, comforted by knowing that they had been logical, born from a positive impetus. With this knowledge, she was able to accept the sadness of never having had the romantic union, but Esta was relieved of the stress caused by disappointment and regrets, and feelings of well-being replaced disappointment and regret.

Once again, Esta had “done what I had to do.” Realizing how strong she had been in the past helped Esta to see that her decision to leave her current husband was coming from an authentic core part of her Self which knew what was right for her now as it had in the past. As she achieved this wisdom, Esta’s feelings of sadness and self-doubt were replaced by a sense of well-being and an appreciation for her experience and her maturity.

In the throes of her single motherhood, Esta was too immersed in survival to see what she was accomplishing, and the era of self-help and therapeutic support had not yet dawned. Now, so many years later, ready to look back and see her success as a single mother, Esta embarked upon a review that allowed her to know how inner wisdom had directed her to cope and survive. Esta told me about the love of her life, a young man who had died before they were able to be married, almost 50 years ago.

Esta recounted the depth of that old grief, and how difficult life became then, and again when her parents, on whom she had so depended, died. Through all these losses, Esta had kept her sense of humor, her belief in God, and the persistent effort to give her son a good life. She maintained her dedication to him even to the day when this son, now a man, asked for her blessing to follow his destiny 3000 miles away. “My heart broke.” She told me. “But what could I say? This is what he wanted, and I wanted him to be happy.”

As she reviewed the events that required such pervasive and abiding courage, Esta was able to acknowledge that, indeed, life had been hard for her. She affirmed that trust in the will of her Higher Power had enabled her to embody the healthy attitude that had been with her into her 90s. When Esta started therapy, she was no longer the young mother with a little boy to bring up.

However, it meant the world to Esta to transform her doubts of having wasted her life into a view of herself that affirmed her strength, and the deep abiding soul Wisdom that guided her so many years ago, when she just “Did what I had to do.”

When asked how I should identify her in my book, Esta requested that she be called “Queen Esther.” Partly, she says, because Queen Esther in the Bible was a wise woman and a survivor; and partly because now Esta saw herself as “Esther,” a modern Queen, courageously having raised a boy into a good man.

Esther told me that she knows that the difficulties she faced as a single mother helped to make her into the Queen she is. She knows that she made choices from an inner truth that directed her to do the right thing.

Queen Esther was then, and will always be, truly a Soul Mother.

This story is excerpted and adapted from Soul Mothers’ Wisdom: Seven Insights for the Single Mother, by and with the permission of its author, Bette Jonas Freedson, and that of its publisher, Pearlsong Press.

Spencer Niles on the Latest Developments in Career Counseling

Posted on January 5, 2016February 11, 2026 by rezendevknowfully.com

There's Got to Be a Better Way

Greg Arnold: Spencer Niles, you’re an expert in the arena of career counseling and are the star of our new video, Career Counseling in Action: Tools & Techniques. You currently serve as dean of the school of education at William and Mary, after many years on faculty at Penn State. Have you been focused on career counseling throughout your career?

Spencer Niles: Career counseling has pretty much been my gig for the last several decades. It’s what captured my focused interest, and I’ve been surprised at how my interest in it has stayed with me all these years.

GA: You thought it was a phase?

SN: Yea, I thought it was a phase. And maybe it is a phase, a very long phase. But I’ll tell you what happened with me.

GA: How did you get interested in career counseling in the first place?

SN: Well, my first graduate school experience was at a very liberal protestant theological seminary that was very much focused on social justice and social action.

GA: Wonderful.

SN: Theology was a great way for understanding how people make sense of the things that happen to them in life. And I still believe that’s true, but working in a religious institutional setting wasn’t quite right for me. It was way too restrictive and not inclusive enough, so I decided to go get some career counseling for myself. I was about twenty-three at the time.

Somebody referred me to this career counseling center, which was actually a vocational assessment center, they weren’t actually doing career counseling as it turned out, but they called themselves that. I was living in Rochester, New York, and it was in Lancaster, Pennsylvania, so I called them and they said they could work with me for a fee of $600.

At the time I had dropped out of graduate school and was substitute teaching in Rochester city schools and working in a gas station kiosk collecting money from people after they pumped gas. That was my life at that point. Just barely getting by and kind of desperate.

A standardized assessment arrived in the mail, and I filled out the bubble sheets, sent them in, and then about six weeks later, drove down to Lancaster, Pennsylvania where this assessment center was and had a series of meetings over several hours, culminating in a meeting with the sort of lead person in this center. $600 was more than a couple of weeks income for me. I was really desperate.

GA: Sure, that’s a chunk of change even by today’s standards.

SN: I was living in a house with about four other people in a little room, having pop-tarts for breakfast and on a good night, a TV dinner for supper.

But I’ll never forget walking into this guy’s office. He had an impressive office, a nice big mahogany desk and he sat on his side of the desk and I sat on my side of the desk, and he proceeded to debrief me and go over the assessment results.

I remember him saying, “If you do anything in psychology, make sure it’s clinical psychology—don't think about counseling psychology, clinical psychology is where it’s at.” But he honed in on speech therapy for some reason. At one point, he asked me a question and I turned to my left to think about it, looked out the window. It could only have been a few seconds, but when I turned back to answer, he had fallen asleep! And I think “oh shit, what the hell do I do now?”

My self-esteem at that point wasn’t all that great, and now I had managed to put my career counselor to sleep. That’s how boring I was.

My self-esteem at that point wasn’t all that great, and now I had managed to put my career counselor to sleep. That’s how boring I was.

Luckily, he woke himself up and went on with the interview, but I was too meek and insecure to say anything to him, so I just pretended nothing happened. And that was it. I left there thinking, “There’s got to be a better way to do this.”

GA: I would hope so! Besides him falling asleep, which is an obvious empathic failure, what else went wrong with that scenario?

SN: Well, to begin with, they used this very rigid, narrow set of assessments that had nothing to do with me. They were just generic questions with no tailoring whatsoever, which was the norm at that time. This very dry, routinized, mechanical directive process.

GA: Impersonal, disconnected.

SN: And the active/passive, expert/novice dichotomies that get set up that are not very empowering.

The truth is that there’s no assessment in the world that can tell you what you should do. It just doesn’t exist.

The truth is that there’s no assessment in the world that can tell you what you should do. It just doesn’t exist. There’s an illusion of precision with these assessments. We pretend that they have more power than they really do. So I’m not a big fan of that style of intervention at all. It’s grounded in my own experience.

The Psychology of Possession

GA: Your style is actually quite personal in the video we’re releasing this month. Can you explain how your approach differs from this old-school style and how you’ve refined it over the decades?

SN: Well, first of all, we start with the belief that there are few things more personal than a career choice and we link career development with human development. We’ve often treated it as if it were isolated from human development rather than a key component of human development.

If we think about setting it in a context of developmental competencies, for instance, then we look at how careers unfold across the lifespan. It wasn’t until the 1950’s when theories that were more developmental in their orientation began to emerge in the work of people like Donald Super, who is a very well-known vocational psychologist who used a developmental perspective. He was on the faculty at Columbia for years and I was part of his research team toward the latter part of his life. It was people like Super that began to say we have to look at longitudinal expressions of career behavior. We can’t look at it as a single-point-in-time event.

For too long the focus on career intervention has relied upon the psychology of possession. What do you possess relative to specific traits that are relevant for career orientation, career decision-making, career planning, etc, relative to a normal curve. So what that guy who fell asleep was doing was looking at the percentile ranking of my aptitude test results and deciding for me what the implications of those ranking were for my career possibilities.

But most of us do not think of ourselves as locations on a normal curve. Nor are we static in our capacities. A psychology of possession focuses on how much we possess of certain traits and qualities, and what our probability for success is relative to others on the curve in particular occupational fields.

GA: Which, as you say, is a very static way of looking at people.

SN: And what it ignores is the psychology of use. How do I use those traits, those qualities, those experiences I’ve had in my life and how do I translate those qualities and those experiences into meaning and purpose?

Now I’ve been interested in career development since about 1980, and I still love it. It hasn’t died. Why the heck is that? There are times I kind of reflect upon that and I think why do I love this stuff so much?

Getting Out of Our Predicaments

GA: Yeah, why do you love it so much?

SN: Many people would say it’s very boring and they don't want to have much to do with. But most people are thinking of an anachronistic version of career counseling when they think that. It’s very exciting work.

In response to your question of how my model is different and more personal, I use an Adlerian-based model that hypothesizes that we’ve all had particular experiences in our lives that capture our attention. And when it comes to our careers, often what captures our attention are the things that happen to us early in life, and more than that, it’s events that were painful. These painful early events create predicaments for us in our lives. And at whatever level, we seek ways out of our predicaments in living.

We seek to make meaning, to turn an early life pre-occupation to a later life occupation, to hopefully make a social contribution.

We seek to make meaning, to turn an early life pre-occupation to a later life occupation, to hopefully make a social contribution. In that process what we do, even at a very subconscious level, is identify role models. Heroes, heroines—real or fictional characters that we see as guiding the way for us out of our life predicaments. As people who have actively mastered what we are passively suffering.

So if you identify an early life hero, heroine, role model, however one wants to frame it, we’d ask the question, what is it about that person that attracts you? In what ways are you like that role model today? What are the solutions you think that role model offered you, given your early life predicaments?

I remember when I was five or six years old—so this was about 1960—my mother calling my sisters and me together to tell us that she was going to get a divorce. I didn’t even know what the word meant, but my sisters immediately started crying and my mother was crying so I knew it wasn’t good.

From that day through the next ten years or so, my life was really turned upside-down. My family was split apart, we moved every couple of years. I went with my mother, one sister went with my father and my other sister kind of went back and forth. In that period in history, no one talked about this stuff. It was a source of shame.

GA: I can only imagine.

SN: So I repressed a lot of that experience, but I remember early on wondering how people make sense of this kind of stuff when it happens to them. It was part of the reason I decided to go to graduate school in theology, to find out how people make sense of their life experiences, their purpose, their vocation. And then when I had the experience of my own career counseling and then eventually took a career counseling course, there it was.

GA: Your own vocation.

SN: Career development ultimately speaks to these questions of meaning and vocation. How do people make meaning out of their life experiences and translate that meaning into a direction, into an activity that they find meaningful and purposeful?

GA: When you couch it in those terms, it’s anything but boring. The person seeking career development is an agent in the act of self-expression, of working through their personal journey that started with these childhood experiences, and they’re informed by heroes. It’s an incredibly significant part of their health and their journey to self-insight and working through their childhood experiences.

Your path reminds me a bit of Carl Rogers, who was initially called to theology, and also Brad Strawn, whom I interviewed recently for psychotherapy.net. He had a similar attraction to theology and the way it can inform our lives and similar frustrations about what theology couldn’t provide that psychology could.

It’s exciting to hear you speak about career counseling in this holistic way. I have to admit I had conceived of career counseling as kind of boring before diving into your work. But I was wrong. In retrospect I don’t think it was boredom as much as a kind of learned helplessness, or this sense that of all the ways we can help people, helping them find the right job feels kind of hopeless to me, and we’re the bringers of hope. It’s just so hard and so informed by factors out of our control. What would you say to counselors who think of it in these hopeless terms?

SN: It makes sense that you would have felt the way given the objectifying way we usually think of careers. As if it’s about getting or possessing certain skills so that you can get some kind of occupational title.

How do people make meaning out of their life experiences and translate that meaning into a direction, into an activity that they find meaningful and purposeful?

What matters much more are the subjective experiences you have in living your life, where and how do you derive meaning and purpose and where have you been struggling to overcome that sense of hopelessness. We need to make the implicit much more explicit. We need to help our clients articulate those kinds of experiences in which they find that kind of meaning.

There’s no test that will help you identify those things, but what I can do is collaborate with you to find it. I can walk with you on that journey of clarification and articulation of how you find meaning out of the very personal things that have happened to you. But ultimately I’m bringing the same skills to career counseling as any good therapist does to therapy. All those competencies that are essential to effective psychotherapy are essential to effective career counseling.

So You Want to Be a Professional Guitarist…

GA: Is there anything over and above that or is it just using the same common factors that apply to any good therapy?

SN: It’s the common factors of good therapy with a focus on helping people make informed decisions about their career changes and choices. For example, if I were to tell you I wanted to be a professional guitarist—and I kind of do, actually—

GA: Me too!

SN: Here’s the problem though.

I didn’t start playing the guitar at all until I was fifty. And I am bad. I don’t lack for enthusiasm, but I do lack for talent.

I didn’t start playing the guitar at all until I was fifty. And I am bad. I don’t lack for enthusiasm, but I do lack for talent. I love to listen to a great guitarist, I love to play my major chords and every once in a while maybe a little bit of a minor chord or a bar chord thrown in there, but that’s about it. It’s never going to happen.

At one level, it’s important for me to have some clarity about that, but I don’t want you as my career counselor to tell me it’s not going to happen. You might ask questions about the probability of that given my competency level. And I might say, as the client, “I hear you, Greg, but this is my passion.” And you’d start to dive into that with me. What is it within that activity that you really resonate with? Is it truly just knowing where a particular note is, or the shape of a particular chord, or is it something deeper than that? Is it more about your creativity? The emphasis in that process is about clarifying and articulating that passion.

GA: Beautiful.

SN: You’ll table the goal for a bit in favor of helping me describe and name the contours of that passion. You’d encourage me not only to come up with real occupational titles, but to make some up, expand the list, really let my imagination run wild.

The process of identifying the passion allows us to connect to our passion and then to look for opportunities that will elicit that passion. We in the West are lousy at really owning the fact that when people are busy making a living, they’re busy living a life.

GA: What do you mean by that?

SN: I don't know of any occupational nirvanas. We create these false expectations for work. I think what is really important is identifying possibilities that allow us to create a life structure that we find meaningful and purposeful. One of the specialities that I’ve worked with over the years that is so effective at ignoring this is lawyers.

GA: How so?

SN: Lawyers, especially new lawyers, if they are doing their job well, they’re probably working a hell of a lot of hours each week. What happens to the rest of your life? Law is an occupation that has among the highest turnover and dissatisfaction rates.

GA: I’m not surprised.

SN:

People simply ignore the fact that work is also life; it doesn’t happen in an isolated, compartmentalized silo.

People simply ignore the fact that work is also life; it doesn’t happen in an isolated, compartmentalized silo. Work happens within a context, and if the context in which it happens doesn’t allow you to express the life-structure that you find meaningful and purposeful, then life’s not going to be good. It’s not going to last long—or if it does, you may end up compensating in ways that are highly dysfunctional.

So we ask, how does this purposeful goal that you might articulate based upon your meaning and passion feed into a life-structure that you would prefer living?

So if you’re a parent, how do you effectively parent if you work sixty hours a week? It might be possible, but I have to say that those times when I’ve worked like that, I probably was much less effective as a dad. And if I had the chance to do it over, I wouldn’t do it again that way. That’s just me.

"Positive" Addiction

GA: That’s a powerful realization.

SN: I wasn’t aware of the tradeoffs as clearly as I should have been. And of course this gets into positive addiction. We get positively reinforced for being workaholics. We get positively reinforced for achieving in our professions at a high level.

GA: Absolutely.

SN: And that’s OK, as long as we make informed, conscious decisions and we’re aware that it comes at a cost. Maybe it’s a tradeoff that we’re just fine making, but we want to be aware of it.

GA: So what you’re saying is that in the West—at least until recently—we were led to believe that we could find the “perfect” job through these assessments that looked only at static traits and matched us based on some normed statistic, which contributes to grand illusions about what is possible in our careers. And then our society promotes workaholism, which creates even deeper dissatisfaction and often leads to unhealthy coping mechanisms. Your way of working is much more nuanced, developmental, humanistic view of career counseling. How prevalent is this in our profession right now?

SN: I won’t be overly optimistic here.

We get positively reinforced for being workaholics. We get positively reinforced for achieving in our professions at a high level.

I’d say slightly more prevalent today than it was fifteen or twenty years ago. A lot changed about the work world in the last part of the 20th century. Layoffs and the notion that the workers are expendable became a fairly well-accepted ideology, which ran in contrast to what we used to think of as kind of a social contract or career ethic between employer and employee. You know, work hard, put your nose to the grindstone, be loyal to your employer and he will be loyal to you.

This translated into people relocating their families with kids in 11th or 12th grade because the company said, “We’re moving you from Poughkeepsie to Omaha.” That was the ethic, but then people began to realize as this happened more and more frequently, that no matter how hard you might work, no matter how loyal you might be, it could happen to you. People began to say, “I’m not sure I’m willing to sacrifice everything for my employer when my employer is so willing to sacrifice me.”

GA: Amen.

SN: The wounds and the challenges created by that sort of lived experience shifted things quite a bit for many, many people. It’s interesting for me to talk with millennials.

GA: How so?

SN: My son is one. He was offered a raise and a promotion at his current job. He’s 24 and he told me this after the fact. I said, “So what did you do?” and he said, “Well, I turned it down.” I said, “You turned it down? What was the job?” He said, “I’m not really sure.” I asked, “What did it pay?” and he said “I don’t know.” “How don’t you know?” “I didn’t ask.”

GA: Wow.

SN: I said, “How could you not have asked these very basic questions?” And he said, “because I love what I do.” I thought, whoa. He loves his current position and he let that guide him in this process. He’s much wiser than I’ve been throughout most of my life, because I would have asked, “What’s the job? What does it pay?” And if it paid me enough, I might have taken the job even if I loved what I was doing. It’s the old idea of propping your ladder up against the wall and then getting to the top of the ladder only to realize you propped it against the wrong wall. So many of us have done that kind of thing. I certainly have.

GA: Sure, most of us have, I think.

SN: There are just so many dimensions to this work. One of the things we’re finding these days, which is becoming more of a focus in the area of career development, is that the self-concept—what we believe to be true about ourselves and all that that entails and all that means, including our passion and purpose—evolves over time. So career development also evolves. It never stops. If we get passive about that, if we ignore that, we do so at our own peril.

GA: Lifespan development.

SN: Indeed. I took a new job at fifty-eight. I’ll probably take at least another couple other jobs before I’m done with it all.

“Busyness is an Offense to the Soul”

GA: I saw a statistic in Forbes earlier this year that more than fifty percent of people are unhappy with their jobs. A huge contributor to that is the perceived instability and the breakdown of the social contract between employer and employee. But then there’s this silver lining of millennials who are pursuing passion over logistical necessities of income or geographical location. Is this preferable in our new world? And how do we accommodate the lightning fast progress of the twenty-first century? How do we prepare for jobs we can’t even imagine twenty years from now?

SN: Those are great questions. The first question, about which way is preferable, is informed both by generational and individual factors. For example, my father was born in 1921, the WWII generation, and lived through the Great Depression. From those experiences he developed a work ethic that he then passed onto me, and, on one level, that ethic has served me well. I’m a very hard worker, I’m success oriented, always have been, and those are attributes that we get rewarded for in this society.

On the other hand, this is an ethic that focuses more on human doing than on human being, and there’s a real cost to that. For example, the notion of being reflective about our experiences and what they might mean for ourselves, of actually scheduling in time during each day to be reflective about the countless number of experiences we’ve had just that day—these things don’t come easily to folks like me. We don't really allow as much time for human being as human doing, which relates to your question. If you’re going to journal, if you’re going to engage in meditation, mindfulness activities and so forth, those activities are focused on human being; they’re not productive in the doing sense.

GA: So has your model of career development taken in more of this human being aspect?

SN: A colleague at the University of British Columbia and one of my doctoral students at a university in Morocco and I have developed a model that begins with self-reflection. The steps are all in a book we published entitled Career Flow, and the first step is engaging in activities that focus on being and not so obviously doing—journaling, meditation, mindfulness activities, however you might define those. If we engage in those activities on a regular basis in very intentional ways, they foster a greater sense of self-clarity, which is the second step in this model.

We have to elevate the importance of self-reflection if we’re ever going to be able to sort through all the stuff that comes at us, sometimes rapid-fire, each day, and that lead us to being so busy.

Our editor asked, “Why did you separate out self-reflection from self-clarity? They’re the same thing.” And we said, no they certainly aren’t the same thing, and that’s part of the problem. We have to elevate the importance of self-reflection if we’re ever going to be able to sort through all the stuff that comes at us, sometimes rapid-fire, each day, and that lead us to being so busy. One of my favorite Christian mystics, Thomas Merton, said that “busyness is an offense to the soul.”

GA: That’s deep.

SN: And I know I offend my soul every day. So the question is, how can we be less offensive to our souls and honor our experiences and who we are by being much more intentional about engaging in self-reflection? There’s a poet, David Whyte, who has written quite a bit about work. One of my favorite lines of his is, “I look out at everything growing so wild and faithfully beneath the sky and wonder why we are the one terrible part of creation privileged to refuse our flowering.”

Squirrels are out there doing their squirrel thing. Same with golden retrievers, same with trees, but we can get misdirected in so many different ways, by so many external influences and so many factors. We seek to please people in a variety of ways that move us away from who we are. Or we chase certain things that in the end don't provide much in terms of meaningfulness and satisfaction. So we have this “privilege” that often leads us in that way. I think if we were more mindful, more self-reflective, and asked the tough questions, lived the questions, we would be less likely to refuse our flowering. So finding a balance of being and doing is an important dimension of creating careers for ourselves.

The CEO of Netflix takes six weeks of vacation each year, and when he’s on vacation, he’s really on vacation. I officially get two days of vacation a month, and I’ve been in this job for three years. I don't think I’ve used more than three weeks of vacation in three years. I mean how goofy is that? That’s really goofy. I’m in a job where you get every six or seven years, you get a sabbatical. This is my twenty-ninth year as a faculty person. You know how many sabbaticals I’ve taken? Zero. These are not things to be proud of.

GA: Well thank you for airing your dirty laundry with me. This is a relic of the depression era, don’t you think? This work ethic of human doing over human being, where we’re rewarded for workaholism. It’s understandable how we fall into these patterns of busyness. So you’re not taking vacations but hopefully you’re finding time for self-reflection.

SN: I’m much better at it today than I was. It’s not something that garners external rewards, but it certainly brings internal rewards.

GA: It seems like you’re really advocating that work be considered holistically as an integral part of health and wellness. That there should be no separation of “life” from “work” in developmental terms, and that therapists need to be considering career development as a fundamental part of human development.

SN: That fifty percent of people who are unhappy with there jobs that you referred to, the majority of those people have no clue what to do about that. We as mental health professionals have done them a great disservice by perpetuating this notion of the separateness of work from other dimensions of life.

GA: So what can we do? What can practitioners do to more effectively work with career issues and actually help clients with these issues?

SN: That’s a great question and challenging question. The National Career Development Association in the United States is a great organization and some of the leading thinkers in this area attend and present workshops at their annual conferences.

I’ve done a lot of work in the area of policy as it relates to career development. I’m on the board of directors for something called the International Center for Career Development and Public Policy. One of the things I’ve learned from working with them is that here in the United States, we don't have many policies and legislation that support the provision of career intervention across a lifespan.

So even those who are from the mental health professions, who are trained in this area, aren’t addressing these issues and intervening at critical moments in people’s lives.

Take school counselors. Career development is supposed to be one of their three major areas of involvement, but it often isn’t because of other pressures that force them in different directions, but they can be absolutely critical with early-life interventions. There are research studies that show that adolescents who leave school early, at maybe seventeen or sixteen, have psychologically left school long before that, often because they see no connection between what they’re doing in their day-to-day activities and their possible futures. Being informed about career development across the lifespan and this more holistic way of approaching it could mean that a school counselor makes the difference, could connect the dots, for a kid who would otherwise drop out.

So there’s a lot of work to be done and it requires engagement from multiple perspectives and multiple stakeholders. It starts with valuing the developmental perspective that you and I have been talking about relative to helping people begin to make much more informed choices about how they find and express meaning in their lives, including within their work.

Also, I think people in our field often denigrate career counseling, but understand that the version of career counseling that is being denigrated is frozen in time and anachronistic, it’s not what many practitioners these days are doing. The National Career Development Association has a list of practitioners who people can be referred to.

GA: Thank you so much. We hardly touched the tip of the iceberg, but I for one take your call to action to put a new face on career counseling, to revise outmoded, anachronistic definitions and learn about and be a practitioner of this developmental, humanistic, optimistic, hopeful model that brings dignity, respect and a personal connection to people seeking work and wellness throughout the lifespan from cradle to grave.

SN: Well said, my friend.

GA: Any parting words you’d like to leave our readers with?

SN: Well, I’ll leave you just with one brief additional story from the poet David Whyte. At the time we was working at a non-profit, and he noticed how bored and exhausted he had become in his day-to-day experience in that work. He was trying to do poetry on the side and fit it in where he could, and he had this ritual of getting together with a friend on Friday evening to read poetry together.

He viewed this person as very wise, a person of good counsel, and so he decided to talk to him about the exhaustion he was feeling. So one Friday night, he confides in his friend and his friend reflected with him that the antidote to exhaustion is not always rest.

Many times the antidote for exhaustion is whole-heartedness.

Many times the antidote for exhaustion is whole-heartedness. Doing those things that engage us in a whole-hearted way. The conversation led him to leave that job and do work in which he felt that sense of whole-heartedness. So we have lots of clues, lots of indicators along the way. Exhaustion can be a clue. The key is to pay attention. It’s our soul’s way of telling us if something is amiss and if we need to redirect our path.

GA: That’s such an inspiring message and also conveys to our readers how inspiring career counseling can be.

SN: Thanks so much for the opportunity to talk with you about it. It’s been a lot of fun for me.

GA: Likewise, it's been a great pleasure.

Cathy Cole on Motivational Interviewing

Posted on May 25, 2012February 27, 2026 by rezendevknowfully.com

Talking About Change

Victor Yalom: I think a good place to start would be to define and describe exactly what Motivational Interviewing is.

Cathy Cole: Motivational Interviewing is a counseling approach that has a very specific goal, which is to allow the client to explore ambivalence around making a change in a particular target behavior. In Motivational Interviewing, the counselor is working to have clients talk about their own particular reasons for change and, more importantly, talk about how they might strengthen that motivation for change and what way making that change will work for them. It’s a way for the counselor to guide a conversation toward the client’s goals, making the choices that are going to work for a particular person.

VY: I know the founder of this, Bill Miller, started in the field of addictions, where, at least for many counselors, there is a very different model of change, which is that the counselor needs to somehow break through the client’s resistance or denial about their drinking problem. In that context, MI has a very different philosophy.

CC: We really wouldn’t view that as resistance. In Motivational Interviewing, we’re listening very closely to what the client says and, more importantly, how the client is saying it. We’re listening for two kinds of language with clients: either sustain talk or change talk. What we might have considered resistance or what had been called denial in the past would actually just be consider sustain talk—reasons not to do something different, like reasons why stopping drinking would not be important, or reasons why, even if it’s considered important, the client doesn’t think they’re capable, or reasons why the client says, “I’m not ready to do this.”

VY: So in traditional alcohol counseling, for example, reasons why they don’t want to change are seen as resistance or denial.

CC: That was considered denial in the past. And it was viewed as the client not having paid enough attention yet to what the professional said they need to take a look at.

VY: So the professional is really the expert.

CC: That’s right. And in Motivational Interviewing, the client is considered the expert.

VY: Miller gives a lot of credit to Carl Rogers’s person-centered therapy in that regard.

CC: He does, and the basic conversational methods that are used in Motivational Interviewing came out of some of the client-centered work, particularly the use of reflective listening. When Bill Miller began to discuss this, he talked about the client being the expert. The clients are the ones who know themselves better than anyone else. The clients have strengths and capabilities, and clients have the ability to decide if making a change is important to them and why, and what would work best for them in terms of going about that change.

This is quite different from the traditional model of, “Here’s your problem. Here’s what you need to do. And if you don’t do it, that’s your problem, too.”

Of course, the counselor has an important role with this, because sometimes clients want to make change but they don’t really know how. So if, after fully exploring clients’ ideas about making change and what would work for them, the client still feels lost, we’re able to come in and provide some ideas for them to consider—things that we know have been helpful to other people or specific ways of approaching, say, stopping drinking. But ultimately, the clients are the ones who decide what they’re going to do. So this was quite different from the traditional model of, “Here’s your problem. Here’s what you need to do. And if you don’t do it, that’s your problem, too.”

VY: That’s the underlying philosophy of it, and then there are a lot of specific techniques. It’s very strategic, from my understanding. You mentioned one idea of sustain talk, and that is the clients telling you why they want to sustain or continue what they’ve currently been doing.

CC: Right. They’re telling you why they’re not going to do something different.

VY: When you’re hearing sustain talk, your goal is not to try to argue them out of it. You’re not trying to show them that they have some irrational thinking or beliefs. What’s your goal in listening to sustain talk?

CC: To me, there are two goals in listening to sustain talk. The first goal is for me to listen so that I really understand the client’s perspective and of why they are where they are with this particular behavior, and what might be interfering with them considering making a change. So I want to first really work on understanding that. And the way that I’m going to convey that I’m understanding that is by the use of reflection. The next thing that I want to do is to use various kinds of open questions to help the client completely explore the sustain talk, again, toward the goal of the client being able to make an informed choice about whether or not they’re going to change.

VY: And the other type of talk, to call it that, is change talk. That’s a really interesting idea, I think, especially for therapists. What is change talk?

CC: Change talk is when the client begins to shift and say that perhaps making change is important, or perhaps they are able to do it, or perhaps they are ready to do it. They begin to shift away from the reasons not to and they move into the direction of the reasons to make change, or the capability of making change, or that readiness to make change. And that change talk can be very subtle; it can be something that we have to really listen for. It may not be the dramatic, “Yes, I have changed my mind. Now I am definitely going to start losing weight or stop drinking or making a change in my drinking.” It could be as subtle as, “Maybe I should start thinking about that.” And the moment that that occurs, we want to then change what we’re doing in relation to that change talk.

VY: I know that Motivational Interviewing is used in a wide variety of settings, from addictions to healthcare, medicine, the criminal justice system. But just to keep things simple for now, let’s use the example of addictions, where it started. Can you give me an example of someone is struggling with drinking and give an example of sustain talk and change talk, and how you might listen for the change talk, and what you might do with it?

CC: The sustain talk might be something like, “My drinking is no worse than any of the other people I hang around with. In fact, sometimes I don’t think I drink as much as they do.” So that’s saying this is no big deal.A shift of that might be, “Well, when I think about it, I realize that some of the people I drink with actually do say ‘I’ve had enough’ and they quit. And I don’t always do that. Even if I feel like I’ve had enough, I just keep on drinking.” Many people might not hear that as change talk, but I hear that as change talk because the person is beginning to take a look at this and the drinking in a different way. I would really want to attend to that very carefully, and then help the client expand on that.

VY: How do you help them expand on it when you first hear that subtle shift?

CC: Continuing this example, my first response would be to do a reflection. I might say, “You’re beginning to pay attention to how your drinking pattern is not the same and realizing that there could be some pretty important differences.” I’m reinforcing the beginning of the client looking at this in a different way. By doing the reflection, that then provides the opportunity for the client to expand on what he’s beginning to think about.

VY: But you’re not jumping on it.

CC: No, I’m not jumping on it like, “Okay, so you really want to do something different,” because I’m just hearing the beginning of it. Again, MI is very client-centric, so I am helping the client move forward just a little bit, and I’m letting him now expand on this little bit of daylight that has started to show up here in terms of him thinking, “Maybe this is something I could look at in somewhat of a different way.” I want to help him move that along. But if I get too far ahead by saying, “Okay, so you realize that you have a problem,” the client will probably immediately push back to sustain talk because I will have gotten ahead of the client or really created some discord in the relationship at that point. So it’s very strategic in terms of how far ahead I’ll actually move.

VY: I know it’s a really important concept in Motivational Interviewing, for the therapist or counselor not to be the one arguing for change.

CC: Absolutely. The clients are always the ones that argue for change. We set the stage for them to be able to do that, should they want to, but they always present the argument for change.

VY: What is the rationale behind that?

CC: The rationale is if we have decided on our own that making a change is important, we’re far more likely to do it. And it’s also human nature that if someone else tells us that we have to make a change, even if we know we need to do that, we argue against it. We push back.

VY: So with this hypothetical client, say you reflect back the early change talk. How might it progress from there?

CC: Then the client says, “Yeah. I realize that if we go out drinking on the weekends, my other friends know that maybe they can drink a little bit more on a Saturday night, but when it comes to Sunday that they need to cut back and maybe not drink at all, or just have one drink. And they go to work on Mondays. I often don’t really slow it down. I continue to drink just as much on Sunday, sometimes maybe even a little more. And I sometimes don’t end up going to work. So I’m a little bit different than they are with my drinking.”To that, I might actually say a reflection back: “Your drinking takes on a life of its own. It actually gets ahead of you.”

VY: Okay, you summarize what they’re saying. You say you don’t want to get too far ahead of the client, but sometimes you might amplify their reflection?

CC: I’ll amplify that a little bit more. I took a little bit more of a step out this time, a little bit more of a risk, because the client actually started giving me more information. He started to have a different perspective. So I edged it out a little bit and really did a metaphor: “Your drinking has a life of its own, and sometimes it moves ahead of you.” I started to help the client really compare and contrast his drinking with other people’s drinking and just expanded, really, on what the client has said.

VY: It’s really a conversation between the two of you. The therapist does a lot of reflection and trusts that ultimately it’s the client’s decision whether they’re going to stop drinking, start exercising, manage their diabetes better, or whatever the behavior is. Does this tend to go on for a long period of time throughout a course of counseling? Is it very focused on a specific behavior?

CC: Motivational Interviewing the way that we’re using it is focused on a particular target behavior. It’s something that the client is talking about with a sense of, “I need to figure out how to deal with this.” Motivational Interviewing is actually considered a somewhat brief way of working with people in that the person is deciding whether they’re going to do something and then what they’re going to do.Let’s say the drinking from our earlier example is the target behavior. The client decides over the course of a couple interviews that this is a bigger deal in life than he had looked at before, so he’s saying, “Now I’m going to do something about this.” Now we’re getting a clear message of, “Yes, I want to move ahead.” So we begin to take a look at how capable the client feels of doing something about this and what it is he wants to do.

Let’s say I’m an outpatient therapist and doing a specific alcohol treatment is not necessarily my strong suit, but I have this client who comes in and that’s what the client wants to explore. It could be that in the course of that conversation, the client decides, “I’m going to do something about this. I’m going to go to a specific center or perhaps even an inpatient program that deals with alcohol problems.” Or let’s say that it’s a brief intervention to help the client get to the place of saying, “Yes. Now I’m going to do something about it,” and then he moves into planning how he’s going to do something about it. That might mean that the person moves away from me and that I’m not working with him any longer.

But let’s say that I am comfortable working with an alcohol problem. So now we have resolved that initial ambivalence. We’ve moved toward, “Yes, this is what we’re going to work on together.” At this point, we’re going to be working with whatever the client needs to take a look at: for instance, is he planning to try to moderate, or is he planning to try to stop altogether? If he’s going to stop altogether, what do we need to address with that? What might be barriers for him in continuing to maintain abstinence once he’s established it? So we’re not into the nuts and bolts of how he’s going to do it. I’m still not telling him what to do, but I’ve shifted away from that first part of Motivational Interviewing, which is just to resolve that ambivalence about doing it in the first place.

But let’s say that client is continuing along in therapy and with this change plan, and couple of months down the line, the client now says, “I don’t know. Maybe I don’t really need to continue to do this any longer.” So now we’re just going to explore that again. I’m always listening for where the client might become uncertain about continuing to work on this particular behavior. Then we’re going to come back and use Motivational Interviewing to work with that ambivalence.

Stages of Change: Importance, Ambivalence, Confidence

VY: Coinciding with this interview, we’ve just completed a series of Motivational Interviewing videos with you. The first one lays out the general principles, and then the next three address different stages in the change process. It’s an interesting way of thinking about the process of change in general. The first one deals with the idea of increasing importance. Can you just state briefly what is meant by that?

CC: When we talk about increasing importance, we are basically talking about the client’s buy-in around making change. The client has to decide, “Why is this an important issue for me in the first place? Why is it important for me to take a look at the role of drinking in my life? In what ways might it be creating problems for me? In what ways would taking a look at this and making some changes enhance, perhaps, parts of my life or what difference does it make for me to actually control my diabetes when I’m going to have it forever anyway? Why would I stop smoking? Why would that be important?” That’s the first thing when we’re talking about making a change. First, we have to believe that making the change is important, because if we don’t believe that it’s important to make a change, then we’re really not going to do anything.

VY: So first the client has to at least consider that it is important for them to change. And even when they consider it’s important, the idea that they might change is often counterbalanced by inertia or sustain talk—they still might be ambivalent about actually going ahead with it.

CC: Exactly. If we think about it, probably one of the most common questions that the majority of people deal with is, “Is it important that I eat in a certain way so that I maintain the health that I currently have? Is it important that I have a regular exercise routine?” And a lot of times, clients don’t actually realize that it is important for them to make a change.Let’s take an example of a client who has had a yearly physical with routine screenings, lab tests, things like that. The doctor points out that some of her lab values are off. Let’s say liver enzymes are off or cholesterol is high. The client has really not even considered that she needs to make any kind of a change, and now the doctor is saying, “These are indicators to me that you should take a look at these things in your life—that you should take a look at your diet, you should take a look at your drinking, you should take a look at the use of exercise to have an impact on these particular health issues that I have a concern about.”

VY: So this is all new information to the client. For the first time, she thinks, “Gee, maybe it’s important that I make some lifestyle changes.”

CC: Exactly. And other times clients have sought counseling about something that they think might be important, but they’re not sure yet. So they’ve come to sort that out for themselves. Or perhaps someone is saying, “I’ve really always identified myself as a person who speaks my mind. I want to express myself honestly, but I’m beginning to get some feedback at work from my boss that that is really not going to help me advance in my career. So I’m thinking maybe I should take a look at that, but I’m not so sure.” So he’s trying to figure out if changing something about the basic way that he has been interacting is important for him to work on.Or perhaps a young mother has been following the ways that female relatives have been telling her she needs to be dealing with her newborn baby, but she’s read some literature that maybe that’s not quite the right thing. So she wants to talk to the baby’s pediatrician about whether or not she should do something different, because she’s getting conflicting information.

VY: We’re moving into territory where the client is aware that there’s some potential need to change, reason to change, but they’re ambivalent. There might also be a reason not to change.

CC: Right. It’s so much easier to do things the way that we’ve been doing them all along. In the case of the young mother, it could be that going against the grain of what she’s being told by these other significant people in her life is something that, while she might think it’s important, maybe she doesn’t think she can pull it off. Maybe she thinks she’s not really capable of standing up to them and saying, “I’m going to bring my child up in a different way,” so it’s easier for her to say, “No, I don’t think it’s that important.”

VY: Throughout the course of counseling, assume you resolve this ambivalence in one way or other and the client decides, “Yes, I do want to cut back on my drinking,” or, “I want to quit my drinking,” or, “I want to lose some weight.” Then you move into the territory of whether they have the confidence to make that change.

CC: Exactly—whether they feel that this is something that they’re capable of actually doing. And if we look at, say, people who have decided that they want to stop smoking, many, many people can say, “I know it’s important not to smoke, but I have tried and failed so many times to stop smoking that I’m just not sure that I can actually do it. So maybe I should just keep on smoking because I really don’t want to fail again.” Now we’re now helping them take a look at the issue of confidence and capability.

VY: What is MI bringing to the table there? How do you help increase someone’s confidence or likelihood of making that change?

CC: One of the things that I would do is explore with these people any past attempts that they’ve had. If they’ve had any success at all, even if it’s just been for a day, I’d like to find out what helped them, or what happened that they were able to be successful even for a short period of time. I’d also want to explore with the person other areas in their lives where they have actually tackled some sort of challenge or made a change successfully, and help them talk about what helped them be successful at that time. Perhaps it was outside support from another person, or it was buddying up with a person to be able to pull off an exercise routine.I also help them determine what natural traits and characteristics they possess that help them tackle things in life that could be difficult, and how could they use those particular traits to help them in this particular area.

Another thing that helps with confidence is actually giving people sufficient information about how they might go about making this change, and helping them explore whether or not they think that would work for them.

Most of us are not going to step out into making a change unless we think we can pull it off, so to actually have an idea of how to go about it can be very helpful.

Offering Advice and Information

VY: As I said, Motivational Interviewing is widely used in healthcare and medicine, although our audience for this interview is mainly counselors and therapists. I think it’s just important to note that, say, in a medical setting, a healthcare provider might have very specific information about managing diabetes or quitting smoking. But also in counseling, if we have particular expertise in addictions, again, we might not tell them what to do, but we might say, “Based on our experience, this is going to be more likely to be successful than this.”

CC: If a person is saying, “I want to do this, I just don’t know how, and therefore I’m not confident,” we might say, “If it’s okay, I can give you some information on what has been helpful to other people, and from there we can see what you think about that in terms of it being useful for you.” I might present two to three ideas, then stop and go back to the client and explore again. “What do you think about that?” And see how they would work with that.So in addictions, I might say, “Some people find it helpful to do things like 12-step recovery and others find it helpful to go to specific treatment kinds of programs, while still others use things like web-based programs to help them deal with establishing abstinence and getting support. Other people have turned toward their faith, if that’s been something that’s important. So I’m just wondering, out of some ideas that I’ve presented, what ideas that brings up for you or what other questions that you might have.”

I’m always coming back to the client and checking in again, because ultimately the client is the one who’s going to decide.

VY: That again, is quite different from an approach where you say, “You really need to go into an inpatient program.”

CC: It’s very different from a prescriptive approach. I want to make sure, though, that folks listening to this don’t misunderstand: the counselor can actually provide specific recommendations, but it’s done in a way that ultimately our clients still know that they are the one making the choice. We’re reinforcing our clients’ autonomy.Let’s say that I have done an assessment with someone in relationship to drinking patterns and what kind of impact drinking has had in this person’s life. And let’s say that the client is now trying to decide whether or not he wants to do some harm reduction, or whether he wants to be completely abstinent. The client might ask me what I think, and it’s perfectly okay for me to give my point of view, but I would say it perhaps in this way: “Ultimately, you’re the one that’s going to make your choice. But from my review of your history and from what I hear about you trying to do moderation in your past attempts, it looks for me like going for abstinence is the right thing for you to do, certainly at this time. That’s my professional recommendation based on what I learned from your history. But again, I want to know what you think about that. Ultimately, you have to make the decision.”

What’s New About MI?

VY: It sounds very consistent with how a lot of therapists work in general. We generally don’t tell the client what to do. We think that we’re listening to them and being supportive. For the therapist who wants to integrate this into their general work with clients, what’s most new about this? When you are training counselors, what do you find really stands out for them about this approach?

CC: Particularly with seasoned counselors, what stands out as new for them is listening for when the client becomes uncertain again about addressing their target behavior—when they begin to shift and begin to have some doubt, perhaps, that they are capable of doing this or that it. It remains important to listen for that and realize that when we begin to hear that, we now need to shift and start to explore that uncertainty again and not act as if we’re continuing to move forward, because then we’re not really in sync with the client any longer.

VY: By that, you mean the client has been exploring the possibility of change but then hit a roadblock and start to get stuck back into ambivalence.

CC: Yes. They go backwards. They shift directions and move back into sustain talk. Let’s stay with the drinking example: say your client has decided that he wants to establish abstinence and he’s done that, and he’s been abstinent for three months and continued to work on possible barriers in supporting that.Then he comes in one session and says, “I’m doing really well with this, but I’m beginning to think that I just needed a break. I just needed to stop for a little while. I could probably go back to drinking again.” So he’s shifted directions. He’s said, “I’m thinking about this in a different way” which means that we have to now shift and begin to explore what’s happened and see where they want to go with this. Perhaps he has decided that the break is what he’s had and now he would like to try harm reduction or moderation. So now we’re attending to this in a new way.

VY: And the therapist needs to watch out for that tendency to want to kind of jump on the client, saying, “But you already decided this.”

CC: That’s exactly right.The temptation is to come in and try to convince the client, “You’ve made this decision. You shouldn’t turn back. You should keep going with this decision.” But then we will have moved into a position with the client where we’re not partnering with him any longer. We’ve decided that we’re the expert and we’re going to tell him what to do.

The other thing I think is new, in terms of really attending to it, is this difference between sustain talk and change talk. Motivational Interviewing really emphasizes that in a way that other counseling approaches doesn’t, and we’re really explicit about this. I find that this is new territory for counselors, to think about client language in this way.

In the years that I have been doing training, I have found that it’s challenging for people to pick up on change talk and to reinforce it. Counselors have to really start to tune the ear to pick up on change talk, to notice when that occurs and then shift direction and actually start to reinforce that change talk. Counselors often know the good client-centered skills, as you have mentioned. But listening for that change talk and beginning to reinforce that is often novel.

I think there’s something about us as therapists, and I think it’s our desire to know, and to know more detail. We get really seduced by the detail. We want to keep hearing more about the why-nots that are on the side of sustain talk. Our curiosity about knowing everything on that side of the world gets us in trouble sometimes, because when that change talk occurs, we really need to abandon everything that has occurred up until that time that has to do with sustain talk, and move ahead. It doesn’t mean that we don’t come back later and explore some of the barriers that the person might have talked about. But we do that once we’ve moved ahead and we’re saying yes to change. Now we may look at what gets in the way. But actually hearing the change talk and, when we hear it, immediately moving with it, can be a challenge.

VY: One way I’m hearing what you’re saying is, as therapists, we often like to look at people’s struggles and how they get stuck. It reminds me of an interview we did with Martin Seligman on positive psychology and psychotherapy, where he said that most traditional psychology is focused excessively on pathology and not giving equal focus on positive factors, on our strengths. So I’m thinking of it in that light, that therapists may get stuck on wanting to explore people’s challenges and problems and not give equal weight to hearing about people’s motivations for change and exploring that equally.

CC: I think you’re absolutely right. And in some ways, I think our initial training may have set us in that direction. To look at the positive side of this for us, we are really good at sitting with the struggles that a client has, at being able to understand it. And sometimes I think that strong capability that we have in that area might get in the way of us hearing those subtle changes of, “I don’t want to struggle this way any longer.” So we have to be very tuned into that.

VY: And sometimes therapists think, “Well, if you’re moving into just supporting them to change, that could be superficial.” I’ve seen you work, and I’ve seen videos of Bill Miller as well. And what strikes me is it sounds simple, but to do it well it’s really very nuanced. It’s very subtle and very strategic.

CC: Yes, very strategic. And there’s nothing more exciting to me than to have a client begin to embrace the changes possible and begin to believe in the capability that they can have in making that change and just watching that deepen. That, to me, is an extremely exciting thing to see happen. And I’ve equally seen the same thing when a client is with a counselor and they have started to say, “I’m really tired of talking about why I wouldn’t change. Now I would like to talk about why I would change and what I’d like to do about it.” When the counselor doesn’t listen to it, the light goes out of the client and the interview. It’s like the client gives up. So it’s a very special way of working with people, to reinforce client autonomy and to realize the extremely valuable role that the therapist has in guiding this process. If clients already knew what to do to make change, they wouldn’t be sitting in our offices in the first place.It’s very rewarding to work in this way and to watch clients become excited about themselves and what they can do. They often will say, “Thank you so much for telling me what to do,” when we’ve not said anything about what to do. They’ve come up with those ideas themselves, but they kind of think that we have. It’s a very fascinating thing for me to watch, and I often will say, “No, you’re the one that came up with that. I didn’t tell you what to do at all. You came up with that idea.” But they appreciate the process.

VY: Again, the counselor or the therapist has expertise in the process of change but they’re not the experts on clients’ lives and what clients should do to live their lives.

CC: That’s exactly right. Our role is to help our clients figure that out and to put words to that, so that they can really solidify that and deepen it.

MI with PTSD

VY: You work in the VA, where of course they’re very concerned about treatment being effective and using empirically validated approaches. I know there’s been a lot of research on Motivational Interviewing. Are you familiar with the research?

CC: I’m familiar with the research on Motivational Interviewing. There’s lots of evidence that clients make more changes in whatever the target behavior is when Motivational Interviewing approach is used rather than some other standard approach. Motivational Interviewing has a specific niche, and that niche is resolving ambivalence to change. I can give a brief example of how I use that in my work.I work with folks who often have had long histories of problems related to trauma, particularly sexual trauma in my line of work. They have posttraumatic stress disorder and have developed a number of behaviors, primarily avoidant behaviors, to help themselves feel safe in the world. And at some point in time they’ve come to my office, either self-selected or by a referral from someone else in the hospital, because they’ve screened positive on a PTSD score or they’ve said something to their doctor, and the doctor has encouraged them to see me. So now they’re in my office and we’ve done some history. We’re now at the place of the client deciding, “Am I going to do something about it?” The target behavior is this avoidance behavior, perhaps, that’s come from the PTSD, and clients now have to consider, “How important is it for me to actually do something about this? What’s that going to mean for me and my life? Am I willing to go through what might be a painful process to address this? Am I willing to face these fears in order to make some changes in my behavior?”

I’m using Motivational Interviewing at that point toward clients letting me know yes or no. “Am I going to work with this or am I not going to work with this?” That’s the engaging, the focusing, and the evoking part of Motivational Interviewing processes that we use.

Let’s say a client comes to a clear yes: “I really need to get on top of this because my 25-year-old son is saying to me, ‘I won’t leave home until you are less fearful,’ and it’s not okay for me to hold my son up in his life.” So the importance is not based so much on what the client wants for herself; it’s based on what the client wants for that son. It’s a clear value issue around the son. The client is now saying, “Okay, I’m willing to do this because it would benefit my son. And perhaps I’ll get some benefits, too, but it’s really so I don’t hold my son up in life.”

Now I have a clear yes, and we’re going to move into talking about the possible ways that this client can actually go about doing this work. And that’s where I can then present the evidence-based therapies that are available, either through me or through our institution, so that the client can then decide which of those evidence-based therapies she will use. So I have done the first task of Motivational Interviewing, which is resolving ambivalence, and now the person moves into some other specific form of therapy.

VY: Which you might provide or someone else might provide.

CC: Exactly. I can then review what we currently offer. I’m still using Motivational Interviewing because I’m letting her know the possibilities, and then she can decide from those possibilities which one do she thinks she would like to try, what might work best for her.

VY: It’s a nice example because it shows how you can integrate MI into a traditional course of therapy and also shows how you can use it with a problem. It’s not as circumscribed as a drinking problem or a specific healthcare issue. It’s a psychological problem that results from PTSD and fear. But it’s circumscribed enough that you can use MI to decide whether or not a client wants to tackle it or not.

CC: Right. So then the client has made a clear, informed decision. I continue to talk about Motivational Interviewing as informed consent. The client is thoroughly exploring the issue and making the decision, and that’s informed consent.

Teaching MI Skills

VY: Another thing that’s impressed me about it from what I’ve heard primarily from you, Cathy, is the training in Motivational Interviewing is very detailed. A lot of training in our field is more theoretical or overview focused, but from what I understand, to be certified in MI or as a trainer, people really look at your work and you get very specific feedback.

CC: Right. I always speak to the certification issue. There’s no particular certification process for people learning Motivational Interviewing, but many people go through training with folks like myself who provide training in MI. And it’s not just coming and sitting through a lecture; it very much involves practicing all the parts of Motivational Interviewing. Then, working with a person who can provide feedback and coaching by actually listening to interviews is what increases trainees’ competency in using Motivational Interviewing.

VY: When you’re listening to someone’s interview, what are you listening for?

CC: Actually, there’s a particular scoring guide that many of us use who provide coaching and feedback. I’m listening for whether or not the person is using what we call MI-adherent behaviors, using open-ended questions, using a higher reflection-to-question ratio, avoiding telling the client what to do, working fully to understand what’s happening with the client’s point of view.We’re listening for whether or not the therapist is keeping the focus on the direction in the interview; focusing on the target behavior, helping the client fully explore and understand the current issue, allowing the client to explore their own ideas about change, and helping the client deepen the meaning of making change.

There are many counselors who are very good at guiding the direction of an interview. They can keep a client on target. But they don’t necessarily do very well at exploring the client’s understanding, exploring the client’s own ideas for change, really validating. They might hear a client’s idea and immediately say, “Yeah, that’s a good idea, but let me tell you a better one.” That statement is completely non-adherent.

We’re listening for all of those things in an interview and providing very direct feedback on what the counselor’s doing. We know that the only way to really develop skill in Motivational Interviewing is to get feedback.

VY: I think we’ve really covered a lot of material here, at least to introduce people to some of the core concepts of MI. If folks are interested in learning more, where would you direct them?

CC: There’s the Motivational Interviewing website, and trainings are listed there. I certainly provide training myself. The trainings that I provide throughout the year are all listed on my website. There are a number of trainers who provide workshops throughout the United States. It’s also possible to engage a trainer to come to an area and provide a two- to three-day training for a group of people that someone organizes locally. So there are a variety of ways to go about getting training.

VY: You’ve been training therapists and counselors in MI for a long time. How have you evolved personally in your understanding and skills?

CC: Yes, I’ve been practicing Motivational Interviewing since 1992 or so, and I’ve been training since 1995. It’s changed me as a therapist very much in terms of my ability to listen, to not judge the client, to really be accepting of the client and the struggle that the client is bringing to the table. Again, that’s basic Rogerian counseling, and it sounds simple. You can spell out the principles in a couple sentences. But it’s very subtle and it’s not easy to do.

VY: Are there gradations in that ability to accept clients where they’re at? Do you see yourself doing that more, better, deeper now than you did 10 or 15 years ago?

CC: Yeah, I do. I think that when I became aware of Motivational Interviewing and I began to learn the very specific ways to have a conversation with a client using MI methods, I became even more aware of the strengths that clients bring to the table, and I became even more appreciative of clients knowing what is right for them, when it’s right for them, and accepting choices that clients make, whether or not I thought they were the right choices for the client or not.

I feel calmer as a therapist working in this way. I’m not disengaged from the process or detached from it at all, but I’m fully appreciative that responsibility for change lies with the client and that I have a very important role to help that client fully explore this possibility, but that ultimately, I’m there to respect the decision the client makes. It’s a very refreshing and calming way to work. I think the feedback from clients really reinforces that for me. It’s not a struggle.

Hanna Levenson on Time Limited Dynamic Psychotherapy

Posted on August 19, 2010February 27, 2026 by rezendevknowfully.com

The Interview

Randall C. Wyatt: Good morning Hanna, nice to have with you with us. Did I pronounce it right?

Hanna Levenson: Either way. My real first name is Hanna-Mae. It’s a hyphenated first name. Hardly anyone knows that.

RW: I like that name, now we all know it. Let’s get right to the work you are most known for, Time Limited Dynamic Psychotherapy, otherwise known as TLDP. Usually when people think of psychodynamic psychotherapy, they think long term, psychoanalysis, or at least that the therapist wants it to be long-term. So it almost seems like an error, a typo or something.

HL: Yes, people do sometimes have trouble putting those two together, although Freud certainly did very, very brief therapies when he first started, and many were quite effective. His length of the therapy elongated as the theoretical parameters became more and more encumbered. So, it doesn’t have to be an oxymoron.

RW: Right. How did you first discover that it wasn’t an oxymoron, Time Limited Dynamic Therapy?

HL: My original entrance into the field is kind of indirect. I was originally trained as an experimental psychologist with emphasis on social psychology and personality theory. And then later on, as my interests and responsibilities grew more and more clinical, I, what they called, retreaded – lovely term – I retreaded into clinical psychology. So I didn’t become steeped in the tradition of long-term analytic therapy. I was used to working with groups, with individuals in a much more pragmatic way, more from a research standpoint than from an academic standpoint. But the whole arena of psychodynamics fascinated me. The emphasis on the unconscious, on conflict, and on transference and countertransference. So it just seemed natural to take that and adapt it to my understanding of social contexts. Plus my own style, I think, is more of a pragmatic, impatient, let’s-get-to-it style so that led me to the brief part.

RW: Impatient? What do you mean, impatient?

HL: It can cut both ways, because I often get feedback that I’m very, very patient in the clinical work, or when I’m teaching, but I’m impatient in that I’m really looking to make every session count. How can I get the most mileage, whether I’m teaching or doing clinical work? How can I help someone get from A to B in an efficient and yet as respectful way as possible? So I like seeing results, but I’m also fascinated with the process, so when I seek results I don’t necessarily mean just focusing on the end point. In those micro-interactions, can I see that the work has deepened? Can I see that the work is furthering?

RW: Well, impatience is a word that generally isn’t used in therapeutic lingo, not that I’m against it, since sometimes patience has its limitations as well. But I imagine you’re using impatience in the sense that it’s a good thing.

HL: Absolutely. I mean, people come in and they’re suffering; that’s the major reason people come in to therapy. They’re suffering, they’re in pain. And how can we be of help to them as soon as possible? Yet also having respect, not just for symptom relief, but for the bigger picture.

RW: What’s the bigger picture to you?

HL: The bigger picture to me includes what is the context in which the person lives? The social milieu? What is their personal background? What are the stressors that they’re dealing with? So, all of that.

Victor Yalom: You focus a lot on their long-term interactional or interpersonal patterns.

Hanna Levenson: Right. What is there about those that might cause someone to come in with symptoms of depression, anxiety or emptiness?

An Integrationist Point of View

VY: So it seems like you try to do two things. You’re trying to cover both bases – you’re trying to work with symptom relief, which there’s a lot of emphasis on in cognitive therapy. But you also try to do some structural personality changes.

HL: Right, and I also should say that originally I was very enamored of cognitive-behavioral techniques, as well as systems theory, which I come by legitimately with my interest in social psychology. So I don’t see these all at variance with one another. It somewhat puzzles me, to tell you the truth, that so many of my colleagues identify with a kind of strict orientation. So there’s the cognitive behaviorists, and then there’s the psychoanalysts, the humanists, and people who are interested in systems. And for me it all kind of really flows together, that these are all valuable orientations, ways of looking at the person, and all orientations are trying to be of help.And so it seems natural for me to look at schema theory. It makes a lot of sense when you’re talking about someone’s pervasive dysfunctional style. It certainly makes sense to look at conflict and unconscious processes. It certainly makes sense to look at the system which might maintain that dysfunctional way of being. So it all just makes sense to hold it together in a more integrationist point of view.

RW: I certainly know what you mean, that a lot of people identify very closely with their own church be it CBT or psychoanalysis, or existential. Well, everybody has a favorite, but do you sense that they aren’t open to other theories, or they’re only open to one?

HL: I have a colleague who very much identifies as a cognitive therapist, but I tease her that she’s a psychodynamic therapist in cognitive clothing. Let me back up. If you open up the door of the experienced therapist and listen in, it’s often very hard to actually discern their orientation. Because I think we all get to be rather flexible and pragmatic and tuned in to what the client needs, with more and more experience. So I think it’s more the neophyte therapist that kind of latches onto a more rigid adherence to a theoretical orientation, and appropriately so, developmentally. Don’t get me wrong. I think that’s an important way of learning – to really steep oneself in one approach, and really push the limits of that approach.

The Essence of Time Limited Dynamic Psychotherapy

VY: Before we start comparing your approach to other approaches, what is the essence of Time Limited Dynamic Psychotherapy?

HL: The way I practice it, I really see it basically as psychodynamic in orientation, which is to say, looking at things like transference, countertransference, conflict, processes that are out of awareness, and combining that with aspects of cognitive and systems orientations. I don’t view people as being fixated in some early intrapsychic stage which is unchangeable. The person may develop a style, a way of being early in life, but that’s always open to change, depending upon other people, other social environments, other trauma that they might come in contact with, or other healing environments, and in my case, psychotherapy. I’m also very interested in the affective component of how someone puts their world together, and very much from attachment theory. So it all just makes sense that it hangs together for me.

RW: What do you take from attachment theory?

HL: I take from attachment theory that basically what drives human beings is not sexual and aggressive impulses, nor how to construe the environment in a more cognitive way, but rather the need to attach to other human beings, the need to be accepted, the need to feel close, and especially the need to feel secure. But that is inborn, and we all seek that. It’s just that things might go awry in that process.

RW: So how does this need for relationships play out in therapy, then, for you?

HL: Well, the person enters therapy and has a way of interacting with me, as well as what they tell me about their past way of interacting with others. I try, from those two sources of information, to formulate what have been some difficulties with attachment in the past, what kinds of security operations might the person need to have developed in order to stay as much connected as possible, and what might be necessary experientially and cognitively that would help them shift from maybe this lifelong dysfunctional pattern in life.

RW: Can you give an example of that?

HL: Let’s say there is a boy who was raised by very authoritarian, dogmatic, punitive, harsh parents. And so he develops a style, a way of being that is subservient, anxiety-ridden, placating. It makes sense given the pushes and pulls from his parents. It might be the only way for him to stay safe in that family, since at a very young age he’s totally dependent on them. He needs to come up with some kind of compromise – compromise on maybe his true emotional feelings, so that the more angry feelings, the more assertive feelings get suppressed. So he goes through his childhood in that way, and then in adulthood, since he’s now got a well-ingrained style and pattern, he continues to manifest this anxiety-ridden, placating way of presenting himself to others, and may even, unconsciously, seek out people who are more punitive, arbitrary, superior — not because he’s masochistic, but because it’s what’s comfortable. It’s what he knows. So then he enters the therapy room, again being this placating, subservient, anxiety-ridden man.

VY: So what do you do about that, and how do you use the therapeutic relationship? How do you address these issues?

HL: In the sessions, I, the therapist, might find myself becoming more the expert than usual. I might find myself becoming more reassuring, maybe more advice-giving. Already I am adopting a style that would be the reciprocal, the complement, of this patient’s style. So, I not only observe his style and way of being and formulate according to that, but I’m also very cognizant of my own reactions to him, what I call interactive countertransference. And then by being aware of seeing how his behavior and interactions affect my own interactive countertransference, I think about what would need to shift in the here-and-now, in the therapy room, that could give him a new experience of himself, that could give him, perhaps, in this case more a sense of being assertive, more a sense of being angry even, and certainly more a sense of me as the therapist as not having all the answers, of not thinking less of him, of not shaming him.

VY: How am I going to do this with a client?

HL: So that’s one thing. This is keeping me on my toes. Secondly, I would want him to have some insight into what’s going on. I want him to have a kind of cognitive understanding—

VY: From the experience and the insight or understanding?

HL: Exactly, both of those. And that makes my approach somewhat different than the traditional psychodynamic approach that is more insight-oriented. You know, the belief that insight will set you free. Well, we know now that insight unfortunately doesn’t set us free. I think it helps a lot, and it’s very interesting, but it doesn’t necessarily mean we’re going to be less depressed and less anxious, and so forth. So I want to go an experiential route, because nothing succeeds like having a new experience of something. And the truth be known, these are two sides of the same coin. It would be very hard to have a true new experience without some understanding and very hard to have a true insight without having an affective component.

VY: I always refer to a quote by Frieda Fromm-Reichman that patients need an experience, not an explanation.

HL: Right. Right, exactly. I’m very fond of that quote. I’m fond of a quote from Hans Strupp, “The supply of interpretations far exceeds the demand.” Speaking of Hans Strupp, it’s very sad, he died last week. A real pioneer in our field. Eminent researcher, theoretician, but also just a mensch. Just a very decent human being. I was very saddened to hear it, he had such an impact on my work.

RW: You studied with Strupp?

HL: I didn’t study with him per se. He was doing his NIMH study in the mid 1980s, and I had read a draft of his book, which came out later in 1985, Psychotherapy in a New Key. Wonderful book. And so I had the chutzpah at the time to just invite myself to Nashville and say, “I think I’m doing something similar to what you’re doing. Can I come and take a look?” And at that point no one had done that, so they were a bit intrigued and very open. And I went, and had the chance to sit in on all of their training groups that were going on, and it was the beginning of a wonderful collegial relationship. And then we ended up publishing some papers together and some chapters together, and so we had a 20-year relationship.

RW: Do you see your work as similar to Strupp’s and his colleague’s work, or different?

HL: Yes, it’s similar in that the way I formulate is very much an adaptation of their way, really looking at what the interpersonal story is that the person is telling and the way he or she acts in the world. Where I differ is what I mentioned previously, is that they were emphasizing that if you have a good enough relationship, a good enough alliance, then go for the insight, go for the understanding. And I’m saying yes, a good enough relationship is of course critical no matter what kind of therapy you’re doing, but above and beyond that, I think you can be more focused in the experiential learning part. I don’t think it’s one size fits all. I think we can really hone in and be much more specific, kind of like an experiential version of insight. Something very unique to the individual.

VY: This might be a good segue back to the case you were presenting on, how you would do something experientially to address the interpersonal problems and patterns.

HL: Right, and in fact, Victor, you just nicely demonstrated one of the ways I do it, which is to maintain a focus. You got us back on the focus where we had left off, after a little side trip, and by your saying that, you bring me back to where we left off. This focusing is an extremely important factor in how most brief therapists work; bringing the person back to a central theme. And so that’s one of the ways I would do it in treating this anxiety-ridden man, for example.One way I would keep a focus is to look for themes. What am I hearing about the redundancies in the way he acts in the world: what are his thoughts, his feelings, his wishes, his behaviors, chiefly of an interpersonal sort, since this is an interpersonal model. Second, what are his expectations about how others will behave? Third, what is the behavior of others? Of course, as seen though the eyes of a patient, we don’t have the others there, except for the therapist. How do they respond? And then fourth, how does that leave the person feeling about themselves? What is that person’s introject? How do they treat themselves? And then that, in turn, causes them to act, think, feel, etc, so we really have described a story about the person interpersonally.

RW: Where does the cyclical part come into play?

HL: I act, think, feel in a certain way and expect other people will treat me in such and such a way. In fact, they treat me in this way, and all of this leaves me feeling X about myself, which causes me to act, feel, think, and then what we have is a cyclical maladaptive pattern.It’s cyclical; it feeds on itself. It’s maladaptive because it doesn’t work well for the person, and it’s a pattern because it occurs over time, over place, over people. So that’s what I’d be trying to do, from an insight-oriented place, help this client see this pattern. At the same time, I will be experientially working on reinforcing and highlighting those places where he is behaving differently, where he is moving out of this rut, and I’d be very mindful of myself and my own reactions, to see if I end up reenacting something dysfunctional with him, or can I step back and help provide him with some new experiential learning?

Working Psychodynamically in the Here-and-Now

VY: One thing I recall from the video that you made, Time Limited Dynamic Psychotherapy was that you actually articulate, put into words, your awareness about your own reactions. And I think that’s different, at least, from people’s stereotype of how more psychodynamic or analytic therapists use countertransference. That you really engage in the here-and-now with the patient, rather than kind of making a transference or countertransference interpretation that is more distant or in the third person, or leaves the therapist out of the equation.

HL: Right, for example, I might say to a patient, “You know, I notice I’m telling you a lot of what to do, and I seem overly sure of myself compared to how I usually am. I’m wondering what might be going on.” And in doing that, I not only allow us to take a look at the here-and-now situation between the patient and myself, but I’m also saying, “I’m contributing to this dynamic between us.”So this is perhaps another, different point of view from the caricature of the analyst, which is that I’m not neutral. I’m not this benign, neutral, mirror representation. I am someone who gets hooked into acting and reacting to the pushes and pulls of the client.

VY: Well, I think it’s a really key point, because I think some of the modern dynamic people, the intersubjective folks, certainly the Gestalt and the existential and humanistic therapists, have talked for years about working in the here-and-now in the relationship. And I think one of the things therapists have the hardest time is really learning how to do that. Do you agree with that?

HL: Yes. I think somewhere students learned either at their parents’ knee or from their supervisors or teachers, if you can’t say anything nice, don’t say anything at all. And of course one always has to be tactful, in therapy as well as in life, because you want to be heard. But we are really depriving our clients of such critical, important information if we don’t share: “Well, this is what I’m struggling with as I interact with you.” And clients are often very grateful for that feedback given all the usual caveats about the timing of it and the nature of the alliance, and all those things we need to be mindful of. But yes, I find it’s hard for beginning students to do that, and sometimes it’s hard for advanced therapists to do that, because what it does mean is you enter the fray.You have to get down into the trenches with the client. You can’t stay up here in a lofty position, and it’s dirtier down there. It’s messier down there, and you don’t know exactly what’s going to happen down there.

VY: And you have to be more vulnerable as a therapist.

HL: Absolutely.

RW: So during the session as a therapist, you’re feeling more vulnerable. In what ways does that serve or not serve the therapy.

HL: Yes, in a healthy, open way. I don’t mean vulnerable in like, “Oh my goodness, I need to become protective. I need to erect a wall because I’m going to be hurt.” That kind of vulnerability would not be helpful, and in fact sometimes I think the therapist seeks the expert position from on high because the therapist does feel too vulnerable. And then you have a defensive or what I call a security operation that sets in, that actually promotes keeping that distance. Rather, I am speaking of an open vulnerability. It’s a trust in the process – let’s put it that way. It’s a trust in the process.

RW: I’m thinking of the intersubjective wing of psychoanalysis and the well-known and prolific analyst Roy Schafer who talked about changing how we therapists speak about ourselves and our clients. Certainly there’s this line of thinking going on in a lot of existential-humanistic, and definitely psychoanalysis, as well. Can you give an example of any time recently where you’ve felt something in the room and you’ve shared it with a client, and it was either negative or difficult to say?

HL: Yes. There are many. Let’s see. A woman I saw, who was rather egocentric, and if one were to diagnose her, they would probably say that she has a narcissistic style.
Early on in our work she found that most everything I said was ineffective to her and sadly lacking. She said my comments were not deep enough, not on point, not psychoanalytic enough. This was a woman who had been in analysis.

VY: She was critical of you?

HL: Yes, she was quite critical of my interventions and of me; she wouldn’t broach it directly, but indirectly with side snide comments and a heavy hand. But of course this was one of the reasons that she had come into therapy. She was having significant difficulties with her daughters and her husband. One of her agendas in coming to therapy was to really shape up her daughters and her husband.But as I was feeling this barrage from her, I could feel myself moving further and further back in my chair and becoming more and more unable to say anything. Certainly I was trying to get a good alliance with her, but it was becoming increasingly difficult.

So I finally said to her, “You know, you’re a force to be reckoned with, aren’t you?” And it kind of startled her. She said, “What do you mean?” And I described my reaction and that I was very aware that I was feeling very ineffective and not competent. Well, this came as a complete surprise to her. She had no intention of wanting to do that, and it was very useful information and something we referred back to time and time again in our work.

Those moments become earmarked, which allows me to say another aside, that I’ve often found that being this open about my countertransferential reactions, can actually build an alliance. It isn’t like you have to wait to have a good alliance before you could say something like this, but like with this woman, you need to find a way to bring yourself back into the room, find a way to bring yourself back into relationship with the person.

VY: It’s hard to genuinely engage her if you’re feeling like you have to stifle all these negative feelings you’re having.

HL: Absolutely.

Becoming Aware of and Using Countertransference

VY: Given that you agree that this is a hard skill for therapists to learn, other than having personal supervision with you, for example, what are some ways that you find that are helpful for therapists to learn how to do this? Because it’s very different than what therapists usually learn in grad school or most post-graduate education.

HL: That’s a great question, Victor. I find that if you can record, preferably videotape, but at least audio-record your work, it’s enormously helpful. When we’re in the therapy room, especially for beginning therapists, it is so difficult to keep track of all that is happening: one’s own feelings, what’s going on in the transference, what’s going on affectively with the client, nonverbal information, etc. So being able to listen to an audiotape after a session, or even better yet watch a videotape of what goes on while the therapist or trainee as observer is in a different emotional state, really allows therapists to see all kinds of things.

VY: And what do you listen for, or watch for?

HL: The therapist’s nonverbal behavior. I might wonder: What am I doing? Why am I doing that, rubbing my hands a lot? What’s going on there? I’m having trouble looking at the client. What’s going on there? What’s that tone in my voice? I sound tremulous. I sound angry.

RW: It sounds like the first step is to be more aware of what kind of countertransference reactions are getting engendered. So then the second step is how to find a way to put those feelings into words in a way that’s going to be helpful.

HL: Yes, and also acknowledging that there is a reality to the client’s perception. That’s another thing. So that when the client says, “Well, am I boring you?” Rather than saying “Well, what makes you say that?” And then they’ll say, “Well, you’re yawning and your eyes are at half-mast.” Then what do you say? “Do other people always look bored to you?” Do you take it out of the room? Do you take it to a safe place distant from you, or do you say something like, “You know, I think you’re right. I wasn’t aware of it but I think I was drifting off. Can we go back and take a look at what was just going on between the two of us? When did you notice that I was not as present? When did you notice that I was looking bored?” It is giving some validity, as an interpersonal slice of life, to the client’s perceptions. It isn’t all projection.

RW: That’s an amazing, amazing concept in itself, which I say with some irony, that the therapist will acknowledge that the client’s perceptions are accurate or have some validity, and aren’t just something to be questioned and wondered about.

VY: In fact, to deny what actually is, is anti-therapeutic in a sense. If they are having an accurate perception and you’re denying it, well, that’s no help to them.

HL: Right, and you said, “If they’re having an accurate perception.” From an interpersonal therapist’s point of view, you would not even wonder right there about the accuracy.

RW: There’s no one objective reality. There are two interpersonal realities.

HL: Right, because if I say they’re having an accurate perception, that means that I have to be all-knowing. I have to know all of my unconscious processes, I have to be aware of everything, and I can determine as the therapist on high what is accurate and what isn’t. So my assumption is that maybe it doesn’t fit for where you are. I know sometimes when I’m listening very intently, I can look angry. I might furrow my brow, and so I know enough about myself that when I’m really looking and listening intently, it can come across as angry.So when the person says, “Gee, you look angry with me,” I may know there’s something being misperceived. But nonetheless, I take what they’re saying as important, and we can explore that and we can process that, and maybe at some point it gets to my actually sharing with them, “I’m really listening very intently, but I know I can come across as angry, and what’s that like for you?” And I can also say to them, “You know, I’m not feeling angry at all, but I really appreciate your courage, your willingness to take the chance of letting me know that.”

What to Self Disclose and what to Hold Back

RW: Let’s go to another level of self-disclosure. How do you decide what to disclose to the client or to keep hidden? Obviously you don’t say every single thing on your mind. You don’t do that with anybody.

HL: Right.

RW: What guides you in disclosing to the client about your own process?

HL: Excellent question. What guides me is the formulation. In fact, the formulation guides me in everything. The formulation leads to my goal, the goals lead me to my interventions. So that in getting that formulation, going back to that cyclical maladaptive pattern, if I have an idea about what is the style, what the person invites in others, what is their own self-concept, etc., then that is going to allow me to devise some experiential and insight oriented goals, and then that is what’s going to guide me.So for example, with the person who comes in who’s placating and subservient, I’ll be listening for any opportunity where he might say something assertively. Anything where he might say, “I want,” especially if it might seem to contradict something I’m saying, for example. So I would want to highlight those times, capture those times, elongate those times, dwell on those times. However, let’s say there’s someone who comes in who is quite hostile, that that’s part of their cyclical maladaptive pattern, and in reciprocation they invite hostility or subservience, and that’s what gets them into difficulty. Then if they keep challenging me, then that might not be something that I’d want to reinforce, that I might want to focus on.

VY: You might instead reinforce the time when they’re more vulnerable or softer.

HL: Exactly, exactly. So what happens in a session is really driven from how I am formulating the case, and what are my goals. So I really need to keep those at the forefront. This also gives me the opportunity to maybe make a little segue in this interview and say that I use this approach even when I’m doing long-term therapy, and I enjoy doing very long-term therapy, as well as briefer therapies. But I do tend to keep a more focused approach when I’m aware of the formulation and my goals.

RW: And so what’s the difference? The way you practice sounds not so different than the way I practice, using insight, experience, here-and-now work, transference, and countertransference. What makes it short term? What makes it time-limited or long?

HL: In general, and a gross overstatement, I try and make every session count, because I don’t know how long I’m going to see the person; that’s up to the client, for the most part. So we know that 80 to 90 percent of clients drop out before the 12th session, whether or not they’re in managed care. People stop when they have gotten enough out of therapy, or it’s reached that kind of threshold between cost-benefit, it wasn’t what they had in mind, they’re not being helped and so forth.So people drop out of therapy and therapists frame it as a premature termination, which again is a little presumptuous. I’m trying to make every session count, not knowing if I’ll see them for five sessions or five years, at the outset. Certainly as time goes on, you have a better idea if you’ll be seeing them longer term or not. So for me there isn’t so much of a clear dividing line between brief and long term therapies.

VY: How do you decide? Do you decide in advance, this is going to be a time-limited therapy?

HL: For some modes of brief therapy, Mann’s model for example, the time-limited nature of the therapy is very critical. In TLDP, it’s not critical. In fact, I think if Hans Strupp and Jeffrey Binder had a chance to rename their approach, it would be something more like “Focused Dynamic Therapy.” And take the “time-limit” out of it, because it doesn’t so much weigh on the brevity of time. Really what heats up the session is the focus on what’s happening in the here-and-now, and being very aware of that in the here-and-now.To get to your question, Victor, about do I decide ahead of time or do I decide as the person comes in, it’s a mutual decision. Again, it’s not a unilateral decision. So what is the person interested in? Where do they see they want to go? I do believe in having windows of opportunity where we might stop the ongoing process of the work and reflect, where are we? Are we at an ending place? Or a client might say, “Gee, I think I’m at a place where I can end.” Or we might just say, “So where are we and what have we gotten out of our work?” There should be windows of opportunity all along the way to reevaluate. It helps keep everyone on the same page, and I think also helps us put our clients’ needs first.

VY: So we’re not just assuming longer is better.

HL: Definitely not assuming longer is better. As my colleague Michael Hoyt has said, “Better is better.”

RW: Better is better, Hoyt can make that a book title.

HL: I think he has. Yes, better is better, not longer is better!

Is Cognitive Behavioral Therapy the Gold Standard?

VY: In the media, almost every time there’s an article now – somehow brief and cognitive therapy especially, seem to take all the limelight. It’s referred to repeatedly as the gold standard, proven, that it’s empirically validated. Psychoanalysis is often set up as the straw man, where Woody Allen goes forever and never gets better. You’ve been involved in lots of research, and my sense is that good therapy is always good therapy, regardless of these orientation differences. Do you agree that the research shows that cognitive therapy is so superior, and if not, why is it getting all the attention?

HL: Well, it certainly is getting a lot of attention. I do keep up on this literature and I write an updated review chapter on cognitive therapy about every ten years for the Review of General Psychiatry. One of the reasons that the research is coming out favoring cognitive therapy has a lot to do with NIMH funding. NIMH uses the medical model and experimental design as the gold standard and cognitive therapy certainly lends itself to discreet interventions that are made in experimental control designs. In addition, the research design often involves having patients who do not suffer from any other condition other than one diagnosis. So no complex cases, you must find subjects who have an anxiety disorder but who are not addicted to substances, who are depressed but don’t have marital difficulties, who do not have a medical problem, and so on.

VY: Pretty hard to find.

HL: Yeah, pretty hard to find, but you can find them for research purposes. So while the studies are easier to do, easier to analyze, and the results can be shown in a clear-cut way, the transition for the practicing therapist dealing with the populations in the real world, is problematic and might not hold much water. The studies do not generalize or apply readily to real clinical populations. However, I also want to say it could certainly lead to wondering about certain interventions that could be incorporated into messy or real clinical situations.I should note that I’m very impressed by the research of Louis Castonguay and Marv Goldfried who have done a beautiful job of really looking at a more sophisticated version of cognitive therapy which takes into account factors such as the therapeutic relationship, the alliance. Safran’s book on interpersonal processes and cognitive therapy is also one of my favorites.

RW: It is my read that APA’s position on evidence based interventions, in particular, Norcross’ work, has room for the therapeutic alliance and relationship as part of these protocols and manuals in addition to the more CBT technique like approaches.

HL: Unfortunately, the evidence based focus on the therapeutic relationship had to come up as a reaction to much pressure — it would have been nice if we could have been more proactive and been out in front of the curve.

VY: Back to the protocols, I’m interested. From your experience in the CBT world, do CBT therapists follow the protocol, perhaps, that’s not “better” to them as well.

HL: Right, that would not be the best approach for their clients. You have to do an idiosyncratic formulation. You have to know when, for this particular individual who’s sitting across from you, when to follow the protocol and when not to, or when the protocol must be adjusted. Jackie Persons’ work in this area is superb.

VY: So I take it you’re not a big fan of manualized treatment?

HL: I’m not a big fan of rote manualized treatments. I think manualized treatments can be wonderful to teach from but not with the point of view of follow it exactly, do this, then this, then this – kind of in a robotic fashion.

VY: Unless you’re treating robots. Even in these severe research conditions you describe, is it in fact the case that cognitive behavioral approaches show superior results to just an experienced, integrated eclectic clinician?

HL: Depends on the study. Some of them show clear-cut advantage. For others the results are more complex. I’m also very mindful as a researcher that who conducts the outcome research, is very critical – that one of the best predictors of the outcome of the study is the theoretical allegiance of the investigator.

VY: So when you read these same articles that I do in Newsweek and the popular media referring to CBT as the gold standard in therapy, what’s your reaction to that?

HL: Take it with a grain of salt. I’m going to have to leave soon, just to give you a head’s up.

Running out of Time

RW: What time to you have to be out of here?

HL: I probably should leave here at noon.

RW: So, can we ask a few more questions? Seems there is a limit on our time here as well.

HL: Please.

RW: What types of client is TLDP intended for? Adults, kids, couples, families?

HL: Good question. Yes, it can be done with individuals, couples, families and groups because of the systems orientation, so it’s going to be looking at interpersonal interactions. It was designed for individuals. I have taken it to the level of dealing with couples, and I know others talk about the similarities with Irvin Yalom’s approach to group therapy, but I don’t know anyone who is purposefully looking at a TLDP perspective within groups per se.

RW: What’s the most satisfying part about doing clinical work for you?

HL: Just the honor of being let into people’s lives. It is really so phenomenal to be let into the depths of their lives like so few people are, and I feel very honored by that.

VY: You’ve obviously been practicing for a few years now, and you’ve trained hundreds of therapists. What are some things that you know now about doing therapy that you didn’t know originally or when you were younger? What are some key points for young or developing therapists that you could pass on to them?

HL: Don’t be afraid. Don’t be afraid to share who you are, to really make who you are work for you. Yes, the theories are important, the expertise is important, the learning is critical, but that which is uniquely within you, make that work for you. If you have a good sense of humor, make that work for you. If you’re more reserved, make that work for you. Whatever it is, that’s what makes for the best therapy possible.

RW: That’s a very good point. Some theories of therapy are extroverted therapies in what they call on the therapist to do. Psychoanalysis pulls for a more of an introverted approach, meaning the therapist is more reserved and less interactive. CBT is a more of an extroverted approach, where you’re coaching more, and so forth. Yet some quiet CBT therapists are wonderful, and some analysts find a way to practice using their extroverted personality.

HL: Yes, make it work for you.

If you can bring the combination of who you are and your unique gifts combined with the expertise, that’s unbeatable.

RW: I think you’re right. Many of the master therapists that we’ve interviewed have focused on the therapist bringing themselves to the encounter of psychotherapy. That whatever you do–the more you can bring yourself into your work, the better it is. And I think it has a lot to do with countering much of what we have been taught, but also it has to do with being vulnerable and being willing to take risks. Well I see we’re at the limit of our time today, so I want to thank you for engaging in this thought-provoking discussion.

HL: I’ve enjoyed it myself. Thank you.

Michael Hoyt on Brief and Narrative Therapy

Posted on June 21, 2010February 27, 2026 by rezendevknowfully.com

The Interview

Victor Yalom: I’m really pleased you agreed to join me today for this conversation. I’m going to try to pick your brain in the short time we have, to really find out about you as a therapist and as an innovative thinker in this field.

Michael Hoyt: I appreciate the opportunity to meet with you. I wanted to start by asking you a question, if I could: What was your particular interest in inviting me to participate in this exciting series?

VY: My vision for this interview series for Psychotherapy.net is to present therapists that are doing really innovative yet practical work, despite the pressures that we are all facing on various fronts. I’m most interested in those who are finding a way to be excited about what they’re doing. I’ve had a sense from your work that you fit in that camp.

MH: Thank you. I’m delighted to be included. I’m very excited to participate.

Narrative Constructivism: Is it All in the Mind?

VY: So, you’ve written a new book.

MH: Yes, it’s called Some Stories Are Better Than Others. It was just published two weeks ago by Brunner-Mazel Publishers.

VY: How did you come up with that name? Obviously, it has a lot of meaning for you.

MH: It does have a lot of meaning. I’ve become, in the last several years, more and more interested in what is sometimes called narrative constructivism, how people put their story together. Rather than having the idea that we discover our reality, or that it’s an objective thing that we find, we are oftentimes creating it. How we look at things affects what we’ll see; and what we see affects what we’ll do. I think that as people live their lives, they may generally be doing fine, but when they get stuck it’s often because they’re telling themselves a story or constructing a world view or a narrative that isn’t satisfying to them—it isn’t self-fulfilling in a good way, but instead it’s frustrating. And people will come to therapy looking, in essence, for a new story, a new way of understanding, a new perception—which can lead to new behaviors and new outcomes. So some stories are better than others—because some stories give people more of what they want in life, where other stories will be more self-limiting. My recent influences include the work of Don Meichenbaum, Michael White, and Steve de Shazer, and other constructivist thinkers going back centuries.

VY: Just this morning, I was reading a book by Zerka Moreno about her late husband Jacob Moreno. That’s what he said about psychodrama—that it’s used as a way for people to construct their life. Existentialists thought the same thing: we’re here, we have to create our meaning, we create our lives with the resources we have. In that way, you’re following yet another tradition.

MH: It’s a long tradition. As I begin to say a few names of the people who’ve influenced me recently, I begin to think of all the people I haven’t mentioned, including Irvin Yalom, George Kelly, and a whole host of people. I think it’s important to realize, though, that this idea of narrative or story is not the entirety of people’s experience.Some people have misunderstood constructivism as meaning “it’s just in your mind” or “that’s your opinion.” Yet, it’s very important to recognize the realities that people are living in. To use the title of one of Michael White’s books, Narrative Means to Therapeutic Ends: the narrative is a means, it’s a vehicle

VY: There is a quotation in your book; something to the effect that social constructivism does not mean that external reality is irrelevant.

MH: Yes. As obvious as that is to say, there’s been a lot of misunderstanding, I think, and it’s become a kind of tiresome argument. We’re not saying that there’s nothing outside. We’re saying the knower has to know the reality, and that knowing involves construal, construction, mean-making, and so on. It gets filtered, mediated through our consciousness, and that we can affect consciousness The situation that people are in can be very significant.Existence determines consciousness as well as consciousness determines existence. Salvador Minuchin has spoken a lot about this. Take the example of people in terrible situations of oppression and poverty—a radical constructivist might say it’s all in the way they’re looking at it—but that would be an absurd position to take, not really appreciating the horribleness of their situation. So obviously we have to take into account social and economic issues, not just internal, intrapsychic processes.

VY: What you are saying, and relating it to the current reality of the therapy world, and what’s driving the idea of this website, is exactly this. Many therapists feel very oppressed, very disillusioned by the phrase, “realities of practicing therapy today”â€”managed care, a glut of therapists in many urban areas, lower fees. And the story that some therapists tell about themselves is that “we’re in the wrong profession at the wrong time, and there’s not much opportunity.”

MH: I’ve seen and experienced some of that personally as well. There’s a lot of demoralization. I think at the extreme psychotherapists are somewhat of an endangered species. On the one hand, there’s the pressures of managed care: Get it done real quick, keep it on the surface and get it done quickly. Then there’s the pressures of biological psychiatry: Use medication and you don’t have to talk too much about it. It’s a very hard time. It’s an interesting coincidence that we’re meeting here at the Evolution of Psychotherapy Conference. “Evolution” requires pressures in the environment, and some kind of genetic variability, and then some new things can emerge. You don’t want to become extinct; you want new things to emerge.I wrote a different book, in 1995, called Brief Therapy and Managed Care. At that time, I expressed the view that there are ways of working with managed care. And I still think there are ways of working with some managed care, but more and more I’ve heard too many horror stories that have impressed me with how much difficulty managed care—especially in the for-profit sector—has been thus far in the world of psychotherapy. Managed care has not yet produced the promise we were hoping for, of being more efficient and distributing services to more people.

It seems managed care has mostly been cost containment, which has meant cutting people off, rather than finding new ways to help people.

The Archaelogy of Hope

VY: How does your recent book shift your focus?

MH: Well, the reason I called my new book Some Stories Are Better than Others is because I think we’re going to need to have a real shift in the field, in many directions, including looking more for clients’ strengths and resources, not just focusing on their problems, pathologies, and pain. The “archeology of hope” (to borrow the subtitle of the 1997 book Narrative Therapy in Practice, edited by Gerald Monk et al.) involves looking for competencies, strengths, overlooked possibilities, latent joy, and other little nuggets that we can pluck and bring forward. So when I say Some Stories Are Better Than Others, I think it’s going to be incumbent upon therapists more and more to see the whole person, not just the problems. I think it’s going to be much better if we’re competency-oriented, more collaborative, somewhat more future-oriented.

VY: I think, going back to Freud, the model is “what’s unconscious is usually bad.” A seething pit of conflict and aggression. While those things certainly exist, my experience has been that some of the most powerful changing moments in therapy are when people discover positive things about themselves that they didn’t know, that may have been repressed, or forgotten, or dismissed. Often therapists are looking for problems, they’re looking for pain and conflict, rather than helping the client develop the capacity to sit with positive feelings which is no easy feat either. If a client comes in with something happy or joyful, the therapist may redirect them into the pain, rather than help them sit with it and explore and really experience something positive, at a deeper level–almost running from the joy. Yet, staying with the positive can lead to profound awareness shifts and life change.

MH: As one of my colleagues quipped, most of the people in this field have been trained as “mental illness professionals,” not mental health professionals. We spend so much time pursuing illness and pain. Somebody will say, “I had a couple of good days, but then some bad things happened.” “Well, tell me about the bad things.” If somebody mentions pain, or sorrow, or looks sad or angry, we feel that’s where the meat is. We’re supposed to go for that. It would be interesting to me, not just to take a history of the present problem, but to take a history of the person recovering. “What in your past, what little clues or keys might help you deal with this better?”

VY: Or simply, “How have you overcome difficult circumstances in the past?”

MH: “How have you dealt with difficult circumstances? How have other people? Role models? Parents? People in your ethnic history? Are there examples you can draw upon? Ancestors you can call upon? Can you project yourself into a time in the future when things will be better? Imagine that time, and how are you going to get to that time? Thinking of times when things are better, a time that inspired you, can that give you some energy, some courage to go toward that?”

Some Stories Are Better Than Others

VY: Can you think of your work with a client where you helped them get to a better story?

MH: I’m thinking of a woman, I’m thinking of how to respect her privacy and confidence, thinking of how to say this – OK, a woman I’ve known for some time who developed a terrible case of multiple sclerosis. Over a number of years she became very incapacitated, to the point where she’s barely able to speak, incontinent, bed-bound. At one time she had been a fashion model—quite a lovely young woman.

VY: Pretty heartbreaking.

MH: Very heartbreaking, but that’s not the whole story. There is a lot of sorrow there, and we cried together over that. But if we see her as only an “MS victim,” then she’s really stuck. Then she’s been terribly delimited. I began visiting her in her home when she couldn’t come to the office. She has cats all over her house. So we started talking about the cats—they’re sitting in my lap—and I found out that even though she’s very limited, she’s doing animal rescue. She’s a phone counselor and helps place animals. I also discovered that she has a whole world of artistic and aesthetic interests. So we were able, over time, without denying the medical reality, to at least enlarge the picture. That she’s not just somebody with MS, but that she’s an animal lover/activist, she’s an art appreciator.She sent me a Christmas card last year—her condition has even worsened—in which she said—if I could think of the exact words it would be better—I’m so choked up thinking about it that I’m blocking on it. It will come back to me.

VY: What’s the feeling of being choked up?

MH: he feeling is that of being deeply moved. I love heroism, and heroine-ism. People triumphing over adversity. People who somehow, despite the odds, find a way to be happy. I met a kid recently down the street, a little boy who had some serious medical problems and he was in a wheelchair. In one way, you could look at him and see all the physical problems he had. And this little boy was laughing, and he had a balloon, playing. He was, at that moment, in a certain way healthier than I was. I was fussing and worrying about something, and he was experiencing the joy in life. I’m very interested in finding ways to bring out that joy for people.And sometimes it’s very hard. And it’s getting harder for therapists. Most of us, I think, went into this crazy business—this wonderful, strange business—for very good reasons. We want to make the world a better place, we care about people. And oftentimes we get suspected: “You’re doing this out of some neurotic need,” “Aren’t you co-dependent?” or “You’re on a power trip” or something like that. The term “countertransference” has gotten to the point now where therapists are sometimes concerned about themselves too much. (See references for Hoyt, 2001a, 2001b, 2001c 2002.) I think it’s very important for us to keep remembering the positive reasons we’re in this field. Otherwise, I think it’s a sure burnout.

VY: I think one way of doing that is to really be able to celebrate the triumphs with our clients. Were you able to emotionally share that joy with the woman you just so movingly described?

MH: Yes, and we both experienced it as a natural, genuine human encounter, not as a technique It’s very important for us to anchor, reinforce, praise, acknowledge, celebrate—whatever terminology you like—our clients’ successes and forward movements. In this case, our relationship has become very important to both of us. She had sent me a note and I wrote back thanking her for the session. I told her that there had been a couple of times that I had been very worried about something, and I thought of her example and it gave me courage.She inspired me: if she could find a way to live her life meaningfully and have joy in it, given the challenges she has, then that inspires me to do the same in my life. And for me not to tell her that would have felt inauthentic and incomplete.

VY: That’s wonderful! I think one way to avoid burnout is to give yourself permission as a therapist to really be human. So much of the training in our profession runs counter to this and teaches us to hold back so much of ourselves.

MH: It’s a fine line. Because I don’t want her to feel that she has to take care of me, or “I can’t tell him I’m having a problem because he’ll be disappointed,” so I think we have to be judicious.

VY: Yes, we don’t want to self-disclose simply because it feels good. You always ask yourself “Is it for the benefit of the client?” In this case it seems like a no-brainer that sharing your joy about her triumphs is a good thing to do.

MH: Yes. I can see ways it would not be if it became her obligation; if she needed to prop me up somehow. But most of the time I think we’re much too invisible; if we’re a blank screen then we’re not real. A colleague of mine, David Nylund, and I have developed an interesting exercise. It’s in my new book. We interview therapists, but we interview them as if they were one of their patients. So, you would interview me as though I had been this patient. And you would ask, “What was it like working with Michael Hoyt? What was helpful and what wasn’t helpful? What did he do that was really good for you? Did you ever let him know that you appreciated him?” There’s a whole series of questions which are useful in evoking the internalized client that we all carry around. We’ve used this in a lot of workshops, and people often say it’s a breath of fresh air, or “it’s like getting a different take on myself.” Particularly if we make it very real, if we start to ask a lot of specific questions. We all internalize our parents, our clients, our friends—all sorts of people. And I think they’re a source of revitalization. You can be reinvigorated if you can find a way to access what inspires you. And this particular young lady really inspires me.Hey, now I remember what the card said: “Memory is what God gave us that we might have roses in December.”

VY: My – how very sweet.

MH: Yeah!

Goals and The Discovery Process

VY: I want to go back to some of the other things in your work, in the brief /strategic/solution-focused types of therapy. One of the concerns I have involves the emphasis on goal-setting. How the hell can you set a goal with a client in the first session, when it is often the case that clients don’t really know what they’re there for? Their presenting problem is often so vastly different than what you’re working on four sessions later.

MH: I think that most clients do know what they’re there for, at least initially. And so I might say, “What’s your goal at this time?” or “As we start today, what do you think would be helpful? What would you like this to be like? How will you know this has been useful?” And then, now and then in the course of the therapy—whether it’s one-session therapy or 10 sessions or 100 sessions—I’ll ask “How’s this going for you? Where are you at now? How have we done in terms of the initial things we were talking about? What should be our focus now?”

VY: “How are we working together?”

MH: Yes. And “What’s next? Do you feel this has been adequate and sufficient? Do you think there are other things?”I think there’s a danger that we can act as though we know more about the client, or what’s best for the client, in ways that actually dis-empower the person. Jay Haley wrote a great paper many years ago called “The Art of Psychoanalysis.” You can keep saying to the patient, “You think that’s the problem, but there’s a deeper level.” Oral interpretations trump. You can always go “deeper.” You can say it was pre-Oedipal: “You’ll have to have years to absorb me, because we can’t even talk about it.” And you can kind of undermine the patient’s sense that they really have autonomy, and they really know what’s best for them. I think sometimes people come in and it’s not the goal I would pick; it seems to me too superficial. Or it’s just skimming the surface. And I’ll ask them, “Does that work for you?” And if they say it really does, I’ll say it’s fine. I might say—if I think they’re taking a solution that’s not really in their best interest — “I was thinking some other things that might be of some interest to you. Does that sound like something you might want to look at?” I might try to open some space. If the person says, “Nah, I don’t think so” or “Maybe someday,” I’ll say, “I just want to let you know it would be available. I’m not necessarily saying it’s good for you, or even true for you, but it might be something to consider.” I don’t want to give people the message, “You think you’ve dealt with this, but you really haven’t,” where you keep undermining their sense of self-control and autonomy.

Often times I think we’ve had the idea that we somehow have superior knowledge. And even if in some ways we know a lot, I think by following the client closely, rather than leading the client, in the long run, the person will become more empowered and more of a person.

You become a “person” by making “personal” decisions.

VY: I agree with a lot of what you say. We can’t know more about our clients, regarding the content of their lives, or in terms of what their actual goals should be. What we bring to the table is that we’re process experts. We can see ways that they’re holding themselves back, how they’re defending themselves. And we have real skills to help deepen their awareness, to deepen their inward searching abilities.
From another angle, one limitation of the question, “What are your goals?” is that it’s a cognitively framed question, and you’re going to get a cognitive response. A few sessions later the goals and the awareness can get larger if they’ve explored new territory and are starting to think and feel differently about themselves or their body.

MH: Yes. We’re using certain metaphors: “superficial vs. deep,” “cognitive vs. in your heart.” And they can be useful metaphors, sometimes. So my deconstructive mind says, “What do we gain and what do we lose?” I’m familiar with the “deep” concept, and I sometimes think that way. I might, even in a brief therapy, say, “Does that solution fit all the way through? I know it sounds good in the ‘top of your head,’ but how does it set in your gut?” or “Does it fit all the way in your life?” or “Is there any part of you that doesn’t feel right with that yet?” We have all sorts of language—we say “the tapes are playing,” there’s an “unconscious,” and all these different metaphors. They all can be useful. I think it’s critical, to try and stay as much as I can in the client’s frame, in the client’s phenomenology.I am not an expert at everything by any means. But I am something of an expert at asking questions. We want to help create a discovery process, and we can ask questions that will open vistas, that will get people to look at things differently, without necessarily directing them. Not “You should do this and this and that.”

For example, you might say to a depressed client: “What you call depression, what else might you call it? Some people would call that sadness. Or some people would call that oppression rather than depression. Is something putting you down or holding you back?”

Managed Care… Or is it ‘Mangled Care’?

VY: Let’s switch to some practical issues. You’ve worked at Kaiser, a large HMO that gets a lot of bad rap from psychotherapists, as any HMO or managed care company does. How have you dealt with that? Obviously you care passionately about the field, and it’s clear from this conversation that you do deep, meaningful work. And yet I’ve heard so often that at Kaiser you have to average 5-6 sessions or less per client. Also, you might see them for the first session, and then your schedule is so booked you can’t schedule a follow-up session for three weeks. How do you work within such a system?

MH: I’m not here as a Kaiser spokesperson, but let me respond to several things you said. It’s true I’ve worked at Kaiser for 20 years, and I’m certainly aware of people’s comments, that it’s “get them in and get them out.” I think the pressures of managed care are affecting everyone, unless you have private pay patients and their income is such that they don’t have to worry about the economics of it and can come as often as they want. There is a major distinction between the for-profit HMOs, who generate most of the complaints, and the not-for-profit HMOs, of which Kaiser is one. No system can be everything for everyone, but it’s the for-profits that rake a large profit off the top rather than putting it back into services. Many years ago I coined the phrase “mangled, not managed care” to describe what some companies often wind up providing. According to all the polls—Time andNewsweek and U.S. News and World Report and various newspapers—Kaiser has actually gotten excellent ratings within the HMO world.There’s also a conflating or confusion between the idea of length of treatment and depth of treatment. There are some patients that I have seen once or twice or three times and it was “deep” or “heart” work or whatever one would call it. And other patients I’ve seen for long periods, it never really had much soul or passion in it. So I don’t think that length of treatment is always the indicator of what is better.

What I have tried to do is a number of things. I’m fascinated with people, and I’m almost an anthropologist at times. I’m curious how people got to be who they are, what makes them tick, what their hopes are.

VY: How does that work in your brief therapy?

MH: For me, the hallmarks of brief therapy are the development of a collaborative alliance and an emphasis on clients’ strengths and competencies in the service of an efficient attainment of co-created goals.In brief therapy, people can get unstuck, or get back on track, get their process going, but I usually don’t get to hear the whole story. I might get to hear one or two chapters or an interesting pivot or turn and then they carry on and do their work without me. I think it’s one of the differences between more traditional longer-term versus briefer treatment. At the risk of oversimplifying it, with the former, the therapist goes well down the road with the patient, around lots of turns, with this shared idea that, “eventually we’re going to terminate.” Whereas the brief therapist, as soon as things really start moving, they’re saying, “We’re only going to meet a couple more times, let’s talk about relapse prevention.”

VY: So you can do some very useful things within the constraints of the system. And certainly it is better than no progress at all. But in terms of what feeds the soul of the therapist, and prevents us from getting burnout, that may be harder. We have a lot of difficulties in our professional life. We’re dealing with lots of people with pain. We’re not making as much money as a lot of other equally intelligent professionals. So we want the emotional gratification/satisfaction that the work brings.

MH: Freud said somewhere that the therapist should have the most satisfying personal life that he or she can have, so they won’t look to their patients to make their life meaningful, to give them satisfaction. And I think some therapists have a strong need—I don’t quite call it “addiction” or “co-dependency”—but there’s some emotional reliance on the experience of getting close and being trusted. It’s beautiful when it’s happening. But sometimes I would ask, “What and whose needs are really getting served? Is it my need to be a long-term therapist for the gratifications—maybe not financial ones—

VY: —or maybe financial.

MH: Yes, maybe financial. I think there are some monetary incentives as well.

VY: Of course it cuts both ways. Clearly, as a private practitioner, there are financial incentives to keep patients long term. There’s no way around that. And, conversely, in managed care, where someone has a pre-paid health plan, or a capitated contract, it’s to the institution’s economic incentive to keep the treatment shorter. So the economic incentives are there; we live in a free market economy; we know the impact of prices and money. And I think private practitioners need to be aware of the point you just raised, just as managed care needs to be aware of the converse dilemma.
How do managed-care therapists and companies deal with this? Weren’t you in the management end at one point? How do you deal with that? To know that you’re doing that right thing, and not being coerced by economic pressures from up above?

MH: As well as being a full-time clinician, I was the director of adult services at a large Kaiser facility for many years. I stopped being the director a few years ago because I had some other interests I wanted to pursue. I think it’s a complicated question. I address it at length in two chapters on likely future trends and attendant ethical dilemmas in my book, Some Stories Are Better than Others. There are lots of thorny issues, and 40 or 50 pages of discussion. I think we have to find ways to continue to function as professionals, with the intertwined implications of competency, autonomy, responsibility and ethicality.

VY: We certainly have to try to.

MH: As much as we can. And there is the fact that “he or she who pays the piper calls the tune,” to some extent. Although it’s true that that we are economic animals, that we’re trying to make a living, we have to safeguard what we think is best for clients, whether we’re working in fee-for-service, managed care, or in whatever arena.This long pre-dated the managed-care issues. Imagine if a patient came into a private practitioner’s office with a long list of issues and problems that obviously required long-term intensive treatment. And imagine he or she says “But I don’t really have any money—I can only pay you $300 total.” Many well-intentioned practitioners would say something to the effect of, “Well, I can see you two or three or four times.” They might do sliding scale, and maybe pro bono for awhile. But sooner or later they would also say, “If you can’t pay, I’m not going to be able to give you professional services on an ongoing basis.” So sometimes I’ve wound up in a situation discussing with patients—whether it’s in an HMO or in a private setting—”How do you propose to pay for this? This is a professional service. For consideration of a certain amount of money you’ll get a certain amount of service.” It becomes a very complicated thing, because you don’t want to just cut people off—but you also need to make a living

Hoyt Under Pressure

VY: Let me put the pressure on you a little bit more.

MH: Good!

VY: I know that at HMOs like Kaiser, and others, in their benefits they give up to 20 sessions per year, and then if you read the fine print, it says, “As needed per medical necessity” Where do you draw the line? Five sessions versus 17 sessions? And what’s “medical necessity”? It’s not really a medical treatment to begin with.

MH: I have a big objection to the term “medical necessity.” I much prefer to call it “clinical necessity.” And they have defined clinical or medical necessity in terms of four dimensions, in general: One is a legitimate DSM-IV Axis I diagnosis. A second is “likely to show significant improvement,” meaning “it’s necessary because it will really help.” A third is “necessary to avoid a worsening,” meaning that if we don’t do it, the patient is going to wind up worse. And the fourth, which has a lot of slimy politics around it, is that some companies are using the DSM-IV, Axis V, the Global Assessment Functioning, just setting a number: they have to be below a 55, or below a 50, or below a 60.

VY: Whatever that means!

MH: Whatever that means. It’s semi-operationalized. But, how low do they have to go? How sick do you have to be? It’s counterproductive and, in my mind, stupid, to say that you have to really fall apart, and then we can start therapy.

VY: There’s an incentive for therapists to make the person look worse! An incentive to game the system.

MH: Right. What happened a long time ago is that we, as a field, made an alliance with the medical model. And insurance has been treated as an entitlement: “I’m entitled to my 20 sessions,” or “I’m entitled to as much as I want.” Whereas it has been written, in contracts, that only if it’s a diagnosable “illness” and a “necessity” will treatment be covered.

VY: By doing that we signed a pact with the devil, if you want to call it that. But whoever bought into that is saying, “I’m going to agree that this is the illness model, the medical model.” I agree with you: If we’re going to go for that, we play by those terms.

MH: And then we’re in the language of DSM pathology, the language of the medical model, and then we’re into “Axis I,” “presenting complaint,” and “symptom resolution.”

VY: And all that jazz.

MH: I do think it can be useful, to a point, at times. It depends what we’re doing therapy for. When people are having panic attacks, and it’s turned into panic disorder, it’s a fairly circumscribed thing. Sometimes diagnosis is not a bad thing. Other times, people want to come to therapy for a kind of growth therapy, or personal enhancement. I’ve been in therapy for those reasons, more than once. It’s a question about whether insurance should pay for it. “I wasn’t there to treat DSM IV, I was there to grow Michael Hoyt.” Insurance is for one thing, but this was a different process. HMOs and other managed-care companies are needing to specify what will and will not be covered, and for how long. (Hoyt, 2000, Some Stories Are Better than Others, Ch. 4, “Likely Future Trends and Attendant Ethical Concerns Regarding Managed Mental Health Care” and Ch. 5, “Dilemmas of Postmodern Practice Under Managed Care and Some Pragmatics for Increasing the Likelihood of Treatment Authorization” (with Steven Friedman); and Hoyt (2001d). Also see “The Squeaky Wheel: Don’t Let Managed care Shortchange Your Clients.” Family Therapy Networker, 25(1), 19-20.)

VY: But that’s such a hazy line. When you talk about the woman with MS, you talk about despair and hope and inspiration. Where is the line between treating illness and symptoms, and growth?

MH: Yes, and one of the ways that treatment was justified to the insurance company was that there is some well-known research, with 50 or 60 replications, that good psychotherapy services reduce unnecessary medical utilization. That’s one of the ways to sell it to the HMOs, showing them the bottom line. And so, if she could have some visits with the psychotherapist, there weren’t going to be so many visits to the internist and the emergency room and the internist. We may have to be “bilingual,” so to speak.I could articulate “symptoms” and “enhancing coping” when I had to, but when I was with her, I wasn’t doing medicine, I was doing humanity.

Words of Wisdom

VY: Before we stop, any words of wisdom or advice or inspiration to the hordes of therapists, many of whom are feeling disillusioned with the field? What do you say to them?

MH: I hope these are words of wisdom; they’ve been wise for me, and they may fit for somebody else. I think it’s good to get more training and read books and go to workshops. I think that’s helpful, but what we really need to do is remember why we came into the field, and honor it. We need to come from our heart. We need to come from our soul. We need to follow our passion, as Joseph Campbell used to say. Sometimes there is a lot of pressure and unpleasantness. That’s true. But don’t let the bastards get you down.Don’t let them define your reality completely. Work hard and keep hope alive—right livelihood is worth it.

I think another word of wisdom is that it’s important to be multi-theoretical, to have different lenses you can look through. The other word is “eclectic,” but I don’t like that word because it sounds like “chaotic” and “electric” in the same breath, like when you throw techniques at someone and you don’t know why. But I think it’s important to be “multi-theoretical.”

We’re in this wonderful, strange business: we go into small rooms with unhappy people and we try to talk them out of it, so to speak. We’re here at the Evolution of Psychotherapy conference. The first speaker was brilliant and right on. And the second speaker was brilliant and right on, and completely contradicted the first. And the third said something really brilliant and right on and had a very different perspective—and each of them and their proponents have helped thousands of clients. Not everything is equal, but there are different ways to go, and nothing works all the time.

I think when you’re stuck — and we all get stuck every day — we don’t quite know what to do or the therapy isn’t going anywhere—the first thing I’d do is consult my client. “How is this working for you? What am I missing? I don’t think we’re looking at this the right way. What are your thoughts and ideas?”

VY: Instead of peer consultation?

MH: Yes, I would start with the client, rather than assuming the resistance is in the client.The first place resistance exists is in the therapist. We have a resistance—we are looking at things a certain way that doesn’t let things go forward. I would start with the resistance being in me, than I would look at the resistance in the interpersonal field, that is, something not working between us right. And finally, and only finally, I might ask, “Is the resistance in my client?” Too often, when it’s not going where we want it to go, we say “”Oh, they were Axis II,” ‘or “There’s secondary gain,” or “They didn’t really want to change,” or “They really like suffering,” or “They’re too attached to their negative affect because of their early experiences with abuse.” We’ve come up with something to explain it, as though the other person is the problem rather than the difficulty is in our understanding them better.

VY: “If it doesn’t work, it’s their fault.”

MH: Right.

VY: “And if it works, it’s our doing.”

MH: Yes. There’s an old saying, “When you point a finger at someone, there are three of them pointing back at you.” So I would take this and say, “What’s going on with me? What am I missing?” That’s one thing I would do.I would also suggest talking to people who have a different theoretical orientation than oneself. If you’re psychodynamic, go talk to a cognitive behaviorist. If you’re a cognitive behaviorist, go talk to a Jungian. If you’re a Jungian, go talk to someone who does biological psychiatry, and so forth. Because the way you’re looking at it, your lens, your frame, your conception, may not allow you to see the client and to see solutions in a way that’s going to be helpful for this person. We often want to go talk with someone we really trust, someone we went to school with, because we had the same professors and the same books are on our shelves. Sometimes it’s like talking to a mirror. You almost know what they’re going to say; they’re going to confirm your pre-existing beliefs, because they have the same frame. It’s OK to do that, because sometimes you get ideas. But if you’re not getting the ideas that are going to move the therapy forward, it’s time to talk to someone from a different orientation. How you look influences what you see, and what you see influences what you do. And if you’re not seeing something helpful, get some new glasses. Some stories are better than others.

VY: Thanks, you’ve helped expand my perspective and greatly enriched my understanding of what your work is all about.

MH: I really appreciate your interest, trying to follow some passion and bring some energy and life into the field by interviewing different people about what turns them on. I would encourage people to look at this whole set of interviews, not just the people they may already be acquainted with. All the people who are going to be interviewed have something to say; if you can hear it. It’s important to stay curious.I used to think that if something didn’t turn me on, it meant that it wasn’t good. I have now discovered that if it doesn’t turn me on, and (especially) if it turns lots of other people on, maybe it’s something I’m not hearing.

VY: Again, the three fingers are pointing backwards.

MH: Thank you for the opportunity.

VY: Thank you so much.

Insoo Kim Berg on Brief Solution-Focused Therapy

Posted on June 10, 2010February 27, 2026 by rezendevknowfully.com

Victor Yalom: You were not born in this country?

Insoo Kim Berg: You think so? (laughter)

VY: Your vita says that you went to college in Korea.

IB: Yeah, yes I did.

VY: How did you end up coming to this country?

IB: To go to school, of course. To get better educated. I came in 1957. I was a pharmacy major in Korea. I came, supposedly, to continue my pharmacy studies. And my parents let me go.

VY: That was a way to get out of Korea, or get out of the family?

IB: To get out of the family, yes. But I thought seriously I wanted to study pharmacy, further my education. One thing led to the other. I did quite a bit of work as a tech because of my pharmacy and chemistry background. I was very comfortable working in an animal lab. I worked for a guy who did stomach cancer research at the medical school. I was very tempted to stay because I was getting good money. I was writing papers with him. I have to tell you, though, I did a lot of work with white rats—surgery on white rats! And I was very good at it because of my delicate hands. They have such a tiny, tiny veins. And you have to cannulate them.

VY: Which means?

IB: You cut a little slit in the throat and put a tube into the bleeding vein. I was pretty good at it! That kind of stuff is fun. One of the things I learned working with white rats is that the rats die on you sometimes. And if you stop at about 2 p.m. it’s too late to get started with a new rat because it takes so many hours for the real experiment to get going. Sometimes I worked there until 8, 9, 10 o’clock at night, because once you get going you really want to stay with it. Sometimes you just say, “I’m so tired….” So I found out that if you put a little air into your vein, it kills you. It does.

VY: Their veins right, not yours?

IB: You know if you shoot air into them it kills them.

VY: So I’ve heard.

IB: So, I would do that. At 1 o’clock or so, I’d say, “I’m done for the day. I’m going home.” That’s my confession. I hope I didn’t kill too many rats. I didn’t keep track. That’s one of my secrets that nobody knows about; but here I am telling you!

VY: So you had such a good scam going, what encouraged you to go into social work, which is much harder work?

IB: Yeah, and much less pay! I really did have a good scam going. I could make my own hours, work late if I wanted to.

VY: So how did you get interested in social work and therapy?

IB: I had never heard of social work before. I got into pharmacy studies because my family was in the pharmaceutical manufacturing business. That was one of the reasons I was selected to be the family pharmacist—that was the scheme of things. I was really shocked when I first came to this country and talked to people younger than I was. They would talk about how they decided they wanted to study something.I thought your parents decided for you and then you obeyed your parents’ wishes. Students in the US had a choice in their area of studies. I was absolutely shocked by that. The idea just blew me away. And so then I got this idea: my parents are 7-8,000 miles away. They have no idea what I’m doing here. So maybe I could do the same. It kind of slowly dawned on me. So I actually switched to social work.

VY: What attracted you to that?

IB: The idea of helping people.

VY: Rather than killing rats!

IB: Rather than killing rats. Make up for all the rats I’d killed! So I switched majors, and I didn’t tell my parents. I thought, “They won’t know.” I didn’t tell them for about two or three years. Eventually I did tell them, and they had no idea what social work was. They’re dead now, but I think even until they died, they had no idea. Pharmacy they understood. Medicine they understood. The rest of the stuff—all the soft stuff, they had no concept of that. So I got away very easy. They didn’t give me any grief. I didn’t tell them about anything. Why talk about something? Why create tension? So I just did my stuff. It was pretty nice. Coming to the United States was a good thing personally as well as professionally.

Phenomenal Failures

VY: What was your initial training in social work and therapy?

IB: I went in the direction of family therapy. That really attracted me. I commuted to Chicago for a couple of years after I got out of graduate school. Those were exciting days in family therapy—the late ’60s and early ’70s. Haley’s work, MRI work, and on the East Coast people like Lyman Wynne were doing some amazing stuff as well.

VY: So your initial training was in some of the briefer, strategic therapies?

IB: Not at all. During my initial family therapy training I had to keep a family in treatment for a year. That was a condition for graduation. It’s very hard to do with a family.

VY: That’s a different incentive. Your approach now is to solve the problem as quickly as possible.

IB: Absolutely.

VY: But your mandate at that point was to keep them in treatment as long as possible.

IB: Yes, and I did. I had one family in treatment—I have no idea how I did that. Of course, I didn’t meet with them every week. One year could have been maybe 10 times. But I did it.

VY: Today you make a point of not continually asking about clients’ problems. Instead, you focus on asking them how they’ve been solving their problems. But at that time you had to keep making sure they had enough problems to keep them in treatment.

IB: In those days, family therapy was still very much like Murray Bowen’s ideas. It’s a literal translation from psychoanalytic concepts to family concepts. So, he had stuff like, what was the word? “Undifferentiated ego mass —if that isn’t psychoanalytic? So that’s what was available in those days. That’s all there was. People who were pioneers in family therapy came from that kind of psychoanalytic background themselves. It was a natural transition. Of course, I was trained in that as well, so it was a very comfortable transition for me.

VY: When did you realize it did not fit for you?

IB: I realized that it was just not helping the families, not helping the clients. I pretty much worked with working class families. I don’t understand all of it, since I come from a fairly financially well off family background, but I felt so comfortable working with working class families. They’re not interested in “insights” or “growth,” or “development”—they’re interested in getting the problem out of the way. Here I was using a very psychoanalytically-oriented family therapy model with these clients.It was such a bad fit. It wasn’t working very well. So I had some phenomenal failures with families, which disturbed me terribly; I wasn’t used to failing. Academically all my life I had been successful, and here I was with all this education and I felt like I was such a failure. I couldn’t stand it.

VY: Where did your ideas go from there?

IB: So I searched and looked around and came across Jay Haley’s writings. It just blew me away. Because I was raised as a Presbyterian. I read the Bible many times, because that’s one of the things you do when you’re a Korean Presbyterian! Anyway, Jay Haley had this article called, “Power Tactics of Jesus Christ.” I said, “What the hell is this?” It’s such an upside-down way of seeing the old Bible stories about Jesus that I had grown up with. I thought, wow, what is this? I became fascinated with this. I just kept reading and reading. And then I came across the MRI approach. I lived in Wisconsin and commuted to Palo Alto, California, to train there. That’s where I met up with Steve; he was living in Palo Alto at the time. He came from Milwaukee, so somehow we got together.

VY: You’re referring to your husband, Steve De Shazer?

IB: Right. He says I put a spell on him. But somehow I convinced him to move to Milwaukee. Can you believe that? Palo Alto to Milwaukee! And he did. And we formed a little group, a team of us. That’s how we got started. Our initial goal was to create a Midwest MRI, in Milwaukee.

Solution Focused Model

VY: This is probably difficult, but can you say in a nutshell what are some of the basic principles of solution-focused therapy?

IB: Instead of problem solving, we focus on solution-building. Which sounds like a play on words, but it’s a profoundly different paradigm. We’re not worrying about the problems. We discovered, in fact, I don’t say that just for an audience today, but we discovered that there’s no connection between a problem and its solution. No connection whatsoever. Because when you ask a client about their problem, they will tell you a certain kind of description; but when you ask them about their solutions, they give you entirely different descriptions of what the solution would look like for them. So a horrible, alcoholic family will say, “We will have dinner together and talk to each other. We will go for a walk together.”

VY: These are the solutions.

IB: Yes. We kept hearing this and we asked, “What is this?” No matter what the problem is, the solution people describe is very similar. Whether it’s depressed people or people who fight like cats and dogs, they still describe the solution in a similar way. They will get along, talk to each other.

VY: The solution being the outcomes. But to get from A to B,that must vary a lot from person to person.

The Miracle Question

IB: That’s where we learned the miracle question, as the quickest way to get there.

VY: And the miracle question is?

IB: “Suppose a miracle happens overnight, tonight, when you go to bed. And all the problems that brought you here to talk to me today are gone. Disappeared. But because this happens while you were sleeping, you have no idea that there was a miracle during the night. The problem is all gone, all solved. So when you are slowly waking up, coming out of your sleep, what might be the first, small clue that will make you think, ‘Oh my gosh. There must have been a miracle during the night. The problem is all gone?'” And that’s the beginning of it. People start to tell you, and they add more and more descriptions.”How could your husband tell that there was a miracle for you during the night? What about your children? What would your colleagues do?” You keep expanding the social context wider and wider.

VY: So then they can start to visualize some concrete steps that could get them to a better place?

IB: Right. Then the followup is, “What do you have to do to get this started?”

VY: To play devil’s advocate, these people may have had other people in their life give them very sensible advice, or asking them, “Why don’t you try this?” or “Why don’t you stop drinking?” Evidently, they have not been able to make those changes, up to the point of seeing you.

IB: Right. That’s why they show up.

VY: So, it sounds so simple.

IB: It is.

VY: So, but why haven’t they made those changes already? How does asking these questions help?

IB: Because we are asking them about their own plan. Not my agenda for you, but your plan. You didn’t even know you have a plan. You actually don’t when you first walk in. You tell me you have no idea what to do. And then in the process of talking, you start to gradually, through this building process, to develop a blueprint.

VY: So you think people have some kind of blueprint to help them grow and change?

IB: No, I think they have all the necessary bricks and lumber, somewhere lying around, but they don’t know how to put it together. I think that talking to me helps them figure out how to put it together. Not only create the blueprint, but which lumber goes where, which piece goes where. That’s how I see it.

VY: Isn’t this somewhat similar in its underlying philosophy to, say, a humanistic approach to therapy? That people have these innate abilities inside them for growth that somehow are blocked.

IB: Yes, I suppose. I’m not familiar with the humanistic approaches. As I said, my background is very psychodynamic.

VY: Well, even from a psychodynamic point of view, people have various strengths and capabilities. But the psychodynamic approaches tend to focus on what the defenses are, or what the blocks are, to people growing and blossoming, and then attempt to help clients remove those blocks. And that’s very different than your approach. You don’t focus on the blocks.

IB: Right. We assume people want to have a better life. We trust that people want to have a better life.

VY: Some people would criticize your approach by saying that clients may not be ready to make those changes, or they may not feel understood. They’re feeling depressed and hopeless, and you’re talking about all the things they can doâ€”or you’re helping them talk about it. But perhaps they need you to first understand how depressed and hopeless they feel. When I see you on videotapes, you’re very optimistic, you’re very enthusiastic. Some people would say you’re not meeting clients where they’re at. How would you respond to that?

IB: That’s not my experience of clients.Clients don’t complain to me, “You don’t understand. Why don’t you listen to me?” They feel very listened to. Because I think that when they decide to do something about their problem, they already recognize that whatever they’re currently doing is not working. So there is this hopeful side of them. If they didn’t have any hope that this could be solved, for example, they wouldn’t even bother. But they must have hope, otherwise why would they go to the trouble of calling up for an appointment, showing up, and paying for it. So I am addressing the hopeful side of them. Otherwise they would have given up a long time ago. Some of these people have been suffering from the same kind of problem for years and years.

VY: So you are allying with their strengths and their hopes.

IB: Absolutely! Right.

VY: I think you have an unusual ability, because you have a natural kind of energy, enthusiasm, and hopefulness that is contagious.

IB: I’m not aware of that. People tell me that, but I’m not aware of that.

VY: I guess another danger that could occur in Solution Approaches is that it is focused so much on techniques: the miracle question, scaling, and so on. Do you think there’s a risk that, like any technique, a therapist could grab onto the technique and apply it without a greater context?

IB: Sure, but that’s the first step. When you learn piano, you have to teach finger technique first. Then after they master that, then go to the next level, the artistic side of it. But without the technique, how can you get to the artistic side of it?

VY: You work with some very difficult clients. Do you think this approach is generally useful for all types of clients? Or do you think there are some types of clients it’s not as useful for, who would benefit more from longer-term approaches?

IB: Steve talks about this. I wasn’t there, but he was doing a workshop for two or three days, and at the end of the workshop somebody raised their hand and said to Steve, “Does this work with people with normal problems?” (laughter) So Steve said, “No,” with his usual humor, “It will never work with normal problems.”So that’s what makes me laugh. So, yes and no, it depends on what you mean by work. If work means, they are going to be living happily ever after, then no. We have a very narrow sense of the goal. We really insist on that from the beginning: very small, achievable, realistic goals. So our job is to carry the client to there. No happily ever after. Then, at least we got them on the right track. The rest of the journey is on their own.

VY: And what happens if someone wants to shoot for a larger change, say, someone who has never been in a successful relationship due to character difficulties. They want to make some more fundamental changes in how they relate to people so they can have a successful, intimate relationship. Would you work with someone like that? Or do you think other types of therapies may be better suited for that?

IB: I would work with that person. Let me give you an example of how I would do it with such a client. I would say something like: “You want to have a good relationship with someone of the opposite sex. So tell me what’s been good about the relationships you’ve had. How did you get that to happen? (Then I negotiate with that.) So you know how to get involved with a relationship?”The client might say: “I am able to get into relationships but they never work out. The beginning is fine, I know how to do that.”

I would respond with something like: “So it’s the middle part of the relationship and onwards that’s bad. Okay, I want you to go out and meet someone that you are serious about. Come back and talk. You do the first part, and we’ll do the second part together.”

That how I do it. So I don’t have to hold their hand every step of the way. Why would I hold her hand when she knows how to do the first part?

VY: Why not?

IB: Why? Why would you want to do that?

VY: It can be helpful. If someone never had a positive, trusting relationship in their life and they can spend 50 minutes a week with one person who can help them, what’s the harm?

IB: I suppose. So if a female client were coming to me with that kind of problem I would say, “How do you know this is a positive relationship? What will tell you that it’s a positive relationship?”And she responds, “Well, he would not steal money from me. He will not two-time me.”

Leading me to say, “That sounds pretty reasonable. So you know how to look for those?”

She says, “Yeah, I think I can tell how to look out for those.”

So I’m trying to be as minimalistic as possible, not so intrusive: “What you have going is wonderful. It just needs a little helping hand.” That’s what I do. I’m not interested in overhauling personality, because what’s wrong with her personality? Most people just have a little quirk here or there that doesn’t work.

Dr. Rubin Joins In

VY: Are there other areas of your work with solution focused therapy that I have not addressed that you think are relevant?

IB: I don’t know. I can’t think of any. (Dr. Berg then turns to speak to Bart Rubin, Ph.D., a psychologist and family therapist who has been observing the interview). Do you have any questions you’d like to ask?

Bart Rubin: Starting where Victor was at when he was playing devil’s advocate. The solutions model is so different than traditional models, and for you it makes so much sense. You throw out so much. You don’t bother with it. And other people are bothering with that stuff as if it’s really important. So I guess I wonder what do you know that they don’t know? What do you make of all these other people who are doing that other stuff?

Insoo Kim Berg: I don’t try to persuade them or try to compete with them. What they’re doing works, and that’s helpful for some people. What I do works and it’s helpful to some people. I’m not 100% successful. We’re still trying to figure out what is the other 20% that it’s not successful with. We have no idea.

BR: When you have self-doubts about the model, what are the doubts that you have? Can you critique it yourself?

IB: Well, self-doubt has to do with, let’s see…in the middle of December there was this brief therapy conference in Orlando. I felt that these people would be really similar to where I am, to how I’m thinking. I tried to attend as many of the other people’s presentations as possible. Those are the kind of times that make me doubtful, when it seems like the whole world thinks like this. And I’m way out here all by myself.

VY: Even among brief therapists?

IB: Yes, I’m way out on the left side. But at the same time there were some disturbing things about what I was seeing and hearing. They were just doing case presentations, going on about what’s wrong with these people.Especially the panel discussions I watched—it was like they were competing with each other about how much they each knew about what’s wrong with the client. I was very discouraged by that. That we’re still, in this day and age, we’re still talking about what’s wrong with people. So on the one hand I got very upset and discouraged by it, and on the other hand, I thought, “Do they know something I don’t know? Do they know something I should know?”

That used to be the way I thought about clients, but I have since I rejected all of that, turned my back on all of that. I have tried not to look back. Most of the time I don’t. But the big name therapists and presenters, they all seemed to be there. In a way, we have come a long way, but in another way we haven’t come very far. So that was pretty discouraging, and at the same time it made me wonder, “Oh, my God. Am I so way out there?” (laughter)

BR: Am I a radical pioneer, or am I missing the boat?

IB: Right. I was thinking about that. I still come back to, “No, I don’t want to join that pack.” It’s so distasteful. They were just going on and on and on and on about what was wrong with this client and that client. How is that going to be helpful? If the client were sitting there in the audience, listening to them talk about him, I wonder what he would say? I think he would get very upset. That’s not how they see themselves.

BR: In your work the therapeutic relationship seems to be important to the extent that you need to do the work.

IB: What’s the relationship for? It’s to do your work better. To do your job better. That’s what it’s for. You’re not paid to bond with someone. You and I are never going to be bonding for life, why would I want to do that? You should go out and have some real life out there.

VY: But when you’re doing longer-term work where you’re doing character or personality change, for lack of a better term, you can examine the relationship. It can give you a lot of data that can help you understand more what’s going on in that person’s relationships.

BR: One model assumes understanding is terribly useful; and another model would see understanding as not necessarily useful.

IB: You’re right. But you get a lot of feedback from the people around you, right? Your neighbors, your co-workers, your friends tell you about how you come across to them.

VY: People don’t usually tell you as directly as in therapy.

IB: But people let you know you’re an ass, right? You get the clue that you’re an ass, that they think that. They don’t invite you to go out to lunch together, that kind of stuff. So you don’t think that you get that?

VY: Well, yes, I do think people in life can give you feedback if you’re an ass. People usually don’t know why they don’t have friends. They may know something very basic. But say in a relationship you find that that person is very dependent, they’re always looking to you for the answers, or they put themselves above other people. Experiencing and understanding that relationship in the room with the client can really bring those issues alive to really help them in their life outside therapy.

BR: I think that in a long-term model, one would spend a lot of time talking about why you don’t have friends, whereas in your model you’d be focusing to get them to started on making friendships work.

IB: Yes, for the most part, we want to get them moving.

Cultural Similarities Matter More than Differences

VY: Let’s switch gears. You travel around the world a lot and teach in many different cultures. And you’re from a different culture originally than most of your clients, I assume.

IB: Yes.

VY: So what have you learned about applying these techniques in different cultures? How do you have to modify them?

IB: I think there are some modifications. Small ones. Again, I have a lot of gripes about the way that cultural differences are talked about in this country.My main gripe has to do with emphasizing the differences between cultures—what is different between you and me, instead of talking about what is similar between you and me. That we are all human beings with the same aspirations, same needs, same goals. When I look at those things, it’s very easy to translate. It’s the same everywhere you go. Everyone wants to be accepted, validated, supported, loved, and to belong to a community. That’s not different at all, no matter where you go.

It’s a different way of belonging to the group, but that’s a small difference. But even among the same culture, like among the white middle class, there’s so many variations. Just because you went to college and I went to college doesn’t mean we came from the same kind of families. Even some Jewish families, some Korean families are so different.

So I think too many people talk about culture/ethnicity as being a bigger difference than is necessary. I feel very comfortable no matter what culture I go. I just look at you as another human being rather than I am this group and you are that group. I think it’s very divisive. So that’s my main gripe.

VY: So you don’t pay a lot of attention to it.

IB: I don’t pay attention to that. People ask me, “Aren’t you feeling discriminated against because you’re Asian, and a woman?” I think “so what?” Some people get discriminated against for being too short, too tall, too blond. So what? It’s not that different from any of those things. I don’t really pay attention to that.

VY: So you focus on the solutions.

IB: Yes, on what works. Because that works. If you didn’t like me, if you really hated where I come from and couldn’t stand it, we probably wouldn’t be good friends very long anyway. I know there are some friends I like, I’m thinking of a couple I know; I love the wife but I can’t stand the husband. So I don’t see the two of them together very often. So we solved that problem that way! There are different ways for getting around that.

Living and Dying with Meaning

VY: I heard that you’re 68 years old, although, I would never have…

IB: Don’t say that! (laughs)

VY: One would never know it by your energy and enthusiasm!

IB: Yes, I am.

VY: So what do you think you know about life and about therapy that you didn’t know 20 years ago? Or 30 years ago?

IB: Oh, a lot. There are good things about getting old. You are much more comfortable with yourself.Take me or leave me, I’m an old hag. What do you expect? I’m old. Take it or leave it. I feel more comfortable with myself than when I was younger. That’s very nice. I figure if you don’t like me, well, that’s too bad, I’ll somehow go on, and you will go on. That’s kind of a comfortable feeling. I think you get a different perspective about life, too. You become much more aware of your body; it’s not what it used to be. I get tired easier. I used to be a very energetic person. I still am, but used to be even more so. I’m one of these very high-energy people; I’m just made that way. But I can tell I need to slow down a little bit more than I used to. You think about end of life more.

VY: What kind of thoughts do you have about that?

IB: How do I want to die? As if I have any control over that. I don’t have any control over that, unless I decide to commit suicide. That’s the only control I could possibly have. But I don’t think I would do that. I don’t have any control.So I’m still trying to accept that, that I don’t have control over how I die.

VY: You learned the trick with the white rats!

IB: I suppose I could use that! I may do that, because it worked! But you think about what is the meaning of life in a very different way when you get older.

VY: For example?

IB: What am I living for? What is the purpose of living on? What do I want to do with the time I have left? That kind of stuff. I’d like to be able to… I don’t know whether I’ll have the opportunity or not… to say on my deathbed (this picture of one dying, surrounded by friends and family…who knows? It may never happen that way). I’d like to be able to say I had a good life. And what’s the definition of a good life? I made some difference. That’s it. If I could just say that. I’ve made some difference because I’ve been here in this world. Life is a little bit better and I contributed to that. I think that would be a good life.

VY: You look a little bit emotional right now as you say that.

IB: Yeah,I’m getting tearful about that because I think it’s really important. I’d like to be able to say that to myself, and believe it, that I lived a good life. I don’t know if I’m going to do that or not. We’ll see.

VY: If you had to answer that using the scaling question that you ask so many people, on a 1 to 10 scale, where would you place it right now?

IB: I don’t know about people like you… you learn something and then you quickly turn it! (laughter)

VY: I didn’t think I was turning it against you!

IB: I don’t know about that.

VY: You can take a pass. You can email me your response.

IB: I am going to take a pass on that, for now at least.

VY: To step back to your life’s work, what do you see as the qualities that therapists need to become really seasoned, skilled therapists, and what are the ways to develop these qualities?

IB: Just keep doing it, doing it, doing it. Like a pianist, for hours and hours and hours. We did that. We used to work from 9 am to 10 pm at night; we’d have cases, cases, cases. We’d be exhausted, go home and collapse, and start over again the next day. Again and again. I tell you, we did that for years. I think that’s what it takes.

VY: How have you used whatever life learnings or wisdom that you’ve acquired to become a better therapist?

IB: Oh, God. You assume that I’ve acquired some wisdom.

VY: Well, some, I would certainly imagine. How do you think you’re a better therapist than you were 20 years ago?

IB: When I was younger I used to think that I was very accepting of people, because of my training. I’m realizing that I still have to learn a lot, and to let people be themselves and let go of that idea. If anything, I think I’m still learning to be more accepting of other people as they are. I’m just learning all the time.

VY: So maybe being less confident that you know so much makes you a better therapist.

IB: Maybe. I think that’s one of the marks of our profession is being very accepting of the other person, where they’re at right now. That’s been something that we try to instill in our students in our trainings. Golly, it’s really hard.

VY: You can’t learn that in a weekend workshop.

IB: I don’t think so. It’s a lifelong learning.

“I am Korean… You Dumb Ass”

BR: In terms of you learning over the course of your career, are there ways in which your earlier experiences with psychodynamic work affects your work now, or lead to your being more solutions-focused?

IB: Yes. Having been there, it’s easy for me to turn my back on that. Having had that experience, and those failures with cases.One experience was especially important. It was in the mid 1970s when soldiers started coming back from Vietnam. I went to Menninger for training in group therapy to work with a Vietnam vets group. We had a horrible case. One young man thought that the Viet Cong was coming after him. So he always slept with a shotgun under his pillow. And in the middle of the night, he shot his wife who was sleeping next to him. I thought, my God. I was a teenager when the Korean War started and was in the middle of it. So I had some experience of being in the middle of a war. I volunteered to work with these returning Vietnam vets because they would not go to VA hospitals. I organized this group. I sit with them week after week after week, and they tell horrible stories. About how they themselves killed women and children, how their buddies next to them had their heads torn off, and that kind of stuff.

VY: What did you do with these groups?

IB: I didn’t know what to do with them. So I made a videotape of a session and took it to Menninger, to a supervision group. This very famous psychoanalytic supervisor was there. I showed him the tape and said, “I need help. I don’t know what to do for these people.”He turns to me and says, “What is your countertransference issue?” I said, “What? What are you talking about?”

I was sort of shocked by this because I was asking for help. He said, “These are veterans, these are people who shot and killed your kind of people.” I was just absolutely floored. Never expected something like that. To turn my plea for help, to turn it around and suddenly it became my problem, that it was my countertransference issue. I thought, “You ass. My kind of people — I’m Korean! These are Vietnamese! You dumb ass.”

I thought, that’s it. That was the beginning of my end with psychoanalysis.

VY: Well perhaps it’s good that you walked away from that, because it allowed you to create a model of therapy that obviously has helped many people, and resonates with your personality. It’s been a pleasure talking with you today.

IB: It’s been a lot of fun.

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The Miracle Question

Dr. Rubin Joins In

Cultural Similarities Matter More than Differences

Living and Dying with Meaning

“I am Korean… You Dumb Ass”