Tom L. Clark, L.C.S.W., M.S.W.
About Therapy
The kinds of therapy I offer in my practice:
Individual Therapy
Couples Therapy
Sex Therapy
Definition of Psychotherapy
Psychotherapy is a process whose purpose is the alleviation of distressful symptoms, the solution of problems and, ultimately, the client's enhanced sense of well-being. While psychotherapy is appropriate and helpful for people with distinct clinical diagnoses, such as depression or anxiety, it can also be a useful process for those with life problems that are not necessarily clinical in nature, such as low self-esteem, chronic difficulty with relationships, or the absence of satisfying life goals.
The Therapy Relationship
The successful process of psychotherapy depends greatly on the establishment of a completely honest and trusting relationship between client and therapist. If this kind of relationship is not established, it is probable that the therapeutic process will be at best minimally effective, at worst, counter-productive.
Toward this end, prospective therapy clients should begin work with any new therapist with these questions in mind: Can I trust this person? Am I willing to be completely honest with this person? Can this person help me? If, after three or four sessions, you cannot answer all of these questions affirmatively, you might consider trying another therapist. While it may in fact take a long time for the condition of total trust to be established, you should have a sense, more or less, that this is a reasonable possibility.
You are probably aware that there are numerous theoretical schools in the world of psychotherapy, and it will help you, of course, if you have some idea of what kind of therapy appeals to you. However, virtually all of the research done on the effectiveness of psychotherapy supports the idea that by far the most important variable in the process of therapy is the nature of the relationship between the client and the therapist. The therapist’s theoretical orientation is of secondary importance.
Theory
Although it may not be intellectually satisfying to some prospective clients, my own theoretical orientation has always been eclectic. While I have great respect many for the well-known theories which are embedded in different schools of psychotherapy, I have not found a single theoretical system I could comfortably embrace. I have borrowed ideas and techniques and aspects of theory from many schools of therapy and from spiritual traditions, such as Buddhism and meditation, and to these I have added my own ideas and ways of making therapy a successful process. I have also found a personality theory called the Enneagram to be a helpful adjunct to therapy. My work as a therapist is not rigidly defined by theory, and it has constantly evolved over the many years I have been in practice.
Reasons for considering individual psychotherapy
People choose to begin the process for an astonishing variety of reasons; on the surface, it seems as though each client who walks into my office has a unique reason for being there. However, while each client is in fact unique, the variety of initial issues and concerns can be reduced to three general categories.
(1) Issues with the Self
As individuals move through the life cycle - especially the earlier phases of infancy, childhood, and adolescence - many people are not able to complete the psychological tasks inherent in each phase. It is not at all uncommon, therefore, for a person to embark on adulthood with an incomplete sense of
Self, and to have certain handicaps which interfere with having a reasonably consistent peace of mine, with having successful relationships and/or finding and doing meaningful work. Sometimes these handicaps manifest as specific symptoms, such as clinical depression or anxiety or sometimes as a more generalized sense of unhappiness and dissatisfaction with life. One of the important goals of psychotherapy, as I practice it, is reduce or get rid of these psychological handicaps so that they no longer interfere with one’s choices, one’s relationships, or one’s sense of well-being. Along with this comes, almost always, an enhanced ability to make appropriate choices in one’s life
(2) Issues with Relationships
Often people who choose to see a therapist do so because they are having difficulties with a special relationship - with a husband, wife: parent, or child. The relationship in question has become so difficult, so demanding, so enervating, that it may have compromised a person's ability to function
and/or to feel hopeful about life in general.
Quite often people seek therapy because they have a history of unsuccessful relationships, a pattern which seems to keep repeating itself, and which may leave one without the kind of satisfying, supportive relationships perceived as essential to happiness and well-being.
Symptomatically, relationship issues can show up as a social phobia, excess anger, or an inability to express feelings. Other relationship problems include fear of intimacy and/or fear of commitment, and unresolved narcissism.
If relationship issues would be the primary reason for seeing a psychotherapist, it is important to remember that the work you do will be about you, not your partner. Otherwise, the process becomes what I call Couples Therapy Minus One, and that is of little use to anyone.
(3) Issues with Work
It is not uncommon for people beginning psychotherapy to do so because of problems in the workplace, including:
The difficulty of finding meaningful work; working too hard and suffering from stress; difficulty in getting along with one's boss and/or fellow employees; difficulty holding a job; lack of advancement along a desired career path.
The most common work-related problem, by far, is the tendency many people have to become trapped in jobs which they do not like and which, as a result, produce a great deal of stress and general unhappiness.
Although 1 have summarized three general categories of problems which people bring into individual psychotherapy, this is merely for descriptive purposes. In truth, all problems in therapy are problems with the Self and it is the Self which should be the proper focus in therapy. It’s not that relationship and work cannot or should not be discussed, it is just that psychotherapy, effectively practiced, will bring the client’s attention back to the Self.
Sometimes the problems are broad-ranging and general, such as low self-esteem or the residual pain from some kind of childhood abuse. Sometimes the problems are much more concrete and specific. Occasionally clients require a few weeks of therapy before it is even possible to define specifically the issues they want to work on.
Regardless of how a client defines his or her problems, and regardless of the specific kind of therapy that is chosen, the end result of effective therapy is a significant improvement of the problems and issues defined by the client. Many of life’s problems are not solvable in the way one might solve a math problem, but they are usually amenable to significant change for the better.
For example, a person can definitely improve his or her sense of self-esteem, but there is no clearly defined endpoint to this process.
The famous Gestalt therapist Fritz Perls once observed that a neurotic is a person who fails to see the obvious. I like this definition because it applies to everyone, myself included. I mention it here because it leads to another important tenet of mine: the phenomenon of choice. In crises or other
difficult life situations, if you believe you have only one choice available, this is often a prescription for great mental stress. I believe deeply that the process of psychotherapy should always help increase the client's perceived range of choices. (And sometimes, paradoxically, the best choice in a given situation is to do nothing!)
As a therapist I do not dwell excessively on the client's past. However, the past cannot be ignored, and central to the process of therapy is a bell-clear understanding, by both the client and therapist, of the essential dynamics of all of the client's primal relationships in childhood. It is also very important to understand each client's childhood survival and coping strategies, since most people drag these into adulthood and are stuck with them, long after they have served their usefulness. An important part of therapy is replacing archaic coping mechanisms with ones which are current and appropriate to the client's needs.
Also, since nearly all issues in psychotherapy are ultimately issues of self-esteem, the concept of self-esteem is central to the way I think about therapy and to the way I practice therapy. While the issue of self-esteem may not necessarily be a specific focus in therapy, if the process of therapy is successful and the presenting problems have been successfully addressed, the client's self-esteem will always improve as a result.
Self-esteem could be thought of as an umbrella that covers many aspects
of the self. More specifically, the list that follows describes many of the ways that we may experience ourselves as wounded or incomplete. (This list comes from an excellent book about relationships, Undefended Love, by Jett Psaris, Ph.D and Marlena Lyons, Ph.D.):
I am not enough:
•I am unacceptable
•My needs are too much
•I am not good enough
•I am deficient/inadequate
•I am a burden
•I am boring
I am undeserving:
•I am worthless
•I am unworthy/not deserving of love or respect
•I am unlovable
•I don’t deserve to have someone I can count on
•I am useless
I don’t belong:
•I don’t matter
•I will always be alone
•I will always be abandoned or rejected
•I am not wanted
•I am not accepted
I am imperfect, flawed, broken:
•I am powerless (defenseless, helpless, weak)
•I am incapable (I can’t do it, do enough, or take care of myself)
•I am a failure (I will fail)
•I am stupid
•I am “damaged goods”
I am bad, wrong:
•I am a mistake
•I am not OK
•I am evil
•I am guilty
•I am flawed
•I am needy
These aspects of the self can manifest as defenses, as fears, or as how we think about and evaluate ourselves.
Style of Therapy
I would describe myself as a moderately active therapist: that is, I express my thoughts, opinions, and feelings when I believe they are appropriate to the process of therapy. I am not a therapist who remains largely silent. Some clients prefer more engagement than others, and I try to gauge the needs
of each client in this respect. I am cautious about self-disclosure, because there is always the risk of disrupting the process of therapy when I speak about myself. However, self-disclosure on the part of the therapist can be an important, if occasional, adjunct to psychotherapy. Some clients seem entirely disinterested in my life, while others seem to require a certain degree of knowledge about who I am before they feel comfortable in the therapy relationship.
I believe strongly in the curative powers of laughter and humor, and while the process of dealing with one's most painful issues is hardly a laughing matter, there can be a place for humor in the therapeutic process.
I am not above giving advice occasionally but I do so with caution, since most people receive far too much advice in their lives. Since a comfortable sense of self-reliance on the part of the client is a proper goal of my therapy, advice should be given sparingly and cautiously.
For those clients who are interested in exploring the more expansive, non-egoic levels of consciousness, I encourage a practice of meditation and/or other spiritual traditions that support this quest.
Short-term, Long-term Therapy
As a therapist I am entirely flexible about the length of therapy, as long as there is clarity about what can or cannot be accomplished. On occasion, I may see a person for just a single visit, because what the client may need is merely a new way of looking at an old problem. While there are no universally agreed upon definitions of what constitutes short or longer term therapy, for my purposes anything between one visit and six months I would consider short-term therapy. As I practice it, longer term therapy is typically between one and three years, although occasionally I have seen clients for longer periods of time.
Short term therapy can be a highly effective way of approaching therapy,
and it usually implies a concentrated focus on a single problem. For clients with a multiplicity of problems, for those who have distressful clinical symptoms, or significant issues of personality and character, short-term therapy is usually not sufficient, because there are too many complex issues to address, and the process of effective change cannot be compressed into a
handful of sessions.
Finally, there are those clients who choose to use therapy as a growth process, and who at some point continue in therapy not because they need to but because they want to.
The Use of Medication
There is ample scientific evidence that certain kinds of depression and anxiety, and O.C.D. (Obsessive-Compulsive Disorder), have a biochemical component to them. While it is not a decision to be made lightly, there are times when the use of medication can be a valuable and even necessary
adjunct to psychotherapy. Although I am not a physician and therefore I cannot prescribe medication, I am quite knowledgeable about the subject and can certainly assist any client in making an informed choice.
For clients who are interested in the possibility of medication, and for whom this seems an appropriate choice, I work closely with Brent Cox, MD., whom I consider to be one of the best Psychopharmacologists in the greater Bay Area. However, I am also open to working collaboratively with other psychiatrists who do medication evaluations.