Psychotherapy

From Dr. Jochem

The menu bar of to the left shows the various services I provide in my clinical practice. The list includes assessment services, a few varieties of dispute resolution, interventions with children post-divorce and also training and consultation. It's a diverse range of clinical services. However, by far and away, the practice of psychotherapy is my core professional activity, both in terms of how I allocate my professional time and, also, with respect to my sense of professional identity. I have been a practicing psychotherapist for well over thirty years. My clinical psychology practice centers upon the provision of psychotherapy with adolescents, adults, couples and families.

I have had the privilege of serving as psychotherapist, diagnostician, consultant, coach or mediator to many individuals, families and couples. One of the first things I always want to know is: what is happening that you are seeking help now? It is often a difficult decision to reach out for professional guidance and it's important that your provider fully understands your struggles and why you are seeking professional help at this point in time.

People seek mental health expertise for a variety of reasons: management of mood problems (e.g., depression), management of fear (e.g., anxiety), exposure to trauma, recent life changes, difficulties with basic functioning, addictive behaviors, relationship difficulties, disputes with others, worries about child/adolescent development—these are among the more common presenting problems.

Regardless of the specific problem described by the patient, I often find that there are a couple of common dynamics or features which often are part of a person's distress:

• No matter what the specific problem or issue happens to be—mood, anxiety, relationships, academic or job functioning—underneath it all, the person is often struggling with a sense of demoralization. Helplessness. Worry and a sense of uncertainty as to how to proceed. People generally try to come up with their own solutions before reaching out for help and it's very common that, by the time someone makes it to my office, they feel discouraged because their own efforts to address problems seem to have failed. Longstanding problems which seem to defy solution can lead to a sense of cumulative stress, fatigue and demoralization. Often, an important service I provide when working with an individual, family or couple is to re-frame their difficulties in a way which suggests a solution. That's not to say that I have the solution, only that psychotherapy can be a catalyst for constructive change. I find that patients are reaching out to me in hopes of acquiring new skills to address difficulties or make important life decisions. Learning to reframe problems in a way which might suggest a solution requires a degree of flexibility which is, itself, a skill which can be developed.
• There is another common trend which is often present, regardless of the specific nature of someone's distress: the patient's attempts at a solution have now become the problem. People who seek professional assistance have generally been trying to manage their difficulties for some time before they decide to reach out for help. Often, though, these efforts to manage a problem have, themselves, become problematic. For instance, the person who is anxious upon leaving the house may find that staying home is more comfortable and now rarely ventures outside. But they now find themselves house-bound. In this case an attempted solution to anxiety—staying home—has now become the problem. Another example: the couple who avoids conflict by limiting their interactions now finds that they have drifted apart. In this case estrangement, once a "solution" to reducing conflict, has now become the problem. Counseling, then, has the goal of helping patients regain a sense of fluid, flexible problem-solving, regardless of the specific kind of distress they are experiencing at that point in time.

Approach

I find that folks who are seeking mental health care are often very informed consumers—this is a good thing. People will often ask, "What is your theoretical orientation?" or, "What is your specialty, what populations do you work with most often?" I think these are perfectly reasonable questions and I'll share some information which might help you with these aspects of my practice.

With respect to theoretical orientation, I should say that I am a clinical psychologist who is the product of Chicago-based training. Indeed, I consider myself very fortunate to have had so many mentors and training experiences which shaped my professional development. Chicago has a long and storied history of mental health innovation and scholarship. Just to cite a few examples:

• Client-centered psychotherapy, a bedrock and foundational approach which is the underpinning of humanistic approaches to counseling, comes from the work of Carl Rogers and his protégées at the University of Chicago.
• American psychoanalytic theory and conceptualizations were significantly broadened and applied by Chicago-based psychodynamic writers.
• Some of American psychology's most influential scholars regarding human life span development come from Chicago—tremendous scholarship came was produced by psychologists at both Northwestern and the University of Chicago.
• The practice of structural-strategic family systems therapy was advanced by Chicago-based facilities such as the Institute for Juvenile Research and Northwestern's Family Institute.
• Pioneering research into the effectiveness of psychotherapy—critical early scholarship to explore how and why psychotherapy works—came from both Northwestern and the University of Chicago.

I was fortunate to have had direct training, supervisory and consultative experiences in all of the above practice areas, in many of these institutions, from experts in their respective fields of study. These Chicago-based psychologists who made significant contributions to theory and practice of clinical psychology were still active when I was in training and I benefitted greatly from their instruction.

Over the course of my own career I've been invited to teach and conduct trainings in various parts of the country and, more than might be apparent to the consumer, I find that regional differences in conceptualization and practice patterns still exist. I came to appreciate that the training I experienced—this was essentially the full decade of the 1980's—was distinctly Chicago influenced. I learned humanistic approaches from professors who, themselves, had been part of Roger's department at the U of C. I was trained in psychodynamic theory by Chicago-based psychoanalysts. I studied life span development from experts in that field and trained in family therapy in the classic structural-strategic model at IJR (Institute for Juvenile Research). I consulted with and was trained by psychotherapy researchers whose scholarship is still considered pioneering. For these experiences I am grateful and they shape my practice pattern to this day, some thirty years since completing my own training.

Much of what I have described above pertains to individual psychotherapy. However, a substantial part of my practice concerns the provision of conjoint, or couples counseling. Most frequently, I am working with married couples, sometimes with partners who are in a significant relationship but happen to be unmarried. My own approach to couples counseling is strongly influenced by the work of Drs. John and Julie Gottman and their associates. When working with couples I am interested in the influence of family-of-origin factors, assess the couple's communication style, providing coaching in conflict resolution and encourage the restoration of closeness, intimacy and collaboration. As is the case when working with individuals, I try to support the development of skills to improve the quality of the relationship.

Style

My clinical style has, of course, been shaped not only by prior training but also through my professional experience over the past thirty years of practice. Here are a few features which I believe characterize my overall style of practice.

Relationship-based practice
In the mediation world they have a saying: the best solutions come from the client. A central feature of my humanistic-based training, which had significant Rogerian-based influences, is an emphasis upon a collaborative therapeutic alliance. Of course, every mental health practitioner strives to provider a comfortable doctor-patient relationship. I'm guided not only by humanistic conceptualizations but also by psychotherapy research, which tells us that a solid collaborative alliance may be more effective in fostering change, skill acquisition and relief than specific prescriptive or directive therapeutic techniques. I seek to be at all times collaborative and to stay close to the patient's own goals.

Evidenced-based practice
Some of the most influential studies on the efficacy of psychotherapy come from the mid-'70's through the '80's. We now know that certain interventions enjoy empirical support for specific populations or with certain conditions. Examples would include exposure therapy for certain anxiety disorders, cognitive behavioral therapy for depression, motivational interviewing for behavior change and DBT (dialectical behavior therapy) for management of flooded states. Over my years of practice I have been open to new developments in the field, have sought training in certain interventions and have conformed my practice pattern to the emerging body of literature regarding evidence-based therapies.

Developmental conceptualizations
My training in psychodiagnostics in the department of child psychiatry at the University of Chicago helped me appreciate the importance of developmental considerations whenever assessing or treating a mental health condition. Subsequent training in the child/adolescent division of the Illinois State Psychiatric Institute, along with years of practice with adolescents, reinforced my view that a patient's presenting difficulties can best be understood with an appreciation of the person's developmental achievements, tasks and current challenges.

Family systems influences
It is my practice pattern to take a genogram—an extensive family history going back a couple of generations—with nearly every patient. I've come to appreciate the importance of family dynamics, roles, scripts, repeated patterns and modeling of one's family of origin in understanding psychological distress and as a guide to intervention.

Motivational interviewing
This is a stand-alone therapy skill that I've acquired and is also an area in which I provide consultation and training. The approach comes from health psychology and is widely applied in substance use treatment settings. It is a strategy which helps to reinforce personal goals as people chart their way through the phases of behavior change.

Skills orientation
My training and experience with DBT (dialectical behavior therapy) has certainly shaped my practice pattern. Regardless of the specific complaint—depression, anxiety, anger management—the central difficulty is often an experience of a flooded emotional state of mind. The practical skills which comprise DBT are often a terrific way to lend focus and provide a framework for patients to actively prevent and manage distress.

Shorter-term approach
Early in my training I became aware of a disconnect between theory and practice in mental health practice. We knew that the modal number of visits which comprise a typical course of psychotherapy (e.g., the most common number of sessions provided to a patient during a single episode of care) was eight. That is, in most episodes of counseling someone would be seen a total of eight visits over the entire course of counseling. But I noticed that psychotherapy training tended to focus on longer-term approaches to counseling, with the assumption that the patient would be engaged in the process far longer than eight sessions. When I was trained in the mid-1980's, the concept of short-term, or time-limited counseling was considered to be somewhat radical and the practice was limited to psychotherapy research trials. Fortunately, I had a number of mentors who provided training in solution-focused, time-limited methods of counseling. While there certainly are instances where I will work with an individual, couple or family for an extended period of time, I generally expect that a course of care will be focused and shorter-term in nature.

Areas of special clinical interest or experience

I have been privileged to work with many individuals, couples and families. People are not "diagnoses" to me; my patients are people seeking assistance with a specific problem area, and I provide the benefit of my experience and training, working towards agreed-upon goals.

For this reason, I'm always uncomfortable listing the diagnoses or problem areas I most often see in my practice—I worry it may give the false impression that I consider my patients to simply be the sum of their diagnostic features. Not true. But, with this caveat, here are the problem areas which I tend to work with most often.

I generally tell folks that, at any given time, the focus of my practice can be described as a "rule of thirds" : about one-third of my practice tends to focus upon care of adolescents, one-third couples/families and one-third adults being seen individually. As a psychologist, diagnostic consultation is a prominent part of my practice. I have also developed specific interests and skills related to mediation, post-divorce parenting and collaborative divorce coaching, which are discussed elsewhere on this website.

Here are examples of circumstances I most frequently address in my clinical psychology practice:

• Mood disorders, most commonly depression
• Anxiety disorders such as generalized anxiety, obsessive compulsive disorder, panic disorder and post traumatic stress disorder
• Issues related to loss and bereavement
• Issues related to the management of a longstanding, serious psychiatric condition such as bipolar disorder or other psychiatric illness
• Issues related to adolescent development
• Issues experienced by couples, such as conflict, estrangement or communication difficulties
• Issues experienced by families, particularly parenting difficulties and difficulties managing major life transitions such as divorce
• Issues experienced by post-decree divorced parents, where parent coordination, mediation or consultation is indicated
• Difficult diagnostic circumstances where specialized assessment skills or experience is necessary. Examples would include fitness for duty evaluations, suicide risk assessment or circumstances where threat assessment is indicated
• Serious conflicts or disputes between parties which can be addressed through formal mediation
• Issues related to divorce, where the couple is managing their divorce collaboratively and can benefit from coaching
• Issues related to general habit control, such as weight management, smoking cessation or other matters concerning lifestyle/health management

There are some clinical practice areas I address less frequently in my practice. These are described below.

• Ages served: I tend not to work with children younger than late middle school. I do frequently work with kids who are late middle school and especially high school aged patients
• Substance abuse: I tend not to begin working with patients where substance abuse is the primary or only concern. Should substance abuse difficulties become evident during the course of counseling I generally base my interventions upon a relapse prevention/motivational interviewing, educative model.
• Eating disorders: I tend not to begin working with patients specifically seeking care for an eating disorder. Should an eating disorder become apparent during a course of treatment I may obtain consultation and may facilitate referral, depending upon the circumstances.
• Gender identity issues: I tend not to begin working with patients specifically seeking care related to a gender identity issue. Here, I am not referring to orientation, per se, but to issues related to gender identity or transsexuality. I tend to believe that this is a specialty area of practice and that patients are better served with a referral to a provider with the requisite expertise and training.

Finally, with respect to my areas of concentration, I also am frequently retained as a consultant to schools or other organizations. This can take various forms. I have been quite involved in the practice of adolescent suicide prevention and offer free training to schools and other organizations in a model gatekeeper training I developed some years ago. My gatekeeper training program may be found on the website for the Lake County Coroner's Office. I have assisted many schools, particularly in northern Lake County, develop their readiness to respond to crises or other traumatic circumstances. I have also received specialized training in threat assessment and work with schools to develop and deploy threat assessment teams.

I provide professional training on a regular basis in a variety of practice areas: treatment of post traumatic stress disorder, suicide risk assessment or case consultation/supervision. These practice areas are discussed elsewhere on this site.

Feel free to get in touch by phone or email if I can provide any additional information regarding my practice.