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Maintaining Therapeutic Gains

Maintaining Therapeutic Gains by Gershon Basch, LCSW, Licensed Clinical Social Worker, LCSW

When Jacob* had started seeing me, he had been in a pretty good place. He had just stopped with his previous therapist, who was moving out of the area. He had successfully worked with his previous therapist on cultivating a good relationship with his parents, with whom he had had a strained relationship since he was a teenager. He was now reaping the benefits of his previous round of therapy and was now benefiting from how his progress played out in his relationship with his wife and in his work relationships.

Jacob’s main purpose in seeing me was to maintain the gains he had made with his previous therapist. He used to meet with me every other week and each time I used to start my session by saying, “So Jacob, tell me what has been improving?”

At first it was difficult for Jacob to notice the improvements that were happening in his life as he was more used to noticing the problems in his life. But with my continual prompting he started noticing the small steps forward he was taking. He started seeing how they were leading to bigger and greater changes within himself and how this was positively changing those around him as well. And he even began to take credit for this as well! This was not something he was trained to do by his critical parents, but he was getting there slowly.

But this time Jacob showed up for his telehealth session looking visibly different. He looked tired, despondent, and his eyes were downcast. I took notice but proceeded to ask my usual opening question of, “So Jacob, tell me what has been going better since last time we met?”

Jacob’s response was expected, “Actually, I’ve not been doing well. People who know me have been saying I look depressed.”

“Yes, I can see.” I said, “So what’s been going on?”

“Well,” he started, “things have been changing around at my company recently. I did not expect this, and I’m worried about the future of my company and, of course, about my own future. I believe there is a lot of mismanagement going on right now at my workplace. And when one area of my life feels unstable it tends to affect other areas of my life as well.”

“Of course,” I replied, “and the same is when we maintain stability in one area of our life, it tends to spread to other areas as well.

“So,” I asked, “in which areas have you noticed yourself maintaining your gains?”

“I don’t know.” he said shaking his head. “Actually, the opposite. I’m sure this has been taking a negative toll on the relationship between me and my wife. It’s a real pity, I’ve worked very hard to get this far and pull my life back in order, and to see it all go the other direction…” He breathed in deeply and sighed.

When we maintain stability in one area of our life, it tends to spread to other areas as well.

“Jacob, can I ask you a question?” I started.

He gave me a look as if to say, “you can try”.

I proceeded, “I know it’s been rough for you now and things haven’t been going in the right direction lately, but in the face of all this what is one thing you have noticed yourself doing right?”

He looked at me quizzically. “Well, nothing really,” he replied.

“Yes, I understand,” I said, “when you are not in the most positive of moods it’s hard to notice anything you are doing is right. But please try to imagine how you would answer now if you were feeling your most optimistic self.”

Try to imagine how you would answer now if you were feeling your most optimistic self.

He leaned back in his chair quietly and I noticed how his face became thoughtful. And then I noticed a subtle brightening of his facial features as he leaned forward and said, “Well, I guess I can say this: Some time ago, as a way to build up our relationship, my wife and I have been making an effort to go out together on a weekly basis. We go out to eat, go for a walk, go shopping together, or something like that and it has done a lot of good for both of us. With the way things have been going the past two weeks I really have not been in the mood of anything, but I gave myself a push to go out with my wife anyway.”

“And how has that been making a difference for you?” I asked.

He thought for a moment and then said, “Well, I have been quieter and more withdrawn on the past two outings, but I still think my wife sees and appreciates that I am trying. When she sees that I make her a priority she feels better about herself and in turn she is more likely to encourage me through this ordeal and that really helps me stay afloat.

“That’s great to hear,” I said, “and Jacob, we both know that this is not the first time you faced adversity in your life.

“Right,” he agreed.

“So,” I continued, “what was the most effective thing you did in previous times to help yourself cope?”

“Well,” he replied, “in previous times I didn’t stay afloat!”

“Yes,” I acknowledged, “but what was the best thing you did to keep yourself from completely drowning?”

“The best thing I did to help myself cope,” he answered, “was to go to the gym every day and I just realized that I have not been consistent with that at all over the past two weeks.”

What was the most effective thing you did in previous times to help yourself cope?

From here we launched into a conversation about what difference going to the gym made in the past for his mood, attitude, and energy level and how that impacted his marriage and work as well. We also discussed what might happen if he would resume going to the gym consistently. Jacob began to visualize himself returning to the gym daily and he listed several small changes he could imagine noticing as a result within himself and in those around him as well, as a reaction to his own changes.

Our conversation generated some ideas of how Jacob could better cope with what he was going through, but much more importantly, we ended out session with Jacob feeling more hopeful and with a renewed positive energy which I was confident would propel him in the right direction.

*This article is based on actual psychotherapy sessions with me, but all names and identifying details have been significantly altered. The purpose of this article is to help potential clients get a feel of what it would be like to work with me, for readers to find ideas for self-growth, and to inspire other therapists in their own work.

About the author

Gershon Basch, LCSW

Therapist, Licensed Clinical Social Worker, LCSW

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