Approach to Psychotherapy

Therapy addresses patterns of experience.

Our brains are models of efficiency. Imagine how difficult it would be for a baseball outfielder to catch a fly ball if he had to calculate its speed and direction as well as where he needed to run and how fast to meet it, all in his head in the couple of seconds it takes a baseball to reach the outfield…all in his head. In fact, that process does take place in the fielder’s head, but fortunately all the calculations take place automatically. The brain has learned, practiced, and automated the work of catching a ball.

Similar processes of automation govern our social behavior and relationship with our inner selves. As adults we rely on patterns of thinking, feeling, and action that were created, encoded, and automated long ago. That’s why people faced with a problem try to address it in the same way they “always” have. Even when those strategies fail, people often do the same thing over and over, unable to find their way toward a different solution. Responses and behavior that were adopted as the most effective available solutions earlier in life now become adult life’s current problems.

Humans are a social species and we are highly evolved for living with others. For example, we develop exquisitely nuanced perceptions of others’ facial expressions, posture, and gestures, and use these perceptions to interpret their attitude toward us. Is that person happy or sad, friendly or aloof? We quickly adapt our own behavior accordingly. Spousal partners adjust to one another. They develop enduring patterns both of what they believe about each other and how they interact. These two-person patterns become just as automated and unquestioned as our patterns of individual experience.

Changing our functioning requires dismantling it and putting better strategies in place. The challenge is that these automated patterns and the difficulties we are trying to solve by using them, operate largely outside of our experience. If this were not so, people could change readily, using their own common sense, the good advice of friends and family members, or a self-help book, and psychotherapy would be unnecessary. However, many people find attempts to follow advice of limited benefit. Persistent attention, a kind of listening to oneself to discern patterns and understand their meaning—what’s something is there for, what’s holding it so firmly in place—is required. Psychotherapists typically don’t give much advice. Instead, they listen really really well and and give feedback on what they observe.

The therapist is a guide, companion, and collaborator in this enterprise. He guides you first in learning how to listen to yourself, partially by how he listens to you himself and also by suggesting what you might profitably listen to. He helps validate what is working and alerting you to what is not. He offers comforting consistency to help endure the discomfort that therapy inevitably involves.

Dr. Rochmes’s approach combines many historical traditions in psychotherapy. It draws on analytic and other “depth” approaches in understanding and valuing the meaning of behavior and draws on the psychodynamic tradition of bringing to awareness motivations that operate outside of experience. It draws upon ancient eastern traditions of mindfulness as a method for listening to oneself. He uses modern cognitive-behavioral traditions to help define difficulties and strategies more precisely and practice alternatives.