The Curious World of Intuition in Psychotherapy Private Practice

One of the things I've noticed in the therapy world is that, whether you're interviewing to work at a group practice, or you're simply describing your therapeutic approach on your private practice 'About' page, people are looking for and want to know which evidence-based therapeutic modalities you are most competent in and in which you base most of your work. This is spectacular, because I believe that using evidence-based modalities (meaning, modalities that have been implemented in double blind clinical trials and have strongly demonstrated that they produce the intended outcome) is inseparable from operating ethically as a therapist. This is because people are coming to you for a certain kind of help, and it is your ethical duty to ensure that you know that what you are offering is not some kind of hocus pocus or charlatanry. Rather it is clinical help, backed by science, and state-of-the-art. State-of-the-art, and scientifically backed, are the only descriptors that I would ever want to apply to approaches that I implement in service to people who come to me looking for, and needing, help.

Having said that, I have noticed something a bit curious in the way that I work with people in my private practice. I have been trained in all of the classical therapeutic techniques like Motivational Interviewing, Cognitive Behavioral Therapy (CBT) (which can work wonders for symptoms of depression, anxiety, or even panic attacks), and in some Control Mastery and Dialectical Behavior Therapy techniques. I also integrate into my approach everything I have learned from working with children and adolescents who have endured all kinds of trauma, and attachment loss, so that I bring a very dialed-in trauma and attachment lens to my work with people of all ages (think: Trauma-Focused CBT). So far, all of these things check out as far as the evidence-based approach officials are concerned.

Here's where I differ, and here is what I have noticed: Each person who comes in to see me is bringing me a unique package of stories, feelings, concerns-of-the-moment and concerns of the past (as it relates to the moment) in each session. And instead of whipping out my CBT cookbook, as it were, and going through steps 1, 2, and 3, I find that I am completely in the flow in each moment of therapy, and I am fully present, tracking my clients as their unique process unfolds before me. Getting into this flow state in session (for lack of a better way to describe it), allows me to not impose a step 1, 2, 3 kind of approach, but rather to draw on my evidence-based therapy training intuitively, in real time, in the moment. I get a sense of which aspect of my training to draw on at each juncture of a given session in the same way that I would get an intuitive hit. For example, "Oh, okay, right here I just noticed some thoughts that we could unpack and question, from a CBT perspective," or, "Okay, now I'm getting a sense of the attachment style, and a way to mention the attachment style I'm noticing gently and appropriately." When I do this, the response I usually get is, "Yes!!!" or something to that effect. I have noticed that when I let go into this kind of intuitive flow in session, the sessions are more powerful and transformative.

I don't think this makes me special. I think we are all deeply tuned in when we want to be. It does require a kind of letting go into the unknown, in each and every session. Why? Because I have no idea what any individual will bring to me on any particular occasion. There is no script for me to follow. Just a perfect, relaxed trust in the flow of the session, and the assisted unfolding process. I believe that this is probably what a lot of therapists do. On the other hand, having a script or a really clearly defined structure for the kind of "treatment" you are providing seems like a way to not exactly meet people where they are at, and to safely avoid letting go into the unknown of the moment-by-moment living process in the therapy room. I believe really good therapy truly does require a kind of letting go into the unknown on more than one level. On another level, it is not my role to bring people out of their subjective perspective and into mine. Rather, my role is to get into my client's perspective, with them (as much as I possibly can), even if they are feeling like they are forty leagues under the sea. If that is the case, I get under the water with them, rather than offering encouraging words from up above. From there, we can join our perspectives and hopefully reach a new, somewhat more objective perspective together, one that expanded both of our previous, subjective worlds. We are both transformed.

It gets even more interesting. In my career, I have had the good fortune to meet and learn from other clinicians, therapists and healers who identify as empaths (this is sort of like being a highly sensitive person, with a bit more of an intuitive bent--- these are the people who will say things like, "There was a feeling in the room and I'm not sure if it was my feeling or theirs."). I have heard some of them say that it is normal to notice somatic sensations in therapy with certain individuals, and often the somatic sensation is located in the same part of the body, session after session. These sensations are valuable data. If they are noticed, in session, out loud, it often becomes a gateway into exploring something that has been in the room the entire time, and into hearing what it has to say. Beyond somatic sensations, I have heard another great therapist say that however another person is making you feel is usually a pretty good indication of how they themselves are feeling. Well, where do we usually notice feelings, if we really try to describe what that feeling feels like? Usually, in the body. Sometimes the feeling is really loud in the chest, or it can be in the solar plexus area, in the throat, sometimes it feels like it is in the forehead, sometimes it is a burning in the face or around the ears. When we notice it and try to describe it (maybe with a color, texture, location, shape, or other quality), bringing the light of awareness to it, it begins to shift immediately. It always has something to tell us. When it comes up in session, it usually does so for good reason. In my clinical work, I have noticed a unique somatic feeling signature, more pronounced with some individuals than with others, and I intend to get better and better at bringing this into the room.

I will continue to explore and write more about this. Until then, I want to offer to any other clinicians or healers reading this: Our field is based in healing work that dates much farther back than Sigmund Freud, and spans many other cultures, and it is a field that is continually evolving. Yes, mentioning the word "intuitive" in a job interview might get you looked at like you have snakes growing out of your head, but I dare say it won't always be like this. Your sessions are more fun and transformative when you can let go into the unknown like this. You know what to do :)