What is my problem?

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The nature of someone's issue is a key factor in deciding which therapeutic approach a therapist and client should take together. Let's say for example you have suffered a difficult loss or change in life circumstances, an effective empathetic listener will go a long way to helping us cope with the difficulty in adjusting, compare this however with suffering from PTSD where continuous empathetic responding might even make the situation worse (by vicariously re-living the experience repeatedly and effectively making us 're-traumatised'. This is why your therapist should pay careful attention to what is going on for you rather than launching directly into treatment. Similarly, we might be guilty of some type of negative self-talk (most of us are to some degree) and irrespective of the accuracy of such automatic negative thoughts (ANTs no less!) there is a real concern over how helpful such thinking can be, so with Cognitive Behavioural Therapy (CBT) we might successfully address the thinking and even change and strengthen some more helpful thoughts. The degree to which someone is simply thinking negatively versus being treated badly (say in a toxic relationship) needs careful thought however, as certainly at times we are our own worst enemy, at other times there is clearly someone else who is the villain and not simply our fallacious thinking.

Other factors which we and our therapists should consider early on is where the problem we are going to work on fits in the big picture. A difficult life adjustment, unfortunately, will inevitably affect us all at some time and counselling is a good place to get help. Such an adjustment, however, is distinct from a recurring: 'I've always been this way' type of a problem. The former might be about dealing with the here and now, thinking, strategies and adjustment to difficult circumstances but the latter may well be much

more about working out how the past (e.g. childhood) is continuing to affect us now that we are grown. This short reflection is really just a rallying cry to take our time in establishing the nature of the problem to help us get the most effective treatment from our therapy.

Dr Trevor Simper

Trevor is a therapist in private practice and associate professor of counselling in Perth, Western Australia