Q: Too often between sessions, my clients seem to forget the epiphanies they've had in my office. Then it seems we're starting over at square one. How can I help them hold onto and follow through on the insights and skills they've learned in therapy?
A: Back in the routine of their daily lives, it's all too easy for our clients to return to old patterns without stopping to examine their actions and reactions in light of what they've recently learned. Even when they try to reflect on the problems that brought them to our office, they're much more likely to follow the beaten track of their thoughts than to explore the new trail that we blazed together in the latest session. Clients who do try to remember what their therapist said may easily be betrayed when their memory plays tricks on them: they may inaccurately or incompletely recall their therapist's words--and their meaning.
Difficulty in retaining new insights and skills from session to session and putting them to use is frustrating for therapists and clients alike. Rather than building on last week's insights, we're too often obliged to take one step back to review, remind, and reinforce. Fortunately, some creative memory techniques can reduce the need to repeat ourselves with our clients. Once you get used to them, you'll be amazed at how simply and effectively you can apply them.
Stimulate the Senses
The first principle of learning and memory is: multisensory memory is stronger than verbal memory alone. Words are powerful, but they usually recruit only the verbal centers of the brain. We're much more effective when we also engage the visual and kinesthetic centers, which activate the implicit memory systems.
When clients having trouble setting limits are overwhelmed by other people's demands for their time, attention, and physical space, I use the metaphor of a fence in a poor state of repair, with gaps and sags that let people through anytime and anywhere. I explain that the result is that nothing we're trying to establish has a chance to flourish: the grass is regularly trampled, and the garden is destroyed. I might even use a picture of a fence from a magazine to send my message to the visual centers of the brain, while my description of invasive people and self-protection ties the visual to the verbal centers in the left temporal lobe. Even better, I sometimes give clients a picture of the fence to take home as something tangible to anchor the insights they've gained.
The more sensory modalities you recruit in your communication with your clients, the more chances you have of reaching them. Every sense involved in learning represents a form of repetition. If your clients hear and think about setting limits while looking at a picture of a fence—or, better yet, drawing one themselves—they have three or four repetitions of the message in different modalities, creating a much more functional memory.
Another principle of learning and memory is that emotional memories are formed more rapidly and imprinted more deeply than any other memories. Moderately heightened emotion, particularly positive emotion, primes our brain to record information with higher efficiency. I remember using this principle with a little girl named Molly, who'd been close to her grandmother until the elderly woman had a disabling stroke, making her frightening and grotesque in Molly's eyes. Everyone was sad about the change in their relationship.
In therapy, I decided to connect Molly with positive emotions before addressing the question of her grandmother. Since I knew Molly loved to draw, I gave her a large piece of drawing paper and asked her what she could do with such a nice piece of paper. She eagerly described all the things that she could draw. When she was feeling quite happy, I said that before her grandmother's stroke, there were lots of things Molly could do with her that were fun. Then I tore away a third of the sheet, explaining that now there was a part of Grandma that didn't work the way it used to, but, like the remaining two-thirds of the sheet of paper, there was still much left that was wonderful. Her love for art and for her grandmother cued a heightened emotional state, helping Molly incorporate the new understanding of her grandma's changed circumstances. During the remainder of the session, we explored together how Molly could still enjoy being with her grandmother. When she left, she took the drawing paper as a souvenir. Her mother later reported that Molly was again spending most of every Sunday afternoon with her grandmother.
Link to Prior Learning
Another principle of memory formation I use in therapy is that knowledge builds on prior knowledge. Creating links between a client's new insights and old knowledge decreases the need for repetition. Linking the concept of setting limits with a metaphor of fences works well for almost anyone who shares that difficulty. We already understand the purpose of fences from direct experience; adding the symbolic meaning is then just an added association. For example, if you found yourself in a technical seminar on the latest findings in astrophysics, you might be utterly lost, and afterward you wouldn't remember a word of what the speaker said. The astrophysicist in the next seat, however, has a specialized knowledge base, which allows her to assimilate the new information by attaching it to the framework that she already possesses.
Increase the Interest
Evolutionarily, we're programmed to focus on new and different things, since doing so can have such survival value. The mind is attracted to novelty because we need to be alert to both threat and opportunity. Pop quiz: what color are the numbers on your neighbor's house across the street? Can't remember? It's not at all surprising. You've probably never focused your attention on them, unless the neighbors have chosen purple neon lighting for them! I'm not advocating that you use purple neon signs with your clients, but getting their attention is crucial to conveying a memorable message.
Anything you say while they aren't fully engaged is essentially wasted breath. To hold your clients' attention, use attention-getting visual props, riddles, humor, and even your tone of voice. Whispering is a great device to recapture a client's wandering focus. Having a repertory of jokes and riddles pertinent to a variety of circumstances is a wonderful resource for soliciting your client's involvement. Surprise your client with whimsical toys, which can serve as therapeutic props to add fun to the therapy session.
Tantalize with Teasers
The last important principle of learning is: the mind seeks answers. Partial information is an almost intolerable torment to the mind. Our curiosity demands further data, until we have the whole story. One of my favorite uses of this principle is with clients in burnout, who often don't seem to be hearing a word I say. I explain that in their energy level, they are at the 0-to-2 level on a scale of 10. Clearly, I say, they don't have a "0-to-2 jar." A what? "A 0-to-2 jar," I repeat. Flummoxed, they repeat their question and I repeat my response, until they demand to know what on earth a "0-to-2 jar" is. Now I have a client who's fully engaged and right there with me, trying to find out what in the world I'm talking about. Then I satisfy that curiosity. I take a small jar with a lid, label it "0-to-2," and explain that when people are in burnout, they don't have the energy to make wise decisions. They need to write down any problems, pending decisions, or troubling thoughts and put them in the jar. Close the jar, and don't open it except during therapy. This simple "trick" awakens the client's curiosity, involves them in the session, and nourishes the therapeutic bond. Most of my clients take their "0-to-2 jar" home; many keep it for years as a reminder.
You may have noticed that these memory tricks—Senses, Emotion, Link to Learning, Interest, Teasers—spell out a memorable acronym: SELL IT! Advertisers and marketers use these principles to sell us products. Every day, they play to our senses, manipulate our emotions, link new information to familiar knowledge, provoke our interest, and tease us with cliffhanger commercials. All this creates lasting memories and positive associations. As therapists, we can use the same principles to "sell" our clients the key lessons that will enhance their well-being.
This blog is excerpted from "Lessons Well Learned," by Danie Beaulieu. The full version is available in the January/February 2004 issue, In the Eye of the Storm: Bessel van der Kolk Has the Trauma Field in an Uproar.
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Tags: big moment | big moments | creative counseling techniques | emotion | emotional | emotional brain | emotional learnings | emotions | memory | preserving memory | skills | techniques | therapeutic homework | therapy techniques