In and Out of Session
So in session, we’re choosing and modeling language to encourage more helpful thinking and behaviors. We’re using metaphors and experiential exercises to get people present, noticing their thoughts and feelings instead of being driven and tyrannized by them. But practice outside of session is at least as important.
Clients must often be reminded that life won’t change if they don’t do things differently. What we often see, and this was true of Hannah, is clients saying, “I’m depressed and don’t want to be. Hey, therapist, please fix that for me. But I don’t want to do anything differently myself.” This is a very stuck place for both client and therapist to be, if the client doesn’t do work between sessions, if only on tiny things.
Mindful Awareness
Hannah was thus asked to practice mindful awareness daily, increasing over time from a minute a day to two minutes; to download a meditation app; and to practice mindful walking. She loves animals, and also practiced mindfulness of her cats and her brother’s dog, really looking at their eyes and touching them. There are many mindfulness exercises online, but again, a client will find more resonance when there’s a personal connection.
Journaling
Being a writer was an important value for Hannah, so keeping a journal was a way to help her connect with that while seeing her thoughts written out, creating a distancing effect. It was still hard to get her to do it, however.
Other Work
Hannah was asked to practice a variety of other activities outside sessions, texting her therapist about successes.
- Requesting support from friends
- Connecting with friends
- Moving her body a little more
- Going dancing
- Cleaning her room
- Traveling to see her siblings, which she was afraid to do, thinking she was too fragile. But it actually ended up being important, hanging out with them and their friends, and seeing how adult life might look and feel.
Writing to a “Friend”
Additionally, Hannah was set other writing exercises. For example, she was asked to write a letter to an imaginary friend, who was given a name. The “friend” was struggling with the same difficulties as Hannah, whose letter provided advice, support, and compassion. This was an elaborate version of the what-would-you-tell-a-friend question, which of course told Hannah some things about herself.
