1. Everyone has challenges.

Clinical psychologist Christina G. Hibbert, PsyD, wants readers to know that they’re not alone in their struggles. “We all have challenges. Even as I sit in my chair helping [a client], I have challenges too. It hurts me to see clients feeling like they’re the only ones on earth who ‘need therapy.’”

Therapist Joyce Marter, LCPC, agreed. She believes that our struggles are simply “part of the human condition…[E]verybody struggles with issues related to self-esteem, identity, navigating relationships, coping with various life traumas, managing stress or challenges in creating the life we want, personally and professionally.”

2. Everyone can benefit from therapy.

Therapy is a healthy and proactive approach to dealing with challenges, Marter said. “A therapist is like a personal trainer for your mind. I believe we can all benefit from therapy at various points in our lives and see it as a preventive and routine form of health care.”

3. Seeking therapy is courageous.

It’s a common myth that therapy is for weak people who can’t fix problems on their own. “I think of therapy as making use of all the tools at one’s disposal to manage negative emotional symptoms and maximize strengths and fulfillment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “People willing to delve into their own psyches are … actually quite courageous.”

4. Therapy helps you navigate life.

You can apply the skills you learn in therapy to any area of your life, according to Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression. “It really doesn’t matter if you go to therapy for anxiety, depression, to lessen obsessions, to quit smoking or to learn how to parent – whatever the reason – the techniques of self-reflection and thought-changing are involved in all.” In fact, she said, many people consider therapy to be the most meaningful and valuable experience of their lives.

5. Therapy is a process of self-discovery.

“To my thinking, therapy does not need to be an excruciating experience. Sometimes I think we do therapy itself a disservice when we call it ‘work.’ For my clients, I like to think of their therapy as a process of self-discovery, more joyous in the end than painful,” Duffy said.

6. Therapy isn’t about blaming others.

“Some people think therapy is about blaming their parents or their life histories for all of their woes,” said Marter, also owner of the counseling practice Urban Balance. Therapy is actually “about honoring those experiences and then taking full responsibility for your life from here forward.” She shared Wayne Dyer’s quote: “Everything you do is based on the choices you make. It’s not your parents, your past relationships, your job, the economy, the weather, an argument or your age that is to blame. You and only you are responsible for every decision and choice you make.”

7. Therapy is a place to say and ask anything.

“Therapy isn’t the place to put your best foot forward and try to convince the therapist that you have it all together,” according to Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy.” Instead therapy is a space to be fully and authentically yourself. Bring everything from your daydreams and fantasies to your harsh opinions and random thoughts, he said. “A skilled therapist will work to understand these impulses and beliefs without judgment and help you make sense of them. Save the pleasantries for the outside world, and let your raw, real thoughts and feelings out here.”

The same is true for asking your therapist questions: If there’s a question you’d really like to ask about your treatment or therapy in general, ask away, Howes said. “If the therapist doesn’t want to answer, let them explain why and how not answering benefits you in the long run. If you’re not satisfied with the answer, let them know.” He noted that therapy is a relationship. “Therapists should be experts at setting boundaries and working through relational issues in a constructive way.”

8. Therapy doesn’t end as soon as you feel better.

Jeffrey Sumber, M.A., a psychotherapist, author and teacher, wishes that people knew that improvement doesn’t signal the end of therapy. “So often, folks begin to feel the shift within themselves, their patterns change, their mood improves, and they terminate treatment only to find themselves in a similar situation down the road.” That’s because those shifts are a mark of progress, not proof of a cure.

“The counseling process is multi-layered and the feelings of renewed purpose and lifeforce that accompany the internal shifts we make are actually there to help propel us forward so that we feel this way every day on our own. I wish people took the signs of improvement as a confirmation that treatment is helping, not over.”

9. Don’t compare your insides to others’ outsides.

“I often hear clients pathologize themselves and suggest that most other people are functioning at a higher level in various aspects of their lives,” Marter said. In reality, however, “we are all dealt a different hand of hardships and blessings. Therapy is a place to help you think through how you want to play your hand.” In fact, she’s seen “people overcome great adversity and others squander great blessings.”

10. Your thoughts dictate your feelings and behavior.

Marter cited Gandhi: “A man is but the product of his thoughts.” This is why it’s so helpful to pay attention to the things you say to yourself and shift your perspective to more realistic, empowering thoughts. “Through therapy, we can let go of negative or irrational thinking and promote positive thinking and a practice of gratitude that will attract more positivity into our lives,” Marter said.

11. Acceptance isn’t limiting; it’s liberating.

“Don’t get me wrong, there are times when we need to keep striving, pushing, and holding out hope for better health, better careers, or healthier relationships,” Howes said. However, many individuals end up wasting their time and energy wrestling limitations they can’t change, instead of focusing on the things they can alter. According to Howes:

We need to accept our age. We need to accept many physical and mental illnesses and addictions. We need to accept the past. We need to accept others as they are. This isn’t to say we need to like it, or that we can’t work to make the best of each of these entities, but we need to relinquish the idea that we have any power or responsibility to change them. Once people realize they can accept instead of fighting things beyond their control, they realize they have much more time and energy for things they can impact.

12. You are worthy. Whether her clients come in with depression, anxiety, relationship problems or parenting concerns, Hibbert believes that, at the core, they’re all struggling with the same thing: “an inability to comprehend and feel their worth.” She’s also seen this with friends and family and experienced it herself. “I’ve had to work very hard to discover my own self-worth.”

She wishes people truly understood that “they’re more than how they feel, what they do or say, and what they think. Deep down, we are each of infinite worth.” Connecting to our self-worth is “the key to living a life of meaning, abundance and joy,” said Hibbert, also a women’s mental health, postpartum and parenting expert. (She talks more about self-worth in this piece.)

13. Life requires balance.

Howes noted that while the idea of balance is cliché, he’s also seen the damage of living in extremes. “People who work too much, party too much, spend too much time online, exercise too much or let themselves become consumed by their relationships will face the consequences of a life out of balance.” The skills for achieving moderation are challenging yet critical to learn, he said.

14. Growth and progress are not linear.

“We all go through setbacks, relapses or regressions in life as a normal part of being human,” Marter said. Experiencing a setback doesn’t mean you’re back to square one. Instead, this is an “opportunity to learn, get back on the saddle, grow and move forward. Life is a process of ebbs and flows.”

15. Work on the inside.

According to Marter, “Some people are waiting for external factors such as a relationship, a job, a perfect body or a fat bank account to make them happy.” Instead, the key is to work from the inside out. She cited Eckhart Tolle: “If you get the inside right, the outside will fall into place.” Marter added: “Therapy is a place to explore your greatest gifts and align your life with those so that you will achieve all you desire personally and professionally.”

“I’m still surprised at the number of people who come to therapy to learn how to get someone else to change,” said Ryan Howes, Ph.D, a clinical psychologist and author of the popular blog “In Therapy.” “They want to know how to get their boss to talk to them differently, or want their wife to appreciate them more, or want their friends to be more considerate.”

Of course the only person you can change is yourself. That includes changing your beliefs, behaviors, reactions and patterns. As therapist Joyce Marter, LCPC, said, “In therapy, change may mean letting go of dysfunctional relationship patterns, irrational beliefs and self-sabotaging behaviors and then replacing them with a more positive, conscious and proactive mode of operation that leads to greater happiness, wellness and success.”

Why is Change so Hard?

According to clinical psychologist Christina G. Hibbert, PsyD, change is difficult because most people don’t know how to change, or we’re just not ready. She believes there are six stages of change, which are part of the “transtheoretical model of change.” This model demonstrates that change isn’t linear but a spiral. She said:

Most people spiral up and down the six stages of change several times before they actually make change that lasts. That’s just part of the nature of change.

As I always say, “As long as you’re in the spiral, you’re making progress. It doesn’t matter whether you’re spiraling up or down, what counts is that you keep on working.” Teaching this to my clients helps them see they’re actually doing better than they think.

(Hibbert explains the model in this post.)

Sometimes change isn’t really what you want. Howes gave an example of a husband who thought he wanted his wife to change.

I’ve worked with couples who claimed to want changes from their partner, but when change happens they want the old familiar dynamic back. A husband wants his wife to be more social, for example, but when she branches out he feels jealous and wants the homebody back. I encourage couples to be clear about the change they ask for, and prepared for that change to occur.

We also gravitate toward the familiar, and fear the unfamiliar, said Marter, owner of the counseling practice Urban Balance. “Change can be scary because people fear the unknown, perceived loss of relationships or the risk of failure.”

Howes quoted the common saying: “The devil we know is better than the devil we don’t.”

Some people hyperfocus on external changes. “I’d say that so many of us struggle with external change because we secretly hope we can bypass the true work which is changing how we feel inside,” said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. Put another way, “when we place too much concern in things looking different then we tend to overlook the deeper need to shift our internal climate.”

Change is tough because it also takes time. According to Serani, “It takes time to discover patterns that create undesirable thoughts and behaviors. It also takes time to understand what issues get in the way of achieving your goals once you know what you need to change.”

Naturally, resisting change is normal, Marter said. “Breaking through defense mechanisms and developing the tools to think and operate differently is a process with ups and downs.”

While change is difficult, it’s to be expected. “I think we need to recognize the inevitability of change. We are all changing in some way or another, every day,” said clinical psychologist John Duffy, Ph.D, author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.

How Therapists Facilitate Change

“I try to teach clients to be like a super-sleuthing detective. I want them not to just crave change, but to be immensely curious about it,” Serani said. In fact, she believes that “enthusiastic curiosity” helps us develop insight and replace old behaviors with new ones much faster.

Healthy change, she said, happens when we ask key questions, such as “Why isn’t this new technique working? What’s getting in the way? How can we make it work better?”

Hibbert, an expert in postpartum mental health, helps her clients learn how to change. “My job as a psychologist is to provide the ‘how’ so the client can get to work. I’ve seen many people make amazing changes, so I know it’s possible. You just have to believe it’s possible for you.”

Howes helps clients gain a clearer understanding of the trade-offs of change.

As pessimistic as it might sound, I try to help people know that change means trading in one set of problems for another. Sure, there may be some clear benefits to change, but there is always a different set of hardships to endure.

Just ask the people who win the lottery. Financial problems are solved, but a host of new problems emerge. If they’re informed and prepared for their new set of problems, change may be welcomed instead of dreaded.

Change is an inside job. Marter quoted Eckhart Tolle, author of The Power of Now, who said: “If we get the inside right, the outside will fall into place.” She explained:

Many people think if they have the perfect job, house, relationship, or body, they will finally be happy. Through therapy, I help clients make internal changes – such as detachment from ego, focus on essence, silencing the inner critic, practicing positive thinking and gratitude – that lead to positive change in life.

Marter teaches her clients to recognize that it’s “inner forces” that determine their lives, not external ones. This way “they feel empowerment to enact positive change in their lives, both personally and professionally.”

Plus, she teaches them to practice assertive communication, which includes “asking for what they need, setting healthy limits and boundaries and saying no to old patterns that are no longer serving them.”

Sumber also helps his clients transfer the focus from external change to internal transformation.

I work with clients to release their expectation of external manifestations and allow for a shift in their conscious awareness of who they are and why they are doing what they are doing. Most clients are surprised in the end to find that things have indeed shifted externally as a result.

Duffy helps clients foster self-awareness, which he views as a requisite “for satisfactory, proactive change. Otherwise, we are simply reacting to life, and often feel we are victim to it.”

Real change requires work and effort. As Serani said, “toxic tendencies or undesirable thoughts don’t happen overnight. They are created and cultivated over time. And the same goes for change. It doesn’t happen overnight either.”

Positive change is a process that ebbs and flows. But it’s worth it. Change is “an essential part of healing and development,” Marter said.

“With 6 kids, ages 16 to 5, a husband and home to care for, a private practice, and my many ‘side jobs,’ including running a non-profit, speaking, writing for my website, blog, and other people, doing some legal consultation, and writing a book, I like to say my life is ‘full,’” said Christina G. Hibbert, PsyD, a clinical psychologist and expert in postpartum mental health. She’s also active in her church and has commitments on Sundays and Wednesday evenings every week.

Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance, also has a lot on her plate. “I am a wife, a mother, a psychotherapist and owner of a group practice with nearly 50 therapists and five locations, a writer with a book in development, a public speaker, the Vice President of the Board of the Illinois Mental Health Counselors Association, and frequently serve as a psychological expert in the media.”

That’s enough to make anyone’s head spin. In addition, Marter takes her kids to and from school, eats dinner with her family, has an active social life, vacations for at least six weeks every year and gets eight hours of sleep per night.

So what’s their secret? Below, Marter, Hibbert and other therapists spill the details on living a fulfilling life and getting things done.

1. They know their priorities.

Hibbert knows what matters most to her, and she focuses on those things first and foremost. “[This] allows me to prioritize my time and helps me know when to pull back from other things. If any of my top priorities are out of shape, I push off the others until things are in order again.”

Her top priorities are: “My relationship with God, my relationship with my husband, and my role as a mother and relationship with my kids.” Her work comes next. But this also has to match her mission: “to learn all I can and teach what I learn.”

Marter takes a similar approach. She starts off with a vision for her personal and professional lives. (For instance, you can create a vision board, she said.) “Then we need to align our priorities and intentions to support that vision. We need to focus our energy on the things that provide meaning, value and life energy and let go of the things that don’t.” She then sets clear goals and firm boundaries around her time, such as her work hours.

2. They have a formula for their days.

“It has taken me many years and several iterations to find a formula that worked for me,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.

He sees clients either three or four days a week from late morning into the evening to accommodate his clients, many of whom are teens. “I work fairly long hours those days, but I enjoy the work.” The other days he works on his next book or with the media. For instance, he’s been on the Steve Harvey Show multiple times.

3. They protect family time.

Clinical psychologist Ryan Howes, Ph.D, wakes up early to make breakfast for his sons and drop them off at school. He comes home around 6 p.m. to have dinner with his family and eventually put his boys to bed.

“After the boys’ bedtime I enjoy the evening with my wife, which includes checking in with each other, talking about our future plans, and watching some reality TV cooking shows.”

Duffy also “[protect[s] nights and weekends for my wife, son and friends.”

4. They delegate.

When Hibbert needs more time to accomplish projects after school, she asks her older kids to watch the younger ones. She asks her husband to help with grocery shopping and dinner several nights a week. She also has a housekeeper come once a week. “[This] is one of the best things I’ve ever done for myself!”

Marter outsources anything that doesn’t “provide personal meaning or value to me. In my business, I delegate the responsibilities that are not my strengths or passion.” At home, she outsources house cleaning and grocery shopping. This way she has time for what’s most important, such as hosting her kids’ play dates.

5. They have pets.

Having a dog actually makes my life more productive,” said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. “I’m responsible to make sure he is well fed, walked and properly taken care of but this also helps punctuate activities in my day and organize tasks around set breaks in my process.”

6. They use activities to ground them.

Sumber uses the walks with his dog to map out his days and intentions.

It is often during my morning walk with Tashi that I run through my day in my mind, determining priorities and goals and create a visual for how the day will ideally play out. This walking meditation is functional as well as intentional and sets me off on a conscious trajectory into my day.

He also finds focus while making his morning coffee.

I also enjoy the process of my morning coffee. I grind the beans, pull the espresso shots and mix the Americano to my personal perfection. This takes me 10 minutes every morning and I might as well be repairing the space station tethered in deep space…I am very focused.

As I sip the coffee, I ease into my morning by sifting through emails (mostly deleting) and then send personal birthday messages to Facebook friends. I typically take time to prepare meals for the day and then set off to work.

Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, uses her senses to switch gears and get things done.

My typical day has me in the role of clinician, homemaker, professor, writer and woman. I know the metaphor of wearing “different hats” gets tossed around in shifting roles, but for me, it’s more of what’s in my hands that helps me get things done.

It’s as if my sense of touch transforms me into who I next need to be. My appointment book helps me shift into clinician mode. As soon as I touch it, I can feel myself move into a professional posture.

I have a home office, so in between patients, when I walk back into my home and I touch the doorknob, I’m into homemaker mode – cooking, doing laundry or tidying up the place.

When I pick up my lecture notebook, I’m into professor mode and readily head off to the local university to teach. And if I’m sitting at the keyboard, I easily shift into writer mode.

When I return home and settle into comfy clothes, I become just a woman again -connecting with my family and myself. I’ve always been a very sense-oriented person, and have found using touch as both a cue for change and a grounding way to cement my identity.

7. They stay fully present.

Howes focuses on being present in all his activities:

Freud said “love and work are the cornerstones of our humanness.” I agree with that and try to make the most of both. I do my best to be fully present when I’m wearing either hat. I want to engage with my family, regardless of what is happening at work, and be fully present with my clients, regardless of what is going on at home. On my best days, I’m able to do both.

8. They practice self-care.

Marter always makes time for self-care, which helps her be more productive in other areas of her life.

I prioritize self-care (like rest, meditation, exercise and fun) so that I have the energy to manage all my responsibilities. I practice gratitude and positive thinking to facilitate the energy and confidence I need to achieve my dreams. I tap into my support network (friends, family, therapist, coach, colleagues, mentor, etc.) for feedback, wisdom and support in helping make my life vision a reality.

Hibbert practices her self-care routine first thing in the morning.

On a day-to-day basis, one of the best things I do is wake up before my kids so I can enjoy an hour just for me. I exercise, meditate, and study scriptures to start my day right. When I miss this time, life just doesn’t seem to run as smoothly.

The morning also designates self-care for Duffy. “I work out, meditate when I can, and get to the office early. I eat breakfast there, page through the paper, and clear my mind for a while before the chaos begins!”

Hibbert prioritizes sleep, which is crucial to her productivity and well-being.

For me, the other big key to getting anything done is sleep. If I’m not sleeping well (and I’m not a great sleeper in general), I can’t function well. I get grumpy and overwhelmed too easily. So, I focus on getting to bed as early as I can so I can get up early, and I try to “sleep in” on weekends, when I am given the chance.

When he has the time, Howes strums his guitar, plays hoops, or works on “creating the world’s next great pasta sauce.”

9. They pay attention to their energy levels.

Sometimes Marter lets her energy guide the projects she works on. “When I occasionally experience an ebb of energy, I let myself rest or do the tasks that are easy for me. When my energy is high, I make a concerted effort to carve out time to tackle tasks that are high priority but low urgency like writing my book.”

All of these clinicians lead fulfilling professional and personal lives. They know their priorities and do their best to protect them. They manage their time effectively, know when to delegate and make sure to be completely present at every point.

“Whatever the reason, it’s vital to bring it into your sessions as soon as you feel it,” said Serani, author of the book Living With Depression. Howes agreed. Wanting to end therapy is a critical topic to explore, he said. And it could be as simple as telling your therapist, “I feel like it’s time to end therapy, I wonder what that’s all about?”

Therapy gives people the opportunity to have a positive ending, unlike most endings, which tend to be negative, such as death and divorce, Howes said. An end in therapy can be “more like a bittersweet graduation than a sad, abrupt, or complicated loss. Ideally, you can have a satisfying closure to therapy that will help you end relationships well in the future.”

That’s because our relationship with our therapist frequently mirrors our relationships outside their office. “We often unconsciously recreate dynamics from other relationships with our therapist,” said Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance. “Processing negative feelings can be a way to work through maladaptive patterns and make the therapeutic relationship a corrective experience. If you avoid this conversation by simply discontinuing therapy, you will miss this opportunity for a deeper level of healing resulting from your therapy.”

Tips on Ending Therapy

Below, clinicians share additional thoughts on the best ways to approach your therapist when you’d like to end therapy.

1. Figure out why you’d like to leave. According to Jeffrey Sumber, M.A., a psychotherapist, author and teacher, the best way to end therapy is to delve into why you’d like to leave. Ask yourself: Is it “because I feel disrespected, stuck or incompatible or [am I] actually feeling uncomfortable dealing with certain things that the counselor is pushing me on?” It’s common and part of the process of changing problematic patterns, he said, to feel triggered and even angry with your therapist.

2. Don’t stop therapy abruptly. Again, it’s important for clients to talk with their therapists, because they may realize that their desire to part ways is premature. Even if you decide to leave therapy, processing this is helpful. “A session or two to discuss how you feel and what kinds of post-treatment experiences you may go through will help ease guilt, regret or sadness that often arises when wanting to stop therapy,” Serani said.

Plus, “Honoring the relationship and the work you have done together with some sessions to achieve closure in a positive way can be a very powerful experience,” Marter said.

But there are exceptions. Howes suggested leaving abruptly if there are ethical violations. He reminded readers that you’re “the boss” in therapy:

If there have been significant ethical violations in therapy – sexual advances, breached confidentiality, boundary violations, etc. – it may be best to leave and seek treatment elsewhere. It’s important for clients to know they are the boss; it’s your time and your dime, and you can leave whenever you want. If the violations are serious enough, you may want to tell your therapist’s boss, your next therapist, or the licensing board about them.

3. Talk in person. Avoid ending therapy with a text, email or voicemail, Marter said. “Speaking directly is an opportunity to practice assertive communication and perhaps also conflict resolution, making it is an opportunity for learning and growth.”

4. Be honest. “If you feel comfortable and emotionally safe doing so, it is best to be direct and honest with your therapist about how you are feeling about him or her, the therapeutic relationship or the counseling process,” Marter said.

When offering feedback to your therapist, do so “without bitterness or judgment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “After all, this person will be working with others in the future, and your thoughts may change his or her style, and help them to better serve their clients in the future.”

“A good therapist will be open to feedback and will use it to continually improve,” added Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health.

5. Communicate clearly. “Your best bet is to be as direct, open, and clear as possible,” Hibbert said. Articulate your exact reasons for wanting to end therapy. Hibbert gave the following examples: “’I didn’t agree with what you said last session and it makes me feel like this isn’t going to work,’ or ‘I’ve tried several sessions, but I just don’t feel like we’re a good match.’”

(“’Not being a “good match’ is a perfectly good reason to terminate therapy, since so much of it has to do with a good personality fit and a trusting relationship,” she added.)

6. Be ready for your therapist to disagree. According to Serani, “It is not unusual for a therapist to agree with ending therapy, especially if you’ve reached your goals and are doing well.” But they also might disagree with you, she said. Still, remember that this is “your therapy.” “Don’t agree to continue if you truly want to stop, or feel persuaded to keep coming for sessions because your therapist pressures you to stay.”

7. Plan for the end in the beginning. “Every therapy ends, there’s no reason to deny this fact,” Howes said. He suggested discussing termination at the start of treatment. “Early in therapy when you’re covering your treatment goals, why not talk about how and when you’d like therapy to end? Will you stop when you’ve achieved all your goals? When the insurance runs out? When and if you get bored in therapy?”

Again, therapy can teach you valuable skills to use for your other relationships. According to Marter, “Even if after expressing your negative feelings, you choose to end the therapeutic relationship, you can rest assured that you took good care of yourself by advocating for yourself in a way that was direct and honest. This is a skill you can bring with you to other relationships that are no longer working for you.”

How Therapists React to Termination

So how do clinicians take it when clients end therapy? All the therapists noted that having their clients share feedback on their experiences is incredibly valuable. In short, it helps them improve and grow as clinicians.

But, when there’s no official end to therapy, therapists are left with many unanswered questions. According to Howes:

When a client terminates via voicemail, fades away with a vague “I’ll call you for my next session,” or abruptly announces the end and leaves, I feel loss and am left with many questions.

What fell short in this therapy? What would have worked better? How could I have been a better therapist for you? What made you feel like you couldn’t discuss this with me? I’m left with no answers for these questions, and that’s difficult. I spend a lot of time reflecting on our work together, but I have no definite answers.

Serani and Marter echoed this sentiment. “Sometimes clients just ‘fizzle out’ without explanation, which has been one of the harder pieces of being a therapist for me because I am very invested in my work with my clients. It causes me to wonder if I did something that bothered them and wished that I knew,” Marter said.

Serani also talked about attempting to understand the client’s decision. “I always want to explore the reasons why. Was it something I said? Was it something I didn’t say? What has happened to make this decision so urgent? I often feel confused, and work hard to make sense of why this has happened.”

Hibbert tries not to take it personally. “Usually clients simply ‘stop coming,’ so it’s not easy to know if they’re just ‘done’ with therapy or if I’ve done something to make them want to leave. When this is the case, I just let it go. It’s their issue, not mine, and I don’t need to stress over it when I don’t know the reasons behind it.”

She takes a similar approach when a client wants to stop therapy because of personality differences. “Only a couple of times has a client verbalized a desire to leave because of ‘personality’ or ‘style’ differences. I can’t say it never stings, but I try not to take it personally. Like I said before, therapy, in large part, is a personality fit, and I can’t fit with every personality.”

When client and clinician are able to have a session (or two) for proper closure, it becomes a great opportunity to reflect on their work together. In fact, for Howes, these are often his most enjoyable sessions.

My goal is to help a client confront life head-on. If they have clear reasons to end therapy and we’ve had the time to talk about it and tie up the loose ends, ending therapy is a great time to reflect on our work, talk about the client’s future, and discuss what has been accomplished and what hasn’t. We can leave with a sense of closure, without lingering questions.

Some of my best sessions have been final appointments where we reminisce about our time together, talk about the client’s future, and I learn how to be a better clinician for others.

Serani described final sessions with mixed emotions. “This is usually an exciting but bittersweet time, where we both feel a loss about the goodbye, but know that leaving is part of the healing process. I’m always sad for me, but happy for my patient.”

Unless there are ethical violations, it’s important to discuss your desire to end therapy with your therapist, in person. As Duffy said, doing so with “respect and integrity will set the tone for other relationship issues you will encounter in life.” It also helps you process your emotions and figure out if you’re leaving too soon. And it gives your therapist valuable feedback that improves their work. In other words, with proper closure, everybody wins.

But that’s why it’s so important to have an assortment of tools and techniques at your disposal. This way, when stress strikes, you have an army of options to deal with it healthfully.

Below, Duffy and other clinicians reveal how they reduce and manage their stress.

Before you can deal with stress, you need to recognize that you’re actually stressed out, which isn’t always obvious. “In order for me to de-stress, I need to acknowledge my stress-state in the first place,” Duffy said. For warning signs, he zeroes in on his body. “I have certain tells, like tapping my feet or slipping into a headache.”

Duffy de-stresses by writing, exercising and being with loved ones.

I write to de-stress, and this is highly effective for me. I get lost in that creative process, especially if I can get into the flow of it, and stress is a non-factor.

I can say the same for exercise. When I am running or working out, it is incongruous with stress for me.

Perhaps the best day-to-day stress manager in my life is spending time with my family and friends. And I know that if I’m laughing, I’m good.

Deborah Serani, Psy.D, a clinical psychologist and author of the book, Living with Depression, focuses on soothing her senses, and sneaks in moments of self-care, even on the busiest of days.

I have so many things I do when I’m stressed out. I’m a very sense-oriented person, so my de-stressing toolkit involves cooking, gardening, painting, meditation, yoga, catnapping, taking a walk, listening to music, lingering in the fresh air of an open window, a lavender-scented bath or nursing a cup of chamomile tea.

I have to say that I truly make “time for me” a significant priority, even if it means sitting in my car for just a few minutes during a busy day with the sunroof open, my seat tilted back just right, the radio playing soft jazz while I sip a warm latte. Just don’t bother me should you spot me in the Starbucks parking lot, okay?

Jeffrey Sumber, M.A., a psychotherapist, author and teacher, takes a meditative – and humorous — approach to stress.

When I’m stressed out I like to cook really healthy food. I like to spend time at Whole Foods getting super clean ingredients and then I like to chop vegetables, make sauces, etc., until I have a great tasting, healthy dish to enjoy.

The process is meditative and ideal for me on practical levels as well! Then I take a picture of the dish and post it to Facebook so my friends are jealous.

I also like to take the dog for a long walk so I can sort of zone out while he enjoys his exercise.

Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy,” approaches stress like he does therapy.

My best protection from stress is the therapy frame: the boundaries of time, place, and role that give structure to therapy. For example, I do my best to begin and end sessions on time so I have 10 minutes each hour to write a note, return a phone call, eat a snack, and strum on the guitar I’ve had sitting by my desk for the past decade. Those 10 minutes are my time to recharge, refresh, and prepare for the next session.

I’m not rigid about this. Sometimes a session needs to run a few minutes long, but I try to hold tight to that boundary because I know it benefits me and my clients in the long run.

I also try to leave work at work by completing my notes, phone calls, and business busywork at the office.

Howes also has a variety of outlets that help him deal with stress. Seeing his own therapist is a major one.

When I’m away from work, I have my family, friends, basketball league, running, writing, and my endless quest to create the perfect tomato sauce. I’ve tried 200 recipes and I’m not there yet.

I’m also in therapy and will continue therapy as long as I’m seeing clients. I ask other therapists to do the same, or at least seek regular consultation or supervision. I believe outlets like this and feedback on your work is essential.

For Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health, daily habits are vital in staving off stress, and coping with it.

As a psychologist and mom of 6, I must admit I feel stressed more often than I’d like. The good news is that, over the years, I’ve learned to see stress coming and tackle it before it gets out of hand.

As a wise person once said, “…calm is something you must go after, whereas stress comes after you” (Judith Orloff, MD). Stress certainly comes after me, so I seek the “calm” in the following ways.

My daily habits help the most, to both prevent and manage stress. These include: morning exercise, scripture study, meditation, and prayer; putting foods in my body that give me energy; and getting to bed in time to get a good night’s sleep (when my kids will let me!).

I also take a daily “rest” before my kids get home from school (or if they’re home, I make them rest too), so I can lay down, take a nap, read, or just unwind for a bit.

For stressed out muscles, I get a deep tissue massage at least once a month, and I’m a big fan of a hot bath on a cold day.

Hibbert turns to cognitive-behavioral techniques to cope with distorted thinking, which only exacerbates stress.

When stress levels rise, I use cognitive-behavioral techniques to manage my thinking—one of the best tools I’ve ever learned for stress management (check out my article on “Thought Management”). This helps me see what my mind is saying and gives me the opportunity to turn it into something more realistic.

She also uses stress as important information to scale back on commitments and focus more on savoring life.

I tend to be “all-or-nothing,” so I also examine my commitments and start saying “no” a little bit more. Mostly I take stress as a sign that I am doing too much. It’s a great warning signal that I need to go back to the basics again—to slow down, let love in, let go of “doing” so much and just “be” for a while.

When stress gets so overwhelming, it’s paralyzing. Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance, uses a tip from Alcoholics Anonymous (AA).

I know that in AA, they talk about “doing the next right thing.” When I get stressed out, I sometimes become almost paralyzed with feelings of overwhelm. I find that doing anything proactive, even something simple like straightening up my space, will make me feel better. Once I gain momentum, I tackle the things that need to be addressed to alleviate the stress.

Like the other clinicians, Marter also has a collection of tools, which includes cranking up self-care, calming uneasy thoughts and putting stress into perspective.

I increase self-care, such as exercise, proper nutrition and rest.

I practice mindfulness techniques, such as deep breathing and meditation, to ground me in the present. This helps me to stop obsessing about the past or worrying about the future, and to realize that basically everything is okay in the present moment.

I silence my inner critic and replacing that voice with a positive mantra, such as “I am only human and am doing the best that I can.”

I take everything off my plate that isn’t imperative and delegate what I can.

I share with my core support system and ask them for help.

I try to remember that stress ebbs and flows and “this too shall pass.”

I try to “zoom out” and gain perspective. If it isn’t a matter of life and death, I try not to be too serious and remember to see the humorous aspects that exist in most situations.

I try to detach from ego and focus on my essence — meaning rather than defending my sense of self (which can be very stressful), I try to let go and live life from a deeper, wiser, spiritual entity within.

Stress is inevitable. And when it strikes, it can feel like you’re being attacked from all sides. That’s why having healthy tools to turn to is critical. Maybe the above techniques resonate with you. Or maybe they help you brainstorm your own set of de-stressing activities. Either way, having a plan to prevent and handle stress can be the difference between falling from a cliff and tripping over a pebble in your path.

But it’s vital to keep looking until you feel a sense of connection and trust with your therapist, said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. If you don’t, find “someone else to work with. Period,” he said.

Hibbert also underscored the importance of believing your therapist can help you. But these signs aren’t necessarily that obvious. In fact, knowing when a potential therapist might not be helpful is just as useful.

That’s why in this month’s “Therapists Spill” series, we asked clinicians to shed light on when a therapist isn’t right for you. Below, they share 11 warning signs that it’s time to find another clinician.

1. They behave unethically.

According to clinical psychologist Ryan Howes, Ph.D, “Any signs that therapy is moving from a professional and empathic relationship to a romantic one should be considered a bright red flag.” (He recommended reading this page for more information.)

But unethical behavior isn’t just sexual advances. It also includes “violations of confidentiality or financial wrongdoings” and offensive comments, said Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance. For instance, a friend of Marter’s had an already-pricey therapist who charged his clients while he was on vacation. In graduate school, Marter had an initial consult with a therapist who made a racist remark. She never went back.

2. They ignore confidentiality and emergency protocol.

Therapists should have you complete an intake form to provide information in case of an emergency, said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. Similarly, every therapist should discuss your rights with you, including the times when they are required by law to break confidentiality, Sumber said. (You’ll also need to sign the confidentiality agreement.)

3. They don’t specialize in your issue.

Hibbert, an expert in postpartum mental health, regularly sees the devastating results from lack of expertise. For instance, she’s seen new moms hospitalized for a month because their clinicians believed they were psychotic. In actuality, they had postpartum obsessive-compulsive disorder, which is nonthreatening and treatable with therapy and medication, she said.

Find clinicians who are trained in what you’re struggling with, she said. Some therapists may simply have exposure in a particular disorder, instead of expertise, said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression.

She suggested asking specific questions about certificates, diplomas and experience. For instance, when you ask “How many clients have you treated with depression?” you don’t want to hear ‘a handful,’ you want to hear ‘dozens or hundreds,’” she said.

Because she doesn’t have training in substance abuse or eating disorders, Serani refers individuals with these issues to colleagues who do. “Good therapists always know the limits of their expertise,” Serani said. Even if you are seeing an expert in the field, don’t be afraid to seek a second opinion, Hibbert added.

4. Their recommendations go against your beliefs.

Hibbert works with members of her church and has heard of clinicians making suggestions that conflict with their beliefs and values. “A good therapist should work within your own value system,” she said.

5. They dodge your questions.

“Therapists don’t answer every question,” said Howes, who also authors the blog “In Therapy.” That’s because the focus is on you. However, they should answer reasonable questions clearly and directly, he said. These questions can be “general get-to-know-you questions to anything pertaining to treatment.”

Howes gave these examples: “Where are you from? What interested you [to] this line of work? Did you have a nice vacation? How long have you been in practice? Do you have experience with my issue? What do you recommend we do to treat this problem? How do you think therapy is going? How do you feel about our relationship?”

6. They over-share.

On the other hand, Howes said, “some therapists share too much about their own life, drawing attention to themselves and potentially pulling you in to take care of them.” He noted that every disclosure a clinician makes should benefit you in some way. (“You’re always welcome to ask how their story helps you,” he added.)

“A good therapist knows boundaries, keeps personal issues tucked away and always strives to make the session treatment productive for their client,” Serani said.

7. You feel worse after your session – regularly.

“This might happen on occasion, even with a therapist that you love, but if it’s happening all the time, then something is not right,” Hibbert said.

8. You feel judged, shamed or emotionally unsafe.

According to Marter, this includes anything a therapist might say or do, such as rolling their eyes. Marter stopped seeing a therapist because of a similar experience.

I saw a therapist for a few months who came highly recommended but seemed to hold a magnifying glass to all of my issues. I felt worse. I talked with her about it and felt even more pathologized. I was confused about whether she was just helping me see my “stuff” and I was being defensive, but made the choice to tell her I needed to end our work together. It turns out, this was the beginning of me setting healthy boundaries for myself and also led to my finding a therapist with whom I feel completely safe and positively regarded, even when we are processing my less than desirable aspects of self.

9. They’re a lousy listener.

While a therapist might not remember minute details, they should remember key facts about you and your concerns. According to Howes:

Not every therapist will remember your dog’s name, where you went to high school, and your favorite breakfast cereal every week. But they should recall your name and what brought you to therapy in the first place. If you feel like you’re constantly replaying your first session to help them help you better, you may want to take your business elsewhere.

10. They disrupt the session.

This includes answering phone calls — unless there’s an emergency — texting or even falling asleep. As Serani said, “A good therapist makes you the only focus.”

11. You just don’t feel “right.”

Howes and Hibbert stressed the importance of trusting your gut. “Sometimes there is no obvious reason — you just don’t feel it’s right,” Hibbert said. According to Howes:

If you feel like something isn’t right in your first phone call or initial session, this may be a bad sign. Some discomfort is a normal part of therapy, just as seeing a personal trainer isn’t always comfortable, but if you feel uncomfortable to the point of dreading or avoiding sessions, you may want to keep looking.

As Duffy said, “you should also feel comfortable in the atmosphere, physically, spiritually and emotionally, that your therapist provides.”

Of course, therapists may make mistakes. They’re only human. Marter shared a story about a friend’s beloved therapist forgetting their appointment. The therapist walked into the waiting room — in her home office — wearing a robe and slippers 15 minutes after their session was supposed to start. The therapist was surprised to see her client, but she was extremely apologetic. “Such human mistakes should be processed directly and can be opportunities for growth,” Marter said.

Finding a good therapist with the expertise you need isn’t easy. But paying attention to these red flags can give you some guidance on when to walk away, and continue looking for a therapist who is right for you.

This sparked a dialogue about how they gauge success. Marter’s knee-jerk reaction was to say that success excludes dicey circumstances such as driving under the influence or dropping out of school.

“Thankfully, I quickly regrouped from this position of fear-based and judgmental thinking and realized I do not truly believe any of those experiences or other life challenges mean somebody has failed or is not successful,” she said.

Hardships make us human and give us the opportunity to grow, she said. None of us is perfect or remains unscathed in life.

Marter’s guests offered myriad definitions, everything from education to prosperity to resiliency to health to happiness.

So what is success? What does being a success look like? Below, Marter and other clinicians spill their views on success.

According to Marter, also owner of the counseling practice Urban Balance, success is authenticity and mindfulness.

Success is to live life openly, authentically, and lovingly in a way that is aligned with the highest good of self and others.

Furthermore, when one is mindfully rooted in the present moment and engaged in relationships and work that promote a loving growth of human consciousness, one is joyous and prosperous. And so, this is my wish for myself, my children and for all humankind.

Christina G. Hibbert, Psy.D, a clinical psychologist and postpartum mental health expert, summarized success in three words: faith, love and joy.

To be successful in my work means that I am able to touch others’ lives, to help them know they are not alone, and to impart some bit of joy or wisdom that will leave them better than before.

To be successful in my family means to love — to listen, to say I’m sorry when I’m wrong, to encourage, uplift, and to always strive to give the best of my time, talents, and heart.

To be successful as a human being means to continually examine myself, my motives, and my works; to connect spiritually, listen to what my Creator has in mind for me, and trust the process — to be open to learning and improving, and willing to share myself and serve gladly.

I guess overall, for me, success = faith, love, and joy (my three-word motto) — striving to do and be my personal best in work, family, and as a human being, forgiving myself when I’m not, picking myself back up, and diligently pressing forward again.

For Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, success lies in the everyday, in the journey from setting a goal to realizing it.

For me, success is when I set a realistic goal, enjoy the journey as it unfolds and dwell in the momentary satisfaction when it all comes together. From cooking a new recipe, to learning a new yoga pose or taking a challenge that stretches my comfort zone, it’s the entire experience that offers me a sense of well-being. Success can be found in little things and big things. The key is to enjoy the ride once you set out on your material or existential destination.

Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy,” also prefers to focus on the flight, instead of the landing.

I try (really, really try!) to view life as a journey rather than a series of goals to be attained. I always feel less stressed and better able to focus on today when I’m in that mindset. With that framework, I try to view success as something to which I aspire rather than a goal with a finish line.

For me, success is achieving a healthy balance between the most important areas of my life. These include family and social relationships, occupational pursuits, hobbies, diet, exercise, rest, my spiritual life, and the continued pursuit of self-understanding.

I don’t think I’ve achieved this balance yet, as I only seem to maintain focus on one or two areas at a time. I may never find a way to keep all these plates spinning at once, but I will try for the rest of my life!

Jeffrey Sumber, M.A., a psychotherapist, author and teacher, described success as a triumph over trials and fear.

Success is overcoming challenges internal and external that at one time felt impossible or overbearing but with hard work and discipline I was able to rise above the fear or anxiety.

For most people success is a shifting concept, which transforms over time. It’s been for John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. Today, his view includes being of service to others and being satisfied with his life.

My definition of success has shifted greatly over the years. I used to think I had to accomplish something that others deemed “great” in order to consider myself successful.

Today, I find success in happiness, kindness, and helpfulness. I find success in loving, connected, available relationships, in my family and elsewhere in my life, including my relationship with myself.

In order to feel fully successful, I feel I need to continue to find new ways to reach out to others and give of myself. Finally, I don’t think I could ever feel successful without a degree of happiness, contentment and humor.

Success has many faces. The definition just depends on who you ask. And that’s the magic of success: You get to figure out what it looks like for you.

Fortunately, clinicians have various effective ways of navigating stuck scenarios. In our monthly series therapists spill the specifics on helping clients move forward.

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, talks candidly with his clients about being stuck. Just having such conversations, he said, ignites change.

Over the course of 15 years in practice, I’ve tried a lot of different techniques when I get stuck with a client. Now, I have found a device that seems to shift the dynamic almost immediately. I make the issue overt, and meta-communicate with my client around the stagnation of the therapy.

Effectively, I express my feelings. I might say, “Lately, it feels to me like we’re stuck, and things are not changing, either for you, or in sessions.”

This type of statement alone tends to change the dynamic immediately. You are no longer ignoring the issue, but you moved directly toward it.

I find that stagnation in therapy matches stagnation in life outside the therapy room. So, starting a shift in the room effectively becomes the therapy. In my opinion, few interventions are more effective, and it’s a model a client can use when stuck in most any area of her life.

Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, focuses on understanding why her clients are stuck. She views these stalemates as stepping stones on the path toward growth and progress.

I’m a psychoanalyst by training, so for me, analyzing why a client is stuck is a meaningful treatment tool.

In the field, this is known as resistance — and the experience becomes a stepping stone that enables us to delve into historical reasons why the client may be blocked, stuck or looping in an emotional holding pattern.

Understanding why resistance is happening leads to newfound insight, which always “unsticks” therapy!

It’s important for readers to know that analyzing resistance is a positive thing, so being stuck shouldn’t always be a red flag. I often tell my clients that being stuck allows us to roll up our sleeves and dig deeper to discover great things.

When he’s stuck with a client, Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, explores what’s going on between him and his client. Again, just bringing up the issue in session has tremendous benefits, as Howes noted.

The first line of defense against feeling stuck is a strong grasp on theory. Most theories present a way to understand and address the common obstacles that arise all the time. In fact some would say that’s why theories exist – to help therapists know “what should I do next?”

For example, a CBT therapist may return to the list of goals and treatment protocols when they feel stuck, while a dynamic therapist may start looking for the client’s unconscious defenses or their own countertransferrence as obstacles. Comprehensive theories almost always provide someplace else to go with the client.

As a relational psychodynamic therapist, I highly value authenticity, equality, and collaboration in the therapy office. When I feel stuck, I look at it as a relational issue and ask myself what’s happening between us that is bringing our progress to a halt.

Is there a misunderstanding that needs to be addressed? Are both of us here in the room, or are our thoughts elsewhere? On some occasions I’ve simply told the client I feel stuck and invite them to solve the problem with me.

If I’m stuck, we’re probably both stuck, and this gives us an opportunity to tackle the stuckness together. I’ve actually found this strengthens the working alliance, helps the client feel more empowered and invested in the work, and demystifies the therapeutic process.

Jeffrey Sumber, MA, a therapist, author and professor, also considers how he might be stalling progress and creatively examines the effectiveness of his treatment.

When I feel stuck with a client, I rely on C.G. Jung’s premise that a client can only move beyond the places in therapy that their therapist has moved themselves, in their personal work.

First and foremost, I ask myself if there is something I am doing to hold the process back … Am I afraid of any emotion in the room? Am I excited about the client’s journey as I used to be? Am I feeling any underlying resentment toward the client?

Then I begin to look at the treatment from new angles, asking new questions to myself and to the client. I often ask the client how they feel our process is going and what is working and what might not be moving as smoothly as they would like. Sometimes I will ask the client to switch seats with me and role-play client and therapist from our new vantages.

Similarly, Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health, carefully analyzes how both she and the client might be contributing to the stagnation in session.

I always try to pay close attention to how I feel when I’m working with a client. What I’ve learned over the years is that when therapy’s working well it’s a smooth, give-and-take process between client and psychologist. It’s when I start to feel like I’m working harder than my client that I know we have a problem. That’s how I know we’re “stuck.”

Of course, each client is unique and therefore each situation requires a unique approach, but in general, when I feel stuck with a client I first take a “step back” to give myself some perspective.

I try to imagine what might be going on with the client and I question myself to make sure there’s nothing going on with me that is getting in the way of the treatment.

Then, I bring it up to the client. I tell her, “Lately things haven’t been working as smoothly as before. Do you feel it too? I thought we should spend some time today discussing why this might be.”

Discussing it directly allows the client to share insights about her emotions, her experience in therapy, and her experience with me. This helps me understand what the client thinks about being “stuck,” gives me insight into any part I might play in the “stuck-ness,” and almost always helps clear things up one way or another. By confronting the “elephant in the room,” we’re able to get “unstuck” and keep the therapeutic process moving forward.

Joyce Marter, a psychotherapist and owner of Urban Balance, considers how her own concerns are affecting therapy with all her clients. Then, like the other clinicians, she talks directly with her client and raises specific key questions.

First, I will consider my countertransference responses to my client by reflecting on my feelings about the client, on other times I have felt similarly, and recognizing if any of my own issues are getting triggered.

I also consider if other clients of mine are also stuck, in which case I am the common denominator and becoming “unstuck” may need to start with me. I bring any discoveries to my clinical consultant and/or personal therapist to address so that I am best able to help my client.

If I am simply frustrated by the client’s “stuckness” and no other issues of mine are being triggered, I will refer to the teachings of Al-Anon to practice detachment with love, or the ability to stay present with my client without taking on any feelings of powerlessness.

Secondly, I will ask my client how he or she is feeling about therapy, our relationship, the process and his or her progress. I also ask if he or she has ever felt this way or had this experience before, as a way of identifying if this is [a] pattern being unconsciously recreated.

Marter shared how these kinds of conversations in session can spark great insights for clients.

I often find that this process sheds new light on the situation and provides an opportunity to take the therapy to a deeper level by exploring dynamics in the therapeutic relationship. Frequently, this increases the client’s consciousness and he or she is able to experience the therapeutic relationship as a corrective experience.

This was the case with a 45-year-old adult male client who, despite being extremely intelligent and educated at the graduate level, had never established a satisfying career. After we worked through issues related to depression and self-esteem, he seemed to be stuck in therapy.

As we explored this impasse in our relationship, he realized that his family (thinking they were being loving) enabled him to not work by making him a trust fund baby and never pushing him to be independent, which he took to mean he was incapable.

The therapeutic relationship proved to be a corrective experience for him, because we pushed beyond where others had stopped and he was made accountable and responded extremely well to that experience. His confidence soared and his career became more defined, vital and prosperous.

Sometimes, it’s the client’s defense mechanisms that trigger the paralysis, according to Marter. When that’s the case, she uses several techniques.

If the lack of progress in therapy seems related to the client’s defense mechanisms, I will consider using a different therapeutic technique as appropriate. For example, I may use a body-centered approach such as EMDR or a technique that is very collaborative and non-threatening, such as the Internal Family Systems Model.

Alternately, I find the use of CBT to address thoughts that are keeping the client stuck to be extremely helpful in moving through them and establishing new belief systems that encourage positive growth and change.

When a client stops making progress or takes a few steps back, clinicians contemplate their role in the stagnation. They have an honest conversation with their clients to pinpoint the problem. And they work on getting unstuck together.

** Thanks so much to KC, a substance abuse counselor, for suggesting this topic. If you’d like to see a specific topic in this series, email me at mtartakovsky at gmail dot com with your suggestion.

The book incorporates 35 years of studies involving more than 100 individuals and families. In order to reveal the sometimes overt repetition of negative behaviors and attitudes that carry on unless interrupted and altered, these studies include multiple generations of the same family. Using this research, the authors proceed to show how to help a client (or oneself) identify and eliminate the negative influences that prevent them from assuming their true identity. This is done, largely, by answering the above question about their wants and goals in the context of their numerous past and present relationships.

Firestone and his colleagues present a convincing case for how our early experiences with parents, as well as later experiences with spouses and others, cause us to develop a second self. This “anti-self” or “alien self” prevents us from becoming self-actualized by influencing our behavior, attitudes, and words, the authors posit. In most cases, negative influences are stronger than positive ones, which creates conflict between us and those with whom we have important relationships. We also tend to establish a “fantasy bond,” the authors explain: an illusion of a close relationship with our parents that causes us to retain negative but false self-images that get in the way of positive adult relationships. The writers also describe Firestone’s “voice therapy,” a therapeutic technique, outlined in other books as well, meant to identify and ease the self-critical “voices” we all still harbor from our parents and to lay bare the roots of our current selves.

This would be a more difficult book to read for us laypersons but for its many narrative accounts of actual therapy sessions that help to clarify the authors’ professional-level explanations. The authors have used voice therapy extensively to help bring out emotion in the self-criticism that clients experience. The result is a fascinating, imagined “dialogue” between clients and their parents, spouses, and children.

Reading the book, there were many instances where I set it down to reflect on my own experiences — as son, husband, father, and grandfather. Such self-reflection can be quite helpful in explaining one’s behaviors, and for that reason, the book is useful beyond its intended audience. For my part, I think I had a fairly comfortable childhood yet found myself continually relating the authors’ and their clients’ viewpoints to my upbringing. I know there are many people who experienced more difficult childhoods than my own who would find the book revealing and perhaps a call for deeper exploration.

The authors state that their goals for psychotherapy “reach beyond helping disturbed or maladapted individuals in overcoming their problems and include helping normal individuals in their process of self-actualization.” I think their book will reach many in that latter category.

The Self Under Siege: A Therapeutic Model for Differentiation
Routledge, July, 2012
Hardcover, 296 Pages
$40.95

And, most important, books are life-changers. The kind that change your career, how you interact with loved ones or how you see the world.

Below, in our monthly series, therapists spill about the books that have changed their lives for the better.

The Prophet by Kahlil Gibran

This book had a powerful effect on psychotherapist Jeffrey Sumber’s perspective on life and love.

Kahlil Gibran’s The Prophet had a huge impact on me as a young man because he was able to address the major elements of life, love and relationship through a poetic angle. There is such beauty and truth to Gibran’s book that I often considered it to be a beautiful version of the Bible without all the names and killing.

I remember sitting on a huge sand dune in the Sinai Desert when I was 21 years old, reading this book and meditating on its meaning in my life. I wish more people read this.

Siddhartha by Herman Hesse

Siddhartha is another pivotal book for Sumber, a teacher and author. He also recommends the book to clients who are stuck in life’s “shoulds:” My life should look like this. I should be doing that.

Siddhartha follows the story of a young man who seeks his own illumination but everything he accomplishes never seems to be enough.

At first many people feel that this fictional book about an Indian man in the Far East has little to do with them until they start to see themselves in his journey. The ups and downs, achievements and challenges all seem to resonate at our core because the overall message of the book is so simple in the end.

Sometimes we get more mileage by just stopping, breathing and contemplating life as it passes by.

A Prayer for Owen Meany by John Irving

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, loves the redemptive endings and hope inherent in Irving’s writing, particularly in A Prayer for Owen Meany.

Irving is brilliant with language, his wild descriptions of family and relationship dysfunction that, in the end, ring fairly true and lie just beyond the norm. There are no clearly delineated villains or angels. Instead, Irving characters are painfully, blessedly human, flawed and terrified and perfectly drawn.

On the whole, though, as bizarre as his stories are, this one in particular, the plot always sits atop an undercurrent of hope and love. It’s a joy to read.

The Giving Tree by Shel Silverstein

This book is a favorite of Deborah Serani, Psy.D, a clinical psychologist and author of Living with Depression. She still finds it stirring today.

As a young girl, Shel Silverstein’s The Giving Tree was a book that I read over and over again. Of course, at first I didn’t really understand its message, but as time passed I realized that it was a story of unconditional love. It still moves me whenever I pick it up to read.

Freud and Beyond by Stephen Mitchell and Margaret Black

Serani’s other favorite is Freud and Beyond, which she also uses as a teaching tool with her graduate students.

As an adult, I have to say that Freud and Beyond by Stephen Mitchell and Margaret Black is one of my favorites books because it beautifully details the origins of psychodynamic psychotherapy from Freud ‘til present time. Chapters cover many schools of thought and give the reader a great taste of theories, technique and practice.

Pig Will and Pig Won’t by Richard Scarry

This childhood book was one of two that led to a significant decision for Joyce Marter, a psychotherapist and owner of Urban Balance.

The two books that have impacted me the most are vastly different from one another, yet the combination of messages I received from each of them sheds tremendous light on why I became a therapist.

The first book was from my childhood, Richard Scarry’s Pig Will and Pig Won’t, which inspired me to choose and develop one of my primary modes of operation. In the story, Pig Will and Pig Won’t are brothers who respond differently when asked to help with chores and other acts of service.

Pig Won’t declines opportunities to help and misses out on the sometimes surprising rewards that come to Pig Will for choosing to be of service to others, such as feeling connected to his community, taking pride in shared accomplishments, or simply being taken out for chocolate ice cream.

At a young age, this story helped me consciously choose to take the path of engaging in life opportunities to be of service to others, and I am grateful that this decision has resulted in countless rewards and blessings both personally and professionally.

This month we were curious about how clinicians felt their work has affected their lives. Here’s what they said.

For Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, being a clinician has changed his perspective on people. He realized that regardless of our successes, all of us have stuff to work through.

Before becoming a therapist I assumed there were two types of people: people who needed help and those who had it all together. But early on I learned a valuable lesson: Everyone has their baggage. I knew I had issues and was intimidated by those who seemed to have everything figured out. As a therapist I soon learned that this wasn’t true.

Everyone, from the most broken to the most apparently successful standout, has their baggage. It took a few rounds of therapy with successful professionals, social dynamos, and even mental health experts to realize that the apparently “successful” people had their own issues they needed to overcome, and sometimes these problems were one reason they had so much visible success.

My job as a therapist was to help them accept and work through their baggage, despite the apparent success in other areas of their life.

As a result, I now find that I’m rarely intimidated by outwardly successful people. I know that most of us are either limited by, coping with, compensating for, or the product of some pain and failure. We all have this in common – pain that we’ve chosen to deal with in our own way. I like how this perspective helps me to see others as equals, yet incredibly unique.

Clinical work has helped Christina G. Hibbert, PsyD, a psychologist and postpartum mental health expert, become a better person and parent.

I chose the field of psychology because everything I learn applies to my own life too. Whether it be tools to overcome mental illness, facts about the mind-body connection, or skills for self-improvement, strengthening relationships, or being a better parent—I love what I do because it makes me a better person.

Being a clinician allows me to utilize the tools that have benefitted my life to help others become “better” too, and that is very rewarding to me. But even more rewarding is learning from my clients. As I listen to their stories, see their strengths, and witness the life changes they make, I am inspired. I get the benefit of receiving their wisdom and learning what works and what doesn’t work for them, and that helps me in my personal and family life too.

It also reminds me I am not alone in my mistakes, and that I can change if I choose to. It keeps me evaluating and improving myself, and that helps me be a better wife, mother, friend, and person. It’s a perfect cycle—as I learn and improve, I help others learn and improve, and they help me learn and improve in return, and so on, and so on.

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, also believes that being a clinician has helped him become a better person thanks to learning from his clients.

We clinicians, I would argue, think about the nature of our lives, and the way we live them, more than most people do as a direct result of their work. I know this is true of me. I have the privilege of learning from the processes of change my clients go through.

One client, for example, devised an affirming mantra for himself in session. He decided that, within each decision each day, he would “write the better story.” I have adopted this nearly daily in my life since then, along with countless other lessons I have learned from my clients.

I think I am a better, more aware person than I ever would have been without this profession. Couple this with the fact that I left a profession I felt particularly poorly matched with, and the work is a bonus!

Joyce Marter, LCPC, a psychotherapist and owner of Urban Balance, has gained greater insight into herself and become a better mom, too.

Being a clinician has touched my personal life in just about every way imaginable because I have had the honor to learn about life, relationships and the human experience through a deep, empathic connection with my clients. This has blessed me with cumulative wisdom and a much more open and broad understanding of life and the mind, body, spirit connection.

I am able to apply this wisdom as I move through my own journey of self-healing, discovery and self-actualization. It helps me to have the compassion for myself that I extend to my clients and understand that we are all human and works in progress.

Being a therapist also allows me to be of service to others, which is not only deeply meaningful and rewarding, but allows me to get out of my own head and see things from a larger perspective.

My work as a clinician has deepened my understanding of myself and my ability to be present, connected and authentic in my relationships. I am most grateful for how this knowledge has helped me to be a better mother and to promote psychological development between my generation and my children’s in the context of our family.

I believe that if we all work on ourselves psychologically, emotionally, relationally and spiritually, we will not only heal and grow personally, but as families, communities and a global society. I have my work as a therapist to thank for that awareness.

Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, noted that working with her clients has given her a zeal for life.

Being invited into the delicate layers of a person’s life has always moved me. It takes great courage to allow another into such vulnerable and fragile spaces, and sharing those experiences has lengthened and broadened my sense of compassion. I’ve always been sensitive to others, but working as a clinician has deepened the textures of my own inner world – which in turn, has given me a passion for life I don’t think I’d have found in another profession.

This month we asked clinicians to share the hardest part about therapy. Five therapists reveal a range of challenges.

The hardest part of therapy for Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, is watching clients work through their issues. Therapy is highly effective. But it requires effort and hard work. And it requires traversing potentially painful territory. She said:

For me [the hardest part is] knowing that talk therapy doesn’t always make you feel better. Making a breakthrough in therapy is exciting and meaningful for both myself and my client. However, achieving awareness sometimes requires you to be brave and fearless. Recalling memories and experiences, or changing a behavioral style, can be trying, upsetting—even overwhelming.

Being in therapy will reduce your symptoms and help you feel better, but it’s beneficial to know that the journey can sometimes be bumpy. It’s hard for me to witness my clients moving through such pain, even though I know the experience will yield important results.

Clients must get past their problematic patterns, which are tough to detach from. For John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, helping clients separate from these profoundly entrenched patterns is the biggest challenge. He said:

I love the process of therapy, especially when it is oriented around growth and strength. I find the toughest part for me, and perhaps my clients as well, is creating movement among long held, maladaptive patterns of thoughts and beliefs. We create our deeply held thought patterns at a young age, and undoubtedly they serve a purpose for quite a while, sometimes years, even decades.

But they are so difficult to let go of when they no longer serve our needs, or they inhibit our growth. It takes strength, resolve, hope, and a bit of a leap of faith in the process to let go. When that finally happens for a client, it is most rewarding.

It’s also challenging to maintain a happy medium between letting clients rinse and repeat these unhealthy patterns and pushing positive change. According to Joyce Marter, LCPC, a psychotherapist and owner of Urban Balance:

One of the most challenging aspects of conducting therapy is finessing the balance between meeting clients where they are at and also encouraging them to grow. I believe we all unconsciously recreate patterns in our life that are familiar to us as a way of working through our issues.

When a client presents for therapy, I will honor their emotional experience and reflect empathy as a way for them to express and release feelings that may be preventing them from moving forward. I will gently but directly encourage them to identify themes and patterns in their life that are no longer working for them.

When clients are ready to make positive change[s] in their lives, they will learn from these insights and empower themselves to choose roles and relationships that promote wellness, happiness and success in their lives.

However, sometimes we need to repeat these patterns over and over until we are ready to look within ourselves and make the changes. It is difficult when clients focus on others (who they cannot control) and continue to cycle in a way that is self-limiting.

It is at these times that I need to practice healthy detachment with love–the ability to unplug from my clients’ stuff and understand that they are exactly where they should be in their journey and they will make positive changes only when they are ready.

I often refer to the Serenity Prayer, which is, “God, grant me the serenity to accept the things I cannot change, the courage to change the things that I can and the wisdom to know the difference.” This reminds me that I should focus on everything that is within my power as a therapist, such as providing empathy, compassion, insight, interpretations, coaching on how to change self-talk and perspective, and increase copings skills and awareness through psycho-education.

I need to continually remind myself to let go of that which I cannot control, such as the clients’ responses, behaviors, progress, etc. I remember when I was in graduate school, a beloved professor of mine said, “Joyce, you are very good at being empathic and breathing people’s stuff in. You need to remember to breathe it out.” Her words were very wise and I reflect on them daily as I continue to grow as a clinician.

Creating positive change is taxing on clients. And, naturally, it’s also emotionally draining for clinicians. Christina G. Hibbert, PsyD, a clinical psychologist and postpartum mental health expert, tries her best to prevent emotional overwhelm.

For me, the toughest part about doing therapy with a client is ensuring I do not get consumed with the emotional drain. I strive to be fully present with my clients, to listen carefully and feel what they are feeling. Empathy and connection in the therapeutic relationship is key to helping the client make change, and it is rewarding to get to know these wonderful people in such a deep and intimate way.

However, it can also be very draining. I used to work longer days and I would come home depleted, with little left for my family’s needs. But now I work shorter days, which helps keep my energy levels up.

I also prepare myself before sessions through deep breathing and visualization techniques that help me feel prepared to be with my clients, to empathize and feel with them while they’re there with me, but to also leave it all in my office when I go home.

I don’t let the emotional experiences “stick” to me like I used to, and that makes doing therapy so much healthier for me, which makes me a better psychologist for my clients.

Adding another person — or party — to the therapy process also can get tricky for therapists. Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, said that “triangles” can be especially trying for him.

I feel great about working directly with clients, but when a third entity enters therapy the work becomes much more difficult. That third entity could be an insurance company that limits our sessions, a spouse or loved one who undermines our work, or intangible factors like finances or schedule conflicts that make our regular meetings more difficult to attend.

Working directly and intensely with a client is empowering, but dealing with an intrusive third entity distracts us and could stunt our work. I know some of these third objects are necessary and at times quite helpful (insurance and family, for example), so I try to face them with as much acceptance and assertion as I can muster, but at their worst, they are my biggest challenge.

Fortunately, self-acceptance is something we can nurture. Look at it as a skill that you can practice versus an innate trait that you either have or don’t.

Below, clinicians reveal 12 ways we can cultivate self-acceptance.

1. Set an intention.

“Self-acceptance begins with intention,” according to psychotherapist Jeffrey Sumber, MA. “It is vital that we set an intention for ourselves that we are willing to shift paradigms from a world of blame, doubt and shame to a world of allowance, tolerance, acceptance and trust,” he said. This intention acknowledges that self-loathing simply doesn’t lead to a satisfying life. “If I set my intention that a life with self-acceptance is far better than a life of self-hatred then I begin a chain reaction within my being geared to a life of peace,” Sumber said.

2. Celebrate your strengths.

“We are much better collectors of our shortcomings than our strengths,” according to Ryan Howes, Ph.D, a psychologist in Pasadena, California. Psychologist John Duffy, PsyD, agrees. “[Many people] fail to see their strengths and cling to antique scripts they carry about their lack of worth,” he said.

Duffy helps his clients hone in on their strengths and abilities by writing them down. If you’re having a tough time coming up with your list, name one strength each day, he said. Start with something basic like “I’m a kind person,” said Duffy, also author of The Available Parent. “Typically, lists evolve as the script loses its strength, and people recognize they are intelligent, and creative, and powerful, and articulate, and so on. Sometimes, we can’t see ourselves until we clear the weeds,” he said.

Howes suggested making a similar list: “Make a list of all the hardships you’ve overcome, all the goals you’ve accomplished, all the connections you’ve made, and all the lives you’ve touched for the better. Keep it close by, review it frequently, and add to it often.”

3. Consider the people around you.

What kinds of people do you surround yourself with? Sumber suggested asking yourself these questions about the people in your life:

Who speaks negatively to me? Who reinforces negative self talk? Why do I allow such people to hurt me? Are they just doing my own dirty work because I’m not willing to choose a different reality?

4.Create a support system.

Distance yourself from people who bring you down, said Joyce Marter, LCPC, a psychotherapist and owner of Urban Balance, LLC. Instead, “Surround yourself with people who accept you and believe in you,” she said.

5. Forgive yourself.

Past regrets can prevent us from practicing self-acceptance. Forgive yourself, and move on. “Whether it’s about something you’ve done or a personality quirk that resulted in a social faux pas, it’s important to learn from the mistake, make efforts to grow, and accept that you can’t change the past,” Howes said.

When the tinges of remorse resurface, remember these words, he said: “I made the best decision with information I had at the time.” “The behavior or decision might not seem correct in hindsight, but at the time it seemed like the best choice,” Howes added.

6. Shush your inner critic.

Many people equate their inner critic with a voice of reason. They think their inner critic is simply speaking the truth. But if you wouldn’t say it to a loved one, it’s not honesty or sincerity. It’s unwarranted — and harsh — judgment.

To quiet your inner critic, Marter suggested choosing a realistic mantra. “I believe in the power of mantra and encourage clients to select a mantra that is normalizing, calming and encouraging during times when the inner critic rears its ugly head,” she said. For example, you could use: “I am only human, I am doing the best that I can and that is all I can do,” she said.

As Marter said, “Our mistakes and our imperfections are not bad or wrong or failures–they are the fingerprints of humanity and opportunities for learning, healing and growth.”

7. Grieve the loss of unrealized dreams.

“Many of our problems with self-acceptance come from our inability to reconcile who we are as compared with the idealized dreams of our youth,” Howes said. Maybe you dreamed about becoming an Olympic athlete or a multi-millionaire or staying married forever or having a big family, he said. Whatever your dreams or goals, mourn that they didn’t come to pass, he said. Then “get back to being the best you possible.”

8. Perform charitable acts.

“When you sacrificially give to others, you see how your deeds are a positive influence on other lives. It becomes more and more difficult to maintain the idea that you are no good when you see how your deeds help other people,” Howes said.

9. Realize that acceptance is not resignation.

Marter described acceptance as letting go of the past and the things we cannot control. This way, “you can focus your energy on that which you can [control], which is empowering,” she said. In fact, for some people accepting that they have a problem is the first step to making positive changes, she said.

10. Speak to your highest self.

Marter suggested readers try the following activity that includes imagining and interacting with your highest or best self.

I often ask my clients to visualize their highest and best self that lies deep within them. I ask them to imagine that highest self stepping outside of them and looking at them in their current life circumstance or situation. I ask the client to imagine what this highest or best self advises them to do.

This process of visualizing a separation or detachment from the current [or] suffering self often helps clients tap into the wisdom that already lies within them — their highest self — to promote healing.

This exercise teaches clients how to be their own best parent and demonstrate empathy, compassion and love towards the self. I advise clients to take a few minutes to meditate and practice this visualization whenever they are in crisis [or] need some direction or some self-soothing.

11. Be kind to yourself.

Many people are hesitant to show even a shred of self-kindness because they see it as selfish or undeserved. But the key to self-compassion is “to understand that weakness and frailty are part of the human experience,” according to Deborah Serani, PsyD, a psychologist and author of Living with Depression. “Coming to accept who you are involves loving yourself because of your flaws, not in spite of them,” she said. You’ll find more on practicing self-compassion here and here.

12. Fake it ‘til you make it.

If you’re unconvinced that you’re a worthy person, keep the faith and keep at it. Keep practicing self-compassion along with the other suggestions. “Most of us do not have direct communication from our deity of choice, yet we take the leap and trust that our God is true and real. The same goes for our self-acceptance. I first must think and do before I know,” Sumber said.

But sometimes as clients, we can stand in our own way. In fact, we might unwittingly hinder the therapeutic process and spoil our progress.

Below, clinicians share eight actions that typically prevent clients from getting the most out of therapy — and what you can do.

1. A poor fit between clinician and client.

It’s common — and recommended — to try out several clinicians before making your decision. According to Ryan Howes, Ph.D, a clinical psychologist and professor in Pasadena, California, “It’s important to check a potential therapist’s license and credentials, their areas of expertise, the logistical factors [such as] cost, distance [and] insurance, and then test drive a handful of therapists before selecting one.” While it might feel uncomfortable telling a therapist you don’t want to work with them, remember that the right fit is important for your progress. “If you don’t feel safe opening up to this person, you’re not likely to meet your goals,” Howes said.

2. Not asking questions. Do you know what your diagnosis means? What your goals are in therapy? What you need to do in between sessions? Many clients don’t ask their therapist questions, Howes said. “[Clients don’t ask] because they feel intimidated, or believe it wouldn’t be polite, or can’t get a word in edgewise,” he said. “Instead, they go home and ask their friends what the therapist meant when she said ______.” Howes encouraged readers to ask questions any time you need clarification.

3. Being inconsistent.

“Therapy is hard work,” said Alison Thayer, LCPC, CEAP, a psychotherapist at Urban Balance, LLC. And there are many obstacles and responsibilities that can easily get in the way. But consistency is key in therapy, she said. “Clients must understand that therapy is going to take time and commitment, and in order to maximize the benefits, they need to make sessions a priority,” she said.

4. Not doing the work outside of sessions.

Change doesn’t just happen in session. It happens outside the therapist’s office. But “some clients seem to leave the session, get swept up in the busyness of the week, and then show up a week later having spent no time thinking about our work together,” Howes said. “Progress is slow to none at this rate.” What does promote progress is when therapy lasts all week, Howes said. In other words, “you’re applying what you’ve learned in therapy on a daily basis and you’re noticing topics you’d like to cover in the next session.” Thayer added: “While the sessions are important, so are the clients’ efforts to reflect [on] therapeutic content and make changes in their lives.”

5. Ditching therapy because of discomfort.

At times therapy can be unpleasant, Howes said. “The subject matter you’re discussing, the blockages you’re working through, or challenges within the therapeutic relationship can make you wonder why you’re dedicating time and money to this unpleasantness,” he said. Such discomfort can lead clients to consistently arrive late to sessions, said clinical psychologist John Duffy, Ph.D. Or some clients simply “cut and run,” Howes said. Rather than leaving, however, Howes suggested sharing your feelings with your therapist. “Together, the two of you might find a different pace or approach that isn’t quite as painful,” he said.

6. Expecting a quick fix.

“Sometimes, clients may have a preconceived idea that they want to resolve an issue in a certain number of sessions,” Thayer said. But this kind of thinking can limit your experience in therapy, she said. “Because every client and presenting issue is unique, there is not necessarily a set, prescribed number of sessions that can guarantee positive results,” she said. That’s why she suggested clients keep an open mind about how quickly they improve.

7. Expecting the therapist to do all the work.

“Therapy is an active process and requires work on the part of the therapist and the client,” said Julie Hanks, LCSW, a therapist and blogger at Psych Central. “Clients who expect their therapist to work harder or invest more in treatment than they are willing to invest in themselves usually don’t get the maximum benefit of therapy,” she said.

8. Reenacting the same patterns.

“Clients will generally use the same defense mechanisms and tactics in the therapy process that led them to seek therapy in the first place,” Hanks said. For instance, a client who has a tough time asserting her needs and puts others first might be habitually late to sessions, thereby depriving “herself of getting her own needs met in therapy,” she said.

But in reality, we don’t need to do anything at all. We are enough just as we are.

In this month’s “Therapists Spill” series, four clinicians reveal when and how they realized that they are truly enough.

For Julie Hanks, LCSW, a therapist, writer and blogger at PsychCentral.com, being a performer and songwriter spotlighted her worries of being good enough. But ultimately embracing her imperfections on stage finally helped her see the truth.

I’ve spent many years feeling that I should be different than I was. I should be thinner, more talented, more confident, smarter, more disciplined. In addition to being a therapist I’m also a performing songwriter. Feelings of “not being good enough” created a lot of stress related to being on stage and offering my songs, especially in live concert settings.

I remember 15 years ago talking with one of my producers and expressing my dissatisfaction with my technical skills playing guitar and piano. He looked at me and said, “People don’t respond to your songs because you’re a great technical musician. They like you because of the genuineness in your lyrics. Just be you. Give your gift.”

The next time I performed I felt freer to be me. I’ve learned over the years to embrace the imperfections in my musical performances and use them to show that I am real. Some of the most memorable moments for audiences have been when I’ve forgotten a chord and strummed the same chord over and over while singing, “Yes, I did write this song. I just can’t remember the next chord. So I’ll just play this one until it comes back to me,” as the audience and I laughed, and then I went on and finished the song.

Another important concept about being good enough is the idea of separating my worth from my performance. My worth is unchanging and is inherent because I was born. I exist. Period. My performance, however, on any given day, in any area may be great or poor or somewhere in between.

Recognizing that my performance isn’t tied to my worth has allowed me to develop a more stable sense of self, to feel freer to express myself in all aspects of life, and to accept criticism in a more helpful way.

Christina G. Hibbert, PsyD, a clinical psychologist and expert in postpartum mental health, realized that she was enough after picking up the pieces after a family tragedy.

Even though I’ve worked for years helping others feel like “enough,” I don’t think I really internalized being enough “just as I am” until a few years ago. In 2007 my sister and her husband both died tragically, and we inherited our 6- and 10-year-old nephews just weeks before I gave birth to our fourth child, bringing us from three to six children practically overnight.

Before, there had been times when I’d felt like I wasn’t enough — as a mother, psychologist, friend, wife — but this was the first time I completely doubted if I was “enough” at all.

What I realized, over time, was that I had been measuring “enough” in all the wrong ways. Enough isn’t about what I do or don’t do, what I say or don’t say, or even who I appear to be; being “enough” is simple –i t’s about love.

Each moment I love my children, I am enough.

Each day that I wake up, out of love, and work for my family, I am enough. And even the days when I don’t feel very loving, I am enough.

I used to ask my clients, “What if you were paralyzed from the neck down and you could no longer do anything but sit there and be? Would you be enough?”

What I know now for sure is that full of love is the only thing we need to be, and loving is the only thing we need to do. When I am full of love, I am most fully me, and that is always enough.

Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, and former perfectionist, discovered the power in imperfection.

I’m glad you used the term “good enough” instead of “perfect,” because it was reading Donald Winnicott’s concept of the “good enough mother” that freed me from the bondage of my inner perfectionist.

Winnicott proposed the radical idea that mothers who display an “ordinary loving care for her baby,” with occasional screw-ups, misfires, and empathic breaches made room for the infant to develop a sense of self as well as the ability to understand and forgive themselves and others. Perfect attunement at all times prevents development in these areas.

As a young therapist, I was terrified of making mistakes that could upset the client or reveal my inexperience. But after reading Winnicott and experiencing the benefits of “good enough” vs. “perfect” a few times in session, I was able to relax.

For example, more than once through the years, I’ve failed to schedule the right time for my appointment, leaving a client without a session. In the next session, after my embarrassed apology, we usually delve into a discussion of the feelings of abandonment that were stirred up and end up having a powerful session.

Personal therapy helped Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, LLC, realize that it’s OK to struggle, and this struggle doesn’t take away from being inherently normal or enough. It’s part of our humanity. She also noted the importance of focusing away from the external as a measure of worth.

To be human is to deal with the various psychological issues that therapists help clients address, manage and overcome. Dealing with stress, depression, anxiety, self-esteem problems and relationship issues are normal life issues that we all face as part of the human condition. We are not crazy or bad or inadequate. We are human.

…

I laugh because in my own personal therapy, I have thanked my therapist multiple times for “making me feel normal.” Her standard response every time is “you are normal.” I have finally integrated this belief and understand that even when feeling overwhelmed, irrational, confused, emotional or any of the other challenges we all face from time to time, I no longer view those states as meaning that somehow I am not normal or not enough. We are all works in progress and nobody is perfect.

…

We often over-identify with the externals in our lives — how we look, what we wear, where we live, our job title, our education, our relationship status, our bank account, etc. Focusing on these externals is a recipe for feelings of perpetual inadequacy as perfection is unattainable and sometimes enough is never enough.

Sometimes we focus on the externals so that we will feel good enough about ourselves to feel we deserve love (i.e., “If I lose 10 pounds, then I will be datable”). If you focus on the inside, the outside will fall into place.

As Eckhart Tolle suggests in A New Earth, detach from ego and focus on your essence — the deeper being within — your true self — perhaps even your soul. Let go of the external and focus on how you really are inside. You are already perfect, lovable and enough just the way you are.

We all know those people who try to pump themselves up with more and more accomplishments, whether it be material possessions, multiple credentials behind their name, or compulsive participation in competitive sporting events.

For some, enough is never enough and they keep chasing the external successes hoping that the internal feelings of self-acceptance will follow. In therapy, I work with clients on achieving self-acceptance and self-love. Then those accomplishments can be enjoyed for what they are, rather than a way to fill oneself up.