How does psychotherapy help people make positive changes in their lives? How will it help me to lead a more satisfying life? These are very important questions that should be considered by anyone thinking about starting psychotherapy. Understanding how a therapist conceptualizes relational functioning and how the process of change occurs will help you to decide if the therapist's approach and way or working are a good "fit" for you and will help you to achieve your therapeutic goals.

There are many different approaches to psychotherapy, many different "theoretical orientations" that guide the therapist in the work with clients. A psychotherapist's theoretical orientation is what guides how he or she conceptualizes client issues and how to treat those issues. The therapist's theoretical orientation forms the rationale for the interventions that he or she uses and is the foundation for the work that occurs in the therapy.

My theoretical orientation focuses on the psychological process of "differentiation" which defines how we function in relationship to ourselves and to other people. I view the central goal of therapy to be helping clients to increase their levels of differentiation.

Differentiation is a psychological process that determines how we function in relationship to ourselves and to other people. Murray Bowen, M.D. identified and developed the concept of differentiation. David Schnarch, Ph.D. has further developed and applied Bowen's differentiation theory. The following description of differentiationisfrom the work of David Schnarch, Ph.D.

1) Our level of differentiation determines how well we are able to self-validate (maintain our own sense of healthy self-esteem). At higher levels of differentiation, our sense of self-esteem is not based on how other people think, feel or behave towards us.

2) Another element of differentiation is our ability to self-soothe (manage our emotions in healthy and effective ways) when we experience the emotions of other people. At higher levels of differentiation, we are better able to maintain our composure (not over react or withdraw), and stay engaged when others are expressing their emotions to us. We are able to stay emotionally connected even when we are uncomfortable with, or don't like, what someone else is expressing to us.

3) Increasing our level of differentiation is a growth process. Another aspect of differentiation is the willingness to tolerate discomfort for growth. Personal growth and intimacy ofteninvolves conflict, anxiety, and uncomfortable thoughts and feelings. Increasing our tolerance for these kinds of discomforts in ourselves, and in others, increases our capacity for growth and intimacy. By pushing ourselves to do things that we find difficult (for example, being assertive with someone even if we think there may be disagreement and conflict) we learn new skills and we grow.

4) Our level of differentiation determines our ability to define and express our sense of identity (our sense of who we are, what we think, what we feel, and what we want) and to be receptive to others defining and expressing themselves to us. The ability to be assertive and maintain healthy boundaries (being able to set limits with others; being able to say "no" to others) is part of the differentiation process.

5) Our level of differentiation determines how well we are able to maintain and protect our sense of personal integrity (our moral and ethical beliefs). At lower levels of differentiation, we are more likely to sacrifice our integrity to avoid the anxiety and tension of disagreement and conflict, and to engage in destructive behaviors such as addictions, infidelity, deceit and other unhealthy forms of self-soothing.

I define anxiety as the experience of emotions that we find unpleasant and/or uncomfortable. Anxiety management and tolerance are key components of differentiation. Learning how to tolerate and more effectively manage our anxiety is what allows us to develop a broader range of healthier and more effective responsestoanxiety provoking situations. Said differently, by learning how to more effectively manage our anxiety we are able to change our ways of responding and behaving in stressful situations. We are better able to face and challenge our fears and to do things that we find uncomfortable- things that we know are good for us but are difficult to do.

How do we learn how to more effectively manage anxiety? Learning healthier and more effective ways of "self-soothing" is essential. Perhaps the most important step to better anxiety management is increased willingness to face anxiety provoking situations rather than trying to avoid them. We increase our anxiety tolerance through experience by successfully facing and self-soothing ourselves in anxiety provoking situations.

How does anxiety tolerance through differentiation lead to change? Unhealthy or ineffective management of anxiety limits the possible responses that we might make in a given situation. By tolerating anxiety more effectively we are able to consider different responses that we previously might have thought too uncomfortable. Assertiveness is a good example of this. People who avoid the potential anxiety of disagreement by not asserting what they think, feel and want have limited ways of responding when potential disagreement becomes apparent. Unassertive people often relinquish what is important to them. In so doing, they avoid the discomfort of conflict but sacrifice some of their integrity in the process.

If, however, unassertive people learn how to more effectively manage their anxiety about conflict or disagreement, they don't have to relinquish what is important to them in order to stay comfortable. They can define and choose other ways of responding. In this example they might decide to set and maintain limits and boundaries. By more effectively tolerating anxiety they can behave in ways that preserve, rather than sacrifice, their integrity.

A friend once told me that "Change happens one choice at a time". This is a wonderful description of how change often requires the proactive making of different choices. By helping my clients to increase their levels of differentiation, my psychotherapy services facilitate my clients developing the courage and self-esteem to make different choices, to positively change their behaviors, and to lead more satisfying lives.