Graduating Therapy

When people identify what’s not working for them and change the underlying behaviors, their lives get better. When their lives get better, their thinking about the past and future changes. The future looks brighter and the past is just that, past.



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It is always a bittersweet moment when a client “graduates.”  I am happy to see their hard work pay off yet sad to see them go.  But, of course, the goal of therapy is healing and that means letting go when the time comes.

From the first session, my goal is to help clients heal to the point of graduation. Some people come at a turning point and want a course correction; others want a major overhaul.  Their lives are out of control and they are feeling hopelessly caught in a downward spiral.

A few years back a client came to me at a turning point.  Like many clients, she needed to make a major life decision.  She came to me when she found herself spending too much time on the computer to avoid making the hard decision.  She felt numb.  Not surprisingly, she was anxious and depressed.

By the time she graduated, she had put limits on her computer time and decided she didn’t really need to make that major life decision after all.  Her depression had lifted and she was again enjoying activities she had abandoned.  She described herself as mostly happy with increasing glimpses of joy.  What happened in between was hard work.

My approach to therapy is behavioral. When people identify what’s not working for them and change the underlying behaviors, their lives get better.  When their lives get better, their thinking about the past and future changes. The future looks brighter and the past is just that, past.  Emotions don’t go away but they certainly get easier to handle.

In individual therapy, my client and I looked at cause and effect. She would bring a situation that recently went wrong to our weekly session (e.g., an argument with her spouse).  We looked at what went wrong (e.g., the argument escalated) and identified how her actions might have contributed to the outcome (e.g., she yelled).  Then we analyzed each step in the causal chain, identifying her thoughts and emotions along the way.  We assessed what she gained and lost from handling the situation in the way that went wrong.  Then I introduced new skills she might use to achieve a different outcome when she is faced with a similar situation in the future.

Repeated analysis of cause and effect enabled us to identify patterns of behavior that led to the situation that brought her to therapy (e.g., not listening which led to misunderstandings which led to arguments which led to yelling which weakened the relationship). With these patterns in mind, she experimented with different ways of doing things and new ways of thinking about her problems.  She practiced applying the same skills in a variety of situations (e.g., with her spouse, her children, at work, with friends).  By noticing when she used newly acquired skills, she learned to intentionally use them more and more effectively, which ultimately led her to achieve her therapy goals.  With time and diligent practice, the skills will become almost as automatic as the self-defeating behaviors that brought her to therapy.

I’m not saying therapy is easy or quick. It takes time and patience.  This client came to me when she had already decided she had to make changes in her own behaviors.  She progressed relatively quickly.  Other people may come when they have a vague feeling something has to change but they are not ready to change themselves.  In these situations, it takes time to help clients accept the situation so that they can begin the process of change.  There is no “right” time to start therapy.  Wherever people are on this continuum, I start where the client is.

I’m also not saying people cause their own problems. I am saying they have to solve them whoever caused the problem.  If a person steps off the curb and is hit by a drunk driver, the injured person has to do all the work to heal even though she didn’t cause the problem.

Nor am I saying causal analysis and skills development are the only things we do in sessions. Rather, analysis of cause and effect coupled with skills development are the foundation on which we build.

This approach to therapy is called Dialectical Behavioral Therapy or DBT as many people know it. It is the primary, though not the only, approach to therapy my colleagues and I use at St. Louis DBT, LLC.  To learn more about DBT, go to our website.

If you need a course correction or life overhaul and this practical approach makes sense to you, give St. Louis DBT a call to set up a phone consultation. We can be reached at 314.932.7415 or  At St. Louis DBT, you will find a warm welcome from experienced therapists who care about you and want you to “graduate” to a better life.

Sandra Miller, MSW, LCSW and sometimes blogger, is one of five therapists who see clients at St. Louis DBT, LLC. Learn more about St. Louis DBT therapists.