Who’s Angela and what does she do?

Hi there! My name is Angela and I’m an MFT (Marriage and Family Therapist). I recently started my own practice after finishing my master’s degree and moving back to my home country — Mexico. I have been practicing psychotherapy for the last 3 years and psychology for the last 6 years. I will talk a little bit about my previous training, how I practice psychotherapy today and I’ll share small pieces of my essence as a therapist.

What should I do with my life?

When I was about to finish my undergrad, I reached a point in my life where I was not sure what I wanted to specialize in. I knew that family therapy was the area I felt drawn to, but I was very unaware of the many models that existed. There I was, a senior in undergrad, studying Psychology at Universidad Iberoamericana class of 2018, trying to find out a program that suited my personal and professional goals — what a challenge.

Undergrad and personal experience

Going a little bit back I want to talk about my work in undergrad. I studied Psychology in Universidad Iberoamericana in Mexico City, today I am a licensed psychologist in Mexico. One of the best and most challenging experiences there were the practicum classes. We have one practicum class per semester and it’s a total of eight semesters throughout undergrad. Additionally, we must do 480 hours of social service in order to graduate.

Throughout undergrad I had the opportunity to work with a wide range of different types of population, starting with

• Small children.
• Adolescents.
• Senior citizens.
• Adolescents in jail.
• Eating disorder patients.
• Children who had been victims of sexual abuse.
• Adolescents with addictions.

All of these were low-income populations and even people in poverty. It was extraordinarily difficult and heart breaking to work with them — it was also incredibly rewarding. From the beginning of my career, I was exposed to different realities and different people. This made me think about the importance of privilege, social justice, equity and mental health care access. We live in a world where getting quality health care is a meter of privilege and this is heartbreaking and outrageous.

I gave this context so you can better understand how my experience informs the way I practice psychotherapy today. I believe that training in psychotherapy is an endless road and I’m sure I’ll continue learning from my patients.

How do I figure out my next step after graduating?

After intense research and a couple of months surviving with just coffee and my laptop, I found a program that was not only what I expected; it was a real challenge — M.S. in Marriage and Family Therapy at Northwestern University. Upon further research I found out that this program was not only one of the best programs in the U.S. I also found out that I would be in training with the authors and creators of the model called IST (Integrative Systemic Therapy). As the name says, it is an integration of several models and approaches to therapy.

What is IST?

You may ask yourself — what makes this model special? Well, first of all it’s evidence based, which means that it has been proven effective, efficient and empirical. Secondly, the research has shown us that a specific type of model (e.g., CBT (Cognitive Behavior Therapy), Psychodynamic, Narrative Therapy, etc…) only helps 30% of the population. I know, this number could be better. Instead, if you integrate models and interventions you can help 3/4 of the population. This makes sense, since every case is as unique as the individuals within the case. Models and theories that IST uses are: Solution Focused Therapy, Structural Therapy, Strategic Therapy, Narrative Therapy, Transgenerational Therapy, Experiential Therapy, Cognitive Behavioral Therapy and Psychodynamic.

IST is a model that works with systems at a micro and macro level. This means that we pay particular attention to the people surrounding a case (individual, couple or family), we ask about family members, past generations, colleagues, friends, community, childhood, traumas and more.

IST psychotherapists believe that context matters and that the people surrounding us affect how we interact with our environment. How can we make efficient change if we don’t pay attention to external factors?

Human beings live interconnected in communities, we need social interaction. The first social unit and perhaps the most important one is family — and family can mean a partner, primary caregivers who may or may not be blood related, friends and even pets. If we really want to understand a presenting problem (what brings you as a patient to therapy) in psychotherapy, we must understand all systems involved.

After reading everything I could possibly read about IST and researching Northwestern I made up my mind and decided to apply — after long months of preparing for the interviews and applications I’m glad to say I was accepted, this is one of my greatest personal and professional achievements.

What do my patients count on me for?

Principles

Every individual I work with can count on me or my team to provide them with the highest level of care and consideration. I have basic principles and rules when I’m practicing. These principles are:

• Affirmative Support — I’m LGBTIQX+ affirmative, I work with gender perspective because I believe (and science has proven) that we have grown and have been forced to develop and express ourselves in a heteronormative, cisgender and white dominated world and this has narrowed our view and capacity to be authentic with others, which has a direct impact in our mental health.
• Cognitive Bias with social justice in mind — I consider myself a social justice psychotherapist which means that I try my best to be aware of my privilege and my power as a therapist. I support my patients compassionately and provide recommendations to provide the right solution for each patient.
• Authentic and safe — Finally, to be as authentic as possible. I have learned that we constantly perform for others. Our performance is something that society has taught us and has rewarded us for being a version of ourselves that best accommodates others. If I’m authentic I can make the therapy room a safe space and I can model to my patients that being the most authentic version of themselves is good. Additionally, this gives me a humanistic approach, treating my patients as humans who make mistakes, who are in pain, who are happy, who are angry, and all of those parts are welcomed in my sessions.

Rules

Further on, I have some basic rules. I would rather talk about what’s happening and how that behavior serves a purpose in the person’s life. Nonetheless, there are certain behaviors I do not accept in therapy and some rules I apply:

Patients can say anything they want as long as they are willing to choose their words carefully, explain and let themselves be influenced by the responses of those around them.

1. I do not tolerate hate speech without patients willing to challenge those thoughts.
2. I do not tolerate physical or emotional abuse inside or outside sessions.
3. Tolerate frustration and lean into the uncomfortable, at your own pace and time but willing to do it, because that’s where change and growth is.

What does a session with me look like?

You may be wondering what a session with me would look like — it would be a deep dive into the unconscious, I particularly enjoy deep and reflective sessions. I found out that I like the depth of the unconscious and the buried memories. I have a collaborative approach which means that my patients and I are equal, I encourage active participation and also encourage any type of feedback.

One of my mottos in therapy is “you are responsible for your own growth because you are capable of overcoming challenges, of being resilient and you are able to change dysfunctional patterns”. Repressing thoughts and past trauma takes perhaps more energy than letting them out, these are parts of you that have a voice and need a space in your conscious mind, welcoming them into your life is the first step to healing. I do this through connecting with my patients using empathy, understanding and validation. I have learned through the years that a moment of validation, a moment of silence and just sitting with my patients and offering kindness can be much more powerful than actively intervening. Believing in my patients is a way I model to them what self-validation can do and how life-changing it can be.

I also like to bring humor into my sessions for two reasons:

1. I am a humorous person and that’s part of my authenticity and
2. I like making my patients laugh and I like therapy to be a place where there are more than problems, fights or pain — a place where you can go back to yourself, a place of safety and a place of joy as well.

I also like to let my patients take the lead in the sessions, I like them to feel in control of what happens in the session and the changes they want to make. This not only gives them a sense of autonomy, but it also gives them responsibility for the changes that they make. If there is a particular topic I would like to talk about during a session, I usually explain the importance of that topic or why I’m interested in talking about it. I try to be very aware of why I do this because patients are not there to satisfy my curiosity, they are there to heal and work on themselves.

If I happen to have a particularly difficult or painful session, I usually offer a moment of meditation, a moment of validation to the client (physical or verbal if the client lets me) and I usually ask what the plan for the rest of the day is for that patients, just for them to have a moment to go back to themselves and self-regulate.

Current caseload

Currently I work mostly with international individuals and couples. Due to COVID-19 most of my sessions are online. In my caseload I have approximately 60% individuals and the remaining 40% are couples and families. I also have 20% of pro bono cases. Most of the presenting problems right now are problems related to communication, anxiety due to the pandemic, traumas, sex related issues and life transitions.

Does Therapy work via Zoom calls online? Does therapy need to be in person to work?

Most patients ask me how psychotherapy changes between online therapy and in person therapy and my answer is: my interventions don’t really change, the models that I use, the treatment plan or protocols are the same. What’s important here is how you as a patient perceive the change. And, apart from offering validation I ask reflective questions like: how do you think psychotherapy could change you if it was an in-person session? How would you notice the different changes? What’s something you think you need in person that cannot be given online? All of these are not judgment-based questions, these are just questions that help us understand better what our needs are and how we can practice flexibility during therapy.

I am currently working with a couple who are struggling with communication and every day interactions, they reported they have had a lot of conflict. They were used to having their own schedules and their own activities and due to quarantine they have had to adapt to a new environment. They struggle with sharing spaces and managing every day activities such as cooking, cleaning and working. This couple presents 4 main constraints:

1. Reacting instead of responding.
2. Not practicing vulnerability.
3. Avoiding clear communication and not naming their needs.
4. They are fighting each other rather than fighting against the problem.

What we are working on is building up a schedule with chores, creating more moments of intimacy and quality time responding, stating clear expectations and practicing clear communication. The couple had been used to a very specific dynamic and right now we need to create new dynamics. It will take effort, intentionality and patience and they are actively working on their relationship and restructuring it from a different angle.

My essence as a therapist

I could spend more than just a couple of pages explaining my essence and who I am as a therapist, instead, I hope you can build up an image of who I am and how I practice psychotherapy. To conclude, I am 27 years old, I have been practicing psychotherapy for the last 3 years and Psychology for the last 6 years and throughout my career and life I have built up (and I will keep building) my essence as a therapist. I am a very human therapist during my sessions, and this means that I try my best to make sessions as authentic and deep as possible, through my previous learning, my previous training and my personal experience.

It is my calling to work as a psychotherapist. I have opened my heart to my patients through empathy and emotion — and have made a connection. My goal in each session is to share a moment of vulnerability, even for just a few seconds and experience what it is to be a human. My ultimate goal is to guide my patients towards the most authentic version of themselves, to teach them how to welcome all of their parts and to comfort them in any way I can. It is almost impossible to separate ourselves from the cases because if we practice empathy and if we put ourselves in our patient’s shoes we won’t be able to feel what they are feeling (their experience is unique) but we will be able to form a connection through emotion and that’s the essence of psychotherapy.