About Dr. Bill Spaine

Dr. Spaine's practice includes work with individuals, couples, and families incorporating traditional depth psychotherapy and a family systems orientation to facilitate healing and psycho-spiritual growth. His work with couples includes treating relational difficulties expressed as extramarital affairs, loss of intimacy and relationship boredom. Dr. Spaine has spent over 30 years working with those interested in psycho-spiritual growth; as a former Episcopal clergyperson, an educator, and in private practice

How Many Therapy Sessions Will I Need?

William E. Spaine, Psy.D.Dr. Bill Spaine

Understandably, people who are considering initiating psychotherapy want to make plans for the amount of time and money that will be required to achieve their goal for the therapy.  Many potential clients for psychotherapy think of the process in much the same way as they do for visiting a medical doctor, say for a sinus infection or a rash.  In this medical model, the physician does an exam, renders a diagnosis, and prescribes a treatment–sometimes with a follow-up appointment. (Yet even in the medical model, the patient is often referred to a specialist for further testing before a diagnosis and treatment are given.  How disappointing if the referral is to a physical therapist who assigns a discipline of exercise, or how frightening should the referral be to a surgeon!)

Frequently, when I ask a client during an initial appointment what their goal is for therapy, they respond, “I just want to be happy,” as if the adverb “just” suggests that the goal of happiness should not be unreasonably difficult or exceptionally aspirational.   Even if the initially stated goal for therapy is to no longer feel anxious or depressed or to get along better in a committed relationship, honest exploration usually reveals that there are more than just a few factors contributing to the symptoms that have brought the patient to my office.

While psychotherapy does have things in common with medical treatment, it has other qualities that more closely parallel the process of hiring a personal trainer to help guide you in losing weight or accomplishing a physical feat.  For example, if your goal is to lose twenty-five pounds, a personal trainer may work with you in establishing a training schedule which involves regular exercise, a healthy diet, and moderate or no consumption of alcohol. (It would require much more knowledge and discipline to lose twenty-five pounds and keep it off for 10 years!).  If you want to run a 5K, a marathon, or complete a triathalon, your training will be tailored to that particular goal. Careful consideration is given to your current physical shape.  You are very unlikely to achieve your fitness goal if you do not stick to your daily training schedule.  This personal trainer-client model is much like the psychotherapist-patient model; it requires a daily discipline on the part of the patient under the guidance of the therapist, whereas, in the medical model (that most of us are accustomed to), an occasional “check in” with our primary care physician is generally all that is required of us.

A bi-weekly training schedule with a personal trainer and little or no exercise between sessions will result in disappointing progress.  The parallels between reaching a fitness goal with a personal trainer and reaching a psychological goal with a psychotherapist extend further.  In each, you must reach a higher level of competence or accomplishment to understand the true state you were in when you began. You also must work to appreciate what discipline is required of you for progress.
Finally, as you advance in fitness or in psychological growth,  you gain a vision of what potential your life holds as you move toward your goal.

For example: if you begin biking with the goal of improving your cardiovascular condition, you will likely discover that your legs get extremely tired before you achieve what feels like a challenging“aerobic effect.”  That is, your leg strength cannot endure long enough for you to maintain an increased heart rate (accompanied by deep breathing) and feel that you have accomplished a good workout.  However, as you faithfully persevere in your regular biking workouts, your legs become conditioned enough for you to pedal longer, you begin breathing harder, and your heart rate is sustained at an increased level.  You are aware that you are able to push yourself harder and for longer periods and that you are getting into better cardiovascular shape. This brings a sense of accomplishment and self-efficacy, you are delighted with the physical results, and you may even adjust your sights for a higher goal.

A similar phenomenon occurs in psychotherapy: after the initial relief of telling someone what is troubling you and gaining hope that you can survive it, you may be surprised or even somewhat immobilized in subsequent sessions by the force of your emerging fears, shame, hurts, anger, or embarrassment.  You didn’t want all of this; you just wanted to be happy!

Many people terminate therapy at this early stage because the therapy is working!  The awakening to one’s own life, which includes awareness of our feelings, often arouses emotions that we learned “long ago” to avoid or suppress because we feared being overwhelmed and we had no one in our lives to teach us how to regulate those emotions.  As we better learn to regulate affect, we often discover that there was much more “beneath the surface” than we consciously knew, and we can develop the ability to recognize our projections, distortions, minimizations, blaming, and rationalizations.  That is, as you grow stronger, you become more competent in recognizing and addressing psychological dimensions that need attention and further development.  Put
simply, you have to get better to get better. The resulting sense of accomplishment, integrity, self-efficacy, and improvement in your relationships (even at work), may even inspire you to a higher goal than you originally identified.

So, the question “How Many Sessions Do I Need” is answered vastly
differently based on the needs and desires of the person seeking psychotherapy,
and quite frankly, on the expertise of the therapist.  Some patients who have come to me for psychotherapy got what they wanted in one session.  Others have come for many years.  Still others have come for a handful of sessions and returned at a later time for more. The number of sessions from which you would benefit will ultimately be determined by you.  Consultation with your therapist on this topic, of course, is usually the best way to decide, but learning to tune into yourself deeply and to make decisions is often a goal of therapy itself.

Copyright © 2011 William E. Spaine, Psy.D.

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Structuring Family Life Reaps Benefits for Everyone

Dr. Bill Spaine

Couples with children face many challenges. Balancing the needs of the couple (or the needs of a single parent), work, extended family, and other aspects of daily life can be stressful on both parents and children and may often lead to an overall sense of chaos in the home.

Patients often tell me that they feel overwhelmed from the minute they walk through the door at home. I often hear from them that their homelife feels like “controlled chaos.” Rather than enjoying their family, they just feel stressed. The idea of enforcing rules and setting boundaries can seem like just another burden at the end of a long work day. In reality, establishing a family structure is an investment in their children and in the peaceful coexistence of the family.

To help restore order, I suggest that my patients with children develop a consistent structure for daily life in the home. Research has shown over and over again that children need and want structure and consistency to feel safe and secure.

I suggest that parents start by developing a set of household rules that they will stick to and enforce consistently. Children are reassured by having boundaries within the family and within the home. They also benefit from what they learn about respecting rules and boundaries at home when they are in school or in other settings outside the home.

Here are some simple guidelines I give them to start with:

  • Give each child a set bedtime (and STICK TO IT!)
  • Set clear guidelines and limits for watching t.v. and playing video games as well as using cell phones
  • Each child should be given daily, age-appropriate responsibilities
  • Parents should establish regular age-appropriate chores for each child
  • Define expectations of how children are to treat one another, their parents and guests in the home
  • Establish age-appropriate consequences for each child if they fail to follow household rules.

While such rules may seem obvious, many of my patients find that they don’t really have much consistency in how their family life operates because they are so busy. When a family really establishes a structure and sticks to it, parents are amazed at the difference it makes in their stress level and the outlook their children have.

Copyright © 2011 William E. Spaine, Psy.D.

Family Rituals: Little Things Mean A Lot

Dr. Bill Spaine

In a family life busy with soccer games, business meetings and household responsibilities, many families find it difficult to connect with one another on a regular basis. In the rush to try and get everything done, many families feel like they’re missing out. Parents feel they aren’t really connecting with each other, or with their kids – they’re just going from one activity or responsibility to the next. Most parents see their kids for just a few hours a day, and they tell me those hours are a chaotic blur.

I urge parents to develop family rituals that will help them to connect with their kids in the the precious time that they do have to share each day. Having a strong sense of belonging to a stable and nurturing family provides children with the foundation they need to tackle the challenges they will face in the wider world.

Here are some of the simple rituals I suggest to parents:

Eating meals together as a family regularly.

Meals should include family discussions and time for kids to share their experiences with their family and talk to their parents. Meals should not include televisions or phone calls (by children OR parents). Putting the world “on hold” to share a meal together signals to the children that they, and the family, are important.

Bedtime rituals for younger children.

I suggest parents set up a regular process of preparing for bed that can include reading a story, prayers together, or any other quiet activity that allows parents contact with their children and helps the child “wind down” for sleep. Parents are amazed that when children get into the habit of following a bedtime ritual, getting them to sleep is easier, and they begin to look forward to bedtime as a time to connect with their parents.

Spending time with children individually.

In a busy household with more than one child, getting time alone with a parent means a great deal to children. Individual time allows the child to share his/her interests with the parent, and for the parent to share his/her interests with the child. One-on-one time between child and parent may even minimize the child’s sense of needing to compete with siblings for attention. Parents may be concerned about finding the time to spend individually with their kids, but building a strong connection helps other aspects of homelife go more smoothly – this is a time investment that will pay off now and in the years to come.

There are other family rituals parents can develop to help bring joy and security to family life. These can range from holiday and birthday traditions to weekly family rituals. They don’t need to be complicated and they don’t have to require a lot of work on the part of parents or kids to be successful. Rituals don’t even need to be serious. I know of a family that had a special Green Eggs and Ham breakfast every once in awhile in honor of their child’s love of Dr. Seuss books and as a way to share time with one another. This simple breakfast ritual not only brought the family together, but gave the child the sense that his interests were acknowledged.

Little things can mean a lot over time. Although their son is now grown, this family still laughs about those silly breakfasts, and the son is planning on continuing this tradition when he has children someday.

Copyright © 2011 William E. Spaine, Psy.D. (Excerpted from Pathways, Fayetteville Psychotherapy Associates’ Newsletter, 2007, Volume 1, Number 2)

Drowning in Emotion Part 4: A Legion of Saviors

Dr. Bill Spaine 

To whom or to what do this latter genre of fleers turn for rescue (and fighters often withdraw after fighting, as do passive-aggressive types)? Who is the lifeguard around whose head you throw your arms? Fortunately, or unfortunately depending upon your perspective, there are a legion of saviors to ease your immediate pain after flight from a hurtful relationship. Each of these deserves a much fuller explanation and analysis than will be devoted to them at this time. So in future discussions, we will delve more indulgently into many of them, for they are a seductive lot. But for now, let me list the usual suspects to whom we turn for rescue and relief.

Alcohol, illegal substances, and the misuse of prescription drugs offer temporary respite from psychological misery. Couples who present to my office in which at least one of them is self-medicating with a substance are often surprised to learn that their alcohol use renders them emotionally less available or even emotionally abusive to their partner. They don’t realize that they are drowning and have drawn in unreliable support.

Frequently, a wife will complain that her husband spends most evenings and weekends watching television, and he quickly counters that when he tries to talk to her, she’s on her computer or smartphone. A new book, Alone Together: Why We Expect More From Technology and Less From Each Other by a clinical psychologist and professor at Massachusetts Institute of Technology argues that, “These technologies are with us, but we have to learn to live with them in a healthy way, according to our human values.” My contention is that it is not the technology that seduces us away from our partners and families so much as that when we flee from our conflicted relationships, technology is there to lend what may appear a helping hand.

But things can quickly become much more sticky than the siren’s voice of technology. While Facebook and other social media have facilitated the cyber-reunion of family and old friends, it also offers a means whereby one might exchange anxious relationship minutes or hours with a spouse or partner for a non-conflicted online relationship with an old (or new!) friend who finds us much more interesting and charming than the person with whom we just fought.

Copyright © 2011 William E. Spaine, Psy.D.

Drowning in Emotion Part 3: Closeness Brings Anxiety and Anxiety Makes Us Selfish

Dr. Bill Spaine

If this metaphor of drowning seems too extreme when you reflect on your own behavior, lie back on the couch and let us analyze a bit. Think of yourself in relationship: with your spouse or partner, child, parent, sibling, pet, friend, work associate, boss, employee, classmate, student, neighbor, or roommate. Now, image an interaction that you have had with any of these individuals in which you lost control of your emotions or behavior.

If your anxiety level reaches a critical stage, you will react in one of three ways: fight, flight, or freeze (and freeze doesn’t last long). If your usual emotional reaction is to fight, you will say attacking or hurtful things to the other– perhaps you will yell. If flight is your accustomed reaction, you become silent, leave the scene; maybe you storm out of the house. Some people deliver the one-two punch of yelling and then charging out of the room or house. The freeze reaction occurs when emotional and behavioral circuits are overloaded, temporarily, and a moment or two passes before the reaction of fight or flight unfolds.

Be honest and self-observant. What goes on internally when that person important to you says or does something that hurts, scares, or angers you or triggers your shame? Are you a fighter or a fleer? If you are a fighter, you likely say and/or do something thoughtless in an attempt to counter the pain that you are feeling. Your behavior, at that moment, is about you and your attempt to treat the pain you are experiencing. Think about it– your behavior is an attempt to regulate your emotion. Even if your desire is to hurt the other person emotionally (or even physically), you are hoping to back them off of you or to pay them back in reaction to your pain.

Returning to our metaphor of drowning, you have just thrown your arms around their neck and shoved them underwater. You are not considering them or your relationship with them. Your goal is survival. (Some people believe they must “win” in order to survive.)

What if your method of coping is flight? Do you clam up, leave the room, or storm out of the house? Some people are sufficiently practiced at the drama of flight that their exit assumes operatic stature. This is the passive-aggressive flight that often leaves crying children in its wake. The intent of this passive-aggression is, like the fighter’s attack, to treat personal pain: an eye for an eye and a tooth for a tooth makes it “fair,” or perhaps it makes you feel better to deprive them of the satisfaction of continued engagement. You may be saying to yourself “This is just going nowhere, and I’m not going to do this anymore.” The exit is used to treat your pain: it is not a thoughtful gesture for the benefit of the other or for the sake of the relationship. Sometimes, passive-aggressive flight takes the form of a more subtle emotional or sexual withdrawal–a process that occurs over a period of weeks, months, or even years.

There is, of course, a denomination of fleer whose aim is simply to get away as quickly as possible from whom they perceive as the source of hurt, fear, anger, or shame. That itself is the remedy; distance is the treatment of your pain. As with the passive-aggressive type, the process of flight may be emotional and/or sexual withdrawal from the person who is, or who is believed to be the source of pain. This flight, too, may be sudden or it may happen a step at a time. Gradual flight can almost seem natural – “we just grew apart over the years…”

Next: A Legion of Saviors

Copyright © 2011, William E. Spaine, Psy.D.