One Common Purpose: Health [Top]

Despite diversity in our backgrounds and training, we share one common purpose in our professional lives -- to ease the suffering of our patients and help them achieve the happier, more successful lives they deserve.

Through my own personal learning journey, I have come to develop, test and use Lifetrack therapy. It has been highly effective with wide-ranging and often challenging patients over the last 30 plus years of my full-time private practice.

I believe I have developed a new and highly effective way of understanding and treating mental health problems, and I would like to share some of the tools with my colleagues through www.mylifetrack.com. At this site, you can track your patients every day.

I treat all my patients using the Internet-based Lifetrack program and cannot imagine practicing without it. In my full-time practice, I treat about 20 to 30 patients at any given time (less than 100 patients a year). All are on the Lifetrack method and performing daily self-rating. Indeed, I feel severely handicapped without a comprehensive and daily tracking of each patient's progress, as if I am a captain of a ship without a compass or a manager of a company without a reliable accounting system.

I believe you too will find the Mylifetrack program to be an indispensable tool to help your patients achieve and exceed their previous best level of adjustment.

Benefits of Tracking [Top]

All my patients enter their daily self-rating data through the Internet at their leisure before coming to each session, and they can analyze their daily self-tracking graphs at home. This allows my patients to be active participants in building and maintaining their own health, rather than passive participants in therapy once a week.

Daily tracking reminds them that building health is a daily exercise. It is about actively changing the way they think, feel and act in the key spheres of their lives: self, intimacy and achievement. When a patient comes to a therapy session, we are ready to look at his or her up-to-date daily self-tracking graphs as soon as we sit down, or as soon as the patient calls for a phone session.

During each therapy session with my patients, I go over their daily self-tracking graphs in depth. Thanks to the Internet-based Lifetrack program, I can review and analyze patients' graphs and conduct therapy sessions when I am away from the office, as long as I have a laptop computer and access to a phone line.

My patients can keep appointments for sessions when they are traveling away from home or when they cannot come to my office for a scheduled session for any reason. I have personally found phone sessions just as (sometimes more) productive as in-person sessions. In fact, some of the most successful outcomes I have had with challenging patients have been achieved entirely over the phone.

Some of my patients keep tracking themselves daily long after their therapy is successfully completed to make sure that they do not forget what they learned in therapy. Should they need to consult with me in the future on short notice, their daily self-tracking graphs provide a wealth of data that are indispensable to effective consultations. It is also comforting to know that I have instant access to all my patients' daily progress whenever I want and wherever my patients or I happen to be.

Excited and happy as I am about Lifetrack, I am also fully and painfully aware that Lifetrack is not for everyone. In fact, Lifetrack may work well with only a minority of practicing professionals.

What Is Required to Be an Effective Lifetrack Therapist? [Top]

The Lifetrack approach is radically different from our traditional professional training and puts special unconventional demands on therapists.

There are several hurdles one must overcome to become an effective Lifetrack therapist. These hurdles include adopting Lifetrack concepts of positive mental health, adopting a fixed Lifetrack model of personality, accepting subjective daily quantification, getting used to computer tracking, persuading patients to use Lifetrack, adopting the role of an active advocate and accepting working with couples as a standard format of therapy.

Lifetrack's Central Focus on Health [Top]

The Lifetrack approach departs from the traditional "disease model" and considers all psychiatric manifestations of distress -- such as anxiety, anger, physical symptoms, depression and psychosis -- as natural and inevitable consequence of the interaction between the individual's existing personality -- the way he or she thinks, feels and acts -- and challenges in life. In organic brain syndromes, brain function is significantly compromised by organic causes. Symptoms of distress are the consequences severely and organically compromised personalities interacting with life's challenges.

Lifetrack considers each individual's existing personality as the "inevitable" or "successful" consequence of the best possible adjustment the individual could make to his or her often unfortunate upbringing. All manifestations of psychiatric distress -- anxiety, anger, physical symptoms, depression and psychosis -- are considered not diseases that cause a problem but warnings that the individual's past experience and current ability to cope is temporarily exceeded by the challenges faced in life.

For example, the Lifetrack method views a borderline personality disorder as a consequence of a highly successful adjustment to extremely adverse early life circumstances in which the child had to survive and adapt while being deprived of adequate psychological protection by his or her parents (or equivalent adults) in a safe and nurturing dependent relationship. As a form of adjustment to life, a borderline personality is considered preferable to a chronic or recurrent psychotic state, substance dependency or antisocial personalities -- though these may sometimes coexist. Under favorable conditions, borderline personality has been frequently overcome through Lifetrack therapy.

However, Lifetrack therapy has been painfully limited in its ability to help change individuals who have been psychotic, manic, substance dependent, antisocial or physically violent. Although my therapeutic experience with these categories of individuals has been limited, the quest for happiness and success through Lifetrack therapy seems particularly difficult or impractical for them because it requires breakthroughs in intimacy and structural transformations of existing personalities. This requires struggling through a period of sustained effort, which causes considerable strain.

Even under more favorable conditions, a surprising number of individuals seem to choose not to go through with the effort to change through therapy, which will take them off their familiar, well- beaten paths on which they have always traveled. Sometimes partners refuse to participate. Some patients prematurely conclude that they can do it on their own after a few initial sessions. Others think that the time and cost required for therapy is more than they are willing to accept. Still others prefer a different approach.

To accomplish personality transformation, the Lifetrack approach requires three essential conditions: that the patient be in sufficient distress, that an appropriate partner be available for therapy and that a three-person team of the therapist and the couple be maintained over several months.

Accelerating growth and health and balancing happiness and success through Lifetrack are not easy tasks and should not be attempted by everyone, nor by every therapist..

Lifetrack Model of Personality [Top]

The key Lifetrack models have been described in depth in the introductory chapter of my book, Breakthrough Intimacy - Sad to Happy through Closeness.

A Lifetrack therapist must be in full command of the models and use them effectively to explain and predict patients' symptoms and their processes of recovery, and to help patients improve beyond their previous best levels of health, overcoming inevitable setbacks and making breakthroughs. These models include;

1. Three Spheres of Personality
2. Hierarchy of Stress
3. Five Alternatives at the Threshold of Tolerance
4. Four Key Steps
5. Mind Wheel

Subjective Daily Quantification by the Patient [Top]

Each patient performs daily self-assessment using the Lifetrack Total Adjustment Sheet, available from lifetrack.com). The therapist introduces patients to daily self-rating at the end of the first session, spending about 30 minutes going through each parameter together. Most individuals quickly become used to the procedure, spending 5-10 minutes at the end of each day.

My patients are encouraged to perform daily self-rating on the Lifetrack Total Adjustment Sheet first and transfer their daily self-rating data into the Mylifetrack program when convenient. However, some prefer to enter the information directly into the Mylifetrack program.

Since the goal of therapy is to help individuals change the way they think, feel and act -- that is, their personalities -- it is essential that any progress, stagnation or retrogression be accurately measured according to fixed parameters over time. Further, it is essential that self-assessments be performed at least once a day because our memory of our day's events and psychological experiences are extremely perishable and subject to distortion.

Looking at their daily self-rating graphs, my patients are regularly amazed by what their spontaneous scores reveal when they are turned into a series of Lifetrack graphs over the course of days, weeks and months in therapy. The graphs give short- and long-term views of the growth process, providing invaluable insights and encouragement along the way.

Although compared with words, numerical ratings have a limited ability to qualitatively describe experience, the power of numbers lie in their ability to measure, compare and graph dynamic changes over time, according to fixed (qualitatively defined) parameters. Although self-rating is just one aspect of the active and dynamic process of therapy, it is an essential tool for accelerated growth and focus. Verbal expression and exchange between the therapist and the Lifetrack patient is intense, with the therapist typically spending two hours per session with the couple dynamically interacting and interpreting graphs and events.

In the world of psychological experience, even more obviously than in modern physics, nature reveals itself according to how we observe and measure it. Since our goal is to change our thoughts, feelings and actions, it is critical that we be able to measure the change we are trying to produce. Graphing is an indispensable tool in achieving this goal.

Computer Tracking [Top]

During each therapy session, the therapist can examine up to 26 standard graphs to analyze the patient's daily, weekly and monthly progress. Typically, the 30 most recent data entries are graphed first for close examination, and then any portion or all of a period of therapy is compressed into one screen. The therapist can also examine up to 52 graphs/person in depth during a therapy session, though the time spent on each graph depends on which graphs are more relevant and useful to the patient and situations at hand. During a typical two-hour therapy session with a couple, I could review up to 104 graphs, although it is usually sufficient to review only the most relevant and revealing ones in depth.

Over the last 25 years and 30,000 session hours, I must have examined easily well over a million graphs working with over 2,000 patients from various backgrounds with wide-ranging problems. The availability of daily self-assessment data is indispensable for accurately assessing the dynamically changing condition of the patient, explaining what has happened and predicting what is likely to happen next in therapy. Immediate graphic feedback from daily self-ratings helps patients receive the positive reinforcement they need to overcome resistance and to improve beyond their previous best level.

Extremely stimulating and encouraging for struggling patients are the graphs of other patients who have gone through similar and eventually successful struggles in therapy. These graphs can be easily displayed whenever it is necessary and are extremely helpful to give hope to suffering and often demoralized patients. In the future, www.mylifetrack.com will offer useful case examples you can use to help your patients, until you have accumulated your own successful case examples.

Persuading Patients to Use Lifetrack [Top]

During the first session with a patient, after listening carefully to the patient's history using history and profile formats as shown in (Movie 2): 'The First Sessions - How To Introduce Patients to Lifetrack (available from lifetrack.com), I formulate the problem using the new perspectives offered by the Lifetrack model. At the end of the first session, I introduce my patients to the Lifetrack Total Adjustment Sheet available from (lifetrack.com) for daily self-assessment.

Spending half an hour or so at the end of the first session, I take the patient through each of the 41 parameters on which they are expected to self-rate, making sure that the patient understands the meaning of each parameter and how it should be evaluated. I then ask the patient to put down a number on a simple 10-point scale (0 as minimum and 10 as maximum).

I ask the patient to do self-rating at the end of every day and return to the next session, say in a week, with seven or more columns of numbers. I have had little difficulty in getting full cooperation from my patients in performing daily self-rating. On the rare occasion when a patient resists or refuses to self-rate, the outcome is invariably less than satisfactory. Some patients stop performing daily self-rating during therapy; this is usually a warning sign of waning motivation to change or severe distress.

Advocacy Role of a Lifetrack Therapist [Top]

Because the goal of therapy is to produce measurable and lasting changes for the better and change is almost always resisted, a successful therapist must be an active advocate of change according to a clearly defined model of health. A Lifetrack therapist must take positions and explain and defend a model of health against the skeptical and probing challenges of discriminating patients.

In fact, many of my patients have told me at the end of successful therapy that they did not believe much of what I told them at the beginning. Only after they found themselves changing as predicted at the outset did they slowly become believers.

A Lifetrack therapist must have a tolerance for repetition, saying the same things in a variety of creative ways that are appropriate to each situation and the state of mind of the patient. The therapist must be highly articulate, patient, enthusiastic and persuasive.

A good sense of humor is indispensable to lighten the otherwise grim, even tragic circumstances in which the patients find themselves. A good humor gives us a surprising and comforting new perspective, which may be empowering. However, there are caveats for being "funny" during therapy. Humor almost always involves putting someone or something down, so Lifetrack therapists must be careful about what they put down. Successful therapists never denigrate their patients or themselves.

The only thing, the therapist can and should humorously put down during therapy is the problem that the patient is trying to overcome through therapy. In Lifetrack therapy, traditional "diseases" are demoted to mere symptoms of real problems, and real problems are reduced to fear of closeness to the safest and most appropriate person.

The role of a Lifetrack therapist is similar to that of a swimming coach teaching a novice to float in the water for the first time. Everyone should float -- you know it, but the patients don't. In fact, most patients are convinced that they are unique and will certainly sink. The job of a Lifetrack therapist is to explain that the reason people sink is because they are doing everything right to succeed in sinking -- stiffening up, trying to hold their head high above water, and so on. Using encouragement and the visual reinforcement of Lifetrack graphs, the therapist must convince the novice to deviate from the well-beaten path, showing the patient how to do it right, how to overcome a natural resistance against change.

The advantage that a Lifetrack therapist brings to the session is a knowledge of the Lifetrack model and the ability to explain problems and offer concrete solutions to the patient and partner. This knowledge combined with accumulated successful experiences of helping suffering individuals gives the Lifetrack therapist the confidence and optimism required to be effective. The only true qualification for a successful Lifetrack therapist is experience in helping suffering individuals through Lifetrack therapy.

Naturally, professional training and credentials are helpful to gain patients' trust and confidence, particularly at the beginning. It can also be helpful to have dealt with cases of extreme distress and high suicide risk that require medication and hospitalization. Most important, however, is that the therapist is a good swimmer and good at teaching others how to swim -- that is, how to be happy and successful in life and eager and capable to help others share it.

Working with Couples as Standard Format of Therapy [Top]

In our traditional training, particularly in dynamic or analytical psychotherapy, we learn far more about how to conduct one-on-one therapy with a patient than with couples or groups. For that reason, and perhaps because of our need as therapists to control our interactions with patients, some of us may be uncomfortable with the couple therapy format, in which there is a "well" partner who has a strong, long-standing relationship with the patient in distress. The "well" partner knows much about the patient and observes each move by the therapist with watchful eyes, participating in each therapy session with the patient.

Without the full support of the patient's partner, therapeutic effort is doomed from start. In fact, the partner is as important a participant in therapy as the patient! For the patient to successfully change through therapy, the partner must undergo comparable change to build and maintain a successful closeness with the patient at a much higher level than they have ever experienced. A dynamic and fascinating sequence of change (the seesaw phenomenon) and a variety of defensive reactions (such as canceling out) manifest in the process of successful personality transformation.

Lifetrack Training for Professionals Therapists [Top]

Although Lifetrack concepts are clear and simple, its actual application in helping patients in challenging clinical situations demands the highest level of therapeutic skills. An already experienced and successful therapist with a temperament compatible with Lifetrack is likely to have the most gratifying and immediate results.

Young therapists who master Lifetrack may have a great advantage in building their practice promoting positive mental health and participating in a new movement of positive health. Although I realize psychiatric residents and other professionals in training may have little time to experiment with Lifetrack (being under overwhelming pressure to learn traditional disciplines as well as care for patients, conduct research and teach), I hope some residents will find the time and energy to explore opportunities beyond the "concept of diseases" on which their training is based.

For professional colleagues who are interested in mastering Lifetrack, case discussions and consultations over the phone will be offered at request when sufficient interest arises. Please let me know your interest through the Your Comments section of this site.

In the final analysis, by far the best teachers are our patients, and the only meaningful training is building a successful track record of helping individuals through Lifetrack.

Another effective learning experience may be to try the Lifetrack program to experience "breakthrough intimacy" yourself before you teach others.

When certain numbers and types of successful cases are completed in consultations with or knowledge of Lifetrack, we may choose to place your name and email address in the Find a Therapist section of this site, or referrals will be made from inquiries that may come to Lifetrack.

Lifetrack Training for Non-Professionals [Top]

A great majority of suffering individuals keep suffering without receiving professional help. We will never have enough trained and licensed therapists to help even a small fraction of people in need.

Since Lifetrack is focused entirely on helping individuals get close to their chosen partners in life, there is nothing mysterious that only professionally trained and licensed therapists can comprehend. Teaching people about intimacy and how to find happiness is not the monopoly of any profession.

However, professionally licensed therapists have an advantage in dealing with severe symptoms of distress that can occur during the process of getting close to a partner in life. For that reason, Lifetrack training is offered preferentially to licensed professional therapists until more experience is gained in training Lifetrack therapists.

Concerning helping people achieve closeness and happiness, two fundamental qualifications stand out: The coach knows how to swim, and he or she knows how to teach swimming. The only meaningful credential is how many people the coach has helped successfully. In that sense, some nonprofessional advisors with Lifetrack training might produce results that are as good as or even better than some professionally trained and licensed therapists can achieve.

However, the important caveat is that the very process of getting closer to a partner may provoke defensive reactions that are beyond what nonprofessional advisors can effectively deal with. In those circumstances, prompt referral should be made to professional therapists who are equipped to deal with them.

There is a very important role for professional Lifetrack therapists and nonprofessional Lifetrack advisors in educating the public about health. Giving individuals or groups help in the form of education or seminars -- for the general public as well as for business, academic or other community or groups -- does not require that one be a therapist. The most effective individuals in the educational role are those who are well versed in the theory and can communicate the core concepts of health, applying them to different fields and organizations.

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