Dr. Carlos Durana, the founder of A Caring Approach, is a clinical psychologist and counselor with over 25 years of experience, practicing in Bethesda, Reston, and Washington DC. I’m your host, Beverly Jones.
In today’s episode, Dr. Durana describes his philosophy and integrative approach to individual counseling and couples counseling. He’ll also discuss what to expect when working with him, from the initial set up of an appointment to the actual counseling session. Welcome, Dr. Durana.
Carlos Durana: thank you, so glad to be here with you.
Bev: I would love to know, why did you decide to become a therapist? Was this something that you wanted to do from an early age?
Carlos: Actually, I think the seeds were there at the early part of my life, as a child. And then in my twenties or so, late twenties, I became more aware of what I wanted to do. But early on in my life there was so much turmoil in my family of origin, so many stresses and challenges, that were very painful, and I had a sensitivity toward that painfulness and dysfunction which I think laid the seeds for following this kind of work, counseling and therapy, later on. I care about people a great deal, just as I care about my family members and their suffering, so it was a very natural unfolding to move in the direction of individual counseling and couples counseling, to relieve suffering of people. That has really been my mission, as it says on my website, you know sometimes you write a mission statement and I did, and it’s about how to help diminish pain and suffering, and how to help people find their way in life, so that their creativity and their gifts can unfold, and they can obtain their goals that they want to pursue.
Bev: So you mention the stress and dysfunction that you saw in the past. What are some of the reasons you see now for people coming to you? What brings people to your therapy practice in Bethesda?
Carlos: Well, some people come under a great deal of stress, and in some cases, suffering. People going through transitions in life that are difficult, whether it be a problem with their job or a separation, or the loss of a loved one. Some people come because of anxiety or depression. Some people come because of personality problems – how they manifest themselves with others. Some people come for relationship therapy, and so on. It’s a variety of things.
Bev: So there are lots of problems, challenges, and issues. What happens when these different clients come to your therapy practice in Reston for the first time? What happens in those initial appointments?
Carlos: The most important thing, I believe, there are certain conditions that are important for therapy to work, and one of those conditions is creating an environment where people feel cared for. Where they feel supported, they feel respected, and they feel like they can trust you, to some degree or another. That trust develops over time. Because they’re coming to share very deeply personal things, or interpersonal things. Creating the right environment provides a condition so that the work that we need to do can unfold. I do my best to manifest that, that care and respect and support, and take an interest in the person. The things that I like about them. I pay attention to their strengths, I pay attention to what’s important to them. What do I know about their life history? I want to know about what they’re interested in, I want to know about their relationships. Of course I want to know — why are they here? What is the main problem? Or the main two problems that we can work with? And in that process I’m also assessing, we use different tools for doing that in couples or individual therapy. Assessing and learning about the person. But all the time, within that context as best as I can, to be compassionate and understanding.
Another thing that’s important for me, I am very respectful of the fact that people have certain strengths and inner resources, and that within them there are possibilities for change. For directions of change. I’m not there as a magician trying to create change. I am there working in a collaborative way to help the person or the couple uncover their assets, their strengths, the abilities that are there, so we can use that towards change. Towards attaining a goal. Because we are more effective, I believe, when we try to change from a position of strength, tapping into our worthiness and ability, and all the many different things that we have learned in life. I’m very mindful of that, and attending to that. When I think of education, there’s a view of the empty vessel, that we put things into people, and that can be helpful to some extent where I teach skills. Coping skills and things that people can learn. But then there’s another aspect in education, and I think it’s the same in therapy, that has to do with how to draw things out. In this case, what we’re trying to draw out are a lot of the resources that may be there that people are overlooking. And strengths that also may be there when they come into counseling. They come discouraged, they come feeling defective, often, or feeling that something is wrong with them, and they can forget about a lot of the assets that they have as well. And so we can use those resources and those assets as we’re trying to help them attain their goals and to change what it is they need to change.
Bev: So you said you’re not a magician, you’re not waving a magic wand to make the person improve. They have work to do when they come to see you.
Carlos: They sure do, they sure do. There are some factors in successful individual or couples therapy, and one of the factors is as I was mentioning the therapeutic alliance. It’s an alliance where we are working together collaboratively, to attain the goals and whatever it is that they want to achieve. I do my part, but they have to do their part. Another factor that is very important is their capacity for growth and healing, and they’re bringing that, and everyone has a certain capacity. And certainly that’s one of the things that is very important to do, to tap into those resources and the capacity that’s there. Everyone has capacity. Along with that is their willingness. How much are they willing to put in, what effort they are willing to make. That’s also a determinant of the success of therapy. There are other factors that are very important as well, the sense of hope, that’s a very important factor in determining success in therapy. And they bring that, but there are also things that we can do to help the person or couple engender more of that hope, which is a fundamental aspect of improvement. And one of the ways that that can be done, and I was talking earlier about inner resources and strengths, we all have certain self-righting mechanisms in ourselves, natural self-righting mechanisms. We use that ability whenever we have a problem, on our own we will try to develop solutions. We then try to implement those solutions, we then might get feedback from the environment or from others as to whether it’s working or not, and so it’s a whole sequence that we do on our own, as a self-righting mechanism. And tapping into those self-righting mechanisms is part of what I’m talking about in terms of tapping into the resources and all of that. To enhance that, and as we do that, our sense of hope can grow even more.
Bev: So our attitudes, our willingness to do the work, our willingness to tap into feedback, all of these things contribute.
Carlos: They do, they do. They’re all very important. And of course our alliance and working together, and creating a good therapeutic environment, all of those things go together. Certainly there’s an aspect that has to do with the therapeutic techniques that we use in couples therapy and individual counseling, and that’s important, but it is actually not the biggest thing in what contributes to improvement or change.
Bev: Really!
Carlos: Yes, it’s interesting. That’s what the research shows. There are factors, the therapeutic alliance between the patient or the client, and the therapist, a sense of hope, the capacity for growth and healing that the person brings, all of those are much more important. And then the techniques, and I can talk about what some of the approaches are, are not as important as contributing factors. Because if we think, for example, the therapeutic alliance and that sense of support that might be there, for example, empathy, let’s say that I might have towards a person when they’re telling me a problem. And I can put myself in their shoes and I can empathize with them, and I can see their problems from their perspective. And try to understand and validate them. And I can do that with compassion. That is a very important thing. That is something I do that can be very important and helpful because that can help them tap into their own compassion, and kindness towards themselves in a way.
Bev: I was going to ask you that, if you’re modeling for them.
Carlos: Yes, certainly. Very important thing to do. As best as I can. (laughs)
Bev: What are the other things that you do that you model that clients can take away?
Carlos: Well, sometimes it’s just by a way of questioning, and the way that one can question someone. With, let’s say with kindness or compassion. So that in itself is a way of modeling. Because basically, when someone comes, what they’re doing is, in my opinion, is really altering the relationship they have with themselves. So there is my relationship with them, and their relationships with themselves (laughs). These relationships are all going on in the treatment room. And so what I’m doing is a modeling of, how can they also relate to themselves? How do they talk to themselves? How can they maybe step back a bit and have some empathy toward themselves in some way? So it is a modeling, and it is also modeling then in terms of maybe the skills that I’m trying to impart, if we’re using some things to help the person, say, deal with their self-talk, and dealing with some skills on how to do that, so you’re modeling that skill so they can take that way. So yes, this is a process of modeling as well. It’s an aspect of it.
Bev: So individual counseling and couples counseling is a very positive experience, or it sounds like it could be a positive experience. Even though clients are coming in to your therapy practice in Washington DC for problems or challenges, if they have the capacity, this can turn into a positive, uplifting experience, if they are willing to do a lot of hard work.
Carlos: If they’re willing to do the work, and sometimes it’s not positive. In the sense that they can experience feelings of pain that can come up from their history. There is also the challenge of changing something, you’re dealing with your own habits, and that is not comfortable at times, right? You’re trying to change something, it could even be something like exercising..
Bev: It hurts! (laughs)
Carlos: You get up and then it hurts, right? But then there’s a payoff, right? But if you’re not willing to go through some hurt, you don’t get to the payoff. And that’s really important. How much is it worth to the person to go for that payoff? Because I cannot do that for them. I can help them, I can encourage, I can coach, I can do a number of things. Create a good climate, provide feedback, but ultimately they have to get on the field and go for the run or the walk or whatever metaphor you want to use. (laughs)
Bev: Well then it gets back to using those inner resources, doesn’t it?
Carlos: (laughs) Right, helping them tap into all of that, but they still have to go and do it. You have to challenge yourself. And if you’re not willing to challenge yourself, despite whatever support I can provide, then you can’t get very far. So it’s a collaborative approach. I do my part and you do yours, and we work together to support you and challenge you in a good way, a constructive way, so you can get to what you want. I’ll be there with you.
Bev: Do you find that most of your clients are willing to do this work?
Carlos: Many, many people are. And some do what they’re ready to do, and that’s it, and I have to be respectful. I’m not there to dictate, I’m not there to create goals for people or to judge them if they don’t want to do something that they say they want to do, and they really don’t want to do. Because sometimes we can say “Yes, I really want to do that, but now I’m not willing to put the effort into it,” okay, I’m respectful of that. If that’s where you are, that’s where you are. But I’ll be there with you, if you’re ready to work together, one hundred percent.
Bev: As a guide.
Carlos: Yes, coach, guide, therapist, yes.
Bev: Dr. Durana, what are some of the therapeutic approaches that you use in your counseling practice in Bethesda?
Carlos: Well, let me say that what is important to do is to tailor the approach to the person. I often tend to integrate approaches. Some people work better with approaches in therapy that are more cognitive in nature, in terms of looking at beliefs and looking at negative beliefs, and trying to alter those beliefs; they can be called cognitive behavioral therapy. Some people are more responsive to using an emotional-focused approach, where they are paying attention more to the feelings and coping with the feelings and learning to expand their feeling repertoire. Often what we do is we suppress certain feelings as bad and then that affects our overall level of wellness and mood and so on, and so it’s all about emotions and feelings. And then I work with another approach, that of mindfulness. Mindfulness is that quality of attention where we can stand back from the situation and witness it with some kindness or compassion, to really get a broad perspective, a bird’s eye view, in a sense, and that’s very important. Because it’s really really important to become aware of that. A lot of our thoughts and feelings are not helpful. But we get involved in them, and we get wrapped up in them, and we believe them. And they cause a lot of stress and dysfunction. And so that ability to get at distance from these thoughts and feelings to witness them is very very helpful. We’re more than those thoughts and those feelings. And learning to experience that is highly important and growth producing.
Another approach would be, how do we use our body? I do a lot of mind body work. There are a lot of physical problems that have emotional, mental aspects to them, stresses, and also the way we feel and the way we think have an effect on the physical symptoms. It’s important to do that integrative kind of work where we are paying attention to what our bodies are saying to us. This is more body-centered psychotherapy. The body’s another signaling system. We can pay attention to our thoughts, to our feelings, to our behavior, but also to our bodies. They that can tell us what’s right, what’s wrong, what’s problematic. And often that’s excluded in therapy work and I don’t think that’s so helpful. I think it’s important to bring that in. Our bodies will hold tensions, psychological tensions that can be expressed. In our neck, in our shoulders, in our gut, and also many different ways where certain specific feelings or emotions may be lodged.
Bev: And a lot of times we try to ignore those symptoms.
Carlos: Yes, we try to ignore them. Or sometimes there’s the idea that we somaticize. We have a feeling that’s very uncomfortable, we turn it into something physical that at least it’s a pain that we can deal with, and maybe we can cope better with that. But at the same time, it becomes problematic as a physical symptom. The body is also a reflection of how we feel, how we’re thinking, our posture. When we’re feeling down our head goes down, our shoulders are bent forward, and so on. Or we when feel shame or anxiety, our body will express that. Our sense of presence in our body is very important in monitoring what’s going on with us, and how we see ourselves, how we feel about ourselves, how we think about ourselves. Our bodies are reflecting, sending signals, always speaking. They never stop. And that’s why communication is so important, because so much of what we communicate is not the content. Maybe fifty percent is content, and the rest is body language and tone. And so it’s extremely important, the inclusion of the body in this whole therapy process.
With all of these approaches, a lot of it has to do with what the person can relate to the most, what’s important for them, and maybe I can express my opinion or something that may be helpful, but if the person doesn’t want to go in a certain direction, that’s fine. We have to use whatever they may be ready for, or what’s compatible with them.
Bev: There are so many different layers, so many different aspects to a person for you to look at.
Carlos: Yes, it’s quite a bit (laughs)
Bev: So I can only imagine how challenging it is in couples counseling when you’re working with two people instead of one.
Carlos: Yes, it’s rewarding and challenging, very much so. Very challenging. But it’s really very rewarding too, because for me, as I was describing earlier in terms of my own family of origin, the pain and suffering there, and the tensions there, when I can help a couple to communicate better, to resolve their conflicts more effectively, to enhance their understanding of each other and their level of intimacy or satisfaction, marital satisfaction, that’s very rewarding for me, given my own history. And it’s also challenging, like you say, because two different people, two different perspectives maybe looking at one situation from an entirely different perspective, and I have to be fair and balanced in how I see them, and be able to empathize with both of them. And sometimes both people can be right in a certain sense.
Bev: Interesting!
Carlos: Yes. And so there are many layers to working with couples. And part of which layers we go to in part is determined by the contract that we have. Some people may come just for learning skills. Communication, conflict resolution, and so on. Learning skills. That could be premarital, it could be that it’s all they want. But then, there is deeper work. Often we bring into a relationship personal issues that have history. Wounds that we have from our history. And those wounds will often get triggered at some point in the relationship. And it’s something that we never hope that would never happen, you know, I married you not to wound me in any way (laughs), or to do something that’s going to trigger me, but it happens. That will happen. How do we deal with that, how do we cope with that? And so we need skills in coping with that when it is activated, and we also need personal skills on how we deal with ourselves when it’s happening. Because one of the worst fights that often happens between people is when both people’s wounds are activated at the same time. And there’s an escalation that often takes place. And people get stuck in that escalating cycle, and they want to feel heard and understood and cared for, at the same time that they’re throwing stuff at each other, because they’re defending themselves at the same time because their wounds were touched, simultaneously, in some way. And so the cycle, which is not helpful, escalates.
Let’s take an example. Let’s say there is a woman, we’ll call her Mary, and she has a spouse named Bob. Let’s say that Mary has a wound from her history about not being cared for. And when that is touched off, for whatever reason, she gets defensive, to protect herself. She may blame. Why aren’t you doing this for me? You’re not good enough as a partner. Bob’s issues, let’s say that he has issues around feeling defective, and criticism is very toxic for him. It touches that wound of defectiveness. And so, let’s say that Mary feels uncared for, then she gets defensive to protect herself, and then she starts to blame Bob and attacks in that way. Then Bob goes into his wound of feeling defective. So then he’s going to react by getting defensive. His defensiveness, let’s say, is withdrawal. So he withdraws, distances. When he does that, it affects Mary. She feels more uncared for. “You’re not paying attention to me and what I need.” Then she becomes more hurt and protective and defensive. She attacks more, and she blames more. Then that triggers his wound, which is feeling defective and criticized. And then, he goes into his posture of defensiveness, protecting himself by withdrawing further.
Bev: It’s a vicious cycle.
Carlos: There are ways to come out of those cycles. There are ways of, first of all, how do we communicate when that’s happening, but also there are skills about self-soothing, and how do I take care of myself when my wounds are activated, and how do we dialogue, and how do we exit out of those cycles of escalation that we have in the best way that we can? Those cycles are awful. This is another layer in couples therapy. When you address it effectively, it can be very healing, but it takes work.
Bev: Well, it almost seems like too much work. It seems like it would be easier to get out of the relationship.
Carlos: Well that’s what sometimes happens. A person feels that it’s easier to get out of the relationship. But what I tell people is that you want to work on the relationship with skills, with things that can be helpful, and do that long enough, so you’ve done enough work. And if at that point, you feel like it’s enough, it’s not going to work, then you separate. You’ve earned it. But it’s not like you’re just walking out.
Bev: Can you give couples who may be listening some tips on what they can do? Some skills they can use to improve their relationships?
Carlos: Sure. Empathy is a big deal. Empathy is about trying to put yourself in the other person’s shoes, and trying to understand their perspective, and even have validation and understanding. It doesn’t mean you agree, but you understand, you can validate yes, it makes sense that you’re feeling that way, that you’re thinking about this. That is extremely important, And that is very hard to do, it takes work, you have to put your own perspective aside as best as you can. But it’s very powerful when we can do that for each other, or anybody else. And I think as I was saying in individual counseling when I do that with other people it’s very helpful to them. Feeling heard, feeling understood and validated.
Mind reading, it’s a problem in relationships. We often expect or hope that our partners can mind read what we need and want.
Bev: Oh yes.
Carlos: And then we don’t say what we need and want. Because of course that makes us vulnerable. And also, “if you loved me you would know what I need and want,” and so we expect that if you love me, really you should know what I need and want, and if you’re not doing that it’s because you don’t love me, and then maybe this is a flawed relationship because of that. So cutting across that mind reading is very, very important. It takes a certain level of vulnerability to do that. To say “I need something from you.” (laughs)
Bev: Yes, absolutely.
Carlos: Just saying that is hard because we may think of ourselves, “no, I don’t need such and such. I don’t need you that way.” And so it’s an act of courage to do that.
Bev: Or if I tell you what I need, what if you say no?
Carlos: That’s the other part of it, exactly. What if you say no, then you feel rejected. You feel your partner doesn’t really care. So it all, it’s – relationships, we take a lot of risks that way. But then if we don’t risk enough, the quality of the relationship suffers.
Bev: So we have to risk being vulnerable.
Carlos: Yes.
Bev: Are there any other tips that you would like to share?
Carlos: Well, a big one is “I statements,” where I talk about what’s going on with me rather than saying “you did this to me” and blaming you and calling you names. “When this happened, I felt upset about that,” or “I feel hurt about that.” You’re talking about yourself. This is what’s happening with me right now. “When you just said such and such, I felt sad about the situation.” Or “I feel upset,” or “I feel hurt.” It’s using I statements.
Bev: These are all so helpful.
Thank you for sharing all of these approaches, tips, and the methods that you use. If someone would like to work with you in your therapy practices in Bethesda, Reston, or Washington DC, they can go to your website, to https://caringapproach.com. But they can also call you, and your number is 703-408-4965. Thank you so much, Dr. Durana. It’s been a pleasure speaking with you today.