What therapy is, to me.
Dr. Jim Mosher, PhD, ABPP
At its heart, therapy is a sacred place where we go to be vulnerable with ourselves in another’s presence.
Further, what is required of the therapist will vary. There is no formula. Sometimes, we play the part of curious questioner; other times we are a mentor or guide; and, still other times, we help you push yourself outside your comfort zone.
No matter my role, to me, the best therapy is flexible, responsive, and creative. It is both serious and playful. There should be blood, sweat, and tears. You will laugh and cry.
“So, where do we start?”
I start most sessions with this phrase to emphasize that you are the active ingredient in your therapy. I believe the more we embrace this reality every time we meet, the likelier it is our efforts will impact your life. We'll continually focus on your deepest thoughts, feelings, and experiences while disrupting the defenses—both conscious and unconscious—that stand in your way.
Understanding the roots.
Being completely candid, I believe people go to therapy because shit fucking sucks. The first step? Accepting that changing your life means breaking a sweat and facing what you’d rather avoid.
Unfortunately, the only way out of it is through it.
I take a non-pathologizing, functional approach. Psychiatric diagnoses may serve insurance companies, but they reveal little about the true nature of your struggles. So, instead of figuring out labels, we focus on understanding your experiences, your problems, and their connections.
We start with the idea that symptoms aren’t problems to eliminate but messages from yourself to yourself about yourself.
Pain signals that something—past trauma or present incongruences—needs attention. It invites exploration and urges action.
By tracing your pain to its roots and then addressing the function, we can fundamentally change how you feel.
Change happens in leaps and small steps so, while we always are swinging for the fences, we understand and appreciate the compounding value of base-hits.
Scientific revolutions & psychotherapy.
In The Structure of Scientific Revolutions, Kuhn (1962) described how fields evolve from nascent to mature sciences. Psychology is what he termed pre-paradigmatic, that is, we have no unified theory that has established consensual agreement within our field. Pre-paradigmatic sciences are characterized by having competing theories that seek to explain the phenomenon of study, though no one does so entirely. Further, there often will be much agreement and disagreement between them.
Functional Psychotherapy & psychotherapy integration
One solution to the pre-paradigmatic puzzle in our field has been psychotherapy integration, i.e., the blending of different theories to (hopefully) create something new that accounts for more of the variance. There are different models of psychotherapy integration, the best-known being common factors and technical eclecticism. (Read more about models of integration, here and here.)
I practice what is called theoretical integration, in which multiple theories are selectively incorporated into a cohesive framework. And, I am developing a model I call Functional Psychotherapy: Our goal is to address your problems at their roots, disrupt the avoidance that prevents their resolution, and then employ some combination of top-down and bottom-up processes to resolve them. Here are the key theories and principles informing my approach (listed alphabetically):
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Attachment theory considers how early bonds and caregiver responsiveness shape us. In therapy, we consider how these experiences color current relational construing and look to repair attachment wounds.
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I use some principles of these approaches, in select instances, for example, considering the role of acceptance and values-based action in building resilience and living meaningfully.
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Constructivism views us as meaning-makers. In therapy, we examine and reconstrue the meanings you have made while fostering flexibility, coherence, and deeper self-understanding.
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Critical theories challenge power dynamics, social constructs, and systemic oppression. In therapy, we consider context, deconstruct biases, and foster awareness to promote justice, inclusivity, and authentic expression.
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Existentialism considers meaning, freedom, and responsibility. In therapy, we cultivate an awareness of the fragility of our existence, thereby enriching our experience by living with immediacy, congruence, and accountability to maximize meaning, every day.
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These emphasize present-awareness, emotional processing, and personal responsibility. In therapy, we focus on integrating conflicting parts, deepening experiencing, and fostering authentic expression to promote bottom-up growth and healing.
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Humanism centers growth, authenticity, and depth in the relationship. In therapy, we consider the healing potential of self-awareness and adaptive change through empathy, experiential processing, and building a coherent sense-of-self.
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This considers how our relationships and roles in them, shape us. In therapy, we explore recurrent relational patterns, self-other dynamics, and the influence of past experiences then identify and shift maladaptive patterns and promoting more fulfilling connections.
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Memory reconsolidation is the brain’s process for updating memories. In therapy, we elicit transformational change by reactivating painful memories and then encountering experiential mismatches to them. In so doing, we aim to dispel symptoms at their core.
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We consider how trauma at critical developmental periods can impact later construing. For example, injuries in early childhood might lead to an egocentric worldview (Piaget) or chronic shame and low self-worth in adulthood (Erickson).
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These emphasize unconscious processes, internal conflicts, and early experiences. Short-term dynamic therapies challenge defenses and use intense emotional engagement to accelerate symptom relief, aiming for rapid transformative change.
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Some of the principles of these theories guide my navigation of the therapy process, particularly as they relate to activating reconsolidation processes.
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Strategic therapy disrupts conscious and unconscious patterns, bypassing resistance with irreverence, paradox, and reframing. Hypnotic principles and inductive techniques can activate innate strengths and unconscious resources to facilitate rapid and lasting change.
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Transpersonal psychology explores consciousness beyond the ego, integrating spirituality and altered states. Psychedelics and simulation theory raise questions about the very nature of reality, perception, and human experiencing.
