Hi, I'm Jeff Fine, Director and Founder of Total Self-Counseling and Fitness, and this
is the webinar, Talk Therapy is Not Enough, How to Integrate Psychotherapy, Exercise,
and Nutrition.
I'm really excited to be talking with you today about the Total Self Method.
It's an innovative method of therapy I've created which combines psychotherapy, exercise,
and nutrition, and allows practitioners to address multiple aspects of the client's
total self simultaneously.
For many years before creating this method, I worked with clients using only the techniques
and strategies of traditional psychotherapy.
In my experience, the Total Self Method is far more effective than psychotherapy alone
in helping clients create lasting mind-body health.
In this webinar, we're going to dig into the Total Self Method and what it means to be
a total self-practitioner.
What is it?
How does it work?
Why is it more effective?
And much more.
My hope is that this webinar will inspire your curiosity and interest to learn more about
how to become a total self-practitioner.
To that end, I'm currently developing a workshop that will cover today's material in far more
depth.
I have your emails and I'll keep you posted.
You can also feel free to check with me for updates.
Okay, let's get started.
So how did I come to this way of working?
Well, earlier in my career, I studied extensively and relied solely on traditional approaches
to psychotherapy.
This included an eclectic blend of modern psychoanalysis, cognitive behavioral therapy,
attachment theory, systems theory, and analysis of transference, counter-transference, resistance,
and dreams.
I did and still do believe that there is much good in the theories and techniques of these
traditional approaches and that they are indispensable.
But I want to challenge you to recognize and accept like I did that working this way has
certain limitations.
For example, clients were routinely reporting that they needed to modify their diets and
lose significant amounts of weight to control dangerous medical conditions like diabetes,
high blood pressure, obesity, and high cholesterol.
I really wanted to help these clients, but I was frustrated with the limitations of traditional
psychotherapy and with my own lack of appropriate education and training to competently advise
them.
Of course, I directed such clients back to their doctors and referred them to nutritionists
to get the information and guidance I couldn't provide.
However, many had already been given this information and guidance or knew it like the back of their
hands and still were not able to improve their health or change their relationship to food.
I wanted to do better for my clients.
Motivated by my frustration with my own limitations and the limitations of traditional psychotherapy,
I challenged myself to find a solution.
After months of struggling with this, a question popped into my mind that hit me like a ton
of bricks.
What if I could work with their minds and bodies simultaneously?
I was so excited by the prospect that one practitioner could provide this kind of continuum
of care that I set out to add the pieces of the puzzle I would need to do it effectively.
First, I completed a master's degree in nutrition counseling and food studies, taking graduate
courses like diet modification, the advanced study of vitamins and minerals, and sports
nutrition prepared me well to understand the nutritional needs of my clients.
I also went on for further education and exercise science, became a certified personal trainer,
and immersed myself in the study of how to improve people's health and fitness through exercise.
Over the past 25 years, I've continued to challenge myself to further develop and refine
this method.
I'm challenging you to think differently, to continue to grow professionally and expand
the scope of your practice.
But though I'm challenging you, I'll guide you and give you the tools and strategies
to use an innovative method that I've found to be more effective than psychotherapy alone
in your work with clients.
Over the past several years, more and more professionals have been contacting me from
around the country to learn how I integrate psychotherapy, exercise, and nutrition.
Their interest, support, feedback, and frustration with the limited opportunities, if any at
all, to formally learn how to integrate these distinct modalities made me realize even more
that there's a market for my method of therapy and that a more formal training program is
worth building.
To that end, I'm excited to share with you that I'm actively exploring creating a center
where other professionals can get the comprehensive training they want and need to competently
integrate psychotherapy, exercise, and nutrition, and practice as a total self-practitioner.
But until then, as I said earlier, I'm currently developing a workshop that will cover today's
material in far more depth.
I'll talk more about this and other training opportunities later in the webinar.
So here's what we're going to cover today.
I'm going to tell you in greater detail about this approach so you have a better understanding
of the total self-method.
I'll talk about what it takes for you, the practitioner, to work this way.
And by presenting a case, I'll show you how this method actually works.
I'll talk about why this approach is important and why it's more effective to work this way
compared to psychotherapy alone.
I'll highlight some of the benefits this method offers to both the practitioner and
the client.
And lastly, I'll discuss some of the common challenges total self-practitioners face.
OK, so what is the total self-method?
It's an innovative method of therapy that integrates three distinct modalities, which
are psychotherapy, exercise, and nutrition.
In the total self-method, psychotherapy is the primary agent of change, which is why
it's at the base of this pyramid.
Working this way offers practitioners an unprecedented opportunity to simultaneously
address complex mind-body problems and the unparalleled ability to deliver total self-improvement.
Exercise and nutrition are both potent agents of change in their own right.
However, in my experience over the past 20 years developing this method, the greatest
gains in total self-improvement are achieved when exercise and nutrition are woven in when
and where appropriate and used to support the psychotherapy work.
The flexible nature of this method is one important aspect that makes it so effective.
Based on the unfolding needs of clients within a session or throughout the course of treatment,
psychotherapy, exercise, and nutrition can at any given time be seamlessly integrated
in ever-varying combinations.
Of course, a client could work with a psychotherapist, personal trainer, and nutrition counselor,
but this requires the time, energy, and motivation to develop three separate professional relationships,
travel to three different locations, and pay the increased cost of three separate fees,
all of which can be barriers to treatment.
It is incumbent on practitioners of all disciplines to strive to remove as best they can.
The hoop's clients must jump through to get the help they need.
The ability of total self-practitioners to provide a seamless integration of psychotherapy,
exercise, and nutrition serves this purpose well.
Okay, so what does it take to work this way?
As is true in any field or discipline, those who gravitate to it have certain common characteristics,
and the same is true for total self-practitioners.
For example, total self-practitioners have a strong interest in exercise and nutrition.
When you are integrating three different modalities, in this case psychotherapy, exercise, and
nutrition, the interest, motivation, and persistence to learn what's necessary to competently
and ethically deliver quality care is vitally important.
But don't worry, this doesn't have to be daunting.
Just assured that if you have a passion for learning, you'll be excited to grow professionally
and expand the way you practice, and, unlike me, you won't need 20 years of trial and
error to find your way.
My goal, as I said earlier, is to provide you with a consolidated learning experience
and give you the guidance, tools, and strategies you need to be a successful total self-practitioner.
The total self-method, where one practitioner provides psychotherapy, exercise, and nutrition,
is by definition innovative because it is new and changes the established way traditional
psychotherapy is practiced.
Total self-practitioners have to have a certain level of comfort thinking out of the box and
adopting an innovative approach that's so few if any other practitioners use.
Total self-practitioners believe that the mind and body are inseparable, and that what
happens in the body affects the mind, and what happens in the mind affects the body,
and as a result, believe the mind and body must be addressed simultaneously.
And lastly, total self-practitioners need to understand when and how to blend psychotherapy,
exercise, and nutrition.
As is similar in traditional psychotherapy, the efficacy of treatment intervention should
be constantly evaluated and carefully chosen on a case-by-case basis, with great respect
for each individual's unique needs and concerns.
Such clinical vigilance is particularly crucial for total self-practitioners to ensure that
clients receive the safest and most effective integration of these three distinct modalities.
To best illustrate how this method works, I'm going to present a case where I incorporate
several different modalities to facilitate growth and change.
Of course, many details have been changed or removed to protect client confidentiality.
However, the learning opportunities remain abundant and uncompromised.
This case began with a married mother whose presenting problems were out of control binge
eating and weight gain as a result.
As I do with all clients, I began with psychotherapy to build rapport and to understand the psychological
underpinnings of her problems.
After several sessions it was clear that as a result of her husband's chronic pain condition,
which left him emotionally unavailable, she was feeling angry and lonely and was binge
eating in an attempt to cope with these painful feelings.
At this point, the wife agreed with my suggestion to invite her husband in for couple sessions
to address their relationship conflict, and I continued to work with her individually.
During the couple sessions it became apparent that the husband needed his own individual
support, so I began psychotherapy with him on an individual basis, while continuing the
couple's therapy and individual therapy with the wife.
Individual work with the husband revealed the toll his chronic pain took on his mind
and body.
He had come to view his body as an enemy, one who constantly betrayed him and could not
be trusted.
Because his confidence in his physical capabilities plummeted, along with his self-esteem, and
because he was feeling increasingly more depressed, hopeless, and worthless, I decided to shift
the primary focus of our work to exercise, knowing I'd have ample opportunity to do psychotherapy
during these training sessions.
I'll talk more about how that can be done in a bit.
Positive results were achieved by the simultaneous use of several different modalities including
individual psychotherapy for the husband and wife, couple's therapy, and exercise sessions
with the husband incorporating psychotherapy.
Initially on the brink of divorce, the couple reported improved communication and increased
optimism about a happy and fulfilling future together, so much so that they renewed their
vows and decided to have a third child.
And the husband, empowered by his much improved fitness, experienced a dramatic increase in
his self-esteem and confidence in his physical capabilities.
This in turn lessened the frequency, intensity, and duration of his self-sabotaging inner dialogue,
which in turn enabled him to better manage his emotional reactions to pain.
When I first began offering exercise to psychotherapy clients, I viewed these two modalities as
crucial but distinct and separate.
However, I quickly discovered that the experiential nature of exercise could, in as little as one
training session, bring to the surface issues that clients have been resistant to dealing
with for weeks or months in talk therapy.
This was exciting to me because it was clear that the modality of exercise offered an ideal
opportunity to address important emotional issues that may have otherwise been missed.
At this point, there was no turning back.
I knew I had to find a way to do psychotherapy during exercise sessions.
Experiential as they are, exercise sessions require clients to take immediate action in
the moment, which for those prone to negative, irrational, non-evidence-based inner dialogue
provokes ample opportunities to verbalize their cognitive distortions.
In my experience, the skillful and supportive use of the techniques of cognitive therapy
to confront these erroneous assumptions is a time-efficient and highly effective way
to help clients identify and reframe their maladaptive thinking.
For example, let's take a look at a brief interaction from an exercise session I had
with a client who struggled with chronic self-sabotaging negative predictions.
After just being informed that he'd be jumping on a box two inches higher than last time,
the client hung his head low and sighed deeply.
When asked about his reaction, he said hopelessly, I'll never be able to do it.
To which I responded, really?
How do you know?
After a modeling for the client had to question his reflexive negative assumptions and encouraging
the search for any evidence to support them.
The fact that he said he didn't know for sure he couldn't do it and agreed to try shows
how effective and efficient a well-timed psychotherapeutic intervention can be during an exercise session.
At this point, maybe you're a bit skeptical in thinking, really?
All that in just one session?
Well much can be accomplished in one session.
Here's an example where exercise, communication skills, time management, nutrition, and meditation
were all addressed.
A client arrived for her 7.30 a.m. exercise session, exhausted because she'd been up
since 2.30 in the morning worrying about the way she laced into an employee of her as the
day before.
Rather than jump right into training, we used the first 20 minutes for psychotherapy to
address the frequency of her hostile, condescending, and intimidating communications to her staff.
Though the problems weren't resolved, the client said she was ready to exercise because
she felt her emotions were more under control after talking.
During the 10-minute warm-up, the client answered a text.
While the client continued to warm up, I did psychotherapy to better understand her feelings
about this.
The client said because she's so busy every day she no longer has a sense of what's
urgent and what can wait, so she ends up treating everything as urgent.
It was clear that to help her feel more in control of her time and schedule, she needed
a more constructive time management strategy, so I quickly taught her about scaling, which
is learning to prioritize tasks by ranking their level of importance on a scale of 1-10,
one being the least important, 10 the most.
This in mind, the client smiled and said enthusiastically, I think scaling will be helpful because the
text I just answered was at most a 2.
The client then did a 15-minute metabolic conditioning workout consisting of three rounds
of overhead presses, box jumps, and sit-ups.
During the next 10 minutes, I stretched the client, while simultaneously suggesting quick,
easy, and healthy food options she could begin incorporating into her crushing morning schedule.
With five minutes remaining, the client said she wanted to meditate, so I guided her through
a mindful breathing exercise while simultaneously continuing the stretching.
Afterward, the client said she was the most relaxed she'd been in a year.
So there you have it, 20 minutes of psychotherapy, 10 minutes on time management while warming
up, 15 minutes of exercise, 10 minutes of post-workout stretching along with nutritional
guidance, and 5 minutes of guided meditation.
The total self-method offers infinite possibilities to meet the unique needs of our clients.
Over the past 20 years, I've faced many challenges and overcome many obstacles to create the
total self-method.
What inspired me most to press on were the undeniable benefits to my clients and the
rewards I experienced as a practitioner when I worked with them this way.
Though there are many, for the purposes of this webinar, I'm going to tell you about
the benefit of a continuum of care, why working with a total self-practitioner is more cost-effective,
and why in my experience the total self-method produces improved outcomes when compared to
just using traditional psychotherapy.
A fundamental benefit for clients in need of psychotherapy, exercise, and nutrition is
the continuum of care they receive working with a total self-practitioner.
The total self-method allows for seamless transition between and integration of the three modalities
based on each client's unique and evolving needs.
This continuum of care also removes a significant barrier to entering treatment, which is the
stress and confusion that arises from having to look for and develop relationships with
multiple professionals who are usually in separate locations.
Another benefit calculated by simple math tells us that the single fee of a total self-practitioner
providing just the right blend of psychotherapy, exercise, and nutrition will be more cost-effective
for clients than having to pay the fees of three different providers to piece together
similar services.
In my experience, clients working with multiple practitioners like a psychotherapist, personal
trainer, and nutritionist have a much harder time staying motivated to change and follow
through on treatment recommendations.
At first, this confused me, because at least on paper, this seemed to be an ideal treatment
team.
However, I realized that my colleagues and I were not in fact a team, but rather independent
practitioners who for the most part did not collaborate and often had conflicting philosophies
about what was most helpful to clients.
Change is hard, even for clients who really want to, so we should do our best not to make
it harder than it already is.
Total self-practitioners are ideally suited to this task.
Because they offer a continuum of care where complex, multi-determined problems can be
treated simultaneously, they are able to help clients avoid disruptive treatment obstacles
that arise when working with multiple practitioners.
By avoiding these treatment obstacles, total self-practitioners can better help clients
maintain their motivation to change and willingness to follow through on treatment recommendations,
the results of which are improved treatment outcomes.
Of course, we're concerned about our clients, but as altruistic as we may be, we still need
to feel rewarded by our work, and the total self-method I've created offers practitioners
the opportunity to enjoy a unique set of deeply rewarding benefits.
These total self-practitioners are able to combine psychotherapy, exercise, and nutrition
simultaneously.
They are able to work with a broader scope of clients and address a wider range of mind-body
problems than traditional psychotherapists and other single modality practitioners.
Though this is rewarding in and of itself, it also provides the opportunity for increased
income since you have the flexibility to provide services to clients that they would typically
seek from other providers.
And for practitioners who have a strong interest in exercise and nutrition, a passion for learning
are comfortable with innovation and believe that the mind and body must be addressed simultaneously.
It's just more fun using the total self-method than psychotherapy alone.
The last benefit I'll mention is that total self-practitioners don't sit as much as traditional
psychotherapists because exercise sessions with clients get us out of our chairs.
This is significant because given the mounting research, warning that increased sitting is
linked to the increased risk of dangerous medical problems like cancer, heart disease,
and diabetes, we have to think of sitting as one of the hazards of the psychotherapy
profession.
My journey to create a more effective way to meet the emotional and physical needs of
my clients forced me far out of my comfort zone.
I knew I would be disturbing the status quo of traditional psychotherapy with new ideas
about how it could be improved on, and that clients, colleagues, and supervisees as well
as family and friends would all have many questions along with some doubts and concerns.
On this journey I faced many unforeseeable challenges and often wished there were others
I could turn to that were working this way.
Though I had to go it alone, the good news is that you don't have to.
I'm going to tell you about some of the common challenges total self-practitioners face when
using the total self-method.
And in future workshops and seminars, I'll go into each of these challenges as well as
many others in much greater depth.
One of these common challenges is ethics, or the recognized rules of conduct for the practice
of psychotherapy.
Of course, ethical guidelines are an important means of protecting clients from being exploited
emotionally, sexually, and financially.
However, since clients have unique needs, I have found that rigid adherence to such rules
of conduct does them a disservice.
That's why total self-practitioners must carefully and thoughtfully decide on a case-by-case
basis whether or not their work with clients is ethical.
Similar to ethics is the challenge of managing complex therapeutic boundaries, especially
given that total self-practitioners can have dual or multiple relationships with clients.
And though I'm a traditionally trained psychotherapist, I have found that similar to ethics, a rigid
adherence to boundaries, regardless of each client's unique needs, often does more harm
than good.
As was true for me when I was developing the total self-method, practitioners who evaluate
boundaries case-by-case often feel uncertain because they miss the clarity that applying
one set of boundaries to all clients seems to offer.
However, experience has taught me that rigid adherence to treatment techniques, theories,
and rules are all too often more comforting to practitioners than they are helpful to
clients.
Digging deeper into the vast and important topic of therapeutic boundaries is not within
the scope of this webinar.
However, for our purposes today, there are three important points I want you to keep
in mind.
The first is that it's incumbent upon practitioners to evaluate case-by-case, which boundaries
are harmful, and which boundaries are beneficial.
The second is that to ensure the client's sense of safety is preserved, and that expanding
the therapeutic relationship beyond psychotherapy is in their best interest, you must take as
many sessions as necessary to thoroughly explore their thoughts, feelings, and concerns about
doing so.
And third, that the evaluation of boundaries is ongoing because what is appropriate today
often changes as the case unfolds.
Another common challenge for total self-practitioners is billing.
The problem is that insurance companies don't reimburse for integrated services where clients
with a psychiatric diagnosis simultaneously receive personal training and nutrition counseling
from the same provider.
Hopefully, as total self-practitioners increase in number and lobby to get their services
reimbursed, such claims will be covered in the not-so-distant future, until then, working
out mutually agreeable self-pay fees with clients is the best option.
Another space is another common challenge, but much less so than you might think.
Though I have a bigger office now, for years I trained people in the one shown here, which
was 11 feet wide and 22 feet long.
Before that, I had an even smaller space, and though some new clients have wondered
whether they could exercise effectively in such a small space, all of them were convinced
after their first exercise session.
Let's take a look at this video so you can really get a sense of how much can be done
in a small office space.
Here you're looking at the part of the office where I do psychotherapy, like quickly moving
just a few things around, like my therapy chair, rolling file cabinet, and of course,
my four-legged office maid Archie.
I can create all the space I need to provide an effective exercise session, and there's
a surprising amount of room for equipment like this large exercise mat.
Here the client is doing body weight squats.
And here bench dips.
As you can see, there's plenty of room for both of us to move without restriction.
And down the narrower stretch of the L-shaped space, I'm able to keep a squat rack tucked
up against the wall, which leaves plenty of room for barbell squats and other barbell
exercises.
In a small office, a pull-up bar in the doorway, with super bands for assistance, makes good
use of a valuable piece of real estate.
And there's even room to unfold a massage table to stretch your clients, part of the
session that few, if any, clients want to miss.
The kind of equipment you choose is a common challenge, but not for the reasons you might
think.
Because gyms across the country collectively spend millions of dollars to fill sprawling,
high-rent spaces with rows of machines and cardio equipment, there exists a misperception
among trainers and clients alike that this is what's needed to exercise effectively.
I assure you that it is not.
The challenge then for total self-practitioners is to accept that this is simply not true,
and learn how to program effectively without expensive equipment like big, bulky exercise
machines.
So here's a photo of the space-saving equipment I used for several years to create amazing
full-body workouts, appropriately scaled to each client's physical capabilities.
It's nice to have some or all of this equipment from the onset, because it allows you to keep
pace with your client's improving fitness and keep your programming fresh and varied.
However, the reality is that you don't need to invest right away, because the unfortunate
truth is that many clients will be so deconditioned that focusing on corrective exercises to improve
joint mobility and muscle flexibility, basic modified body weight exercises, and building
a base level of aerobic fitness will be more than enough for several weeks to several months.
The last and perhaps most important challenge for total self-practitioners is that there
are few, if any, educational opportunities to learn how to integrate psychotherapy, exercise,
and nutrition.
As promised, I will guide you and give you the tools and strategies to become a skilled
and confident total self-practitioner.
To that end, I'm currently developing a comprehensive workshop that will cover today's material
in far more depth, and I'll be sending you information about the workshop once all the
logistics have been worked out.
So should you sign up for the next workshop?
Well, if you've always wanted to work this way and are eager to learn now that I've
shown you it's viable, then yes, the workshop is for you.
If you're intrigued with the total self-method but are at the beginning of your career and
exploring ways of working that are best for you, the workshop is also for you.
Are you looking for an effective model of therapy you can use to breathe life into your
existing practice and increase your income?
The workshop is definitely for you too.
Lastly, for those of you who are energized and excited about becoming a total self-practitioner,
believe the total self-method matches up well with your professional goals and aspirations
and want to begin training right away, consider applying for an opportunity to train with
me directly one-on-one.
This is a unique opportunity to receive personalized attention and training individually tailored
to your specific learning needs and goals.
And since we can connect by phone, Skype, or FaceTime, this opportunity is also ideal
for those who want one-on-one training with me but are unable to meet in person.
For more information about one-on-one training, the selection criteria, and the application
process, as well as upcoming workshops and seminars, contact me directly by email at
Jeff Fine at MyTotalSelf.com or by phone at 646-591-3641.
