Q&A About Therapy with Karl Southgate
Therapy isn’t just about managing symptoms, it’s about developing deeper self-understanding, greater agency, and the ability to navigate life with more clarity and intention. In this Q&A, Empowered Therapy therapist Karl Southgate shares how he helps adolescents and adults work through anxiety, depression, ADHD, executive functioning challenges, and major life transitions. Drawing from psychodynamic and existential approaches, he explores how past experiences shape present struggles while also helping clients build practical tools, challenge limiting self-beliefs, and reconnect with a stronger sense of possibility and self-trust.
How do you approach therapy with men or adolescents who may not be used to talking about emotions or vulnerability?
Answer: I can usually get a sense early on if a client isn’t used to or comfortable with talking about emotions and vulnerability. When this is the case, I make sure (especially in the early stages of therapy) to avoid asking too many questions about feelings and to just allow the client to talk about what’s important to them.
I do think therapists are sometimes naturally predisposed to focus on emotions to the exclusion of other aspects of client’s experiences and psyches and try to keep this in mind when working with men and adolescents especially. Over the course of work with clients, they almost always become more comfortable discussing their feelings and this ultimately becomes a valuable part of the changes that they experience in therapy
What does psychodynamic or existential therapy look like in practice during a session with you?
Answer: Historically, psychodynamic and existential therapy have been very different approaches both philosophically and in practice. The major contributors to these schools of thought often had basic beliefs about human experience that in many ways were the complete opposite of one another. Two of the most significant differences between these two approaches regard the degree to which people have free will and what therapists should focus on during therapy sessions.
Although this is a significant oversimplification, I would say that (a) psychodynamic approaches prioritize the role of early experiences in determining choices and direct therapy sessions to the exploration of unconscious processes and (b) existential approaches emphasize free will and therapy sessions focus more on the here-and-now experiences of the client.
Over the course of my career, I’ve been able to develop an approach that utilizes both ways of thinking about peoples’ difficulties. There are times when it is clear that a client needs to develop insight into how family of origin issues contribute to their difficulties. By allowing space for the client to engage in free association, therapy sessions often lead to surprising discoveries and unexpected feelings. Insights that clients derive from this process allow them to achieve more clarity and agency as they navigate their daily lives.
There are other times when a client’s struggles are centered on existential issues such as mortality or a sense of powerlessness in their lives, and in those times I prioritize such issues through facilitating here-and-now exploration rather than attempting to make connections between current and past experiences or to uncover unconscious processes.
When working with ADHD or executive functioning challenges, how do you balance insight work with practical support?
Answer: I would say that at least a third of my clients have struggled with executive functioning challenges, and I have worked with these issues in child, adolescent, and adult clients both in school and private practice settings. It is often the case that such difficulties need to be addressed quickly and practically, as clients are sometimes at risk of getting low grades or losing their jobs.
I prioritize developing concrete strategies with such clients and frequently facilitate communication with their school or employer so that they are afforded the accommodations they deserve and that they need to perform to their potential. It is sometimes the case that meeting with a psychiatrist is the best course of action (in addition to continuing therapy).
At the same time, clients who have struggled with executive functioning for most of their lives have often developed narratives about themselves that characterize them as lazy or stupid. These beliefs about the self typically result from the accumulation of experiences in academic, family, and occupational settings that falsely equate difficulties with executive functioning with a lack of motivation, intelligence, or respect.
I focus on helping these clients to identify and to disentangle themselves from messages they received from their environment, which then allows them to develop a sense of self that acknowledges their very real difficulties while also realizing their potential and cultivating a more positive sense of self.
What does growth or progress typically look like for clients dealing with depression, anxiety, or major life transitions?
Answer: Most commonly, I find that clients’ growth is characterized by increased clarity, a greater sense of agency, and the ability to view themselves and others in a more nuanced way. Many clients with depression and anxiety experience themselves like a pinball that is being batted around unexpectedly by painful thoughts and feelings. It is also common for them to feel as though they have very little choice in their daily lives and to feel like life is just happening to them.
It is also the case that people struggling with depression and anxiety have out of psychological necessity developed views of themselves and others that are not reflective of the whole person; this often leads to or perpetuates relational difficulties and poor self-concept. As a therapist, I strive to help depressed and anxious clients develop a greater understanding of their emotional rhythms and thought patterns, achieve a sense of control over their lives, and to appreciate the complexity of themselves and others.