7400 Hours, Psychology, Clinical Supervision

About three years ago, my friend and colleague Judy McGehee LMFT (Partners in Recovery) began a supervision program for Marriage and Family Therapist interns (people that have completed their coursework for Masters degrees) and trainees (those who are about to complete Masters degree coursework).  Borne solely out of a desire to be helpful, and pass on the ability to provide effective human service, for fun and for free, Judy took on supervising 8 or so trainees and interns.  We were joined also by a visiting therapist, Ted Aaseland, Psy.D.  A little over two years ago I joined her in this endeavor, as I care deeply about passing on how to do “The Work”.

Over the course of those years, those interns provided services to the Glendora School District and elsewhere to children and adolescents for free.  Some of these turned into outpatient clients, individuals and families, also for free.  There were also public speaking engagements for adults and adolescents, professionals and non-professionals.  After all was said and done, over 7400 hours of free therapy (not including the speaking/community education efforts) were provided, all for free.

Interestingly and tragically, there are several stories that run in parallel with this one.  Before I get there though, it would be instructive to tell you a little about this process, both from the perspective of the licensed folk/interns/trainees, and from the folk we hope we were helpful to.

Will start with the experience of the trainees/interns/licensed folk.  Most universities require several hundred hours of internship/clinical experience for graduation.  The processing of these hours is supervised by a licensed therapist (who can be a supervisor, as regulated by the Board of Behavioral Sciences), and the student must pay for this process.  Most universities, in an uncomfortable wrenching of common sense, either don’t have someone to organize/and or set up/maintain these supervision placements, or they’re simply not updated for various reasons.  The student/trainee however, is still required to do this.  To add insult to injury, the trainee when in supervision, if they can find an agency, is rarely given a real experience of being supervised at their work.  It seems flabbergasting to consider this, yet it’s tragically true.

Similarly, interns (therapists just out of school) have to complete over 3000 hours of work with patients/clients, just to sit for the two licensing exams.  They have six years to complete this process, requiring continuing education to reset their chance to sit for the exams.  That means that they have to see clients, and that those hours also have to be supervised.  Related to both this issue and Judy’s (Ted’s, and mine) efforts, we were completely unable to get other clinicians to volunteer for either of these processes (for trainees or interns)- not even a couple of hours a month, let alone the minimal 2-4 hours a week.  In light of the complaints of most people we know not feeling like they received quality supervision, this is no small issue.

The second body of material that is really important here is the students and families.  There were of course the predictable experiences with clients who struggled with behavioral problems, substance use/addiction, depression, stress, bullying, pregnancy, self esteem, eating disorders, anxiety and the like.  It was also really common to have active suicidality, reports of abuse, the precursors of “thought disorders” (schizophrenia, and the like), violence, abandonment, PTSD, mood disorders (bipolar disorder and related problems) and more.  There was psychoeducation, crisis intervention, abuse reporting, ensuring of safety, documentation, creation and use of materials, referrals to resources, interfacing with administrators/Department of Children and Family Services/other clinicians/teachers/families and more, interviewing, showing up for IEP/planning meetings and more, and oh yeah… individual and family therapy.

The interns (and will give a little credit to us as well) braved all of these issues and more.  All for free.  Seven thousand, four hundred hours of it, and the attendant signing off of supervision hours.

We met weekly for all this time, as individuals and as a group, to meet the requirements for the relevant university, and for the Board of Behavioral Sciences.  We met in between to take care of paperwork.  To problem-solve.  To handle questions.  We met for lunches, at each others’ homes, in restaurants, in parking lots.  We celebrated birthdays, mourned losses, processed issues, checked one anothers’ heads.  There was a lot of happiness, crying, efforts to glean resource support to continue the work, discovery.

There’s certainly more to be said, and obviously, more work to be done.  Though this cycle of supervision is over, we still have a lot of passion and ideas for what might be next.  The whole point of writing this though, is simply to honor the work of Michael Cardenas, Eryka Gayoso, Elva Cortez, Jessica Wilson, Jeffrey Craig, Melissa Lamoureux MS, Ted Aaselund Psy.D, and most of all, Judy McGehee LMFT.  Thanks so much for making all this matter, and letting me participate.

From the “Something That Came Up Today” Department… More on “Stopping”

Truth, it comes up a lot.

We’re all trying to “give up” some stuff, trying to stop doing some things, but often have difficulty doing it.  Aside from a blog I wrote about this a while ago, we might want to think of such things as surrender instead of “quitting”, stopping, etc… but I digress.  We endeavor to stop drinking, overeating, eating poorly, isolating, perfectionism, controlling things, spending, video games, TV, and a host of other things.  Sometimes we’re trying to avoid things that are actually good for us- exercise, going to a support group, going on a job interview, self care and the like.  Most of the time we point at a lack of insight, “willpower”, or related ideas.  For dozens of years, people have been going on *wince* Dr. Phil, Oprah, Donahue (I don’t watch too much TV- who do we have now?), and others asking why people can’t stop __________.

There’s an interesting colloquialism in 12-step programs that addresses this.  Some say that “what makes people drink is sobriety”.  Whatever one feels about 12-step programs, this is a pretty elegant, and deep idea when applied to alcohol or drugs or other things we might want to give up.  Consider it this way- what if our inability to stop something (or start something) is not the difficulty in stopping or starting, presence or absence of “willpower”, but the difficulty of how we will feel if we do?

Try this thought experiment.  How would an alcoholic feel if they stopped drinking?  Someone that stopped “obsessing” over __________?  A person obsessed with control feel if they stopped controlling things?  Someone that stopped overeating?  It’s intuitive to say that these folk might be “relieved”, but I’d argue that’s a superficial look.  I think these persons (and other people with other issues) would feel pain, fear, sadness, even shame and anger.

What I’m getting at (simply) is this: if we have trouble surrendering something, it’s more likely that is difficult because of how it would feel to do so.  More difficult than the effort or organization or “insight” about what we need to give something up.  If that’s the case, it points to why much deeper “work” is more often necessary than simply will-ing our way into stopping something.

Attitude of Platitude

Talking with a client the other day, the subject of platitudes came up.  Many of us use them routinely.  Whether opining about inferences made, used polemically, or giving feedback to a friend or loved one, they’re used fairly often in all different kinds of discourse.  These certainly occur in therapy, twelve step programs (Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Co-Da, ACA, Overeaters Anonymous, etc).  We hear them at church/synagogue.  They’re used copiously in political speeches and discussions.

Many years ago, a friend began saying to me when discussing platitudes, “Cliche alert!  Cliche alert!” ala the robot from “Lost in Space”.  It was his way of indicating that the user was often either not really saying anything, and/or wasn’t really aware of the content or context of the cliche being used.

One of my favorite quotes is from Gandhi: “It is because we have at this present moment everybody claiming the right of conscience without going through any discipline whatsoever that there is so much untruth being delivered to a bewildered world.”  What I think he was getting at was pretty fundamental, and horror-producing… we all claim a right to truths and perceptions without really going through any real self or “concept” examination, and impose a subsequent template on the world in its wake.

That’s a fantastic way to create and/or perpetuate problems.  Am bringing it up because it seems that platitudes are a common ways this occurs.  Not that many platitudes or cliches aren’t true, just that we often don’t seem to examine if we’re using them, truly understand them, use them in context and the like.  I often see therapists, psychiatrists and other mental health professionals use cliches and platitudes simply because they don’t know what else to say.

Going back to twelve step programs, one cliche that is often used is “attitude of gratitude”.  With equal measure, it seems that an “attitude of platitude” is what is often in use.  Ideas like “just do what you’re doing”, “keep it simple”, “I decide for me, you decide for you, we decide for us”, and more are arguably great ideas.  These ideas even have utility for depression, relationships, self esteem, addiction, grief, loss and more.  However, our command of the language doesn’t necessarily indicate a real handle on what they mean or how/when/what context to use them and make them practical.

You can find out more about Petar at: April30th.org

Recognition for Partners in Recovery

Last Monday (9-26-11), Judy McGehee MFT, Melissa Lamoureux MS, Erika Gayoso MA, Ted Aaselund PsyD, Michael Cardenas, Jeffrey Craig, Jessica Wilson, Elvia Cortes MA and myself were recognized by the board of the Glendora Unified School District at their monthly meeting.  Formally, the agency is called “Partners in Recovery”, a nonprofit organization of clinicians providing services in Glendora and surrounding communities.

Judy, and I have been providing clinical supervision (a necessary component for grads and soon-to-be grads to get their “hours of experience” to sit for licensure as therapists or social workers) for the above mentioned interns and trainees.  Trainees are obtaining hours to graduate with their Masters degrees, interns are working on their hours (3000 hours of service over 104 weeks) to sit for the licensing examination with the Board of Behavioral Sciences.  In turn, the supervisees (the ones above and others from previous years) have provided thousands of hours of free services to the Glendora Unified School district, from elementary thru high school.  The supervisees from Partners have been assisting with issues of depression, abuse, family discord, eating disorders, suicide, addiction, grief and loss, bullying, self esteem, anxiety problems and more.

The program has been running since 2009 with Judy at the helm, and will continue at least through this year.  Judy, Ted, and the interns/trainees are all highly skilled clinicians.  It is a fantastic way for people to get services that might not have otherwise.  Nicely done everybody.

Making Friends

Was reading the PsychCentral blogs (one in particular called “8 Tips for Making Friends”), and found something that frustrates me a little as a clinician, and a person. The piece presents some fairly solid, simple, and doable encouragements about making new friends.

When it comes to doing therapy or any other related type of recovery, the confusion and difficulty that arises can prevent movement and change, unless a relationship we may be working on and our support group (or “resource group”, as my friend/colleague Barbara Waldman PhD refers to them) can support our efforts and suffering. Would argue that this is an essential component to working through all kinds of issues.

The only thing difficult for me about the blog was an idea that I think we often leave out. There was no mention of having our own personhood and “friendship skills” intact to begin with. It seems to me that we engage in many relationships without having gone through some important steps to insure our readiness for such to begin with. In short, as the colloquialism goes, you might have to be a friend to have one. Being a friend is often a “work” as some fighters say, and not necessarily an innate part of who we are. A sense of our own personhood is an even more fundamental responsibility, and too is demonstrably not an innate characteristic. Seems that both of these are requirements for making friends, keeping them, and of equal importance- being one.

More information about Petar at April30th.org.

New Office Space

Have to start here with some gratitude. As many of you know, The Work is really a mission of sorts for me- trying to put myself out of a job so to speak. So many have been so kind and encouraging about my work. Clients, colleagues, friends. It’s really important to me to have a clearsighted and organized way of being a partner with people in eliminating suffering, having principles… preferably both.

Left doing inpatient full time in April, in favor of doing private practice full time. The folk above (and more) have responded by sending a lot of folk my way to do service with/for. As a result, my longtime office space with Brendan Thyne MA, and his dad Rick Thyne MFT (Patrick Thyne and Associates) became too small (time wise) to accommodate my clients.

Noting this because getting a new space wasn’t just a task- it is a loss in a lot of ways. Brendan and Rick are relatives (of choice and affiliation)- and fantastic therapists. The space across the street from Pasadena City Hall has been beautiful, and I really enjoy the surroundings. Between losing the familial contact and the space, is a big deal.

That said though, have found a fantastic space to do The Work in. Am hoping that it will bring an energy and space that can be filled with whatever it is that people need. Want to send some appreciation specifically for Yvonne, my dad, Judy McGehee LMFT, Erika Gayoso/Michael Cardenas/Ted Aaselund and Elvia Cortes. Also appreciation to Jeff Boxer Esq, David Wolf, Ed Wilson PhD, Sue Stauffer, Barbara Waldman PhD, Barbara O’Connor MFT, Tricia Hill, of course Lali and Sadie. A special note for my clients though- you all continue to humble me deeply, and have been fantastic supporters of my work.

Here’s a pic of the new space- near the end of the 110, the 134/210. New address is 547 S. Marengo Ave, Pasadena, 91101:

Preaching Prudence but Practicing Evasion

Just by virtue of having eyes and ears, we have emotional responses to everything. When we have experiences that create loss, damage, violate our sense of self or ethics (prompt an experience of feeling “less than” or being broken, also known as “shame”), frighten us or etc, we have to do something with how that feels. Just like falling off a bike and skinning our knee, we hurt in part because that’s the healing process in action. Many therapists and others refer to these unresolved hurts as “issues”.

If we don’t have a means of healing/dealing with these, there are lots of unintended consequences. Not healing “hurts” (shame, fear, sadness, etc) causes “neurotic” behavior. “Acting out”, drug use, manipulation, self-ful-ness, isolation, “codependent” behavior, “anxiety”, avoidant behaviors, etc. Long term and in the wake of continued losses/traumas, these can turn into more serious problems- depression, relationship issues, “mental illnesses”, addictions and etc.

Sometimes these other problems and behaviors are simply ways of surviving or “coping” with our feelings about things, sometimes they become problems in and of themselves. Exercise, church (etc), self-help books, “will”, diet and nutrition, hobbies etc are all efforts that can be helpful in varying degrees, but for reasons too long for a blog post, they’re insufficient and/or incomplete for this task. Some of these things sometimes turn into means of avoiding our feelings as well.

If we don’t have a fairly organized (and effective) means of transforming or eradicating our experience in this way, as above, we create or perpetuate problems in our lives. Different therapists have different “tools” suggested to help resolve or diminish the intensity of these issues. My sense of this process though, goes something like this:

List the behaviors we use that put distance between us and how we feel. Some of these are external- but some are internal. Some examples are food, alcohol, work, spending, sex, focus on others, perfectionism (whether imposed on ourselves or others), TV, turning our feelings into anger, etc.

Diminish (or preferably, maybe necessarily) or stop those behaviors. There’s many, many ways of making this happen- see my blog “Wanting to Stop” for some suggestions. As has been said in other blogs, “letting go” means little for something we are not fully letting ourselves “have” in the first place.

Give the feelings we’re experiencing/left with as simple, and common a name as possible. I encourage mad, sad, glad (happy), afraid, ashamed, and/or hurt. And/or because we can certainly feel more than one at a time. Simple, because we often use euphemistic or complicated language as just another means to dissociate (separate) us from our feelings.

Share those feelings, as much as possible with the person we’re having the feelings about, as close to the time we experience them. It’s also really important that we’re actually allowing ourselves to have the feelings as we’re expressing them. Of course this isn’t always appropriate because of time or circumstance. Sometimes, it’s not appropriate because of the person we’re with. Be careful though not to “preach prudence when practicing evasion”.

As has been said by many, “you can’t heal what you can’t feel”. This process is assisted by doing it with a professional who has has both education and experience in doing so not just as a therapist, but hopefully as a person as well. We are trained in various means that facilitate some really important parts of this process that are sometimes not intuitive to our friends, families, loved ones. Am getting at a fairly simple list of ideas here- stop doing what we do to not feel, have an organized way of naming and letting go of or diminishing their intensity.

Sheldon Kopp

You may remember being a kid, and having someone suggest you write an essay about the person who influenced you most.  With the exception of a musician or two, the person that is likely that for me is Sheldon Kopp.  I was given his most famous book “If You Meet the Buddha on the Road, Kill Him! The Pilgrimage of Psychotherapy Patients” by my then “mentor”, when I was 17.  It’s really a book about principles, an organized way to live our lives and deal with Things As They Are.

He’s written something in the way of 18 books, died a while ago not of the brain tumor he had (that required removal 3 times), but of heart failure and pneumonia.  Having heard a rumor about his death, I looked him up on the internet once, and sent an email to a similarly named person, hoping I might find him or learn of his passing.  Essentially my note stated that this was a person who had been extremely influential and helpful in my life, and I wanted to know if it might be him.  I was lucky enough to get a response, that made it clear it was actually him: “Yes Petar, I too have heard rumors of my untimely demise, but I find them unconvincing.”

In “Buddha”, as became customary in many of his books, at the end was included ideas that he considered truths, or principles.  This was the most famous of them, called, “An Eschatological Laundry List: a Partial List of 927 (or was it 928?) Eternal Truths.”  Many of the ideas here have guided me in everything from my own emotional and “spiritual” work, work with my clients.  People that have suffered all of the things here that I’m trying to diminish for as many people as possible- depression, stress, relationship issues, abuse, loss and grief, addiction, self esteem issues and the like.  Hopefully, they will give you as much as they’ve given me, inspire you to read his books, and of the greatest importance: give you a ways and means of passing the ideas on to others.  Would love to hear what you think of them.  And to the “Truths”…

1. This is it!
2. There are no hidden meanings.
3. You can’t get there from here, and besides there’s no place else to go.
4. We are all already dying, and we will be dead for a long time.
5. Nothing lasts.
6. There is no way of getting all you want.
7. You can’t have anything unless you let go of it.
8. You only get to keep what you give away.
9. There is no particular reason why you lost out on some things.
10. The world is not necessarily just. Being good often does not pay off and there is no compensation for misfortune.
11. You have a responsibility to do your best nonetheless.
12. It is a random universe to which we bring meaning.
13. You don’t really control anything.
14. You can’t make anyone love you.
15. No one is any stronger or any weaker than anyone else.
16. Everyone is, in his own way, vulnerable.
17. There are no great men.
18. If you have a hero, look again: you have diminished yourself in some way.
19. Everyone lies, cheats, pretends (yes, you too, and most certainly I myself).
20. All evil is potential vitality in need of transformation.
21. All of you is worth something, if you will only own it.
22. Progress is an illusion.
23. Evil can be displaced but never eradicated, as all solutions breed new problems.
24. Yet it is necessary to keep on struggling toward solution.
25. Childhood is a nightmare.
26. But it is so very hard to be an on-your-own, take-care-of -yourself -cause-there-is-no-one-else-to-do-it-for-you grown-up.
27. Each of us is ultimately alone.
28. The most important things, each man must do for himself.
29. Love is not enough, but it sure helps.
30. We have only ourselves, and one another. That may not be much, but that’s all there is.
31. How strange, that so often, it all seems worth it.
32. We must live within the ambiguity of partial freedom, partial power, and partial knowledge.
33. All important decisions must be made on the basis of insufficient data.
34. Yet we are responsible for everything we do.
35. No excuses will be accepted.
36. You can run, but you can’t hide.
37. It is most important to run out of scapegoats.
38. We must learn the power of living with our helplessness.
39. The only victory lies in surrender to oneself.
40. All of the significant battles are waged within the self.
41. You are free to do whatever you like. You need only to face the consequences.
42. What do you know . . . for sure . . . anyway?
43. Learn to forgive yourself, again and again and again and again. . . .

Radio Interview

Next Thursday (May 6th) at 1130 AM, Judy McGehee MA, MFT (www.mcgeheepartners.org), Tom Aaselund MFT, and myself will be discussing… whatever comes up… about psychology, therapy and etc for what I think is half an hour.  It will be on the “Project Get Well America” show with Dr. Mark.  It’s live streamed and podcasted.  The link for the show is here.  If there’s any more details, will let you know.

Communication With Adolescents? Communication With Everybody.

Got to do a talk with the aforementioned Judy McGehee MA, LMFT (www.mcgeheepartners.org) tonight at the “Parent Summit” organized by the Glendora School District. There were breakout sessions with different professionals and agencies providing talks on different topics. Dr. Mary Suzuki (wife of Dr. Dan Suzuki) began the session with Captain Rob Castro of Glendora PD, who discussed a previous summit focusing on adolescents and use of pharmaceuticals (illicitly).

Judy and I did a talk entitled “How to Talk so Your Kids Will Listen, How to Listen so Your Kids Will Talk”. As we discussed in our PowerPoint presentation, it became pretty clear that this was a misnomer- not only because it has more to do with relationships with kids, and further, much of the skills we discussed were relevant for most relationships in general.

During her talk, Judy identified the importance of being interested in your kids, not letting technology like cell phones and iPods get in the way of communication, ideas about developmental stages, roadblocks to communication and more. The parents and professionals who attended asked her a lot of questions about different types of age-appropriate communication, problem-solving specific issues and etc.

My talk endeavored a practical approach that highlighted suggestions to put me out of a job (one of my personal goals), principled ideas for use in communication, and some adolescent/child specific tools. We also discussed problem-solving issues like when/when not to intervene between siblings, children (who were sometimes adults in the examples) “stonewalling”, giving short and/or avoidant responses, even what might be described as resentful feelings prompting one or another to not talk all together. The details of these are of course beyond a blog.

That said though, will copy/paste some of the suggestions I had here. Any questions, ideas, encouragements etc are welcome. Again, would offer that many of these are useful in communicating with all types of people, in all different types of relationships. Here’s the abbreviated list:

• Don’t yell.
• Don’t be critical and/or judgmental.
• Don’t try to change others’ mind or behavior.
• Don’t interrupt.
• Don’t only have feelings of fear or anger, or not have feelings at all.
• Be graceful with the feelings you do have.
• Don’t interrogate. *only be a parent* (meaning, resist the temptation to be a police officer, financial adviser, career counselor, etc)
• Don’t interrupt.
• Don’t say one thing, then do another.
• If someone says something you don’t understand, ask them to explain it.
• If someone starts yelling, speak quietly.
• Avoid power struggles.
(Here is where some of the adolescent specific ideas began)
• It might be a good answer to them.
• Don’t be afraid of technology. Learn to text. Email.
• Ask their opinion.
• Tell them you love them, and what you like about them.
• Learn their language. You don’t have to use it. (www.urbandictionary.com)
• Use the “rule of five”, particularly in crisis. Five words a sentence, five letters a word.
• Find a way to be interested in them- what they think, what they like and care about, and why.

This is certainly not an exhaustive list. It also doesn’t address some of the principles that might otherwise be employed, doesn’t give some answers in context, and doesn’t explain why some of these tools might be important. Those ideas, as a rule, have to be discussed, processed. They also don’t address specifics about working through problems or issues. Most of these things are best done with a professional, over time. Hope some of these can be helpful.

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