Clumsy Solutions

For many years now, I’ve noticed something that I think is pretty interesting.

We all have similar problems.  Problems of love, death, loss, fears, mistakes, power, our bodies, work, school, relationships, resources, abuse, abandonment, depression, addiction, self worth and the like.  In one way or another, most of these touch all of our lives.  Our responses to them too, seem common between us- we all have “bad” feelings and “good” feelings associated with these experiences.

It appears to me, that we also have solutions in common.  But what’s strange about it, are the solutions themselves.  If we just look at the “problems” (for shorthand purposes) we have in our lives, and our response or “reaction” to them (or as I’m calling them here, “solutions”, though we may not see them as such in the moment), the way we deal with them from this perspective is tragically ineffective.

Here’s what I mean, more specifically.  The way I see us (and of course, have done myself in many cases), is that we respond to perceived problems with (in no particular order):

  1. Avoidance, procrastination.
  2. Using our limited human intellect, and our limited human will, coupled together as a salve we cover everything with.
  3. Drugs, alcohol, food, spending, money, property, prestige, gambling, etc. ad nauseum.
  4. “Codependent” behaviors (oversimplifying: doing things for others that they can and should do for themselves, so that we don’t have to feel bad for one reason or another).
  5. Lying (or, in addict nomenclature, “manipulating”… insert tongue-in-cheek emoticon here), often, when telling the truth would be easier.
  6. Perfectionism.
  7. Control.
  8. Enduring untenable circumstances or relationships.
  9. Isolation.
  10. Ruminating.
  11. Reasoning with “unreasonable” people, or in circumstances that may not always be subject to such (there’s a large philosophical question here that can’t be addressed in a blog, hope the spirit of the thing comes through…).
  12. Self obsession.
  13. Being critical.
  14. Thoughts or attempts of suicide or related self harm.
  15. Worrying (the behavior… not to be confused with being afraid- as John Bradshaw once opined, “Worrying is like beating the drums to keep the evil spirits away.”).
  16. Pride or ego.
  17. Lashing out verbally or physically.
  18. Intellectualizing…

Et cetera.  This is clearly a truncated list, but am hoping most of us can see our most frequent responses here.  What I’m hoping to get across (at the risk of reiteration) is that these are our responses to perceived problems, and arguably, when observed, appear to be solutions that we employ to a whole host of life’s difficulties.

More striking to me is what’s absent from the list:

  1. Emotional availability, disclosure, and the like.
  2. Asking for help (having a “responsibility partner”, other similar ideas).
  3. Responsibility.
  4. Having “boundaries”.
  5. Kindness.
  6. Critical thinking skills.
  7. Service focus on others.
  8. Writing (and preferably, sharing that writing with one or more people).
  9. Art (painting, sculpture, music, performances, poetry, etc).
  10. Honesty.
  11. Support groups, 12-step meetings, or other types of community.
  12. Amends.
  13. Mindfulness.
  14. Meditation.
  15. Diet, exercise, natural healthy sleep.
  16. Being self supporting through one’s own contributions mentally, emotionally, physically and “spiritually” (for lack of a better term).
  17. Acceptance.
  18. Therapy, counseling, coaching.
  19. Community, relationships.
  20. Intimacy.
  21. “Non intervention”, being still.
  22. Forgiveness, “letting go”, and other similar solutions.
  23. Gratitude…

Seems I’m laboring the point here (hopefully in a continued effort to be helpful).  Have long looked at my own old behavior (though it still shows up sometimes!), and of course the behavior of others, and as I see “problems” come up, inevitably, I see the first set of responses above.  Often, repeatedly and perpetually for the same problem and/or new ones.  Have also observed that these responses almost inevitably make things worse, or create new problems.

While the second set of ideas don’t always “solve” things (sometimes, when honest, simply in the shadow of our own limited perspective), when practiced, my experience is that we all start to feel better about things, and certainly act better.  Very rarely, do I see the second set of  ideas create or perpetuate more problems.  Making a practice of replacing our first responses in the first section with the ideas in the second section, has been life changing for me, and lots of my clients.  If the theme rings any bells for anyone, would love to hear/see other ideas.

What the Heck is “Euthymia”, and Why Should I Care?

Before getting into details, let’s make note of this: I’m altering the definition of the term as a way of creating a framework that allows us to look at something we don’t hear enough about in psychology and counseling- what is healthy!  We’re great at discussing “issues”, what’s “wrong”, what’s “unhealthy”, “mental illness” and etc, but we’re not so great at talking about the opposite!  Something to work toward, identification of what’s mentally, emotionally, and “spiritually” healthy, is a great way to change our feelings and our lives.

Oversimplifying, “euthymia” is a medical term, a term most often used in psychology, psychiatry, or philosophy to describe happiness or wellness.  Wikipedia separates out euthymia in terms of medicine, and philosophy.  In both, it is used to describe a “non depressed” mood, or “world perception” or “view” (Weltanschauung) as noted by the famous Greek philosopher Democritus.  Wordnik, a preferred website of librarians and info scientists for definitions of terms, defines euthymia as: “n. Philosophical cheerfulness and calm; the avoidance of disturbing passions, as inculcated by Democritus and Epicurus.”

As anyone who knows or has worked with me can imagine, I prefer the more global definition, the one hinted at in philosophy.  As promised, I’d offer that euthymia as a term might be most useful if looked at this way: an emotional response that is reasonable, adaptive, and of “right size” intensity, in response to one’s current circumstances.  In short, a healthy emotional response to one’s current circumstances.  Or (again, oversimplifying), a way of knowing that one has a healthy emotional response to the world.

Let’s start by thinking about what might be some indicators of an unhealthy response to the world, commonly understood by the medical and psychological communities.  Someone experiencing a “low grade” depression for an extended period of time might be diagnosed with “dysthymia”.  These symptoms being present, in absence of “psychosocial stressors” (AKA “problems” in life…), is arguably an indicator of something south of optimum health.  Without anything “bad” happening, to be “depressed” is regarded as unhealthy by most helping professions.  In a like way, being “sad” or “depressed” in a way that prevents us from doing things in our lives (work, play, relationships…) about something that happened say, 10 years ago is arguably not a healthy response to what is happening now.  To exaggerate to make the point, in schizophrenia (literally to be “split from reality”), this is an extreme version, the opposite of “euthymia”.  More specifically, if one is seeing things (having visual hallucinations, a common symptom of schizophrenia), I sometimes like to describe this as a response that’s not euthymic.

One of my goals as a therapist is for all of my clients… people who are depressed, anxious, have low self esteem, addicts, codependents, whoever- to have a reasonable, here and now response to their given circumstance.  If we behave for instance, based on old hurts to a current circumstance we tend to at best not be able to resolve either issue, at worst, make one or more of those issues more difficult.  Another way of saying this is that, if I experience a perceived sleight (someone makes fun of me, forgets a “small” responsibility to me, etc), but respond to that with isolation, threats, emotional blackmail, substance use or etc, this isn’t a “right size” response- it’s not euthymic.  Knowing that we are not having a “euthymic” response in this example, or as a way of problem solving, can help a lot in terms of dealing with our problems as right size, and might enable us to problem solve more effectively.  For someone suffering from anxiety, low self esteem, depression, addiction and more, this can be a great tool to start on the road of dealing with our current circumstance as it is.

Going back to some more painful considerations, I would suggest that in taking the example of the death or similar loss of a loved one or animal or etc, being sad is a euthymic response.  Just as our body has less than comfortable sensations in response to illness or injury- these are indicators of recovery from them.  Why don’t we see our relationship with our feelings in a similar light?  As an example of this, when we fall off a bike and skin our knee, most of us who know a little about science know that much of the reason it hurts is because of the inflammatory process- this is due to the healing and protective agents of our bodies (white blood cells to fight off infection, proteins to rebuild the part, fluids for transport of these materials and etc…) being sent to heal the injured part.  It hurts both as an indicator for us to know not to do that again, but as much, because it is healing.  Endlessly interesting to me, humans don’t see their non physical feelings, their emotions, in the same light.  We regard them as something terrible, something to be avoided.  It seems to me that we have them because they give us other information about our environment that we might not otherwise discern from our other senses, and a way of healing other aspects of our lives- hurts, shames, losses and etc.  It’s not to say that our feelings are all necessarily facts, but indicators of possible realities (more on this idea from my blog here).

If the above paragraph is any indicator, in many circumstances, having “bad” feelings might be the process of dealing with non physical difficulties.  Extreme (in terms of intensity) or maladaptive (not useful) responses to these create in turn more problems, and in some cases, diagnosable difficulties.  Having the idea of euthymia as a guidepost, it might give us a more tangible way of gauging our problem solving, behavior, and more.

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.

Therapy, Counseling, Mental Health: Things That Put Me OUT of Work

My last piece of course is begging for a follow up.  If there’s semi-tangible things that put me in a job, there should be some things that will put me out of a job, so to speak.  Ideas, principles, behaviors that clients do that get them and keep them out of our offices, clinics, and hospitals.  Again, we as clinicians talk about them fairly often, but I rarely hear/see them showing up in discussions outside of our colleagues.  In all fairness, as with all professions, there’s arguably some things we don’t agree on or see a little differently, but if we’re really endeavoring to be socially responsible and progressively-minded about our responsibilities, I think we ought to be transparent about some of these things.

Should mention some of the spirit of where these ideas come from.  One day at a hospital I was hired to create dual diagnosis programs at, it dawned on me that there were a lot of suggestions that most clinicians of all types, gave to clients of all diagnoses/problems, in an effort to be helpful.  I created a beginning list of these as I saw them, and asked different psychiatrists, therapists, social workers, nurses, and recreational therapists to add/change/delete parts of the list.  After compiling 60 or 80 different items or so, we began using this as a resource tool for the clients.  The list below is some of those ideas, but am leaving some of them out for brevity’s sake.

They’re not really new.  Most of these appear not just in different forms of therapy, but some religion, philosophy/worldviews and the like as well.  It should also be said that they ought to be useful for most any problem- not a panacea, but consistent across categories of problems… depression and sadness, low self esteem and shame, anger, pain, grief and loss, abuse, “thought disorders”, affective disorders (depression, bipolar disorder, anxiety disorder, addictions, etc).

As with my last blog, would suggest that these might take deeper explanation and guidance, and hence, some of that work is beyond this medium.  That said though, I think that some of these ideas are extraordinarily useful (despite their age… ;-p  ), and can be applied a lot of places.  Some of these are simply ideas that I think “getting a handle on” and using them as a start for problem-solving is really helpful.  Not an exhaustive list, but as a start…

  • Knowing who we are and how we are is one of the most important things- and arguably the basis for dealing with a lot of our problems.
  • Have a “congruent affect” (affect is “feeling” or “emotion” in this context)… let your outsides match your insides.
  • Learn how to identify feelings, and share them with supportive/healthy people in ways that are easy to understand.  Might want to try using the “six basic feelings” of mad, sad, glad, afraid, ashamed, and/or hurt.
  • Don’t treat all feelings as facts.
  • Have “boundaries”.  Know where we each “start and stop” mentally, emotionally, “spiritually”, and physically.
  • Eat healthy, exercise, regulate sleep.
  • Remove thoughts/behaviors that put distance between us and us, us and others, or are used as simple distractions.
  • Being “right” is not necessarily more important than being loved.
  • We have to “have” something to “let go” of it.  This arguably applies to how we feel.
  • Is there another choice besides acceptance?
  • Mindfulness.
  • Using critical thinking.  Skepticism, defining terms, consideration of alternate interpretations, considering how an idea might not work/go wrong, resisting oversimplification/generalizing, comparing/contrasting with other people’s ideas…
  • Have a “resource group”… people with whom we exchange ideas, get support, do critical thinking with etc that have experience and/or education with the things we struggle with.
  • Treat happiness as an inside job.
  • Avoiding self-medicating with drugs, food, alcohol, shopping, gambling, sex, TV, etc.
  • Be self-supporting through our own contributions, mentally, emotionally, “spiritually”, and physically. (this particular item is a lot deeper than it may seem at first blush)
  • Don’t just read literature related to our problems and difficulties- actually try the ideas contained.
  • Give up comparing our insides with other people’s outsides.
  • Delay gratification.
  • Know and work on our “issues”.
  • Consider and act on “love” as a verb.
  • Get out of abusive relationships, maybe even relationships that are “potential” rather than “actual”.
  • Stop trying to control other people, places, and things.
  • Be of service.

Again, this is a painfully truncated list, some of the ideas are certainly arguable, and none are a substitute for working with a professional for learning how to do them if they are going to be useful.  My experience though, is that my clients who take up these things, with a pro, have a pretty common experience of feeling and behaving better themselves.  In some ways, it’s hard to imagine doing treatment without these things.  Of course, a lot of these are hard to do, but not impossible, and easier if made practical- things we can measure and point at.  Would love to hear ideas from other folk about things that they think are fairly indispensable, and might work for a lot of folk in a lot of different circumstances…

Therapy, Counseling, Mental Health: Some Things that Keep Us in Work

As I’ve said before, I try to work in the spirit that it’s my job to put me out of a job.  There’s some things I see pretty often though, that seem to be both counter intuitive and appear to keep me and my type in work.  My experience with therapists is that we often see these things, but rarely talk about them in a semi-organized way.  As much as loss, abuse, and abandonment cause depression, sadness, shame, low self esteem, anger, pain, addiction and etc, there are things we do that perpetuate our suffering in this way.  Some of these are survival or coping skills and thus necessary, but don’t really go very far to help someone get, and stay out of places like my office.  Here’s a list of some of those things off the top of my head:

  • Absence of critical thinking.
  • Responding to struggles by simply “staying busy” or just “trying harder”.  AKA, operating as a “human doing” instead of a human be-ing.
  • The kind of thinking that “Time heals all wounds…”, “It’s water under the bridge…”, “You’re just giving __________ power over you…”, “The past is in the past…”, “Just stay positive…”…
  • Using ideas and principles that got us suffering in the first place, to resolve that suffering.  Drugs, alcohol, isolation, shopping, food, gambling, etc.
  • Simply not knowing, and/or avoiding feelings.
  • Thinking and/or behaving as if the only answer to our suffering is for someone else to change or stop their behavior- even if their behavior was the cause.
  • Money, property, prestige.
  • Carrying the torch (or stick, if you will) of someone else shaming or diminishing/devaluing us.
  • For those that can and should, not being self supporting through one’s own contributions mentally, emotionally, physically (food, clothing, shelter…), and “spiritually”.
  • Perfectionism- both imposed on others, and ourselves.  Same is true for managing and controlling everything.
  • Going where the love “should be” in our lives, instead of going where the love is.
  • On a related note- staying in abusive or emotionally unavailable relationships.
  • This one is a little backwards from the context in the opening paragraph: took me a while to realize that I don’t have to do everything I think.
  • Blame.
  • Poor boundaries.  More specifically, not knowing where one person “stops” mentally, emotionally, physically, and/or “spiritually”, and another “starts”.
  • Operating as if our feelings are facts.
  • Euphemistic language.
  • Behaving or thinking as if we have to not be, or stop being afraid, before we can accomplish a task.
  • Same as the above, but instead of stop/not be afraid, that we have to be “motivated”.
  • Being an “island”.  Meaning, not having closeness with other folk, using ourselves as a sole resource for support or perspective or interpretation or encouragement, etc.
  • An inability or unwillingness to be “present”.
  • Can’t emphasize this one enough: not knowing who we are, and how we are.

Am guessing I’ll be adding to this list as time goes on.  The ideas above certainly warrant a deeper look/discussion to both understand and make them practical.  It appears to me that there’s a lot of fairly simple myths that might be dispelled that could help us all reduce chaos, and “increase the signal to noise ratio” in terms of our perspective and thinking.   The ideas above, I think, are a pretty great start at doing that.

“Show Your Work!”

When “solving problems” in addition to good “issue identification”, “diagnosis” (or whatever), it’s really important to examine methods/means to diminish or solve these problems, and have those methods be principled.  As Huxley opined:

“We are so anxious to achieve some particular end that we never pay attention to the psycho-physical means whereby that end is to be gained. So far as we are concerned, any old means is good enough. But the nature of the universe is such that ends can never justify the means. On the contrary, the means always determine the end.”

But even principled means don’t go far enough.  I have been discussing with a couple of clients and friends in the last week about getting from “point A” to “point B” as relates to The Work.  With these discussions in my head, have also come across a couple of psychology related blogs addressing resolution of specific problems.  What these conversations and blogs have in common, is my friends/clients complaining that when they’ve mentioned a problem to someone (anxiety, impulse control issues, depression, for example), and when given advice by some folk about how to resolve them, we have found essentially that at worst the suggestion amounted to “stop being __________ (anxious, impulsive, depressed)”, or simply suggesting that the opposite behavior/idea be employed.  Even from professionals.

Of course, the “middle part” here is really important.  There should be attention to the steps taken in the middle.  Those steps should specifically address the issue at hand, not simply be something rationalized as “good” or needed or healthy.  As some of my heroes have suggested, these ideas often amount to “activity instead of action”.

For instance, exercise arguably helps depression, anxiety and the like, but seems that in many cases does not specifically address the concerns identified that might be causing such in the first place (loss, abuse, etc).  In addition to that, the steps taken from anxiety to “calm” or “groundedness”, sadness/depression to happiness/serenity/gratitude (or somesuch) etc should be principled.  Meaning, they should be rooted in ideas that are repeatable, work for different kinds of problems, and preferably don’t create new ones in their wake.

Much of this is intuitive, but what keeps coming to me about these ideas is when observing “problem solving” from the outside, it’s often difficult to point to the work that is done.  Just like we’re encouraged in most math classes, we should be able to “show our work”.  When dealing with issues/problems/concerns, problem identification is really important.  So are means of problem solving- but what seems a good test of the effectiveness or value of such is the ability to point at the work done that specifically addresses the problem at hand.

As a simple example… telling someone to “calm down” rarely helps them behave differently, let alone feel differently.  There’s no steps to show, it’s difficult to see any principles this idea of “calming down” is based on.  While problem-solving emotional or relationship problems and the like it’s tempting to simply give advice and/or lean on philosophy, but there’s a lot of value in making such practical- something we can “point at”.

In our martial arts training group, if one of us has or is taught an idea/principle, we test that idea out in real time with a resisting opponent.  We also try to “break the idea”- see what conditions or problems it will not work with.  In some circles this is referred to as “pressure-testing the material”.  The same ideas might apply when solving other real world problems.  Clearly identifying the issue/context, having a principled means of intervention or “problem solving”, having a practical (empirical) means of determining the usefulness of the idea… showing our work and evaluating its utility.

Am advocating here for critical thinking when it comes to the utility of tools or ideas for problem-solving.  It seems that one of the places this utility is revealed is in whether or not we can show our work- make use of an idea in a way that is repeatable and observable (what we say/don’t say, do/don’t do).  As a therapist, I really endeavor (and hope other professionals) to give ideas that can be used by anyone, ideas that are practical enough to show the work that specifically addresses an identified problem, not something that simply gives us the feeling that we are doing something.

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

What to Do?

From P.16 of the PDF “Statutes and Regulations” from the California Board of Behavioral Sciences (the regulatory agency that oversees MFTs, Social Workers, and etc):

“§4980. NECESSITY OF LICENSE (a) Many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships.”

Clients as above, come to us for wise counsel.  Among other things of course.  This idea has far-reaching implications, not just for our clients, but for us.  Wisdom is hard to come by!  Oversimplifying, “wisdom” in this case is often a euphemism for answers.

Claiming (or believing) one has wisdom or answers is of course a Bad Idea, yet it seems we have a responsibility to work toward them.  There’s some great ideas and techniques supporting the principle of not giving “answers” (suggestions, direction, etc) outright to clients (or loved ones, certainly) from the therapist’s chair.  My basic mode of operation is to try to lead someone to those answers, typically only giving direct suggestions when my efforts to lead a client to their own answers have been exhausted.

We do treat several diagnoses and/or issues that have “community standards”, fundamental practices or “conventions” most therapists agree on how to treat.  Schizophrenia, bipolar disorder, and other more severe illnesses for instance almost always direct the client to: not “self-medicate”, takes the best supportive medication regime as directed, and is getting :talk therapy” and/or peer/familial support with their illness.  There are few that argue with the utility of these interventions.  There are other examples for addiction, depression, anxiety, and more.

Two things are of interest to me though.  The first is that during the therapeutic process, I often see clients get a suggestion, and dismiss the suggestion out of hand.  What I think is happening is that rarely do I suggest an idea that in a vacuum will ever be sufficient.  What I mean is, most any suggestions I have will never be singular.  It seems that the depth of our sadness or anxiety or pain or whatever often keeps us from “getting” what is offered, unable to accept the responsibility of taking several suggestions.  Summarizing: rarely is one idea sufficient to change anything in the therapeutic process.

The second thing that prompts me to mull this over is the “active” therapists versus the “passive” therapists.  In my view there is room (and each therapist I think, ought use) both styles, often with the same client.  There are times that we should be directive, and not just in terms of extreme examples like when a client is being abused.  Discouraging self-medicating, engaging a support group, ruling out medical concerns with a physician, ways to stop a behavior etc are all examples where there is little controversy over giving someone “direction” about an issue.

People come to us for answers.  We are paid to have a toolset, methods, principles of operating that in many cases should help diminish depression, stress, relationship conflicts, behavioral concerns and the like.  On the subject of not holding these ideas close to one’s chest: there is a great (and occasionally controversial) martial arts instructor who critiques traditional means of training, idealizing the “teacher” and etc.  He also critiques traditional martial arts training as being “cultish”- keeping secrets, claiming answers from some (out of touch and unknowable) “higher source”.  His “instructors” are all referred to as “coaches” or by their first names, and their focus is very simple: performance improvement.  That last idea is part of what I’m getting at here- the “answers” we give as therapists should improve “performance”, which I would argue is diminished if we are too passive.  It is very significant of course, that what is being improved, is clearly defined.  If we think something might be helpful though- there are certainly compelling reasons we should disclose it.

When it comes to performance, we should be helping people get more in touch with their emotional condition, have those feelings gracefully, diminish (but not eliminate) the intensity of negative emotions.  Our interventions should help decrease or stop unwanted behaviors.  The direction we give should help increase intimacy.  Of course this is not an exhaustive list, it may take a long time for these things to happen, and some cannot happen without the others.

My experience has been that many (arguably most) of my clients have come into my office, suffering enough, and out of enough answers, that they are willing to do most things we come up with together.  Had they been in possession of this material on their own to begin with, there would be no (or little) need for my education and experience with the issues they struggle with.

My effort is to put me out of a job and it does people a disservice I think, to have an insight that I wait for them to come to on their own… which they’ve already arguably been trying to do.  Sometimes I ask my clients if they have spent a great deal of time in their lives, saying something like this to themselves: “I just wish someone would tell me what to do about this.”  There are many things, that most(not necessarily all) people can do, directly, to diminish feelings of low self worth, sadness, struggles in relationships and most of the problems they come to a therapist.  If I didn’t go to school to learn to help people know and do these things, then what exactly did I go for?

Wanting to Stop

Have had several people in the last week ask me specific questions about wanting to stop (sometimes called “abstaining” or “cessation”) doing some “behavior”. Drinking, smoking, gambling, over/undereating (or not at all), self-harm behaviors (cutting, burning oneself etc), “codependent” behaviors, controlling behaviors, manipulating, even saying or thinking certain things and more. While some of these require more intense interventions (stopping alcohol or drug use for instance would require medical intervention), some other behaviors can be stopped or minimized by other means.

Though we (therapists) are oft charged with the responsibility of helping clients stop these behaviors, we’re not always direct about how to help someone do so. There are real-world, practical means of helping us stop these kinds of behaviors. It should be noted though: in many cases, these are caused by unresolved emotions. It’s really important to note this, because no intervention we might suggest will work if there is a sufficient mental/emotional/”spiritual” and/or physical prompt to do so.  Or more simply and by way of example, if someone is suffering enough emotionally (or otherwise), no intervention will stop the behavior.  The feelings (even if physical) have to be transformed/diminished enough for the intervention to work.

These things in mind, here’s some ideas. Some of them are direct, some of them will take hold over time:

1.  Pay attention to how we feel.


2.  Ask ourselves, “Am I mad, sad, glad, afraid, ashamed, and/or hurt right now?  What ‘possible reality’ does this indicate?”

3.  Putting off the behavior.  For example, “I’ll _________ (smoke, drink, gamble, eat, etc…) an hour/day/week/month from now.” 
 
4.  Context.  This isn’t just a principle.  It can be practical.  Asking, “What am I supposed to be, or supposed to be intending to do right here, right now?”

5.  Service.  Finding a way to be of help to another person.

6.  12 step program attendance/participation.

7.  Saying the “Serenity Prayer“.  Even if not “prayerful” people, this can be a form of self-talk (the word “God” can also be removed).  For things we’re “powerless” over, “God, grant me the serenity to accept the things I cannot change, the courage to change the things, I can, and the wisdom to know the difference.” makes us mindful of principles and behaviors that can also help with abstinence.

8.  Speaking of praying (or doing self-talk)- praying for the obsession to have __________ (smoking, drinking, gambling, eating etc) be removed, helps.  “Please remove from me the obsession to stop _________.”

9.  If that is hard, praying/self-talking for the willingness to stop __________.

10.  Calling someone.  This, to me, is one of the most powerful tools.  Having someone who knows what we are working on that we can call when considering the behavior to: pull our covers (so to speak), have them talk us out of it, and/or “be” with us as we struggle with the feelings of letting go of the behavior can be pretty powerful.

11.  A different item from the above- calling that someone as a pre-emptive strike.  Meaning, calling them when we might be in a situation this will come up, before we go do the thing we have to do.

12.  Make a list of the times these things (smoking, drinking, gambling, etc) occur most frequently.  Take that list, and either apply the things above (and below) to those circumstances if you HAVE to be there for these instances, and or use the list to avoid those times entirely.

13.  Write a list of the negative consequences of the acting out behavior.  
14.  Maybe most important, is simply identifying the issues (even by making a list, which we will also do in a formalized way) that have prompted us to operate this way, and have an organized means of getting through these (which therapists are charged with the responsibility of).

15.  Based on that list of things/people/circumstances that get us in trouble, have a list of replacement behaviors.  For example, I know I shouldn’t be __________ (smoking, drinking, gambling, eating etc), so, I’m going to go to church/support group/call my friend/read this book/exercise/take a walk/write about it and more etc.

16.  Speaking of writing: when “tempted” to do the behavior, write about it.  That’s pretty common information from most therapists.  However, I think it doesn’t go far enough, unless you read this to your therapist and/or a loving friend and/or a sponsor (if one attends a 12-step program), priest, pastor, and etc.  Maybe more than one of these people.
17.  Putting a rubber band around our wrist, and giving it a gentle snap when considering doing the behavior.
18.  Making a “fund” for the behavior- putting a pre-determined amount of money in a jar when we do the behavior (or consider it maybe), and donating it to a charity or some related idea.
19. “Play the record through.” All the way through. Consider every step of what will happen, what it leads to, and its consequences.

Again, I want to reiterate that no amount of ideas to “stop” a behavior (that we do in our heads or outside of them, so to speak) will be sufficient without working through the attendant (and/or consequential) emotions that come with them.  Those are really strong reasons pointing to the idea of having a therapist that can help use these kinds of tools (and more), and walk through the related issues.  It’s important too that many types of concerns will require medical attention by a physician with experience with the specific problem.  Good luck with any of these efforts…

Post Script: It should be noted that the soul of such things is what Carl Jung would have called “illegitimate suffering”- meaning, we do these things as an alternative to simply feeling whatever we feel when we don’t do the behavior.  One of the things we do these over is feeling “bad” (about ourselves), broken, less than, “not enough” and the other variations on that theme.  Often, if we do the behavior we’re trying to stop, we feel those very things (“bad”, broken, etc).  As we often do the behavior to diminish or eradicate feeling those things, then we feel those very things for doing the behavior.  Simplifying: I feel “broken”, less-than, etc, I do a behavior to not feel that way, then feel “broken” (less-than, etc) for doing the behavior.  It sets up a vicious cycle, a repetitive cycle.  

Where I’m going with this is, if you happen to do the thing you’ve been trying to stop, “beating yourself up” for doing the behavior may be the very thing that prompts you to do it again.

Flickr Photos

DSM IV TR

Sadie first day home

Stranger Hand

More Photos

Available Tuesday through Saturday

626-676-0541
Hours vary, depending on the day.
%d bloggers like this: