Advice for New Therapists… and Longtime Ones.

A week ago, my longtime friend Stan Smith MSW asked me to do some talks at USC.  The students were fantastic- they were really attentive, experienced, knew a lot of stuff, and so cool for me to see- were really into being of service in a climate that often doesn’t support our efforts.

The talks were focused on the idea of “legitimate suffering”, mostly.  It’s an idea stolen from Carl Jung, an idea near and dear to my heart for a bunch of reasons.  As I always do, we spent some time addressing questions that came up from students about doing The Work.

In both classes, the question came up, “What advice do you have for someone new in the field?”  This question mirrors too what a lot of our clients come in with.  I think the underlying theme of this for both mental health professionals and clients is, what do we do to give/get help?

It can be a complicated question, on both sides of the office/clinics etc.  As relates to depression, abuse, loss, addiction, anxiety, self esteem, relationships… whatever, if we intend to serve people suffering with it, we have a responsibility to an organized body of material that we think can be helpful.  My experience is that if it is used, it’s often helpful, when it’s not used, it is not.  Rarely is it simply not helpful at all.  The biggest mistake in my view, is simply not having a philosophy and principles for such things.  They should be agreeable both for client and caregiver, and of equal importance- they should be practical, empirical… things we can point at, that someone can do to improve the quality of their life, relationships, and decrease suffering from the things it is in our purview to treat.

We get some practical information as clinicians, some ideas framed by some “theoretical orientation” (Cognitive Behavioral Therapy, psychodynamics, Dialectical Behavioral Therapy, Jungian Psychoanalysis, etc).  Often though, it reaches what some patients need, but usually in the context of that orientation specifically.  It’s not to say that this information can’t be generalized, but it misses some of the fundamental aspects of what I think I’m being asked by a new clinician when they ask me what advice I have for someone new in the field.  This is talked about even less with “seasoned” or experienced clinicians.

More specifically, I think I’m being asked things like;

“How do I develop my style?”

“How do I provide great service?”

“How do I avoid burnout?”

“What can I do to develop my skills in an ongoing way?”

“How do I set and problem-solve boundary issues with clients?”

“What should I do to pass my licensing exams?”

“How do I set fees/schedules/obtain clients/deal with insurance companies/etc?”

“What can I do to get a job, and to stay busy in this as a career, when the economy is bad, insurance companies are difficult, agencies and hospitals are few, and there’s little funding available?”

“How do I deal with difficulties with specific clients, or colleagues?”

And etc.

As these are big questions to be tackled, and there’s certainly more, it’s better served to answer them in a book (or in school, but that happens little).  Sadly, there’s really only two practical guides for therapists that specifically address these kinds of considerations.  Finally getting to the point, here’s a truncated list of ideas that we discussed in these classes that I think might be helpful in some of these areas.

1.  Make sure you’ve endeavored to work through your own stuff. We’re already notorious for “going into the field to figure out ourselves and our own families”.  Get therapy.  Go to support groups or twelve step meetings.  Write, and share it with other people.  Have a meditative practice…

2. Focus on putting yourself out of a job, and the rest is easier- surviving, avoiding problems like job loss or getting referrals or whatever.  High quality patient care is the best way to do anything, as far as I’m concerned.

3.  Spend time mulling over what a high quality of attention is, and use that everywhere in your life.  Kids don’t just equate love and attention, they also feel the quality of that attention.  Same with our partners, and clients.  In our world, it’s one of our most-taxed commodities, and one of the greatest sources of creating or perpetuating problems.  It might be argued then, that it’s one of our most viable means of solutions.

4.  Read Sheldon Kopp- particularly “If You Meet the Buddha on the Road, Kill Him!” and “Back To One”. The former has the subtitle, “The Pilgrimage of Psychotherapy Patients”.  Would argue as much as it’s great for them, it’s better for us.  The latter is one of the two books I know about that are a practical guide for clinicians.  In it, he talks about a lot of the questions above- even how he deals with running into a patient in an elevator.

5.  Have principles you live your life by, and share ’em with clients.  One of the things I tell my clients the first day is, I have a responsibility to try to be the healthiest person in their life.  For me, that comes from principles.  On a totally unrelated note, since many ask, this is also part of the source of the pet name “April 30th” for my practice.  It helps as an anchor to remind me of what those principles are.  It’s also a great means of putting me out of a job- if my clients leave with principles, they have methods of problem-solving, so that they don’t need to stay with me to solve them as they come up.  At least, until they get good at using those methods.

6.  Survive school. It’s a place to learn, not get straight A’s.  There’s nothing wrong with that in and of itself, except for the fact that many of us with self esteem/perfectionism problems of our own, this can become a terrible handicap.  School, in my opinion, is designed to expose us to what legislative and regulatory bodies see as the most fundamental body of material we, and they, have a responsibility to, that insures we provide service safely and ethically.  It therefore almost can’t be a place where we really learn how to put ourselves out of a job.  That, in part, is why I think our ongoing efforts are called a “practice”.  Doing school in a way that is unhealthy (feeds perfectionism, supports us trying to fix a flagging self esteem, etc) makes us less useful long-term.

7.  Remember why you got into the field in the first place.  This one elegant idea can get us out of a lot of emotional, ethical, and practical scrapes.  On a related note, I’ve seen some of us get so fearful of our ability to stay busy that we forget and/or compromise this idea, to the detriment of not only our clients, but in maintaining a base of people to care for.  If we operate in the spirit of helpfulness, my experience has been that we can more effectively stay in jobs and clients to take care of- more than any “marketing strategy”.

8.  Have a life outside of The Work. This is also a responsibility to our clients, I’d argue.  Nature seems to reward diversity in most every environment.  This is true too, in being a mental health provider.  It keeps us culturally aware, maintains our own health in different areas of our lives, and asks us to use skills we try to teach clients.  Hobbies, activities, intellectual curiosities, responsibilities, and of course relationships- but more on those below.

9.  Accept that the licensing exam is unlikely to make sense, in light of what you intended for the field. Referring back to #6, my experience with MSWs, PhDs, PsyDs, MAs/MSs and etc, few of us felt like the licensing exams really asked us to know what we thought we should when we took them.  This was true too, of my licensure as a Psychiatric Technician (all the way back in 1988 or so).  They help regulatory bodies insure that we are safe to work, and little else.

10.  Have relationships, first by working on how to be worthy of them, and make them matter.  So often, I have people ask me how I’ve not just survived, but been passionate about doing The Work since 1984.  That is a deep question, and really goes to how I deal with all of my feelings about all my life… hence, too big for a blog.  Having relationships though, is a huge part of that.  We all want love, fun, humor, depth, responsibility and etc, but my experience is that we often focus on getting these things more than we do being these things.  Being these things I think makes us more likely to have them in a way that has quality, and certainly, enables us to live more gracefully with living a life where we often have to wade through human suffering.  This does more to prevent “burnout” than any amount of exercise, hobbies, and etc (though I of course think these things are important too.

As per usual, this is a really truncated list, and certainly doesn’t address all of the relevant dynamics of these considerations.  They do though, reflect a lot of what I wish I had as a basic framework to operate from when going through a lot of getting to mental health, and working in it since 1984.  Sure gives me some parts of another book I feel a responsibility to work on…

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. . . .

You Can’t Heal What You Can’t Feel

We constantly “do” things- behaviors and thinking, that put distance between us and us, us and “others”, us and ‘god’ or the ‘universe’ as we MISunderstand s/he/them and/or it.  Food, sex, TV, gambling, relationships, rationalizing, avoiding, intellectualizing, alcohol, money, property, prestige, drugs, toys/devices (cell phones, computers, etc), fixing other people, “acting out” etc.  Overstating, when it comes to distance between us and us, we’re talking about putting distance between us and our emotional condition.  Simply using a lot of words (Lao Tzu has famously said, paraphrasing, that “many words lead one nowhere”) and even certain types of words can put distance between us and our feelings.

To simplify getting in touch with and processing our feelings about things, I encourage using what are sometimes referred to as the “Six Basic Feelings”.  These are mad, sad, glad, afraid, ashamed, and/or hurt.  Certainly, we can have one or more of them at any given time, even about the same issue.  I really resist other words if at all possible, for reasons too long to go into here.

If we’re engaged in the aforementioned behaviors, we are often mood-altering, and/or simply less or unable to be in touch with our emotional condition (and as a result, others and the rest of the “universe”).  If our feelings are indicators of possible realities, if these are altered or stunted, we may not have all the information about a given circumstance.  The idea we’re going for is to talk about them in a way that transforms them, and or helps us clarify different circumstances.

So, my suggestion to get in touch with and begin transforming these is this: know the things we do that are mood-altering, let go of those behaviors (a whole other note all together), and as our feelings come up, say the facts of the circumstance, and one or more of the six basic feelings.  For instance, “When my mom (or whoever) said/did/didn’t say/didn’t do __________, I felt __________.”  That’s all.  Trying to avoid inferences, interpretations, assessments, judgments, manipulation, controlling, etc., certainly avoiding behaviors we do that ignore or diminish our ability to be in touch with how we feel.

It’s been said too that we can’t heal what we can’t feel.  So the process I’m encouraging is identifying what we do to not feel, letting go of those so that we can feel all of our feelings (“all” meaning each one, in all circumstances, and with 100% of the intensity we’re experiencing them…), naming them simply, communicating them in a way that helps us stay in touch with/get help/transform them, then finding ways to live our lives gracefully through what comes up as we process them.  This is a process I encourage with therapists, relationships, as many places as is possible.

It’s really important to point out that I’m not advocating for this process to change anyone else’s behavior or perspective.  This is not an idea about right and wrong, certainly not about comparing the relevance of our feelings to others.  It’s simply a way of getting in touch with what we feel, so that we can change it.  We often say to one another that we should “let go” of things- but you can’t let go of feelings you don’t totally have.

Utility of Sadness

We do some *ahem* interesting things with sadness.

Often, people ask us how we are.  I think the real question is about how we feel, but we will oft answer “good” or “bad” or “not so good”.  All judgments about how we feel.  Most of us would argue that “sad” is a “bad” feeling.  If we can get past that, we may use another euphemism: “depressed”.  Our relationship to this thing is often not great.

When I left my office this morning (my second office at the Life Fitness Center, a group that provides a more holistic set of services), I was sad myself.  I’d spent several hours with people who were in horrible circumstances, and had already been suffering.  Mightily, and understandably, I might add.  When I got to the light, I noticed a gentleman, probably 7ish, walking through the crosswalk with his mom.  One of my licensures is in developmental disabilities and other related problems, and I noted his cerebral palsy right away.  They were holding hands, and though his body was having a hard time- his soul certainly wasn’t.  He appeared really happy.

Behind my wheel though, I was pretty sad.  For my clients this AM, and for him (though he was probably fine).  Most of the time when we get sad, we find some way to resist it.  We push it away with our minds, set our attention elsewhere, numb it with all kinds of different behaviors, even shame ourselves for having such feelings in the first place.

Would argue though, that my sadness, has great utility.  Not only is it the most effective way to heal my losses, it certainly makes me useful to other people.  Exactly how it heals grief and loss is not quite the gist of this missive, and takes time with a therapist/counselor/life coach to know how to do effectively and gracefully.  Am certain that my sadness today assisted me in being kind and present for my clients, and likely would keep me “softer” when dealing with folk like the gentleman in the crosswalk.

My hope is that I never lose this.  As long as I am sad about the suffering of humans, I have business doing the work that I do.  The point of this though is that this is true not just in terms of my relationship to my clients or other folk in the world, but all of us in relationship to ourselves and one another in general.  Honoring our sadness does more to “cure” “anxiety” (sorry for the consecutive quotes), relieve “depression”, and make us available for intimacy than most any other thing I can think of.

Reconciling ourselves with sadness, and finding some “grace” in how we live with it, if the above is true, surely presents some great reasons we should stop treating our sadness as something repugnant.

On a different note: as a reminder, Judy McGehee and I will be on the radio/live stream/podcasting at the link below tomorrow from 1130AM until noon on the “Project Get Well America” show with Dr. Mark.  The link for the show is here.

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