The Fourth Reason

Make more mistakes

When I ask most people about what gets us into therapy, the usual responses are; stress, depression, anxiety, relationship problems, drugs or alcohol, and a few others. In a more general way, I’d suggest there are three primary “issues” that get people into therapy; grief and loss, abandonment and neglect, and abuse of all kinds. There are certainly more reasons people cite in wanting to see a therapist, but in my experience, there is a fourth thing that prompts people to come in: perfectionism.

For many of us and many cultures, at first there seems to be little downside to perfectionism. In truth, some of the character assets that come with it drive many of the personal and cultural improvements we’ve made in all kinds of areas. Like many things though, it behooves us to look at the fine print. There is definitely a price for this way of behaving. It is sort of a softball to point at the usual and sundry – loss of time at home and in recreation, medical problems like heart attack and stroke, the aforementioned mental health treatment. These things are certainly caused by a constellation of problems, but if looked at a little differently, by looking at the symptoms of perfectionism and their subtlety, it might shed some light on perfectionism and its consequences.

Clients who self-identify perfectionism being a problem for them report a host of symptoms that are pretty easy to see are related to this issue. Here’s a few:

  1. Rumination/obsessive thinking, replaying or imagining how we think some experiences should go
  2. Hypervigilance
  3. Imposition of high expectations on self or others
  4. Sacrificing parts of ourselves/lives that we can’t afford to lose (time, sleep/rest/breaks, exercise, money . . .)
  5. Saying “yes” when “no” might be better for us
  6. Being critical of self or others in ways that have negative consequences
  7. An “incongruent affect” (a clinical term) – the way we “look”, our facial expressions and the like, don’t match how we feel on the inside
  8. “People-pleasing” – similar to #4 above, but subtly different
  9. Lack of compassion/kindness for mistakes/foibles made by self and/or others
  10. “Social engineering” or “the Jedi Mind Trick” – managing other people’s perceptions, thoughts, and feelings about us
  11. Different types of negative “self-talk” – “How could I be so _____ (stupid, fat, ugly etc.)?”, “I should have/could have done more/better…” (there are TONS of examples)
  12. “Punishing” oneself (staying later at work or activity, working more, sacrificing more, putting off things we’ve earned or deserve, sometimes physical or “verbal” self-talk punishment . . . ) for “not doing enough”, “not measuring up” and etc.

There are many more examples of symptoms of perfectionism. There are also more examples of the consequences than the ones listed above. Strange as it may seem, perfectionism can also show up as an unhealthy relationship with food, alcohol, drugs, sex, how we treat our partners and children (having high expectations, for instance), picking or staying with unhealthy friends/partners, depression, low self-worth, anxiety and more.

So, what to do? Many of the typical suggestions from therapists are helpful, but sometimes insufficient. Lots of these are intuitive, and can be done without paying somebody – there are plenty of resources available on the internet. They usually are ideas like:

  1. Trying to remove the word “should” or “could” from discussion (including self-talk) about our abilities/behavior
  2. “Being gentle with ourselves” (a strangely vague direction, I’d argue)
  3. Changing/lowering expectations
  4. “Having healthier boundaries” (often ill-defined)
  5. Using “positive affirmations”

There’s certainly more. What I would offer might be more concrete suggestions. This is an incomplete list due to the medium, and per usual, many of these are better utilized with the direction of a therapist on an ongoing basis. Here are some other ideas:

  1. Learn to have (and survive) a “congruent affect” – how to gracefully and appropriately have your outsides match your insides
  2. Get “peer review” – ask trusted friends to help with an objective sense of whether we are asking too much of ourselves, and the like
  3. Make a list of the perfectionistic behaviors we engage in, and stop engaging in them. If that is difficult, would suggest using some of these ideas to help stop them. This is a great example of the kinds of things that might need more ongoing therapy to come up with specific strategies, as is the next item . . .
  4. List quotes of our negative self-talk. These can be replaced with more “right size” ideas/statements, or counter ideas that both keep us from adding to the pile, but a way of starting to counter this self-criticism and other similar behavior.
  5. Yet another really important method that would be better done with ongoing therapy, identification and processing of the issues/experiences that might have prompted us to suffer with this in the first place.
  6. Learning what healthy boundaries are, and how to employ them
  7. Replacing “punishing” ourselves, being hard on ourselves and the like with more compassionate/loving kinds of ideas. Every therapist on the planet (almost) suggests self-care/self love as a solution, but we are terrible at being specific about it. Will offer a quick “thought experiment”. Think of a person or thing you are pretty sure you are good at being compassionate/loving towards. Think about the principle that is involved in these ideas. Attention? Providing basic needs? Verbal affection/appreciation? Consistency/responsibility? There’s tons of examples, but whatever we come up with, if we add a little critical thinking skills/objectivity/guidance from a therapist, we can readily come up with some great ideas that we do for others, and learn how to apply those ideas to ourselves.
  8. Learning how to handle the consequences of saying “no”, and methods of communicating it clearly/assertively
  9. Learning “thought-stopping” techniques
  10. Consider making __ (insert your age here) year-old mistakes

As I noted, while there are clearly more ideas that might be employed, I think this is a pretty good list. In some cases, this behavior might point to the ill-defined issue of “codependency”, but that is an idea better tackled for a blog (or book) of its own. It is hard for me to write about this and not make at least a mention of the idea of “humility”, another misunderstood and ill-defined term in some ways. However, humility, what I would suggest is a principle that helps us consider our awareness and relationship with our own individual human-ness, the quality of our human-ness, can also really help us have a “right-size” relationship with who/what we are. This seems to be a method too of diminishing perfectionism in a healthy way, but is beyond the scope of this blog as well.

It seems to me that our society, certainly here in the US, is fraught with nudges for us to behave in a perfectionistic way. Though we all agree that our expectations of ourselves tends to be unhealthy, how it shows up in our lives is even more subtle than the messages we get this from in the first place – comparing our insides with the outsides of others, trauma, poverty, advertising blaring one-way communications with us about who we should be/what we need, and the like. The pain, shame, and anxiety this produces is intense, being a therapist in the room with many of my clients (and having struggled with this myself many times in my life).

One of my heroes, Sheldon Kopp has admonished, “Why be perfect, when you can be good enough?” in many of his books. My hope too, is to get us to consider that the only thing wrong with us is that we think there is something wrong with us, and give us more practical methods of changing our relationship with this on a daily basis.

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.

Difficulties, Diagnoses, the DSM.

In a New York Times Op-Ed piece from today, one of the leads on the DSM-IV (the “Diagnostic and Statistical Manual”, the current edition of an industry standard tool for mental health, primer here) task force wrote about the upcoming changes in the DSM-V (likely to be released in early 2013).  Summarizing, Allen was suggesting in part, “…after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription.”, and that the American Psychiatric Association was  arguably no longer in a place to be singularly in charge of the meting out of diagnoses, calling it a “monopoly” (offering that an agency akin to the FDA or National Institute on Mental Health might be examples of ways to provide oversight in the efforts to insure some science around diagnosing emotional and mental problems).

Am with Allen on quite a bit of this.  What comes to me often too, is that we have equally large fish to fry with the DSM and the profession than just the pathologizing and monopolizing he suggests.  We have been over-diagnosing ADHD (attention deficit hyperactivity disorder) and bipolar disorder, among others.  Our differential diagnosis (rationalizing one diagnosis vs another) has also been resulting in much harm to people by way of treating issues unneeded, and/or incorrectly.  We are also arguably guilty as a discipline of using interventions that are more “intrusive” than necessary (for instance, medicating a problem before efforts at traditional talk therapy and/or other interventions have yet to be tried).

It seems to me that in reviewing the DSM, we are more currently in need of insuring the accuracy and value of our diagnoses, in terms of insuring that those so suffering are treated more appropriately.  We do know ways to treat depression, anxiety, addictions, bipolar disorders and etc.  We do have means of helping people through grief/loss, communication problems, abuse, suffering with stress and etc.  As the saying goes though, the “cure” (a dubious word to begin with) is only as good as the diagnosis, and with the numbers of the diagnosed only increasing in the US year after year, either our diagnosing or treatment (or maybe a bit of both) are not faring as well as they might.

A quick aside here- not all of the missed treatment opportunities are about the above issues.  Some of them are due to the influence of Big Pharma (an intense imposition by the pharmaceutical industry), access and funding of mental health treatment, the insurance industry and more.

Specifically related to the DSM though, my hope is that we’d simply be better at a lot of the material we already have.  Adding diagnoses, or simply separating them into finer and finer constellations of symptoms seems both unnecessary and unhelpful, philosophically speaking.  Part of what I’m getting at above is that I think we have some good ideas about how to help many ills- I just wish we spent more time treating them, and less time diagnosing new ones.

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…

“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

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.

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. . . .

Therapy is Not the Answer

This is sort of a PSA for clients and therapists alike.  Therapy is not the answer to our problems of relationships, depression, grief/loss, addiction, taking food from others, communication, our sense of broken-ness/low self worth/shame, loneliness, etc.  Therapy isn’t just a way of being either.  It’s probably a way of being that solves these problems, and can prevent many in the future as a result.  The only exception, if seen in a particular light, might be around issues of safety that require immediate intervention.

Therapy should be a space where we work through the feelings we’re carrying with us that prevent us from coming to these answers on our own.  It’s an activity that should prompt us to be without our defenses and distractions as much as is possible, with a guide that has done enough of their own work that we can be taught how to live gracefully with these feelings, let go of them/transform them, and provide us principles and ideas that will help us not make some of these mistakes in the future.

We certainly should be giving direction about how to handle some circumstances, communicate more effectively, learning parenting and relationship skills, symptom management, relapse prevention and etc.  There should be an organized body of material to assist with these things.  They will all be rendered useless though, in absence of a principled way of operating, and or in the presence of enough emotional intensity that the tools cannot be used or we cannot see “answers” clearly or the simple consequences of not having these feelings gracefully end up exacerbating problems.

So, a suggestion.  Learn some survival skills that lend themselves to our ability to get some new ways of operating.  Have enough support from family, friends, and professionals that will enable surviving the process.  Deal with the feelings that come up, then set about “solving” things.

Transformation.

So, we can’t heal what we can’t feel.  If we’re really trying to transform “depression” (not a feeling, but a diagnosis), “anxiety” (another non-feeling), grief and loss, abuse, abandonment and neglect etc- we have to “let go of some old ideas” about how we perceive and experience these circumstances, and the attendant e-motions (emotions, energy in motion).

Some of these ideas we have to let go of are:

1.  That we can turn our feelings on/off.
Stimulus/response (to steal loosely from Gary Larsen and others).  All we perceive has a stimulus and response attached to it.  It both amazes and saddens me that despite such a fundamental law of physics we behave as if we can somehow do something (or not) that will allow us to not have a response to a stimulus about what someone says or does.  Some basic “untruths”: “I need to not take _____ personally, give _____ power over me/allow them to ‘get to me’, it’s water under the bridge, it’s all in the past…” etc ad nauseum.

2.  That we can decide how intense a feeling we are having/going to have.
Back to physics- we can’t decide or influence how much of a stimulus we take in.  Save with the use of drugs or alcohol, even despite attention- we experience what we experience.

3.  That we can decide what type of feelings we’re going to have in response to some experience.
Sometimes we feel sad about something, only to have a similar experience later and feel hurt instead.  If this were true- why couldn’t we simply “decide” to feel joyful, grateful, happy, etc about a thing?

There’s more, but these are a fairly good starting list.  If we’re going to transform our feelings (or help others to do so), we have to change our philosophy, our relationship to our emotional condition.  Some of the most frequent problems I run into both personally and professionally around this are around the kinds of beliefs above.

Beyond this, we do things that prevent us from being fully in touch with our emotions.  As Sheldon Kopp has famously (or not so famously) said, paraphrasing: “When we stop trying to overcome anxiety, avoid depression etc, we can experience how sad and scared and hurt we sometimes truly feel.”  I would argue that one of our most basic problems as humans is that we do things that put distance between us and us, us and others, us and the “universe” or “God” as we MISunderstand he/she/them and/or it.  The list of the things that we do that result in these effects, is the list of things we have to stop doing to have access to how we feel, and transform it.

On a professional level, I have been struggling deeply with how far away we’ve gotten from doing “depth work”, processing, “uncovering, discovering, discarding”, “naming it, claiming it, and dumping it” (or whatever euphemism one prefers) for dealing with the likes of grief, loss, addiction, depression, anxiety, relationship problems and etc.  “Outcome measures”, insurance companies etc do not support this process.  There are sociopolitical (or as I prefer, “sociopolytrickal” as in “many tricks”) forces that diminish both focus and support on these types of services.  The hows and whys of this are beyond the scope of what I’m getting at here.

My tactic for dealing with issues are (hopefully) pretty simple and direct.

1.  Take the list of things we do that put distance between us and us/others/the “universe” and/or “God” if one prefers, and stop doing those things.  If it’s hard to stop doing them, try doing these things.

2.  Take steps to survive not doing those things.  This may take therapy, a support group, a church, support group, or whatever.

3.  What will most definitely take therapy: process what comes up.

Even if one does need medical intervention with psychopharmaceuticals, has a medical condition that might prompt difficult feelings/behaviors etc, getting therapy can only support this process, and arguably in some cases, is insufficient without it.  These three simple ideas above support all the ideas about “processing” (like the “uncover, discover, discard” etc above).  Hopefully we will get past the era of simply thinking that we all only need to act better, or otherwise “get over it”.

Lastly, need to make mention that this is of course not this simple, and would encourage more work around these things to be “happy”, free of depression, anxiety, addiction, etc.  A “resource group” of supportive people is necessary.  An organized set of principles to deal with new issues is significant.  Would also say that it’s important to have principles that allow us to grow as people- doing the work to transform and/or let go of these issues are the bare essentials for us to get to these things… and are totally possible.

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