We Should Be More Critical…

… in our thinking. While loathe to say that in the current environment, and think we second-guess ourselves in unhealthy ways, am referring to a different type.

Whatever first brings my employers (clients) to my office- relationship problems, depression, anxiety, addiction, low self esteem, “stress”, anger etc…, I would argue that it’s really four things: they want to be happy, have a sense of self worth, have a relationship with another person, “succeed” in the environment/community around them. For all the Cognitive Behavioral Therapy, attachment theory, Dialectical Behavioral Therapy, Gestalt, existentialism, psychoanalysis, client-centered-solution-oriented-short-term-evidence-based-practices employed by the therapist or improvised efforts on the part of the client, critical thinking can go a long way toward the wants/issues above. Critical thinking is an organized set of principles, and tools, that should be used as ways of knowing and problem-solving things.

When confronted with a problem, we tend to throw “will” (some kind of effort that is nothing more than improvisation) and/or thinking at it. That thinking tends to show up without use of actual critical thinking skills. Worse, these efforts are usually based on a tacit approval of both the cause of, and solution to a problem. There is a term for this in both philosophy and psychology: naive realism. More simply, we tend to identify causes and solve problems based on whatever arrives in our consciousness, without examination. As a default we treat our anger as righteous, our hurts as immediate and “true”, etc., though experience tells us we are usually “wrong” as often as we are “right”. This is a very poor foundation upon which to build problem-solving methods of any kind, let alone imposition of will and intellect. There is a whole discipline of philosophy dedicated to how we actually know things called “epistemology”, to which we arguably owe credit for the tools below.

In addition to will and intellect, there’s clearly other means to solve problems- asking for help, being honest/taking a risk about something, not intervening at all (something that’s really difficult for a lot of us), compassion, waiting/being patient, making amends, setting a boundary, “softening up” (as opposed to resisting, building up defenses, etc), educating ourselves about the problem and more – but these rarely get to see the light of day when it comes to our sorrows because of naive realism. Some problems that arise in therapy stay unresolved too due to critical thinking errors that we call “cognitive distortions”. A different way to begin problem solving is to have the tools of critical thinking at our disposal.

Few of us are taught critical thinking skills “proper”. These are specific skills/principles, and there’s methods for their use. Unfortunately, we’re not really taught what they are – even if we’re encouraged to use them. Our schools, family constellations, churches, therapy offices may suggest them, but there’s little attention on giving them consistent names, defining them, or employing their use. Though addressing how to employ them is beyond one blog, as a start, I’ll offer some important/fundamental ones that are almost universally accepted in science and philosophy:

1.  Skepticism

2.  Defining and examining “terms” (words, ideas…)

3.  Being cautious when drawing conclusions (most people don’t know the difference between correlation and causation, for instance, creating errors)

4.  Considering alternative interpretations of problems, solutions, words/terms

5.  Avoiding oversimplification or generalizing

6.  Observation, examination of evidence

7.  Socratic method/asking “higher quality” questions

There’s more ideas, and more technical means of critical thinking thanks to philosophers, but won’t labor those here.  Here are a few examples of “cognitive distortions”:

1.  Absolutizing (sometimes called “all or nothing thinking”, this creates or perpetuates a lot of relationship conflicts by way of asserting something “never” and/or “always” happens)

2.  “Mind reading” or “fortune telling” (making assumptions about people’s thinking or future behavior)

3.  Emotional reasoning (“I feel __________ so it must be true.”, an example of naive realism – these show up for example as “righteous anger”, low self worth, fears, etc)

4.  Mental filter (“cherry picking” evidence- though 9 things were done correctly, one was done incorrectly, the incorrect item is what’s focused on)

5.  Catastrophizing

6.  Solipsism (seeing things only from one’s own perspective)

7.  Perfectionism (both with self, and others)

8.  Fudging on efforts to change now, in favor of believing plans to “do differently/better later”

9. False equivalence (seeing/arguing that two things are somehow equal, that are not)

10. “Ad hominem” arguments: because __________ (a specific person said it), it is incorrect . . . this works both ways – that because __________ (a specific person said it), it must be correct (often called “appeal or argument from authority“)

11. My favorite of late – mistaking an interpretation or inference for a fact

Again, there’s more of these too. Others might be added, though they’re not always thought of as critical thinking errors or cognitive distortions in therapy circles. Beliefs about the ability to change others (sometimes calling it “influence”), awareness of powerlessness over a situation but endeavoring to manage or control it anyway, doing the same thing more than once and expecting different results… all might be additional examples.

Critical thinking though, can often be an antidote for cognitive distortions and a method for solving problems. Without principles or tools for doing so, we’re just burning calories (and few, at that). Or, as I often refer to clients “wasting cycles” (like a computer chip). A couple more examples: when feeling “low self esteem” (or as I prefer, “shame”) or anger, it might be helpful to “examine the evidence”. Are there current facts in hand, that are evidence I should feel “less than”? When ashamed or angry, many of us assume or treat their feelings in and of themselves as truth (like the “naive realism” mentioned above) … often finding out later there was little or no reason to do so. Many conflicts arise because a speaker or receiver make little (or no) effort to define or examine what they (or someone else) is trying to say, or because we have very different ways we’re defining a word or situation.

Regardless of what kinds of problems we’re assailed with, these critical thinking tools (and others) are very useful. It doesn’t seem to matter if these are problems of relationships with ourselves, relationships with others, or “Earthbound” problems (cars, money, weather, gadgets breaking…)- critical thinking tools are always necessary to employ, and are often quicker/more effective than our usual styles of solving problems.

There are quite a few fantastic resources for critical thinking, great people in our time that are doing important work in this way. Some of these people books are linked below.

The “industry standard” ideas and examples for philosophers is the “Delphi Report on Critical Thinking”

Daniel Dennett (Professor of Philosophy at the Center for Cognitive Studies at Tufts): a recent work, “Intuition Pumps and Other Tools for Critical Thinking”

Morgan D. Jones (former CIA analyst): “The Thinker’s Toolkit”

Christopher W. DiCarlo (Philosopher of Science and Ethics, Harvard and elsewhere): “How To Become A Really Good Pain in the Ass: A Critical Thinker’s Guide to Asking the Right Questions”

Peter Boghossian (Professor of Philosophy at Portland State University): part of the “Skepticism 101” resources at the Skeptics Society, Peter’s “Knowledge, Value, and Rationality” syllabus.

Winnie think

Success of Relationships

Was asked recently by a student, “How long do you think a couple should be together before they get married?”  There’s no way to give a full answer to this in a blog, but think it important, and would like to put out some fundamental ideas that I don’t think we can ignore.  Seems to me that this is not only about “knowing” when, or even the success of a romantic relationship- would suggest that some of these ideas are about all relationships.  What follows is my response:

Would offer that it’s not a question of how long.  The reason we think in terms of time, is because something is supposed to happen during that period, but we never say what it is!

Oversimplifying, first and foremost, my philosophy is that both persons should be self-supporting mentally, emotionally, physically, and “spiritually” (not necessarily religious, but not necessarily excluding it).  They should be able to see, and assess these things about one another.  It’s much deeper than it seems- mentally: responsible for one’s own critical thinking, memory, organization, prioritization, intellectual curiosity.  Emotionally: responsible not only for one’s own happiness, but one’s own sorrows and fears and shames and hurts as well (even if caused by others- this is really important).  Physically: responsible at least for food, clothing, shelter, medical care, diet/sleep/exercise.  “Spiritually”: responsible for one’s own connection to one or more communities, also for one’s own sense of place and purpose.  Short of that, the relationship becomes responsible for one or more of these things missing, and is diminished.

In more detail, any of these things absent weighs on the relationship.  One partner inevitably becomes resentful at having to “pick up the slack” for one or more of these things absent, or tries to get the other person to take up their responsibility, or withdraws, etc.  This shows up a lot for instance, in these examples:

One person bears on the other due to “insecurity”/low self esteem.  (emotional, “spiritual”)

One person struggles with providing their own needs for food/clothing/shelter/medical care etc.  (physical)

One person depends on the other as their sole source for community or purpose (sometimes, simply by providing community when the other doesn’t have it).  (“spiritual”)

One person expects or needs the other for reminders of appointments, choicemaking about how to spend money, interests about the world.  (mental)

Am sure everyone can come up with many more.

It takes varying amounts of time to know if someone is able to do these things, because it takes varying kinds of circumstances to have them come up.  Even discussed in a “principled” way as I’ve tried to above, there’s a lot of things to be considered.  When someone dies, does the person “deal” with it gracefully (grieves), or do they get intoxicated or treat others poorly?  When they get sick, do they have the means and do they do the work to do some of the effort to care for themselves?  Does this person avoid talking about feelings in general, or have a maladaptive way of dealing with them?  Do they have hobbies, interests, and do they occasionally get new ones?  Do they provide for themselves long-term?  Do they maintain relationships long-term?  How do they handle their successes?  These are all circumstances that often take a protracted amount of time to show up.

These things are also not simple for individuals.  As such, would argue that without having/knowing these things about ourselves, these qualities are difficult to identify in other people.  It takes a chunk of time, usually beyond adulthood, to really have a method and examination of knowing these things.

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.

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…

Why Being a Therapist Is Better than Being a __________, at Least for Me.

When I was a kid and started thinking about what I was going to do as a “career”, I always knew I’d be a therapist or musician (as it turned out, was lucky enough to do both).  The reason is in part, growing up, I didn’t watch the usual TV shows- I was watching “The Twilight Zone”, “Kung Fu”, “Star Trek” (the original version), “M*A*S*H”.  What so intrigued me about the likes of Rod Serling, Kwai Chang Caine, James Tiberius Kirk and Benjamin “Hawkeye” Pierce was that they seemed to think there was “more” to the world, saw things others didn’t, and had deep passion.

In their wake, I tried to be “good” at lots of things.  Some of this came from feeling a deep sense of “not being enough”, and what still feels to me an unavoidable passion to do things That Matter.  The former almost killed me (as Sheldon Kopp said, “Why be perfect when you can be good enough?”), but the latter stays with me to this day… thankfully.

My first inpatient job while working on my Psychiatric Technician licensure (completed in 1988), I remember thinking how cool it was that all I needed to do my job was a black Bic medium point ball point pen, and my personhood.  In subsequent years, have come to a number of other awarenesses that have meant much to me.

It seems to me that it’s become a luxury for many of us to simply do what we would like to do, if we were to have our choice.  Many of us fall into what we do and begin to love it, maybe we do what our parents did, or simply honored a family business.  Lots of us do what we think we ought, or simply take on what feels best to serve and provide for our families.

All these are of course noble pursuits, but on the coattails of Rod Serling, Kwai Chang and Hawkeye, I have always felt compelled toward human service.  Famously, Lloyd Dobler (played by John Cusack in the film “Say Anything”) said, “I don’t want to sell anything, buy anything, or process anything as a career. I don’t want to sell anything bought or processed, or buy anything sold or processed, or process anything sold, bought, or processed, or repair anything sold, bought, or processed. You know, as a career, I don’t want to do that.”  Some of this points to why I’ve resisted other careers (and, Lloyd and I also turned to martial arts… a totally different story).

Many of us serve ourselves, but are still unsatisfied.  We work at jobs we are unhappy about, sometimes with people we are unhappy with, sometimes for things we don’t really need.  In some cases, these pursuits relieve others of resources that might be used otherwise- resources like money of course, time, and all too infrequently mentioned… our attention.  Some of these efforts are unsustainable, and environmentally unsound.

Not as if therapy, counseling, psychiatry and etc don’t have their defects that are creating some problems.  Overdiagnosis, starting with interventions like medication when arguably not called for and/or lesser interventions haven’t been endeavored, pathologizing and symptomatizing everything (often even the most understandable and euthymic kinds of feelings/emotional experience), passivity on the part of the clinician and more create big and often lifelong difficulties as well.

It’s hard though for me not to see a poor relationship with ourselves, others, our sense of worth, depression, addictions (and “codependency”), anxieties and fears, and maybe a couple more as being the soul (and result) of much human suffering.  That also creates in my view, the suffering of other creatures.  In the shadow of this, helping us through these concerns, and providing a framework for others to operate on in a like way are at this point, the most useful thing I can think of doing.  At least a thing that I’m good at.  ;-p  That’s a quip about my “musicianship”.

It is of great import to me that I have a small footprint on the planet.  Deeply concerned about where humans are going mentally, emotionally, physically and “spiritually”, I can scarcely think of a way to be more useful.  Therapy is a practical way of putting philosophy into use.

Something that matters to me a lot in light of some of the above is that it’s a great way to create something that can be easily passed on by others.  An organized, simple (but unfortunately not terribly easy…) and principled way of behaving in the world that can be shared can create great change of course.  Doing clinical supervision, teaching, giving tools to parents, or simply doing work with people who are in a place to impact others are my favorite areas of focus, and seem to be the most practical way of passing on what we’re capable of.

In the digital age, I don’t even have to use my pen or paper as often.  I get to impact people deeply, and most of what it takes is just me being as healthy a person as possible, and my time/being deeply present.  It’s also something I should be capable of doing for a long time.  I get to share and experience different people, cultures.  Many types of work are possible- use of humor, sharing resources, sharing experiences, teaching, problem-solving, processing, consulting and more.

Gratefully, all these years later, I could scarcely think of doing anything else, and still feel deeply committed to The Work.  The “how’s” and “why’s” of avoiding what some call “burnout” are an entirely different thing to write about.  Point is though, I’m so, so lucky I get to do something that I still feel so deeply passionate about, and doesn’t violate any of Lloyd’s principles.

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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.

Depression, Shame, Community, Intimacy

Though depression, shame, fear, anger, pain and the things that cause them (abuse, abandonment, loss) keep me in a job (some of you know I think it my job to put me out of a job), another thing that keeps me in work are ideas and terms that are ill-defined.  One of these terms is “intimacy”.

I was told once of a rumor that someone had asked Confucius what he would suggest doing to help society, and he replied “I would revamp the language.”  A lot of my work is about what we speak about, how, and how we define things between one another.  According to Alexa.com, Facebook is currently the number two most visited site on the internet.  For many years before that, MySpace was most frequently visited website.  It seems to me that these are about two things- being known and knowing/connection others.  Intimacy and community.  I think we all want intimacy and community, and the presence of these sites are great evidence to support this idea.

As I started to mention above though, the terms we use are rarely common between us.  At the suggestion of my partner, the woman I call “The World’s Most Dangerous Librarian”, I use Wordnik (www.wordnik.com) as my internet reference source for words.  “Intimacy” is most frequently/commonly defined as (using Webster’s here):  “n. The state of being intimate; close familiarity or association; nearness in friendship.”

What’s “close” though?  Association?  Friendship?  Am only tackling “close” here though, and think I can offer something that might be a helpful principle.  When describing intimacy to my clients, I suggest that intimacy is “me having feelings about your feelings about your life”.  Frequency, disclosure, and intensity of course mediate the depth of that intimacy, but I think this is a pretty principled way of defining that closeness or “intimacy” we’re most often talking about.

As Tom Waits said though, “The large print giveth, and the small print taketh away.”  This capacity for depth in closeness is largely dependent on both parties being in touch with their own feelings to begin with (see my previous blog “You Can’t Heal What You Can’t Feel“).  How clearly, presently, and transparently we both have our emotional experience affects our ability to be intimate with one another.

These also obviously affect our capacity for community.  Without a sense of my place and my purpose on this planet, a sense of purpose and community, we all suffer.  Absence of this breeds shame (low self worth/low self esteem), loneliness, sadness and depression.  As confusing and difficult and even painful as it might be, us having our own feelings, giving others access to them, a willingness to risk and be intimate with one another, seems to be our best shot at avoiding these things.

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

“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

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