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.

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…

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

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

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

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

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

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

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

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

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: 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

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.

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