“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

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.

Who’s To Blame?

Much of my time is spent here, and in my therapy/counseling practice, attempting to get folk to honor how they feel.  That’s an oversimplification, but will leave it for brevity’s sake.  This is a daunting task because of the intensity and availability of our distractions, but I keep trying anyway.

One of the things that oft keeps this from happening is that when someone “hurts” us (shames, takes something away, etc), we find ourselves (understandably) making sense out of why they’d do such a thing.  We think more about the person in question “doing their best”, “having had a hard time” etc than we ever do simply saying “Ouch, that hurt…”, or some variation on that theme.  It’s safe to say that many of us, often don’t honor how it affected us at all.  Working on problems of low self esteem, depression, addiction, abuse and more we don’t want to “blame” anyone (nor should we), and oft go so far as to think our therapists are prompting us to “blame” that person, our parents, etc.

As for my sense of this, I think we could safely remove the word from our vocabulary entirely.  Maybe even replace it with considerations of “responsibility”.  In terms of a solution, will offer something I hope is very simple: we’re only blaming someone else for our feelings or problems, if we do nothingwith our feelings about it.

What to Do?

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

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

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

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

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

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

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

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

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

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

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

Transformation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shame, "Self-Esteem", and Buddhism

Been thinking a lot about how most of us, when we were kids, didn’t have a lot of compunction about playing with other kids, meeting new people we liked and such. Maybe when we were very little we might have been “shy”, but in this case I think we’re talking about caution, fearfulness, as opposed to lack of a sense of self esteem.

When I was a kid, it was easy for me to go down the street and ask about a kid there I thought was my age that I could play with, to try new things… I think because we’re actually born with a sense of self esteem or self worth, and that sense of worth gets taken away. That sense of our value, how we are connected to others, self esteem or self worth, gets replaced by shame- feeling “less than”, insufficient, unlovable, broken and defective as human beings.

This sense of self esteem is diminished or removed a lot of ways. Verbal abuse- actually being shamed by others, made fun of, called names, diminished for mistakes or lack of knowledge of a thing, literally being told one is somehow bad, not going to amount to anything, being compared against others, being yelled at or threatened.

Physical abuse. The predominant message a person gets when struck by another person out of anger, an effort to discipline, etc. is that they are somehow flawed. Being treated gently shows someone their worth. It takes effort… attention, patience, softness- the opposite of which takes little effort. Of course, this is often coupled with verbal abuse, sometimes sexual abuse.

Sexual abuse. When this happens to someone, they often get the message that this is their only value, their only utility as a person. It’s also extremely common, in order for the abuser to be able to continue the act, that they diminish the victim as a person. Taking away their power, their human-ness, their self worth, makes it easier to continue violating them. The act itself literally causes shame- it instills something in the person that they have to hide, something that makes them feel less human, separates them from others.

The media. There’s a lot of images in our society, a lot of messages that we get about our worth. Television, magazines, movies, other people, all bombard us with a message about what we “need” to do, have, look like. We are given the sense that unless we’re attached to some product, some lifestyle, some particular achievement, we are somehow not successful. This is not simply a message about how far we’ve gone in life, it’s a message about our being-ness, our human-ness.

We do a lot of work to “get” self esteem- take care of ourselves physically, our appearance, do esteemable acts, visualization, affirmations and etc. Those of us that have done these things often haven’t been able to maintain our self worth despite such efforts. These ideas help us feel better in the moment, but long term, we often still experience a deep sense of shame.

Some have said that a central idea in Buddhism is that at the center of each human being is the fear we don’t exist. This lends itself to the idea that we are constantly reaching outside of ourselves for things, naming and labeling them, attaching ourselves to them, trying to obtain them. In doing so, being attached to a thing (person, etc), we can fear less that we don’t exist. So we go about our lives in a way that diminishes our personhood, our being-ness, our selves being “enough” simply as we are.

The answer to this is not simply adding things to our lives, behaviors, personhood. Shame, low self worth and etc is something we have to give away. We have had experiences that diminished our self esteem- abuse, abandonment, exposure or humiliation, being diminished or demeaned verbally- those are the things that make us feel less of ourselves. Until we find a way to “let go” of those feelings, to give them away, to make space for our self esteem, we will be unable to experience it no matter how many “creative visualizations”, affirmations and etc. that we do.

Feelings Aren’t Necessarily Facts.

Because it’s been coming up recently, and because it’s a fundamental principle of what I do in terms of therapy:

Feelings aren’t necessarily facts.  They are just indicators of possible realities.  Of course this doesn’t mean they’re not facts- but that’s beyond the scope of a blog.  They give us information about our environment that might not otherwise be discernable or supported by our other senses.  They do much more than this, but that too is too long for a blog.

Unless we have a relationship with our own emotional condition that is healthy, I’d argue that we will have a difficult time “seeing” things clearly (circumstances, other relationships, etc.), and making choices about how to handle things.  This is true even in absence of grief and loss, depression, relationship problems, abuse, addiction and etc., and is certainly made worse by the presence of these issues.

Processing feelings (emotions as some call them, or as I often do, e-motions), transforming them, reconciling with them, how to identify them and what to do about our sense of things in light of our feelings is of course what counseling, therapy, and life coaching are all about.  At least seeing this idea as a principle, even in absence of those things can help us tell real alarms from false ones, provide some simple relief in some circumstances, give us an opportunity to be kinder to ourselves, and an opportunity to be kinder to others and more..

Love and Service.

Thanks for dropping by my blog page.  As the introduction notes, I am a Licensed Marriage and Family Therapist, Licensed Psychiatric Technician, and Masters level Addictions Counselor in Pasadena, California.  Though I’ve been doing some private practice for many years in addition to the twenty-six I’ve been doing inpatient work, I’ve now gone out on my own, to do just private practice.
            Providing treatment is my life’s work.  Having not just survived, but also (somewhat) gracefully dealt with some suffering of my own, I have been given not just some answers- but with those answers, also responsibility to others.  Holding on to those responsibilities is not only bad for other people, it would be unhealthy for me too.  So, very early, I started being of service.
            Having worked inpatient for so many years, I’ve been lucky (and saddened) to take care of most every type of human suffering possible.  Most of my work has been with adults and adolescents.  Depression, loss, grief, addiction, trauma, abuse, stress, mental illness (for lack of a more graceful term), relationships, desires (and need) for personal growth or “life coaching”, chronic pain, medical illnesses, family problems, couples problems and more have all been tragically present and have arguably increased over the years I’ve provided service.  There is much work to be done about all of these things and more.  It seems now that the most effective way to care for these problems is for me to see individuals, families, and couples privately.
            It was suggested by someone I consider wise that I find a way to make myself available to people when they are not able to be around me.  Aside from writing a book, providing materials from talks I do in the community, I am starting a blog.  There is much work to be done, and many answers are possible that can improve the quality of all our lives, if we’re willing to live by some principles and do some work.  My hope is that I can take you along with me as I do so, by way of communicating here.
            And so to it.

Speaking of Service…

My friend and colleague Judy McGehee MA, LMFT (www.mcgeheepartners.org) along with Ted Aaselund LMFT have been providing clinical supervision (completing hours for graduation and/or eventual licensure) for a great group of interns and trainees at Judy’s office in Glendora, California.  They have been providing sometimes up to 40 hours of services to local schools with these Masters level folk to students and families who might not get these services at all otherwise.

I have been truly humbled by the work of these people, and lucky to get to participate in part of the supervision.  We have been discussing the obvious concerns about professional standards, law and ethics concerns, types of interventions, philosophy, differential diagnosis, addiction, depression, abuse and etc.  What has been so remarkable though is the intensity of the losses and difficulties these students and families have had, but equally, the grace and commitment of the interns and Judy insuring that these folk get taken care of.

It appears now that eventually, on top of the individual services that are being provided to the educational institutions, students, and families, there may be an opportunity for a multi-family group therapy at low cost for these individuals.  This is such a great service, but sadly, there is no funding available for this to happen (space may be made available at a school).  Of course I can’t discuss the details but, there have been some huge losses for these families that they are getting little support for treating from a public standpoint, the responsibility of both the service and the internship being largely on the shoulders of Judy and the interns, a little on Ted and I (as we didn’t take this on from the beginning).  The families served aren’t just getting low-level services- they are getting truly insightful, wise, professional services thanks to the good heartedness of the people involved.

Providing clinical supervision is such an important part of what I’m lucky enough to get to do.  It means much to me that I’m in a place where I’m not just empowered to help people, but that I am empowered to help people, who can further be of service to others.  What I do, I hope, matters a great deal, and the opportunity to share some of that with other people who might further use some of that to help yet other people is amazing.

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