We Should Be More Critical…

… in our thinking. While loath 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. Review and clarification of goals/”answers”/desired outcomes
  2. Defining relevant terms
  3. Asking “higher quality questions”
  4. Awareness of underlying emotions related to evidence and conclusions, application of the skills above (and more) to those emotions
  5. Skepticism
  6. Avoiding oversimplification or overgeneralization
  7. Identifying and “unpacking” assumptions or premises of assertions
  8. Consideration of types of evidence upon which conclusions are based
  9. Review and critique of conclusions from evidence
  10. Consideration of alternative interpretations of evidence
  11. “Peer review”

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

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…

Difficulties, Diagnoses, the DSM.

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

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

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

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

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

PTSD, Euphemisms, and George Carlin

The famous American standup philosopher George Carlin has a fantastic piece about euphemisms.  Paraphrasing and simplifying, he offers that he’s against euphemistic language.  Part of what I’m with him on is that euphemisms tend to conceal the truth.

May 5th, there was this article in the Washington Post indicating that there are a group of psychiatrists hoping to change the term “Post Traumatic Stress Disorder” (AKA “PTSD”) in the upcoming DSM-V (the “Diagnostic and Statistical Manual, 5th Edition”, the industry standard for all things psychiatric diagnosis… quick primer on my website here) to “Post Traumatic Stress Injury“.  The change, they hope, will make it easier for people, particularly military personnel, to more readily seek help.  They are citing that the term PTSD has a stigma attached to it.

While it arguably does, “Post Traumatic Stress Injury” might also be an equally unhelpful euphemism.  Non-military personnel frequently get the symptoms of PTSD as well.  Victims of crimes, violence, sexual abuse and more often have sufficient symptoms to justify being diagnosed with the disorder (Wiki here, for a quick look).

My concern about this is not simply haggling the diagnosis.  In all candor, the tome (the DSM) is a convention (with some real science too, but arguably still a convention)- a means of shorthand for mental health professionals to communicate.  My interest in the book is mostly about how it helps us guide treatment, and obtain treatment from the relevant funding sources.

Back to Carlin, he specifically addresses PTSD.  He takes us through the historical context- that the problem began with our recognition of the symptoms post war.  A condition we used to refer to as “shellshock” gave way to “battle fatigue”, then “operational exhaustion” (probably the grossest evasion of the depth of the severity of the symptoms of the problem), eventually leading to the current “PTSD”- arguably in light of the awareness that lots of things besides war can cause the aforementioned symptoms above.

We need a shorthand.  This will be the 6th shorthand (if we count “combat stress”) we’ve endeavored to come up with.  What we need more though, is an honest representation (and advocacy of awareness) of the consequences of these horrific events.  I’m less worried as a professional about whether or not someone suffering needs help than I am about whether we can actually get them access to it- and our evasion of these truths, often through our language, prevents us from getting legislation, funding, and other resources necessary that we can serve all victims of trauma in the ways that they need and deserve most.  Sadly, my experience of the last 28 years (at this point) has led me to feel that how we communicate about these problems has led largely to desensitization, in part, due to a euphemistic way of communicating such problems.

On a related note, often, a lot of the language in my discipline serves the individuals and the discipline itself, rather than the sufferer.  Pharmaceutical companies are served, occasionally a “new” theorist is served in terms of marketing their ideas, insurance companies are served, but rarely is it people that are suffering who are served.  It’s a source of consternation for me, both personally and professionally.

Some might say I need to come up with a more accurate term.  Maybe I should, but it’s not really the part of this that I’m invested in.  It takes longer to talk about someone suffering flashbacks, avoiding situations and experiences, fears, hypervigilance, poor regulation of their feelings, struggling with being overwhelmed by sadness or shame, having their ability to function in their responsibilities and relationships diminished (and much more), and explain what these things are to people, specifically.  But seeing how these folk are so suffering, it’s clear that doing so is worth it.  Taking the time to live with these words and feelings means much not just in terms of understanding the suffering, but honoring it.  If we’re truly going to care for people who are suffering, it will take at least that.

From the “Something That Came Up Today” Department… More on “Stopping”

Truth, it comes up a lot.

We’re all trying to “give up” some stuff, trying to stop doing some things, but often have difficulty doing it.  Aside from a blog I wrote about this a while ago, we might want to think of such things as surrender instead of “quitting”, stopping, etc… but I digress.  We endeavor to stop drinking, overeating, eating poorly, isolating, perfectionism, controlling things, spending, video games, TV, and a host of other things.  Sometimes we’re trying to avoid things that are actually good for us- exercise, going to a support group, going on a job interview, self care and the like.  Most of the time we point at a lack of insight, “willpower”, or related ideas.  For dozens of years, people have been going on *wince* Dr. Phil, Oprah, Donahue (I don’t watch too much TV- who do we have now?), and others asking why people can’t stop __________.

There’s an interesting colloquialism in 12-step programs that addresses this.  Some say that “what makes people drink is sobriety”.  Whatever one feels about 12-step programs, this is a pretty elegant, and deep idea when applied to alcohol or drugs or other things we might want to give up.  Consider it this way- what if our inability to stop something (or start something) is not the difficulty in stopping or starting, presence or absence of “willpower”, but the difficulty of how we will feel if we do?

Try this thought experiment.  How would an alcoholic feel if they stopped drinking?  Someone that stopped “obsessing” over __________?  A person obsessed with control feel if they stopped controlling things?  Someone that stopped overeating?  It’s intuitive to say that these folk might be “relieved”, but I’d argue that’s a superficial look.  I think these persons (and other people with other issues) would feel pain, fear, sadness, even shame and anger.

What I’m getting at (simply) is this: if we have trouble surrendering something, it’s more likely that is difficult because of how it would feel to do so.  More difficult than the effort or organization or “insight” about what we need to give something up.  If that’s the case, it points to why much deeper “work” is more often necessary than simply will-ing our way into stopping something.

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.

“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.

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