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.

Clinical Supervision: A New Intern!

One of the better ways I think I can be of use to the community is by training other therapists and interns.  Have now hired and am doing clinical supervision with a new Marriage and Family Therapist Intern, Sarah Wood, MS, MFTI (#66300).

Am really happy about getting to do this.  With the Partners in Recovery program for interns sunsetting at the end of the last school semester, there’s been less opportunity to get to work with folk that way.  Am double excited about getting to do so with Sarah, because she’s already great at what she does, and really has a taste for The Work.

She comes on the recommendation of one of our last interns, Melissa Lamoureux, who was also at Partners in Recovery.  Sarah did her graduate work at the amazing program at Cal State Fullerton.  She’s done a lot of great work in the community already, specializing in therapy with children, trauma services for all ages, eating disorders/other addictions and more.

I feel like it’s a stroke of luck to get to work with her, am happy to get to recommend her services.  Please go by her website and learn more about Sarah at sarahwoodtherapy.com.  Welcome Sarah!

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.

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…

Depression, Shame, Community, Intimacy

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

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

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

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

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

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

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

“Show Your Work!”

When “solving problems” in addition to good “issue identification”, “diagnosis” (or whatever), it’s really important to examine methods/means to diminish or solve these problems, and have those methods be principled.  As Huxley opined:

“We are so anxious to achieve some particular end that we never pay attention to the psycho-physical means whereby that end is to be gained. So far as we are concerned, any old means is good enough. But the nature of the universe is such that ends can never justify the means. On the contrary, the means always determine the end.”

But even principled means don’t go far enough.  I have been discussing with a couple of clients and friends in the last week about getting from “point A” to “point B” as relates to The Work.  With these discussions in my head, have also come across a couple of psychology related blogs addressing resolution of specific problems.  What these conversations and blogs have in common, is my friends/clients complaining that when they’ve mentioned a problem to someone (anxiety, impulse control issues, depression, for example), and when given advice by some folk about how to resolve them, we have found essentially that at worst the suggestion amounted to “stop being __________ (anxious, impulsive, depressed)”, or simply suggesting that the opposite behavior/idea be employed.  Even from professionals.

Of course, the “middle part” here is really important.  There should be attention to the steps taken in the middle.  Those steps should specifically address the issue at hand, not simply be something rationalized as “good” or needed or healthy.  As some of my heroes have suggested, these ideas often amount to “activity instead of action”.

For instance, exercise arguably helps depression, anxiety and the like, but seems that in many cases does not specifically address the concerns identified that might be causing such in the first place (loss, abuse, etc).  In addition to that, the steps taken from anxiety to “calm” or “groundedness”, sadness/depression to happiness/serenity/gratitude (or somesuch) etc should be principled.  Meaning, they should be rooted in ideas that are repeatable, work for different kinds of problems, and preferably don’t create new ones in their wake.

Much of this is intuitive, but what keeps coming to me about these ideas is when observing “problem solving” from the outside, it’s often difficult to point to the work that is done.  Just like we’re encouraged in most math classes, we should be able to “show our work”.  When dealing with issues/problems/concerns, problem identification is really important.  So are means of problem solving- but what seems a good test of the effectiveness or value of such is the ability to point at the work done that specifically addresses the problem at hand.

As a simple example… telling someone to “calm down” rarely helps them behave differently, let alone feel differently.  There’s no steps to show, it’s difficult to see any principles this idea of “calming down” is based on.  While problem-solving emotional or relationship problems and the like it’s tempting to simply give advice and/or lean on philosophy, but there’s a lot of value in making such practical- something we can “point at”.

In our martial arts training group, if one of us has or is taught an idea/principle, we test that idea out in real time with a resisting opponent.  We also try to “break the idea”- see what conditions or problems it will not work with.  In some circles this is referred to as “pressure-testing the material”.  The same ideas might apply when solving other real world problems.  Clearly identifying the issue/context, having a principled means of intervention or “problem solving”, having a practical (empirical) means of determining the usefulness of the idea… showing our work and evaluating its utility.

Am advocating here for critical thinking when it comes to the utility of tools or ideas for problem-solving.  It seems that one of the places this utility is revealed is in whether or not we can show our work- make use of an idea in a way that is repeatable and observable (what we say/don’t say, do/don’t do).  As a therapist, I really endeavor (and hope other professionals) to give ideas that can be used by anyone, ideas that are practical enough to show the work that specifically addresses an identified problem, not something that simply gives us the feeling that we are doing something.

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

Attitude of Platitude

Talking with a client the other day, the subject of platitudes came up.  Many of us use them routinely.  Whether opining about inferences made, used polemically, or giving feedback to a friend or loved one, they’re used fairly often in all different kinds of discourse.  These certainly occur in therapy, twelve step programs (Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Co-Da, ACA, Overeaters Anonymous, etc).  We hear them at church/synagogue.  They’re used copiously in political speeches and discussions.

Many years ago, a friend began saying to me when discussing platitudes, “Cliche alert!  Cliche alert!” ala the robot from “Lost in Space”.  It was his way of indicating that the user was often either not really saying anything, and/or wasn’t really aware of the content or context of the cliche being used.

One of my favorite quotes is from Gandhi: “It is because we have at this present moment everybody claiming the right of conscience without going through any discipline whatsoever that there is so much untruth being delivered to a bewildered world.”  What I think he was getting at was pretty fundamental, and horror-producing… we all claim a right to truths and perceptions without really going through any real self or “concept” examination, and impose a subsequent template on the world in its wake.

That’s a fantastic way to create and/or perpetuate problems.  Am bringing it up because it seems that platitudes are a common ways this occurs.  Not that many platitudes or cliches aren’t true, just that we often don’t seem to examine if we’re using them, truly understand them, use them in context and the like.  I often see therapists, psychiatrists and other mental health professionals use cliches and platitudes simply because they don’t know what else to say.

Going back to twelve step programs, one cliche that is often used is “attitude of gratitude”.  With equal measure, it seems that an “attitude of platitude” is what is often in use.  Ideas like “just do what you’re doing”, “keep it simple”, “I decide for me, you decide for you, we decide for us”, and more are arguably great ideas.  These ideas even have utility for depression, relationships, self esteem, addiction, grief, loss and more.  However, our command of the language doesn’t necessarily indicate a real handle on what they mean or how/when/what context to use them and make them practical.

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

One Less Supervisee.

Yes!  As of today, I have one less supervisee… Brendan Thyne passed the second section of his licensing exam!  He has always been a fantastic therapist, and this is a great thing to happen for everyone, patients and colleagues alike.  Brendan Thyne, LMFT.  Nicely done Bren… you rock, and can’t say enough about who you are and the work you do.

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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