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…

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

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

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

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

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

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

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

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

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

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

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

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

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

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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!

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.

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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