My blog has moved!

Hello all... have moved my blog to my personal website at April30th.org... just click that link and you'll go there. Please share and follow and etc as you can. Appreciate all the support. :)

New Office Space

Have to start here with some gratitude. As many of you know, The Work is really a mission of sorts for me- trying to put myself out of a job so to speak. So many have been so kind and encouraging about my work. Clients, colleagues, friends. It's really important to me to have a clearsighted and organized way of being a partner with people in eliminating suffering, having principles... preferably both.

Left doing inpatient full time in April, in favor of doing private practice full time. The folk above (and more) have responded by sending a lot of folk my way to do service with/for. As a result, my longtime office space with Brendan Thyne MA, and his dad Rick Thyne MFT (Patrick Thyne and Associates) became too small (time wise) to accommodate my clients.

Noting this because getting a new space wasn't just a task- it is a loss in a lot of ways. Brendan and Rick are relatives (of choice and affiliation)- and fantastic therapists. The space across the street from Pasadena City Hall has been beautiful, and I really enjoy the surroundings. Between losing the familial contact and the space, is a big deal.

That said though, have found a fantastic space to do The Work in. Am hoping that it will bring an energy and space that can be filled with whatever it is that people need. Want to send some appreciation specifically for Yvonne, my dad, Judy McGehee LMFT, Erika Gayoso/Michael Cardenas/Ted Aaselund and Elvia Cortes. Also appreciation to Jeff Boxer Esq, David Wolf, Ed Wilson PhD, Sue Stauffer, Barbara Waldman PhD, Barbara O'Connor MFT, Tricia Hill, of course Lali and Sadie. A special note for my clients though- you all continue to humble me deeply, and have been fantastic supporters of my work.

Here's a pic of the new space- near the end of the 110, the 134/210. New address is 547 S. Marengo Ave, Pasadena, 91101:

Clinical Supervision/Partners in Recovery

Quick note from Partners in Recovery about the work we've been doing. They can now be found on Facebook:

"Petar Sardelich, LMFT, MACII, LPT, has joined Judy McGehee, LMFT in supervising La Verne University Trainees, and Interns, in the Glendora Schools Internship Program. Since September 2009, interns, therapists and trainees have been offering 40 hours per week of probono mental health counseling and education in the community. This includes Whitcomb High School, Glendora High, Sandburg and Goodard Jr. High. Community and Parent nights have educated participants about drug and alcohol abuse, building communication between parents and teens, and in March, 2011, information regarding bullying and helping individuals in combatting this behavior. PIR is a non-profit organization where volunteer therapists and board members provide mental health services and referrals in the community."

Partners in Recovery website:
Judy McGeehee/Partners in Recovery

Preaching Prudence but Practicing Evasion

Just by virtue of having eyes and ears, we have emotional responses to everything. When we have experiences that create loss, damage, violate our sense of self or ethics (prompt an experience of feeling "less than" or being broken, also known as "shame"), frighten us or etc, we have to do something with how that feels. Just like falling off a bike and skinning our knee, we hurt in part because that's the healing process in action. Many therapists and others refer to these unresolved hurts as "issues".

If we don't have a means of healing/dealing with these, there are lots of unintended consequences. Not healing "hurts" (shame, fear, sadness, etc) causes "neurotic" behavior. "Acting out", drug use, manipulation, self-ful-ness, isolation, "codependent" behavior, "anxiety", avoidant behaviors, etc. Long term and in the wake of continued losses/traumas, these can turn into more serious problems- depression, relationship issues, "mental illnesses", addictions and etc.

Sometimes these other problems and behaviors are simply ways of surviving or "coping" with our feelings about things, sometimes they become problems in and of themselves. Exercise, church (etc), self-help books, "will", diet and nutrition, hobbies etc are all efforts that can be helpful in varying degrees, but for reasons too long for a blog post, they're insufficient and/or incomplete for this task. Some of these things sometimes turn into means of avoiding our feelings as well.

If we don't have a fairly organized (and effective) means of transforming or eradicating our experience in this way, as above, we create or perpetuate problems in our lives. Different therapists have different "tools" suggested to help resolve or diminish the intensity of these issues. My sense of this process though, goes something like this:

List the behaviors we use that put distance between us and how we feel. Some of these are external- but some are internal. Some examples are food, alcohol, work, spending, sex, focus on others, perfectionism (whether imposed on ourselves or others), TV, turning our feelings into anger, etc.

Diminish (or preferably, maybe necessarily) or stop those behaviors. There's many, many ways of making this happen- see my blog "Wanting to Stop" for some suggestions. As has been said in other blogs, "letting go" means little for something we are not fully letting ourselves "have" in the first place.

Give the feelings we're experiencing/left with as simple, and common a name as possible. I encourage mad, sad, glad (happy), afraid, ashamed, and/or hurt. And/or because we can certainly feel more than one at a time. Simple, because we often use euphemistic or complicated language as just another means to dissociate (separate) us from our feelings.

Share those feelings, as much as possible with the person we're having the feelings about, as close to the time we experience them. It's also really important that we're actually allowing ourselves to have the feelings as we're expressing them. Of course this isn't always appropriate because of time or circumstance. Sometimes, it's not appropriate because of the person we're with. Be careful though not to "preach prudence when practicing evasion".

As has been said by many, "you can't heal what you can't feel". This process is assisted by doing it with a professional who has has both education and experience in doing so not just as a therapist, but hopefully as a person as well. We are trained in various means that facilitate some really important parts of this process that are sometimes not intuitive to our friends, families, loved ones. Am getting at a fairly simple list of ideas here- stop doing what we do to not feel, have an organized way of naming and letting go of or diminishing their intensity.

Sheldon Kopp

You may remember being a kid, and having someone suggest you write an essay about the person who influenced you most.  With the exception of a musician or two, the person that is likely that for me is Sheldon Kopp.  I was given his most famous book "If You Meet the Buddha on the Road, Kill Him! The Pilgrimage of Psychotherapy Patients" by my then "mentor", when I was 17.  It's really a book about principles, an organized way to live our lives and deal with Things As They Are.

He's written something in the way of 18 books, died a while ago not of the brain tumor he had (that required removal 3 times), but of heart failure and pneumonia.  Having heard a rumor about his death, I looked him up on the internet once, and sent an email to a similarly named person, hoping I might find him or learn of his passing.  Essentially my note stated that this was a person who had been extremely influential and helpful in my life, and I wanted to know if it might be him.  I was lucky enough to get a response, that made it clear it was actually him: "Yes Petar, I too have heard rumors of my untimely demise, but I find them unconvincing."

In "Buddha", as became customary in many of his books, at the end was included ideas that he considered truths, or principles.  This was the most famous of them, called, "An Eschatological Laundry List: a Partial List of 927 (or was it 928?) Eternal Truths."  Many of the ideas here have guided me in everything from my own emotional and "spiritual" work, work with my clients.  People that have suffered all of the things here that I'm trying to diminish for as many people as possible- depression, stress, relationship issues, abuse, loss and grief, addiction, self esteem issues and the like.  Hopefully, they will give you as much as they've given me, inspire you to read his books, and of the greatest importance: give you a ways and means of passing the ideas on to others.  Would love to hear what you think of them.  And to the "Truths"...

1. This is it!
2. There are no hidden meanings.
3. You can't get there from here, and besides there's no place else to go.
4. We are all already dying, and we will be dead for a long time.
5. Nothing lasts.
6. There is no way of getting all you want.
7. You can't have anything unless you let go of it.
8. You only get to keep what you give away.
9. There is no particular reason why you lost out on some things.
10. The world is not necessarily just. Being good often does not pay off and there is no compensation for misfortune.
11. You have a responsibility to do your best nonetheless.
12. It is a random universe to which we bring meaning.
13. You don't really control anything.
14. You can't make anyone love you.
15. No one is any stronger or any weaker than anyone else.
16. Everyone is, in his own way, vulnerable.
17. There are no great men.
18. If you have a hero, look again: you have diminished yourself in some way.
19. Everyone lies, cheats, pretends (yes, you too, and most certainly I myself).
20. All evil is potential vitality in need of transformation.
21. All of you is worth something, if you will only own it.
22. Progress is an illusion.
23. Evil can be displaced but never eradicated, as all solutions breed new problems.
24. Yet it is necessary to keep on struggling toward solution.
25. Childhood is a nightmare.
26. But it is so very hard to be an on-your-own, take-care-of -yourself -cause-there-is-no-one-else-to-do-it-for-you grown-up.
27. Each of us is ultimately alone.
28. The most important things, each man must do for himself.
29. Love is not enough, but it sure helps.
30. We have only ourselves, and one another. That may not be much, but that's all there is.
31. How strange, that so often, it all seems worth it.
32. We must live within the ambiguity of partial freedom, partial power, and partial knowledge.
33. All important decisions must be made on the basis of insufficient data.
34. Yet we are responsible for everything we do.
35. No excuses will be accepted.
36. You can run, but you can't hide.
37. It is most important to run out of scapegoats.
38. We must learn the power of living with our helplessness.
39. The only victory lies in surrender to oneself.
40. All of the significant battles are waged within the self.
41. You are free to do whatever you like. You need only to face the consequences.
42. What do you know . . . for sure . . . anyway?
43. Learn to forgive yourself, again and again and again and again. . . .

Who's To Blame?

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

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

As for my sense of this, I think we could safely remove the word from our vocabulary entirely.  Maybe even replace it with considerations of "responsibility".  In terms of a solution, will offer something I hope is very simple: we're only blaming someone else for our feelings or problems, if we do nothing with our feelings about it.

Therapy is Not the Answer

This is sort of a PSA for clients and therapists alike.  Therapy is not the answer to our problems of relationships, depression, grief/loss, addiction, taking food from others, communication, our sense of broken-ness/low self worth/shame, loneliness, etc.  Therapy isn't just a way of being either.  It's probably a way of being that solves these problems, and can prevent many in the future as a result.  The only exception, if seen in a particular light, might be around issues of safety that require immediate intervention.

Therapy should be a space where we work through the feelings we're carrying with us that prevent us from coming to these answers on our own.  It's an activity that should prompt us to be without our defenses and distractions as much as is possible, with a guide that has done enough of their own work that we can be taught how to live gracefully with these feelings, let go of them/transform them, and provide us principles and ideas that will help us not make some of these mistakes in the future.

We certainly should be giving direction about how to handle some circumstances, communicate more effectively, learning parenting and relationship skills, symptom management, relapse prevention and etc.  There should be an organized body of material to assist with these things.  They will all be rendered useless though, in absence of a principled way of operating, and or in the presence of enough emotional intensity that the tools cannot be used or we cannot see "answers" clearly or the simple consequences of not having these feelings gracefully end up exacerbating problems.

So, a suggestion.  Learn some survival skills that lend themselves to our ability to get some new ways of operating.  Have enough support from family, friends, and professionals that will enable surviving the process.  Deal with the feelings that come up, then set about "solving" things.

What to Do?

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

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

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

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

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

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

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

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

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

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

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

Connected.

This will relate to you and psychology/therapy/counseling, I promise... just hang in there with me...

Some friends of mine have been really struggling with the BP oil... spill? (Wiki here)... it's so big, I scarcely know what to call it.  Have seen and heard some things I'll not reiterate- not because it wouldn't serve, but simply because we've been so inundated with the details of most of this news I'd be afraid that anything I'd have to say to describe such would be heartbreakingly insufficient.  The effects of this are catastrophic, to say the least.

Earlier too today, I was talking with a client about consciousness.  What is "I", how we know such things and etc, a lot of things rooted in Eastern thought, the ideas of Daniel Dennett (Dennett's Wiki), Stephen Pinker (Pinker's Wiki), and the like.  My client began to talk about having the awareness that we're all "one" (maybe that should be capitalized), and what that means in terms of how we experience our world.

This made me bring up another great thinker, a gentleman named Chuck Chamberlain who wrote a book called "A New Pair of Glasses".  In it, he asserted what I think is a fundamental truth (paraphrasing), that our real problem as humans is seeing ourselves as separate from "God" (the "universe", physics, whatever one prefers).  Ignoring this is far from inconsequential.  Our view, true or not, that we are somehow separate from others is part of what enables us to lie, cheat, steal, things much worse.  Even make oil spills.

As I'm alluding to above, whether we are all "one" or not, it's arguably true that we indeed operate (behave) this way.  We certainly see the consequences, but as with many things, we don't really see the etiology of them.  The Horizon spill is only the most immediate example.

Had we been behaving since the industrial age as if we are all connected, including the flora and fauna we are surrounded by (or more tragically accurate, that we are surrounding...), our world would look much different.  As promised, bringing this full-circle to the soul of this little corner of the web, the application of the idea that we are all connected has deep-reaching utility in psychology/therapy/counseling.  My world, and I hope the world of my clients have likely been improved greatly by finding ways to operate on this premise.

As noted earlier, it's pretty easy to see the negative consequences of operating as if all humans, animals, plants, etc are different, whether this is true or not.  There's pretty amazing benefits to operating as if we are indeed one in the same.  Behaving this way allows me to be as gentle a person as I intend.  It's a great method for being more considerate/thoughtful.  This may be true, because it's an idea that lends itself to increasing empathy.  It's a great way to diminish selfishness/self-ful-ness.  So many people are speaking in the "human potential movement" (*ahem* I struggle with these kinds of euphemisms and etc, but for the sake of simplicity...), behaving as if we are all one is fantastic mindfulness training.  We could certainly use a softer, warmer world (among some of the other ideas above), and this is a great way to help turn some of those problems around.

Again, I find that there's too many positive things to gain from such an idea to write here.  What prompts this though, is my own deep sense of sadness for the creatures upon whose lives we've so encroached because of not just our desire for a certain way of life, but because we avoid the emotional consequences of such a life in part, maybe because of the misperception that we are separate from these creatures, making it much easier for us to operate the same way every day, regardless of the consequences they have to endure.  Much as it's important for us to clean up the spill, have clean means of energy and etc- all of these things are rooted in a philosophy of separateness, that if we sit with a minute, we might realize how much less of our own hurts, sadness, fears, shame and etc might have been avoided had we or the person who stepped on our toes behaved as if this encroachment was really upon themselves.

Transformation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What We Don't Get Taught

Have been lucky enough to do some clinical supervision with Judy McGehee.  As I've mentioned before, she and some interns have been providing free services to their community for some time now.  Some concerns I've had with other venues of supervision have come up the last couple of times we've met. 

Clinical supervision, like therapy, is different things to different people.  Many times it's the opportunity to "present cases", problem-solve clinical, legal, ethical issues and etc.  It's also a place for us to have the opportunity to discuss or work out struggles we have as therapists- something that certainly should go on for our entire careers.

One of the things I like to do in supervision is talk about the issues that are not necessarily explicitly processed when we go to school.  There's lots of these sorts of concerns...  how to deal with our own feelings as therapists.  Issues of responsibility- where ours are vs. where the clients' responsibilities are, how much is "enough", concerns when we're sometimes working harder than the client is (or not).  Handling boundaries about parents endeavoring to influence issues discussed (or simply perspectives about them), concerns that arise in couples therapy or family therapy like one person in the "group" disclosing something that affects the others outside of the "group" proper.  How to handle when a client isn't being honest about a problem or circumstance or behavior.  Determining how to handle "terminations"- planned discharges, "therapeutic discharges", discharges against medical advice... sometimes when a child is "pulled" from treatment by a parent against the better judgment and suggestion of the therapist.  Speaking of, there is little discussion about how to handle referrals to other types of resources or therapists.  Specific methods to avoid (or deal with) "burnout".  Very "nuts and bolts" concerns like documentation, treatment planning, dealing with insurance companies and such.  Fee setting.  What to do if a therapist runs into a client outside of the office or other milieu.  How to handle when a client is "stonewalling". Handling clients that are self-medicating.  My personal favorite is specific goals and underlying philosophy of our methods as therapists.  There are many, many more.

It is of course really important to do case conference, have both group and individual forums for processing what is happening with specific clients or groups and the like.  I find it of great import too however, to discuss the above issues.  It is one thing to discuss a specific case, but I think it another to discuss what it is about that case that will come up (or has) repeatedly, in a principled manner.  Would argue too that discussing issues like responsibility, boundaries, terminations, referrals etc often lead to greater resolution with clients "in the room", as well as provide a way of generalizing our knowledge and methods, thus making it a more organized and effective way of treating folk.

Am not suggesting that these things never occur.  It has definitely been my experience however, that most of the above ideas are not discussed in depth, if at all.  Certainly concerns of symptom ID and management, differential diagnosis, theoretical orientation and etc are of great import, but it is uncomfortable and counterintuitive to run into a circumstance that occurs frequently or that is a fundamental part of operating in our discipline (treatment planning, for example) that is largely omitted from our education.

More than anything else, I think I'm advocating for more of a focus on our underlying philosophy for employing the methods that we do as therapists.  I'm not simply trying to help someone (or their parents) improve failing grades, or get someone in a relationship to be more sensitive or attentive, or even to diminish "depression".  What I hope to achieve in most (most) circumstances, is to:

1.  Insure safety and stability necessary to do "The Work".  (absence of suicidality, abstinence from drugs, ETOH, or a behavior, have medical concerns be ruled out by a physician, insure that necessary resources to do the work are in place, etc)

2.  Identify "issues"- the events (relationships, circumstances, etc) or other causes that prompt us to feel mad, sad, afraid, ashamed, and/or hurt and/or "behave" in ways we struggle with.

3.  Process those issues in a way that diminishes, transforms, and/or (almost) eliminates them and subsequently behaviors, choicemaking, or perspectives that might contribute to these issues in an ongoing way.

4.  Provide a "body of material" (patient education, referral sources, resources etc) that enables the client to be able to do these things without the therapist.

5.  Insure that the client has sufficient resources (support groups, family, friends, etc) that support the work and use of that material in an ongoing way.

These are an oversimplification, but I think they go beyond simply "resolving a problem", eliminating a behavior and etc.  Much of the inner workings of these ideas don't get processed as much as I'd hope while we're being educated about our discipline, but again, of course this philosophy likely exists in many of our "theoretical orientations".  In my sense of things, the presence of such a philosophy doesn't go far enough- we as individual therapists need to have a grasp of our own sense of these things to make them as effective as possible. 

Would say further that none of this is supported unless part of our own supervision is about dealing with our own experience both as a therapist, and a person outside of therapy.  My ability to problem-solve many of the issues "not discussed" above is diminished by not having the opportunity to explore these things as part of our own clinical supervision.  The largest of these things for me are the underlying treatment philosophy, and the effectiveness and grace that I deal with my own life- including my life as a therapist.

Shame, "Self-Esteem", and Buddhism

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

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

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

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

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

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

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

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

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

Wanting to Stop

Have had several people in the last week ask me specific questions about wanting to stop (sometimes called "abstaining" or "cessation") doing some "behavior". Drinking, smoking, gambling, over/undereating (or not at all), self-harm behaviors (cutting, burning oneself etc), "codependent" behaviors, controlling behaviors, manipulating, even saying or thinking certain things and more. While some of these require more intense interventions (stopping alcohol or drug use for instance would require medical intervention), some other behaviors can be stopped or minimized by other means.

Though we (therapists) are oft charged with the responsibility of helping clients stop these behaviors, we're not always direct about how to help someone do so. There are real-world, practical means of helping us stop these kinds of behaviors. It should be noted though: in many cases, these are caused by unresolved emotions. It's really important to note this, because no intervention we might suggest will work if there is a sufficient mental/emotional/"spiritual" and/or physical prompt to do so.  Or more simply and by way of example, if someone is suffering enough emotionally (or otherwise), no intervention will stop the behavior.  The feelings (even if physical) have to be transformed/diminished enough for the intervention to work.

These things in mind, here's some ideas. Some of them are direct, some of them will take hold over time:

1.  Pay attention to how we feel.

2.  Ask ourselves, "Am I mad, sad, glad, afraid, ashamed, and/or hurt right now?  What ‘possible reality’ does this indicate?"

3.  Putting off the behavior.  For example, "I’ll _________ (smoke, drink, gamble, eat, etc…) an hour/day/week/month from now." 

 

4.  Context.  This isn't just a principle.  It can be practical.  Asking, "What am I supposed to be, or supposed to be intending to do right here, right now?"

5.  Service.  Finding a way to be of help to another person.

6.  12 step program attendance/participation.

7.  Saying the "Serenity Prayer".  Even if not “prayerful” people, this can be a form of self-talk (the word “God” can also be removed).  For things we're "powerless" over, "God, grant me the serenity to accept the things I cannot change, the courage to change the things, I can, and the wisdom to know the difference." makes us mindful of principles and behaviors that can also help with abstinence.

8.  Speaking of praying (or doing self-talk)- praying for the obsession to have __________ (smoking, drinking, gambling, eating etc) be removed, helps.  "Please remove from me the obsession to stop _________."

9.  If that is hard, praying/self-talking for the willingness to stop __________.

10.  Calling someone.  This, to me, is one of the most powerful tools.  Having someone who knows what we are working on that we can call when considering the behavior to: pull our covers (so to speak), have them talk us out of it, and/or "be" with us as we struggle with the feelings of letting go of the behavior can be pretty powerful.

11.  A different item from the above- calling that someone as a pre-emptive strike.  Meaning, calling them when we might be in a situation this will come up, before we go do the thing we have to do.

12.  Make a list of the times these things (smoking, drinking, gambling, etc) occur most frequently.  Take that list, and either apply the things above (and below) to those circumstances if you HAVE to be there for these instances, and or use the list to avoid those times entirely.

13.  Write a list of the negative consequences of the acting out behavior.  

14.  Maybe most important, is simply identifying the issues (even by making a list, which we will also do in a formalized way) that have prompted us to operate this way, and have an organized means of getting through these (which therapists are charged with the responsibility of).

15.  Based on that list of things/people/circumstances that get us in trouble, have a list of replacement behaviors.  For example, I know I shouldn't be __________ (smoking, drinking, gambling, eating etc), so, I'm going to go to church/support group/call my friend/read this book/exercise/take a walk/write about it and more etc.

16.  Speaking of writing: when "tempted" to do the behavior, write about it.  That's pretty common information from most therapists.  However, I think it doesn't go far enough, unless you read this to your therapist and/or a loving friend and/or a sponsor (if one attends a 12-step program), priest, pastor, and etc.  Maybe more than one of these people.

17.  Putting a rubber band around our wrist, and giving it a gentle snap when considering doing the behavior.

18.  Making a "fund" for the behavior- putting a pre-determined amount of money in a jar when we do the behavior (or consider it maybe), and donating it to a charity or some related idea.

Again, I want to reiterate that no amount of ideas to "stop" a behavior (that we do in our heads or outside of them, so to speak) will be sufficient without working through the attendant (and/or consequential) emotions that come with them.  Those are really strong reasons pointing to the idea of having a therapist that can help use these kinds of tools (and more), and walk through the related issues.  It's important too that many types of concerns will require medical attention by a physician with experience with the specific problem.  Good luck with any of these efforts...

Post Script: It should be noted that the soul of such things is what Carl Jung would have called "illegitimate suffering"- meaning, we do these things as an alternative to simply feeling whatever we feel when we don't do the behavior.  One of the things we do these over is feeling "bad" (about ourselves), broken, less than, "not enough" and the other variations on that theme.  Often, if we do the behavior we're trying to stop, we feel those very things ("bad", broken, etc).  As we often do the behavior to diminish or eradicate feeling those things, then we feel those very things for doing the behavior.  Simplifying: I feel "broken", less-than, etc, I do a behavior to not feel that way, then feel "broken" (less-than, etc) for doing the behavior.  It sets up a vicious cycle, a repetitive cycle.  

Where I'm going with this is, if you happen to do the thing you've been trying to stop, "beating yourself up" for doing the behavior may be the very thing that prompts you to do it again.

You Can't Heal What You Can't Feel

We constantly "do" things- behaviors and thinking, that put distance between us and us, us and "others", us and 'god' or the 'universe' as we MISunderstand s/he/them and/or it.  Food, sex, TV, gambling, relationships, rationalizing, avoiding, intellectualizing, alcohol, money, property, prestige, drugs, toys/devices (cell phones, computers, etc), fixing other people, "acting out" etc.  Overstating, when it comes to distance between us and us, we're talking about putting distance between us and our emotional condition.  Simply using a lot of words (Lao Tzu has famously said, paraphrasing, that "many words lead one nowhere") and even certain types of words can put distance between us and our feelings.

To simplify getting in touch with and processing our feelings about things, I encourage using what are sometimes referred to as the "Six Basic Feelings".  These are mad, sad, glad, afraid, ashamed, and/or hurt.  Certainly, we can have one or more of them at any given time, even about the same issue.  I really resist other words if at all possible, for reasons too long to go into here.

If we're engaged in the aforementioned behaviors, we are often mood-altering, and/or simply less or unable to be in touch with our emotional condition (and as a result, others and the rest of the "universe").  If our feelings are indicators of possible realities, if these are altered or stunted, we may not have all the information about a given circumstance.  The idea we're going for is to talk about them in a way that transforms them, and or helps us clarify different circumstances.

So, my suggestion to get in touch with and begin transforming these is this: know the things we do that are mood-altering, let go of those behaviors (a whole other note all together), and as our feelings come up, say the facts of the circumstance, and one or more of the six basic feelings.  For instance, "When my mom (or whoever) said/did/didn't say/didn't do __________, I felt __________."  That's all.  Trying to avoid inferences, interpretations, assessments, judgments, manipulation, controlling, etc., certainly avoiding behaviors we do that ignore or diminish our ability to be in touch with how we feel.

It's been said too that we can't heal what we can't feel.  So the process I'm encouraging is identifying what we do to not feel, letting go of those so that we can feel all of our feelings ("all" meaning each one, in all circumstances, and with 100% of the intensity we're experiencing them...), naming them simply, communicating them in a way that helps us stay in touch with/get help/transform them, then finding ways to live our lives gracefully through what comes up as we process them.  This is a process I encourage with therapists, relationships, as many places as is possible.


It's really important to point out that I'm not advocating for this process to change anyone else's behavior or perspective.  This is not an idea about right and wrong, certainly not about comparing the relevance of our feelings to others.  It's simply a way of getting in touch with what we feel, so that we can change it.  We often say to one another that we should "let go" of things- but you can't let go of feelings you don't totally have.

Honoring What Is.

Laughing to myself a little now because, though I intended to write about honoring our feelings and "sense" (perception?) of things, was quickly reminded of how hard it is to know how we feel in the first place.

That aside, the idea of "honoring" our feelings has come up a lot lately.  Am assuming we're in a place to know how we feel to begin with.  Don't run with this idea and think honoring our feelings is in conflict with my earlier suggestions that our feelings aren't necessarily facts.  Paraphrasing one of my "heroes" (though he'd certainly admonish me for having any heroes in the first place, particularly him...), Sheldon Kopp has noted along with so many others (Tolstoy, Jung...) how curious it is that we spend so much time and energy actively not honoring our experience of things.  In favor of doing so we dismiss our feelings, compare our insides to others' outsides, diminish the importance of our feelings (sometimes by comparing ours to what others have been through), distract ourselves (food, buying, drugs, sex, alcohol, TV...) and etc.

The consequences of not honoring our feelings are huge.  It can cause depression, acting angry (as opposed to being angry), addictions, irritability, not acting as the person we'd like to be, allowing people to violate our boundaries, is a huge factor in a lack of self esteem and more.  It can cause us to not trust our own eyes and ears when we maybe ought to.  It can keep us in relationships that are not healthy for us.

Honoring them is arguably as difficult as not honoring them.  It's likely one of the primary reasons we don't honor them.  For many of us, it's not even an idea we've really considered.  Much could (and will, eventually) be written just about how to have our feelings in the first place.  Once we do have them though- honoring them and doing so gracefully is a very difficult challenge.

From my sense of things, "feelings" are called that for a reason.  It's so tragic that we behave in a way that indicates we often think we ought to do everything possible with them besides simply having them.  They're called feelings because we're supposed to feel them.  They give us messages about our environment and allow us to heal.  Feeling them and not "folding, spindling, or mutilating" them is the first step.  Once we have them, giving them a name is useful- I always begin with encouraging mad, sad, glad, afraid, ashamed, and/or hurt.

Am also a huge fan of treating them gently once we have them and have named them, whether they "make sense" or not.  Not being gentle with them exacerbates them, or simply prompts us to change or otherwise avoid/ignore them.

Once having them, naming, and being gentle with them, we've begun to honor them.  If we know we have them, know what they are, and are experiencing them without trying to do something unkind with them (make other people see/think differently, harming ourselves, avoiding them with some of the behaviors above and more), we can process them based on what they are.  Crying when we're sad or hurt, are pretty clear ways to honor our feelings.  Telling other people what is happening for us when we feel ashamed (some say "guilty", or less than, broken, etc...) honors our experience.  Telling other people how we feel honors them.  Asking people to be with us when we're scared or feel broken is a great way to honor our experience of things.  Being mad instead of acting mad (a subject for a whole other missive) is a way to honor it.

We don't honor our feelings in relationships either.  We're loyal to people that are disloyal to us.  We treat ourselves more poorly than other people often do, but when we do get treated poorly by others, we oft treat them more gently than we do ourselves, or ignore it wholesale.  Though we may get our feelings hurt about something, we keep it secret.  Sometimes we are sad or hurt or ashamed or angered by something, but keep it from the other person as not to hurt their feelings, but are often taking from them the chance to do or see something different.

Sort of wishing I hadn't begun writing about this particular thing.  Honoring our feelings is dependent on so many things- not doing things to get in the way of feeling them, having simple names for them, having them gracefully, treating them gently, not thinking or communicating about them as facts, processing them.  So much might be written about any of those ideas.  It's come up so often recently, and is such an important idea though, am compelled to put at least something out there about it.

Utility of Sadness

We do some *ahem* interesting things with sadness.

Often, people ask us how we are.  I think the real question is about how we feel, but we will oft answer "good" or "bad" or "not so good".  All judgments about how we feel.  Most of us would argue that "sad" is a "bad" feeling.  If we can get past that, we may use another euphemism: "depressed".  Our relationship to this thing is often not great.

When I left my office this morning (my second office at the Life Fitness Center, a group that provides a more holistic set of services), I was sad myself.  I'd spent several hours with people who were in horrible circumstances, and had already been suffering.  Mightily, and understandably, I might add.  When I got to the light, I noticed a gentleman, probably 7ish, walking through the crosswalk with his mom.  One of my licensures is in developmental disabilities and other related problems, and I noted his cerebral palsy right away.  They were holding hands, and though his body was having a hard time- his soul certainly wasn't.  He appeared really happy.

Behind my wheel though, I was pretty sad.  For my clients this AM, and for him (though he was probably fine).  Most of the time when we get sad, we find some way to resist it.  We push it away with our minds, set our attention elsewhere, numb it with all kinds of different behaviors, even shame ourselves for having such feelings in the first place.

Would argue though, that my sadness, has great utility.  Not only is it the most effective way to heal my losses, it certainly makes me useful to other people.  Exactly how it heals grief and loss is not quite the gist of this missive, and takes time with a therapist/counselor/life coach to know how to do effectively and gracefully.  Am certain that my sadness today assisted me in being kind and present for my clients, and likely would keep me "softer" when dealing with folk like the gentleman in the crosswalk.

My hope is that I never lose this.  As long as I am sad about the suffering of humans, I have business doing the work that I do.  The point of this though is that this is true not just in terms of my relationship to my clients or other folk in the world, but all of us in relationship to ourselves and one another in general.  Honoring our sadness does more to "cure" "anxiety" (sorry for the consecutive quotes), relieve "depression", and make us available for intimacy than most any other thing I can think of.

Reconciling ourselves with sadness, and finding some "grace" in how we live with it, if the above is true, surely presents some great reasons we should stop treating our sadness as something repugnant.

On a different note: as a reminder, Judy McGehee and I will be on the radio/live stream/podcasting at the link below tomorrow from 1130AM until noon on the "Project Get Well America" show with Dr. Mark.  The link for the show is here.

Feelings Aren't Necessarily Facts.

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

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

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

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

Space.

So many of us are looking for self esteem, happiness, "God" (if one believes in such), good relationships and etc.  These ideas come up a lot in my work, from all kinds of people, all different kinds of age groups and backgrounds.  They're understandable, and common efforts, much of what make our lives worth living.

We do a lot of... interesting... things to get these. We "socially engineer", we try to bolster our sense of self with our egos, we do all the prescribed things that religions or spiritual traditions or philosophies (or therapists) encourage us to do to get a sense of "spirit" or "God", we buy things, try to get him or her to be interested in us.  We use drugs, alcohol, money, property, prestige.  We even use a lot of methods we've gotten from other therapists or self-help books (or programs) to get these things as well.

More and more, I think that these things, if we're to have them at all, are far less about "getting" them than they are about making space for them.  If we've been told all our lives that we'll never amount to anything or have had things happen to us that have made us feel "less than" or broken or defective, no amount of the above ideas (and more) will be sufficient to bring us self esteem or happiness.  The ideas I'm suggesting about "God" or relationships etc are much the same- we have to make space for these things, that are usually occupied by some loss, hurt, anxieties and etc.

The how and why of this is beyond the scope of a blog, but it's certainly an idea worth pondering.  Overstating, learning how to let go of hurts, losses, shame, ego- these will go much further in bringing us healthy relationships, a healthy relationship with ourselves, a sense of connectedness to "God" or others or the "universe", than any amount of money or anything else will ever provide.

Speaking of Service...

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

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

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

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

Love and Service.

Thanks for dropping by my blog page.  As the introduction notes, I am a Licensed Marriage and Family Therapist, Licensed Psychiatric Technician, and Masters level Addictions Counselor in Pasadena, California.  Though I’ve been doing some private practice for many years in addition to the twenty-six I’ve been doing inpatient work, I’ve now gone out on my own, to do just private practice.

            Providing treatment is my life’s work.  Having not just survived, but also (somewhat) gracefully dealt with some suffering of my own, I have been given not just some answers- but with those answers, also responsibility to others.  Holding on to those responsibilities is not only bad for other people, it would be unhealthy for me too.  So, very early, I started being of service.

            Having worked inpatient for so many years, I’ve been lucky (and saddened) to take care of most every type of human suffering possible.  Most of my work has been with adults and adolescents.  Depression, loss, grief, addiction, trauma, abuse, stress, mental illness (for lack of a more graceful term), relationships, desires (and need) for personal growth or “life coaching”, chronic pain, medical illnesses, family problems, couples problems and more have all been tragically present and have arguably increased over the years I’ve provided service.  There is much work to be done about all of these things and more.  It seems now that the most effective way to care for these problems is for me to see individuals, families, and couples privately.

            It was suggested by someone I consider wise that I find a way to make myself available to people when they are not able to be around me.  Aside from writing a book, providing materials from talks I do in the community, I am starting a blog.  There is much work to be done, and many answers are possible that can improve the quality of all our lives, if we’re willing to live by some principles and do some work.  My hope is that I can take you along with me as I do so, by way of communicating here.

            And so to it.