Tag Archives: therapy/counseling

July 21, 2012 · 10:53 am

Creating and Nurturing Change

I just returned from a few days “off the grid” and have been amazed at the conflict between my desire to hold on to the feelings and mood of my respite and the pull to fall immediately into the habits and patterns I was so glad to leave behind. I worked a little yesterday to put myself back into the tempo and peace of being back at the island park we visited. I imagined feeling the rocking of the boat, hearing the water lap the shore, the birds, the smelling the wind, the woods, and the beach. For a moment I was there, then my cell phone played its tune; I saw a virtual stack of email waiting to be sorted, read and answered; and I was reminded I need to call the appliance repairman because the refrigerator isn’t working right. The serenity of the previous moment was gone.

Neuroscience has shown repeatedly that our imagined experiences are as “real” to our brain as our physical experiences. We have the ability to use visualization to improve physical functioning. It takes focus and repetition, but even an athlete can improve performance by repeatedly imagining her successful moves. This kind of practice can assist us emotionally as well as physically. Imagined experiences can also inhibit or otherwise impair our functioning.

One of the difficulties with anxiety and depression is that we create and repeat emotional scenarios that feed the fear and certainty of rejection and loss. Our self-talk is increasingly pessimistic or critical. We lose sight of possibility, of alternative explanations, of changes toward the positive. Anxiety takes on a life of its own, so that our fear is about the feelings of anxiety, rather than the specific circumstances or triggers. With depression, we lose memories of previous better times, and create a belief that things never were better and never will be. But there can be change, and it can be change for the better.

I remember many years ago when visualizing and affirmations were being taught in management classes. I was a state social services administrator, and we were experiencing severe funding and staff cuts. Remaining staff members were becoming discouraged and burned-out. The agency provided a motivational speaker at a management conference, and he worked hard to pump us up. After a morning of identifying example after example of the power of affirmations, visualizing success, and modeling success, we broke for lunch. My director turned to me and said, “This is really good stuff. It’s just not for situations as bad as ours.”

Yes, it is. We might actually need it more than the people who use it to deal with inconvenience and discomfort. The thing is, it’s hard to do. It’s hard to get started and it’s hard to keep practicing. It takes discipline. It takes action. It takes repetition. It helps to have support, to share your goals, to help you see options. But it is ok to start with just a little at a time.

Choose one thing to change: be specific, be focused. Reward approximation when it occurs. Approximation is the process of getting closer to what you want to have happen. Think of teaching a child to talk. You don’t wait until they can say, “Could I have a drink of water, please?” to reward them. WaWa or LaLa is close enough to start with. That’s approximation – you are rewarding movement toward the goal. Do the same for yourself.

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Remember, this forum is not intended to be therapy. I have no way to view your body language, hear your tone of voice, or see if your words and your displayed emotions are matching. These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of harm to self or others, and suspected abuse of children and vulnerable adults. I am located and providing these services in Washington State.

Again, I am open to communicating directly with you here. If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

Redefining Normal

Thinking back on my experiences as a seeker of care and a provider, I remember two big misconceptions. “Everyone experiences what I do,” and “No one understands what I’ve been through.” While these statements may seem to appear opposites, they easily co-exist in the belief systems of people experiencing emotional distress. Since I grew up in an alcoholic family, I have easily identified with the movement from the 70’s and 80’s focusing on Adult Children of Alcoholics: identifying the family system, the cognitive adaptations that help your world make sense, and the internal belief systems that rise from families where there is role confusion, denial,unpredictability, and secrecy.

When you do not talk about your inner life, you have few ways to compare it to others’. I remember in my 20’s having an eye exam that showed I was very far-sighted. The doctor asked me if I had experienced seeing double when trying to read. My response was, “Of course, I do. Whenever I get tired. Doesn’t everybody?” Or in my late 30’s when the dentist asked in a standard survey, “How frequently did I have headaches?” then responded with concern when I answered 5-7 days/week. “How had I gone so long without being concerned about it?” I thought it was “normal.” Today I look back with gratitude that someone asked a question in a way that I could respond, which resulted in recognizing that I could have a different experience than I had. It wasn’t normal, everyone did not experience it the way I did, and it wasn’t necessary that I struggle with it either.

The flip side (and yet companion) of defining your personal experience as normal, is seeing yourself as abnormal – the only person who feels this way or has had this experience. Part of the benefit of the Adult Children of Alcoholics (ACOA) movement, pioneered by people like John Bradshaw, Claudia Black, Jane Middleton-Moz, and Timmen Cermak,** was that it described a developmental process and set of beliefs that large groups of people had previously identified as individually unique to them. In the same way, group therapy is often the most helpful with persons having similar trauma experiences, because the individuals see that others have had very similar feelings, emotional or physiological responses, and common self-talk, generated from the common experience and not from a personal deficiency or inability to cope. This exposure to others who share your difficulties “normalizes” the experience and the person’s response, and confronts the internal view that one is somehow “not doing it right.”

Now with all that said, don’t be too concerned about “Being Normal.” A recent post by a friend said something like, “Normal is just a setting on your washing machine.” And when you see a therapist or counselor, and they somehow start to describe fairly accurately how you might be feeling, or thinking, or experiencing something; don’t be alarmed. They are not reading your mind. They are discussing common experiences of many persons in similar circumstances. Experiences you might learn from.Experiences that may be common, predictable, understandable, and human… that’s normal.

** These writers were important to me. I have not tried to be inclusive here.There are many contributors to the ACOA knowledge base and treatment approaches.

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Remember, this forum is not intended to be therapy. I have no way to view your body language, hear your tone of voice, or see your emotional expressions. These are essential to effective communication and great tools for the therapist (and for the consumer when reversed.) I will attempt to be as helpful as I can. I will refer you the best I can to needed services. Even though I will not be your therapist, I am a health care professional bound by law and ethics to act to protect persons from harm. I am required to report my concerns of harm to self or others, and suspected abuse of children and vulnerable adults. I am located and providing these services in Washington State.

Again, I am open to communicating directly with you here. If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

Therapy: What it is and What it isn’t

Whether you call the process Therapy or Counseling, there are many misconceptions about it. I don’t pretend to know all the issues, but there are several I have run across – as a seeker and as a provider.

Your therapist cannot “fix” you. First, this assumes you need fixing, and secondly, it assumes the repair work is completed by someone else. Healing from loss or trauma is a process that you take on. Changing behaviors that create barriers to your happiness takes a process of awareness and practice. In therapy, you choose a guide to assist you with the processes. Remember, the answers are within you and your therapist helps you find them – your solutions, not theirs. As you engage in a relationship with your provider, your patterns of interacting with others rise to the surface. So do the relationship behaviors of the provider (more about that in another post).

Your therapist is not your friend. You are not paying for friendship. This seems to be an accusation that comes from others who for reasons of their own, need to discourage your healing experience. Your relationship with your provider has specific boundaries regarding when and where you meet, and has a specific purpose – to guide you in identifying and achieving your emotional or relationship goals, or to relieve your symptoms of distress. Friendships are reciprocal in a way that counseling relationships are not. Both parties have roles, but they are not the same as friends. Don’t call your therapist for a ride after dropping your car off at the dealer’s, and don’t expect to be invited to their summer barbecue.

The actual rigidity of professional boundaries is affected by many things, including the size of community you live in. Living in Seattle, you might never even see your provider out of the office. If you do, they might not acknowledge you unless you have indicated a connection first. In a much smaller community, you may interact frequently, sharing the kids’ soccer field, the grocery store, church, or even social groups. Not acknowledging you in public in this setting might be viewed as “snubbing.” How you prefer to deal with these situations will probably be a session discussion topic. Whether in a small or large community, you have the right to have your professional relationship kept confidential if that is what you prefer. No matter the setting, sexual relationships and providers using the therapy relationship for personal gain are never appropriate.

When I say that your counselor is not your friend, I don’t mean they do not care about you. It is a relationship and a collaboration. My experience is that providers share consumers’ successes and concerns. Depending on treatment orientation, your therapist may have accepted the responsibility of modeling nurturing behaviors such as acceptance, encouragement, and responsiveness. They expect to care about you.

Paying for assistance does not reduce its value. You have chosen to engage in a relationship with a specific purpose. For the provider, this specific purpose is a professional service. You are paying for the education, training, and experience of your provider, as you would a doctor, mechanic, or plumber. Remember, in this process, you are the buyer and you have a right to choose the service you get. You are not obligated to “stick it out” if you are unhappy with the provider or the process. Ask for what you need. There is nothing wrong with looking for a provider and a methodology that works for you, or with changing providers and methodologies after you have started.

The credentials of your provider do not indicate relative competency or quality of care. There are several paths into the profession of psychotherapy. These include several master’s level degrees, nurse practitioners, PhD’s and MD’s. Other than the ability to prescribe medications, Psychiatrists (MD’s with specialized training) and Psychiatric Nurse Practitioners (Registered Nurses with specialized training and experience) do not necessarily have more counseling expertise. Many have less counseling /talk therapy training than the others. Clinical psychologists in Washington State have to have academic doctoral degrees and pass a licensing exam. Some states allow folks with Master’s degrees to be licensed as psychologists, and some states permit psychologists limited prescribing authority. Psychologists also do not necessarily have more counseling training or experience. They are often valued for their testing and assessment credentials. Master’s level degrees in social work, psychology, and counseling also offer entry into counseling. If you are looking for a therapist, explore their training and experience in the areas of concern you have. Above all, ask yourself after an interaction, ” Is this someone I could work with?”

Sometimes, the most difficult aspect of participating in therapy is the reactions of the people closest to you: The mother who believes she will be blamed for all your sorrows; The friend who wants your time and attention; The spouse who is afraid your therapist will tell you to leave your marriage; or the person who thinks you should just “buck up.”

The goal of therapy is positive change. Change is difficult for most people – even good change, so there may resistance on your part and from the people around you. Try to be accepting and patient with yourself and with them.

This is a journey of self discovery and healing.

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Again, I am open to communicating directly with you here. If you have questions or concerns, please leave a comment. I will attempt to address the content if I can.

Tag Archives: therapy/counseling

Creating and Nurturing Change

Therapy: What it is and What it isn’t

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