No Detours

Dedicated to LC who didn’t live very long but inspired many

Many years ago Linda was a client that I was working with. She was a very complicated young woman. She had chemical addictions, eating disorders and an assortment of other significant issues. Her chemical addictions were getting out of hand and she needed to go to detox. Linda agreed and assured me that she would go on Monday. On Monday, after she didn’t arrive at the detox, I called her and the conversation went something like this:

Me: What happened?
L :  You know
Me: You took a detour?
L:   Yes
Me: Ok, (pause, pause, pause,)but really you need to go to detox
L:   I know
Me: How about tomorrow
L:   Ok
Me: So you’ll call them now so you can get in tomorrow?
L:   Yes
Me: So you are going tomorrow?
L:   Yes
Me No detours?
L:  No detours

Linda did arrive at detox the next day, she looked like, someone who was on the highway to hell. She completed detox, but soon her multiple issues and continued detours led her to her final highway. She died way too young, unable to deal with many issues that she could not even speak about.

Linda’s detours sadly led to her undoing in a permanent way, but many people that I see don’t listen to their internal gps settings. They appear to be on the verge of getting better only to get off of “Healthy Road” and make several turns on to “Self-Defeating Avenue” or “Self-Destructive Boulevard”. These detours tend to last way longer than necessary and ultimately lead to lots of guilt, shame, remorse, and self-loathing. When people drive back and find “Healthy Road” they generally have to clean up the messes they made from their detour. As people start to clean up those messes they begin to ask themselves the following questions:

• Why did I do that?
• What’s wrong with me?
• Why can’t I succeed?
• Am I doomed to always do this?
• Can I be healthier?

When people bring these questions to my office, we need to do some probing for the answers. We need to look at how their detouring behavior is “wired”— that is what causes this behavior? Is it something from their past? Is it a long standing issue with their self –esteem? Is it from some traumatic event that has occurred? There may be hundreds of hypotheses about the reasons this behavior exists and the mechanisms that keep this behavior going. Once we have an idea about why a person may detour, then we need to identify how to change this. This can be a very painful process because some the issues have never been addressed. It takes great courage, patience, and trust to work through the pain.

Linda never got the opportunity to do this. Her detours to hell, ultimately led to her demise. Her fear and shame led her to take her secrets with her to her death.

As we head for the New Year, we can work to stay on “Healthy Road” with frequent turns towards “Self-Improvement Street” and “Feeling Better About Myself Avenue”. Whatever the issues are, they can be identified, and healed. No one needs to keep detouring from the right path.

Change is possible

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The Other Side

 

There is a light flashing on the answering machine. Wow. Could it be a referral? Is it someone I can see? Is it someone I can help? Will our schedules match up? I impatiently go to the message “Hi this is Lois, I got your name from Dr. Don Henry at St. Paul’s medical center. He said you specialize in couples therapy and addictions. I’d like to make an appointment” My heart races, my breathing increases. I’m a specialist? I am, I guess. I call Lois on the telephone. We discuss some of the clinical issues, insurance, and scheduling. I feel awkward trying to communicate the key points. I have to remember to tell her my address, give directions to the office, and tell her where to park. I successfully accomplish all of this and Lois and her husband Bill come in. I get to share my “expertise” with them. There are so many issues—Bill’s drinking, Lois’ control, and the impact on the relationship. Where do I start? Can I help these people? I’ve helped hundreds of people like Bill and Lois when I worked for someone else. But this is about my name, my reputation, my career, my future.

I see Bill and Lois and their multiple problems. They get better. My initial fears get smaller. Week after week, the phone keeps ringing. There are more messages. A man with an angry sounding voice named Tom, calls saying “I gotta come see you; my boss is such a jerk; he’s gonna fire me if I don’t come” He comes in, and over time, he’s not so angry. A sweet, soft sounding woman named Joan, calls to get help for her panic attacks. She comes into my office and is not as sweet as she sounds. In fact, she’s quite angry, in fact about everything. People continue to call and ask interesting questions “Can you see my son and not tell my ex-wife that he’s coming for therapy even if she calls you”? “Can I tell you a secret that my husband doesn’t know”? “Do I have to be honest during therapy, I mean tell you everything?” These questions and their answers all test my therapeutic skills and challenge my knowledge of both ethics and the law. (if you are scoring at home, it’s no, yes, and no)

Among the other new challenges is the business part of the practice. This includes billing, collecting, marketing and advertising I listen to my colleagues who share the ongoing debate ” I have too many clients to be part time, but not enough to be full time” I wonder ” Will I suffer the same fate?” “What if I do too good a job, and all of my clients get better?” “[pullquote align=”right” cite=”” link=”” color=”#9370db” class=”” size=””]What if the phone stops ringing?”[/pullquote]
What if the phone stops ringing? (It actually did once for a period of 12 days). Will I be like other therapists in private practice, here today, closing up shop tomorrow?

Over time, my fears get smaller, and more clients attend. I begin to realize that as a result of information that I learned from continuing education classes and from reading journal articles, that prospective clients want to find a therapist who has good clinical and interpersonal skills. They want to find a practitioner who is also human. They want to find someone who has the following characteristics:

Characteristics of desired therapists:
• Positive
• Shows empathy
• Respectful
• Genuine
• Non judgmental
• Keeps good boundaries
• Good interpersonal skills
• Is human
• Trustworthy
• Hopeful
• Sensitive
• Open to other viewpoints
• Self-aware

The above characteristics seem obvious to me, but many clients have reported that they have had poor or unsatisfactory experiences with previous therapists. Some are robotic. Some are non-communicative. Some only care about getting paid. I’m glad that’s not the feedback that I have received over these many years of being a therapist.

Time has passed; technology has given us new ways of communicating. We now have voice mail, text messaging, and email, all direct ways for new clients to begin their journey towards change. Over the last few years I have discovered that two trends have started to happen. I have been receiving calls from second generation clients. These conversations usually start the same way “you saw my mother/father some years ago and I would like to make an appointment.” It’s funny to see the adult version of a person who their parent once described to me. The other interesting trend is the returning client. This is a person who I met with more than ten years ago. Those conversations too have a familiar sound to them “Hi my name is Sue and I don’t know if you remember me but I saw you 15 years ago. You helped me so much then and I have some issues that I know you can help me with again.” These two trends are very gratifying to me because they demonstrate my beliefs about change. If two people work together on a problem, and there is good “therapeutic chemistry”, change will occur. This has been proven over my entire career. I am grateful to be a part of that chemistry.

If you are looking to find a therapist, use the “characteristics of desired therapists” list to find your person.

Change is possible.

 

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This Train

“There are many ways of getting strong, sometimes talking is the best way.”
Andre Agassi, Open

We all want to be stronger. In order to do that  psychologically, many people go to therapy.  However, according to recent studies less than 4% of the American public utilizes psycho-therapeutic services.  This  shockingly low number speaks to the ignorance of many people, and the apparent stigma of therapy.

In my 30 years of being a therapist, I have my own observations. Starting therapy is one of the hardest things to do. When people find the courage to pick up the 10,000 pound telephone to make an  initial appointment, they don’t leave messages.  Other people call, leave messages, and never return a follow up call.  If people return the call and make a first appointment, 15% of them  cancel late or do not show up at all.  Anxiety and fear of change  is running wild!

For years, therapists have made many statements about when people will attend therapy.    We have said things  like “when the person is ready to change, they will attend”, “when the pain is great enough..”  “when they hit  bottom…”  These well intentioned bumper sticker statements don’t help a scared and running like hell population. They only rationalize the person’s behavior and put little band-aids on our inabilities for more people to get better.

The question about how to get more of the population to attend therapy is a huge issue.  Psychological groups have started awareness days for disorders(alcohol, depression, anxiety, etc.) in an effort to give people access for help.  There is  “National Psychotherapy Day“(this year on 9-25-14)in which supporters of therapy are requested to wear turquoise to show support.  We’ve given people more opportunities to have health insurance and created parity laws to “level the playing field”. It is unknown if any of these macro movements produce change.   My pitch for more people to attend therapy comes via Bruce Springsteen.  Springsteen recently recorded a song entitled “Land of hope and dreams”  I think the refrain serves as a great invitation to come to therapy. Watch the video and see if you agree.

This train
carries saints and sinners
This train
carries losers and winners
This train
carries whores and gamblers
This train
carries lost souls

This train
carries broken hearted
this train
thieves and sweet souls departed
this train
carries fools and carries kings
this train
all aboard
I said this train
dreams will not be thwarted
This train
faith will be rewarded

this train
hear the steel wheels singing
this train
bells of freedom ring

 

The train will soon be boarding…

Change is possible

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Digging in the dirt

I’m digging in the dirt
To find the places I got hurt
Open up the places I got hurt

Peter Gabriel

 

 

Recently,  the Rock and Roll Hall of  Fame inducted Peter Gabriel.  As the front man for the band Genesis, Gabriel’s elaborate costumes got the band noticed.  His unique singing and writing led to the band’s success. In 1986, Gabriel left Genesis and released the album So which sold five million copies. His next album Us was released six years later.  On that album you will  find the  song Digging in the Dirt.

According to Gabriel,Digging in the Dirt  is a song about his therapy.  There are many interpretations about the song.  These include domestic violence, murder and many others.(you can find more of those here.)  Since there are no factual interpretations, please indulge my therapeutic perception .

This is the chorus of the song :

This time you’ve gone too far [x3]
I told you [x4]
This time you’ve gone too far [x3]
I told you [x4]

Don’t talk back
Just drive the car
Shut your mouth
I know what you are
Don’t say nothing
Keep your hands on the wheel
Don’t turn around
This is for real
Digging in the dirt
Stay with me, I need support
I’m digging in the dirt
To find the places I got hurt
Open up the places I got hurt

The beginning part,

This time you’ve gone too far [x3]
I told you [x4]
This time you’ve gone too far [x3]
I told you [x4]

Don’t talk back
Just drive the car
Shut your mouth
I know what you are
Don’t say nothing
Keep your hands on the wheel
Don’t turn around
This is for real

 

I believe  this is Gabriel’s fear and  shame  speaking.  He wants to run, avoid, and not deal with the places he got hurt.  Gabriel is shaming himself with the repeated yelling “this time you’ve gone too far/ I told you”.  He knows that he should not be sharing his innermost thoughts with anyone( a message perhaps that he received in childhood).  In the next part of the song, Gabriel sounds like a small boy who is hearing what he needs to do :

Don’t talk back
Just drive the car
Shut your mouth
I know what you are
Don’t say nothing
Keep your hands on the wheel
Don’t turn around
This is for real

Gabriel’s inner shame and self loathing have taken over.  He is worthless, afraid, and ashamed.

Although afraid and ashamed, Gabriel is aware that he is in need of the therapist’s help. Later in the chorus he finds his healthy voice:

Digging in the dirt
Stay with me, I need support
I’m digging in the dirt
To find the places I got hurt
Open up the places I got hurt

The phrase “stay with me I need support” is a request to  the therapist to be with him on this journey of “finding the places I got hurt”.  He knows that he is in a trusting therapeutic relationship because he not only wants to find those places, he wants to “open up the places I got hurt”.

Gabriel sounds calmer, less shamed, and very aware in the next verse:

The more I look, the more I find
As I close on in, I get so blind

He knows there’s a bunch of issues that he has to find.  He gets overwhelmed as he starts to uncover the pain.

This song is a great example of the therapeutic process.  The chorus is so appropriate for many people that I have seen over the years.

I  have seen  clients having a  “this time you’ve gone too far” reaction  many times by doing the following:

  •  having “hot flashes” (men too)
  • getting uncomfortable physically–fidgeting, playing with pens, keys, pillows, etc
  • needing an immediate bathroom break
  • standing up
  • abruptly changing the subject
  • leaving the session

Like Gabriel’s experience, therapy is scary.  It’s full of fear, pain, shame and guilt.  People keep looking and finding.  They keep asking “why” sometimes without answers.  Sometimes they find answers that they don’t like. Sometimes people become aware that they need to take action and those actions are overwhelming and scary.   Sometimes there are no answers, only questions.  Sometimes, my best and only contribution, is my understanding of the pain, sadness, and loss that my client is feeling.

I’ve seen many clients over the years go through storms in order to find their rainbow (If you’d like to read more on this topic,  go to one of my old blogs “You can’t have a rainbow without a storm”).   I enjoy the experience of seeing people make changes in their lives.  As we “dig in the dirt”,  we get to plant seeds and crops that grow year after year.  They are fruitful, they are plentiful, and they are healthy.  Don’t be afraid to dig–Change is Possible!

 

 

 

 

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We have met the enemy and it is us

The original concept behind a week in the life was to identify a common theme that occurred in my office and write about it. It was to be a kind of therapy diary—an opportunity to share my ideas with others. This topic goes back to the roots of the idea.

Many times people coming into therapy are upset with others around them–their spouses, employers, kids, family members, etc. Their anger, hurt, sadness, and fear is directed to those people, and how they have been treated unfairly. There have been people that I have seen over the years in which that’s all we talked about. For them, it’s what they needed – a chance to vent these feelings without carrying them around. This was helpful because it improved the quality of their life. Recently, a bunch of people have come in and have stated the standard “they are doing this to me” etc. However, in the session, something remarkable occurred. These people stated that they were responsible for other people’s reactions to them!!! They were asking “What role do I play in this?” “How have I contributed to my own unhappiness?” “What do I have to do to be better?”

It is exactly:

It’s amazing to me when this occurs–particularly with people who are coming to therapy for the first time. To have an insight like this is something that happens later in the therapy process. It is an “acquired taste”, which usually develops after the emotionality has decreased. For these new therapy entrants to ask the very insightful “what role do I play in this?” was very exciting and very energizing. It’s a statement of I want to work on ME– on my pain, on my issues.

The most interesting part of their insights was that it happened several times in the week. These were all different people with different sets of issues. I asked the very same question–”What’s my role in this?” I was probably more stumped than they were!!! Had I magically transformed my therapeutic skill to be able to direct people to insightful declarations earlier in therapy. Had I done something differently with these people than I have done over 26 years of being a therapist? Was this a function of too much snow in NJ in the months of January and February?

My conclusion to this stumper of a question was my belief in the power of change. People will change: when they are ready to change, have the right ingredients for change, and have the motivation for change. That was my role in this–I produced some of the right ingredients for the change process. People felt safe and not judged. They felt that they could open up and probe into themselves. They felt validated and understood. They were able to handle a little therapeutic “nudging” to push them a little further. Therapy is like a good recipe–the tastiness of the dish is not brought about by doing the exact same thing over and over. The tastiness occurs by adding a little of this or taking out a little of that. The end result is a good tasting meal. I’m going to keep “cooking” with my clients each and every session to keep making tasty dishes of change.

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