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An Allegory of Negative Attachment

11 November 2011, 12:06 pm

The problem with the desire to prove ourselves through negative attachments is it doesn’t work. It’s like the story of the alligator who offered to give the frog a ride across a wide river. The frog wanted to cross the river but had no means for crossing. The alligator offered the frog a ride. The frog said, “There’s no way I’m going to ride across the river on your back. You’re an alligator. You’ll eat me alive.” The alligator looked very hurt at this and appealed to the frog’s sense of fairness, “Frog, we’ve known each other for years now. I deserve a chance.”

What Frog didn’t realize is Alligator’s offer appealed very much to a desire Frog had to prove himself to those who normally couldn’t care about a frog. Alligator was a perfect stand-in for Frog’s rejecting mother, who had never wanted to be tied down with children and left Frog all alone at a very young age. Frog wanted to be special enough to make his mother want to stick around and care for him, but that didn’t happen.

But, here was Alligator willing to give Frog a ride. A frog cared for by an alligator would be a very special frog, indeed. Throughout the course of their relationship, the more Alligator rejected Frog, the more Frog tried to prove to Alligator he was worthy.  “Now” frog thought, “All my efforts have paid off, for here is Alligator offering me a ride across the river.” Frog thought Alligator finally saw that he was worthy and if everybody saw him being ferried across the river by Alligator, the whole village would recognize his worthiness.

In the traditional version of this story, the alligator eats the frog halfway across the river, and just before he swallows, frog musters one last breath and says, “Why, why are you doing this?” Alligator responds, “Because I’m an alligator.”

In real life, Alligator says “Because you made me eat you by not being good enough.” If Frog survived, he would try harder and harder to prove himself by throwing himself over and over in Alligator’s path, hoping to get a different outcome.

At around the age of fifty, Frog may realize he can leave Alligator to his opinions, that it really was about Alligator and not Frog all along, and that there is nothing to be gained by hanging out with alligators.

 

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How Not to Keep Teenagers off Drugs

23 October 2011, 6:40 pm

The longer a child or adolescent can be kept off of alcohol or other mind altering substances, the better.  The younger somebody starts, the greater the risk they will become somebody who qualifies as a full-blown alcoholic or addict and the onset will be earlier. This is because adolescent brains are going through a critical phase of development and there is greater potential for “hard-wiring” something into a developing brain.

Teenagers don’t think like us.  Neither do children. We tend to think those who respond to us in a language we understand have the same ways of comprehending information we do. This is not true for teenagers. One case example is “Scared Straight” programs which became popular subsequent to a 1978 documentary of the same name.

In the documentary, a group of juvenile delinquents spent three hours in a state prison while a group of prisoners attempted to scare them straight by screaming and yelling at them, as a form of aversion therapy.  The teens in the documentary were deemed to have been scared straight. Subsequent to the release of the documentary, “Scared Straight” prevention programs became popular for a time.

Scared Straight programs ended up actually increasing the probability a teenager would engage in crime, as opposed to decreasing it. Teenagers who went through the programs were more likely to engage in delinquent behavior than those that hadn’t. Those programs were abandoned, except by parents who continue to attempt to frighten youth onto a straight path thinking teenagers care about consequences in the same way a healthy adult would.

Parents who had negative outcomes from their own history of delinquency like to tell their children what happened to them, as a deterrent to engaging in similar behavior. This is understandable, but it actually is not the thing to do. What the adolescent brain hears is “My mom/dad did it and they are fine.” You may be living in a tiny apartment wearing raggedy shoes and wishing you could afford an i-pod because you threw away a promising medical career as a result of past drug use.

What the teenager sees is that you have your own place to live and so are doing fine. To the teenager, the idea of having a tiny apartment of their own is Nirvana. The message becomes “My mom/dad did it and they are okay.” Plus, the thought of being your age at all is very difficult for them to comprehend.

Given what is happening in the adolescent brain, most will not have the capacity to put themselves in your shoes and apply your situation to a future self. That would involve executive functioning and the processing of multiple abstractions. The regions in the brain that would allow them to do those things with any proficiency aren’t fully developed in the human brain until the age of twenty-four or twenty-five.

This is also why a lot of teenagers aren’t sympathetic to a parent who had a hard day at work and aren’t able to understand the connection between that and your desire to stay home instead of drive them to the mall. You might as well be speaking Swahili. All they hear is that you must not really love them or you would take them to the mall. I know there are exceptions out there, but this is how a brain without a fully developed frontal cortex or cerebellum is prone to respond.

This doesn’t mean we don’t try to explain things to teenagers. Although you are better off not talking about your past drug use.

The more teenagers hear about others engaging in delinquent behavior, the more it norms the behavior for them, even if you are telling them not to do it.

This may be why the old versions of the DARE program which focused on education were found to be completely ineffective and in some cases appeared to also increase the probability a child would use. The people who say, “I listened to a DARE presentation and decided I would never use drugs or engage in underage drinking” are the youth who likely would not have engaged in the behavior, regardless. Or, they are a rare exception.

Other ways we norm alcohol and drug use and therefore increase the odds youth will engage in the behavior are through the “I know you are going to do this, it’s what teenagers do” stance. When media puts out headlines they read “Twenty-five percent of youth report binge drinking!”  They should read “Seventy-five percent of youth report they do not engage in binge drinking!” When we norm the behavior, we greatly increase the odds youth will engage in the behavior. It doesn’t really pay to be the understanding authority figure who turns a blind eye to teenage drinking and drug use.

I recently attended a very informative day-long presentation by Linda Chamberlain PhD, MPH on the adolescent brain. Related to alcohol and drug prevention, I was struck by a statement she made: “The teenage brain loves novelty.” This was explained as being related to chemical changes that occur in the brain during adolescence which results in a teenager’s “feel good circuitry” being triggered by novel or risky behavior.

I thought this made sense as nature’s way of encouraging teenagers to become more independent and to strike out on their own.  This explains my teenaged self’s eagerness to drive miles and miles by myself in a rickety car from the rocky mountain state I’d attended high school in to San Diego, where I didn’t know anybody, with $200 dollars in my pocket and no job prospects because I’d heard it was a nice place to live.

“Scared Straight” programs may trigger the teenager’s love of novelty and risk,making a life of crime seem more, rather than less, compelling.

When my grand-nephew turned twelve I started arranging an adventure for him each summer which was my conscious effort to keep him from becoming one of the kids smoking cigarettes in parking lots.  The first year he had his first trip in an airplane. The next we went to San Francisco and traveled up the coast for his first view of the ocean. The next year I took him to San Diego to see his favorite football team play (Chargers).

I had a sense the teenaged brain loved novelty. Science just hadn’t proved it yet. When he was fifteen he told me he didn’t intend to drink  or do drugs. I hope that continues.

One-shot approaches don’t really work. One big adventure isn’t going to change the course of a teenager’s life. In the world of prevention, the activities with my grand-nephew needed to be integrated into ongoing relationships and patterns to have an impact.

A hand-out from Linda Chamberlain’s training states, among other things, “Approximately one-fourth of high school students are considered binge drinkers (defined as consuming five or more drinks in a row).” This means three-fourths of high school students are not binge drinkers. The message to give teenagers is it is not normal behavior for teenagers, as opposed to winking, nodding and saying “I know you are going to do it. All teenagers do.”

Given the teenager’s love of novelty and risk, one of the best things you can do is provide regular opportunities for novel, challenging, healthy risks and experiences. Take them to see the Blue Man Group, if you ever get the chance. Then get them a set of drums. Take them on hikes or backpacking trips. Take them fishing. Teach them how to build a shed with power tools.

Get them involved in opportunities to engage in positive activities in the community such as performing on stage. Help them find a cause that excites them where they can make a difference, such as volunteering at an animal shelter or raising money for starving children in Africa or helping local seniors.

One local parent has given his daughter the opportunity to write a weekly column for a local newspaper.

An essential thing to do to increase the odds for your teenager’s novelty-loving teenage brain is to provide opportunities for positive activities that are challenging, new, and engaging. One thousand lectures will, unfortunately, be of limited use. Be aware of where your teenager is and who they are hanging out with. If they are spending a lot of time at a particular friends, get to know that friend’s parent(s) or guardian and make sure there is supervision. Verify your child is where they are supposed to be.

Once a teenager has been given freedom, it is very hard to reign it in. Pulling in the reigns after you realize there is a problem and after the teenager has been allowed substantial freedom is very, very challenging.

Keep any prescription medications locked up and appropriately dispose of them when you are done with them so there is no temptation sitting in your medicine cabinet. Prescription medication abuse is steadily growing among teenagers and the most common way they are obtained is through a parent’s medicine cabinet.

Janice Maddox, MFT

Reno Counseling

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The Love We Crave

24 August 2011, 6:41 am

When I was in graduate school a wise professor talked about the Object Relations Mother versus the Environmental Mother.*   The  Environmental Mother is the mother that is authoritarian. The mother who tells the child to wash their hands before they eat dinner and not to eat with their mouth full. The Environmental Mother as I conceptualize her is a mother that is harried and has her hands full and is just trying to get the job done. She can be very impatient.**

The Object Relations Mother is the mother who is warm, and nurturing and who seems to have all day to just focus on the wonder of the child. They may give them cookies and envelope them in warm hugs. They look in the child’s eyes and smile and let that child know they are inherently precious, even if they don’t always remember to brush their teeth. We need an appropriate mix of Object Relationship and Environmental Mother in our lives.  Today, we seem to be throwing the Object Relations Mother under the bus.

When I first got into management I read a lot of books. One thing that stuck was the idea that when I had an employee in my office, I needed to focus completely on that person and act like I had all the time in the world for them. I couldn’t seem impatient and like I was just waiting for them to leave. This was part of being mindful of employee morale and retention. In other words, I needed to be fully present and let the person know they matter, like an Object Relations Mother.

This is something con artists and abusive people know how to do really well. A con or sociopath comes on strong and knows how to make somebody feel like they are the most special, important person in the world. They look in their eyes, completely focus on the person in front of them and really listen. This makes somebody feel like they really matter. It’s so rare in some lives that it can feel like love, even when it isn’t. People want to follow the person around and give them money. If bodies are found in the sociopath’s yard, somebody who basked in what felt like loving attention will say, “No, not Charlie. There’s no way he would do that.”

Conversely, people who really love us can be impatient, preoccupied, and not listen. So it feels like it isn’t love, when it is.

When it comes to children, it is all about relationship.  There are times your child comes to you and wants to tell you something. They may want to say something about their day. They may want to show you something they drew. You may be exhausted, and overwhelmed. You may have five children. You may feel like somebody has stuck an IV into your arm and is sucking the life force out of you, one drop at a time. You may notice their hands are dirty.

That’s the big one. The lesson. We seem to have an inability to stop teaching lessons. At the end of the day, and particularly when they are teenagers, it is not going to be about the dirty hands. It’s going to be about the relationship. When the child comes to you with the dirty hands to show you their picture or to ask why the moon is in the sky, you can give a terse, “That’s nice. You need to wash your hands,” or “Not now!” Or, worse, “How many times have I told you to wash your hands?”  with an expression of annoyance. An opportunity to build connection is lost. We lose sight of the real goal.

The main goal is not to have a clean child who doesn’t chew with their mouth full. If we are all Environmental Mothers with children, when they are teenagers, they are prone to look for love in all the wrong places. They go where it is easy to be accepted, and that is to congregate with other people looking for the Object Relations Mother. They may seek her in drugs, sex, or through trying to be special to somebody who withholds love. Love is the drug they crave, so they keep trying to get love. If God is love, this can be thought of as worshiping false gods.

And, you do love your child. They should know that, right? I wish that were true. I know you are so busy. We are all so busy. Being Object Relations Mother for people can seem to take so much time, but pays off big in the long run.  And, it’s a dying art.

This applies to partners, also. How often do you just stop and give your partner what they want? The truth is, being Object Relations Mother doesn’t have to take a lot of time. It’s a softening, a listening, a relinquishing of the need to be right. A relinquishing of the need to understand or be understood. A relinquishing of the need to ask “Why?”  “Why did you do that?” Meaning, “I would never do that. What is the matter with you?”

As discussed in earlier posts, we are primed to  focus on what is wrong. Our brain is designed to look for the threat in our environment. This means that 99% of things can be good, but without intention, we’ll focus on the 1% that our minds tell us need to be fixed. The dirty hands. The more stressed and busy we become, the more likely we are to react rather than respond. We focus on what needs to be fixed, reinforcing the perception that those around us are fundamentally flawed.

How many times a day can somebody do something wrong? A test is to count how many times in a week you can let somebody have their way. Letting somebody have their way means not pointing out what you’ve noticed they’ve done wrong, or gotten incorrect, or the fundamental flaws in their logic. It means going out for pizza at their request, even if you really want lasagna. It means thanking them for doing the dishes instead of pointing out that the floor hasn’t been vacuumed.

Give those in your life a dose of Object Relations Mother on a consistent basis. It doesn’t take much time. Giving your partner and child fifteen minutes of focused attention a day can make a difference. If you have five children, this can start to add up, but will be worth it in the long run. Turn off the cell phone. Be present.

Don’t try to teach your child everything at once through correction of everything you notice they do wrong. If you do, they are going to be wrong too many times in a given day. Choose one to three things to focus on during a given time period. When those are accomplished, move on to another lesson.

Regrettably, obedience to authority doesn’t work like it used to. Today it is all about the relationship. Children listen to those they have a relationship with. That relationship needs to be solidly in place before they are teenagers. Relationship is built on a foundation of trust, consistency and history of positive interactions.

*  In Object Relations Theory, the “objects” of the theory are both real others in one’s world and one’s interalized image of others. The Environmental Mother as used here can be a man or a woman. Children need a mix of Object Relations Mother and Environmental Mother, as do employees in my experience.

**I’ve reversed the terms used in the original article, based on comments from those more academically astute. See comments below.

http://en.wikipedia.org/wiki/Donald_Winnicott

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Nutrition and Mental Health: What You Need to Know

30 July 2011, 6:00 pm

The brain is not separate from our physical body. We know we need calcium for bones, and Vitamin C is an antioxidant, but it doesn’t end there. Just like a plant, if we aren’t getting the proper nutrients, our leaves will fall, one by one. We can use the best mental health interventions in the world, but if the issue is unaddressed dietary or nutritional deficits that cause or contribute to anxiety, depression, or other issues, results will likely be negligible.

Disclaimer: Seek the advice of a competent medical professional before making any decisions that could affect your health. I am not a medical doctor or a dietician. Information relayed here is for you to explore further, should you choose to, through discussion with your family doctor or other qualified professionals.

I was first introduced to the potential benefits of magnesium in addressing anxiety by two people who introduced magnesium into their diet under the supervision of a practitioner of alternative medicine. In separate incidents (they didn’t know each other), they each wanted me to know how much the magnesium had helped them, so that I could incorporate the information into my work.

According to Michael B. Schachter, M.D, symptoms of magnesium deficiency can include “…insomnia, anxiety, hyperactivity and restlessness with constant movement, panic attacks, agoraphobia, and premenstrual irritability,” among other things.

Some years ago I read a book Change Your Brain Change Your Life, by Dr. Daniel Amen and began incorporating some of his teaching into my work with certain clients. After reading the area in our brain associated with depression, the deep limbic system, directly processes our sense of smell and “stores highly charged emotional memories, and affects sleep and appetite, cycles, moods, sexuality, and bonding,” and that certain smells were shown to have a calming effect on the area of the brain associated with anxiety, the Basal Ganglia, the use of smells was integrated into cognitive behavioral interventions with some clients, with positive effect.

For example, a client who is struggling with anxiety in their place of work could tie an affirmation or other practice they have found useful for alleviating their anxiety together with the use of the scent of lavender, which has been shown to have a calming effect on the area of the brain associated with anxiety. They could keep a tiny jar of lavender oil at their desk, and as needed, unscrew the cap and take a smell, which could be enough to change the course of their anxiety (note these interventions are always client-specific and initially experiments to see what works and what doesn’t for a given client).

I’ve handed out Dr. Amen’s book Change Your Brain Change Your Life like a drunk-on-love Hare Krishna handing out flowers and banging cymbals at a Venice Beach drum circle. I do recommend this book.

Information I’m giving here on Dr. Amen’s work is very incomplete. He also states you should talk with your doctor before implementing any of his teachings. In addition to multi-faceted and very interesting information about the brain and the impact of head injuries on emotional regulation, Dr. Amen touches on a variety of nutritional components and other factors that could impact mental health:

If you struggle with anxiety, “You’ll do better with a balanced diet that does not allow you to get too hungry during the day. Hypoglycemic episodes make anxiety much worse.” In addition, “the B vitamins, especially vitamin B6 in doses of 100 to 400 milligrams, are also helpful. If you take B6 at these doses, it is important to take a B complex supplement as well.”

Dr. Amen notes, “In two studies in the American journal of psychiatry, men who had the highest suicide rates had the lowest cholesterol levels. Our deep limbic system (associated with mood) needs fat in order to operate properly. Some fats are better for us than others, such as the omega-3 fatty acids found most prevalently in fish.”

I was first introduced to the concept of adequate protein as a component of mood regulation by a personal trainer. Proteins are the building blocks of brain neurotransmitters, including dopamine, serotonin, and norepinephrine, which are all implicated in depression and other mood disorders. It makes sense that somebody who is getting most of their energy from carbohydrates, may find their mood negatively impacted by inadequate levels of protein needed for emotional regulation.

Dr. Amen states, “It is essential to eat enough protein in balanced amounts with fats and carbohydrates. Too much protein for some people may actually restrict the amount of ‘brain proteins’ that cross into the brain. Not enough protein will leave you with a brain protein deficit.”

When it comes to nutrition, balance is key.

Of course, as Dr. Amen mentions, it is often helpful to eliminate caffeine and “eliminating alcohol is often a good idea as well. Even though alcohol decreases anxiety in the short term, withdrawal from alcohol causes anxiety.”

People who become dependent on alcohol will generally have high levels of anxiety, which is related to a variety of factors.

Undiagnosed physical ailments can also cause mental health symptoms. Undiagnosed thyroid disease can be a cause of significant anxiety or depression. For this reason, thyroid levels are usually checked for patients admitted into a psychiatric hospital.

I encourage readers to ask their doctor to include a test of their Vitamin D levels when having their routine blood work done. Many who are feeling fatigue or muscle weakness these days are experiencing undiagnosed vitamin D deficiency, which can have profound long term negative impacts on health. I don’t advise increasing your intake of Vitamin D without having your levels checked by your doctor.

Many doctors now check vitamin D levels routinely. Many still do not check Vitamin D levels. Some doctors don’t even have a practice of doing blood work for their clients as part of an annual physical exam, although it’s an important component of preventative medicine. Most nutritional deficiencies won’t be detected through routine bloodwork. Here is a recent article on vitamin D deficiency http://www.healthcentral.com/rheumatoid-arthritis/c/80106/141740/aut/2

We do have to be mindful of how we approach nutrients. Yes, we can get too much of a good thing. I satisfied a science requirement in college by taking a class on nutrition and learned when it comes to nutrition, there are complexities within complexities and most of the information presented to the general public is limited.

Do buy the book, Change Your Brain Change Your Life, Dr. Daniel Amen.

Janice Maddox, MFT

Reno Counseling

http://www.mayoclinic.com/health/thyroid-disease/AN00986

http://www.huffingtonpost.com/therese-borchard/vitamin-d-and-mental-heal_b_211636.html

http://www.mbschachter.com/importance_of_magnesium_to_human.html

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For the People of Norway

24 July 2011, 12:07 am

How to Help Somebody Who Has Lost a Child:

When my partner’s son died and we were still a shattered home after six months had passed, people would say “But, it’s been six months,” as if that were a long time. In our case, time stopped completely for one year. We spent a year in shock trying to grasp what had happened and going over and over and over events in our minds.

There is nothing like the experience of waking up after a sleep helped along by sleeping pills and having to yet again go through the process of remembering what happened and again trying to assimilate it into your reality. The loss can be simply impossible to comprehend for a while. After a year, time started to move.

I couldn’t take away my partner’s pain, and it is profoundly challenging to watch somebody you care about suffer. After four years and a gradual climb, my partner appeared to have found  peace. It is very hard to let go of grief when letting go seems to mean letting go of your love for your child. It’s not something somebody can make themselves do. Eventually, we let go in spite of ourselves.

What to do when somebody you care about is going through a profound loss? Know they are in a different world than you are.  Your words may not even be registering. Understand that people need breaks from feeling the pain and that is a process that occurs naturally.  If somebody has had a profound loss and they are on the job, it can be helpful to not mention it when they are compartmentalizing their grief to focus on work.

Know that even during the initial, most difficult phases of grief, people have the capacity for laughter.  We’re just built that way. There needs to be occasional relief from the heaviness of the situation. This does not mean joshing somebody out of their pain, or ignoring it. But, you don’t need to be the 100th person they talk to that day and the next day and the next  and the next who is somber and referencing their loss. Let them have breaks from that.

I am not advocating going on at any length in the vein of inanity or chatter with somebody who is grieving.  Any imposed interludes should be kept brief. I don’t advocate making small talk when news of a tragedy is fresh and the person is still trying to grasp the situation. That is a time for just sitting with them and helping to absorb the energy and shock. They need the space to process and try to fathom their experience, not make small talk.

Give the individual or family food.  Something easy to heat and easy to get down, like lasagna or casseroles. Carbohydrates are good at times like these. Not sweets or chips.  They won’t want to munch.  They aren’t going to feel like eating.  Just put a plate in front of them when you know they haven’t eaten. They will often go ahead and eat what is placed in front of them. Same with water.  Staying hydrated is always important.

If you are an intimate enough friend that they don’t mind you going through their things and accept your offer, it would be nice to help with household chores like laundry, cleaning and yard work during the first few weeks.  Your griever may be one that wants to keep busy in the early stage of grief and doesn’t need or want help, although that is rare. They may want to be left alone, although that is rare during the initial stage of grief, also. Their wishes should be respected, of course, with the caveat they may be too shocked to have a clue what they want.  However, they will usually be able to express what they don’t want, if there is something they really don’t want.

Food will continue to be an issue for a few weeks, although that kind of support understandably gradually disappears.  Everybody is busy and people have limited resources of time and money.

It is fine to let somebody know you are sorry for their loss.  If you experienced something similar, it can be okay to let them know that, only to the extent needed to let them know you understand. The experience needs to be fairly similar to resonate.  Losing a pet is hard, but when somebody told me they understood what I was going through when my dad died because their dog had just died, it didn’t resonate for me.  When my former partner’s son died, it was meaningful when somebody shared they had also lost a teenager and offered their support.

Don’t avoid talking about their loved one. They are thinking about their loved one constantly, you aren’t going to bruise them by mentioning the person. People generally appreciate hearing memories of their loved one, and over time want to know people remember them.

I’ve learned when there is a loss of a child everybody says “I wouldn’t be able to handle that if it happened to me.”  Two weeks before the loss of my partner’s child, I looked at him and thought, “Nothing better ever happen to (his son), he wouldn’t be able to handle it.”

There are not special people chosen to go through these things because they have a special capacity for handling it. We get through what we have to get through. Sometimes, there isn’t a choice.

If you tell somebody who just experienced a horrific loss to think positive, you contribute to a sense of profound alienation those who have suffered a traumatic loss generally feel. You won’t make their pain worse. You may become a recipient of their resentment.

In some cultures it is normal to spend days rocking and wailing when a loved one dies.  Grief needs outlets and by nature we generally know how to express our pain in ways that ultimately help us heal from it. Sometimes those around the grieving person think profound expressions of grief are not okay.

My belief is that it is important to let someone express the full range of their grief when they first hear the terrible news, without truncating the process with a pill, but I’m always open to the possibility I may be wrong about some things.  People who receive terrible news may need something  on a short-term basis to help.

There are times somebody benefits from taking antidepressants for a time, to navigate prolonged grief and continue to be able to function.  At the end of the day, however, there isn’t a pharmaceutical solution that can take away grief. The only way is through, not around.

Be aware, on the other end of the continuum, some don’t cry easily when they experience a loss, and that is okay, also.

People of Norway, I’m so profoundly sorry for your tragedy and loss.

The original and full version of the post this was taken from is here – http://www.janicemaddox.com/?p=1683

Janice Maddox, MFT

Reno Counseling

 

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Myths About Twelve-Step Programs

18 July 2011, 5:59 pm

There  are many 12-step programs including Sex Addicts Anonymous, Gamblers Anonymous, Emotions Anonymous, Overeaters Anonymous, Narcotics Anonymous, Adult Children of Alcoholics, and Alanon. I’ve included a link to websites for these 12-step programs at the bottom of this post.

Below is a list of Myths and Facts about 12-step programs, based on the misconceptions I’ve heard most frequently, over the years:

MYTH: Twelve step meetings are full of practicing alcoholics and addicts and are therefore a good place to go if you want to get drunk or score drugs.

FACT: People who don’t want to go to 12 step meetings will tell their counselor or others the meetings are full of people who drink and use, and therefore it is not a good place for them to be. They will say things like “Everybody goes to the bar after the meeting and gets drunk,” if it’s an Alcoholics Anonymous meeting. For Narcotics Anonymous meetings, they say people sell drugs at the meetings.

This is basically an urban legend. While there are always opportunities for out-lying experiences, Twelve-Step meetings are run by people in recovery.  The peer pressure/social influence is pro-recovery.

While there may be some who are only there because they are court-ordered and some who have not yet committed to their recovery, they aren’t people with influence in the program. They come to the meetings and leave. Those who sabotage the recovery of others are ostracized and in some cases prevented from attending future meetings.

From a common sense perspective: Drug dealers have much better places to sell drugs than recovery support groups. If somebody announced during an AA meeting they were going to the bar to get drunk after the meeting, they would likely be descended on by people in recovery who want to save them from themselves.

I think the fact people have had successful recovery through Sex Addict’s Anonymous speaks volumes for the pro-social pressure of recovery support programs.

MYTH: The program encourages powerlessness  and self-degradation through admissions of powerlessness and subjecting people  to a moral inventory, which increases their sense of shame.                       

FACT: The first step of a 12-step program is an admission of powerlessness over an addiction and related unmanageability. The nature of an addiction is loss of control over something. The admission of powerlessness is an admission that the person has a problem and needs help.

It wouldn’t make much sense for the  first step to be “I have control over (insert problem),” and control over my life. If that were the case, there would be a lack of motivation to seek support for recovery from whatever the problem was. Some might say about the concept of  powerlessness, “I’m not responsible for my disease, but I’m responsible for my recovery.”

The fourth, fifth, sixth, and seventh steps discuss “moral inventory,” admitted to another person the “exact nature of our wrongs, ” and removal of “character defects.”

I encourage counselors and others to get the book for whichever 12-step program they are concerned with and read  the process for doing the steps through that program. Each 12-step program has its own  guidelines for conducting an inventory and none of them are a straightforward “write down everything you have done wrong in your life.”

In Alcoholics Anonymous, the inventory largely involves a review of resentments and fears.

MYTH: Twelve step programs are too religious, or are not religious enough.

FACT: I’ve been told by a Pastor he is very much against 12-step programs because they let people choose their own higher power. I’ve had people tell me they are against 12-step programs for being Christian-based.

Twelve-step programs are spiritually-based programs, yet people who claim to be atheists do participate and the spiritual path is an individual one. There is room for many belief systems. Again, rely on what you read in the handbook of a particular 12 step program for information on what is meant by a higher power.

Sometimes individuals in meetings will speak from their particular belief system and this can lead to an impression that the program endorses that particular belief system, when really that was the path of one person in a room with fifty other people, and not based on that particular program’s beliefs.

MYTH: All 12 step meetings are the same.

FACT: There are large variances among the different 12 step programs. Each seems to have its own character. Additionally, there are wide variances among meetings in the same program and these variances can occur even among meetings held at different times at the same location.

One meeting may attract mostly bikers, another mostly business people, another may have a predominance of participants with new-age beliefs, another may have a particular draw for those with Christian beliefs, another may be a mix of all types.

In very small communities the program can look a lot different than it does in a larger community as the program can become dominated by one or two participants who may be operating under their own biases.

Here it is again helpful to read the literature and traditions to know what the program philosophy actually is.  It is also helpful to attend a few meetings at different locations, days, and times, to get a better understanding of variations within a program.

MYTH: Only a very small percentage of people who participate in Twelve-Step programs have success.

FACT: This depends on how you define “participate” and “success.”

If by participate we mean “attend” or “are ordered to attend” meetings, that may be true. If by participate we mean attend a minimum number of meetings, find a home group, get a sponsor and work all the steps, I imagine the percentage of people who have success would be fairly high.

In my experience, the rule of thumb for successful engagement in AA is “ninety meetings in ninety days.” very few people are going to feel comfortable their first few meetings. For Alanon  a person generally needs to commit to attending six meetings in order to start finding the program helpful. Adult Children of Alcoholics meetings usually resonate for people immediately, unless they hit their first meeting on an off day.

Definitions of success can be nebulous in the recovery field. Some treatment centers define success as successful completion of the treatment program and therefore claim very impressive 90% success rates with treating addiction.

MYTH: You have to believe in a higher power or God to try a 12-step program.

FACT:  The steps involve individual exploration of what a person may or may not be willing to use or consider a higher power.  There is no telling what would come out of working the steps for somebody, prior to them working the steps.

I once worked in a detox center where a gentleman came in repeatedly and steadily deteriorated physically over a course of time. It was clear he was going to die from his alcoholism/addiction if something didn’t change.

When I encouraged him to try working the steps of a 12 step program, because all else had failed and he was at the point where his days were numbered, he said he couldn’t get past “the God stuff.”

This was a person that would rather die, and did die at a fairly young age, as opposed to giving the steps a try. My belief continues to be it is certainly worth trying the steps when all else has failed, and as professionals we shouldn’t close the door on 12-step recovery as a possibility for a client based on our own prejudice.

MYTH:  Recovery should be like Disney Land

FACT: I’m always bemused by clients who decline to go into residential treatment or pursue an alternative path to recovery based on not “liking” the situation.

When I’m told by clients they don’t “like” residential treatment, I always let them know I’m glad to hear that and that otherwise I might worry about them.

People don’t have an expectation they will like going to the hospital in order to get medical treatment.

It’s not supposed to be like going on vacation.  Treatment is not supposed to be on par with going to Disneyland.

If we only did what is easy, I doubt if any of us would do much of anything.

MYTH: Some programs are better than others. For example, Alcoholics Anonymous is better than Narcotics Anonymous.

FACT:  Many people qualify for both Alcoholics Anonymous, and Narcotics Anonymous. Some people like AA and don’t like NA and say that AA is “better.” Some people prefer Narcotics Anonymous over AA.  In these situations, it appears to be a matter of personal preference.

Links to some 12-step programs:

Sex Addicts Anonymous – http://www.sexaa.org/

Emotions Anonymous – http://www.emotionsanonymous.org/

Alcoholics Anonymous – http://www.aa.org/?Media=PlayFlash

Narcotics Anonymous – http://www.na.org/

Overeaters Anonymous – http://www.oa.org/

Gamblers Anonymous -

http://www.gamblersanonymous.org/ga/index.php

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Helpful Hints for Success in Counseling

12 July 2011, 4:54 am

Here are some things to keep in mind when accessing counseling services:

1. Having degrees and a license doesn’t necessarily mean a counselor has adequate experience, training or expertise in an area that may be of concern for you.  This can particularly be an issue when it comes to things like couples counseling, domestic violence and substance abuse.

It is okay to call counselors and ask them about their relevant background, knowledge and belief system, prior to scheduling an appointment.

It can be helpful to contact a local residential treatment center, advocacy group, or association that specializes in your area of concern and get names of counselors they are comfortable referring people to.

2.  An element of awkwardness when entering a new situation and talking about things you don’t normally talk about is to be expected. However, pay attention to how comfortable or uncomfortable you feel with somebody.

3.  Some things we go through create a sense of alienation and isolation in our lives.  It is reasonable to expect a certain level of empathy and understanding for your situation. If you feel the same sense of alienation and disconnect in counseling as you do outside of counseling, you may want to find a counselor who is better able to connect with what you are going through.

4. Think about what is important to you and factor that in when scheduling an appointment. It is okay to ask a counselor about their experience with your culture or belief systems.

For example, if you are Native and connected to your cultural roots, you will likely be interested in finding somebody who has respect for indigenous ways.

Your counselor should be open to learning about your culture and beliefs and approaching things in a way that is respectful of the things that matter to you.

5. Don’t substitute a counselor’s judgment for your own. Graduate school doesn’t make us all-knowing.

6. Know that just because your friend went to a particular counselor, loved them and had wonderful results doesn’t meant that counselor  will be a good fit for you.

At least, I have found this to be the case in giving referrals. One person will have outstanding results with a particular  counselor and sing praises. Another person sent to the same counselor will have a different experience and need another referral.

7. Don’t give up if you don’t find a good fit for  you right away.

8. Show up to your appointment even if you didn’t do homework from the session before.  It  isn’t school and you won’t be in trouble for not following through with  something . It just means barriers to doing whatever the task was may need to  be explored, or maybe it wasn’t the right homework for you.

9. This one can be hard, but try to bring yourself to  communicate to the counselor when you feel the session has gotten off track, or  that your needs aren’t being met.

Ideally, your counselor will check in with you on your experience and keep in touch with what your experience is, so things can be adjusted as needed. Unfortunately, a lot of counselors don’t engage their clients in these types of check-ins. Clients usually won’t express concerns about how counseling is going unless asked  directly for feedback, so there is no corrective opportunity.

Your counselor should be open to discussing your concerns. Most of us want to do a good job, I think, and none of us are perfect.

ONCE UPON A TIME I went to a counselor and told them what I was dealing with in my life,  and they missed the importance of what I was telling them.

They expressed little interest in what I shared and asked what my relationship was like with my mother  growing up. They focused on my childhood in each of the three sessions I had with them.

Responses to what I had shared may have been, “What is it like for you to experience this?”  “What are your theories about why this is happening?”  “How would you like me to help you with this?”

Today, I think I would let the person know we weren’t addressing my concerns in the few sessions I attended.   At the time, I felt too vulnerable and self-conscious to speak up.

Experiences such as the one above have helped me be in touch with how important it is to really hear what people are saying and find out what it means to them.

The image I get when thinking of these types of experiences is of the cat that brings the dead mouse home and lays it at their owner’s feet. Maybe I’m wrong, but I think to the cat this is a very big deal.

The cat is essentially saying, “I, The Great Hunter, have brought you a Mouse because I love you and I want you to know that I am The Great Hunter.” Instead of saying, “I see this Mouse and acknowledge you are The Great Hunter and a very good cat,” the person so greatly honored with the mouse-offering misses the magnitude of the gift and throws the mouse away.

 

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Why Therapists No Longer “Just Listen”

5 July 2011, 5:48 am

When seeing a new client in my practice I ask about past experiences in counseling and what they found helpful and unhelpful about their prior experience.

 

The answers are always interesting. They help me know what resonates for that particular client and what to avoid.  In one case, the feedback made me very mindful of what type of shoes I wear and what I do with my feet during sessions.   

 

The thing I’ve heard most often that was deemed to be not helpful was that the therapist just listened and fed back what they heard the client say, which is called reflective listening. If the client asked for feedback the therapist would put it back on them, “What do you think?” which is called being non-directional.

  

Use of reflective listening and unconditional positive regard for the client is generally called Rogerian Counseling, or Person-Centered Counseling. It was developed by Carl Rogers in the 1940s and 1950s. The website www.person-centered-counseling.com states:

 

Rogerian counseling involves the counselor’s entry into the person’s unique phenomenological world. In mirroring this world, the counselor does not disagree or point out contradictions. Neither does he / she attempt to delve into the unconscious…

 

 …A ‘growth promoting climate’ requires the counselor to be congruent, have unconditional positive regard for the person as well as show empathic understanding…

 

Some research shows that 30% of clients who enter therapy will show improvement regardless of what approach the therapist uses. For the 30% in the studies, Rogerian counseling worked just as well as anything else.

 

Research also has shown that clients rate the most positive and transformational instrument of change in the process of therapy, regardless of what approach the therapist used, as being the relationship with their therapist.

 

Apparently, this approach was not the approach preferred by clients who expressed they could have gotten the listening and empathy from other forms of support in their life and expected more from therapy. If it had worked for them, I’m sure they would have stayed with that therapist and not come to see me.

  

Rogerian counseling is on a swift decline, thanks to insurance companies and community mental health funders who want to only pay for evidence-based treatment which involves clearly defined goals and objectives at the outset of counseling that are agreed upon by both the client and therapist, ways of measuring the achievement of those goals, and documented implementation of treatment that has been shown to be effective for a majority of clients in clinical studies.  

 

There is now an expectation that clients can meet their objectives in twelve sessions, the number of sessions usually approved by insurance companies. Employee Assistance Programs generally allow three to six sessions.  We can ask for further sessions on our client’s behalf and often do, but we need to show the issue isn’t lack of use of an evidence-based approach and the need for continued counseling and hoped-for outcome has to be very clear.   

 

Per contractual agreement, the therapist who provides initial EAP sessions often cannot be the therapist who provides sessions beyond that, even if the client is paying for further sessions out of their own pocket. The concern is we will be motivated to keep the client in therapy and that our decision to suggest more counseling represents a conflict of interest if the person were to continue to see us.

 

As far as Rogerian Counseling, sometimes it is what clients want. I’ve come up in a Treatment Plan/Objectives oriented world and some of my growth as a therapist has been to learn to be comfortable with clients who do just want a safe place to talk things out.  

 

I’ve learned to not sit there with measuring instruments and a stop watch shouting, “But WHAT is our goal here? What do you WANT?” with these clients.  For some clients it takes time to trust me enough to let me know what their real concerns are. Some just need and want the support of a safe place to talk. Some things do take time to work through. But, this isn’t a model that managed care models are interested in reimbursing for. As a therapist, it requires comfort with ambiguity.

 

Clients will encounter the therapist-on-steroids more and more and the therapist who “just listens” less and less. Hopefully a norm will evolve that combines the ability to move from one paradigm to another, as needed.

 

In the meantime, know therapists are under incredible pressure to produce measurable results fast these days. Otherwise, we lose our contracts in a world where the number of private-pay client referrals continues to dwindle. Not being on insurance panels or contracted with Employee Assistance Programs or other entities means no referrals these days, for most therapists.

 

If we work in agencies, the agencies are subject to audits by their funders. If client charts don’t document  the use of evidence-based treatment, the agency could potentially lose their funding, or face a hefty penalty. In some cases, the funder will want back all the money they paid for client care for a given time period. In the case of an every-five-year audit, they could (and do) request the return of millions of dollars, depending on the size of the agency and amount reimbursed. This particularly is a possibility with Medicare and Medicaid audits. 

  

The good news is, there are some really good research-based options available these days. If I were not making progress with a client who was struggling with a history of trauma and didn’t refer them to a therapist who was certified in Eye Movement Desensitization and Reprocessing (EMDR) to give that a try, I wouldn’t feel I was being fair to the client.  I recently heard EMDR is not effective with clients who are taking sedatives. Otherwise, EMDR sometimes makes a difference where nothing else has worked and can be done in very few sessions. 

 

Emotionally Focused Couples Therapy is an evidence-based approach for counseling couples in that 70% of couples have been found to have improvement in clinical research.  I haven’t personally read this research, yet.  For now I am assuming it involved a control group and comparison to couples who received other types of therapy, although assumptions can be wrong.

 

I’m going to write a follow-up post on finding an effective therapist for your needs and avoiding a therapist who may be counterproductive for your particular needs. First, I felt a need to explain what the current landscape of therapy looks like. 

 

I do like to leave formal citations for research I discuss. The research quoted above is research I’ve been exposed to repeatedly in literature and lectures over the years and know by heart. I will try to include the citations in the follow-up article. In the meantime, it’s past my bedtime and I have the horrible policy of never going to bed without posting my article, even though we are supposed to sleep on these things.   

  

 

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Leaving the Familiar

3 July 2011, 7:27 pm

I used to teach a class to those who had been subject to domestic violence and were involved in the court system. My job was to teach them the signs of an abusive relationship. At a certain point I would turn the class over to a woman who would tell what I thought of as The Milk Story. I loved this story, for some reason, and would hang on to every word each time I heard it.  The Milk Story seemed to sum up the challenges of blowing up our lives, whatever the circumstances are that lead us to blow up a life we have in the hope there may be something better.

The idea of major change is often thrown out blithely, “Just leave.”  If you don’t like your job, find a new one. Move across country. Granted, there are times in our life when this is easier than others. Sometimes the urge to run away from a current reality is so strong and what we want so clear, there is no doubt.

The most challenging situations involve lack of complete clarity and doubt. Situations where there is no tornado to run away from, just a subtle sense of things not being right. As we get older, change can seem more daunting as the road narrows and we think in terms of less time to recover from mistakes.

Sometimes action is better than inaction. Sometimes we just have to punt, as opposed to sitting on the razor’s edge of indecision in limbo year after year.  But, making the decision to punt is usually hard. There is often a period of grief and doubt, afterwards, which can lead us to take everything back. Then, there are situations in life that call for staying rather than leaving and how do we know which is which?  

The Milk Story

There once was a woman who grew up in a nice home and married and raised a family and did the very best she could with what she knew every single day.  So, one day when she felt a sense of dying inside, she was confused. This didn’t seem right. Why would she, somebody who had always tried to do the right thing, be dying inside?

She brushed the feeling off and got on her with day, but the feeling came back another day; a sense in the pit of her stomach that she was dying inside. The feeling continued to return again and again and eventually she was unable to ignore it. She cried out in frustration one day, “Why?  Why am I dying inside?!” 

To her great surprise, a voice came down from the heavens, “By measure of your faith it will be done unto you.” 

“What? By measure of my faith?” This made no sense to her, but over time it became clear she was being asked to empty her glass.

What she had nourished herself with every day of her entire adult life was a glass of milk that was rancid. Of course this is what she nourished herself with, it was all she had.

The idea of completely emptying out everything in her glass was terrifying. She made a few efforts to do this, here and there. She would dump out some of what was in her glass and then panic, scooping it back up and putting it back in as fast as she could.

Finally the day came when a remarkable thing happened. She somehow had the courage to empty her glass. She dumped the entire contents onto the ground and stood there afraid and trembling, holding a completely empty glass.

Standing there with a completely empty glass is a terrifying thing.  This is what is called an identity crisis. Fortunately, physics tells us that nature abhors a void. The lady who volunteered her time to come tell this story twice a month (I think her name was Vicky) would say, “This is science ladies!” Nature abhors a void.  Vacuums are made to be filled. When cold wind rushes out of a valley, warm air rushes in.

Slowly, over time, the woman’s glass became filled again. This time she put a little screen over the top and was very mindful of what she let in.  If she went out to lunch with a friend and found herself feeling fat or stupid or somehow off-balance and confused, she would avoid going out to lunch with that person again.

If she went out to lunch with somebody and found herself laughing and feeling light and good about herself, she would seek out that person’s company again.

Over time, her glass was filled with nourishment and the sense of being poisoned went away.

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Death Ray Thoughts and Limitations of Mind Reading

30 June 2011, 11:32 pm

Today I was on the phone with a friend and they mentioned their partner interrupting them when they are engaging in a certain activity. This was seen as a sign of inconsideration. I asked if they let their partner know they don’t want to be interrupted. They stated they had not. They told me they send “death ray thoughts” when interrupted.  

I suggested they let their partner know they don’t want to be interrupted.  In a normal world, they may need to let their partner know more than once. Maybe they can get it down to their partner interrupting one out of four times. We are impulsive and habitual creatures and some have more of a desire to touch base with their partner than others.  Aside from that, things often require repetition before they stick. 

One thing is clear: Their partner can’t read their mind. Yet, many people seem to think others should just “know.” Actually, people can’t read our minds. Isn’t this a good thing? 

Other times, people think they are communicating their needs when they are not. I have a friend who doesn’t want people to pet her dog, because the dog doesn’t like being approached by strangers. She lamented how inconsiderate people are in approaching the dog when she tells them not to.

One day, I was with her when she let people know to leave the dog alone and in spite of her telling them to leave the dog alone, they insisted on petting the dog.

What she actually did was smile when somebody walked up to pet the dog and said in a soft, jovial voice, “He might bite,” and then laughed nervously. People had no way of knowing what she meant was “Please leave my dog alone.” 

If we think others should know what we want without telling them at all, we definitely think they should get it when we hint. Actually, some people just don’t pick up on hints. It may be as in the case of my friend and her dog, where she is coming across as being friendly and approachable when what she means is “Go away.” 

In the case of my husband, he doesn’t pick up on hints, period. I could say, “It sure would be nice if SOMEBODY cleaned the kitchen, and glare at him. I could leave the dishrag on his chair. I could complain about how much time it has taken me to clean the kitchen each day. I could say, “It sure would be nice if somebody helped with the kitchen.”  I could let things pile up in the kitchen. 

My husband is a nice, intelligent man who I think would do anything for me, but he does not get hints. If I didn’t know that about him, I could go to martyrdom in a situation like the one above. I could start thinking he clearly doesn’t care about me and my needs.

Once I start down that track, I could start thinking about other ways I’ve been wronged, putting each thought like a stone on top of the other, until I build a little wall. 

Fortunately, since I’m a Marriage and Family therapist, I am automatically a perfect wife (okay, that was  a joke).    One thing I do know, is I need to communicate clearly and not go to martyrdom over the idea my partner should just know what I need (after all, didn’t I slam the dishes around when I was washing them?)

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