Thanks!

I want to recognize the contribution of those supporting this blog

~Your donations are appreciated.~
 
 At this point, there have been a number of donations by you, the readers and you the members of the blog.
I do this blog as a gift.  I feel I have been privileged to come from a family that encouraged education.  I feel honored by all the people who have come to my practice and trusted me with their most personal concerns.  Because of these 2 things (well, I also have done a lot of hard work for a long time---got to give myself credit!), I have a tremendous inner resource. 
Look at how much I have written---and, still going strong!

This blog is my offering but it is so heartwarming to me when I receive a donation.  I can do a whole lot on my own steam but I need encouragement just like anyone else.  So, thank you for your contributions.

This blog shows a lot of promise.

This is a user supported blog.

Dial 411 for Information

Announcement
  If you would like to see an interview done with me by LoveAnswer, here's the link:   http://www.loveanswer.net/interview-with-a-loveanswer-net-relationship-specialist/.  This site has also published an E-Book about mistakes that men make with women and some suggestions to men on what to do about it.  I wrote some of the pieces for this book but the contributing authors are not named.  See if you can recognize my work!

* * * * *

 Dial A Therapist's Thoughts for 411 posts on learning and memory, the butterfly effect, transparency, 1st therapy session, how therapy works, true intention and how to use it, feelings, dream boards, fear of death, children's imaginary companions, and many, many more.  Isn't even that little sample list interesting?  If you just landed here, doesn't that sound inviting?

Frustrating For Me

Wasted Posts

You all, the wonderful people who come to my blog seeking something, seem to me to be missing out.  When you come here and see something you like and want to explore more, naturally you click on one of the Popular Posts on that list. 

So, what happens is that------Google counts the visits to each post and, thus, the same posts get listed and re-listed as being the most popular because most visits are limited to those posts.

There are 360 posts here (there are only 10 on that list), probably at least a few of that other 350  are better than those on that list.  Or, maybe there are some that will be of more interest to you, in particular.

So, please try some other search methods:

1. Click on a label that sounds intriguing
2. Type a word or topic into the search bar
3. A 3rd way is to go to the Archive and click on a month

I promise, there is more here, much much more than just what shows on that list of 10 "Popular Posts". 

Besides that, you don't want me to be frustrated do you?

Sometimes Ignorance is Bliss

A little mid-week lightheartedness                         

  There are some who just will not follow the rules.

Flow

Flow is linked to happiness, health, and, even to success

"Flow is the feeling of total immersion in an activity with the loss of a sense of time and sometimes of self; in flow, emotions are positive, energized, and focused solely on the task at hand."  Mihaly Csikszentmihalyi.  

Credited with authoring the concept or notion of "flow", he has also said:  It is the creative moment when a person is completely involved in an activity for its own sake.

Sometimes we will hear people say things like, 'As I was playing the piano today, I got completely lost in the music.' or, 'I was so immersed in the experiment that I totally lost track of time.'  These experiences are so common  that expressions have evolved into the language to express them. 

And, yet, often we don't notice.  Once we finally interrupt ourselves or, are interrupted, by everyday demands, we forget to remark upon the the fact that we were feeling joy.

Most people want to be happy, and in fact, pursue happiness as if it were an obtainable object.  And, yet, many of us are enjoying the positive emotions that are vital to health, well-being, and, happiness itself on a routine basis.  It seems as if we just don't know to take note of it.

So, notice!

From Dacher Keltner, here are some words to help you focus on the good in your own life experience:  

• play and mirth
• beauty
• compassion and empathy
• contentment and savoring

See my related post, titled, Reverse Charting
http://therapiststhoughts.blogspot.com/2010/09/reverse-charting.html  
and
Nourishment to the Soul
http://therapiststhoughts.blogspot.com/2010/06/nourishment-to-soul.html

During what times, experiences, encounters, do you experience flow?---please share with us.

Wishes Come True

A fantasy of mine or, imagining having a magic wand

This weekend, I bought a state lottery ticket.  The jackpot is $241,000,000.  It's a lot of money in my book.  Isn't it fun to dream about what you will do if you win?

One of the things that I like to think about is how I could make wishes come true.  

My dear friend who has a terminal illness and is struggling and fighting to stay alive---I would pay for the world's best doctors who specialize in his diagnosis.  I have a young relative who really wants to move but doesn't have the wherewithal to accomplish that.  Voila!  I would move her.  I know a couple who have a house and a car but they need a second car and a new house.  Or, even more fun would be to re-model, completely, the house they have.  Speaking of properties, I do know someone who is caught in this 'under water' loan situation that now exists here (value at which property was bought and for which a bank loan was procured, is now worth thousands of dollars less); I would take care of that in a minute!  I have a colleague, a wonderful, talented therapist who has her office in the middle of a very poor community.  She has made the interior of her office very attractive but, her landlord at her building is unwilling to do any repairs or upkeep.  It would be fun to buy that building, get her a receptionist and fix it all up so she could be comfortable in that important work she is doing.  Thinking about work, I know an artist and a yoga teacher each of whom would be ecstatic to have their own studio.  Done!  Magic!

Daydreaming:  I love to fantasize about this.  How would I do it?  Would I be an anonymous good fairy or a joyful friend?  

Every time I ponder this, I think of different people who have shared their dreams with me or, even who haven't but, just obviously could flourish with that one added thing that is out of their reach financially.
 It's fun.
This is a huge departure for me.  I've never written on the blog about anything so simply personal.  Sharing a bit of my inner child, I guess.  Usually you only hear my adult, professional voice.  I thought maybe there would be someone out there who could understand this fantasy, so I indulged myself today.

By the way, it isn't that I don't have my own wishes.  Of course I do.  Just like anybody does.  And I like to imagine being able to have those too.  It's all part of a happy daydream.

P.S.  No sooner did I write this (not posted yet, still in draft) but one of my clients said, sharing a regret:  "Every day I wake up  wishing I had finished school."  Funny how that happened, huh.  Wish I could make his dream come true.

Vulnerability

An inspiring video

  If you have 20 minutes, this is an encouraging video to watch.  Like many talks and books, it gets better as it goes.  Get past the 1st 2 minutes and then she, the speaker, starts rolling.  By the time you get to the end, you'll get to the good stuff.

http://www.ted.com/talks/brene_brown_on_vulnerability.html

I think that if you watch this, you'll find that it fits with my message here at the blog.

Let me know.  Did you like it?

Dalai Lama

May 16, 2012  -

The many factors which divide us are actually much more superficial than those we share. Despite all of the things that differentiate us – race, language, religion, gender, wealth and so on – we are all equal concerning our fundamental humanity

Call For Participation

Asking Your Advice

This is  not a half-hearted offering.  This is not a neglected blog.  This is not something I do in an off-handed way.  I work on this blog every single day ( yes, really---every day).  It's a devotion.

Writing to you comes naturally to me.  The computer, I wrestle with.  I did not grow up with computers, so sometimes I spend a lot of time trying to get something changed or added or fixed, here.  Some blogs are snazzier than mine with things zooming across the page, pictures that can be moved by placing your cursor on it, and so on.  But even though my presentation is simple, I make no apology for my content.  It is solid.  And, I put my heart into that,---well, into the creation of the whole blog, really.  But, I just feel fine about what I am offering, in ideas, in sharing inspirational quotes, in offering summaries of seminars I attend, and in stories about the dear people who are my patients.  Even my photographs, which my daughter told me are "quirky", I like (quirky can be okay).  In fact, I believe they've gotten better over time.
 I think having healthy self-esteem means you can own your personal assets and be grateful for and proud of them  while, at the same time, not being afraid of recognizing your limits and weak points.  I mean to be a role model for that here.

When I began the blog, it was a full-out wish to give and to share.  I've written about benefactors before and about paying it forward and the butterfly effect.  I was wanting to be a benefactor to the world, in a way or, at least, to be a butterfly effect in starting something good.

It has been so much fun for me to see the map that Google provides me and note the different countries that my lovely readers are from.                  

Artist, Elisabeth Lecourt

  In fact, I have a paper map up on my wall with a colored stick pin in each country that has visited here.  I know what's in my heart---my intention is to help, to lift up spiritually, to introduce possibilities, to spark your imagination, and to create an alive space for you---in which you can grow, evolve, and learn.
That sounds awfully ambitious, doesn't it.  But, I do it at my office, in my psychotherapy practice. Some of the comments you have written have been such a great addition.  When I see that, I know that what I hope for is happening.  It's really wonderful and exciting for me!

Much earlier in the blog, I tried, briefly, allowing advertisers to place ads there.  That didn't last long!  Ugh!  Some of the ads were so inappropriate, it was almost funny.  When an ad came up that was exactly opposite to the intention of my post (maybe some of you saw it, it was on the post titled, Shyly), they were out!  I also just didn't like the commercial look of having advertising on here.
This is a professional blog, a loving, personal, professional blog.  It has it's own character.  I just couldn't stand compromising my message.  I had Amazon as an option for readers to use until they (Amazon) had some trouble with California laws.  When they got that straightened out, I didn't re-up with them as my readers had never used that option.

Recently I have been trying to notice how much time I actually spend on the blog.  It's hard to tell as I go to it first thing in the morning (yes, I first look to see who's come to visit! You are important to me); I work on it in the evening, on weekends (it is Saturday morning right now) and, once in a while, I get to work on it in the middle of the day.  Usually though, I am working at the office (most therapists refer to that as "the consultation room"...!) with my patients at that time.   I guesstimate it at, maybe 30 or more hours a week.
In 2011, I made an attempt in the other direction, instead of seeking support for the blog, I tried doing less for the blog; to make the blog less taxing on me, I reduced my frequency of posting-if you look at the archive on the right, you'll see the difference in the total number of posts between 2010 and 2011.  I am still on the new program, but it really isn't the answer.  For the blog to be what I want it to be, for my readers---high quality information, interspersed with some lighthearted offerings, and generally current, positive, and useful---it requires attention.
So, as I approach my anniversary of putting out this publication for three years, I have thought about how can I continue to sustain this on my own.  I know that there are a number of ways to generate some income from a blog, like pay-per-click, turnkey service, advertising and affiliate programs, paid subscriptions, EFT from reader to blogger, etc.  I really don't want to go the commercial advertising route again.  If I had one, or a few good sponsors who were selling something that was congruent with what I am trying to do here, that would be wonderful.  But, so far, they have not appeared...!
I don't want to do a paid membership blog because part of my vision for this offering is to make something available to people who may not have access to it otherwise.  

What do you think?  I am calling for your participation here.  Do you have any ideas about how I can generate some income to support the blog?

 This is, this time, writing to you not about what I've learned but, writing to you to learn.

  First post on this topic:  http://therapiststhoughts.blogspot.com/2012/03/is-three-lucky-number.html

Please comment


  
Artist, Brian Kershisnik 

A New Friend

Dear Kim.  What a nice surprise for me to find you here this morning!  You are my 21st Follower.  Does that make me a grown-up blogger now?  (just a little friendly humor).

For those of you who like to explore what the other Followers are doing, Kim is producing a very attractive and useful blog herself; she has an idea about how to deal with worry that I think you may find comforting.  Check it out.

Once Bitten, Twice Shy

One reader has answered the poll so far; the vote was for posts about therapists.  So here it is.

 A new and improved product.  We are constantly being told that we are getting the new and improved version of toothpaste, floor cleaner, running shoes, and a myriad other products which we are being urged to buy.  The best deal is when you get the new and improved cereal for the same price!
Most of us are pretty immune to this advertising ploy by now.  Once you have fallen for that line, bought the new version of your toothpaste and found that it was really the same just fine toothpaste you always had, this sales pitch falls on deaf ears.

However, there IS something that does get constantly improved.  It's not a product, it's a service.  If you are in therapy, in most areas, a licensed therapist is legally required to keep improving!  My state, for example, requires 36 hours of continuing education every two years.  If I don't complete that training requirement, I can't renew my license.  If I am not licensed, I cannot legally practice psychotherapy in my state.
Something like this is true for almost all licensed therapists.  So, even if your therapist doesn't talk about it (although, you could ask if you are curious), they are probably attending seminars and workshops all the time that they are working with you.  So, they are learning, expanding their knowledge base, and, being stimulated to think in new ways, on-going.  If you conclude your therapy and then decide to begin anew after some time has passed, you should actually, for real, find a "new and improved version" of your therapist awaiting you!

In addition, most therapists avail themselves of therapy themselves or, have done.  Some, also go for consultation; in other words, if they have a case that they feel they need another therapist's input on, or they are unsure of the effectiveness of their direction with the patient, or they are looking for suggestions about how to help a particular patient or couple or family, they may go to a colleague for advice.

A less expensive alternative is to form a consultation group with colleagues where there are regular meetings designed to discuss cases, talk about oneself as a therapist, share new research information, talk about the business aspect of running a practice and anything else that might be productive for the members.  This is good in that it is continuous, not just sought for a discrete problem as in seeking consultation with another therapist on a particular question/issue and, there is the advantage of getting feedback from several points of view.  In the group, there is, as in all groups, the second hand learning that also takes place, i.e., we learn by listening to others struggle through their conundrums.

In addition to my required trainings, I, myself currently do two of the three outlined, additional educational activities.   
I also read a lot in my field, participate in on-line discussions with other therapists, and hold a lifetime membership in my professional association which also keeps me updated.  Yep, I admit it, I am an egghead!

How complicated it is to become a therapist and what it takes to maintain oneself in that profession is understandably, not apparent to the consumer.  It's a lot easier to see, when an attorney writes a complex brief or a surgeon performs a curative intervention, how much training they must have.
A therapist who is sitting with you, smiling  as they listen may appear to be doing something easy. 

However, they are also remaining present when you dissolve into tears, remembering from session to session- what your issues are, thinking with you, trying to understand your story, holding themselves in a position of compassion, looking for patterns, considering what they might offer that will be helpful, and attempting to hear beneath the surface.  On the face of it, it can look like nothing more than a social visit.  But, what is really occurring is much more than a simple visit.
 
The level of responsibility that a therapist shoulders is not necessarily apparent to the patient but, it is to the state, thus the demanding requirements, rules, laws and regulations that they have in place.

Of course, some therapists will do the minimum requirement, others will pursue their work as a calling, and there will always be everything in between---as in all professions.  But, at least to some degree, you are guaranteed a, if not new, continually improved, 'product,' as you go!

Is the information here of interest to you?  Please comment!

Biggest Bang For Your Buck

How to Get The Most Out of Your Therapy Session

 The post I wrote about therapists, called The Imperfect Therapist, has received a lot of attention and continues to attract a lot of readers.   That post discusses what you should expect from a therapist.  However, there are two sides to the story.  How beneficial your therapy is depends, not only on how effective your therapist is but, also, on what you bring to the table.
If you've never been through a course of therapy, it's hard to know how to make the most of it.
How to best use therapy is actually something to be learned.  It is different from  going to other professionals such as a medical doctor or accountant, or tax preparer, or dentist or financial adviser or lawyer since these people usually do something specific to or for you.  For example, a dentist does a procedure to your teeth (oooo, we don't really want to think about that too much, do we!), a lawyer drafts a will, a doctor writes a prescription, and so forth.  So, to these professionals, you simply present your problem and they do something about it. 

The difference in working with a therapist is that it is a collaborative effort.  So the best therapist in the world can't  be very successful with you if you go to them with all your defenses up:  They can't help you move in the most productive direction for you if you lie;  if you are hiding your feelings and restricting what you share, it will be hard for the therapist to make a connection with you.  Your therapist will be trying to begin and build, a trusting, reciprocal, safe, creative relationship with you.

 ~Most therapy effectiveness studies show that the quality of the relationship with the therapist is the most significant determinant of the outcome of the therapy.~

Therefore, the first step is to carefully select your therapist.  Personal referrals are good if you are lucky enough to know someone who has a therapist they like and think would be good for you.  Otherwise, beyond the basic credentials, you want to look for someone experienced, who seems competent to you, and with whom you can feel comfortable.  I don't mean that therapy is always going to be a cake walk, just that you should feel faith in doing your personal work with this particular person.

Next:

• Think about yourself before your session.  You may have a lot of things on your mind, but, try to feel what is foremost.  What has the most charge for you?  Bring that to your session.

•  Leave your cell phone in the car.  It is a distraction, even on vibe.  Your therapist isn't answering the phone during your session (I hope!), nor interrupting her attention on you to glance at incoming cell calls.  Take the therapy hour as time for yourself; leave your other obligations aside for the session and devote it, uninterrupted, to yourself.              

• Try to make it to every appointment if at all possible.  There is a psychological rhythm that gets established if you attend therapy regularly.

• Stay focused in the session.  It doesn't mean that free association shouldn't happen---sometimes insights come up---and it is an off-shoot of your original focus.  That's all right.  In fact, that's good.  Sometimes great leaps of learning take place there.  But what isn't good is if you just go off on tangent after tangent and end up only having poured out your mind contents without achieving any in-depth understanding on any of it.  That can  be frustrating if it happens a lot.

• Allow yourself to truly consider what suggestions your therapist might offer.  Sometimes the pent up emotionality of a topic will make it difficult for the patient to listen.  If you can't really consider it in the session, try still to take  in what your therapist says and consider it later. 

•  Have both your feelings and your thinking in gear during your session.

• Be forthcoming.  Be flowing rather than self-inhibiting.   The more you offer up, the more your therapist and you have to engage with and to consider.  Don't be a tightwad!  Be generous with your inner self and personal information in therapy.

• Think about what transpired in your session afterwords.  If it is at all possible, take some time right after your visit to digest what has occurred.  It's better not to just put it away and go running off to the next task in your day.  Definitely don't spew it all out to a friend or spouse or relative.  Even if you feel a lot about some of it---excited, stirred up, puzzled, or anything else, it's better to stay with that feeling and see what evolves.  If you immediately share it with someone else, it dilutes the therapeutic effect.

 If you stay in the process, you may continue to move along in your personal growth or toward the resolution of a problem, during the time between sessions; you may have realizations that result from what occurred in the session.  This is ideal as you hope one day, to be able to grow and change on your own.  By the way, therapy does ultimately help you to become more independent and differentiated.  It can take time, and you may feel dependent on your therapist for awhile, but, eventually you will begin to discover self clarification and firmer boundaries,  more flexibility, increased consciousness, and an improved ability to make good decisions for yourself.

Therapy is not only for problem-solving; it can also serve to help you grow and mature.  It even has, sometimes, an effect of improving physical health.                                                                  

Does therapy sound effortful?  Well, yes, it is.  To get the most out of it, you have to put something into it.  But, on the other hand, in an on-going therapy relationship, there is always room for just using a session here and there, for some nurturing and understanding.  If you have been sincere and genuinely sharing with your therapist, the therapist will be able to offer you attentive listening and real compassion.  Now there's a rare and treasured life experience.

Please share your reactions and comments.

Our Uncertain Situation

We Live in Ambiguity

As certain as we are here now, we truly do not know what tomorrow will bring.   We function based on an educated guess but what we all know is that, we really don't know.  A lot of us try to pretend, to ourselves, that we know.   We do things to safeguard the future to try to make it as predictable as possible.  We know we will die but many of us try not to know that and, indeed, we can't know when or how.
A certain amount of denial is necessary, I suppose.  How would we function without it?  For example, we can't think every time we get into our car to go somewhere that we are in charge of a 2 ton weapon.  We'd never head out for anywhere!  Who would take the chance!  The current film, The Tree of Life seems, to me, to try to address or at least display this uncertainty in part.

Here is another offering on this subject:

September 19, 2012

"THE DREAM OF CONSTANT OKAYNESS

It’s not impermanence per se, or even knowing we’re going to die, that is the cause of our suffering, the Buddha taught. Rather, it’s our resistance to the fundamental uncertainty of our situation. Our discomfort arises from all of our efforts to put ground under our feet, to realize our dream of constant okayness. When we resist change, it’s called suffering. But when we can completely let go and not struggle against it, when we can embrace the groundlessness of our situation and relax into its dynamic quality, that’s called enlightenment, or awakening to our true nature, to our fundamental goodness. Another word for that is freedom—freedom from struggling against the fundamental ambiguity of being human."  Pema Chodron

Sometimes people think that therapists are weird or therapists are different from ordinary people or, even, that therapists have magical powers.  Actually therapists have families, and problems, and bills to pay, and good luck and bad luck, and health issues and schedules and pets and so on, just like everyone else.
The one way that we may be different is in being more able to or, perhaps, more accustomed to, sitting in the ambiguity.     We have to learn how to not always have an instant answer for everyone.
We have to try not to decide for a client what is right for them.  For the most part, we do not tell people what to do.  We have to learn to position ourselves in the middle of another person's ambivalence or two-horned dilemma and see both sides. (You may notice that this is part of what makes a discussion of your problem with a therapist different from your discussion of it with a relative or friend.)   We have to be able to stay there with the patient while the patient struggles with their effort toward resolution. 

Sometimes our role requires us to sit with someone while they suffer.  Sometimes a therapist so wants to save that person or, at least relieve them of their pain in the moment,---of their sadness, with comfort.  But, that's just what it would be, momentary.  And, in so doing we would rob them of possible progress toward an insight.

We help people toward integration by staying with them and helping them stay with, and not avoid, their issue.  We are facilitators; we try to help our patients find their own way.

We tolerate what may ordinarily be uncomfortable so that the patient has a better chance of facing their own reality.

Here is a lovely quote on this topic, written by Tom Kelly, MSW, called Learning to Live with Not Knowing:  "Jung's concept of individuation is often misconstrued as striving for a nirvana-like state of bliss.  In truth, individuation---the process through which we form our own personalities

apart from others---is anything but a comfortable journey into wholeness.  Our psyche requires that we go beyond the familiar to confront the unknown in the world and the unknown parts of ourselves.  The challenges we face are giving up the illusion of control, developing a living and vibrant relationship with our own psyche, and learning to live with not knowing."

Over and Over

The one tip that so many guys need.

Women are different sexually from men.  Most guys learn that one fairly early.  But do guys ever get, i.e. really take in, the one thing that I hear over and over again in my office, from women?

Here it is:     For women, unlike men, visual cues and genital stimulation are not enough.  Women need a lead-in, historically referred to as, "fore-play".  I actually don't like this word as it denotes a separation of sexual stages that isn't really true to reality.  Women need, usually, a feeling of closeness, before and during sexual activity with a man (and, ideally, also after---start the cycle again!).  Sometimes this may be expressed as a wish from the woman for a romantic gesture on the part of the male.  Some women want personal attention which can come in many forms, one of which would be feeling attractive and desirable.The closeness can be developed in a number of ways, such as:

• An unexpected gift, or
• a hug or other physical affection, or
• the doing of something for her, or 
• verbal declarations of love or fondness, or appreciation of her beauty or her personal qualities. 
• Sometimes even doing something for someone she loves, such as her child, can produce tremendous tenderness in a woman.  

• Quality time is important to sustaining and enhancing almost any relationship.  Spend time together that is especially designated for the 2 of you.  At that time do the things suggested in the post titled, You Can Catch More Flies With Honey Than Vinegar.  Quality time is when the time is primarily devoted to being together.  And, I'm sure there are more ways---maybe you can think of some and share them in the comment section here.                                                                                                                                                         Any or all of these are worth doing.  Some will have more effect on a particular woman than others.  But, don't make the common guy-mistake of testing until you find the one that gets the quickest and biggest reaction and just keep repeating that.  It doesn't work that way for women and, besides, the woman will catch on and begin to feel manipulated.  The point here is, you need to move into an emotionally intimate space (for real, not just with an end-goal in mind) with the woman before, during, and after the physical intimacy.                                                    Five Love Languages by Gary Chapman is a book that discusses in more detail most of the above suggestions in the bullet list.

Of course, women can force a sexual response out of themselves without the emotional intimacy being present but, it is far less enjoyable and satisfying.  It may even be harder to get her engaged the next time.  It seems to be very difficult for men to really believe this, probably because it is so different from how they function.  For men, sex is much more direct and, in a way, simpler.  Of course, by the same token, it is difficult for women to understand the male side too.
Sticking to the subject, for this post, anyway, for most women, relationship is everything.  They may be able to "multi-task", to accomplish tremendous things in the outer world or the domestic world; they may have great success in many spheres of life.  But, if their primary relationship is in trouble, it will affect everything for them.  They may be well able to hide it, at work, etc. but they feel it.  It colors the mood of their day until it is remedied.  This is also different from men in that they (men) are more likely to "compartmentalize".  For men, one part of their life doesn't necessarily spill over into another.  Thus, for women, an unhappy relationship is, really, an unhappy life.

Rule of thumb:  A happy woman is more likely to be interested in sex.  A woman who gets the extended version of sex outlined above is much more likely to be happy.

So, You Want To Be Free

                                  The Wish For Personal Freedom vs. Reality 

 "Brother.  Sister.  So you want to be free.  To live your life the way you want to be."
These are the opening lyrics to a song recorded by the artist, Seal.

I seem to be hearing a lot about the subject of freedom in my therapy office lately.  Of course, this is coming from patients who enjoy living in a country which has the Bill of Rights; the Bill of Rights guarantees us many freedoms, such as freedom of speech, the freedom to practice the religion of our choice, the right to a trial in the case of being criminally prosecuted, and many more.  Abraham Maslow, who studied and wrote about the human being's potential for positive development, would say that it is for this very reason-the fact that we already have all these freedoms-that we might be able to imagine even more.
What the people I am thinking about now are hankering for is freedom from societal constraints.
Here are some examples:  A 25 year old male patient (who is with me due to drug abuse, now 'clean and sober'), completed junior college, had planned to go on to a four year university to earn his degree but now has decided he doesn't really like school and that is it very freeing to him to consider giving up college.  He has been in a steady relationship with a young woman and now has begun seeing others and recently broke up with her.  He has declared that it feels so much better
to him to 'play the field'.  He was athletic and has freed himself from the constraints of being a part of a team.  He enjoys playing the guitar and it comes to him rather naturally.  So, he is planning to become a musician and imagines making lots of money very easily.  His first role model, his Dad, actually earned his advanced academic degree during the early years of Jason's youth.  His Dad is now in his profession and still working very hard.  Thus, Jason had an example of someone spending a lot of energy on achieving a goal and realizing that goal. However,  rather than looking at it this way, he sees his Dad as being too serious.  He avoids his Dad because he doesn't want to be around anyone who might rain on his parade. So although he began following in his father's footsteps, he, for now anyway, has chosen to veer off into a different path.

The second patient I am struck with as I think about this wish for freedom is a 46 year old woman, a breast cancer survivor who, just as she was about to make the 5 year mark, cancer-free, has been diagnosed with a metastasis.  She is now in a situation where the cancer will not be cured.  It can be managed for awhile.  She will, (over a long period of time) gradually feel worse and worse.  She now calls it a "condition"; it is a chronic, progressive, terminal condition.  Right now though, she is functioning almost normally---working, attending to her teen-age child's needs, and generally maintaining her life.  But, she had an affair, an affair with an old work acquaintance.  This man, whom she hadn't seen in years, had previously been a flirtation, someone she was quite attracted to.  But that was long before the cancer diagnosis and she is a married woman so she resisted the temptation.  Her rationalization for betraying her husband now is that she has this horrible condition and she should, therefore, be able to do what she wants.  She feels somewhat self-righteous about  how she is suffering, what she is facing, and her right to do as she pleases and have fun now, while she can.

What do you think about these two situations?  Are these people making the right choices?

I've been noticing this wish for personal freedom as, at least, a sub-theme, in a number of my cases lately.  Probably it has always been present but being so prominent in these two cases has high-lighted it for me.  Other ways that people may more commonly and less dramatically try for this sensation is through consuming alcohol to disinhibit themselves or by going to places where they are a stranger; some people think, especially when they are in a foreign country, that common sense and common courtesy no longer apply.

What are some other methods that people may use to feel free?  I'm interested in hearing your thoughts on this.

It seems to me that, as social animals, we are bound to live in the midst of others.  It doesn't seem possible, under that condition, to escape all rules of conduct.  There are some who isolate themselves from other people; we usually call them hermits or a recluse or, an eccentric.  It isn't considered normal to completely cut oneself off from interaction with others.
So, how possible is it to have it both ways---not too possible I think.  It's sometimes called "having your cake and eating it too."

As children, we clearly don't have much freedom (school, parents), as adolescents we long for the apparent freedom of adulthood because, as teens we still have school, parents, rules, curfews, etc.  But it seems that the glittering world of adulthood actually has even more rules, regulations, codes, obligations, and responsibilities, which we find out when we get there!  Not so glamorous, huh!
But to live in harmony with others, we can't steal, run our car as fast as we want no matter where we are, ignore whatever role we might be playing in any institution and think only of what we want for ourselves, arrive at work whenever we feel like it, etc.  Other people will get mad!  Other people will protest!
The achievement of a college degree or a high school diploma or a certification in a trade or craft requires more than just obeying the law.  It also demands self-discipline.  However, this kind of training means it will be easier to be hired in a desired job.  It usually means a higher income.

To enjoy the benefit of a companion who commits to sharing your life with you requires tremendous self-restraint---in what you do (and don't do!), in how and where you spend your time, your energy, and in on-going attention.
A radiologist, in this country makes an incredibly high salary-about $350,000. per year.  But doctors have to complete  24-25 years of school and residency programs.  It is a prolonged period of self-discipline and there is a pay-off.
"Freedom is just another word for nothin' left to lose."  Janis Joplin, song title:  Me and Bobby McGee.
I think that we can function very well and be healthy mentally if we simply take the constraints of the business, legal, and social world as a given and don't try too hard to escape.  After all, we always get to think, privately, whatever we want!!!  A true and permanent freedom.

The Imperfect Therapist

                                      What can you expect of a therapist?
Good therapists, bad therapists, outright quacks, inspired brilliant therapists, terrible therapists, therapists who have a seemingly endless reservoir of compassion, and, the truly gifted therapist---they're all out there.  I get some of the fall-out in my office from the not-so-good counselors and it is sometimes astonishing to me, the things I hear clients tell me that happened to them with another therapist.  Some of the outrageous things I have heard include, the therapist falling asleep in the session, the therapist reprimanding a patient for nervously wringing her hands in a first session, the therapist asking a question and then getting angry at the patient for their (honest) answer.  And the list goes on and on.  The resilience and determination of these people who got unlucky on their first try but still persisted until they found someone who could actually help, is laudable.
Therapy is a valuable and wonderful resource for us all.  In the post titled, Cute Client Comment, I have a link to a concise article about the benefits of psychotherapy.  But to be effective, it has to be the right match.  No therapist is going to be the best choice for everyone.  But, there are some, who are almost in a calling to the profession,  and those, will be best for most people.

You would think, with all the training* that we are required to get, that we would all be excellent helpers, but, just like doctors---some are better than others.  Part of the effectiveness of the therapist is in the match or, that elusive thing we sometimes call, "chemistry":   How do you feel in that person's presence?  How's the interaction between the two of you?  Do you feel accepted?  Does the therapist seem comfortable in their job, comfortable with you, and in considering the problems you present?  Does the therapist seem to have less anxiety than you do?!
 
As time goes on, you should begin to feel that you are in a real relationship.  A professional helping relationship is, of course, different from your friendships---you want it to be; that's why you're there.  It is mostly one-sided, you will not learn much about the therapist's personal life.  They may share a little, here and there-especially the more relaxed, experienced ones or they may share for a purpose:  There may be something you are struggling with and the therapist herself has a good example from her personal life to illuminate the topic.  Or, sometimes a therapist may share with you that something difficult is going on with them in their own life so that the patient doesn't sense something is wrong and misinterpret it to be about them.  I have done both of these.  But, generally, a therapist is trained to be not too revealing and there is solid scientific reason for that.


If you are currently in therapy, there are a few things you should not hold against your therapist.  The therapist may not always remember every detail of your life.  This is especially true if you don't attend regular weekly sessions.  There's something about that consistent contact that seems to keep the file on you in the forward position in the therapist's mind.  But, think for a minute how much a therapist has to remember...They have to keep the names, relationships, events, and facts of a person's entire life---whatever has been shared in the therapy office---in their immediate memory.  And the therapist has to do this for a number of people.  It isn't easy to remember all about a person you've never met but we must do that as, often, patients want counseling about their relationships with other people in their lives.  Thus the therapist has to remember and retain an impression of, and even facts about, that other person-so important to the patient but, only heard about-by the therapist.  Sometimes my patients will bring me a picture, a snapshot of their family or, a particular person they have issues with.  That helps me to fill out the image in my mind.

A reason that I may miss a detail (and so I imagine other therapists may do this too-I hope they do!), is that facts are not where my focus is.  I am looking for the deeper meaning for the patient or I am working on delineating a pattern in the person's functioning or I may be noticing an incongruency that seems important.  This kind of listening is what is different from what one can expect from a friend.  It is what you come to a therapist for.  So, try not to be impatient if a therapist forgets one little fact.  Try not to say to your therapist:  "I told you that!!"

Also, while it appears that therapists make big money, we don't.  The public sees us getting anywhere from $40. to $200 or more, per session, and multiplies that by 40 hours per week.  Well, with all the paperwork, phone calls, treatment planning, and, yes, sometimes worrying about people, we do clock in 40 hours, and then some.  However, a full-time practice is but 20 sessions per week.  Some practitioners can't tolerate even that much and only see a few patients---6 or 12.   (The last survey by my professional association reported an average fee of $70. per session and this does not subtract rent, phone, insurance, licensing fees, association dues etc., in other words, overhead). This  is why private practice therapists usually don't have secretaries or receptionists.  Sometimes in a building that rents to  therapists only, a receptionist salary can be shared.  But, by and large, therapists do all of your letter writing, filing, insurance claims, report writing, copying , etc. for you, themselves.  The nice part for you is that it all is, really private.  No one else sees anything to do with you but the therapist himself.  If you pay for your own treatment (don't use insurance), it is really exclusive because, in that case, even  insurance company personnel will not see your paperwork.
  So, just don't be annoyed if the therapist asks you to do some part of this yourself or maybe complains a bit about your insurance company (most are difficult and time-consuming to deal with), or isn't as quick as you would like with whatever---writing a letter for you, having your account at the ready, etc.  Each patient has a different payment method, and this the therapist also has to keep track of.  It can be complicated.  Most of us don't like this part as we are clinicians and were not trained to do clerical work (and aren't good at it!).  We want to do the interpersonal work.  So, if you have a therapist you respect and are fond of, help him or her out by keeping it (the business aspect) simple.
Most of us are used to the doctor's office where all paperwork is handled by support staff.  When you have a therapist who agrees to do this for you, they are actually doing you a favor.

Therapists  may sometimes behave in ways that seem really odd.  If you don't fully understand the powerful constraints of confidentiality, you may be taken aback when you accidentally bump into your therapist in a public place and the therapist doesn't run over to you to say "Hi!"  We must wait to see what you do---you may be with someone, you may have any number of circumstances at that time, you may for some reason  not want to reveal that you are acquainted with the therapist; so the therapist will follow your lead.  They try to gracefully await a sign from you as to whether or not you want to be acknowledged.  But, it is awkward sometimes.

The other part of that problem is, what if the therapist is out with someone?  If you were to speak to each other, the polite thing to do is to introduce people.  But, if the therapist introduces you to her companion, she cannot say, "I'd like you to meet Mary Smith, one of my patients."  This would betray confidentiality.  Probably, a friendly nod is really the best bet most of the time.

Therapists are not allowed to have what is referred to as "dual relationships".  It may seem so natural to you to invite your long-standing, beloved therapist to your daughter's wedding.  But, the therapist cannot attend.  The definition and protection of the therapy relationship requires it to be kept separate from the other parts of your life.  We can't go into business with you,we aren't even allowed to do bartering; we cannot exchange our services for yours, we can't ask you for hot stock tips, etc!!!  (You can, however, give us a raise...!)

You can and should expect to be treated with regard and respect by your therapist.  Your therapist should be genuine and straightforward but professional in conduct.  Your therapist should not be expected to be and should not pose as, a 'guru'.  Your therapist should be human and compassionate.
In this unique, not like any other, sort of odd relationship, can you expect your therapist to care for you personally?  Maybe, but, not necessarily:  I have heard some therapists say that they can treat anyone, whether they like the person, or not.  Not me.  I have rarely refused to treat anyone, but if I can't find something in them to feel for, I would.    I look for that loving part or that growth motivated part or some part that I can connect with in a positive way, personally.  But, usually I find it easy to like the people who come my way.  Many therapists will become quite fond of a patient if they see them regularly for a long time.  The close attention that a therapist pays to a patient, the effort to understand what is beneath the surface, the careful listening, the thinking about that person and their issues, all of this leads to feeling affection.  It's normal; therapists are human.  At the same time , the therapist must maintain a professional position in relation to the client so that the client can feel that they can depend on the therapist.  And the therapist always has to remain ready to hear that client decide to say good-bye.

 There's so much to say on the subject of what you can expect from a therapist but this is already a long post.  If it gets a lot of traffic, I'll write more on this topic.  Be sure to let me know if you have any questions about this.  In any case, I hope that, in your therapy experience,  you are happily surprised.  I hope what I've offered here  helps.
If you'd like to read another therapist's offering on this subject, here's a link to one I think is down-to-earth and thorough.  It's also a chance to see the difference in style between she and I.  As I've mentioned, each therapist is so different and thus, you have to find the one who is a match for you. http://www.therapist4me.com/what_makes_a_good_therapist.htm
Here is another one with yet a different tone:  http://www.
wheneverydaymatters.com/?p=96
 
*The training is slightly different for each license but for my license, this is required: 19 years of school (not counting nursery school!), 3000 hours of supervised (unpaid) internship hours, an oral and written exam from the state and 36 hours of continuing education every 2 years.

Please join the discussion and leave a comment.

Addendum:  I said I would write more on this topic if it got a lot of traffic.  Turns out this has become one of the All Time Most Popular Posts and continues to be.  So, I did write more on the topic, as promised.  Here is Part 2:  http://therapiststhoughts.blogspot.com/2012/03/look-before-you-leapthe-imperfect.htm  And, you can look forward to more; there is a Part 3, in draft.

Expressing Yourself

A lighthearted quote with a bit of truth.

"Say what you want and how you feel
because those who mind don't matter and those who matter don't mind."
Dr. Seuss

Offered by a patient who speaks her truth without shame.

Self-Esteem

     How self-confidence can shine out from you and help you drop unnecessary defensiveness.

 Lots of defensiveness in a personality comes from low self-confidence.  Having defenses is not all bad,  in fact, we need to have some.  Psychological defenses are part of how we handle all the dilemmas, unanswerable questions, unpleasantness from others, and many other difficulties that are a natural part of life.  But, some people are too defended.  They don't ever open up to others and, thus, rob themselves and those close to them of the experience of emotional intimacy.  They can never admit to a mistake.  You are highly unlikely to ever hear an apology or a true one anyway, from them!  They guard their inner thoughts and feelings behind an iron gate.


How does a person come to be so very guarded?  Often they had parents who were very critical or they may have been reared by shaming parents.  Some parents even think it's funny to ridicule children.  Children are very impressionable and ridiculing makes them believe there must be something wrong with them.  Many parents don't realize how much power they have, psychologically over their children; these demeaning interactions, repeated many times over the course of a childhood, can have lifelong effects on the adult personality.

A self-confident individual usually uses defenses less and only when necessary.  When they do need to protect themselves, they are more likely to do it with something like humor or sublimation.
(The less confident, more guarded person will use defenses such as a passive aggressive defense, apathetic withdrawal, denial, rationalization, or devaluation - to name a few.)  If you think it's unpleasant to interact with such a person, think about what it's like to live inside that armory!

If you can't ever take any feedback from anyone and think about yourself a little (self-reflect), if others can't assert themselves toward you, if you can't listen openly enough to let in a new idea, not much personal growth can happen for you.

So, build your self confidence and your defenses will automatically be reduced; you won't need them so much!  How do you build self-confidence?  Paradoxically, psychotherapy is a good component in a program to build self-confidence.  I say paradoxically because you have to be willing to look at the tough stuff, to cry about it, to face your personal demons, to give up long-held miss beliefs or illusions.  You have to be willing to question your own behavior in the presence of another.  You have to be able to go back the next week and face that person (the therapist) after having revealed your deepest, darkest secret.  You have to take personal risks.  You have to try doing things a different way.  You have to be willing to go out of your comfort zone, to function in the unfamiliar, to try new things. You will have to change.
When you have an experienced, (confident themselves), accepting, therapist, it is possible to do this and it is healing.  As you go through this process, you become less of a stranger to yourself and less afraid of revealing something ugly to others.  More self-knowledge leads to more self confidence leads to less rigorous use of defense mechanisms.

The other thing you can do, which I have discussed in a previous blog, is to provide yourself with positive self-talk.  Start now replacing those old negative messages you were inundated with as a youngster with good, positive messages.  For example, at the end of each Yoga class that I do, I  say one positive affirmation to myself, like, "You did something good for yourself."  or, "You spent sometime today helping your body to be healthy."  Simple as that!  Jack La Lanne, one of the first famous health and fitness promoters told people that he encouraged himself after every workout by saying to himself as he left the gym, "You did it again, Jack!"  There are so many times during the day when you can help yourself this way.  If you commute, use some of that time to review your accomplishments.


In some cultures it would be unseemly to tout your success to others.  That's all right - you don't have to become obnoxious to be more self confident!  Just do it mentally, in your own head.  If you worked hard at something and it came to fruition, acknowledge yourself.  Try to find personal qualities  in yourself  that you like and notice them, develop them.   Try not to go through life wearing a virtual suit of armor---you will miss out on so much.  Share your joy with others!

(Related post: Unfinished Business http://therapiststhoughts.blogspot.com/2010/10/unfinished-business.html )

Blog Note

There are nearly 200 posts on the blog now (194 to be exact).  Most of those are as pertinent today as they were when they were written.  This blog is unusual in that regard:  You can roam around it almost as you would, a reference book.  The topics are timeless.
There are a few that announce an event, for example, that occurs at a certain time-usually an art event-and, there are posts on cutting edge psychology theory as I pass on to you what I learn at the presentations I attend that are by some of the most renowned researchers in the area.  These are a few exceptions.  But!  99% of the posts are as readable now as when they were written.

I've noticed that many of you take advantage of looking at the "Popular Posts" listed on the right of the blog which is great!  It does, however, have the effect of keeping the same posts on that list since each post read is kept track of in the statistics done by Google.
Maybe you would like to try accessing some of the posts listed under "Labels".  These are organized because at least one thing in the post qualifies for the label, such as  "Suggestions" or "Client Quotes".  Once you click on one of the label titles, you will be taken immediately to all of the posts that are so labeled.  You can find some interesting things that way.  Give it a try!

Dietery Supplements & Mental Health

A few notes taken from a presentation by Edward R. Blonz, PhD, UCSF

Some of the most commonly used dietary supplements in self-treatment for mood and state of mind problems are:

• St. John's Wort
• Rhodiola
• L-Tryptophan
• Omega-3 Fatty Acids
• Sam-e
• L-theanine 
• Valerian

According to Dr. Blonz, some of these have litttle-known side-effects (such as, photosensitivity in St John's Wort) and all of them, except the Omega-3 fatty Acids and Sam-e have been subjected to only very small studies or studies that have produced inconsistent results.  In this country, anyway, there is very little regulation so the preparation you purchase may or may not have in it what it says it does on the label.  Some, such as L-tryptophan, or 5-HTP, a pre-curser of L-tryptophan have, currently a safety question about them.  In that case, since they produce extra seratonin, it may be that seratonin will appear in parts of the body other than the brain and can lead to Seratonin Syndrome.
The main message of his lecture was to be cautious when opting to use these things.  They do have factors in them that, in some, have an effect of mood stabilization, some purport to alleviate stress, and some address anxiety or reduce depression; the problem is, you may be getting varied doses, regardless of what the label says.  Also, I would add, self-diagnosing can be a risky business; it usually helps to get the objective opinion of someone else, best if it be someone trained in the field.
The two exceptions on the above list are the fatty acids and sam-e.  The fatty acids, which are plentiful in fish, do lots of good things for our health such as reduce the risk of heart disease.  But they also seem to affect depression.  A real study was done on depressed children who were treated with the fatty acids and the result was a 50% reduction in depression!  Check clinical trials.gov for more about this study.  By the way, the ALA produced in plants is sometimes touted as being the same as the DHA+EPA that is what is found in fish but, in fact, it has a very low conversion rate in the body to this form.
Sam-e is something our body makes itself.  Sometimes, some people have a disruption in this process, in which case, it would be a good supplement.  SAM-e is used in the body to make everything and it helps many problems, notably arthritis.  In addition, it seems to have a positive effect on mood.

I happen to be what some would (and have!) called a "health nut" and so I do avail myself of supplemental vitamins, minerals and herbs.  But, after this compelling lecture, I think I, myself, will be a little more judicious in my use of these things and will look more to my diet for these nutrients.  A couple of exceptions are Calcium which most people above age 30 will do well to supplement and, vitamin D which has been recently discovered to be epidemically absent in our systems (esp. in northern areas).
Dr. Blonz recommended Natural Medicines Comprehensive Database as a reliable site to use for information on these topics (be careful, there are a lot of salespeople on the internet posing as information sources) and I like it too.
Take care of yourself.  Take care of your health.  Just make considered choices.

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