Meditation

Sit with a straight spine.  Tuck in your chin slightly.  Put your hands together.   Close your eyes.  Focus on your third eye point.  Notice your breathing.  Observe.  Notice what is happening in your body.  Notice where the energy is.   Notice what your mind is doing.  Observe.  Focus.

Meditation instructions by Amar Khalsa, Kundalini Yoga teacher

Russian Readers: Special Notice for You

                                       A wonderful, unusual exhibit.
There is an interesting art exhibit coming to Russia in the next 2 weeks.
Check it out here:
http://russianamericanexchange.weebly.com/
This link is fun; it has a slide show, a video, sound track, and even shows the artists (3 collaborators on this project), working on the piece.  It is a huge fabric sculpture which was designed especially for Russia.
It's beautiful, dramatic and thought-provoking.

Let me know what you think!

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.

Making Your Own Happiness

Plant your own garden and decorate your own soul 

instead of waiting for someone to bring you flowers.

Advocating for the Helpless

Highlighting the humanity and individuality of our elders

Abraham Nievod, Ph.D, J.D. is attempting to change people's understanding of the elderly with his documentary photography project titled, Portraits of Aging and Dementia.  His awareness of this issue developed as a result of his work as a neurologist and doing evaluations of competency for the elderly and the mentally disabled for the courts and for other therapists.  Many times the legal issues are decided for the elderly by people who've never seen them, never met them.  When he realized this, he began going to the elderly person (usually housed in some sort of assisted living situation), photographing them and including the picture with his report.  (One judge commented that it was the first time he had ever seen anyone for whom he had made a competency decision!)

This picture including effort grew into the portrait project.  As he went to seek out these individuals, he observed how they were living in such an isolated, circumscribed world with very limited horizons.  He decided that he wanted to show the elders in an individualized, personal way.  He told parts of a few of their stories:  One person was one of the first women Marines. One man was sold as a child; 40 years later, his brother became a government official, tracked him down and introduced him to his mother and father for the first time.  One man he photographed standing in front of a painting that he had done in earlier years as an artist.  Dr. Nievod is trying to counterbalance the tendency for people to begin treating them differently once a person gets labeled as incompetent.  (An unfortunate fact, according to Dr. Nievod is that sometimes the judgment that someone is incompetent to deal with their own business matters is based on a 10 minute test, the MMSE-mini mental status examination score).

A basic description of dementia is memory impairment and disturbances in executive function*, however, there are now thirteen different kinds of dementia identified.  Also, anxiety and other mood disorders can effect executive function.

There is usually a difference between the assessment of a 32 year old accident victim and an 88 year old accident victim.  It is this unfairness that is highlighted by the project.

The elderly must be protected from being taken advantage of.  Elder abuse is something to be aware exists.  It is important to remember that even though a person is older, slower, less sharp, not as strong as a younger person, that they are still a unique individual, may still be quite capable of making choices and decisions for themselves and, should be treated with the regard expected for any adult.

For the California laws pertaining to this topic, see Probate Code Section 810-813.

*Executive function refers to such abilities as using abstract concepts, to reason, to plan, organize, and carry out actions in one's own rational self-interest, ability to use logic.

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 )

Meditation

                           "Close your eyes.  Empty your mind. Practice to be still."

                                            Sally Wang, Yoga instructor

In the Eye of the Storm

                         Was one or both of your parents a problem drinker?

In the midst of a crisis is when some people feel most alive, at their best, competent and confident- at the controls.  On the other hand, most people are, at the least, taken aback in a crisis; they may have to take a moment to gather themselves.  It is common to experience a state of confusion in the immediate, when a crisis strikes.  Sometimes fear is felt.  It isn't unusual to be a little off-center for awhile in the aftermath of a crisis.  And yet, there are those who will always step to the forefront and take over in a crisis with no hesitation.  They will assume responsibility for others or for the situation and may even seem to overextend themselves in helping and burdening themselves with the problem.  So, while most people would rather avoid a crisis, there are some who move toward it and find themselves most comfortable in the middle of chaos.

If you have ever wondered whether alcoholism affected your childhood, these are some of the characteristics of those who have come to be referred to as Adult Children of Alcoholics.  This term comes from an idea that has been so important to people who have struggled to understand why certain problems keep cropping up in their life over and over again.  The development of this concept and understanding how children growing up in alcoholic homes can be affected has been instrumental in answering that question.  Some ACA's have felt tremendous relief when they found out there was a reason why.

"In many alcoholic homes only terror exists...Children and spouses frequently experience intensely frightening and physically dangerous situations."  The adult who grew up this way is so accustomed to drastic events, that they have become, in a sense, comfortable in them.  At the very least, we can say that it is familiar.  Taking responsibility is learned early on.  When the adults in the home are unable to take responsibility, usually one of the children will learn to do this.  They become a temporary surrogate adult, out of necessity, so it is second nature to continue to do this in their own actual adult life.
"...young Billy told me how he was taking the air out of the car tires so dad wouldn't drive when he was drinking.  His youngest sister, Ann, was putting water in dad's vodka bottle; his oldest sister was putting apple cider in dad's whiskey."  Ideally children should be focused on school and encouraged to play.  But in an alcoholic home, they learn to be very watchful and to try to manage things to prevent disaster.  They become used to feeling overburdened.  This leads to the adult who is often referred to as one 'who does too much'.  They continue to overcompensate even when it is no longer necessary.  As they say, old habits die hard.  Even though friends may say things to them such as, You work too hard!! or, You'll be burned out by the time you're forty!, they really don't understand what their friends are trying to tell them.  It is just second nature to them to do too much, to be over-responsible and to live an over-burdened life because they were trained to do that in childhood.

In fact, people who suffer these aftereffects of growing up in an alcoholic family and have not identified them do often begin to have physical symptoms earlier than their peers simply because they push too hard.  (We all need time to recuperate, time to restore our energy.)  After all, how do you know how to let go at the end of a hard day, or relax on a vacation if you didn't dare lose yourself in play as a child, for fear a calamity would occur?

+Alcoholism in a family is nothing to be ashamed of.+  There are programs and therapists who can help resolve the problems that sometimes result from the presence of alcoholism in a family.  If you think that parental drinking affected you, seek out a therapist to talk to about this.  Or, try out some Al-Anon meetings.  Help for these and other effects from growing up close to an alcoholic, exists.

Quotes were from the book It Will Never Happen To Me by Claudia Black, PhD, MSW

                There are a number of other posts on the topic of addiction and alcoholism, such as. +When Fire Water Causes Conflagration http://therapiststhoughts.blogspot.com/2010/11/when-fire-water-causes-conflagration.html,

+Subtracting to Add http://therapiststhoughts.blogspot.com/2011/01/subtracting-to-add.html,

+Addiction http://therapiststhoughts.blogspot.com/2010/08/addiction.html

and, + No Denial Here http://therapiststhoughts.blogspot.com/2010/12/no-denial-here.html.

You can simply go to the label, Alcohol and addiction on the right and see a list of all posts on this topic or that include this topic.