Transformative Postive Change
|Posted on May 3, 2017 at 1:55 AM||comments (0)|
This weekend I’m headed to New York City to participate in the Center for Group Studies weekend training series. This particular weekend is about Specialized Topics in Countertransference. It’s Block 7 out of 9. There are 3 training weekends a year so it will take me a while to get through all 9 weekends.
I’ve only heard good things about CGS. It’s been recommended to me many times over the last 10 years. Group therapy is already my strong suite. Yet, I still want to go further in my ability to conduct therapy groups. I learn how to conduct groups by being a participant in groups. From what I hear, CGS is the place for me to be. I’ll have my own experience and see if it’s a group/community I want to have in my life.
|Posted on February 24, 2016 at 7:00 AM||comments (0)|
|Posted on February 15, 2016 at 6:00 AM||comments (0)|
I have two presentations coming up at the Colorado Mental Health Professionals 2016 Conference.
4/22/16 at 8am is "Smart Business Skills for Psychotherapists."
4/23/16 at 8am is "Providing Therapy Groups that People Will Want to Attend."
This year's conference is at the Colorado Convention Center and Dr. Irvin Yalom is the keynote. I got to listen to a lecture he gave in San Francisco last year at AGPA. My take away from what he said there was to relax and enjoy my patients.
|Posted on June 21, 2014 at 5:00 PM||comments (1)|
Therapy groups are powerful beings in and of themselves full of pulls toward induction, acting out, and other forms of what is called “action.” Specific groups form their own culture and seem to have a mind of their own sometimes called the Group Mind, Group Ego, or Group Conscience (Freud’s superego applied to group theory). I prefer Group Mind because it is more inclusive of our humanness.
Therapy groups are talking groups rather than action groups. This is why the part of the clinical frame that describes what we are in the group to do—to put our thoughts, feelings, and impulses into spoken words rather than actions—is key.
In support groups, we share. In therapy groups, we connect by doing our best to follow the clinical frame in real time.
A person who attended one of my groups put it in a reflective question: Am I monologuing or dialoguing? Individual therapy is about monologue and group therapy is about dialogue.
Don’t expect your experience or advice to change someone or to help someone feel better. Expect that to bore most people in the group because they have been cut out of the communication. The group became irrelevant to them. You’re having an impulse and the feeling behind the impulse needs to be explored not the advice or recommendation necessarily shared. The bored or disconnected group member needs to bring this up too; otherwise, he or she will likely not come back to the group. Group therapy in the here-and-now is rarely boring.
Keep in mind that someone else in the group may be having a similar experience that you’re having at the same time. This type of resonance is normal and it is useful to discuss. Sometimes you may be surprised to hear someone say exactly what you are thinking. I don’t fully understand this but it’s pretty cool and sometimes freaky when it happens. We’re not as solid as we would like to believe, and this is probably a good thing.
Support groups are about stories, other people, events, etc. Therapy groups are about us and what is happening in the room, how we impact others in real time, how others impact us in real time, and how our internal world impacts us while in the group. Exploring why we are having the memory that would typically be shared in a support group and seeing how an association with someone in the room is bringing our past into our present internal world is more appropriate for group therapy. Now we can work on developing internal boundaries and emotional regulation—what is called “discriminating awareness” in Buddhist Psychology.
I tend to use an interpretation to make the content of a story relevant to the whole group or an individual who was spacing out. Psychodynamic group theory suggests that every communication in the group is somehow connected to the whole group or a statement about the group. However, we may not understand the connection in the moment.
The talking time is shared making the energy flow around the room so no one is holding more of any particular emotion than anyone else. Then we learn how to verbally discharge emotions in skillful ways that bring others closer to us rather than overstimulate ourselves. Use the spin of the group to help stay emotionally regulated.
The group has what I think of as an orbit or spin based on communicating what is occurring internally rather than each of us taking our turn to tell someone what he or she should do. This is why I often interrupt and ask, “How are you feeling right now?” when this scape goat dynamic manifests before it turns dark.
The group becomes a deeper richer experience when around 80% of the communications occurring in the group are real-time group related material. We’re making statements describing how we are feeling toward group members, sub-groups of group members, to the group as a whole, and to the group therapist(s). Therefore, group therapy requires a major commitment.
Then we move beyond history and symptoms and dive into our fabric of character and personality and by doing so we begin to rewrite our futures.
|Posted on September 27, 2013 at 7:00 AM||comments (0)|
Many people hem and haw about starting their own business. The Small Business Development Center a great resource located upstairs in the Touber Building. They have lots of resources to guide and coach you along your journey. They can also help you figure out if being an entrepreneur is a good idea for you or not.
|Posted on September 25, 2013 at 7:00 AM||comments (0)|
Here is another important TED Talk given by the Director of The National Institute of Mental Health positioning psychopathology as a disordered brain. He quickly moves beyond the assumptions of Psychiatry and pharmaceutical companies and focuses on what evolves within our brains well before behavioral symptoms manifest thus making psychotherapeutic intervention preventive.
I've often been asked the relevant question, "I'm taking antidepressant medications. If depression is about serotonin then why do I still feel depressed?"
|Posted on September 22, 2013 at 3:45 PM||comments (0)|
This TED Talk given by a psychiatrist named Eleanor Longden who at one time in her life struggled through Schizophrenia illustrates the importance of some of the key components that differentiate our services such as viewing symptoms as messengers rather than enemies, developing our inner curiosity rather than reinforcing criticism, and transforming our basic relationship with ourselves from shame, loathing, and fear to a friendship based on compassion, understanding, and trust. I encourage you to watch the video and apply some part of it to how you related the most despised parts of yourself.
|Posted on June 22, 2013 at 7:00 AM||comments (2)|
I wish I could get excited about the DSM-5 coming out. It's supposed to be the "Holy Grail of Mental Health." This is the book that lays out how to tell if someone has a mental illness or disorder. It does not describe how a person got to be this way or what to do to help them recover. Previous DSM editions were used to justify research; however, the funding source of much of this research isn't on the DSM-5 bandwagon either, but for different reasons. (Most of the NIMH researchers study mice brains rather than human suffering.)
When I work with someone, I want to think of the person from as many dimensions as I can. Dare I say, holistically. I want to understand lifelong patterns, current symptoms, history of all sorts, childhood attachment patterns, health issues, nutrition, etc. I need to put a person's current life into the context of their life as a whole, get a read on relationships, and environmental factors. The DSM tells me based off a set of symptoms that a person meets "criteria" for a disorder. Treatment based off DSM assessment becomes focused on reducing a set of symptoms rather than resolving underlying issues.
Sometimes my understanding of DSM concepts informs my practice; however, I focus on resolving underlying issues. The PDM is a better resource.
|Posted on June 20, 2013 at 7:00 AM||comments (0)|
Here is a great article about the history and (lack of) effectiveness of confrontation in substance abuse treatment settings.
There is no shred of evidence that it has helped anyone enter into or sustain his or her recovery process. However, it has shown that people tend to relapse at higher rates and use for longer periods of time when confronted on his or her substance use.
So why do therapists confront their patients? I was attending a meeting earlier this week where a pseudo-provider was boasting about catching clients in lies and pointing out reality to them. This sort of approach makes better liars rather than facilitates positive changes. I think some truly believe it helps their clients to give them tough love. Then there is also the factor that working with a substance abusing client is fruatrating for the therapist and acting out with confrontation "giving him a dose of reality" makes the therapist feel better irregardless of the potential for positive change experienced by the client. We've learned time and again from research that confrontation equals relapse. It seems clear that a therapist confronting a patient is acting out his or her countertransference which indicates either a lack of quality training or a lack of quality supervision or both. There are likely lots of other reasons therapists do this. None of which are very good.
As the article illustrates, there is an alternative. It's been around for a long time. It's grounded in developing empathic understanding and using natural consequences as a way for people to make their own decisions about their lives. It's all around easier to point out a pattern, ask questions, and help the person make decisions based on what they want. Positive change then becomes an internalized process rather than something done to placate someone else.
|Posted on June 18, 2013 at 11:45 AM||comments (0)|
Sometimes I'm asked to teach "distraction skills."
While I'm all about serving my customer, I have to stop and reflect on what is implied and how this sort of intervention evolved.
We live in a culture and society based on distraction. Most of our homes have constant television, with the internet on our lap, and a smart phone at our thumbs. I'm impressed when someone needs psychological intervention to increase his or her ability to distract from the content of one's mind.
Sure. Symptoms can be overwhelming and painful. We tend to not like feeling depressed or anxious. Our natural tendency is to do our best to get rid of the feeling. Paradoxically, our efforts at suppression tend to intensify the very feelings we're trying to shake. For example, abusing a substance when experiencing grief or trauma tends to prolong the life of the related symptoms.
Putting this type of intervention into theoretical context, the person is asking for stronger emotional defenses through some sort of intellectual exercise. They're asking to not feel. They want to develop a negative while indirectly focusing on the aspects of themselves they are most disgusted by. Strengthen one part of the brain to battle against another far superior part attempting a type of psychological amputation.
Do we want to cut ourselves off from our emotional world?
I'm going to assume the answer is no. We want to feel proud of our kids when they accomplish something important. We want to feel close and connected with the people most important to us. We want to appreciate beauty and experience love. Aristotle considered these sorts of feelings as part of a good life.
The so-called negative emotions are just as important because something is being communicated to us, by us, about us. These are very important communications and deserve serious consideration. Rather than shooting the messenger, it might be more helpful to strengthen our brains around understanding why the more powerful parts of our brains are screaming that something isn't right. We might not understand why we are having the experience we are having yet, but if we stay present to what we're going through, we are open to possibility rather than closing off our opportunity to learn, grow, and change.
I find that when people can remind themselves to come back to this type of relationship with their emotional experience that they tend to outgrow their symptoms and molt the necessity of that particular layer of psychological defense. It lets us understand what our needs are and then gradually create our environment in order to thrive.
|Posted on April 11, 2013 at 7:00 AM||comments (0)|
I recently gave a presentation on Stress Reduction to young people struggling with authority and family stress. Their situations seemed complicated and at times extreme.
I began the discussion with a breathing exercise focusing our attention on our natural pause in breathing that happens right before we inhale encouraging us to find some mental space through this practice.
This group focused on a different value each week. I happened to meet them when compassion was the value. We began our discussion with self-compassion. Soon our resistance to relating to ourselves in this way came up. There were many reasons why we don't deserve our own compassion. Most of the reasons didn't last long with awareness and group support. It was evident how we've been trained to relate to ourselves in an almost hostile manner yet hold the expectation to be saintly toward everyone else.
I used some basic group psychotherapy techniques giving the young people a feeling of togetherness with their struggles and how emotionally overwhelming many of their situations are. Soon the presentation took on a life of its own. The young people were directly sharing with each other and offering what has helped them through challenges as a way to connect with their peers. I merely steered the discussion with questions about relationships and decision making regarding natural consequences.
Then the group began seeing their parents in a different way. They began to grasp the bigger picture their families live in and see their role and how they have responsibility for their boundaries and reactions. Their pain was very real and their struggles seemed almost political. While some of them decided they had to get a job and become self sufficient as soon as possible, others wanted to learn specific skills regarding how to get our emotional needs met with difficult people. There was a tenacity to stick with it and make something better happen.
I left the presentation feeling impressed with the courage these young people live through and honored that I was invited to meet them.
|Posted on January 16, 2013 at 7:00 AM||comments (2)|
In grad school, I wrote a paper called Waiting For The Bell. It was a paper about how I let the sands of my life sift through my fingers because I was more occupied planning the next thing while doing the current thing. Sitting in meditation waiting for the bell to ring. Running on a treadmill watching the countdown. Going to the grocery store planning the rest of my night out.
The paper ended up being many pages long, and I reached some important distinctions. I still think of this paper years after it was graded.
Leaping into the rabbit hole, I came to the conclusion that all this waiting had to do with fear. The fear was based on anxiety. The anxiety was based on repulsion of this moment--right now.
Why is the present moment repulsive?
The repulsion comes from wanting my life to be better. Hope. The conclusion that this is just not "it" for me and someday I will get there. Taking forward-feeling steps with false confidence directed toward some unknown desire. Shooting from the hip into the dark.
Is there any other way?
Maybe. If we play it safe and take no chances. If we follow someone else's plans for us. If we figure out their rules and be good. In psychotherapy, that means using the same "proven" manual for every client irregardless.
The alternative is freedom. Marrying art and science into a co-created experience that only exists because of this moment. Our existential anxiety is a marker of our freedom. We take root and bloom within the present moment.
|Posted on January 11, 2013 at 7:00 AM||comments (2)|
There is just as much anxiety as thrill with taking a stand in our lives. Anxiety can be an important point on our emotional compass. We have to work toward resolving our anxiety to make lasting positive changes.
I'm talking about two different kinds of anxiety--two different points on the compass. There is anxiety that we lack something, and there is freedom. If we're really going where our heart leads, then we haven't been there before. It's new territory. The unknown. There's neither map nor blueprint. We're left with our creative devices. Hopefully, we have some good trusted friends.
I recently told one of my trainees, "Psychotherapy is going into the unknown. We don't ask people questions when the answer is already known. It's an exploration. A broadening of life."
What to do when the anxiety of doing something great hits (and it will)?
Take that energy and fold it into your project. There is pressure. People do depend on us. We have important responsibilities. Fold the anxiety back into the project how a sword is repeatedly folded and forged back into itself. Take action on the project.
The alternative lets the anxiety eat us up. Continue sitting on the couch. Procrastination.
When we train ourselves to stand up and take action harnessing the anxiety and doubt some "magic" does happen. We start making rapid progress and opportunities begin presenting themselves. Our peers will tell us we're lucky. Maybe they're right because we knew enough to take a stand.
We have to take a stand.
|Posted on January 9, 2013 at 7:00 AM||comments (0)|
Another barrier to success is wishful thinking or an idea of entitlement. This myth was captured in The Secret through a misinterpretation of the so-called Law of Attraction. All we have to do to get what we want is to think about it. This type of magical thinking is another way to procrastinate. It's also on the edge of psychotic. People who turn their ideas into realities do spend a lot of time thinking about them. Perhaps there is an obsession similar to a mother with her child, but they are doing a heck of a lot more than mental gymnastics just like a mother is likely working harder then she ever has before.
There are at least two ways to look at the so-called Law of Attraction: First, it's procrastination to only sit and think about it. Second, we're focused and dedicated so of course it's what we're thinking about because it's what we're planning, forming connections, etc. all day. The difference is action. We've started something, and we continue chipping away at it.
Here is an exercise. Do this to see if you're really wanting to do what you've concluded you could do to improve the world, your family, or even yourself. Take one hour each day and work on it. No matter what. No excuses. Do it for one hour every day and see if you're really interested. You may find that you are and naturally start spending more time with this interest. Or, you quickly realize this isn't for you. That is just as valuable a discovery. Let it go and find something else.
A warranted word of caution. Protect your hobbies. They are more valuable than money.
|Posted on January 6, 2013 at 11:45 PM||comments (0)|
It's the time of year to reflect and refocus on what matters most to us. (Maybe we need to back up and figure out what holds meaning in our life if we're not clear.)
The Big Questions generally follow the same motif: Who/What do we want more of and, conversely, less of in the future? We likely know what we're wanting to do. Our problem relates to getting there.
I think a big barrier to getting across the chasm to where we want to be is our absolute aversion to Delay Of Gratification. I find the story of how The Beatles developed mastery inspirational. The first Beatles show in the U.S. was to 10 non-fans. However, we associate to the Ed Sullivan show and Beatle Mania and then believe our goals will (some day) come into fruition similarly. With reflection, we reach the conclusion that it is insane to believe The Beatles had that type of following (and invited to perform on 1 of the 3 prime time TV channels) just because they bothered to get on an airplane. Greatness is contained within time. Dedication isn't a one-day or one-project deal. The Beatles had logged 100's of hours in front of their audience before tipping. The same is true for us.
I want to encourage you to start taking the small steps forward to get your life organized and positioned where you want it to be. Just like how psychotherapy doesn't happen all in one session, it takes more than one day to make dreams reality.
|Posted on December 16, 2012 at 10:30 PM||comments (0)|
There is an old Zen parable illustrating Enlightenment:
"A man walking across a field encounters a tiger. He fled, the tiger chasing after him. Coming to a cliff, he caught hold of a wild vine and swung himself over the edge. The tiger sniffed at him from above. Terrified, the man looked down to where, far below, another tiger had come, waiting to eat him. Two mice, one white and one black, little by little began to gnaw away at the vine. The man saw a luscious strawberry near him. Grasping the vine in one hand, he plucked the strawberry with the other. How sweet it tasted!"
I'm reminded of this story by the recent events in CT. We want some kind of guarantee but most things are well beyond our control. We try to maneuver to secure some feeling of safety but... Makes me think that we're running from Jason on Friday the 13th. Jason (time) keeps his steady pace while we're in a state of terror tripping over our own feet.
The terror is optional. The strawberry captures this story's wonder. The slowing down. The savoring.
Another option is going even faster in the rat race--to strengthen the delusion that nothing will ever happen to us. Medicating to work more hours. Outsourcing our most important relationships. Panic. Regret.
We always have a strawberry. It takes hard work to focus on what is right in our world.
|Posted on December 12, 2012 at 7:00 AM||comments (0)|
Clients often ask me to teach them "skills." I ask what kind of skills are they wanting to learn, and I'm informed that past therapists went over worksheets that told them what to do such as distraction or call a friend. Buying an interesting self-help book would have saved a lot of money.
I think I'm being asked to help someone develop the ability to live skillfully. There comes a point when we want to be more skillful in relationships rather than impulsive and destructive. Perhaps skillful could be replaced with the concept of diplomatic.
I'm not the kind of therapist to pull out a worksheet and tell someone to fill it out and all will be well. I actually have some strong opinions about this kind of intervention. But for me, I don't feel right about taking someone's money and handing over a sheet of paper as if that is a psychotherapeutic intervention. It might be a good thing to take home and contemplate later or use to treat your insomnia
I'm more likely to explore and find out where he or she has already acted in skillful ways. Then expand to generalize learning.
Skillfulness requires seeing the big picture and having an understanding of our role and our desired outcomes.
What does this mean in psychotherapy?
Many times, there is a destructive repeating pattern requiring resolution while we're developing powers of observation and self understanding. As much as I would love for it to be, it's not a linear systematic problem to be solved. We make progress on multiple areas of the equation at the same time in a systemic manner. We're burning the candle at both ends. For example, a spouse's coping with copious amounts of alcohol may decrease as her ability to relate productively with her partner increases. As we become less impulsively hostile when we're not getting what we think we want when we want it, we're also developing the ability to delay gratification and work toward getting what we need in an important relationship.
This is why we meet in psychotherapy over the course of multiple sessions. We break these patterns down into small pieces to work them through much like taking one bite of food at a time allows our bodies to digest a meal. Understanding the impulsivity and what we are trying to achieve through this behavior. Deciding what we're after in a relationship and if it's realistic with a particular person. We take a small piece and focus on it.
Appreciate this part of your life similar to admiring a gem in the palm of your hand.
|Posted on December 7, 2012 at 7:00 AM||comments (0)|
Here is an assignment I have my Psychology students at Colorado Mountain College do. I think it is a wonderful exercise in learning more about our "Character Strengths" and then adapting our lives to be more in tune with what we already are good at. Consequently, a less frustrating life.
"Please write a 3 to 5 page paper on how living through your natural strengths has helped or will help you develop a sense of psychological resiliency. Use this site for help identifying your strengths: http/www.authentichappiness.sas.upenn.edu/default.aspx, create an account (it is free, and I've never been spammed), and take the VIA Survey of Character Strengths. A full credit paper will elaborate on both understanding your personal strengths along with forming a plan on how knowledge of both navigating life stress and further developing your strengths will help make your life happier. You will need to understand what resiliency means and convey this in the paper using a tone of empowerment."
There are other assessments on Sieglman's website that are interesting. I've been taking these surveys for years. It's fun to see how my scores change over time.
|Posted on April 17, 2009 at 11:45 PM||comments (0)|
I have almost completed my first cycle of an MBCT group. I encourage you to look into their material and either start your own group if you are a clinician or follow their syllabus in their books at home if you want to help yourself recover from depression. The feedback I have received from participants has been great. I think it helps that my psychotherapy training included 3 months of formal retreat practice along with required sitting practice so I can relate directly to difficulties that arise when practicing meditation and other mindfulness practices. The cool factor is that the group members have wanted to form a practice/process group after the formal 8 sessions is complete. I am happy to accommodate this. Some of my clients want to stop individual psychotherapy in lieu of this group.
I would love to take full credit for the participant enthusiasm, but I know better. I think a lot has to do with people knowing that what they get back is related to the effort they put into the program, and I screened people who will be willing to do their best with the homework requirements. For example, handling rumination that can be a part of resisting homework assignments is one of the best examples to emphasize the philosophical points of MBCT.
|Posted on February 26, 2009 at 10:40 PM||comments (0)|
It may be more productive to focus on improving your quality of life rather than concentrating on symptom reduction when it comes to treating and preventing a relapse in depression. Increasing your psychological well-being is a great place to start.
According to Ryff and Keyes, there are 6 dimensions of psychological well-being:
1. Self-Acceptance: Possessing a positive attitude toward yourself versus feeling dissatisfied with one’s life.
2. Positive Relations With Others: Having warm relationships with others versus having few close friends.
3. Autonomy: Independent versus overly concerned with others’ opinions.
4. Environmental Mastery: Feeling competent versus difficulty managing every day affairs.
5. Purpose in Life: A sense of meaning versus lacking a sense of meaning in life.
6. Personal Growth: Continued development versus stagnation.
Look at this list as an opportunity to improve your life. We can all make minor changes that will reap large benefits. If you find that you are being self-critical then notice what you are doing, validate yourself, and come back to the outcome you want in looking at the above list.