Wednesday, September 28, 2011

Why we say goodbye forever

The date always sneaks up on me. You'd think I'd have it marked down on a calendar somewhere, circled in black maybe. But it sneaks up. This year I was listening Dreamboat Annie and thinking about going to my very first concert at Miles Field and it hit me - today marks 13 years since Greg's death.

I kind of like the word "death" in situations such as this one. I didn't "lose him," because I know right where he is, scattered on the hillside at Ostrich Peak with an excellent view of the Rogue Valley. We're going to go visit him next week, my friends and I. He's not "late," even though he was always late, infuriatingly, chronically late. He wasn't late for his own funeral, but only because as far as I know he had no control over that one.

He hasn't "passed on." He never passed on anything. That, as much as anything else, hastened his demise. For a while, I was there with him, keeping up. Racing with him, shot for shot. Gonzo. After a while I had to get up the next day and could no longer close the place down every night. After a while I drifted reluctantly into adulthood. He tried.

Before I wrote this, I took a walk so I could spend a moment fully feeling that weight in my chest that had started building. I walked out into a brilliant fall day, all crisp and full of promise, and I let the tears come. As I walked across an open field I watched my shadow, cast sharp and black in mid-day. I let my breath lead me through. I gave thanks that I'm still here.

Closure is a myth. I don't want closure. Closure is a word people use when they yearn to figure out how to shut the pain away. I think that the pain is now a part of me, giving some weight to my natural buoyancy, some shadow to the ball of light that sits inside me. We are an assemblage of every breath we've ever taken, every midnight clock-tick, every smile. My grief over Greg's death is a book, shelved and treasured. Today I take it down and hold it. I write. I shelve it again, back in the gap that was left when I pulled it down.

Sometimes now I'll have a client who is in the fresh clawing stages of grief, and I am graced with having been there. I'm made better by my knowledge of how it feels when someone is there one day, and gone the next. I know how it feels to try and make sense of it, and to finally realize that there is no sense, only that mixture of emptiness and eventual acceptance.

I'm grateful to know how that feels. Thank you, my brother. I'll see you soon, next week on the hillside. I'll tell you then, too.

Sunday, September 25, 2011

How much should my therapist talk about himself?

One of the joys of my job is helping to train new therapists. Every fall, our clinic hires doctoral students to work with us as trainees, and I have the pleasure of helping to supervise them. New therapists consistently ask questions about some of the things that we struggle with in our profession - "how do I deal with suicidal clients? "What do I do with a client who won't let me get a word in edgewise?" And, "how much should I tell my client about myself?"

We call this "self-disclosure" in therapist parlance, and it's an ongoing question for therapists. I've worked with clients who have told me of therapists they've had who couldn't shut up about themselves, griping about family issues, medical problems or just day-to-day crap. As you can imagine, their clients started to feel bad about bringing their problems to such "troubled" people.

A more common issue for trainees, and for all of us in the field, is whether to do any level of personal disclosure. As we hear about things our clients are experiencing, we're invariably reminded of our own lives. As we listen, we are weighing the costs and benefits of sharing that we've been through the same things. Will it help my client if I tell them that I, too, have lost a friend? Would they be dragged down or elevated by knowing that I've had similar problems?

For some therapists, depending on their theoretical orientation, self-disclosure is the antithesis of what they are in session to do. For some of my colleagues with a psychodynamic bent, their job is to remain enigmatic so their clients can project onto the therapist all the things in their subconscious (note: this is a drastically oversimplified depiction of a very complex process - work with me here!). And almost any therapist you see will limit what they say about themselves - it is, after all, your hour, not theirs.

When my trainees ask about self-disclosure, I start with my very simple rule of thumb - am I doing this for my client, or for myself? If my theoretical stance and my relationship with my client dictate that it would helpful for them to know that I've suffered similar tragedy, or that I have children, or whatever else, I'll carefully share. If I'm telling them that I saw their favorite band from front-row seats, does that do anything other than show them how cool I am? I'll hold that one back.

As I think about it, I apply that rule to everything I do in therapy. I filter my words based on whether they are about the client, or about me. One of our basic ethical principles is that of nonmaleficence, of doing no harm to the client. While it's a stretch to say that telling someone about my life while they are seeing me for therapy is harmful, it certainly isn't helpful. And, any time of theirs that I take to work out my own stuff is time that they could have spent working on theirs.

Next time your therapist makes a personal disclosure, think about that rule of thumb. If you find that you're working with someone who is disclosing to help themselves, maybe it's time to at least have a conversation about their habit. If that kind of self-disclosure persists, it may be time to move on.

Thursday, September 22, 2011

One minute to putting extra love into the universe

Over the course of a day spent seeing clients, no matter how much I try and remind myself to keep my mouth shut and listen, I invariably say a lot of things to a lot of people. Like all people everywhere, there are some things I say more than others. "It takes time" is one. "What do YOU want?" is another. And, "Put some extra love out into the universe, and you will get more in return."

I say this thing about extra love because I believe it. I've seen it work, over and over. I'm a dedicated believer that love and positivity, given freely without expectation, will come back to you in quantities greater than you could imagine. Naturally, some of my clients are skeptical, as they have a right to be. And many simply want to know HOW.

As with my post about one minute of gratitude, there will not be a test after this. There's no right or wrong to putting love out there. And as with anything worthwhile, it takes practice and perseverance. Practice is the fun part - you get to make people happy! Here's a little list of ideas to get you started.

Pay someone a genuine compliment. Compliments come in many forms. Obsequious, empty flattery usually feels as hollow to the receiver as it does to the sender. A genuine compliment, on the other hand, especially an unexpected one, can make someone's day.

Give a genuine smile. Try this sometime - pretend like you've been given 5 smiles that you have to give away in the next ten minutes. Take a walk downtown, or through the halls of your workplace, and give those smiles away while looking people right in the eye. This works best on people you don't know. I realize that there are places in which a random smile from a stranger might not be acceptable. Choose somewhere else, and give those smiles away.

Give someone a hand. Offer unsolicited help. If you see someone engaged in a mundane task, see if they could use some assistance. Carry something for someone. Open a door. Watch your neighbor's kid so they can get a peaceful cup of coffee (as a parent I will tell you that this is worth 4000 Karma Points).

Give thanks. Heartfelt gratitude is an amazing, contagious thing. If your boss makes your job a nice place to be, let her know. If your spouse does a routine, daily task, thank them.

Tell someone that you're glad they exist. I love this one, and practice it regularly. "I'm happy you're in my life" is something that people never grow tired of hearing. Call someone out of the blue, and tell them exactly that, for no reason other than the generation of extra love.

Let someone know that they're on your mind. "I thought of you today" is another lovely present to offer someone. As I've discovered in my work, people are often surprised to learn that you've been thinking of them.


Most of us have been raised to offer conditional gifts - "I gave you that, what are you getting me in return?" The act of giving without expectation does take practice, but it's the kind of practice that feels good, even if you stumble a bit. Fill your world with unconditional love, and watch it bloom into something life-sustaining.

Monday, September 19, 2011

Ask the Doc - Will my professors know I've been to the counseling center?

I just got this question in my email, and it's one of those basic questions that a lot of people ask. It's about a really important question that is at the heart of the therapist/client relationship - confidentiality.

Q. If a student goes to a counselor/psychologist ON STAFF at the college, does it get put into their academic file? I guess what I am asking is, can it be held against them? I think we have a counselor at my college and I've been thinking about it but what if my professors decided it meant I am not a good candidate to work in my chosen profession? I can't risk that.

A. The good news is that you don't HAVE to risk that. On your first visit to your counseling center (and to just about any other place you'll go for therapy) they'll take a few minutes to explain your rights of confidentiality. In short, they won't let anyone, even a family member, know anything about your time there - not even whether or not you've ever been seen. When someone calls my clinic and asks about a client, we say, "I'm sorry, I'm not allowed to confirm or deny whether that person is our client."

So, if your professor, your dean, or your mom calls the counseling center to ask about you, they won't get an answer unless you've signed a specific release that expressly permits the center to give out information about you. Those releases are very specific for a reason. It could be that you want your mother, but not your father to have information. Or it could be that you'd like it shared with a professor that you've attended counseling, but nothing beyond that.

As for your records, the same thing applies. Without your written permission, no one but counseling center staff can look at your file. At our counseling center, the medical staff isn't allowed to look at your records without a release of information. This varies from clinic to clinic, so be sure to ask. Your therapy records will never be combined with your academic records. In addition, colleges have FERPA rules that cover confidentiality of academic records. Ask your registrar about these rules.

There are exceptions to the confidentiality rules, and those will be explained to you as well. The short version is that if you are imminently at risk of suicide, or have identified someone you plan to hurt, confidentiality may be breached. In some cases, abuse of an elderly person or a minor may be reported as well.

It is important to note that just talking about suicidal thoughts will NOT trigger this breach of confidentiality. It is important to us as clinicians that you can be as honest as you need to be about how you are feeling. Only if we feel you may complete suicide if you walk out of your session will we break confidentiality. Even then, we do everything we can to stop short of that. Confidentiality is one of the most important things about our relationship with our clients, and we'll do everything in our power to maintain your privacy and security.

Saturday, September 17, 2011

Ask the Doc - What should I do when I see my therapist in public?

Q. - I was out for a drink the other night, and saw my therapist at a nearby table. Should I have said hello? Should she have waved? What are the rules for this kind of thing?


A. - I work at a small college. A walk across campus often puts me in the path of one of my clients. Sometimes they are alone, but more often they're with a group of friends. And even though I live in a city that has over a million people in the metropolitan area, I see clients out and around more often than you'd think.

This is one of the times that my usual social reactions aren't necessarily the best solution. While I am happy to say hi to a client, or stop and chat if they'd like, I'm aware that they might not want to answer their friends' questions about who I am (or more likely, "where do you know that old guy from?"). Some of my clients proudly tell their friends that they're in therapy; others feel that it's between them and their therapist.

With this in mind, I've got a simple rule of thumb - I just ask my clients to say hello first. We talk about this during our first session, as part of our "informed consent." That way, if they'd like to chat, they can let me know that in a comfortable way. If they'd like to keep our relationship on the down-low, they can do so just as comfortably.

As with everything in our therapeutic relationship, I want things to be about them, not about me. And my desire for social interaction is just that - MY desire. I want them to be able to choose. After that first public encounter, we'll talk about in our next session. My clients will often let me know that it's fine to say hello, and I'll do so next time. That should be YOUR call with your therapist, not theirs. No matter what your decision, it's important that you have the power to choose.

Thursday, September 15, 2011

Obligatory "holy crap haven't posted in a while" entry

Hi folks!

Have no fear, Doc Blog is up and going strong. I'll be back this weekend with some new posts, and then should likely be a little more frequent after that. Thanks for your patience!

-jeff

Thursday, September 8, 2011

One minute to let go of guilt

Hey, busy person! Have you got a minute? Forgo that last quick click over to Facebook, and let's spend that minute on something a little longer-lasting.

Step one in today's plan is to go read back over my post about one-minute forgiveness. Letting go of guilt is really about self-forgiveness and self-acceptance. I know, not an easy task, but let's at least get started practicing. It comes with time.

Again, we're going to find a comfortable spot, even if it's your office chair with the door closed and the lights dimmed. Give this the room and respect that it deserves. A minute of guilt reduction might make your day go by easier. I know for a fact that it won't hurt.

Breathe. So simple. Such a key to so many things that we do for ourselves. Your breathing helps to center you - it helps to bring you back to where you started from. Simple, slow breathing, the soft beating of your heart, the quiet... relax into this. Sometimes I visualize the aftermath of an explosion, or a fireworks display - watch as you inhale and all of those scattered bits come back to you, make you whole and centered again.

Letting go of guilt is an act of self acceptance. Guilt is rooted in our comparison of ourselves to a perfect ideal - we're punishing ourselves for doing something wrong. Guilt runs deep, and most of us are trained to do this from a very early age. Guilt is well-modeled in many families as a way to modify behavior. We internalize it and use it against ourselves.

Find that little point of guilt - let's start small! - and notice it. Observe it. Describe it. Look at it without judgment. "I see that I am guilty about yelling at my child when I dropped her off at school." Nothing beyond that. No "why did I do that?" No "that was shitty." Just the simple observation of the fact that you feel guilty.

Now the fun part. That act that you feel guilty about? It's over. It is now out of your control. If you want to, you can apologize for it some time in the future. You can resolve to never do it again (hey, you're human - in all likelihood, you'll do it again. Accept that!). But, in this moment, in this breath, you can forgive yourself. You can accept your humanity and your imperfection. And you can LET IT GO. Visualize, if you'd like. That guilt can be a stone that has been warmed too long in the sun, and it's burning your fingers. Put it down. Holding it tightly is not doing you any good. Put it down and let it cool. Accept it as it is. Flood it with love for its natural beauty. Direct that love at yourself. You're human. You're beautiful. And in this moment, you accept and forgive yourself, because in this moment that is your only task.

Forgiveness, you'll find, is often something more easily practiced on others than on oneself. This is the way we're built. Self-compassion is frowned upon in many ways. With a little practice, though, we can reveal that oppressive social training for what it is, and we can relieve ourselves of some of the unnecessary burdens we carry. Accepting responsibility can be a very positive thing. Punishing ourselves for doing something "wrong," long after the fact - not so much.

Try this, more than once. And, if you miss a day, try not to feel too guilty about it. :)

Monday, September 5, 2011

Is it a bad idea to cheer someone up?

I've written from time to time (including this post about memorializing him) about the death of my best friend, as it was one of the formative experiences of my life. I learned a lot from his demise, and carry many of the memories with me to this day - and I use a lot of those lessons in my job as a therapist.

One of the most important and long-lasting lessons I learned from that terrible time was that it's not always such a great idea to try and cheer someone up. I heard so many versions of "it's going to be okay!" and "he's in a better place!" and "it's all part of God's plan."

What I didn't hear, at least until his brother said it to me, was "Wow, you must really be hurting. You guys were so close." And that was exactly what I did need to hear. I figured out quickly enough that the people who were trying to cheer me up were doing it mostly for their benefit, not for mine. I'm a cheerful guy. Seeing me grieving threw them off. It made them feel weird, and they wanted me to cut it out. They weren't being malicious about it, or likely even making a conscious choice - but it was clear that it wasn't okay for me to just be there in my grief in front of them.

Going through that has changed what I do when someone is showing emotion. Greg's death came as I was training to be a therapist. Maybe that was his gift to me - his passing solidified and made real the lessons I had been learning in the classroom. No longer was I in a hurry to cheer someone up, and that holds true today both in the therapy room and out.

A simple "you sound sad" or "looks like things are tough for you right now" can really help someone just expand into that space where they're holding their feelings. No need to ask questions ("are you all right?" puts someone into their head as they try to figure out an answer - "you look sad" lets them stay in their heart). Simply let someone know you see them, and you are okay with what you see. This is another one of those easy "therapy tricks" that you can bring into your everyday life to help you strengthen relationships and open yourself to what's really going on with people.

Next time you feel the urge to cheer someone up, ask yourself whether you are doing that for them, or for you. And, make the conscious choice to let them feel what it is they need to feel. In the short run, it may be a little uncomfortable until you get used to it. In the long run, you'll find out how satisfying it can be to give people such a simple but powerful gift.

Friday, September 2, 2011

The Sad Faced Girl

My daily commute is a long one. I bring a book, I listen to music, I tweet and Facebook and blog and email and stumble upon things, but it's a long ride in what amounts to a moving tube full of interesting people. Like everyone else, I look around to see who my neighbors are. I'm a psychologist, and when you're a psychologist if you don't have a natural interest in people you're going to be a very bored psychologist in a very short time, and I'm anything but bored. I love studying people's faces and thinking about their stories. I don't "analyze" them, as people always seem to fear, but I like imagining what they're like and where they're going.

The first time I saw her, she was in the car ahead, obscured by dirty MAX windows and the vibration of a moving train. It was early, and I was just sort of glancing up from my book, and I saw her.

I saw the Sad Faced Girl.

When I was in grad school, learning to be a therapist, I had a classmate with a naturally sad appearance. This classmate was warm and witty and full of life and just cursed with a visage that evoked a feeling of moderate despair any time she looked at you. Not a great package for someone who gets paid to listen to bummed out people, and to this day I wonder if she ever made it in the psychology world. My guess was that she would eventually leave the profession and take up something more physically appropriate, like delivering funeral wreaths or telling people that they've been elected Speaker of the House.

The Sad Faced Girl makes my old classmate look like a smiley-face icon. She's so imbued with this classic, heavy sadness that I envision her face framed by the cold stonework of a medieval tower, her gaze longingly sweeping over the land from which she's been exiled. In my imagination, she has experienced a terrible loss, her heart heavy with it, her entire being slowed to a near crawl, her existence reduced to the experience of Olympic-quality mourning.

The next time I saw her, she was in the same car as me, facing forward, eyes closed. She was listening to music. I could only imagine the music - some dark minor-chord bereavement, bagpipes or maybe just a recorded voice intoning a list of victims of some horrible disaster. She looked tired, she looked downcast, she looked... sad.

A few weeks later, she boarded the train and sat right across from me. I understand the rules of commuting, and despite my urge to plumb the depths of her soul, I held my counsel and just cast a furtive glance once in a while. Her face was clear-skinned and pale, framed with wispy blond hair. Her eyes sparkled with intelligence. Her upper lip, though, was a genetic gift if one wanted to look permanently dysthymic, her Cupid's bow deeply indented, curling the rest of her mouth into a melancholy curve. Like my grad school classmate, she was destined to look sad no matter what she felt like on the inside.

The Sad Faced Girl's big secret was that she probably wasn't sad at all.

I tried once or twice to coax a smile from her as we rumbled through Orenco Station or the Beaverton Transit Center. Like all well-versed MAX riders, though, I knew better than to spend my time leering at her like a fixated schoolboy. Respect for personal space and for the eye-contact boundaries of others is one of the things that allows us to ride along, packed like slices of bread, and to pretend as though our arm isn't rubbing that of a stranger.

I see her now, every once in a while, and resist all attempts at diagnosis. Sadness, maybe not, but Sad-Faced? Severe. Chronic, with no inter-episode recovery. And she's fine just like that.

I wonder how I look to her.