Sunday, July 29, 2012

Tips for new therapists

I was visiting an internet forum this morning (what are we supposed to call those now? There are forums, boards, sites, subReddits, groups, lists... just use what you want) and someone asked about tips for new therapists. Even though this blog is aimed at people who GO to therapists, for the most part, I thought you all might get some insight out of what I wrote. If not, then go me for being lazy enough to cut and paste a forum reply and call it new content!

I work with early-career therapists, and I've found over the years that a lot of advice I give them is pretty simple stuff - the same things I try to remember when I work with clients. Here are some of the things I keep repeating:

Slow down and listen. Seriously. Let your client pause and feel without lobbing an intervention in there. Just shut up sometimes.

ALWAYS ask yourself if what you're doing is about you, or about your client. Are you saying something so your client will like you? That's not bad in and of itself, if it's for the client and has to do with relationship-building and gaining trust and openness. If it's so they'll simply like you, shut up and listen. :)

You're doing more than you think you are, simply by listening without judgment. That doesn't mean you don't have work to do, but don't do work simply to do work.

The beauty is in the work. Your journey with your client is what it's all about. You might end up somewhere, but there's a good chance it won't be where you thought you were going.

Clients learn when you don't think they are learning. They feel when you don't think they're feeling. A year later, they'll tell you that something you said changed their life, and you won't even remember saying it. You'll be too busy remembering that amazing intervention you came up with that you were SURE was going to change everything.

You're better than you think you are. Your client is more resilient than you think she or he is. The world is a more complicated place than either of you can fathom, and your job is to simply exist in that moment with your client and do what you can. Be genuine, and keep that in mind.

Therapists aren't perfect. They're humans with some knowledge and skills that others can use. Go easy on yourself.

Boundaries are everything. If you find yourself doing something for your client that you wouldn't do with another client, think seriously about what that is about. Always remember to think about whether your actions are for you, or for your client.

Approach everything with love. Everything.

That's it. Now you're a therapist! Well... almost.

Sunday, July 15, 2012

Three quick ways to lift your mood RIGHT NOW.

Change, as you know, can take time. It takes practice to un-learn things, to relearn things, to work at finding the path and staying on it until the changes come. The journey can be a long one.

Sometimes, though, you just want to feel a little something RIGHT NOW. Long term sustainable change is awesome, but every once in a while there's nothing wrong with making a little mid-course correction that you can feel right away. Here are three things you can do that will help right now.

Give a call. Everyone, I mean everyone, has a call they can make to someone who could use it. A friend, a parent, a coworker - someone could really use a call from you that simply says, "I was thinking about you. How are you doing?" The trick here is to not expect anything in return. Call with the simple goal of listening, and caring. Truly listen. Truly care. The rest will follow.

Lend a hand. Unexpected help lifts the mood on both sides of the equation. Carry a grocery bag. Open a door. Take a minute to find a volunteer effort that could use your help. Write a check to a charity and mail it. Donate online to a friend's fundraising walk. It should be pretty easy to find an opportunity.

Drop some praise. "Your yard looks amazing." "I love that coat." "Your smile always brightens my day." Just say something positive to someone. If you're the shy type, push yourself a little. Or, leave a note for the restaurant manager to talk about great service someone gave. Write a letter to someone you admire. The way you do it doesn't matter. The fact that you give appreciate and praise without any expectation of return is what counts.

All of these decidedly little things can do decidedly big things for your mood, but here's the big secret: they can also be completely "meh." The key is in your approach. If you're just making another obligatory phone call, that's pretty meh. That won't do a thing for you. If, on the other hand, you decided to completely engage in that moment, if you can find yourself completely in love with that little piece of the path, if you can give all the love you have within yourself through the act of making that phone call, then you're onto something.

It's like everything else - nothing has to be boring, or worthless, or stupid, if we choose to engage in it to the peak of our abilities. Flow is flow, whether you're doing brain surgery or cutting up a piece of celery. Find yourself there, give of yourself, and watch your mood change for the better.

Thursday, July 12, 2012

Quick practice: non-judgmental listening

Here's one of those little mindful things you can do no matter where you are.

Listening is one of those things that is simple to learn and nearly impossible to master. I spend my workdays listening, and even with all the practice I have had, it's still tough sometimes to separate myself from what my client is saying. My goal, when really listening, is to get rid of that "how does this impact me?" thing that we've been conditioned to do to survive. I want to really open up to what my client is saying - sometimes feeling heard is just what they need to move forward.

Here's your task: whether you're at work or at home, next time someone speaks to you, really listen. As those "hey, what about me" thoughts come in, notice them and let them go. Ask a question about what you just heard, rather than passing judgment or offering a solution or sharing a fear or... you get it.

The opportunity might not come up immediately, especially if you're at work. "Yo, Bob, I'm going to go to the bathroom" is NOT your opportunity to dig in. However, "I'm worried about getting this done on time" is. Think about that scenario, and how quickly we'd say something like "me too... in fact I think we're really getting piled on here," instead of "what do you mean?" or "why?" or "are there other things you're worried about?"

People ask me all the time about social skills, and how to get better at interacting with people. People like to be heard. If you truly listen, you will get your chance to speak. And, if you don't get a chance in that interaction, it simply means that that person had a need to be heard that exceeded anything else. And how can giving them that chance be anything but good?

So, nutshell version: just listen. Ask a question. Indicate that you're willing to hear more. I'm here to tell you that REAL listening saves lives. And, while that might not happen at the office, you might be surprised at how quickly being a great listener pays off in other ways.

Tuesday, July 10, 2012

A one-minute method to help move past old hurts

When people come to therapy to see me, they're often trailed by an almost-visible string of old injuries - a hypercritical parent, a missed opportunity, a horrible breakup. And, when I point out to them that they've got some past pain stuck on their shoe, their reaction is almost universally the same: "I've been trying to understand why that happened."

I've worked with clients, sometimes for months or years, whose stated goal is to UNDERSTAND. Why did mom act like that? What could I have done differently?

Here's a little secret. Often, when we spend our time trying to understand things in the past, or the things that people have done to us, or the breaks that haven't come our way, what we're really doing is STALLING. Rumination is a defense mechanism that trades little doses of low-level pain to avoid the thing we're really afraid of - moving forward. When we're working on change, maybe it doesn't matter so much WHY your mom treated you like that, as it does HOW to accept it and move forward. Whether she was controlled by aliens, tortured from within by forces you'll never understand (and my money is on this one, by the way) or simply a crabby person, the fact is that it's unlikely that even a crystal-clear understanding will do a whole lot to move you forward. That's your job.

So, here's your one-minute task. Next time you catch yourself in a rumination about the past that has some impact on your present life (as do all ruminations), just do this: Trade a why for a how. Instead of "why did that happen?" just say "How can I move one step forward?"

Approach, don't avoid. Rumination is avoidance, and you'll likely never get the answer you think you so badly need. Pretend like that part of the hard drive is wiped. The question is how, in this beautiful moment of life I've been granted, do I take a step forward? Just one step, not the whole path. Just one moment, not the whole day.

Take your minute. Use it to move yourself forward. Then tell yourself you are beautiful, strong, and capable. Because you are.

Saturday, June 30, 2012

Make changes more easily by harnessing the chain of behavior

Most of us have been there - you make a few resolutions at the new year, and they fall by the wayside. A couple of months later, you try again, recalling those failed resolutions and deciding to just go it on your own, regardless of what the calendar says.

Now the year is half over. Despite your heroic attempts at approaching the problem, rather than avoiding, the changes just haven't taken effect. You lose your focus. You don't really have a solid plan in the first place.

With that being said, however, there are certainly times when a resolution makes a lot of sense. For example, that four-dollar latte is costing you about a thousand dollars per year. Why not try to cut it from your routine?

Here's where you've got some decisions to make. Back in the good old days, you'd summon up your willpower, that magical quality that was apparently bestowed upon some of us at birth while the rest of us spent our days striving to figure out how to find it. The legend had it that willpower would take you through these sorts of things - you'd just power through, forgo those lattes, and be done with it.

The problem, of course, is that willpower isn't really a thing at all. Some people have a personality that makes it easier to do some things, and others have personalities that serve them in areas unattainable by the willpower crowd. If you're one of the many who didn't receive that willpower gene, it's time to resort to good old behavioral science. In this case, you'll be calling upon the Chain of Behavior to help you stop sipping those spendy coffee drinks.

The Chain of Behavior works like this - think about all of the steps it takes to get that latte into your mouth. You have to pay for it, sure... but before that, you have to walk into the coffee shop. And before that, you have to get to the street the coffee shop is on. To do that, you have to leave wherever you are before you go to the coffee shop. And, to get where you are before you go to the coffee shop, you have to drive, or walk, or take the bus from your house. And, don't forget payment - to pay for that latte, you have to have your wallet or purse with you, and money in your purse, and... well, you get the idea.

So, that's the chain. If you break it, you don't buy the latte. You can break it at many points, but the further up the chain you go, the better the chance of success. Not walking into the coffee shop is great. Not being on that street is better. Not having your money with you is even better! See how it works? Figure out the chain of events that get you to the last link. Then break the chain as far up as you can.

This also works with things you are trying to add to your life, not just trying to quit. There's a chain that gets you in the gym that starts with having the time, and the gear, to work out. Putting your clothes in your gym bag is a link. Putting your gym back into your car is a link. You get the idea.

So, to those of you who are still working on those resolutions, best of luck. Hopefully figuring out the links to your particular chains will help you succeed. And for those of you who are just plugging along, day by day, everything you do is a chain as well. Take a look at the links, make adjustments where you can, and keep trying your best. And, whatever you do, don't forget to give yourself some praise and reward when you wrestle one of those chains into submission. You can do it!

Sunday, June 24, 2012

Ask the Doc: When a therapist breaks your trust

Q. Someone dear to me was a client of a counselor/therapist who radically broke her trust, and she's never been able to trust any counselor/therapist since. How do you learn to trust a therapist/counselor after your trust has been betrayed by one? (I asked for additional information, and was told that the therapist shared personal information about the client without permission, in order to enable the person outside the relationship to "help with the therapy).

First, before I go anywhere else with this answer, I want to express my dismay about what happened to your friend. As with any profession, there are people who don't follow the rules. I've had clients tell me about a prior therapist who fell asleep in session, or walked out to take personal phone calls. These rogue professionals are thankfully rare, but they do exist. The therapy relationship is entirely built on trust, and your friend's experience has created an injury that will be hard to overcome.

While no one can "fix" this situation, here are some things for your friend to think about while considering whether to give therapy another try. The options range from reporting the therapist to simply working on rebuilding an attitude of trust, and all are about choices that your friend can make.

One choice your friend can make is to report the therapist for a confidentiality violation. If the therapist is licensed, the state licensing board will handle the complaint. This is obviously not a choice to be made lightly, as your friend would need to continue to be involved in this traumatic situation. I always inform my clients of their rights when they feel they've been harmed by their previous therapist, and I always understand when pursuing a complaint sounds too difficult to them. I'm there to support them in whatever they choose to do. This is what you can do for your friend, as well. Let them know about their choices, and support them unconditionally.

Another choice to be made is when (and whether) to reengage in therapy. If therapy begins again, the choices are about how much to disclose, and when to disclose it. The difficulty here is that this kind of dilemma is perfect therapy fodder, and your friend is likely very resistant to therapy. Some make the choice to "get back on the horse," while others need to let time heal the wounds.

Your friend will likely need to spend some time considering her feelings, really thinking about what will be needed to rebuild a trusting relationship. When the time comes to disclose things in therapy, the process will be made easier by having thought beforehand about where the boundaries are, and what the true feelings are. A good therapist will be open to working on this process - your friend can tell the therapist that a core issue is trusting the therapist, and the work can begin there. A good, careful therapist will be willing to take as much time as needed, while at the same time knowing when to gently push a little.

As therapists, we understand that our clients have often navigated a bumpy road before ending up in our office. We get that we might have to start from scratch, maybe more than once. I hope your friend can forgive herself if she feels gun-shy, and I hope she can realize that it will be difficult to start a new therapeutic relationship. It's okay if she starts and stops before she finds someone she can trust. The therapy work is about her, not about the therapist, and it's perfectly natural for her to pick her way carefully down the path.

Saturday, June 23, 2012

Try this today...

Set an alarm for two hours from now. Use your phone, a kitchen timer, whatever works. When the alarm goes off, do this:

- Take five deep breaths. Visualize the stress of the last two hours leaving your body, and fresh energy for the next two hours entering your body.

- Look in a mirror. Say "I love you. You're doing the best that you can."

- Take 30 seconds to say something nice to someone, either in person or via text or email.

- Set your alarm for two more hours. Repeat.

Try it. Just for today.