When I was a child, the beginning of summer was just that: a beginning. It was a time of what seemed to be endless possibilities. The countdown to the end of school usually started some time in the middle of May and built to a feverish crescendo that climaxed on or about June 5th, when the last textbooks were stacked in the multipurpose room and we were released into the warm June heat of the Virginia summer.
Early on as a child, I found, to my profound disappointment, that I was a failure on any number of sports courts and fields. Despite endless hours of practice with my naturally athletic cousins, I failed to find either proficiency or personal satisfaction on the baseball diamond, basketball court, or football field--three of the staple neighborhood sports at which boys that age usually excelled.
You can imagine my surprise--and delight--when, at the age of six, I discovered that I could swim! Not only stay afloat, but, with training and determination, I could traverse the length of the pool with enough velocity to compete with--and sometimes beat--my opponents.
It's no wonder that I looked forward to summer so much. I grudgingly suffered through three of the four seasons: football, basketball and baseball. But when the fourth season arrived--swimming--it was my time to shine. Relatively.
For a child who was routinely picked last--or nearly last--for most sports teams, I reveled in my 4th, 3rd, 2nd and the occasional 1st place ribbons I earned each Monday night from June through August. My parents, to their credit, never provided me with either excuses or rationalizations about my wins--or my losses. When I ended a swimming event--all splash and fury--only to find out I had finished an honorable "4th" I wasn't consoled with "You had a bad lane," or "You were swimming with the sun in your eyes," or worse, "The lane judge disqualified you because he doesn't like our team." (And believe it or not, I actually heard parents feeding their kids those lines when I was a swimmer, as well as years later when I was the coach of the team).
In fact, I wasn't really consoled at all. Instead, when I began my own rationalizations, my mom (usually) or dad (sometimes) would hand me a dry towel, look me in the eye and ask calmly: Did you do your best? As difficult as it was to admit that my "best" had only netted me 4th or 5th place, I would soberly reply, Yes. To which my parent(s) would reply, Then you did your best. And, today, in this race, others swam a little better then you did. Next week there will be another race.
Forty-odd years later, I can remember these moments as if they had happened yesterday. I came to look at these as our "no-excuses" moments. Just a realization that my best sometimes wouldn't be as good as somebody else's. And, more importantly, that my best was just fine. Now I suspect there may be some parents out there who will be horrified at my next statement, but here goes: Not only was my best "just fine," 4th, 5th--god forbid last--place was just fine, too. Because I gave it my all.
And, wet and shivering at pool's edge in the early evening chill of a June evening--my self-esteem was born.
Don't get me wrong. Satisfaction with my best didn't mean settling for 4th, 5th or last. It meant pushing myself to whatever personal best I was capable of. And, the summer I turned 14, for a few glorious weeks between our regional meet and state finals, I held the state record for the 50-meter backstroke. There were no parades, no newspaper articles, no celebrations of any kind that I remember. Just the self-satisfaction that, for a handful of days, not only had I finally beaten our city's golden-boy swimmer, Richard Hughes (his real name--sorry Richard) but I had--for just a moment--set the bar for that event. My best, for that brief time, was the best.
I'm not sure what caused that sweet memory from so long ago to surface now. Perhaps it's the fact that it's August and, my sense memory still lingers--August means that summer is winding down. School will be starting soon (in those days we squeezed every drop out of summer, starting school after Labor Day). Perhaps, it's because I see clients often struggle with the competitive nature of jobs--and life--in the Bay Area. Maybe, it's just the fact that, sometimes, the events of the world remind me that this is a time that feels...complicated. And the memories of affirmation--and brief victory--feel simpler, purer, more true.
Now, I'm the first to admit that my memory can be selective, embellished, and optimistic. But, in this instance, the memory of my experience--and the values imparted to me--is pretty much true to the time.
In the Virginia summer of my childhood, this would be the time of summer heat, humid nights, fans blowing cool breezes, lighting bugs at dusk and the winding down of lazy days.
Years later, I still feel late August is a time of anticipation. Of a new beginning. Of a new season. Of things unseen and unknown. And, because of my parents' refusal to rearrange reality to suit my life disappointments, I feel blessedly prepared to meet the unknown. Head-on.
Next week there will be another race.
Thanks, Mom and Dad.
And thanks for listening.
Wednesday, August 24, 2011
Tuesday, August 23, 2011
Gaining Perspective And Getting Out Of Your Head or, The Rx For Depression: Volunteer.
Because I'm not a physician, I can't, of course, prescribe medication. However, I have found, in both a personal and professional realm, that a powerful tool in treating depression is participating in volunteer activity. It can be as simple as serving at a soup kitchen, reading to the elderly, assisting teachers in the school setting, distributing magazines and flowers at a hospital...and the list goes on.
The difficulty when you're depressed, however, can be inertia.
Making that first phone call can be monumental hurdle. And, yet, clients (and friends) report that once the call is made and they overcame their first discomfort with a new challenge, they felt something they had not felt in some time: they were needed. They mattered. They had a contribution to make.
I've related in a previous blog my path to becoming a therapist. Looking back, I'm not certain I was clinically depressed, but I was feeling despondent about my career in advertising. I didn't have a someone special in my life. And I was outside of the US, geographically far away from people I loved. Consequently, I was working hard to "figure out" my life. I was spending alot of time in my head, sometimes spinning in details of my life journey to date: my choices, my talents and shortcomings, my relationships and my loneliness. A friend (who probably was tiring of my constant self-examination) suggested volunteering. Her rationale was sound: You have the time, you're good with people, and the worst that can happen is that they can fire you. So you wouldn't be any worse off than you are now, right?
The first step in that journey was becoming a volunteer at the palliative care ward in a local hospital. The training was great and the experience even greater.
If I had to boil the benefit down to one word it would be: perspective.
When we're trapped in our own heads with our own thoughts, the perspective is short, narrow and limited. When we can interact with others on a personal basis, forgetting for a moment our world and its limitations, we're free to develop an amazing quality: empathy.
The folks at Merriam-Webster define empathy as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another... When you think about it, it makes perfect sense. It would seem almost impossible to be able to "understand, " "be aware," and "vicariously experience" another's world if we're trapped in our own world view.
Interestingly, the same folks at Merriam-Webster have the following to say about "depression:" ...a disorder marked especially by sadness, inactivity, difficulty in thinking and concentration,...feelings of dejection and hopelessness.... My clients often use words like "stuck" and "spinning in my own stuff."
When a task, service or responsibility becomes about anything but you, your perspective is forced to change--just for a time. But change it must. That's when you "leave your head" and concentrate on the needs of others. It can be a freeing change of scenery.
I remember, several years ago, when my father's best friend, Ron, retired from a lucrative career that was a major part of his life for more than 40 years. After retiring, he became grumpy, withdrawn and generally difficult to be around. His wife, in an effort to simply get him out of the house, insisted he volunteer--anywhere. Reluctantly, Ron volunteered at a local after-school program teaching six-year-olds to read.
It makes for an interesting image. Picture a six-foot-four, 200 pound bear of a man sitting in a tiny little chair, at a tiny little table, holding a tiny little book in front of...yes, a tiny little six-year-old. As the kids learned to read, Ron began to have purpose again. He began to engage others, to laugh, to talk with pride about "his kids," the ones he was teaching to read. His sense of humor returned. He not only became a favorite of the kids, but his long-time friends were glad to have the old Ron back.
Was Ron depressed? I couldn't say. But, when he went from being in charge of a company to having no business influence, he certainly seemed to have lost purpose. It took a six-year-old to bring that back. He went from being "stuck" in his own head to being relevant. And needed.
Will volunteering cure your depression? "Cure" is asking alot. But could it help? My personal and professional experiences say that it certainly won't hurt. And, if things are looking particularly bleak, how can you argue with a change of scenery?
Until later, thanks for listening.
The difficulty when you're depressed, however, can be inertia.
Making that first phone call can be monumental hurdle. And, yet, clients (and friends) report that once the call is made and they overcame their first discomfort with a new challenge, they felt something they had not felt in some time: they were needed. They mattered. They had a contribution to make.
I've related in a previous blog my path to becoming a therapist. Looking back, I'm not certain I was clinically depressed, but I was feeling despondent about my career in advertising. I didn't have a someone special in my life. And I was outside of the US, geographically far away from people I loved. Consequently, I was working hard to "figure out" my life. I was spending alot of time in my head, sometimes spinning in details of my life journey to date: my choices, my talents and shortcomings, my relationships and my loneliness. A friend (who probably was tiring of my constant self-examination) suggested volunteering. Her rationale was sound: You have the time, you're good with people, and the worst that can happen is that they can fire you. So you wouldn't be any worse off than you are now, right?
The first step in that journey was becoming a volunteer at the palliative care ward in a local hospital. The training was great and the experience even greater.
If I had to boil the benefit down to one word it would be: perspective.
When we're trapped in our own heads with our own thoughts, the perspective is short, narrow and limited. When we can interact with others on a personal basis, forgetting for a moment our world and its limitations, we're free to develop an amazing quality: empathy.
The folks at Merriam-Webster define empathy as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another... When you think about it, it makes perfect sense. It would seem almost impossible to be able to "understand, " "be aware," and "vicariously experience" another's world if we're trapped in our own world view.
Interestingly, the same folks at Merriam-Webster have the following to say about "depression:" ...a disorder marked especially by sadness, inactivity, difficulty in thinking and concentration,...feelings of dejection and hopelessness.... My clients often use words like "stuck" and "spinning in my own stuff."
When a task, service or responsibility becomes about anything but you, your perspective is forced to change--just for a time. But change it must. That's when you "leave your head" and concentrate on the needs of others. It can be a freeing change of scenery.
I remember, several years ago, when my father's best friend, Ron, retired from a lucrative career that was a major part of his life for more than 40 years. After retiring, he became grumpy, withdrawn and generally difficult to be around. His wife, in an effort to simply get him out of the house, insisted he volunteer--anywhere. Reluctantly, Ron volunteered at a local after-school program teaching six-year-olds to read.
It makes for an interesting image. Picture a six-foot-four, 200 pound bear of a man sitting in a tiny little chair, at a tiny little table, holding a tiny little book in front of...yes, a tiny little six-year-old. As the kids learned to read, Ron began to have purpose again. He began to engage others, to laugh, to talk with pride about "his kids," the ones he was teaching to read. His sense of humor returned. He not only became a favorite of the kids, but his long-time friends were glad to have the old Ron back.
Was Ron depressed? I couldn't say. But, when he went from being in charge of a company to having no business influence, he certainly seemed to have lost purpose. It took a six-year-old to bring that back. He went from being "stuck" in his own head to being relevant. And needed.
Will volunteering cure your depression? "Cure" is asking alot. But could it help? My personal and professional experiences say that it certainly won't hurt. And, if things are looking particularly bleak, how can you argue with a change of scenery?
Until later, thanks for listening.
Wednesday, August 17, 2011
It's All About You--Part II: Keeping Healthy Boundaries.
Last time, I shared my thoughts on the therapist's self-disclosure in session, and why I feel the focus should always remain on you--the client. In this post, we'll look at the nature of the professional client-therapist relationship, and a few ways to maintain healthy boundaries.
Our relationship is professional. Personal details can blur the lines.
I genuinely care about my clients and their well-being. I'm honored that they choose to share personal and intimate details about their lives. I hope my clients can feel my compassion for their difficulties and my satisfaction in their therapeutic accomplishments. However, despite the caring nature of the relationship, it is first, foremost and always a professional one.
For example, I can feel great satisfaction for a client who has worked to improve interpersonal skills in order to secure a job, and in session, I will congratulate this client for his success. However, I choose not to send cards, make congratulatory calls, and won't--under any circumstances-- go out to dinner to celebrate.
My relationship with you as a client will never be a social one. We meet in a professional setting, and maintain professional boundaries. Because of confidentiality, if we happen to pass each other on the street, I will not acknowledge you unless you have given me explicit permission to do so in advance. If you think about it, if you're with other people and I say, "Hello," the natural question can arise: So, how do you know each other? Ethically, I cannot tell anyone that you are my client, and this conversation puts you in the potentially awkward position of having to disclose that you are in therapy. It may seem cold, but it's an ethical boundary that has served my clients well.
So, what do I disclose to my clients in session?
Again, for me, the acid test is, what is in the best interest of my client? For example, I have worked with many clients over the years who have lost one or both of their aged parents. At times, I have felt it appropriate to share--briefly--about the loss of my parents in order to to show empathy for my client's grieving process. Again, it's not about getting my clients to take care of my grief--it's about showing empathy for theirs.
I don't have an "approved list" of self-disclosures. It usually happens in the moment, is brief, pointed, and designed to benefit the client in the moment. If I'm not sure it's in your best interest to share, I pass.
Does this mean if your therapist discloses more or less than I do that it's "wrong?" By no means. As I said at the beginning, therapist disclosure in therapy is a very individual thing. However, if you feel that your therapist is spending more time talking than listening, and you don't feel like the hour is yours, you might want to address it.
Years ago, before I'd ever been in a therapy session, a friend was describing her therapy to me: I go once a week. My therapist is totally focused on what I have to say, never makes it about herself, and doesn't make me feel bad when I admit my mistakes. She's genuinely interested in what I choose to talk about, but gets me back on track when I ramble. It's the one hour a week where I feel like what I have to say really matters. I feel heard.
Feeling heard. In therapy, it can only really happen when one person does most of the talking--you.
Thanks for listening. (I feel heard.)
Our relationship is professional. Personal details can blur the lines.
I genuinely care about my clients and their well-being. I'm honored that they choose to share personal and intimate details about their lives. I hope my clients can feel my compassion for their difficulties and my satisfaction in their therapeutic accomplishments. However, despite the caring nature of the relationship, it is first, foremost and always a professional one.
For example, I can feel great satisfaction for a client who has worked to improve interpersonal skills in order to secure a job, and in session, I will congratulate this client for his success. However, I choose not to send cards, make congratulatory calls, and won't--under any circumstances-- go out to dinner to celebrate.
My relationship with you as a client will never be a social one. We meet in a professional setting, and maintain professional boundaries. Because of confidentiality, if we happen to pass each other on the street, I will not acknowledge you unless you have given me explicit permission to do so in advance. If you think about it, if you're with other people and I say, "Hello," the natural question can arise: So, how do you know each other? Ethically, I cannot tell anyone that you are my client, and this conversation puts you in the potentially awkward position of having to disclose that you are in therapy. It may seem cold, but it's an ethical boundary that has served my clients well.
So, what do I disclose to my clients in session?
Again, for me, the acid test is, what is in the best interest of my client? For example, I have worked with many clients over the years who have lost one or both of their aged parents. At times, I have felt it appropriate to share--briefly--about the loss of my parents in order to to show empathy for my client's grieving process. Again, it's not about getting my clients to take care of my grief--it's about showing empathy for theirs.
I don't have an "approved list" of self-disclosures. It usually happens in the moment, is brief, pointed, and designed to benefit the client in the moment. If I'm not sure it's in your best interest to share, I pass.
Does this mean if your therapist discloses more or less than I do that it's "wrong?" By no means. As I said at the beginning, therapist disclosure in therapy is a very individual thing. However, if you feel that your therapist is spending more time talking than listening, and you don't feel like the hour is yours, you might want to address it.
Years ago, before I'd ever been in a therapy session, a friend was describing her therapy to me: I go once a week. My therapist is totally focused on what I have to say, never makes it about herself, and doesn't make me feel bad when I admit my mistakes. She's genuinely interested in what I choose to talk about, but gets me back on track when I ramble. It's the one hour a week where I feel like what I have to say really matters. I feel heard.
Feeling heard. In therapy, it can only really happen when one person does most of the talking--you.
Thanks for listening. (I feel heard.)
Tuesday, August 16, 2011
It's All About You...Or, My Thoughts On Self-Disclosure In Your Therapy--Part I
Individual therapy is a unique relationship between two people. One is encouraged to come in and share any and all details of his/her personal life in an effort to gain self-insight, make decisions around personal growth and change, and process deep and personal feelings and experiences from the past and present. The other person--the therapist--sits and listens, usually addressing only what the client brings into the room in a professionally concerned manner.
I've been asked more than once, How come I tell you everything and you never say anything about yourself?
Self-disclosure by therapists is...well, very individual. Most therapists are trained, in general terms, to disclose personal information only as it serves the best interest of the client, i.e., you. The term "best interest" is open to interpretation by each therapist, which means that one therapist may be vastly more self-disclosing than another.
I tend to err on the side of "less is more." And the reason is simple: this is your therapy, your session, your journey, your time, your money--the only thing about me that should enter the room is an experience, an anecdote or a personal detail that will specifically be beneficial to you.
Why "How are you?" is a thoughtful, but loaded question.
My clients often settle into a session with a polite, "How are you?" to which I always smile and answer, "Fine. Where would you like to begin today?" Clients who know me well, know that I won't say more. The reason? Everyone occasionally has a bad day, even your therapist. However, it's not your job to soothe, cajole or otherwise take care of my needs. I'll be ok. And, for some clients, it can be less difficult to divert the conversation to me and my problems, than to talk about their own difficulty. And this can put a roadblock in the way of the real reason you're here.
My experiences are not the important experiences in the room.
Yours are. How I might react, my history in a similar situation, my personal experience in a similar setting are largely irrelevant, as it's your reaction, your history, your personal experiences that matter. Because we're all unique human beings with different histories and backgrounds, it would be presumptuous--and unprofessional--of me to begin to think that you would react to a given situation or pain the same as I would. The important information about your distress is about you.
My feelings are not the important feelings in the room.
Again, yours are. If you ask me in session, How would that make you feel?, I'm likely to gently ask you how it made you feel. Your thoughts, feelings and behaviors are some of the variables that we'll work with in session to help you achieve the changes you're looking for. My feelings about your experiences--aside from my desire to be non-judgemental and compassionate--are simply irrelevant. My goal is to help you by making it safe to look inward.
If you spend your time focusing on me, you're not focusing on yourself.
Many therapists, including myself, have spent time in therapy looking at our own issues and difficulties in life. That said, most therapists can empathize with the fact that, as a client, it's sometimes easier to talk about something other than yourself. However, it's in your best interest--there's that phrase again--to keep the conversation focused on your experiences, feelings and movement forward toward your therapeutic goals.
Next time: It's All About You, Part II: More about the professional nature of the client-therapist relationship and keeping healthy boundaries.
Thanks for listening.
I've been asked more than once, How come I tell you everything and you never say anything about yourself?
Self-disclosure by therapists is...well, very individual. Most therapists are trained, in general terms, to disclose personal information only as it serves the best interest of the client, i.e., you. The term "best interest" is open to interpretation by each therapist, which means that one therapist may be vastly more self-disclosing than another.
I tend to err on the side of "less is more." And the reason is simple: this is your therapy, your session, your journey, your time, your money--the only thing about me that should enter the room is an experience, an anecdote or a personal detail that will specifically be beneficial to you.
Why "How are you?" is a thoughtful, but loaded question.
My clients often settle into a session with a polite, "How are you?" to which I always smile and answer, "Fine. Where would you like to begin today?" Clients who know me well, know that I won't say more. The reason? Everyone occasionally has a bad day, even your therapist. However, it's not your job to soothe, cajole or otherwise take care of my needs. I'll be ok. And, for some clients, it can be less difficult to divert the conversation to me and my problems, than to talk about their own difficulty. And this can put a roadblock in the way of the real reason you're here.
My experiences are not the important experiences in the room.
Yours are. How I might react, my history in a similar situation, my personal experience in a similar setting are largely irrelevant, as it's your reaction, your history, your personal experiences that matter. Because we're all unique human beings with different histories and backgrounds, it would be presumptuous--and unprofessional--of me to begin to think that you would react to a given situation or pain the same as I would. The important information about your distress is about you.
My feelings are not the important feelings in the room.
Again, yours are. If you ask me in session, How would that make you feel?, I'm likely to gently ask you how it made you feel. Your thoughts, feelings and behaviors are some of the variables that we'll work with in session to help you achieve the changes you're looking for. My feelings about your experiences--aside from my desire to be non-judgemental and compassionate--are simply irrelevant. My goal is to help you by making it safe to look inward.
If you spend your time focusing on me, you're not focusing on yourself.
Many therapists, including myself, have spent time in therapy looking at our own issues and difficulties in life. That said, most therapists can empathize with the fact that, as a client, it's sometimes easier to talk about something other than yourself. However, it's in your best interest--there's that phrase again--to keep the conversation focused on your experiences, feelings and movement forward toward your therapeutic goals.
Next time: It's All About You, Part II: More about the professional nature of the client-therapist relationship and keeping healthy boundaries.
Thanks for listening.
Saturday, August 13, 2011
From The Therapist's Deck Chair: Why Pets Make Good Therapists.
The weekends take me and my partner north of the city to a place overlooking the Alexander Valley. It's a beautiful morning, one of those Saturday mornings where I can hear the sound of dogs, sheep, horses, goats and roosters from the valley below. Oddly enough, the roosters greet every hour and random minute--not just the dawn--with gusto and abandon.
Close by it would feel like a noisy intrusion. Somehow, in the near distance, it's reassuring that we're not alone on the planet.
Aside from this personal observation (as well as a long and mostly satisfying relationship with George and Gracie, our cats), there is scientific data to support the therapeutic benefits of having pets. Studies have found that human-animal relationships can positively affect mood and health, instill healthy lifestyle changes, and play an important role in healthy aging.
Improved mood and health. Recent studies have shown:
*Pet owners survive heart attacks longer than non-pet owners
*If you have a pet, you're less likely to suffer from depression
*Pet owners tend to have lower blood pressure in stressful situations
*Pet play can increase dopamine levels in the blood, which can help you feel calmer and more relaxed
* Pet owners have lower blood indicators of heart disease (lower cholesterol and triglyceride levels).
We can attribute many of the health benefits of pet ownership to the power of touch. Stroking or holding an animal can actually provide a calming effect in times of stress. Interaction with our pets is a way we can express--and receive--affection. Some of our furry friends require physical activity, which can motivate us to move with them. And some forms of vigorous exercise are known mood elevators.
Pets and healthy lifestyle changes. As I mentioned above, pets can help motivate us to exercise. Dog-walking and house play with your cat are two simple ways to get off the couch.
Caring for your pet can also help you feel less isolated and more needed. When you focus on your pet, you are taking your mind off of your troubles and providing nurture for another living thing. The companionship of a pet can reduce anxiety and stress while providing company and comfort. For those who feel life lacks purpose, many pet care regimens provide structure and purpose on a daily basis.
And, if you've ever visited a dog park you know that walking your dog is a great way to socialize with other animal lovers.
Pets and healthy aging. As we grow older, we often become less connected to others. We retire, our children move away, health concerns make us less mobile, and, inevitably, we begin to lose friends and family members to death.
In older age, making new friends can be difficult. As mentioned above, a dog can be a great new friend for you, and can also provide a pathway to new friends.
Dogs and other pets also encourage movement, playfulness, exercise and even laughter (just add one kitten to one roll of toilet paper and you'll see what I mean).
And, in a life that may feel less and less meaningful at times, the responsibility of a pet and its care can not only provide renewed sense of purpose, but also increased morale and optimism.
Like many joys, pets require commitment and responsibility. Before you decide to add a pet to your life, consider the following:
* While a pet can be playful, it's not a plaything. All pets require daily care and attention. Feeding, walking, litter box care--they all take time and when you neglect these tasks you're neglecting a living being.
* While pets keep on giving, they also keep on costing. Money. Pet maintenance--food, licenses, spaying and neutering, vet care, boarding fees--can amount to significant sums of money. Be sure you're willing and able to make this commitment before taking on the responsibility of a pet.
* Adorable pets can do deplorable damage. Despite all your best efforts at training your pets, occasionally they can shred, tear, soil and otherwise damage your furniture, rugs, walls, clothing and virtually anything you leave unattended. You need to consider: pets are not humans and don't understand why we value the items we value. They will encroach on our territory and our things.
* Some pets carry health risks. The most common health problem associated with pets is allergies. The time to find out about pet allergies is before you take on pet ownership, not after. And for some older adults, it will be important to match your stamina, mobility and stability to the right pet.
After all that, you may be wincing and saying to yourself, Well, why bother? Any pet owner can tell you why. And, I began all this with the notion that pets make good therapists. If for no other reason, pets, like a good therapist, listen to us without judgement. Yes, while some pet owners won't admit it, most of us talk to our pets. We ask them how they feel, if they like their food, and confide in them about our day.
The therapeutic part? They listen without reservation. They don't judge or offer advice we may not want. They don't take sides or provide rationales that make our reasoning seem lame. They simply listen. They entertain us. They provide good company.
And wait for the next scratch behind the ears.
Until next time, thanks for listening.
Close by it would feel like a noisy intrusion. Somehow, in the near distance, it's reassuring that we're not alone on the planet.
Aside from this personal observation (as well as a long and mostly satisfying relationship with George and Gracie, our cats), there is scientific data to support the therapeutic benefits of having pets. Studies have found that human-animal relationships can positively affect mood and health, instill healthy lifestyle changes, and play an important role in healthy aging.
Improved mood and health. Recent studies have shown:
*Pet owners survive heart attacks longer than non-pet owners
*If you have a pet, you're less likely to suffer from depression
*Pet owners tend to have lower blood pressure in stressful situations
*Pet play can increase dopamine levels in the blood, which can help you feel calmer and more relaxed
* Pet owners have lower blood indicators of heart disease (lower cholesterol and triglyceride levels).
We can attribute many of the health benefits of pet ownership to the power of touch. Stroking or holding an animal can actually provide a calming effect in times of stress. Interaction with our pets is a way we can express--and receive--affection. Some of our furry friends require physical activity, which can motivate us to move with them. And some forms of vigorous exercise are known mood elevators.
Pets and healthy lifestyle changes. As I mentioned above, pets can help motivate us to exercise. Dog-walking and house play with your cat are two simple ways to get off the couch.
Caring for your pet can also help you feel less isolated and more needed. When you focus on your pet, you are taking your mind off of your troubles and providing nurture for another living thing. The companionship of a pet can reduce anxiety and stress while providing company and comfort. For those who feel life lacks purpose, many pet care regimens provide structure and purpose on a daily basis.
And, if you've ever visited a dog park you know that walking your dog is a great way to socialize with other animal lovers.
Pets and healthy aging. As we grow older, we often become less connected to others. We retire, our children move away, health concerns make us less mobile, and, inevitably, we begin to lose friends and family members to death.
In older age, making new friends can be difficult. As mentioned above, a dog can be a great new friend for you, and can also provide a pathway to new friends.
Dogs and other pets also encourage movement, playfulness, exercise and even laughter (just add one kitten to one roll of toilet paper and you'll see what I mean).
And, in a life that may feel less and less meaningful at times, the responsibility of a pet and its care can not only provide renewed sense of purpose, but also increased morale and optimism.
Like many joys, pets require commitment and responsibility. Before you decide to add a pet to your life, consider the following:
* While a pet can be playful, it's not a plaything. All pets require daily care and attention. Feeding, walking, litter box care--they all take time and when you neglect these tasks you're neglecting a living being.
* While pets keep on giving, they also keep on costing. Money. Pet maintenance--food, licenses, spaying and neutering, vet care, boarding fees--can amount to significant sums of money. Be sure you're willing and able to make this commitment before taking on the responsibility of a pet.
* Adorable pets can do deplorable damage. Despite all your best efforts at training your pets, occasionally they can shred, tear, soil and otherwise damage your furniture, rugs, walls, clothing and virtually anything you leave unattended. You need to consider: pets are not humans and don't understand why we value the items we value. They will encroach on our territory and our things.
* Some pets carry health risks. The most common health problem associated with pets is allergies. The time to find out about pet allergies is before you take on pet ownership, not after. And for some older adults, it will be important to match your stamina, mobility and stability to the right pet.
After all that, you may be wincing and saying to yourself, Well, why bother? Any pet owner can tell you why. And, I began all this with the notion that pets make good therapists. If for no other reason, pets, like a good therapist, listen to us without judgement. Yes, while some pet owners won't admit it, most of us talk to our pets. We ask them how they feel, if they like their food, and confide in them about our day.
The therapeutic part? They listen without reservation. They don't judge or offer advice we may not want. They don't take sides or provide rationales that make our reasoning seem lame. They simply listen. They entertain us. They provide good company.
And wait for the next scratch behind the ears.
Until next time, thanks for listening.
Thursday, August 11, 2011
"It's None Of Your Business." And 9 Other Reasons People Say "No" To Therapy.
Suppose someone proposed the following to you: 1.) Call a complete stranger on the phone; 2.) Make an appointment to see that stranger to tell her about a distressing or shameful part of your life; 3.) Show up and actually tell that person things about yourself and your personal life that you've never told anyone else on the planet--while the stranger says virtually nothing about herself; 4.) Write the stranger a check.
Is it any wonder that therapy could be feared or misunderstood?
Of course, anyone who has been to a compassionate and competent therapist is likely to give a fuller, more balanced account of therapy. In fact, about 8 out of 10 people would report that therapy actually helped them feel significantly better.
So, why do people say no to counseling--at least at first? Here are the "Top Ten:"
1. It's a sign of weakness. Sometimes we're taught that accepting help--of any kind--is an indicator that we can't solve our own problems. But, if we take that analogy to its extreme, that same person would have to believe that it's a sign of weakness to have your appendix removed, your broken leg set in a cast, or your high blood pressure diagnosed. In fact, it takes a very strong person to recognize a difficult situation and take steps to get help.
2. Only crazy people go to therapy. It's far from "crazy" to have the insight and the intelligence to be able to recognize a difficulty that is causing you distress--and to ask for the help that you need. A popular definition of "insanity" is repeating the same behavior over and over and expecting different results. People who take the brave step to enter treatment are ones who are, very likely, tired of the same results and who wish to try a different way.
3. I can't afford it. It's for rich people. It's true that therapy can be expensive. However, most health care plans provide for some mental health care benefits. And, more and more, therapists are offering a sliding scale for clients who cannot afford full fees. In the end, it comes down to the value you place on relieving your distress--and your belief in feeling better.
4. If I tell someone about my horrible experience, everyone will know. Far from it, licensed therapists are ethically bound to hold confidential your therapeutic conversations. In fact, your therapist cannot even acknowledge that you're in treatment without written permission from you. There are a few instances that involve your safety and the safety of others that require your therapist to break confidentiality. Please see my previous post to learn more.
5. I don't want to betray my family. A good therapist will be sensitive to strong familial or cultural beliefs that discourage you from "airing the family laundry" with someone outside of the family circle. Working with your therapist, you can determine how much, and a what point you're ready to talk about family and relationships you have with them.
6. I wouldn't even know where to start. That's ok. However, the one person in the world who is an expert on you is...you. With your therapist's help, you can learn to talk about how you feel about yourself, your relationships, the way you act and the way you think. As you move forward, you can determine how you would like things to be different for you at the end of your therapy.
7. It's nobody's business but mine. No matter how private a person you are, your life, your actions and your choices can have a big effect on others. And others' reactions to your life choices can have a profound--and sometimes negative--impact on you. And so the cycle goes. Recognizing our connectedness in the world can be a first step in actually helping ourselves feel better.
8. Just talking couldn't possibly help. Actually, imagine talking with someone who will never judge you, never disapprove of your choices, never shame you for your past, and who will listen intently with genuine concern and compassion for your pain. This is what the therapeutic relationship is all about. And it may be unlike any other relationship you've had in the past. It can provide you with a safe room to talk about painful things. And, over time, it can allow you to try out different ways of looking at things that have previously felt too "stuck" or shameful to examine.
9. Dwelling on problems will just make them worse. Sometimes, when you first begin to talk about concerns and worries that you've been reluctant to look at before, it can be painful. However, over time, talking freely, in a safe environment can help lessen the pain and provide clarity for future change and choices. Remember, you're not alone in the room.
10. Therapists only want to get you on medication. A competent therapist is going to work to provide you with the best possible care within his or her scope of practice. Unless your therapist is a physician (psychiatrist), he or she cannot prescribe medication for you. It's true that some therapists may refer you to a psychiatrist for an evaluation for medication which may be helpful in relieving your distress. However, it's important to remember, it's only a referral. You decide whether you want to include medication in your treatment. It's only one part of many conversations you will have with your therapist.
As with any relationship, you and your therapist start out as strangers. But, unlike most other relationships you may have, your therapist, through education, training and a genuine desire to help, puts your well-being and best interest at the forefront of your time together. Without judgement. Without pressure. Without an agenda. For once, it's truly all about you. Which can be a very good reason to say "yes" to therapy.
As always, thanks for listening.
Is it any wonder that therapy could be feared or misunderstood?
Of course, anyone who has been to a compassionate and competent therapist is likely to give a fuller, more balanced account of therapy. In fact, about 8 out of 10 people would report that therapy actually helped them feel significantly better.
So, why do people say no to counseling--at least at first? Here are the "Top Ten:"
1. It's a sign of weakness. Sometimes we're taught that accepting help--of any kind--is an indicator that we can't solve our own problems. But, if we take that analogy to its extreme, that same person would have to believe that it's a sign of weakness to have your appendix removed, your broken leg set in a cast, or your high blood pressure diagnosed. In fact, it takes a very strong person to recognize a difficult situation and take steps to get help.
2. Only crazy people go to therapy. It's far from "crazy" to have the insight and the intelligence to be able to recognize a difficulty that is causing you distress--and to ask for the help that you need. A popular definition of "insanity" is repeating the same behavior over and over and expecting different results. People who take the brave step to enter treatment are ones who are, very likely, tired of the same results and who wish to try a different way.
3. I can't afford it. It's for rich people. It's true that therapy can be expensive. However, most health care plans provide for some mental health care benefits. And, more and more, therapists are offering a sliding scale for clients who cannot afford full fees. In the end, it comes down to the value you place on relieving your distress--and your belief in feeling better.
4. If I tell someone about my horrible experience, everyone will know. Far from it, licensed therapists are ethically bound to hold confidential your therapeutic conversations. In fact, your therapist cannot even acknowledge that you're in treatment without written permission from you. There are a few instances that involve your safety and the safety of others that require your therapist to break confidentiality. Please see my previous post to learn more.
5. I don't want to betray my family. A good therapist will be sensitive to strong familial or cultural beliefs that discourage you from "airing the family laundry" with someone outside of the family circle. Working with your therapist, you can determine how much, and a what point you're ready to talk about family and relationships you have with them.
6. I wouldn't even know where to start. That's ok. However, the one person in the world who is an expert on you is...you. With your therapist's help, you can learn to talk about how you feel about yourself, your relationships, the way you act and the way you think. As you move forward, you can determine how you would like things to be different for you at the end of your therapy.
7. It's nobody's business but mine. No matter how private a person you are, your life, your actions and your choices can have a big effect on others. And others' reactions to your life choices can have a profound--and sometimes negative--impact on you. And so the cycle goes. Recognizing our connectedness in the world can be a first step in actually helping ourselves feel better.
8. Just talking couldn't possibly help. Actually, imagine talking with someone who will never judge you, never disapprove of your choices, never shame you for your past, and who will listen intently with genuine concern and compassion for your pain. This is what the therapeutic relationship is all about. And it may be unlike any other relationship you've had in the past. It can provide you with a safe room to talk about painful things. And, over time, it can allow you to try out different ways of looking at things that have previously felt too "stuck" or shameful to examine.
9. Dwelling on problems will just make them worse. Sometimes, when you first begin to talk about concerns and worries that you've been reluctant to look at before, it can be painful. However, over time, talking freely, in a safe environment can help lessen the pain and provide clarity for future change and choices. Remember, you're not alone in the room.
10. Therapists only want to get you on medication. A competent therapist is going to work to provide you with the best possible care within his or her scope of practice. Unless your therapist is a physician (psychiatrist), he or she cannot prescribe medication for you. It's true that some therapists may refer you to a psychiatrist for an evaluation for medication which may be helpful in relieving your distress. However, it's important to remember, it's only a referral. You decide whether you want to include medication in your treatment. It's only one part of many conversations you will have with your therapist.
As with any relationship, you and your therapist start out as strangers. But, unlike most other relationships you may have, your therapist, through education, training and a genuine desire to help, puts your well-being and best interest at the forefront of your time together. Without judgement. Without pressure. Without an agenda. For once, it's truly all about you. Which can be a very good reason to say "yes" to therapy.
As always, thanks for listening.
Tuesday, August 9, 2011
Confidentially Speaking: What Your Therapist Can--And Cannot--Share.
In principle, the therapy room is "Las Vegas:" What happens here stays here. Well, almost.
If you're in therapy with a licensed therapist in the state of California, your therapist has (or should have) already told you that there are a few instances where he or she must break confidentiality in order to address an issue of safety. These instances are:
1. If you tell me that you're going to harm yourself. On occasion, you may have heard many people say in a moment of frustration, "I could just kill myself." Often, this is just taken as a figure of speech, and passed over with no real concern.
However, in the therapeutic setting, even if I really don't think you're serious, I'll discuss the comment with you to understand if you're serious, somewhat serious, unsure or not serious at all about harming yourself. I take any comment about harm to self or others very seriously, until I'm sure there is no reason for concern.
The standard for reporting a client's self-harm is "reasonable suspicion," that is, if, after talking with you directly about your suicidal thoughts and/or plans, your therapist has a reasonable belief that you are going to hurt yourself, your therapist is obligated to call someone to help keep you safe. Before breaking confidentiality, your therapist may attempt to have you agree to a no-harm contract. If this is not successful, or if your therapist believes that you are not sincere in making the contract, he or she may call in the police, paramedics or other emergency response team trained to assess for suicidalitiy.
If these professionals feel you are an imminent danger to yourself, they may initiate a "51/50" which allows you to be taken to a safe place for observation and treatment. The length of the hold will depend on the assessment of the mental health professionals involved.
2. If you tell me you're going to harm someone else. Again, a frustrated person may blurt out in anger, "She's such a jerk. I could just kill her sometimes!" Again, I take the words seriously, and will assess to see if there is any reason to be concerned. Like the scenario for self-harm above, if I have a reasonable belief that you are an imminent danger to another person, I have an obligation to notify that person (if at all possible) and to notify the police.
3. If you tell me that a child (under the age of 18) is being physically or emotionally abused. This child doesn't necessarily have to be in your family. I have an obligation to try to identify the child and make a report to Child Protective Services (CPS), or any similar agency in your community. Physical abuse includes certain forms of hitting, using excessive force in any way and/or sexual abuse. Emotional abuse involves repetitive and degrading behavior, often verbal, designed to intimidate and demean the child. Again, I don't have to have "proof" that there is abuse, just reasonable suspicion. It will be up to CPS to determine if an investigation is warranted. If so, they will usually make a visit to the home or school to gather more information, clarify facts, discuss the situation with the child's family or legal guardians and take any corrective action needed to keep the child safe from physical or emotional harm.
4. If you tell me an elder (aged 65 or older) is being physically, emotionally or financially abused.
Again, this person doesn't necessarily need to be related to you. The criteria for physical and emotional abuse are virtually the same as for children. Financial abuse has to do with unwanted interference with the financial dealings of an elder, theft from assets, cash or accounts, or negligence in the management of an elder's financial matters. As with all instances listed here, I don't need proof. This will be up to a team of investigators from Adult Protective Services, or a similar agency in your community. Like the other scenarios listed above, I'm required to report a reasonable suspicion of these kinds of abuse with elders.
5. If a judge orders me to release your client records. While it has never happened in my practice, on a rare occasion, a judge will compel a therapist to release confidential psychotherapy records. It can sometimes happen when couples who are divorcing or contesting child custody ask their attorneys to subpoena family psychotherapy records.
I am only authorized to release your records (or any requested information about your treatment) if 1.) you provide me with a written, signed release stating that I may do so, or 2.) a judge overrules my attorney's objections to release your records and orders me to provide them to the court.
Currently, these are the specific instances I'm required to report to authorities, and all are directly related to human physical, emotional, or financial safety.
What about domestic violence? Currently, there is no mandate to report incidents of domestic violence between adults. While I may work with you to help you decide how to stay safe or access resources so you can ensure the safety of yourself and your children, I cannot, by law, break confidentiality in this instance.
I've been fortunate. I have never been compelled to release client information. On rare occasions, my clients themselves have asked for very specific information about their treatment to be released. I will only release this information if I've had the opportunity to discuss this with my client so that we both can adequately understand the ramifications of release of such information.
A good therapist will freely discuss with you the limits of confidentiality in therapy. If you're not sure, ask. Neither you nor your therapist should leave disclosure up to a roll of the dice.
Until next time, thanks for listening.
If you're in therapy with a licensed therapist in the state of California, your therapist has (or should have) already told you that there are a few instances where he or she must break confidentiality in order to address an issue of safety. These instances are:
1. If you tell me that you're going to harm yourself. On occasion, you may have heard many people say in a moment of frustration, "I could just kill myself." Often, this is just taken as a figure of speech, and passed over with no real concern.
However, in the therapeutic setting, even if I really don't think you're serious, I'll discuss the comment with you to understand if you're serious, somewhat serious, unsure or not serious at all about harming yourself. I take any comment about harm to self or others very seriously, until I'm sure there is no reason for concern.
The standard for reporting a client's self-harm is "reasonable suspicion," that is, if, after talking with you directly about your suicidal thoughts and/or plans, your therapist has a reasonable belief that you are going to hurt yourself, your therapist is obligated to call someone to help keep you safe. Before breaking confidentiality, your therapist may attempt to have you agree to a no-harm contract. If this is not successful, or if your therapist believes that you are not sincere in making the contract, he or she may call in the police, paramedics or other emergency response team trained to assess for suicidalitiy.
If these professionals feel you are an imminent danger to yourself, they may initiate a "51/50" which allows you to be taken to a safe place for observation and treatment. The length of the hold will depend on the assessment of the mental health professionals involved.
2. If you tell me you're going to harm someone else. Again, a frustrated person may blurt out in anger, "She's such a jerk. I could just kill her sometimes!" Again, I take the words seriously, and will assess to see if there is any reason to be concerned. Like the scenario for self-harm above, if I have a reasonable belief that you are an imminent danger to another person, I have an obligation to notify that person (if at all possible) and to notify the police.
3. If you tell me that a child (under the age of 18) is being physically or emotionally abused. This child doesn't necessarily have to be in your family. I have an obligation to try to identify the child and make a report to Child Protective Services (CPS), or any similar agency in your community. Physical abuse includes certain forms of hitting, using excessive force in any way and/or sexual abuse. Emotional abuse involves repetitive and degrading behavior, often verbal, designed to intimidate and demean the child. Again, I don't have to have "proof" that there is abuse, just reasonable suspicion. It will be up to CPS to determine if an investigation is warranted. If so, they will usually make a visit to the home or school to gather more information, clarify facts, discuss the situation with the child's family or legal guardians and take any corrective action needed to keep the child safe from physical or emotional harm.
4. If you tell me an elder (aged 65 or older) is being physically, emotionally or financially abused.
Again, this person doesn't necessarily need to be related to you. The criteria for physical and emotional abuse are virtually the same as for children. Financial abuse has to do with unwanted interference with the financial dealings of an elder, theft from assets, cash or accounts, or negligence in the management of an elder's financial matters. As with all instances listed here, I don't need proof. This will be up to a team of investigators from Adult Protective Services, or a similar agency in your community. Like the other scenarios listed above, I'm required to report a reasonable suspicion of these kinds of abuse with elders.
5. If a judge orders me to release your client records. While it has never happened in my practice, on a rare occasion, a judge will compel a therapist to release confidential psychotherapy records. It can sometimes happen when couples who are divorcing or contesting child custody ask their attorneys to subpoena family psychotherapy records.
I am only authorized to release your records (or any requested information about your treatment) if 1.) you provide me with a written, signed release stating that I may do so, or 2.) a judge overrules my attorney's objections to release your records and orders me to provide them to the court.
Currently, these are the specific instances I'm required to report to authorities, and all are directly related to human physical, emotional, or financial safety.
What about domestic violence? Currently, there is no mandate to report incidents of domestic violence between adults. While I may work with you to help you decide how to stay safe or access resources so you can ensure the safety of yourself and your children, I cannot, by law, break confidentiality in this instance.
I've been fortunate. I have never been compelled to release client information. On rare occasions, my clients themselves have asked for very specific information about their treatment to be released. I will only release this information if I've had the opportunity to discuss this with my client so that we both can adequately understand the ramifications of release of such information.
A good therapist will freely discuss with you the limits of confidentiality in therapy. If you're not sure, ask. Neither you nor your therapist should leave disclosure up to a roll of the dice.
Until next time, thanks for listening.
Tuesday, August 2, 2011
Sitting With Discomfort Or, Accepting What Is.
Discomfort, frustration, disappointment--none are strangers to most of us. And, none are classified as "disorders." However, if you suffer from an anxiety disorder or clinical depression, the ability to "sit" with your discomfort--to temporarily accept what cannot be changed--can be an extremely helpful coping mechanism.
Developmentally, tolerance of discomfort is usually mastered gradually, starting in later childhood and spanning into adulthood. However, it's a skill or talent, which suggests that we may all have varying degrees of ability in this area. And, given our financial circumstances, physical health, mental health, life stressors--even our diet and drug/alcohol intake--our ability to tolerate mental discomfort can vary widely in different life stages.
I don't like this, I don't want this. But I can't change this. Now what do I do?
According to the Cleveland Clinic's web page on "Emotional Well-being," there are several ways to help cope with things, events--even people--that are causing us distress.
Lowering your expectations. Can you think of a time when you really were expecting too much of the situation? The person? The environment? Or, perhaps, yourself? Adjusting expectations can be a helpful first step in sitting in the here and now.
Asking others to help or assist you. Sometimes relief is just a question away. Trying to do everything on our own can cause us to feel isolated and overwhelmed. Learning to ask for help can lessen the discomfort.
Taking responsibility for the situation. Said another way: "Own your stuff." This can be difficult, especially if we're used to trying to share the blame. You may not be able to change a situation, but if you can own it, you may be able to accept responsibility until a solution comes along.
Engaging in problem solving. Sometimes, it's difficult to look for solutions when we're feeling down or hopeless. But, breaking the "there's no way out" self-talk can provide an alternative--even in theory--to what may seem to be a dire situation.
Maintaining emotionally supportive relationships. Sometimes, it can be extremely helpful just to talk with someone--someone who knows you, listens to you and can give you what you want in a listener. Sometimes we want someone to listen and provide feedback. Other times, we simply want someone who will let us vent. Maintaining supportive relationships can give us these outlets.
Maintaining emotional composure or, alternatively, expressing distressing emotions. I've never been a big fan of "holding it in," but there can be therapeutic benefit in not letting our emotions get the best of us. What does this mean? It can be as simple as resisting strong emotional urges: to cry, stomp, throw things, yell--or worse. Constantly yielding to every emotional urge can lead to feelings of being out of control. Expressing distressing emotions through discussion, journaling--even art therapy--can provide a socially acceptable outlet for our emotions that doesn't add to our distress.
Challenging previously held beliefs that are no longer adaptive. Self-talk can be central to coping with discomfort. By listening to our internally-held beliefs and challenging their usefulness in our lives, we have the opportunity to literally change our "internal" minds, and release ourselves from beliefs that no longer serve us.
Distancing yourself from the source of distress. Sometimes "acceptance" takes the form of distance. If a person or situation is causing emotional discomfort, putting distance between yourself and the source doesn't necessarily solve the problem, but it can make it easier to tolerate.
Viewing the problem through a religious or spiritual perspective. Using the "filter of faith" can be helpful in relinquishing a problem. "Giving it up to God, " or "surrendering a problem to the universe" can provide both relief and freedom from a discomforting situation that is beyond your control.
Regardless of which techniques you use, experts agree that coping is a process rather than an event. You may find yourself using one or more coping mechanisms or alternating between them.
If you're reading this and finding that you're quietly resisting help at every turn, you may want to ask yourself: What's in the way of my accepting an alternate way of dealing with my distress? Why don't I want to try to lessen my discomfort?
Unless you live a charmed life devoid of stress or disappointments, you'll likely find that sitting with discomfort is a part of everyday life. If nothing else, take a few deep breaths and take mental stock of your blessings. Gratitude can be a wonderful healer, too. But that's a subject for another posting.
Until then, thanks for listening.
Developmentally, tolerance of discomfort is usually mastered gradually, starting in later childhood and spanning into adulthood. However, it's a skill or talent, which suggests that we may all have varying degrees of ability in this area. And, given our financial circumstances, physical health, mental health, life stressors--even our diet and drug/alcohol intake--our ability to tolerate mental discomfort can vary widely in different life stages.
I don't like this, I don't want this. But I can't change this. Now what do I do?
According to the Cleveland Clinic's web page on "Emotional Well-being," there are several ways to help cope with things, events--even people--that are causing us distress.
Regardless of which techniques you use, experts agree that coping is a process rather than an event. You may find yourself using one or more coping mechanisms or alternating between them.
If you're reading this and finding that you're quietly resisting help at every turn, you may want to ask yourself: What's in the way of my accepting an alternate way of dealing with my distress? Why don't I want to try to lessen my discomfort?
Unless you live a charmed life devoid of stress or disappointments, you'll likely find that sitting with discomfort is a part of everyday life. If nothing else, take a few deep breaths and take mental stock of your blessings. Gratitude can be a wonderful healer, too. But that's a subject for another posting.
Until then, thanks for listening.