The moment 

One of the most compelling aspects of therapy is the moment when a client realizes change has occurred.  I have witnessed many of these powerful moments.  Often I do not know when it happened but the client looks different, speaks differently, and are able to reglect on their life from a place of health.  Those moments are what compels me to continue this work.

I have had clients ask, “how will I know I have reached my goals, that real change has occurred?”  My response is always that I do not know but we will arrive there together, they will have my support and encouragement through out.  In the end I believe that is why they came to my door, they became tired of doing the hard work of change and healing alone.  So we share the journey and the moment of joy when change occurs together, as a team.

Teens and cutting

In my practice I have noticed an increase in teens struggling with cutting.  Often the parents are very scared and the teen is in a lot of emotional pain.  Their parent may be afraid that they are suicudal or attention seeking.  More than likely, they are seeking a way out of their pain and are addicted to the act of cutting.

When working with the parent there are a few standard things they can do to help their teen.  First, remove all objects that could be used to cut including scissors, razor blades, paper clips, and even the binding of notebooks.  Then make a contract with the teen to not cut for a certain amount of time.  Lastly, and this may be painful, you must check them for fresh cuts.  This can seem scary or like a violation of privacy but it is important that they know they will be held accountable if they choose to continue the behavior.

Why would anyone want to cause physical harm to themselves?  According to teens I have worked with it is a relief of all the stressors and pressure they are carrying within themselves.  It is a way to express the emotional pain without having to risk the vulnerability to share with another human being that they fear may judge them.  During this time in an individual’s development there is a need to figure identity out, who you are and what it means to the world.  It is very important to encourage this exploration and independence, this is why not allowing the teen to have time alone when cutting is very damaging.  With support and limited access to  tools they can use to cut, they will recover.

Mental illness and work

Given the recent tragedy of the Germanwings flight accident and the belief that this was caused by an individual with an extensive history of mental illness, I was considering how having a mental illness needs to be dealt with in the workplace.  It is surely hard for someone struggling with mental health challenges to speak with their employer regarding their concerns.  Likely they need their employment to survive, to have the health insurance to get treatment, and to have a reason to get out of bed each day.  These realities would make one feel very vulnerable when it comes to expressing challenges related to mental illness.

Yet, if one becomes disabled to the point where they can not preform their job function or, such as happened with this co-pilot, could be a risk to others, it seems that reporting mental illness would be the responsible decision.  From my knowledge of the symptoms of mental illness and the impact that it has in individuals, the relationship that the employee has with the company/management coupled with policies that allow an individual to be able to retain employment and benefits while being responsible for their mental well being seems essential.  

It is my belief that mental illness needs to be treated as any other illness that, when unmanaged or has a severe impact in functioning, must be treated and not looked down upon.  This plays into the importance of removing the stigma associated with mental illness and companies promoting open and safe communication by employees as well as creating an environment that supports the mental wellness of it’s employees.  It is sad to consider that this co-pilot felt a level of desperation in his life that he felt justified in killing so many others to find relief from his struggles.

Until the next marker

I was never an athlete by any measure of the word.  Therefore, signing up to run a half marathon seemed like an idea that may not have a favorable outcome.  I committed to it and, like most other things in life, I decided to just figure it out as I went along.  I was scared yet my expectations were not very high so I was ok with running slowly or walking occasionally.  My mantra, as the number of miles increased, became to tell myself “the first mile is always the hardest.”

This was how I got myself in the correct frame of mind to start each run I did.  Then I found another challenge, after a few miles and my mind started chattering with the “I can not keep going” conversations I created a new trick.  The new trick was I told myself I only had to make it to the next marker.  Instead of 5 more miles the mission was to touch the next tree, stop sign, or the edge of the sidewalk.

This way of thinking is very powerful when dealing with mental health challenges.  The “I can’t” conversation can become overwhelming but can be replaced by small steps and goals to get through the next week, day, even minute.  I found that knowing and seeing where I was going increased my determination.  Sometimes knowing that all you need to do is make it to that next marker makes all the difference.

Holding Hope 

There are many things in life that can not be controlled.  One day life fulfills all of the expectations that you could ever have and the next you feel lost and disappointed.  The ebb and flow of life is continuous and unpredictale.  Dealing with constant change and uncertainty can lead to feeling overwhelmed and burned out.  

Amidst this reality is a central factor that can be controlled and is ever present.  This is having hope for a future that brings you a sense of well being and contentment.  You never know if you have reached rock bottom or if you have farther to fall.  You also do not know if the feelings of joy you are experiencing are the ultimate experience of this positive emotion or if there are joys yet unknown.  

At the end of particularly intense sessions I ask the client if they have hope that there situation will improve.  I am aware that if the answer is no there is an uphill battle because, without hope, how can progress be made?  The reassuring piece is that people that do not have hope do not come to therapy the client comes and continues with the hope that their life can or will get better.  So hope really is the foundation for all of my work and is what I look to offer those that are struggling through a hard time in their life.  

The gift of presence

One of the main reasons I became a therapist is because of the ability it gives me to be present.  When individuals are sharing parts of themselves that are very private and personal I feel a deep level of connection to humanity and the struggle that it can be and that brings a feeling of aliveness.  There are those moments that you can feel somebody releasing pain that has remained stuck inside of them and it is escaping which causes them to become more free. 

It is relaxing for me to be listening to others because my own inside chatter disappears.  I am certainly not perfect, occasionally the voice of inner doubt creeps in, but I recognize it quickly and, with this recognition, it goes away.  That moment is filled with relief that I am back in the world of the client, connecting with another human for another period of time.  This becomes meditative for me, living in the world of another human being that graciously allows me into their sanctuary.

I am grateful for the clients I work with and their bravery and generosity.  Their desire to be healthy and seek support to do so is inspiring.  Living in another person’s world takes me to places I have not known before yet there is a familiarity in the experience of being human that makes me feel at home.

Learning from the darkness

Individuals come to therapy because they are seeking support for some part of their life that is not functioning as they want.  Often they are experiencing a time of darkness, a realization that their life is not giving them the results or the positive emotions that they need.  Often this causes them distress and negative experiences.  However, what if this is the ultimate opportunity for learning and appreciation of life?

Without darkness we would not know light.  Without sorrow, how would we know joy?  Part of the human condition involves times that do not feel easy or good.  These are important.  Think of the last time you felt bad and then consider the lesson that this pain was meant to teach you, how it was designed to protect you.

One of the main lessons I have learned from times that are dark is a deeper sense of compassion.  To know how it feels to feel unwell and without hope allows for you to be able to really be one with others going through challenging moments.  Life is full of light and will have darkness.  Instead of indulging in or hiding from the darkness, see it as a wise teacher whose lesson is love, compassion, and a light towards better life choices

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Power of Rumination

Rumination is a primary symptom of mental illness. This occurs when an individual has cycling thoughts of negativity that cause them to feel that their present, past, and future will be and was a failure. When working with clients it is interesting how often they are not aware that they are engaging in ruminating about what is happening in their lives and making negative meaning out of it. With the awareness that this is occurring, change in this pattern is possible.

An example of this occurrence is as follows:
A client is late for an appointment. This brings about a cycle of thinking about all of the bad things they have done to cause themselves to be late. The difference between rumination and normal thinking patterns is that the person is likely to become immobilized by the thinking pattern and not able to problem solve. The experience is of being stuck in the thoughts about what they did wrong versus being constructive in the moment such as contacting the person to let them know you are late, finding ways that may in the future allow you to be on time, or moving on from the event by not thinking about what occurred for too long.

The most tragic feature of rumination is that it steals any possibility of having joy or appreciating that moment. It is like a happiness assassin, killing off all joyful aspects of the time spent in this cycle. It is not possible to have more than one thought at a time so the ruminating moments deprive you of the opportunity for positivity that is always on the other side of suffering.

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The impact of domestic violence

Domestic violence has an impact on the whole family system. Children of domestic violence especially suffer because of the confusion they experience seeing people that they love treat each other in ways that are not loving. The victim in a domestic violence relationship experiences a strong sense of hopelessness and loss of self esteem. The aggressor lives a life filled with rage and lack of true intimacy.

Working with victims of domestic violence there are clear symptoms present. They are dealing with guilt that they have allowed themselves to be treated badly by someone they love. They are often disappointed that the person they thought they would have mutual love and respect from did not give them these things they needed. The most common symptom I have witnessed is a complete loss of identity and self worth, they no longer trust anyone to love them or give them respect, especially in a romantic relationship.

The children often become the protector of the victim or the justifier of the aggressor. Children have an amazing ability to love their parents no matter how awful their circumstances may be. The resilience of children is remarkable. However, later in life, they often become the victim or perpetrator of violence. There parents their primary teachers, and the cycle continues….

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If Everything Is An Opportunity

In developing my model of working with clients, which is a constantly evolving process, there is one principle that comes up again and again:  Everything is an opportunity.  I see this as mostly an exciting prospect, although this also creates a lot of responsibility and hard choices at times.  For the purpose of this article, I am going to assert that everything is an opportunity for growth.  What is possible when this is the perspective I take as a clinician working with clients and if the clients can also embody this as well?

I will suggest a scenario, a client is struggling with a depressed mood most days.  I am working with them on observing their thought patterns and I give them the homework to see everything that happens for one week as an opportunity to grow.  When they speak with their partner, children, teacher, employer, and therapist this colors every conversation.  When one of these individuals tells them that they are not listening, this could evoke anger.  From the perspective of growth, what a great opportunity to be able to see an area to improve their relationship.  A client or employee tells you that you are being bossy or controlling, what a great growth opportunity for you to see how you can improve your contribution to the morale of your workplace!

Let’s take a look at the other side, if you take these same scenarios and see them as obstacles to your growth.  You are told you are not listening and it becomes another thing you are not doing right in the relationship and you become angry and distant or stop communicating.  Then you are informed that you are being controlling and this becomes an obstacle for you to be able to complete your work effectively and give instructions in the workplace or help your client meet their goals.  The same scenario, opposite outcomes.

Looking at my work with clients, when I can come from a place of opportunity to grow, I find that clients reach their goals more efficiently and are able to have better and more fulfilling relationships.  There is nothing more gratifying in my work then to see clients achieve the goals that bring them a sense of purpose in their lives.  They are able to continue to grow far beyond treatment given this tool and teaching them to apply it in their everyday experiences.