Friday, November 27, 2015

McDonald's and Relationships

Awhile back, I was talking with a client of mine, and she was discussing her previous treatment. She stated that her previous treatment had not been very helpful. As we probed into this further, she divulged that she had not told her previous therapists that she had a trauma history. Because the therapists did not have that information, they could not address the real issue.

Now, I firmly believe that clients tell us what they want us to know when they are ready. I am not writing this to be critical of the client for not telling her previous therapists. The reason I bring it up is that it occurred to me that we, as therapists, often assume that we understand what is going on and don't always think to ask directly about other options. Training is becoming more "trauma-informed" these days, and clinicians are instructed to ask everyone directly whether trauma has been part of their history.  If that training had been more present before, I wonder if my client would have had more helpful treatment?

People, in general, tend to make similar assumptions. We say something to a friend, family member, or significant other, and we assume that they understand what we mean. One person's idea of doing the dishes might be putting them in the dishwasher, where another person might include wiping down the stove, the counters, and the table as well.  Frequently, we get frustrated when we have asked somebody to do something and they do not do what we expect.  Similarly, we will often  say something to someone else anticipating a particular response and then find ourselves angry or hurt when we do not get that reaction.

As I have thought about this in my own life and experience, I have come up with a technique I call "The McDonald's Method of Communication."  Picture yourself coming up to the drive-thru at McDonald's. ("I don't go to McDonald's!" I hear you say, "The food there is terrible for you!"  Just go with me on this one, okay?)  When you get to the speaker, what do you do? Do you say, "Hmm, I don't know.  Whatever you feel like giving me is fine?" Do you say, "Don't you know? If you don't know already, I'm not going to tell you"? Generally, I would think not.  You say, politely,"I'd like a Big Mac, large fries, and a Diet Coke" (or whatever you prefer).

Think about what this form of communication does.  It is brief, specific, and respectful.  You communicate exactly what you would like, in an appropriate manner, and there is no question about what you need.  Furthermore, if the person working the window is on their toes, they will either repeat the order to you or ask you to check the screen to verify that the order is correct. This, again, helps to make sure that the communication is effective.  Finally, if you find a mistake in your order at any point, you have an option to correct the problem.

I wonder how much less frustration we would have in our lives if we spoke to each other the way that we speak to the people at the drive-thru? "Would you please wash the dishes and make sure that you wipe down the surfaces as well?" "Can you give me a hug? I've had a rough day." "When you did not say 'thank you' to me the other day, I felt taken for granted. Can we talk about it?"  All of these express needs and feelings appropriately and invite others to respond specifically to your request.  It may not feel as romantic or special to be so specific, but it greatly increases your chances of getting what you want.  Others cannot read your mind, and you may not realize that you are asking or expecting them to do so.

A therapist I admire once told me that the secret to doing therapy was to "be present and assume nothing."  This advice, I believe, carries over well into the everyday.  I need to remember not to assume that others know what I want or what I am asking for. I need to remember to ask all of my clients about whether or not they have experienced trauma, had suicidal thoughts, or misused substances.  I cannot assume that they will volunteer the information, and I might be missing out on important elements of their lives.

How would your life be different if you were more direct and specific? What might you be missing by not digging deeper?  This all sounds very easy, and it is -- in theory. Self-esteem issues, traumatic history, lack of trust, depression, and other factors may make this much more difficult. If this seems overwhelming, I hope you will find me. I look forward to being present with you and assuming nothing.

Thursday, November 19, 2015

Gratitude and Positivity

It's funny to me as I sit here writing this, because it's coming up on Thanksgiving and I am writing a post about gratitude.  In my head, I never want to be trite, and this seems to lend itself toward that, but I promise this is not a Thanksgiving post.  Over the last few days, I've found myself feeling grateful for the job that I have and for the wonderful people I have encountered doing it.  I started off the year in a dark place and felt stuck. I was sure nothing was ever going to change or get better.  I could not have imagined feeling the way I do now.  I am so thankful for having had the opportunities I have that have allowed me to reconnect with my love for counseling and for the people I have the honor to serve.

Does my life still have struggles? Sure.  Those are always present in life, I think. Certainly, it's better when they don't all pile on at once. It seems, though, that when we can find an anchor, struggles are easier to bear.  This experience has served to remind me that nothing stays the same and that time, indeed, does give some grace.

So often, particularly when people are depressed or have a history of severe pain and hurt, things feel fixed -- not repaired, but stuck.  Studies show that, when we are depressed or overwhelmed, our creativity decreases.  I take this to mean that we literally cannot imagine the possibility of change. Sometimes, I guess, we need others to hold on to that hope and belief for us. I have been fortunate in having supports who have helped me in that way before and continue to do so as I need it.

One of the aspects of my work that I feel is sacred is holding onto hope when my clients cannot hold it for themselves.  Hope is more than a wish.  We can wish for anything: a million dollars, a unicorn, Prince Charming, etc.  Hope involves actual belief that something can happen.  It may be difficult, it may be a long time coming, but it is possible.  Many times, clients come to me feeling hopeless. They are in pain, feeling overwhelmed, and afraid that the pain that they have will never stop.  I try to be an anchor for them to create a safe place for them to rest and grow until they can hold hope for themselves.

Sometimes hope can build from new perspectives. Focusing on steps taken rather than those left to take can foster a sense of progress and capacity. Identifying positive choices and aspects of self can help build self-confidence and self-trust.  Meditating on those things for which we are grateful can help us focus more on the positive aspects of life and not just those that do not work.  I think we need to be honest with ourselves, but that involves not just acknowledging our weaknesses, failures, and losses, but also our strengths, courage, and potential.  For a balanced picture, we need to look at both.

I wonder what you have done well today.  I wonder what little gifts there may be in yourself or your life that you are not seeing. Take a moment and look around you and inside you. Is there something to be thankful for? Give yourself permission to be grateful or glad or proud of yourself. All of those help to create hope. If you are having trouble with that, I hope you will find me and allow me to hold it for you until you are able to do so yourself.  Thank you for taking this time with me.

Wednesday, November 11, 2015

Acceptance and Forgiveness - Brief Thoughts

If acceptance is different than approval, what might you allow yourself to accept? Acceptance involves recognizing what things are and not expecting those things to be different.  This could apply to anything from the weather to aspects of ourselves and our loved ones.

If forgiveness is not permission, what might you be able to forgive? Forgiveness relates to acceptance in that it is acknowledging that someone has done something and that nothing you or they do can change it. Secondarily, it involves giving yourself permission not to put more energy into trying to change what happened.

Acceptance and forgiveness are strong words, and I believe that we accept and forgive when we are ready, but I wonder if changing the understanding of the words takes some weight away from them.  Perhaps you can even learn to accept and forgive yourself.

Sunday, November 1, 2015

Lean on Me...

When I was in eighth grade, I was struggling a lot with figuring out how to interact at school. I was shy, and we had only been in that city for about a year.  In that city, in particular, everyone knew everyone else, and social status and history were very important. Being new and not having any social status to speak of, I didn't know how to engage.  As a result, I was pretty quiet. I had this one enrichment class with Mr. Suits.  He was creative and funny, and I really enjoyed his class. My class had ended up with a seating chart, and I was stuck in a back corner. This left me feeling isolated and intensified my quiet. One day, as we were waiting for the bell, I heard Mr. Suits saying, "Stephanie, just shut up! We can't get a word in edgewise with all your racket! Gosh!" In case it isn't clear, he was kidding with me. I started smiling and laughing, and I began to feel connected and engaged. He had noticed me, and I mattered. That was a clear turning point for me and one I remember with great fondness.

Lately, I find myself struggling with the business side of counseling.  When I decided to become a therapist, I, like many others, focused more on the relationship in the room and less on the business of finding people to come into that room. I am used to being a behind-the-scenes person, and marketing requires me to bring myself and my work to the fore. In many ways, this reminds me of work I need to do -- both for myself and for my business.

While in the shower today, I found myself pondering what I value in the work I do. I have worked with people with many and varied struggles: depression, anxiety, bipolar disorder, schizophrenia, PTSD, relationship problems, low self-esteem, and many others.  What is it, in particular, that I bring to the room, and what do I believe helps to facilitate needed changes?  As a counselor, I can list all kinds of techniques and ideologies that influence my work, but most of that would sound like gobbledygook to anyone outside the profession.  The more I thought about it, I realized my core focus is connection.

Most of the struggles I see in my clients reflect some element of disconnection. Grief, for example, involves loss of connection with someone or something we value.  Depression involves disconnect from engagement with the world and with friends/family/relatives. Psychosis involves disconnect from reality.  PTSD involves disconnect from others and even from self.   With all of that disconnect, developing connection can help bring healing.

What does that connection look like? In a very real way, that connection starts with the relationship in the room. Sitting with someone who will listen and try to understand without judging or creating harm can start to build a sense of safety and trust that allows for attempting other challenges. Learning to share needs and feelings in an appropriate way helps needs get met and feelings get respected. Trying new things with a safe person helps develop confidence and skills.

Connection also involves building awareness of your struggle and how it shows itself. Mental illness and other life struggles do not define the people they affect, but they certainly make functioning difficult.  If I can connect with my stressors/problems enough to understand their signs, symptoms, and patterns, I can find new ways to manage them more effectively. Maybe I can make healthier choices in what I eat or how I practice my self-care. Maybe I can find safe people to talk to when I am having problems. Maybe I can learn some skills to help prevent things from getting worse or to help things get better. When I know what I am dealing with, I can make educated choices.

Connection with safe others is also important. Cultivating a support system and identifying safe people helps create a safety net when we are struggling. Safe relationships can give a sense of fulfillment and a sense that we make a difference in the world.  Love, in its truest sense, is very healing.

Finally, connection with self creates a stable base from which to grow.  If I can know who I am, strengths and weaknesses alike, I can decide what I want to change and what I want to keep. I am not subject to the whims of other people in defining myself. I can know what I want and need, how I feel, what I like and don't, and where I want to go next.  This connection with self can be very difficult when trauma, depression, psychosis, and other life stressors tell us that we are not good enough, that no one will love us anyway, or that others want to harm us. It can take great courage to look at ourselves, and therapy can help with this.

I enjoy creating connection with my clients. My goal is to meet them where they are and help them develop the connections they need to make the changes they want to make. I believe connection is healing. I also believe it is a necessary life skill. Learning to develop connection is not always easy, but I definitely believe it is worth the effort.  Feeling disconnected? I'd love to help.