Tag: InSession

Overreacting

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Overreacting

So, what if I started with something a little provocative? (What’s new, Ellis?) But really, I have a thought that…

…there is no such thing as overreaction.

What’s your reaction to THAT? 🙂

What I mean when I say this, or how I follow it up with clients, is that if you think you (or your partner) are “overreacting,” let me suggest that you are simply not aware of what you are REACTING TO. 

Really, this is just simply CBT. There’s something that happens, or a stimulus of some kind. There is a perception of that stimulus and likely a thought about that stimulus, and there’s an emotional reaction to that thought/perception (not to the stimulus, precisely). And maybe that emotional reaction is “out of proportion” to the stimulus (or at least as far you’re concerned, your partner is overreacting to the stimulus – it’s just spilled milk, it’s just being a little late, he’s just a friend). And maybe that emotional reaction is even “out of proportion” to the thought that you are aware of thinking about it. 

But the emotional tone and intensity can be the information that prompts us to look deeper…

  • perception of stimulus (milk, the clock, the text message with heart eyes)
  • thought (spilled milk is inconvenient, my boss might see me come in late and fire me, that’s a weird emoji for a friend to use)
  • schema (being inconvenience is intolerable and shouldn’t happen to me, I have to overperform people will find out I’m an imposter, I am always at risk for losing my partner)
  • core belief (I won’t ever by happy or comfortable, I am not good enough, I will end up alone)

If you’re really reacting to the fear of dying alone, that’s a BIG DAMN STIMULUS and the emotional reaction is perfectly reasonable. I’ve had clients really do well with this idea, and feel both quite validated in their own experience as well opening a door to be more curious (and less quickly and globally judgmental) about their partner’s experience. 

Comment below: What are some of the ways you talk to clients about emotions, emotion regulation, and so forth? 

 

 

 

 

Telehealth Arriving Rituals

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Telehealth Arriving Rituals

So, we know there are benefits to in-person work over telehealth (at least if we’re doing anything more than coaching/psychoeducation, and probably even then!). But we also know telehealth isn’t going anywhere. If you haven’t read the Teletherapy Rant, you might want to. Or you might want to skip that but look at the tip sheet for clients. 

But if we’re going to be telehealth (and we are), and some clients are only going to do therapy that way (and they are), how do we give them the best experience. One thing I’ve been playing around with lately is the idea of “telehealth arriving rituals.” 

Some therapists (and yoga instructors, LOL) use arriving rituals even for in-person meetings. In-person therapy has its own natural built-in ritual as well – the client drives someplace, they wait a bit, you collect them, you walk together to the room, maybe small talk along the way, you both enter the “sacred space,” and you settled into chairs or couches. Telehealth doesn’t get that (and often doesn’t get a sacred space at all!).

So, how might we do this? Here are some ideas, some of which I use:

  • I have one client and we show each other our coffee cups in a sort of “cheers” moment to show that we’re both “ready to begin”
  • With one client, we made mindfulness training part of the treatment plan, so we do a new (or requested) mindfulness activity in the first 5 minutes of each session
  • If you like to use a singing bowl or similar in “real life,” that’s the kind of thing that could work in a telehealth setting (but I haven’t tried this)
  • I’ve done variations on a body-oriented kind of thing, that I just started doing and then my clients have picked up on, like I stretch my arms up and then let them fall down and I say “mmmm, ok, I’m here, how about you?” (which I also sometimes do in-person, as well)
  • I’d be interested in doing some guided imagery work in one session, and creating a mental “perfect therapy space” and then inviting the client and I to enter that space as we get online (I have a client who “built” an incredibly beautiful, luscious hidden library as his therapy space and I sometimes go there by myself!) 
  • Just always starting with a homework check-in is something I do with some clients in-person and via telehealth. If agenda setting is your thing, that could work, too.
  • And maybe the thing to do is ask the client. Just explain that you’d like to make sure that the therapy time feels sacred, even if they’re in one of their many typical life-spaces, and ask “What could we do at the beginning of session to help you really get into the therapy mood/mindspace?”

As I think about it, maybe telehealth does have its own natural ritual in a way, as we ask the interminable but ethically required questions about where clients are and if anyone is also with them, and do the inevitable “I can hear you, can you hear me” rigamarole! Oy. At least I try to start that with, “Welcome, I’m so glad to see you!” 

As a side note, I also like to encourage clients to have a TINY bit of time set aside before and after their sessions, too, which they would normally get at least in the waiting room and driving. No one seems to, though. 🙁

Oh, and don’t forget your own between-session rituals when you’re doing telehealth all day! What do you normally do between sessions? This is my (preferred) regular in-office pattern – 9:50 notes and coffee refill, 10:50 notes and bathroom break, 11:50 notes and protein bar, 12:50 notes and deep breathing or a quick walk, 1:50 notes and a bathroom break, 2:50 notes and run like mad to get in the kids’ school pickup line. (Yes, I really do notes after every session!) 

 

Comment below: What ideas do you use or can you think of for rituals-of-virtual-arriving? 

 

 

 

 

Prioritizing for Numbers People

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Prioritizing for Numbers People (of which I am not!) 

Ok, I don’t make decisions like this. I’m much more of a Gendlin “felt sense” kind of chooser, or I’ll use my “Verb-ed To Do List” to decide based on what kind of energy I seem to have at the moment. But, sometimes I’m challenged in session to come up with experiments or homework that work for clients who are really different from me. This is a simple one that came up in session with a pair of engineers who were feeling overwhelmed because there was a lot on their “high stress to-do list” and they couldn’t seem to choose where to get started. (Yes, this is also sort about the emotion regulation piece of procrastination, but maybe that’s a post for another day.)

This was helped by the fact that they already had a (massive) to-do list ready. So, we take the to-do list, and we add three columns out to the side, with numbers 1-10:

 

  • How EASY is this? (1 – desperately hard, 10 – super easy)
  • How MUCH use will it be? (1 – not much use, 10 – incredibly useful)
  • Sum. 

That’s it. We didn’t’ quibble about what “easy” meant, though we chatted about how it might be effort, time, overcoming resistance, etc. We didn’t quibble about what “useful” meant, either, though we chatted about how it means something like pragmatic utility, stress reduction, etc. But they didn’t have trouble with either of those. So, they got started with the item that had the highest total sum and went from there. 

Maybe it was even better that I’m not a numbers person, so I didn’t get drawn into complex formulae and overthinking the whole thing. And it was so simple, and the answer so clear, I think that helped them not tie themselves up in further knots about it.

And it’s not perfect, and if there were more resistance, I think it would need to be processed (e.g., if they tried to spend all session or all week arguing about the numbers in order to avoid doing anything). But not everything in therapy turns out to be a terrible struggle, actually! 🙂 And of course, they didn’t get through the whole list (partly because they realized some stuff on their list didn’t matter at all and partly because to-do lists are eternal). But that wasn’t the point. The point was giving them a way they could handle their decision fatigue/paralysis and get started. And they did. 

 

Comment below: This seems to work pretty well for some of my Numbers/Engineering type clients, but I’d love to hear from you if you are one of those people… Or, how do you help clients with building the skills for prioritizing (or decision making, or problem solving, or…)

 

 

 

 

They might be an alien…

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They might be an alien…

If you haven’t read the Crazy, Stupid, Awful blog, go ahead and do that first. 

. . . . . . 

For fun, to help a couple who has a deeply difficult time understanding the other’s internal logic, I gave them an assignment to watch a sci-fi or fantasy movie for a date night, or even a family movie night. I requested that it be something neither of them had seen, and that they let me know what it was, so that I could make sure I watched it before we met again.

I suppose this could work with any kind of movie, but I thought the extra distance element might help. 

So, when we got back together, we spent several minutes talking about what makes sense in the movie that would NOT make sense in Real Life? And then taking it to the character level (which is why it might work with any kind of movie). When this heroine does this amazing thing at the end of the movie – does it make sense? (Yes, if the movie’s any good.) And would it make sense if any other character did that amazing thing at the end? (No, if the movie’s any good.)

And then we go through what we learn (that is, what the movie writers, directors, and editors teach us) about each character so that their behavior makes sense. In a well-done story of any kind, the writer has to give you certain pieces of information so that the characters’ actions are understandable. And because writers try to give readers/watchers at least a few different main characters (with different background, motivations, etc.), most stories will work for this exercise. 

Now, if your partner is an alien, you need them to teach you what things are like “on their planet” or “with their species.” You need them to teach you, as if they are the writer/director/editor of a movie about them, what you need to know about their biology/neurology/history/experiences/culture in order to understand why they – as a character in this story – do not behave in the same way you do. And you need to simultaneously realize – YOU are not the earthling. You are not the holder of all reality, and that’s where the sci-fi/fantasy thing helps more, I think. 

I don’t think this is specifically a lot different than any kind of empathy or phenomenological understanding or perspective taking work, but it was helpful with these clients who really struggle. And now they have a language to say to each other, “That’s not really how it works with my species” or “How is that different on your planet?” that is giving them a little more space to talk about their differences in a friendly way.

And they had a fun date night. 🙂 

Comment below: How do you help clients who really struggle with this?!

 

 

 

 

 

 

Emotions for Engineers Part II

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Emotions for Engineers – Part II

I first addressed the issue of “emotion for engineers” (or for “traditionally raised men,” or for “thinking types,” etc.) here. I recently had the opportunity to expand this concept into a “flow chart for emotion regulation,” prompted by one of my favorite clients saying, “Can you say that all again, but use steps?” So, here is what I came up with. It emphasizes the need for time between a stimulus and response (rather than a quick reaction) and it pairs nicely with a discussion of how you wouldn’t implement a new project or budget at work on a whim. 

I even gave it an acronym (by client request!): DEER

Define, Evaluate, Express, Respond. Check it out here: Emotion Regulation Process

(As always, free to use, please don’t sell.) 

Comment below: How are some ways that you talk about emotions with people who aren’t already well-versed in emotions? 

 

 

 

 

The Most Important Question – The Scrubbing Bubbles Story

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The Most Important Question – The Scrubbing Bubbles Story

Sometimes, therapy is REALLY easy and short.

But first, let me tell you a story. 

So, I was cleaning the kitchen tile grout when I moved into my new house. (Yes, those are my actual kitchen tiles, in progress. ACK! And it is beige grout, not white, just so you don’t get all judgey on me! Haha! ) This is how that went: Squat, Spray, Wait, Scrub, Spray, Wait, Scrub, Rinse, Heave-off-of-creaking-knees-to-move-two-feet, Squat, Spray, Wait… for FIVE HOURS. And then, something happened that I thought was a complete disaster. … Halfway through my kitchen, I ran out of spray. 

“Oh no!” I thought to myself. “Now I’m going to have to change sprays and use the crappy spray under my sink that is not the special spray I bought for cleaning tile grout and it’s going to be so much more work and so much more time… WAAAAAAAH!” But I decided to do that (rather than, I realize now, going to the store and buying more, which possibly could have saved me a bunch of time, but I was messy and sweaty and cranky and didn’t want to.) So, I huffed out a breath and got the other spray out from under my sink. 

It was a miracle spray. WHAT?! NO squatting – the spray stream was awesomely direct and I could spray every grout line standing up. NO waiting – by the time I got back to my initially-spray tile, it had already done its work. Almost no scrubbing – this spray was amazing effective! I finished the rest of the kitchen in under an hour.

So much pain and effort and time saved, by just trying something different that was already at my disposal, even though I thought it wouldn’t work.

Some of the ways this has shown up in therapy:

  • How’s your sleeping?
  • Have you recently changed medications? 
  • Are you sure that’s necessary? 
  • Did you tell them that out loud? 

I probably could have titled this “The Most Important Question – What have they tried so far?” But then, that would have been too easy and short, right? 

Comment below: What have been some of the wildly easy “fixes” that have made a big impact for your clients? 

 

 

 

 

Alfred Adler and Taylor Swift

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What do Alfred Adler and Taylor Swift have in common?

Shockingly, in this case, the answer might be…. relational wisdom?

Adler, describing the psychotherapy relationship says, “A tactless truth can never be the whole truth; it shows that our understanding was not sufficient.” 

And Swift, describing one of many terrible breakups calls her lover’s communications “casually cruel in the name of being honest.” 

I think – and this might be controversial, though I wish it wouldn’t be – that the culture has a thought brewing that authenticity means doing exactly what you want and saying exactly what you think without regard for the audience. But, you know what? It doesn’t really work. 

The clearest, most honest communication you can make with yourself still has to cross at least 2 barriers – the experience, history, filters, schemas, current nervous system functioning, etc. of the listener and everything that fills the space between you and the listener, which might contain the larger culture, personal history between you, effects of the time and location, and more. Without considering those factors, your ultra clear and honest communication is going to get all distorted. You can communicate MORE truth by taking the other person and the situation into account than by tapping into this new (problematic) kind of “authenticity.” 

 

Comments below: What do you think? Do you see this in therapy, especially with couples? But also in your communications with clients? Or not? If this feels controversial to you, talk about that, too! 

 

 

 

 

 

CLEAR thinking

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C.L.E.A.R. Thinking

 

Oh dear. If you know me, you know one of my pet peeves is “made to fit” acronyms. Ugh. I am familiar with the research about how that makes things easier to remember, yes. And I’m the first one to criticize, let’s say, Yalom for making the (would-be) “acronym” for the curative factors of group therapy AIIIIUECCCS. Not helpful. But, maybe it was just too many years of church sermons forced onto artificial acronym scaffolds that gave me a bad taste about it. I especially don’t like when the concept has to be twisted or something has to be grafted on to make the acronym work. 

That being said, this one sort of made itself in a therapy session one day, so I’ll share it. Blerg. 

CALM – brains that are all geared up don’t think very clearly. Or rather, they might think clearly, but they think in very limited ways – limited to RUN, FIGHT, APPEASE, etc. Useful for predators, not so much for the rest of life. This goes along with other bodily things that can get in the way of clear thinking, like hunger, exhaustion, and pain. 

LOOSE – really good thinking is flexible. It’s structured enough that it’s coherent, but it’s not so structured that it loses its openness. Like any high-functioning system, clear thinking is semi-permeable. 

EFFECTIVE – clear thinking prioritizes effectiveness. That means both recognizing potentially multiple goals and prioritizing them. Effectiveness over winning, unless winning is the only goal. Effectiveness over comfort, unless present comfort is the only goal. Etc. 

ACCURATE – it’s got to happen in a reality-based way. Distortion is unavoidable, but the more we can be aware of our biases, the typical tricks of cognitive distortions, our own fantasies, etc., the clearer our thinking will be. 

RELATIONAL – there’s no escaping that we exist in relationships, all the time, even when we’re alone. Keeping thinking relational means we’re better at taking others’ perspectives, more likely to consider real systems that are at play, and keeps our feet out of our mouths (pretty often).

 

Comment below: Ok, lay it on me. Should I give up the acronym? Is it forced? Could it be useful? Can you improve on it?! 

 

Blocks provide you with everything you need to build a larger page. They contain a variety of content elements, such as images, buttons, headings, and more. These elements are arranged in rows and columns, which provide a useful structure, as well as a sense of balance within the overall composition. You can modify this structure using our intuitive drag and drop interface, which allows you to rearrange content to your heart’s content.

 

 

 

 

Productive Purposeful Pleasant

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Productive – Purposeful – Pleasant

After ending last week’s blog, I realized I haven’t ever posted about this little language-based motivation/behavioral activation technique that I sometimes use with clients. Probably because I really don’t like it when people make (or especially seem to force) alliteration or acronyms, and I don’t want you to think I did that! Haha! This actually just popped up in a session one day, fully formed (fully P’d!) and it has been useful several times. 

This little technique seems to be sometimes beneficial with clients who have mild/moderate depression, the kind of anxiety that keeps them sort of paralyzed (not catatonically paralyzed! Just keeps them from moving forward effectively), and some who deal with procrastination. (Although straight mindfulness is good for all of these, too, especially procrastination.) 

The technique is really simple – it just involves (Step 1) taking the things on the client’s to-do list (whether that is take a shower and check the mail in the case of depression or the long list of household chores or whatever), and dividing them into these categories, or labelling them… is the task Productive, Purposeful, or Pleasant? (or some combo?)

*Wouldn’t it be nice to have lots of things on the list that are all three?!*

Step 2: Just take anything else off the list! What’s it doing on there, anyway?! This can sometimes bring a sense of relief and permission to clients who need it. 

Step 3: Make sure there are items in every category, especially the pleasant category! (This is a kind of sneaky way to measure anhedonia and sometimes to figure out distress tolerance ideas!) 

Step 4: Invite clients, in session if it’s possible or as homework, to choose items from anywhere on the list.

I often start with Productive… is there anything on there that they have the motivation/energy/etc. to do right now? If they can, they often feel a sense of accomplishment and also relief from “checking something off the list.” It’s ok to make use of session time to get this started! Do they need to make a dr’s appointment – just have them call, right now! Do they need to update their credit card information on their bill pay? OK, do it! 

If not, how about something purposeful (meaning tied to values, even if it doesn’t “get things done”)? Is there a value of relationships or being a kind person – choose text a friend from the list (add it right in the moment if it comes up!) Is there a religious/spiritual value – choose read a scripture verse. Is there a value of being a good parent – write a sticky note for your kid and put it in their room. Is there a value on making progress in therapy? Listen to your affirmations, read a few pages in the homework book, etc. Make sure that plenty of these are easy, low energy, low cost options. (This is a kind of sneaky way to get to identification of values, as well, which can be helpful in most cases.)

Nothing doing there, either? Well, no problem! Because you have a list of activities that are for nothing but pleasure! Encourage clients that choosing something from the pleasure list is OK! (There might be a little bit of cognitive work to do here, about being “allowed” to do something for pleasure when there are things on the productive list. And one of these days I need to do a post on how “laziness” is just a really good energy management strategy! HA!) But remember – doing something is better than doing nothing, and often increases motivation and productivity in the long run. Even if the pleasant thing is doing “nothing,” like taking a nap, sitting quietly, etc., doing it mindfully is a positive step! 

Comment below: What do you do to help clients with behavioral activation? 

 

 

 

 

More than Five Love Languages

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There are More than Five Love Languages

I don’t love the “five love languages.” I don’t love the book because it stresses me out when books about mental and relational health aren’t grounded in research. I don’t love the concept, because I find it very limiting and prescriptive. There are clearly more than five love languages! (Although when couples have already read it/heard about it, I won’t put it down, I’ll just try to “stretch it out.”)

I do like that the idea that couples are made of two people who are different from each other, and I do like the idea of shared vocabulary for shared understanding. One of the most important things for couples to learn in this kind of empathy work is understanding that the other person might experience something differently than you do – maybe even oppositely! 

That being said, here’s a slightly more comprehensive list of ways that one person might feel loved/validated, that the other person might not understand well – or might understand in a completely opposite way! (Note especially the blank bullet points at the bottom. I like the visual assumption that clients will add their own!) 

 

  • Being helped (my partner assumes I’m worth helping/ they assume I’m not capable)
  • Being asked for help (my partner needs me because I’m worthwhile / they don’t want to do their fair share)
  • Being complimented (my partner thinks nice things about me / they’re flattering and they want something)
  • Being given gifts/money (I’m valued / they think they can just buy my love)
  • Being sexually pursued (I’m desirable / they’re just using me for their own gratification)
  • Hugs/cuddling (they love to be near me / they’re clingy and smothering)
  • Doing things together (they like spending time with me / they can’t stand being alone)
  • Introducing to friends (they think others will like me / I’m too much for them to handle alone)
  • Giving advice (they care and want to help me / they think I’m stupid)
  • Monitoring behavior (they care and want me to be safe / they’re invading my privacy and autonomy)
  • Inviting to share interests (they think I’ll also enjoy that / they don’t care what I like)
  • Letting me make decisions (they trust me / they don’t want any responsibility )
  • Making me part of their FOO (wants to include me deeply in their lives / wants to take away my individuality)
  • Encouraging me to grow in xyz way (wants me to be my best self / thinks I’m garbage and wants to change me)
  • Emoting strongly (I’m a safe place for them / they can’t handle their anger, etc)
  •  
  •  
  •  

This kind of thing can help couples do that work of perspective taking and empathy, like when they realize they didn’t marry someone Crazy, Stupid, or Awful.

Comment below: Any others you can think of or that have come up in session? How have you used the “love languages” concept to good effect in couples’ work? 

 

 

 

 

Book Announcement

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So… I did a thing…

Here’s a book! I wrote it. 

ROUTLEDGE published it, and the level of fanciness I feel saying that is not measurable. 

It’s a lot like this blog, only you can get it in paper and you have to pay for it. Oh, and it has no pictures. 🙂

Actually, it’s much more comprehensive and better structured than the blog, though the writing style is a lot the same and the idea is the same – let’s BE BETTER THERAPISTS. Let’s use theory and research and our colleagues to help us do that. 

Therapists, in general, I think will really like it and get a lot out of it. So will advanced practicum students and interns. 

At any rate, I’m supposed to tell important people. So, there you go! 

It is available at Routledge and through Amazon! Oh, and if you go to the new Book page on the blog, there’s a coupon code! 

 

 

Obviously…

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Obviously… (the false consensus effect)

This is a pretty awful word. 

The false consensus effect is a cognitive bias – it’s our tendency to see our own choices and judgments as  common and appropriate to existing circumstances. And that means, almost all the time, that we think other people really ought to be thinking, perceiving, believing, valuing, and choosing the same way that we are … obviously. 

Because we’re therapists, our job is to accept and understand the different ways that other people are thinking, perceiving, believing, valuing, and choosing. (And we don’t do this perfectly, by any stretch!)

But for a lot of people, if you aren’t thinking what’s obvious to them, you’re obviously crazy, stupid, or awful. 🙂

So, where are the places we can eliminate this word, as a way of beginning to unchain ourselves from this bias? 

 

  • We can stop using it in session, for a start. When is there a time that this word is beneficial in session? I’m guessing pretty much never. 
  • We can teach this in session, to clients. It comes up a lot in couples’ work, especially. 
  • We can work to take it out of our conversations in our non-work lives, too. 
  • And we can watch for sneaky synonyms like “of course!” 

 

 

Comment below: Now you’ll be catching yourself using this word! Post a comment about your situation! (Including if you think there ARE useful times to use it!)

 

Words of Regret

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Words of Regret

Sometimes, a small change in words can make a world of difference! 

 

I know we talk about the word “Should” in therapy a lot, especially in the Albert Ellis kind of way – “shoulding all over yourself.” But there’s this one specific instance where clients seem to use “should” in a profoundly destructive and usually inaccurate way. When they regret something they have done, or haven’t done, or the way some situation went, they say: 

  • “I should have said things differently.
  • “I should have acted more quickly. 
  • “I should have been a better partner/parent/friend.

It turns out that most of the time, clients actually did the best they could with the information and resources that they had at the time. So, it’s a bit of a logical fallacy to say they should have acted differently (and certainly some other cognitive distortions in the way they imagine the difference it might have made). I have also found, though, that when they are expressing this deep, sometimes grief-filled, regret… they’re no really in the mood to talk about how unrealistic they’re being. So, sometimes I ask them to just make a tiny language change, or sometimes I just make it when I reflect it back:

  • “You wish you had said things differently.
  • “You wish you had acted more quickly. 
  • “You wish you had been a better partner/parent/friend. 

There are other words that could fit, too, but I like wish because it can be modified in terms of intensity pretty easily. “It’s the most desperate wish of your heart…” “You deeply wish that…” 

We’ll get around to talking about the specifics and the reality and all that, of course. (Side note: these shoulds/wishes are almost always much too vague, precisely because the exact right action that would have brought about the desired outcome is not knowable now, just as it was not knowable then!) In that moment, though, removing or lessening the burden of unnecessary guilt can be as simple as using language with intention. 

Comment below: When have you found that small language changes have made big impacts for clients? 

 

 

 

 

Crazy, Stupid, or Awful?!

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Crazy, Stupid, or Awful?!

The foundation of couples’ work is often training them to listen. And of course, listening is actually incredibly difficult and relatively complex. For example, it involves all those difficult skills like self-soothing, holding difficult emotions, making space for the other person, accurate empathy, maximizing the use of working memory, tolerance for ambiguity, etc. And that seems overwhelming even here on this therapy blog, and it’s certainly overwhelming in session. But here’s an idea I sometimes put out in session when things start spiraling: 

You aren’t crazy, stupid, or awful and you probably didn’t marry someone who is crazy, stupid, or awful. So, there might be a misunderstanding in here somewhere. Let’s find it, shall we? 

Clients are more than likely to agree with the idea that they themselves are not crazy, stupid, or awful (and it’s nice to  validate them first, before going on to “defend” their partner). They also usually aren’t willing to say in therapy that their partner is one of those things. They at least don’t want to be married to (or in a relationship with) someone who is crazy, stupid, or awful.

This pause on our end often lets them pause on their end and create a little bit of space to hear their partner’s content differently. Yay! 

Occasionally, they will say their partner is crazy, stupid, or awful. Ok, no problem – now we know we’re in a contempt-place (in the Gottman way), and we can change gears to a process-rather-than-content level. 

 

Comment below: How do get couples to pause and refocus in session? Also, “QuotesFromSession” is a new tag – do you have any go-to session quotes that you often find useful? 

 

 

 

Reversal Theory “On The Couch”

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Reversal Theory “On The Couch” 

This one’s not going to make much sense if you haven’t been following the Reversal Theory series, but if you want to check them out, here’s #1, #2, #3, and #4.

Here, as promised, are some RT-based techniques (and tweaks on classic techniques) that I’ve used in really cool and fun ways in therapy, to good effect. 

 

  • Intake Questions: Most clinical interview/intake questions are aimed at determining the client’s presenting issues and background information for diagnostic purposes. Sometimes, questions are included about clients’ expectations for therapy, their goals, and their perceived strengths.
    • RT transformation:
      • How much do you experience yourself as being serious and goal oriented? In which area of your life do you experience the best sense of “achievement”? In which area of your life do you experience that the least?
      • Playful/enjoyment; Being like others/fitting in; Being an individual/freedom; etc.
  • Cognitive Therapy: Thoughts, feelings and behavior are all connected, and that clients can overcoming difficulties and meet their goals by identifying and changing inaccurate, maladaptive thoughts. First steps are identifying maladaptive thoughts, evaluating them for accuracy/utility, and then  developing reasonable counter-thoughts, which clients tend to struggle with.
    • RT transformation:
      • The opposing nature of the RT states gives a quick, easy way to begin identifying potential, but reasonable, counterthoughts. For ex, clients often have anxiety provoking thoughts such as “this  storm is very dangerous” or “I can’t do well at this and that’s awful”. Clients tend to try to create counterthoughts in the same state, and these can be hard to swallow or not very accurate. For ex, “this storm isn’t all that dangerous” or “Maybe I am good enough at this after all”
      • Changing states creates fresh, conceivable options. For ex, “This storm is fascinating and awe-inspiring”  or “I don’t need to do well at everything to be valuable.”
  • Couples Work
    • Couples are taught to identify the RT states they are in during typical conflicts. They re-enact the conflicts in session, with an emphasis on “getting into the partner’s state” (each in turn) to improve empathy, reflection, and problem solving.
    • Techniques to help couples see from their partner’s perspective include overt state-disclosure, switching seats, mimicking partner’s posture/expression/tone, letting the partner “paint the picture,” guessing the partner’s state, and state-mapping
  • Group Work
    • This is a psychodrama-type technique I call “the gauntlet.” Two rows of 4 pairs of players (“auxiliary egos”) line up and each speak from the opposing states on the problem the protagonist has identified. The protagonist (the client who is doing the current work) “walks the gauntlet” and listens, makes comments, moves players (sit down, back up, etc.), turns the volume up and down, etc., in an improvisational way.
  • Guided Imagery
    • In the Eight Rooms technique (specific to Reversal Theory) an individual or group is instructed by a leader in a guided imagery session. The participants envision a hallway with eight rooms, four on each side. Each pair of rooms represents a pair of RT states. The participants are instructed to enter each room and fill it with colors, objects, scents, memories, and anything that helps to define each state for them. For example, a telic room may have paneling on the walls, a large clock, diplomas, and a work desk. A paratelic room may have brightly painted walls, a hammock, a tiki bar, loud music, and a bubble-machine. The participants are instructed to use as many senses as possible and not to limit themselves to ordinary furniture or objects. They are encouraged that, after the guided imagery, they will be able to use their memory of each room in order to induce the state desired at the time.

COmment below: What ways can you imagine using RT in session? 

 

 

 

Measuring Sticks

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Measuring Sticks

Do you remember Mary Poppins’ measuring tape? When she measures Michael, it reads “Rather Stubborn and Suspicious” and when she measures Jane, it reads “Inclined to Giggle Doesn’t put things away.” And what does it say when she measures herself? “Practically Perfect in Every Way.” 

Clients come in to therapy with their own measuring sticks – and based on their own histories, experiences, biases, fears, hopes, etc. – they have a tendency to believe that their measuring stick is the RIGHT measuring stick. They’re quick to assume that their memory of the last argument, their assumption about their partner’s (or boss’ or kids’) intention, their prediction of the future is practically perfect in every way. 

One of the biggest and most pervasive challenges in therapy, I think, is getting clients to trade in their rulers. (After all, they’ve been using this trusty ruler since childhood, probably. It must be a good one!) Sometimes, they’ve been using “trick rulers” that just don’t measure the peril or injustice (etc.) in the world in an accurate way. (Yes! Those are real, and I want to buy one for therapy to use in a fun experiential activity, but I can’t bring myself to spend the $25!) Helping clients to recognize that maybe their genetics, physiology, past trauma, or many other factors have distorted their way of measuring may work better in a metacognitive kind of way than just helping them to measure each situation more accurately. 

Sometimes, they’re using their own ruler to judge someone else’s experience instead of using the other person’s ruler. In those cases, even if they have a super “accurate” ruler (which they probably don’t) or they took notes on the last session with their kid, or they recorded the last argument with their partner, or they pull out the email from their boss – they don’t get any close to understand the other person’s experience or intention by judging with their own rulers. 

I think a lot of this dysfunction comes from a generically nice place. When kids are little, they’re often told things like, “Don’t take Cindy’s doll. How would you feel if Cindy took your doll?” Which is probably better than not thinking about Cindy’s feelings or experience at all, but it makes the mistake of assuming that Cindy will have the same or similar experience to us. But what if we have 100 dolls and Cindy only has 2? We may damage Cindy so much, destroy the relationship, and be completely perplexed about why we’ve lost our best friend! What if we love Barbies and would treasure this stolen Barbie in a deeply forbidden, guilty way, but Cindy hates Barbies and wouldn’t really care? Then we miss an opportunity to ask Cindy if we could share or have her Barbie, Cindy misses out on an experience of altruism, we don’t get to enjoy and treasure the Barbie in a shame-free way, and we both miss out on building intimacy. 

Judging the world, and other people, solely from our own perspectives destines us for failures in empathy. Even if our measuring stick is more accurate than someone else’s. 

Comment below: How have you helped clients to use a different ruler or make theirs more accurate? 

 

 

 

 

Sphere of Whelm

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The Sphere of Whelm

WHELM.  

Why don’t use this word? We say “overwhelm” and “underwhelm.” Why do we never say whelm?? Probably because it’s sort of useless, as the word “whelm” technically is a synonym for overwhelm, meaning “to be submerged by.” 

::rolling my eyes:: 

I RECLAIM this now useless word for special therapeutic purposes, and like many psychological terms, will give it my own definition. I like clients to conceptualize “whelm” as just the amount that I can handle right now or saturated but not spilling over. I think of it in a similar way to being in one’s “Flow zone,” but rather than engagement or skills development, I mean it to pertain to emotion regulation. 

We all definitely know that too much stress, too big of emotions, or too much going on can lead clients to feel overwhelmed; we see them all the time. Less often (though sometimes), we see underwhelmed clients – the disillusioned nihilist, or anyone with existential ennui. And sometimes we see clients who are so numbed or checked out that they seem underwhelmed, when really they’re just shut down because of overwhelm. 

Let me suggest that we can change our level of over/underwhelm by modifying the space and time we are attending to. When clients are overwhelmed, they’ve often cast their attention out too far – too far into the future or encompassing too much “distance” (which usually means too many people). No one can handle the anxiety of a nation during a pandemic. No one can handle the regret of their whole mountain of history all at once. No one can handle the existential threat to their children for a lifetime. 

When life is too much, when we are in grief, rage, or terror – we sometimes do this naturally – bring in our spheres to just our families or ourselves, to just “getting through today” or “just what I need to do next.” We invite clients to mindfully shrink their fears when we teach them mindfulness – just what you are aware of in exactly this moment, just in your body. And sometimes clients need more – think Adler and social connectedness – sometimes depression or anxiety are presenting because we are underwhelmed. over-focused on our own troubles or discomfort, and need to widen our spheres to include other people, or a longer time perspective. 

One of my favorite ways to do this with clients is as part of a guided imagery. Creating a sort of bubble that they practice shrinking and expanding until the bubble is just encompassing their heart or encompassing the whole city, and doing that safely with me.

How do you like to? I know you you already help clients do this – you just didn’t use this fancy name. What kinds of techniques do you use to help them manage their spheres? Comment below.

Three Rules for Couples Counseling

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Rules for Couples Counseling

I have three rules for couples’ counseling. Sometimes, I say them overtly, in the first session, sometimes they come up as we go along. I don’t really think of them as “my” rules, exactly, as much as I think these are pretty well required for couples’ counseling to go well. 

(1) A true, actual, capital-R “Reality” may exist, but neither of you (nor I) actually know it and it is not knowable.

So, we will not be spending much time arguing about how things actually happened or who is Right. We will spend a lot of time talking about how you each experience(d) things and how to effective co-construct your world. (Sometimes this has to be followed up with psychoeducation about perception and memory.)

(2) Relationships aren’t fair and that’s not the goal.

We will not be measuring out love. We will not be counting resentments. You are different people and we will not compare you  (your needs, desires, pains, etc.) to each other. We will absolutely NOT be doing a tit-for-tat scenario. If you want the relationship to improve, you will have to commit to your part of the work regardless of whether the other person does their part. 

(3) Your relationship is Your relationship. 

We will not be comparing it to your parents’ relationship, or the relationships you’ve learned about from romantic comedies, the relationship your growing-up church told you that you must have, or the relationship of your best friend on Facebook. We will focus on building the relationship that works for Y’all. 

 

You’d think they run away, but they usually don’t. 🙂 

 

Comment! What kinds of rules or guidelines do you find useful working with couples?  

 

 

 

Not Just For Decoration

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Not Just For Decoration

I keep lots of things in my office that are not just for decoration. You might have read the post on the “useful treasures” box. This is sort of an extension of that idea, but things that I keep out in the office, either because they’re pretty, or because it’s useful for clients to see them, or because they don’t fit in the box.

 

  • Singing bowl
    • I keep a Tibetan singing bowl in the office partly because it’s just simply gorgeous. I also like to have it available to use with clients when they are learning meditation (of course), but also sometime as an “arriving” or “departure” moment, especially for client who are doing tough work, like trauma work. It can help them to have a minute to get settled in, check homework, do updates and then something to mark the transition clearly. Doing so at the end of their “deep work” also helps them to wrap up and transition back into the “real world.” I also use it sometimes when I need a super fast grounding moment between sessions.
  • Long feather for balancing
    • I have two ostrich-style feathers that sit in a cup on my desk. They’re pretty but not ostentatious and they have long, un-feathered stems. I typically have clients try to balance the feather by the stem on one fingertip. This is great for younger clients with ADHD to practice active mindfulness, it’s nice for couples as a way to not get too worked up during conflict discussions, and it’s good for many clients who need a “distractor” while they access and speak about difficult material. I’ve also let clients use the feather-end to create a sensation that they can focus on, in a DBT distress-tolerance kind of way.
  • Highlighters in many colors
    • Highlighters can do all the work of markers, don’t dry out as quickly, and obviously can be used over text as well. I use highlighters in a million ways – I’ve even printed out a list of erotic-story-words during session for a very shy client to read with her husband so she could highlight the words she feels most comfortable with him using without having to say them out loud! Also, along with the bubbles and blank paper (in my useful treasures box), highlighters are a great distraction for kids who randomly show up.
  • Phrenology bust
    • Actually Charlton (pictured above) doesn’t technically live in my office anymore, now that I share an office. But when he did, I liked to use him as an example of how we can hypothesize, gather data, and update our theories – in psychology, in therapy, and individually.
  • Jar of rocks
    • I like to keep a little clear glass jar in my office, filled with random rocks. It’s unobtrusive, and clients rarely mention it. But I like to have the rocks in case I need something to give a client as a transition object (e.g., a client with strong BPD who will be worried about abandonment) but I don’t want to give them something I actually need, use, or care about. I also occasionally give them to client who are working on habit control, as a “holder” for their motivations – so that when they are in a tempting situation, they can hold the rock. And, it’s fun to just always be on the lookout for pretty or interesting rocks!

 

Comment: What other useful things do you have in your office? Have you “pulled a MacGyver” and used something in your office for an unintended but epically useful purpose?

 

 

 

 

Connect These Dots

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Connect These Dots

Connect these dots. Go ahead. Geez, at least imagine doing it!

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Chances are one of these pictures is something like what you imagined as “the way” (or “your way”) to connect the dots, and some of them aren’t. Some might have surprised you, in a delightful way. Some of them might even feel…. wrong to you. ::Gasp!:: This isn’t a mind blowing concept – people connect dots in different ways. They perceive the same situation differently. This is just another way to demonstrate this for clients. I like it because it’s experiential and also relatively non-threatening (and super easy – you don’t need anything but what you normally have in your office to do this) The Horse & Frog pictures exercise is another way I like to do this.

I’ve recently taken this exercise to the next level in a fun way…

I made this picture (it was much harder than I expected to find the right “star level” for this activity, especially royalty free) and I printed it as a photo multiple times. I keep them in my office along with 3-4 of the metallic sharpies. I hand one photo and one sharpie to each client and tell them, “Imagine you are priest-king of an ancient civilization and create a constellation.” They do, and they obviously create different constellations. One of the bonus-features to this activity is that they typically use most of the same larger stars, but they also use different medium/background stars to complete their constellations. That gives us a way to talk about connecting the dots differently, but also things like cultural background, personal history, and perceptual differences in how they construct a narrative.

 

Comment below – I’d love to see the other ways you connect these dots, or ideas you have about bringing this concept into session! And definitely feel free to steal this!

 

 

 

 

Office Treasures

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Office Treasures

What kinds of useful treasures do you keep in your office?

Aside from the boring box of things-I-might-need-or-have-forgotten-at-home (headphones for ADHD assessment, bandaids for strange emergencies, deodorant because I’m sometimes in a rush, etc.), I have a box in my office of useful treasures that I pull out in therapy sometimes. It has mostly been populated because I really wished I had something in session and didn’t! I thought I’d share a few of those items with you:

 

  • Heart rate monitors
    • I keep two inexpensive heart rate monitors (the kinds that clip gently on clients’ index fingers) in my office, along with extra batteries. I use these in the Gottman way, when couples have a tendency to escalate (to help them see when they need a time out) and I also use them with individuals sometimes when we’re learning relaxation techniques
  • Copies of therapy-pics I’ve made
    • I like to make “take homes” for clients using stock photography, either for use in session exercises or to reinforce special ideas. I try to keep a few copies of my favorites so that I have them available and can send them home with clients
  • Bubbles
    • I use the small tubes of bubbles that are popular as kids party favors. That way it’s easy for them to be single use. The primary way I use these is to teach unpanicked breathing. Attempting to blow one large or many little bubbles is an easy way to get across the basic principle of “exhale longer than you inhale,” and clients seem to like the interactive nature of the activity. I also occasionally have couples use them when they need to discuss conflict calmly. And they’re part of my “emergency protocol” when an adult has brought a kid to session with them who I wasn’t expecting!
  • Small flag
    • I keep small plastic flags (the 10 for a dollar kind) in my office to use mostly when I am doing communication training with couples. After we’ve talked about whichever “rules” we are working on, I literally wave the flag when the rule gets broken. It makes for less of an interruption than actually interrupting, and clients seem to feel less “criticized.” (If I have a really high functioning couple, I may send them home with two flags to use during homework practice!) I will occasionally do the same thing with an individual, if we’re monitoring something together (e.g., yes-buts, self deprecation)
  • 8” inflatable beach balls
    • They take up almost no space, and (along with also being good for visiting kids), I like to use them with couples and individual trauma clients in the Bessel Van Der Kolk kind of way – creating a reciprocal, socially engaged, dynamic-yet-predictable interaction that can help to regulate the nervous system! Also, it can give clients a way to do a semi-dissociation while they talk about difficult things, kind of like how they do their best processing while knitting or petting a therapy dog. They’re the perfect size the be easy to throw and catch, even for not-very-coordinated people, but not so big that they take over the space.
  • Blank paper
    • I know, this sounds so ridiculously simple, but this is hands down the item I use most often. There are many times that I want a client to make a quick sketch, or co-create a visual metaphor with a client, or draw an explanatory diagram. I never know when that urge is going to pop up, and I really like not having to use the back of their progress note or the regular lined paper I keep I around, and not even having to get out of the chair and break the mood.

 

Comment: What do you keep in your office to use during therapy? Tell us how it works!

 

 

 

 

Slowing Way Down

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Slowing Way Down

I really like having couples for double-length sessions, at least 90 minutes. There’s just SO much work to do! And how often does that dream come true? Almost never. Which is one of the reasons I use this technique, even though – I warn you! – it’s going to seem counter-intuitive.

Couples are infinitely complex and unique…except in the beginning. Because in the beginning, they all have some of the same problems. In one of those problems is a basic difficulty with saying what they mean and hearing the other person. I’m sure you had the all too common experience, to; it starts out reasonable, then there speaking over each other, saying the same things over and over, getting louder and louder. When that happens, I quietly stand up, go over to my box of supplies, and pull out a pack of index cards. Then I sit quietly, and wait for their quite confusion.

Next I hand them each one index card and a pen.

Rules are pretty simple: First, take your time – because you get the front of this one index card to save the most important things that you want your partner to hear. (It’s surprising how much event held by the size of fonts they write with during this exercise!) After you’re both done, switch cards. Read the card as many times as you need to. Quietly; no speaking. As best you can, write what your partner told you in your own words on the back. After you’re both done, switch cards.

The next step depends on your intention in using the exercise. You might take both cards, read them both and help them make corrections on their interpretations of what the other person said. You might have each of them read their partner’s interpretation, and then use a new index card to write their initial statement more clearly. If they’ve done well, and the point was mostly just to cool the temperature in the room down a little bit, you might invite them to speak again about what they’ve just written (I use a random number generator to decide who goes first).

Yes, this takes basically an entire 50 minute session. For one note card. And you know what? They usually have communicated more during that session that may have in any session before we used the technique.

Bonus: this is a relatively easy task to then assign for homework!

 

Comment below: What pitfalls can you imagine using this task with a couple you have now? How would you handle them?

 

 

 

 

Just close your eyes and rest…

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“Just close your eyes and rest.”

This is what we need to tell our kids, and ourselves. Trying to demand that you fall asleep, or that awful thing where you think “if I could just go to sleep NOW, I’d get 5 hours. … if I could just go to sleep NOW, I’d get 4 ½ hours…” NOT HELPFUL. Changing this language is just the beginning of the wide array of strategies we can use to help clients get restful sleep – something that’s associated with pretty much every physical and mental health measure there is! 

 

Sleep hygiene is maybe the thing that’s most applicable to virtually every client – more so even than journaling, I’d say! It’s a shame, I think, that many accessible resources for sleep hygiene are quite poor (even though they’re usually pretty accurate). I’d like to share with you the sleep hygiene handout I made for my clients – feel free to share (but, you know, obviously don’t SELL!).

 

It’s geared toward adults, but could pretty easily be modified. It doesn’t mention sleep meds (which are often antipsychotics or antianxiety meds – BEWARE; also the sleep specific meds like Ambien have some really alarming side effects!) or pharma sleep “helpers” (like antihistamines or melatonin). It also doesn’t mention some of the sleep re-set techniques for when sleep has gotten really out of control, e.g., the 24 hour re-set or the 5.5 CBT-I strategy .

 

 

Comment if you teach sleep hygiene to clients, or if you’ve learned a new sleep hygiene technique you can share! 

 

Frog: A Noble Creature

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Frog: A Noble Creature

I know. Frogs don’t seem that noble. And whether they are or not, or even if the case could be made that they are (and I believe it could), that’s not even remotely the point.

You see, “Frog: A Noble Creature” is just what I title this image when I give it to one half of a couple. “Horse: A Noble Creature” is just what I title this image when I give it to the other half. See why?

…

(If not, tilt your head so your right ear touches your right shoulder)

It usually takes just a moment for the two of them to notice that they have the same picture. Which is good, because the point is to show them that they can’t easily see the other person’s picture the way they see it, unless they come around to the other person’s position and look from where they’re sitting.

It’s just a little introductory exercise to empathy and perspective taking, but it really seems to drive the point home better than a lecture. Here are two of my other favorites.

 

 

Comment, please! How do you explain empathy to clients? Do you know of any other optical illusions to share that would help?

Note: I hate posting images without original sourcing, and I don’t know the original source for any of these. If you do, please share!

 

 

 

 

Therapeutic Apology

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The Therapeutic Apology

If you haven’t said “I’m sorry” to a client this month and meant it, you might want to check in. In real relationships, we blow it sometimes. So, if you’re having authentic, therapeutic relationships with client, apologizing will be a part of the deal. Not only is it an important part of a real relationship, it models something very important for your client. Here are some tips:

 

  • Recognize when to apologize
    • When you have violated part of the explicit or implicit contract
      • Running late, mistaken charges, delays in providing requested documentation, unclear communication, etc.
    • When you haven’t honored them well
      • Made an assumption, not listened well, gotten distracted, interrupted, followed your own agenda, etc.
    • When you made a mistake you shouldn’t have made
      • Forgotten to check their homework and they missed session time to process something that was important to them, started into a metaphor you often use but then realize it’s not well tailored to this particular client, overstepped a boundary, pushed too hard that day
      • Note: When you make a mistake that was reasonable at the time, and not due to a lack of knowledge/ethics/conscientiousness on your part, just explain it without apologizing. This is excellent modeling!

 

  • Only apologize for things you have control over (i.e., your own behavior)
    • Avoid the “habitual apology” (women are especially prone to this). That’s when you say “I’m sorry” when no offense actually occurred.
      • “I’m sorry (for taking up space in the hallway because I have a body and walk at the same time as you which is obviously not my fault)”
      • “I’m sorry (because you were speaking very softly and the air conditioner is loud so I couldn’t hear you which is obviously not my fault”
      • Resist the urge to apologize just because they don’t like something (e.g., for your email/contact policy, for ending session on time, experiencing difficult feelings, referring them appropriately)
    • Apologize for what you DID, not for what happened.
      • NO: “I’m sorry we had a misunderstanding just then.”
      • YES: “I’m sorry I wasn’t listening well just then and assumed incorrectly.”
    • Two exceptions to this rule:
      • Go ahead and say “I’m so sorry to hear that….” when something unfortunate has happened to a client. Even though sorry isn’t exactly the right word, that’s so culturally established that if you don’t say it, the moment will be really weird, and that moment is also usually moment when you need to NOT be weird, and really be attentive and present, and not explaining weird cultural, linguistic idiosyncrasies.
      • Go ahead and apologize if your administrative staff, office management/maintenance people, etc. have done something unpleasant or insensitive. The client often sort of sees them as an extension of you.

 

  • Apologize WELL.
    • No beating around the bush, be specific and own it.
      • “I’m sorry for getting distracted just then.” “I’m sorry for not listening well.” “I’m sorry for running late today.”
    • No passive aggression. Avoid giving your “reasons,” unless you’re sure they’re really reasons (not excuses) and they’re actually important to the process. In that case, be specific.
      • NO: “I’m sorry for getting distracted just then. I have a lot going on personally right now.”
      • YES: “I’m sorry for getting distracted just then. What happened was that what you said really struck a chord with me around grief, and I’m wondering now if or how grief is playing a role for you?”

 

  • Follow up.
    • They’re likely to say something like “oh, no worries” or “it doesn’t matter.” So, follow up on that with something like “thanks for you patience” or “you do matter to me, so I just wanted to let you know.”
    • Add what you’re planning to DO about it.
      • “You have my full attention now.” “Can we go back and you can describe it to me again so that I can understand better?” “I’m going to make sure I adjust your fee for the missed time today.”
      • Oh, and then DO that.

 

Comment with your own “rules” for apologizing, or a time when you have used the therapeutic apology and it’s been important.

 

 

 

 

Focusing – Gendlin

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Focusing

Recently, we talked about the 7+/-2 principle of working memory and how the brain is a pinball machine. We went on to talk about how therapy work like journaling and PCT can be effective, and how to maximize the 7 +/-2 principle in our work with clients. Which is great! And now, I want to see about taking things to a whole new dimension…

You can only THINK ABOUT  7+/-2 things at a time. Even when we’re maximizing that, clients can only experience a few of the multiple parts (e.g., thoughts, feelings, sensations) of any given situation in sequence. But you can SENSE the whole thing at once, if you allow yourself to do that and don’t rush to get ahead of yourself with words. This is called the felt sense. The felt sense (Gendlin, 1978) is different from feelings, emotions, thoughts, or regular body sensations. It is the fuzzy, unclear “gestalt” of awareness.

The felt edge is the next step that follows completely naturally from the complete felt sense and leads in the direction of more life in the body. Every natural experience has a natural next step, and only that next step will REALLY satisfy.

Hunger → eating; Arousal → orgasm; Grief → tears; Curiosity → exploration

What options do you have when you are thirsty?

Exercise? Reading a book? Vodka? Pineapple? Water? Gatorade? (Infinite options!) But which one is the one to which your thirst is leading? The BODY KNOWS.

The felt edge is like standing in patient readiness, without tension, observing all of the possible next steps and getting the sense of what feels like more life in the body.

Focusing  is the process by which we can experience the felt sense of any given problem or situation – the whole of it, at once –  and thus, approach the felt edge where we are most likely to have an awareness of the most right next movement.

The Six Steps of Focusing

  • Clearing a Space – Asking yourself: What is the main thing for me right now? Sense it, but don’t go inside
  • Felt Sense – Experience (“Feel”) the many parts of whatever it is, all together. Get a sense of what all of the problem feels like.
  • Handle – Give a name, phrase, or image to the quality of the whole felt sense.
  • Resonating – Gently go back and forth between the felt sense and the handle, patiently ensuring that you have just the right fit.
  • Asking – “What makes the problem so _____?” “What is ___ in this?” Be sure you are sensing freshly (not remembering!) the felt sense. If you get a quick answer, without feeling it in the body, let that go and stay with it.
  • Receiving – Be open, in a friendly way, to any shift in the body. This will be accompanied by some change in the whole of the problem. Accept that change gently.

 

If you want to learn more about this, you’ve absolutely got to read Focusing (Gendlin, 1978). It’ll change your life, your therapy, and your clients’ lives… guaranteed. And if you think you can’t learn something so experiential from a book…try it anyway. Focusing is all about tuning in to your own experience anyway; Gendlin’s voice through his writing may be all you need for direction.

 

Tons of other free resources and readings of Gendlin’s and The Focusing Institute here. 

Gendlin, E.T. (1978). Focusing (first edition). Everest House.

 

 

Comment below if you use Focusing in session, or if this is your first exposure!

 

 

 

 

 

 

Emotions for engineers

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Emotions (for Engineers)

I know this is not typical, but I’d like to share with you an intensely useful metaphor that I absolutely hate. Hating it is especially difficult for me, because I made it up. It’s just not….me. But it’s wildly effective with some clients – especially the analytical, emotionally restricted, very controlled clients.

Let’s start with this: there are 6 basic human emotions. (I know, some researchers say 5, 7, or 9. Some are currently working on disputes. Of course, there are cultural, familial, and other influences. Maybe that’s a topic for another day, along with the relative absence of really good emotion lists or wheels. Today, we speak of Paul Ekman, the father of universal emotion research.)

FEAR, SADNESS, ANGER, DISGUST, JOY, INTEREST

And while I most want to write about the varieties of emotional experiencing, primary vs. secondary emotions, emotion constellations, and more, instead I’m going to tell you how I sometimes talk to people about emotions who aren’t as “into” emotions as I am. This may be because they’re truly alexithymic, because they were raised in a traditional male gender role or any of a number of cultural systems that value emotional restriction, or because they’re Vulcan. Here goes:

Think of emotions as an internal indicator about the allocation of resources in your environment. Resources could be anything – money, time, relationships, etc.

FEAR – Fear is an emotion that tells us a resource is in danger. The importance of the resource and the level of perceived danger (in intensity, closeness, and ability to deal with it) will determine whether we feel nervous (like when the resource of social status might be threatened by potentially having poor public speaking performance next week) or terrified (the resource of life/health is threatened by an oncoming 18-wheeler).

SADNESS – Sadness is the feeling we have when a resource has been lost. Again, the level of sadness we feel is determined by a few moderators like the importance of the resource (like a close family member), the irretrievability/irreplaceability (like death as opposed to a job loss), and the “realness” (e.g., we feel disappointment when we perceive a loss of something we didn’t actually have yet).

ANGER – We experience anger when resources are perceived to have been distributed unfairly. When we don’t get something that we believe that we deserve, we feel anger in response. It’s something that we can feel this as a response to someone else being unfairly resourced – an abused child being denied safety and love, the environment being destroyed through improper resource management, our kid not winning the science fair even though their project was definitely better than those other kids’.

(note: people often experience anger or something like anger as a “secondary” or “substitute” emotion when they have learned that other emotions are too painful or not acceptable to express, typically fear and/or sadness. More on this in another post, sometime.)

DISGUST – Disgust occurs when a resource is potentially threatened with corrosion or infection. This can be a physiological kind of disgust, like when we are exposed to an obviously ill person or a rotted food. It can also be when we believe our character/environment might be threatened with moral decay or infection by the presence of contemptible others.

JOY – Joy happens when we believe our resources (again, this includes all kinds of resources – money, love, status, purpose, etc.) are sufficient and safe. If we have just enough and aren’t worried, we feel contentment. We may even feel a burst of happiness or delight when we receive an unexpected resource – a winning lotto ticket or spontaneous hug. (You might prefer to use the word “happiness” for this emotion in general because you believe “joy” is tied up with purpose and meaning. Great; I support that!)

INTEREST – Interest, like all of the emotions, comes in different intensities. For example, curiosity, wonder, and awe are emotions we feel when we recognize that a resource is salient. It often combines with other emotions to tell us how salient a resource is in what way. It acts as a modifier (e.g., telling us whether something is a bit scary, pretty scary, or very scary).

 

It’s a work in progress, so comments below, especially if you have questions or ideas!

 

 

 

 

Seven +/- Two

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The Power of 7 +/- 2

(How Working Memory Works in Therapy)

How many things can you remember to get from the grocery store without writing it down? Well, never mind, I guess I already gave you the answer. Obviously, it’s 7+/-2. Or it is for most people.

And you probably learned about this in your intro psych class in college. But how is it meaningful in therapy, you ask?

It’s meaningful because your brain, and your clients’ brains, are pinball machines. You can really only hold about seven pieces of information in your brain at a time, and relatively small pieces of information at that. And they just “bounce around in there,” ad infinitum, unless we do something intentionally to get them out. And here are three ways that we can capitalize on this quirk of our brains in therapy.

 

#1: Journaling

I know that you already know that journaling is awesome. I know you could extol its benefits to almost any client, I know that you’ve seen it work its magic, maybe in your own life, and (because I’m a therapist, too) I also know that you sometimes recommend it for clients as homework just because you don’t know what other homework to give them. (We all do it!) And that’s OK, because journaling is pretty safe and, let’s face it, it sort of is magic. What you might not realize is how the 7+/-2 function of the working memory plays into the effectiveness of journaling, and how you might be able to use it even more intentionally and beneficially than you have been. One of the ways that we can get those bouncing pinballs inside our brains to get out is to write them down. I’m sure you’ve given this assignment to your anxious clients who have trouble getting to sleep at night because their pinballs are all the worries that they have about the next day. And you encourage them to put a pen and paper next to their bed, so that they can write down any anxious thoughts that they have or anything they need to remember for tomorrow, temporarily letting it go so they can sleep. Great!

Occasionally, that has unintended consequences. And you have a client who, instead of staying up for two hours thinking about the same five worries over and over, stays up for five hours writing down all the worries that came up after they wrote down the first five. And while they don’t like that very much, that’s part of the magic. When those five, seven, or nine thoughts keep bouncing around, they don’t leave any space for anything new. They don’t leave any space for other worries or concerns, and then those get kind of trapped, unexpressed, maybe even living inside and wreaking havoc on the client’s body. (More on this kind of thing in another post.) So they are not aware of, and cannot make you as their therapist aware of, all of their legitimate concerns. Journaling helps them to flesh all of those out. As if that weren’t enough, those seven pinballs also keep other new thoughts from coming in. Hopeful thoughts, new solutions, brilliant ideas, etc. So, one of the ways that we can take advantage of the 7+/-2 principal in therapy is to use journaling in a targeted way, whenever we want to give clients freedom to explore both the true breadth and depth of their concerns and also open them up to new possibilities.

 

#2: Healthy Conflict

Ok, how often have you had a couple in therapy and they’re discussing their latest argument, and the one of them who remembers everything perfectly (because there’s usually one) pulls out some exact quote from the other person that was really hurtful, and then the other person says, “ok, yes, but I was mad, I didn’t mean it!” And naturally this never satisfies the hurt partner, and they don’t believe them.

(Let’s be very honest, how often have you said that? And you know you didn’t really mean it, and your partner doesn’t buy it. And how often has your partner said that, and you didn’t buy it? Hmmmm?)

Let’s put this in the context of 7+/-2. When we’re upset about something, we ruminate. It’s one of the easiest times to see 7+/-2 in action. One thing that our boss/mother/partner/kid/etc. says – we just repeat it over and over along with a refrain of “how dare they,” and a chorus of “I didn’t deserve that.” That’s it. Over and over. And that’s bad enough by itself, right?

But then, we actually bring it up with the other person. And as we are “having our say,” we start with all of those things (pinballs) that have been bouncing around. After we say them out loud… That’s right, they’ve made a way for brand-spanking-new thoughts. Brand new thoughts with brand new words that we haven’t taken the time to decide whether or not we want to say. And because all of those pinballs have just made space, in the heat of that moment, all of these new, unfiltered, unevaluated, and probably regrettable words just fall out. That’s what’s happening a lot of the time when we say “I was mad; I didn’t mean it.” And you know what? It’s pretty much true.

We really don’t want to base our jobs on an unedited report that we threw together at 2am without really thinking about it. That’s not our “real work.” Our real work is composed, thoughtful, edited for appropriateness, thorough, concise, and clear. That’s what we want our bosses to judge us on. Our best. And that’s what we want to give to our partners, and what we want them to judge us on as well. So, you can teach this to couples along with other techniques for conflict management (more on this in another post), and help them to keep their pinballs from falling out and rolling all over the floor.

 

#3: Person Centered Therapy

PCT is just magic right? Right. But seriously, past the humanistic underpinnings, have you ever wondered-in a technical sense-how person centered therapy works like magic? I think I have an idea. Just an idea of mine, mind you. But it’s based on the 7+/-2 principle. And it goes like this:

What are the main techniques of PCT? Silence, reflection, paraphrasing, summarizing. (Remember, in honest-to-goodness Rogerian PCT, even questions aren’t very present.) So, what do these techniques to do? First, silence allows clients space to get the first seven pinballs out of their heads. Then, reflection allows them to know that their pinballs are safe, not going anywhere, and you create a holding space inside the session for those pinballs to live for a while, almost like little sticky notes. Lo and behold, the client suddenly has more access to their own genuine thoughts and feelings that have been locked up behind those first 7 thoughts. Great! So they can put even more pinballs out into the session with you – emotions, ideas, etc. – that they may not have had access to before. Like journaling, that might be therapeutic enough on its own.

But PCT goes further. When several of those pinballs/sticky notes get out into the space between you, it’s time to paraphrase. When you paraphrase, it’s like taking a couple of sticky notes, condensing them, and putting them together on one index card. Imagine, just by paraphrasing, you might take 30 of your client’s sticky notes and turn them into 15 index cards. Then what? Summarizing. When we summarize, and draw together common themes, it’s sort of like taking those index cards, condensing them even more, and maybe stapling them together. So, by the end of one session, you’ve let a client have access to much more of their internal experience, maybe even some of their inner wisdom, you held all of it safely in the session with you, and you’ve condensed it and given it back to them in packages small enough and few enough that they can make a new 7 +/-2 and they can re-organize their internal experience. That gives them more “brain space” for knowing themselves well, entertaining new ideas, in essence… space to grow.

 

Now, go do magic with the power of 7+/-2. Comment with how it works out for you!

 

Philodendron

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All Hail the Lotus! 

There’s a reason the lotus appears on virtually every psychotherapy (and spa) website from the east to the west of the internet. Not only is the lotus beautiful, but it grows out of mud, so it makes a great therapy metaphor. And you get to quote Thich Nhat Hanh, which is always a plus.

But that is not a lotus, you notice.

Ellis, why do you have a common houseplant on your blog?

Let me introduce you to the philodendron, the underappreciated gardening-therapy metaphor. The philodendron is an ordinary, yet extraordinary, plant.

First, it can grow almost anywhere, in almost any way. It can have roots underground and/or above ground. It can get all of its needs met through the soil, through rain, or even just through the air. It changes its growth methods based on the resources available, its own maturity level, and its changing needs for nutrients and light. The philodendron can live and thrive in almost any environment.

It makes symbiotic relationships with other plant and animal life, wherever it finds itself. This includes its neighbors – nearby plants and the trees on which it sometimes grows. It also includes traditionally undesirable companions, such as ants, trading shelter for the ants’ nests in return for the ants’ protection. Oh, and they have good boundaries – their glossy leaves are a natural deterrent to many insects and larger herbivores, like deer, so they don’t get taken advantage of easily.

When it is time to grow new leaves, the philodendron first creates a small pocket of protection for the new sprout. Once it’s grown enough, this pocket is no longer needed, and it lets it go. When it does, it leaves a tiny scar – a reminder.

There are almost 500 recognized subspecies, and even philodendrons from the same subspecies will look different depending on their stage of life, the specific environment they’ve grown in, and the various resources available.

They’re happy to “stay single,” mate with other philodendrons, or hybridize with other plants. They may enjoy a full life a few feet tall, close to home at the base of a tree. Or they may grow outward, covering tropical forest floors or gloriously wild backyards. Some will grow spectacularly tall, using nearby supports to reach heights of over 1000 feet high. They’re even happy to hang out in your house.

Best of all – I found out about philodendrons because I have something of a black thumb… I don’t seem to care very well for things that don’t communicate verbally. They’re virtually indestructible. And you can trust me, because I’ve even killed aloe vera. More than once.

Now tell me, do you want your clients to be a lotus? Or to be like the incredibly hardy, adaptable, diverse, relationally competent philodendron?

Or, leave a comment with your own plant-metaphor!