Sunday, May 31, 2009

Telephone Calls: To Answer or Not

The phone sounds that double ring that lets me know it's client. Two doctors on Grey's Anatomy are just debating going into the on-call room. We all know what that means. AND I have to answer the phone?

That's my own debate. I know how to talk to my clients, how to reassure them and how to discourage them from doing anything to hurt themselves. Is it fair that I should now interrupt my evening to use these skills? Of course I do answer the phone. They know I will stay on the phone for only ten minutes. As a result, they present their problems concisely and immediately.
After she has described her crisis, I ask my client what she has done to take care of herself. Right Now. We discuss suggested alternatives from her skills notebook. She is usually able to offer steps that are exactly right for her.

While I serve as a sounding board, these telephone calls give the client an opportunity to experience her own power in managing intense pain. Once we have identified a satisfactory solution and agreed on action she will take, the telephone call ends. She has found mastery and feels safe. In ten minutes or less, my client has found a way to tolerate her pain, in the moment.

Oh, yes, at the conclusion of this conversation, I am able to pick up Grey's Anatomy where it was paused. Because it is recorded, I avoid advertising and can answer those calls without missing the guilty pleasure of that wonderfully mindless fluff.

Saturday, May 30, 2009

Lying Part III: Does it Really Matter?

What happens when a client lies? How do I feel if I suspect s/he is not telling me the truth? Will this inaccurate information get in the way of my working with her or him?

I have a client who regularly exaggerates events in her life. She tells me about the elegant Hollywood parties she is catering. I want to accept this report a factual but she is unable to tell me about the menu or the kitchen in which she will cook. As a former caterer, I have suspicions that this party may not exist.

Another woman reveals only limited information about events in her life. This omission is another form of lying. I am unable to effectively support her in learning to solve problems in her relationships or employment. How effective can I be as a professional, as her counselor, if she does not give me a valid picture of her life?

When I call her on not giving me a complete picture, she stated she wants me to see her as managing her life. I wonder out loud, since everything is going so well, what purpose is served in seeking my support?

Her answer does not produce more accurate information but does motivate her to tell me that she’s afraid she’ll be rejected if she’s not perfect. I don’t use the term "lying" when I discuss the way these clients provide information. I use the concept integrity. For me, Integrity is the foundation for all healthy relationships.

Friday, May 29, 2009

List Making

Making Lists
something I rarely do
and yet so very reassuring

Measuring out my life with check marks for tasks completed

What do I list
tasks to complete
calls to make
groceries to buy

and when they are checked off
what have I accomplished?

measures based on numbers of tasks completed
a life contained in the activities that
can be counted and measured

so reassuring
not abstract
visual and contained.

Thursday, May 28, 2009

Trauma, Fear, Uncertainty

Trauma, fear and uncertainty: words with which we are confronted daily. Perhaps you have just been told that your department is being downsized (terrible word). Even more painful, you have been asked to stay while some of your colleagues are told to leave. You watch as people pack their desks wondering when will you be asked to leave AND you still have a job. For how long?

In this environment of uncertainty it is important to care for yourself and for the people you care about. How do I care for myself when I am feeling so overwhelmed? Breathe. At this very moment you can take care of yourself by being busy helping your colleagues. Be sure you know how to reach those people with whom you worked so that you can share resources.

Share your own uncertainty and fear. Your partner, spouse and close friends need to know how you are and what is happening with you. Their support is important in this time of change. Ask for help. Sometimes the most important support is simply in finding the right person to listen to you. You can offer the same resource to your friends.

Breathe. Ask yourself: "at this very moment, am I safe? Can I tolerate the place, physical and psychic in which I find myself at this very moment?" Stay in the moment. When your mind begins to move to the fearsome possibilities that are out there, bring yourself back to this very moment. Stay here now. Breathe.

Wednesday, May 27, 2009

Computer Crash or Sometimes Everything Seems Wrong and It Still Turns Out Okay

How do I explain to my clients that I - strong, grounded, centered clinician - must learn how to manage the problems of a system for which you have no control? The issue arose because my hard drive crashed and now I have to resolve a problem not of my making. My only choice in the midst of this problem was how I would handle it.

First, before throwing the machine across the room, I took a deep breath and focused on what I could do at that moment. I sat and reminded myself to simply breathe. I wanted to get myself out of the fury mode and into this very moment here. The silence was calming.

Silence is a luxury. Our minds are an organ not unlike our hearts or our lungs which are part of the autonomic nervous system. The heart beats and the lungs bring air into out bodies without our telling them to work and our brains think.

We have the capacity to slow down the beating of the heart and the intake of air by focusing on inhaling and exhaling. We have the capacity to control the intensity. Controlling the constant flow of thoughts through our minds is very similar: our brains are built to think therefore thoughts flow through, usually in a disorganized fashion.

To create some quiet, we must first recognize that our brains are doing what they are supposed to do. We aim to gain silence between thoughts. When a thought comes in, we acknowledge the idea and let it go. It takes practice. Again and again we turn our mind back to the space between thoughts. And that space between thoughts, the silence, grows so that we have more quiet than thoughts.

The final outcome is that the hard drive just died. the good news is there was NO virus so after my computer maven did his magic, I received a new hard drive and have rejoined the cyber world.

Breathe. Allow the cool calm light to enter your lungs. Release any tension that may remain in your chest and belly. Breathe and lighten up.

Tuesday, May 26, 2009

What Makes a Lie a Lie?

Sometimes the simplest statement can open a whole can of worms. Questions rise out of the words that are spoken and the listener wonders if the information shared is true. What makes a statement a lie? First there is the obvious - the information given is not accurate. The most frustrating lie though comes from information withheld. Figuring out the truth in a statement that is not factual is often easier than understanding what is accurate when the speaker has not responded completely.

I have been chewing on this topic for several days as I work with various degrees of inaccuracy in my clients. How do I teach these individuals to communicate with integrity? I request accuracy; responses must be factual without judgment, without assigning values. And I direct people to reframe statements so that they include only the facts without emotional content. Emotions can be a powerful influence on honesty.

To learn clear truthful communication, examine the following thoughts. What does it mean to be honest with yourself? How can you be truthful and care for yourself if you are always worrying what the other person thinks? The only way to guarantee your own integrity is always to be factual and accurate with yourself. The place from which to initiate integrity for yourself is with yourself. We can't always depend on genuine honesty from other people but we must be able to rely on our own truthfulness.

Keep breathing.

Taking Risks

Which one is harder? Finding a new job or finding the right place to live? Yes being is love is hard but that's a whole other type of challenge and that experience involves sharing and willingness on the part of two people to communicate.

Having a job and a place to live are basic needs that must be met before you can do the hard work of managing painful emotions. In order to learn how to live with intense emotions, you need a living space that makes you feel safe.

If you are sharing your living space (not a partner, but a roommate) with someone who understands your privacy it is because you communicated your needs. Expressing your basic needs in a shared space begins with your knowing what you must have. For example, if you are someone who needs quiet after 10pm, you must be willing to state that priority and you must hear your roommate's desires as well so that you share healthy, supportive environment.

Make a list of what is important to you in your living space and in the individual with whom you will share that space. Sometimes you must make adjustments to your priorities. For example you may find the perfect physical space in the right neighborhood but you must also be comfortable with the person with whom you will be sharing space. What are you both willing to give in order to live together?

Be willing to compromise. Stick to your own values. Take care of yourself and stay mindful of what really matters to you. Know yourself and what is important to you.

Keep breathing.

Sunday, May 24, 2009

More on Taking Care of the Therapist

I always say, if you can't take care of yourself, how can someone else know how to take care of you? Yesterday, I turned down a really great chance to go to the theater. Now, don't get me wrong, I enjoy being with this friend. she is one of the people with whom I can feel comfortable even when I'm not feeling friendly. And she understood when I told her: I've got to have some time for myself.

We all need quiet time in which to just digest the events in our lives. We don't generally acknowledge how important it is to take time for our selves. It is a fundamental aspect of self-care to respect the hours or even days we spend alone. This time is an essential restorative and healing tool for surviving today's stressful times.

Alone time, personal time is a precious commodity. Sometimes we set time aside for ourselves and end up using this valuable resource for the hard work of paying bills or doing the laundry. It is tough to allow ourselves to choose a gentle way for using those rare personal minutes. And it is important to maintaining our health that we spend time listening to favorite music - not using the music as the sound track for scrubbing the bathroom.

Take a walk on a sunny afternoon, spend time on a beach or beside a lake watching the water. Water is an important healing element. Schedule time for yourself. Arrange your schedule so that you have that rare and precious commodity. You will feel better and live more happily. You can be okay.


Saturday, May 23, 2009

Stay in the Moment

Sometimes we know the appointment scheduled for 2:30 on Wednesday is going to be really painful. We wonder how we will get through it. And there we go: projecting into the future what might happen, what awful things will be said and (especially) how horrible we are going to feel. First, you must understand that the event is not happening at this very moment. And, naturally, you will ask: shouldn't I be prepared for that tough experience? The best preparation is take care of yourself in this very moment.

How can I take care of myself right now when there is nothing to fear at this moment? And that is exactly the awareness you must maintain. You must narrow your focus sufficiently so that you are able to know and feel the security of this very moment.

When we face challenging interactions, we frequently put all of our emotional energy into what may possibly happen in the future. We are not taught that staying in this very present moment makes it possible to experience the feeling of safety. In the next moment, when you may be facing that person who can make comments that are painful, narrow your focus so that with each sentence, even each word, you are able to tell yourself "in this instant I am okay."

People often say, but I'm not okay. My response is it is okay to say, "I'm okay" even when you don't feel it. You are now teaching yourself that you can be okay AND have your fear. You can be in the midst of a stressful event, a painful confrontation and still be okay. First you must teach yourself that it really is okay to feel okay, even in the midst of a painful experience.

Breathe. You are okay.

Friday, May 22, 2009

Taking Care of the Therapist

Because I have made a commitment to work with challenging clients, I must take care of myself as well. There are the obvious ways in which I care for myself: setting clear boundaries so that the client knows when he/she can reach me and being clear how long I will talk on the phone. There is also the scheduling of appointments, and, of course, there is support and guidance from friends and professional colleagues.

There are also the not so obvious steps of giving myself a vacation. I must watch the red flags to know when I must schedule a day or several days of pampering. During this past week I have been annoyed at small matters and irritable with friends. I saw the warnings. I realized this annoyance is not about the challenges but about needing some self care.

I made arrangements to attend a seminar in a nearby city for a brief vacation. Preparing for this break includes doing the on-line search of restaurants, cultural events and farmers markets. Before I leave, making plans gets me ready to relax.

It is important for people working and/or living with people with challenging symptoms schedule time to be kind to themselves. Planning this brief vacation is pleasurable. Meanwhile, I have my daily routine of self-care: Healthy meals, cookbooks and other fun reading and caring for my dog (an important support system). I also have a regular routine of yoga and meditation.

Self-care involves the everyday tools for maintaining my health as well as breaking the routine with various interventions including travel, massage and conversations with friends.

Keep breathing!

Thursday, May 21, 2009

Taking Care of Yourself

Are you looking for support because you haven't found a professional to help you get over your depression? Or attempting to support a client who is unresponsive to your most skillful guidance?

I work with individuals who have struggled with intense psychic pain for years and have developed some tools that have proven effective in lessening their discomfort. I want to share my experience with consumers and clinicians and this blog is an opportunity for me to develop this information into a format for that purpose.

I invite comments from bloggers: as a consumer share the experiences that have not worked for you; as a clinician ask questions about the tools you need to effectively support your own clients.

The very first thing I tell my own clients is: breathe. Feel that calming breath going all the way down the the bottom of your spine and with the exhale feel the tension leaving your belly.

Come back into this room. Feel yourself safely seated and take a deep breath. Breathe and, if you can, softly smile.

Wednesday, May 20, 2009

Today's Toughies

Today I saw patients with whom I have been working for some time. The question is how do I support these individuals in learning to tolerate their fears and have the peaceful life they each deserve. I have learned that so many of our fears arise out of lessons we learn as children. We learn to be afraid of the things our parents tell us are fearful even when those fears are unrealistic. It is scary to take risks but we must take risks in order to move forward with our lives. The unknown is frightening. We cannot control the environment - people and physical - but we can learn to trust ourselves. This trust is the foundation of being willing to take those chances.

My job is to help these clients to take risks. Through these risks, going to a party, making a telephone call, and the big one, asking for help, they develop a solid foundation for trusting themselves. Being willing to experience fear is very powerful. Willingness means that the individual is open to participating. Willingness does not remove the fear but is allows him or her to see and feel that the feeling of fear won't kill them.

Tuesday, May 19, 2009

Is there one secret to Parenting?

I often tell clients and friends that the secret to being a good parent lies in the ability to communicate unconditional love through all the lessons that must be taught and/or learned. Everyone makes mistakes. Parents become overwhelmed and make critical remarks, children misunderstand and rebel against the lessons that must be learned. Through all this interaction, when the mother or father is able to show his or her child that he or she is loved, that small person gains the ability to survive the tumultuous experience of growing up.

There are, unfortunately many people out there raising children who are unable to let their sons and daughters know that they are loved and are valuable individuals. And the question is raised: How can people who call themselves parents inflict such horrors on their off-spring? Do those people dislike themselves so much that they are unable to separate their own pain from the sorrows being inflicted on their children?

When working with my clients I am regularly reminded of the fear and anger their parents must have experienced in their own lives to create such pain in the people in my office. I do NOT expect my clients to forgive the mother or father who said and did unspeakably cruel things but in the process of getting stronger and of learning how to care for themselves, they often gain an understanding of their parents' pain. The benefit of this insight enhances their ability to create loving relationships for themselves (first) and then for the significant people in their lives.

Monday, May 18, 2009

Getting Well:Part I

Getting Well Part I

It ain't easy! When you've lived with depression or fear or anger for a long time, you've learned how to have a life that includes feeling these negative emotions. As you begin to experience the daily events of your life without constant psychic pain, you begin to learn how to feel okay without that pain. Having less or even no emotional sadness can be uncomfortable. You are accustomed to being sad, or angry or fearful. You may even miss it when you realize you have gotten through an afternoon without the unhappiness. You may be surprised that you are able to spend time comfortably with challenging people.

What's happening? Something's missing. What has changed? You are getting stronger. You are gaining skills for accepting who you are without resorting to big emotional outbursts or intense lows. This new feeling comes from the process of getting healthier. Each step along the path to learning how to live inside your skin requires the skills you are now gaining. You are learning how to take care of yourself in an effective and safe fashion.

While you are beginning to feel better, your new found strength may be surprising for some of the people in your life. This change may even make some people uncomfortable. Other people's reaction to your new behavior is one of the painful aspects of getting healthy. Some people will expect you to respond in the way you have always acted. There is nothing wrong with you. You are learning how to take care of yourself in a gentler and kinder fashion. That ability is what you gain from the hard work you are doing in treatment in order to get better.

Give yourself credit for the hard work you are doing and understand that these changes don't always feel comfortable nor are they easy. And congratulate yourself for being willing to hang in with the work even when it isn't comfortable or easy.