Tag Archives: therapists

mental health advice: tell me what you think

the other day i received a phone call from william (not his real name), very distressed. he was in the psych ward, on his third week now. “i gotta get better, i gotta get better!” he kept saying. his hospitalization had been preceded by a good six weeks of progressively worsening mental health. anxiety, depression and borderline personality disorder were only some of the diagnoses that had been with him for many years. when he is healthy, he is funny and quirky, a dedicated stay-at-home dad who enthusiastically shares his two daughters’ passion with field hockey. when he cycles into his illness, his thought patterns quickly become more and more one-dimensional until all that is left is a looming preoccupation with how bad of a father he is and a clinginess that becomes almost unbearable to his partner, especially since it tends to be laced with hurtful sarcasm.

my involvement with william is only at the margins. when things get bad, though, we often spend a lot of time on the phone. he finds our phone calls comforting; i think it’s because i treat him like a normal human being, because i, too, have personal experience with mental illness, and also because i keep pointing out my boundaries, gently but firmly.

when william called and kept saying, “i gotta get better, i gotta get better”, my instinct made me blurt out, “you gotta make a choice here. either force yourself to get better – the old pull-yourself-up-by-the-bootstraps method – or accept that you’re sick right now, and that this could be a slow process. but if you keep going back and forth between the two, it’s going to drive you around the bend.”

in my observation, one of william’s major problem seems to be that he is stuck in a painful, very tight loop of thoughts and feelings, a cage of unrelenting self-talk of self-loathing, control and neediness (“i’m a failure!” “no-one wants to spend time with me!” “jean bought the wrong kind of potatoes again!”) my blurting and telling him what i think he needs to do – not exactly according to the textbook of counselling – was at least partially informed by this observation. perhaps i was trying to say, “get out of your cage!”

over to you, readers. what do you think? was my exclamation to make a choice clumsy, too directive? if you were william, how would you have reacted? would you feel connected because i simply followed my instinct and therefore related on a real level?

blogathon: therapy, and then … ? a short story

canadian mental health association

this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, email me or use this URL: www.canadahelps.org/CharityProfilePage.aspx?CharityID=d2252. you should be able to get there by clicking the link; if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps.

thank you for visiting, reading, commenting and, if you can, donating!

***
i wrote this short story a few years ago, during a writers workshop. perhaps it can be seen as a sort of continuation of my last post.

“there’s too many … too many …….. tinsel in my head”

her face is all wrinkled in the effort to find the words. the words are there, she knows, she just can’t reach them or see them. it’s like being on the ferry back to the island for the umpteenth time – she knows it’s there, but in the dense fog she can’t see it and is still disoriented. but it’s a familiar disorientation, softened by the knowledge that eventually she’ll arrive. in the meantime, all you can do is sit there and do your best.

across from her, facing the garden beyond the big french windows, barbara has installed herself in the rocking chair. relaxed, as always, she holds finny on her lap – the most comfortable cat you can imagine. she jumps on your lap when you’re good and ready, stays soft and still there (none of that frantic kneading that other cats like to get into), and hardly ever holds it against you when you get up.

so barbara just sits there and listens. she has time.

eva’s face lights up: “no, not tinsel! thoughts! too many thoughts! they all bump into each other and i can’t tell which is which and then i … then i …”

“it gets a bit chaotic in there, doesn’t it?” barbara strokes finny. “maybe it feels a bit more chaotic than it used to but don’t forget, there’s chaos in everyone’s head. lots of it.”

a smile. eva’s smile is still so sweet, so delightful – maybe more so now after the stroke. something shiny must have crept into her that night when she just keeled over, in the middle of the dinner party. there’s something different about her since then. “it’s not the stroke, it’s not that she can’t talk so well anymore, or that her face looks a little, how should i say – well, you know, with her eyebrow drooping – no, it’s not that!” eva had tried to explain that to len a number of times, and after a while, she had gotten a little frustrated. “it’s like a halo – no, that sounds wrong; it’s – geez, see, eva’s not the only one who can’t find the words!”

eva’s smile rests on barbara. like the cat on her lap. it justs sits there, soft and loving. receptive.

barbara looks down at the cat. “there’s lots of chaos in my head, i can tell you that. should i take this teaching gig in the summer or not? what if i do? how will len react? why should i care about what he thinks? and what about the book, i only have one more chapter to write, can you believe it, and i haven’t touched it for six months. what’s all that about? and len’s wheelchair, it needs fixing, and frankly, i don’t want to do it, he’s old enough to look after himself, and – oh, i hate it. i wish i was like finny.” she sighs. finny doesn’t mind. she’s used to humans getting all wonky and worried about things, it’s just like the weather, nothing to fret over.

and eva sits there, too, opens her mouth: “balloons!”

barbara looks at her, her head a little to the side: “balloons!”

eva nods.

“hmmm …. balloons … oh! like all these things and thoughts, they’re all balloons?”

eva laughs.

“yes! it’s just the words that came out of my mouth, but yes, that’s it! just let them be balloons, going up in the, in the … you know?”

a sentence or two, and the words disappear again. but the smile is still there, a big grin now –

and tears run down barbara’s face. once again, here she is, barbara, the brilliant therapist, all being a good listener, all doing the sitting-relaxed-in-the-chair thing, all showing herself off as the woman who has her life together – and here she is, across from old eva, her client, who is probably never going to fully recover from her stroke – and old eva is the one who shows her the way.

balloons!

ah, maybe it could all be so easy – maybe … but then there is len, barbara’s stepson, who came into her life only three years ago, after he reconnected with his father, barbara’s second husband, fred. then fred died only six months later, a merciful death after a short battle with cancer. barbara offered len that he could stay with her in the big house, and somehow she’d slid into becoming his mother. that was strange and often trying enough but then it turned out that len was buddy-buddy with eva’s favourite niece, clara. eva had been barbara’s client for years. now, after the stroke, somehow barbara’s relationship with len had become entangled with her relationship with eva. she’d go and visit eva and bump into clara and len as they’d come out of eva’s little apartment in the extended care home.

what was she thinking, talking about len to eva? barbara’s opens her eyes wide at this huge faux pas and she sits up in the chair.

eva leans forward, “what – what’s the ladder?”

“what’s the matter? i just remembered something. i should – i shouldn’t …”

eva smiles. barbara can tell, she just knows that eva understands. she understands what it’s like not to know the words – or wait, that’s not it. that’s not barbara’s problem. she knows the words but she doesn’t want to say them. this is not something she should discuss with eva. no. chaos in her head. or wait – does eva understand more? more than that barbara doesn’t seem to be able to find the words?

“it’s different now, you know?” she hears eva saying.

what’s different?

for a moment barbara finds her way out of her jungle of thoughts. her eyes meet eva’s.

and then there is a while when they don’t say anything. their eyes meet in a soft place, and a connection is made between them, a band of weightless love that carries them both, as they walk together, side by side, through a small yet infinite measure of time. the hummingbirds outside the french windows whirr, a breeze lifts a few bamboo branches out of their droopy sleep and makes them swish, and little shadows from the poplars dance on the roof of the pagoda, framed so lovely by the big old gilded windows. far, far away, it seems, the sound of nursing students chatting (just really down the hallway but – yes, far away …)

slowly, eva leans forward and pats barbara’s hand.

“the … the man …. the man in the, the coach …”

barbara looks at her, “the coach? you mean …?”

“yes!”

“len?”

“yes!”

that smile again. a big, open, friendly, reassuring grin now: “don’t worry about him. it’s all different now. we can’t be, we can’t be, we can’t be – strangers? strangers anymore? you and i. don’t worry. it’s all easy now.”

barbara slides back into the jungle.

strangers? they are not strangers! years and years of therapy together –

and back out again. held by the weightless band.

together. oh. they were doing therapy together? not therapist and client, but therapy together?

barbara smiles too, now. together. side by side. no-one guides the other. side by side. indeed; they are together now.

the bamboo leaves keep swishing. finny gets up and stretches. eva and barbara sit there, without words, smiling together.

blogathon: compassionate curiosity, knowledge and objectification

posed in a tone of compassionate curiosity, “why?” is transformed from rigid accusation to an open-minded, even scientific question. instead of hurling an accusatory brick at your own head (e.g., “i’m so stupid, when will i ever learn,” etc.), the question “why did i do this again, knowing full well the consequences?” can become the subject of a fruitful inquiry, a gentle investigation.

this is a quote from the chapter entitled “the power of compassionate curiosity” in gabor mate’s in the realm of hungry ghosts: close encounters with addiction

the idea of therapy as a research project has always intrigued me, and it’s something i’m still working towards. it’s a very delicate thing; where is the fine line between such compassionate curiosity and the wild power that comes with acquiring knowledge? knowledge is intimately connected with power, and knowledge-about is very similar to power-over. it objectifies. in both, there is a sense of grasping. i “have” power. i “have” knowledge.

by the very nature of things, the therapist always knows more about the client than the client does about the therapist. even in a situation where both parties strive for as egalitarian a relationship as possible, an equalization of that knowledge would end the therapist-client relationship.

talking about the nature of that knowledge, the nature and amount of knowledge about one another, can help. bringing difficult relationship dynamics out in the open always helps.

transforming the nature of that knowledge can be even better: turning knowledge about into knowledge with. knowledge about is a one-way affair. in “i have knowledge about you”, one is the subject, the other is the object, and that’s it.

in knowledge with, knowledge changes from a one-way street to an open and shared field. this is where curiosity comes in and is so important. curiosity is about openness, about allowing possibilities. curiosity is not linear, it is not one-way. it is 360-degree.

“hmmm, i wonder what happened there?” as opposed to “why did you forget again?” “let’s see what we can try to do differently next time” as opposed to “you better learn this once and for all!”

compassionate. curious.

canadian mental health association

this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, email me or use this URL: www.canadahelps.org/CharityProfilePage.aspx?CharityID=d2252. you should be able to get there by clicking the link; if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps.

thank you for visiting, reading, commenting and, if you can, donating!

leaving a therapist, finding a therapist

over at my “buddy blog” finding your marbles, there is a really good discussion about what happens in therapy. this post here talks about ending therapy. scott asked me to comment on a conundrum a commenter is experiencing.

here’s the problem:

i was sure i could go it alone but couldn’t face telling my therapist (of 2yrs) goodbye. so i sent a letter in which i told her thanks to her great guidance i am strong enough to go it alone. just 2 weeks later i am depressed and want to go back but my pride is stopping me.

she was a great therapist and after years of searching she was a great match for me. but i was unable to totally open up to her. i fear it will take me ages to find another one as good as her. but know if i go back it will be the same situation of been unable to open up to her.

really confused. anyone got any advice for me, please?

and here are my comments. yes, they are comments, not advice – i don’t know the person, don’t know the circumstances, don’t know the therapist. but i’ve run into similar situations before and perhaps my experience can shed some light on it. and those of you who read this blog regularly will not be surprised to see that i phrase much of this in terms of questions 🙂

first of all, let me tell you that i agree with scott’s comments. calling the therapist and explaining to her why you left is a good idea. it might bring you some closure, and maybe that’s partly why you’re not feeling well right now. also, yes, making it two weeks on your own is an accomplishment!

discussing the client-therapist relationship
in the course of your therapy, did you ever discuss your relationship with your therapist? my personal stance on this is that this is important. the vast majority of us go to therapists at least partially because something’s not quite right with our relationships. so the relationship with the therapist becomes a testing ground, a playground.

for example, i might say to a client something like, “it often looks like you’re a bit uncomfortable when you first come in the door here. what’s your guess, is that something about our particular relationship, or do you find that happens with other people, too?”

you may want to resolve that whatever your next step in therapy looks like, discussing with your therapist your relationship with her or him is a useful course of action.

going it alone – a bit scary at first
you say you want to go back. let me propose two extremes: “i need to go back because my life is falling apart around me, and i can’t go on without my old therapist’s help” on the one hand, and “geez, i’m missing her comfortable voice and how good she makes me feel” on the other. one is a strong need, like the need for food and shelter, and the other is longing for old comfort, like missing an old sweater that you finally decided to give to the salvation army. if the strong need was a 10 and missing the old comfort was a 0, where do you find yourself now?

it may just be that you’re feeling the normal anxiety that comes with taking off the training wheels.

pride – a strong force in all relationships
you say your pride is stopping you. what exactly do you mean by that? this pride is obviously a strong force. you might find it interesting to journal a bit about that.

shopping for a new therapist
i don’t know how you went about looking for this therapist. if and when you’re ready to indeed look for another one, it doesn’t have to take that long. have you ever thought of writing down what you’re looking for in a therapist? that would be a good idea at any rate, even if you decide to go back to your current therapist. you can take this list and literally go shopping.

helen, hopefully these thoughts are helpful. i’d be very interested in hearing what you think!

for my other readers: if you’ve been in therapy and are comfortable discussing it – do you have any experience to contribute?

family and money

the other day, nancy asked an interesting question in her saturday case study:

jeff and his two siblings, a brother and sister, each inherited a sizeable legacy when their parents died. jeff was conservative, and grew his legacy into an even more significant nest egg and is now independently wealthy.

he came to me because there was an unintended consequence to his wisdom: his siblings have very little left to show for their inheritance. he is too uncomfortable to let them know of his secret small fortune in comparison. as you can imagine he then has to hide his lifestyle which has resulted in increasing distance between him and his brother and sister.

what approaches might you suggest to jeff for bridging the gap, while protecting his own inner boundaries about his wealth?

this is an age-old question and i can think of a number of fairy tales with similar dynamics!

if i were to see jeff as a therapist, i might use “miracle questions”:

  • imagine you wake up one morning next year and a miracle has happened: you know that you now have a comfortable relationship with your siblings around money.
  • what would you tell others about your siblings?
  • what kinds of things would you be looking forward to do with your siblings? conversations? family gatherings? little joint projects?
  • how would you be displaying your lifestyle?
  • and what did you do to be so much more comfortable with your siblings?

it’s possible that just having a conversation with these questions as guidelines might bring about a change. for example, maybe talking about family gatherings might help jeff become aware how important they are for him – even more important than the money.

it’s also possible that this whole scenario is only the tip of the iceberg. maybe his relationship with his siblings would be difficult even without the money problem.

another possibility is that the discomfort around the difference in wealth is mostly on jeff’s side. as we all know, a great many problems in relationships stem from lack of communication. unfortunately, we often tend to make up for this insufficient and incomplete communication with imagined scenarios – but most of us are pretty bad mind readers and what we imagine is not quite the case.

but all of these (and more) are just possibilities.

if jeff came to see me, though, i’d do my best to keep these ideas far in the corner of my mind; i want to be as open, curious and receptive as possible when i see a new client. after all, my clients live with themselves 24/7 and are, therefore, much better experts at themselves than i can ever be.

my job is simply to be a midwife – to ask questions they may not have thought of before, to point out a perspective they might have forgotten, to support them in becoming even better experts of their lives.

to paraphrase henley: you are the master of your fate, you are the captain of your soul.

and that includes steering the ship of your financial life. you don’t want that to be captained by fear and discomfort; you want it to be captained by purpose.

now it’s your turn: how would you help jeff?

(if you look closely, you’ll see that this post is included in tony’s crazy surfer’s hullaballo carnival