One Word

She glanced up momentarily as her hands relentlessly picked away at a tissue in her lap, eyes moist and reddened, yet unable to mask an inner resolve as hard as steel.  The counsellor across from her shifted in his chair, and casually folded one leg over the other.  When he spoke, it was with a quiet hope that his voice would not waver.

“There’s one last thing I’d like for us to do.  It’s a visualization, of sorts.  Just a way  for you to have something to take away that will help remind you of the work we’ve done here.”

As he spoke, her awareness drifted back to her fingers as they tore nervously at the tissue.  Knowing that it was all coming to an end, she eventually looked back up at him and nodded, a mix of apprehension and curiosity washing over her.  He took a breath and nodded as well.  Her fingers went still.

“I’d like you to reach into this bag and choose one of the small rocks inside.  It’s going to be your rock, so take a moment and pay attention to how you are making your choice,” he said as he passed her a small ziploc bag full of small, smooth stones.  A look of interest flashed across her face and she began to carefully feel several rocks before selecting two, feeling each in the palm of her hand.  After a moment of thoughful examination, she made her choice.  A roundish one, uniform gray in colour.

“Great.  I’d like you just to hold on to that rock in your hand for a minute.  Now, I’d like you just to take a deep breath and make yourself as comfortable as possible in your chair.  Plant your feet firmly on the ground, and close your eyes, if you’re comfortable.  We’re just going to take a few moments to reflect on what coming here has been like…”

As he spoke, calmly and evenly, thoughts and images of the last several months began to race into her mind.  She saw herself in the waiting room, fidgeting nervously and keenly aware of others’ sideways glances.  The long walk down that hallway to his office, trying to make idle conversation.  The familiar, crippling fear she felt when she first decided to come for help that had never completely gone.  The pain, the panic, the frustration.

“…now, as you’re recalling all of these memories and sitting in that experience, just try to let a word come to mind that seems to fit for you.  Just one word, one that wants to come on its own.  Don’t look too hard.”

Several moments passed as the air in the room thickened.  He watched the thoughtful expression on her face twist up for a moment, then suddenly, a single tear shot down her cheek.  She opened her eyes, and let him know that she had found her word.

“Here is a marker.  Now, if you’d like, you can write your word on the rock, and it will be my gift to you.”

She didn’t hesitate as she reached for the pen and carefully drew onto her rock the word that had so clearly come to mind as she remembered the fear, the anxiety, and the many, many tears.  She turned the rock over to show him what she had wrote, and in clear, purposeful lettering, one word was scrawled:

“Strength.”

I’ll see you around

this sad goodbye bear is going goodbye

“You must have the worst job in the world,” a client once told my supervisor.

I would be quite inclined to disagree, obviously.  However, the context in which these words were spoken lend them a strong element of truth.

There are probably lots, but I’m hard pressed at the moment to think of many jobs outside of the helping professions where you habitually build significant relationships with people, who are more often than not in a state of distress, see them change, grow, improve (or worsen),  hear some of their closest secrets, their worst fears, and at the end of the day, without fail, have to say goodbye.

And I’m quickly discovering that this is one element of being a helper that, for lack of a more descriptive word, sucks.  It’s balls.

It’s one of those things that you read in the intro to counselling textbooks and think that you’ve got a handle on, that you’ll know all the right things to say, that you’ll know how to take care of yourself when a client walks out of your office for the last time visibly trying to hold back tears after you’ve stumbled through saying goodbye.

I feel like there have been a lot of those lessons, the ones where all of a sudden what you read or learned about makes sense in a totally different way once you live it.  And you’re left thinking “ahhhhh… that’s what they were talking about!”  Except it’s just not possible to really know what they were talking about before you experience it.  You think you do.  But you don’t.  I’ll have a post of some of these lessons sometime in the future.

But one has to ask: why do we put ourselves through this painful process of saying goodbye, when it goes against every human impulse to remain connected, to just say, “I’m sure I’ll see you again, somewhere, sometime”?

Because there really is every impulse to say something to that effect.  Something about saying “goodbye” is so final, so definitive, such a reminder of our mortality, that to face it head on can be incredibly anxiety provoking.  Endings are uncomfortable, and experiencing one often brings up memories of endings from our past.

One of the most salient such memories for myself is having to say goodbye to my grandfather on his deathbed.  What could I possibly say that would communicate what I feel?  And how?  I’ll always remember how awkward that moment was, and how really, I couldn’t think of the ‘right’ thing to say.  How, more than anything, I felt embarrassed, and then guilty that this was the strongest thing that I felt.

In the situation I’m in now, at the end of an 8 month practicum, saying goodbye after goodbye after goodbye to the very people I had previously been trying to get to know better, to build a strong therapeutic relationship with, it’s hard not to be reminded of all the times I wish I had done a better job saying goodbye to other people in my life.

But I guess that’s just human nature.  It’s easier to avoid the hard feelings.  To ignore the discomfort.  To say, “I’ll see you around sometime” when we know that we damn sure won’t.

It’s time to reclaim goodbye.

Finally, a therapist in the family

This spring when I shared the news with friends and family about my acceptance into a master’s program their response usually comes in two parts. The first, as expected, is some form of congratulations, which is always greatly appreciated and nice to hear. Often following this is some version of, “So you’ll be able to help me” or “Free counselling for family members/friends right?”

In most cases these responses are so outlandish or humorously delivered that it’s easy to share a laugh about it and move on. Every so often I get a comment that has a hint of seriousness and in a few cases the people are genuinely asking to meet with me once my training in complete. These conversations are a little more awkward than when it’s all just a joke.

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1-800-DOCTORB. The B is for Bargain!

It just struck me as rather… juxtaposed… that I’m sitting here right now, doing some research for this post on none other than Dr. Drew of MTV fame while simultaneously listening to one of the best records ever recorded, Abbey Road by the Beatles.

I suppose that one could be doing a lot of silly things while listening to such an album, and the listening experience would still be quite pleasant, if not fantastic.  It was just a thought though.

I tried to find an embarrassingly bad picture of Dr. Drew, but he has proven so striking that not even 3 pages of google images yielded any such results. So I leave you with this "I'm listening thoughtfully and still looking cool" image.

Something about Dr. Drew very much rubs me the wrong way.  I was convinced for so long that there was no way he was an actual doctor.  Sadly, wikipedia proved me wrong.  Anyway, I’ve become quite interested in how therapy is represented in the media (in fact, I realized after it was too late that it would be an interesting thesis topic… oh well).  Dr. Drew seems to be the exact opposite of what used to be therapy’s most popular television icon…

Alternatively, this was THE FIRST result on google images for Dr. Phil. Don't look too closely at the bald spot. It'll burn into your retinas.

Despite the obvious visual improvements and lack of funny accent with Dr. Drew, I can’t help but think that we’ve gone from one extreme of terribleness to the other.  Dr. Phil, as we all know, began his TV career with the help of Oprah, meaning that his target audience was probably middle class females between the ages of… I dunno… 30 to 50.

Dr. Drew, on the other hand, seems the epitome of cool.  Dr. Phil was on Oprah, Dr. Drew is on MTV.  Dr. Phil got a daytime talk show, Dr. Drew got shows on everything from Discovery Health to radio to shows like “Celebrity Rehab with Dr. Drew,” “Sex Rehab with Dr. Drew,” and “Sober House.”  His target audience is clearly young, attractive, upper class yuppies.  I’m pretty sure Dr. Phil had some kind of terrible divorce or something.  Dr. Drew has three kids (triplets), probably a hot younger wife, and apparently he’s some kind of opera singer.  That’s one fail at life for Dr. Phil to at least three wins at life for Dr. Drew.

Irrevocably cooler, yes.  But an improvement?  I’m not so sure.  I mean, I’ve never watched a full episode of any one of Dr. Drew’s shows (I either get too angry or too saddened to watch), but his carefully groomed, perfectly plucked, and youthful image just somehow seems wrong to me.  Does this man look 51 years old?  Does he?  Dammit man, does he!?  It’s not right!

Am I jealous?  Is this some kind of twisted man-crush?  Why… the cruelty!

I started this post with the full intention of making him out to sound like a quack, and look at what’s happened.

Okay – all I ask is that we stop naming these TV “doctors” by their first names.  It’s not right.  Dr. Phil.  Dr. Drew.  We have to stop this pattern before it gets out of hand.

Dr. Dave.  Hmm…

Changing menus: Getting your drink on

As a psychologist in training, I have the unique pleasure of trying to figure out, on a regular basis, exactly what I do for a living.  When I stopped to really think about it, I think it isn’t quite entirely my fault that I still don’t know.

No, seriously. Stop laughing.

The best reason I have for blaming someone else for my sustained confusion is that the questions that psychology asks are so profound, so broad, that it would be like identifying as a ‘democrat’ or a ’republican’. Everyone understand it’s just a bit more complicated than that, but uses those terms out of convenience.

A more developed reason is that, rapidly approaching, if not already in effect, is an era in which the question “what kind of psychologist are you”, is pretty much as natural as “what type of medical doctor are you?” I’m sure that back in the day, a doctor was the man that took care of your illness, whatever it was, and really did the best he could with the leeches and the damp towel cloth, or whatever level of understanding and technology he had. But, as time progressed, and the wealth and technology available increased, we got to a point where we have pediatricians, anesthesiologists, neurologists and dermatologists.

And when I thought more about why I didn’t know exactly what the hell I did for a living, something else occurred to me.

‘Psychology’ is dead. Now before you get upset or accuse me of being sensationalist, just gimme  a minute to ‘splain.

Originally conceived as a branch within philosophy, as the study of the mind, ‘psychology’ come so far, and gone in so many directions, that any attempt to define it is doomed to failure. Anyone that’s suffered through an introductory psychology course knows this well. It’s like the blind men who try to describe the elephant as they use their hands to feel the part closest to them. To one, it’s a like wall, to another, like a pillar, and to another still, like a rope.

Back in the day, when there was just one giant land mass, things were simpler. But as we all know, over time, things broke off,
separated and developed their own unique climates, plants and animals. Hawaii lucked out, and Greenland just had to deal with it.

The tricksy (yes, it is a word because I want to use it as one, like psychology) part of it is, time, in a rate of movement sense of the word, is speeding up. One of the key reasons for this is rapidly enhanced communication methods like the internet. Another is the fact that we can use tools which help us make better tools, which speeds up the movement of those giant moving plates that we give different names and borders to as time passes and wars are won and lost. We do to knowledge what we do to land. We fight over it, but in different ways.

With knowledge, as with tectonic plates, there’s a lot of pressure that’s been building, in different places, in different issues, as a result of this speeding up of time. And as always when plates and worlds collide, there’s a lot of damage, but in the end, what emerges is a new vista, a place of elevated height where we can see further than we’ve ever before. If we’re lucky, maybe, just maybe, we can catch that it’s not flat, but it curves, ever so slightly. Instead of on the shoulders of giants, we find ourselves on the edges of plates, and by extension, paradigms.

So, if all this take of the ground moving gives you motion sickness, don’t stress. This is good news. I promise, and everything.

In a concrete way, this means that we can carve out a critical role in preventative care as people that teach others how to take care of their bodies, and the behavior that’s so intimately connected with them. It means that we can more deeply understand and explain to others how thoughts are wrapped in language, and fired through cannons of genetics set off by environmental fuses.  It means that with positive psychology we can measure the upper limits of human mind and spirit, and train people how to reach them before we send them out to face the challenges on behalf of others.

I live in Florida at the moment, and I see the flux, I sense the sublimated chaos oozing from everywhere around me.  Even people in my own building are foreclosing on a regular basis. Chaos is a part of growth, and true change means destruction before reconstruction, and dissolution before recrystalization.

It’s been said that the best way to predict the future is to write it. As a field of thought in flux, fledgling, the synthesis of so many other things synthesized before it, a great many things are now possible. Millennia old thoughts like mindfulness are being recast as therapies that help those previously thought to be forever on the cusp of self-harm. Enigmas are giving way to sharper ways of expressing truths that were always known, but never fully articulated.

Old wine in new bottles? Maybe.
Old wine in red bull? Intense! (see health psychologist)
Open bar? Sweet.

I’m not saying it will be easy, but it is being done, and will continue to be done, with or without your two cents.

Terrifying? Possibly. Exciting? Most definitely. Your choice? Always.


One thing I always say about anxiety

For quite some time, and likely still, the “common cold” of mental health seemed to be depression.  Statistics are hovering around the 1 in 10 mark for experiencing a depressive episode in one’s lifetime, with men being the more likely gender to suffer it.  Keeping in mind, of course, that these are only reported cases in which a diagnosis was given.  If we acknowledge that in a lot of cases a depressive episode will go unreported and undiagnosed, that number goes up a significant amount.  I would guess that it doubles at least.

But this is not a post about depression.

I recently decided to go through the list of people that I’ve seen in the last 8 months and tally up the “presenting concerns.”  The issue at the top of the list, unsurprisingly, was our common cold – depression (incidentally, only a small fraction of these people had a diagnosed ‘disorder’ such major depressive disorder – though many met the criteria).  But coming up at a close second was another issue that has been, in my view, becoming more and more prevalent: anxiety.

It’s not always easy to separate the two.  In fact, in the DSM-V, they are flirting with creating a new diagnostic category called mixed anxiety depression because the two so often play together.

In any case, if I were to count the number of issues of my clients without limiting it to one issue per client, I’m confident that anxiety would be at the top of the list.  It’s just something that accompanies other problems.  And there’s good reason for that, which I’ll get into shortly.

Now, I’m not too big a fan of the manualization of therapy.  I like to think that each individual person that I sit with has a unique life situation and that there are many equally valid ways of resolving whatever distress they are going through, and that we have to work to find out which way is going to be the most productive.  I have a problem with pretending to know exactly what is required to do to ‘fix’ a person before I even know anything about them.

However, when it comes to anxiety (and perhaps more specifically, panic), there’s come to be one thing that I ALWAYS do, and it couldn’t be simpler.  It takes 5 minutes.  It’s so simple that I’m going to do it with you, right now, because I know that you’ve experienced anxiety before and that this might be new information for you.  But that’s all it is: information.  So, without further ado, I present to you…

A Brief Discussion on the Physiological/Evolutionary Nature of Anxiety
with illustration!

At some point in our evolutionary history, the fact that some folks had something that we now call the ‘autonomic nervous system’ became somewhat of a survival advantage.  You see, this nifty gifty had  two sub-systems: one called the sympathetic and one called the parasympathetic nervous system.  The former had this neat function where it got us really pumped up in response to some kind of threat in our environment.  Maybe a poisonous snake crossed your path, maybe some pre-historic douche-canoe was making moves on a certain female member of the species that you wouldn’t mind impregnating.  In any case, a threat is detected.  This is where the sympathetic nervous system decides to step in and do its thing.  Suddenly, more blood starts pumping out to your arm and leg muscles, your heart rate doubles, breathing becomes fast and shallow, and your pupils dilate, and all sorts of chemical changes start happening.  In a split second, you are literally stronger, faster, and more alert.  Now, you have much more capacity with which to either flee the threat or engage it physically.  This is what is more popularly known as the fight/flight response.

This is all well and good.  Obviously this all developed over generations and the process of evolution refined it to be what it is today.  But as with so many traits that allowed us to survive in an ancestral environment, it doesn’t always function with the same level of effectiveness in our lives today.  The simple fact of the matter is that, for the more fortunate of us, we don’t live life surrounded by the possibility of constant threats to our survival.

So, for those of us who don’t have problems with anxiety or panic, this system tends to be well-regulated most of the time.  Every now and then a legitimate threat is perceived and you’ll get that response happening, but most of the time, when faced with normal everyday stimuli, nothing happens.

When we start talking about anxiety, and particularly with panic attacks, what effectively has happened is that the sympathetic nervous system’s threshold has been lowered way down.  It’s been over-sensitized for some reason (which obviously varies depending on one’s history – in the case of trauma there is very good reason for this).  But the point is that there is a natural, physiological process that is happening – one that was well-developed back when our ancestors didn’t have the cognitive abilities that we now possess in order to make logical sense of the the world around us.

So, when someone with social anxiety begins to have a panic attack when forced to interact in a group, we (and they) can easily come to the conclusion that it just doesn’t make any sense for that to happen – nothing bad is going to come out of it and there is no logical reason to become anxious.  But on a deeper level, this system that’s basically been told to go into red alert status starts going off the rails.

So what about this other subsystem of the autonomic nervous system – the parasympathetic one?  This one is actually responsible for the exact opposite function of its sister – it calms us down when a threat is no longer present.  Our blood begins to flow back to our core, heart rate slows, pupils return to normal size, breathing slows, and all sorts of chemical changes happen.  It’s no longer adaptive to be hyper-vigilant and ready to spring at the drop of a pin.  And this is also the system that has to start kicking in when maladaptive anxiety is starting to cause panic.

It’s just not possible for both of these systems to be fired up at the same time.  You can’t be anxious and relaxed simultaneously.  And this is the bottom line of what I say to anxious people.  The beauty of it is that there is an incredibly simple way to kick-start the parasympathetic nervous system’s calming effects – it’s as simple as taking control of your breath.  Slow down your breathing, you slow down your heart rate, and just maybe, that gets some of the other processes going.

I find it to be a hopeful message.  It’s just a starting point, and it’s by no means the ideal, ultimate  solution to anxiety, but it is simple enough that it’s worth saying every time.