Saturday, April 25, 2009

Of Brainwashing and Arguing

It might be too late for this to get noticed by the majority of the class, but I think the answer to the question regarding my opinion on the matter is that it would likely be inappropriate to voice heavily in this setting.  None of you plunked down money to hear me talk about politics or morality and I have little expertise worth paying for in either topic.  I am here because I love to teach future therapists and because (hopefully) many of you want to learn.

My hunch is that entering into the debate could lead some of you who feel strongly about the issue to have less passion about learning.  What a pity that would be!  Thus taking a strong stand on the issue would contradict my stated purpose.

As a therapist, this is also true.  Your job is to help others heal.  You do this by providing an environment where people feel safe, accepted and loved.  I've had clients come to me who are clearly sex addicts and have zero interest in working on it.  They're here to quit drinking or drugging or whatever.  Can I treat a sex-addict who is disinterested in addressing that issue?  You bet!  I can be of some service by accepting him or her where they're at and seeing where we can go.   Arguing about whether or not their a sex addict will simply drive them to someone else's office...

Hopefully that makes sense. 

A bit more on the argument piece... Studies show that when there is debate between two sides, those talking move farther away from the "center" so to speak.  Not surprising.  What is surprising though is that the audience typically does the same.  If you watched two people debating something, by the end of the discussion you will generally have sided with one member of the talk or the other and your own opinion will be more akin to theirs even if you had started out at a more moderate position!

What's REALLY interesting about that, is that if I'm unscrupulous I can use this to really mess with your head.  Let's say I wanted to convince you that - and I'm trying to come up with something fairly neutral here - that cigarettes don't cause cancer.  One way I could do this would be to put two people in front of you, one arguing passionately that science on this matter is inconclusive and the other arguing equally passionately that cigarettes are actually healthy and good for you!  Sounds ridiculous, right?  Well, studies show that often by the end of the conversation if it's a topic you have interest and those speaking have "expert" credibility in your mind, by the time the discussion is over you'll lean toward one or the other. Which are you more likely to side with?  The majority of the audience will have forgotten that they formerly believed that cigarettes cause cancer.  They will now be deciding between the lesser of two crazy positions and be pulled in the direction that I want them to.  Muhuhahaha... 

So, there's a lesson in brainwashing 101.  Next time you watch tv news or listen to the radio, look at the topic and see what's being debated.  If you put your mind to it you could find this technique being used with regularity...

 

Thursday, April 23, 2009

Rigidity and Racism in Family Systems

The experience of braking away from family norms can carry some deeply significant consequences.  In cases where the family system is rigid and unyeilding, in can end relationships.  In addiction counseling, we frequently see clients who must choose between alignment with the family and continuing their addictive behavior or choose an essential departure from family norms, which can mean expulsion from the family system. 

Many who come to see a counselor will be from family systems that were rigid in nature, that is to say, families that do not accept deviations in thought or opinion. Often, but not always, these family systems have a patriarch (or matriarch) who plays the Higher Power role. Children who come from this sort of family system will frequently display oppositional characteristics toward authority.  Sometimes these oppositional characteristics will be overt, as in the rebellious, angry client who tells you where to stick your theories, therapies and jargon.  Clinically though, it will often appear more subtlety, as with clients who are consistently late or breaking appointments, who say yes when they mean no, are (often sincerely) forgetful of assignments or tasks, or who behave in similar power-garnering ways.  It's no surprise then that such clients also frequently have spirituality issues (they'll become rigid or rebellious in relationship to their Higher Power), and struggle to make connections in intimate relationships due to difficulties with trust.

The opposite of a rigid family system is a family system that has is permissive in nature. In this sort of family, anything goes. The children are often expected to take care of themselves and will sometimes be related to by their parents more as siblings or friends then progeny. Clients who come a permissive family system are usually deeply anxious and don't know why. This anxiety often finds it roots at the age of 4 or 5 where it suddenly dawns on the child that although mom and dad are going to provide some of the essentials for survival, socially and emotionally speaking they are all alone.

As counselors, what we do with these folks is try to bring them back to the middle. With clients who come from a rigid background, there are two tasks. The first is to aide the client in the process called individuation. Individuation is helping the client decide who they are outside their family system, i.e. "Client, what are your goals, beliefs, values and desires?" Ideally individuation is accomplished in adolescence, but this is rarely the case with clients seeking clinical help. After individuation, the goal is to help the client get back to the middle. Clients who grow up in rigid households will drift to extremes; either becoming the person their parents wanted and expected, or becoming the precise opposite, much to the chagrin of the family.

With some situations, such as the overt racism in his family of origin brought by one client, it is less about guiding the client back to "the middle" and more about helping with values clarification and the combination of guilt and anxiety. In situations where overt racism was present growing up there will often be a certain level of anxiety that manifests when talking members of one of the minority groups that the family system had rallied against. Commonly the client will realize that the information that has been provided from his family system is insufficient and incongruous, but to still carry some fear that he'll say the wrong thing and guilt that he still has those messages with you at some level. 

Wednesday, April 22, 2009

Making mistakes.

That sounds about right to me. We are all "beggars." My life's pretty good some days, and a mess on others.

My friend Tom liked to say "I find no matter what I do, I've always got problems. But today my problem is that the engine in the boat I keep at my lake house won't work. That's a pretty good problem to have. I think life is at least partly about improving the quality of my problems."

I tell that story to couples I work with especially. I say "I can't solve all your problems, and even if I could you'd just have a bunch more by next week anyway. But I can teach you to see that they're not as important as you think they are..."

Self-doubt still plagues me too, unless I'm doing something that I've survived failure at. As a professor, therapist and public speaker (three things I've done a lot in my life) I have made pretty much every imaginable mistake (actually, the CLC thing this week was a new one, so almost every imaginable mistake ;-)), and lived to tell the tail. I remember being completely terrified for about my first four months at The Meadows because here I was at a world class treatment center, and I couldn't figure out who the weak link was. You know how they say if you're playing poker and you don't know who the sucker at the table is, it's you? I was pretty sure it was me. I was quite scared! Then one day, it happened. In front of a peer a client chewed me up and spit me out. Then her family did too. Then one of the other client's parents, who had been observing the group, said "this is total crap. We're leaving." They went down to my supervisors office, chewed him out, and took their kid home.

I thought I'd better get my bags packed. I called my supervisor and he said "Hey, tell me next time someone's coming to my office all pissed off, ok?" I said "OK." and waited. He said "Have a good weekend." I said "... OK." And hung up. Then I went home.

After that day I was a lot less nervous. See, one of the things I'd feared the most was that a client wouldn't like me. Then it happened, and I survived it, and then all the sudden, it didn't bother me as much. There were countless other fears I had as a therapist (and teacher, and speaker). Many of them came true. And I grew from the experiences. Teaching therapists is like teaching electricians; you want to give them the necessary information so they know enough not to kill themselves or someone else, but once that's done they have to go do the job until they get good at it. Grad school is learning enough that you can't hurt people, your internship and first two or three years are about actually learning to do the work. So, no need to get to worried just yet.

Tuesday, April 21, 2009

Sex Addiction Resources

At The Meadows we would offer the sex addicts a celibacy contract. The ones who stuck with it often struggled with sleeplessness, headaches, nausea... I think Pat Carnes lists 15 regularly reported symptoms of sex addiction withdrawl. Carnes, by the way, is the Michael Jordan of sex addiction. For clients who think they might be sex addicts, you might consider referring them to "Out of the Shadows." For clinicians and/or clients who want more detailed information on diagnosis and treatment, "Don't call it Love" is excellent, though a little dated nowadays, and his newest project - I think it's called facing the shadow? - walks through 18 stages of recovery or something like that? His work is thorough and pretty impressive. For success I've found it needs to be coupled with 12-step work as all sex addiction is essentially about loneliness and dichotomizing the personality.

Sex Addiction and Arousal Templates

Sexual addiction is actually very trendy these days, thanks to the internet. Have you all heard of an "arousal template"? It's basically a fancy word for "what floats your boat." An example of an arousal template would be a adolescent male walking home from school, who happens to look into a neighbors window and catches a couple having sex. If this experience is a sexually powerful for him, that is, it creates a high, he may try to replicate it by looking into other windows or, later, drilling holes in locker room walls, etc.

Not infrequently an arousal template is related to sexual abuse. I remember working with a client who was raped in early adolescence by a man 20 years older than her. She grew up and married, not one, not two, but four different men (at different times) who were all about 20 years older than her.

So the sneaky part of this is that these porn folks on the web understand it. So when you look at porn - I mean, that is, well, I'm sure none of YOU have ever actually seen pornography on the internet, but, you know, let's say your clients may have... so, uh, when your clients look at porn, there are often advertisements for other porn sites that are at the "next level" so to speak. That is a "normal" porn site will show advertisements for voyeur or foot fetish sites in an effort to snag the viewers arousal template, because once they hit that, you're hooked. I once worked with a client whose struggle was looking at pornographic images of women being strangled while under water. There are web sites for that. At least two of them...

Context in Therapy

I keep the class comfortable and do my best to always be clear that we are all on equal footing here. One of my favorite supervisors ever, Mike Graham at The Meadows, had a sign on his wall that said "no one cares how much you know until they know how much you care." It's tempting as a clinician (and as a professor) to allow the built in power-differential to create an environment where I am the guru and you are the student. But ultimately that doesn't work because it's based on a lie. The fact is that we're all worth the exact same, because we're all precious children of God. Now given, you are paying me, so I'd better having something useful to tell you or you'll be upset, but the casual atmosphere I keep both as a professor and clinician is really designed to get away from the idea of the therapist guru and closer toward the idea that we're all a bunch of schmoes who have to figure life out together.

For more on this idea buy a copy of Sheldon Kopp's book, "If you see the Buddha on the Road, Kill Him!" Kopp has some concepts that I adamantly disagree with, but for the most part that book is totally brilliant as far as understanding the contextfrom which therapy happens. Classes and coursework are all about content, which, frankly, is not all that useful much of the time. context (in contrast to content) is everything other than the content. It's the feeling I get sitting in your office, it's the subtle read of your body language, it's noticing if my connection with my Higher Power is stronger or weaker in your presence... context cannot be taught. It really can't even be written about, though I'm giving it the good 'ol "college try" (sorry. couldn't resist.). context has to be repeatedly experienced, and gradually integrated. But here's the trick - and remember this because it's probably the most useful thing I'll say in this course - when it comes to healing, context is what matters. One of my wife's favorite professors always said "They'll forget everything you tell them, but they'll remember the relationship." That's context.

In my opinion, most great therapist aren't taught, they're born. Occasionally there are training programs where context shows up, most often, I think, by accident. I was lucky. I went to grad school at a place that understood this, and I interned at a place (The Meadows) where the clinical staff lived it (to the degree that such a thing is possible anyway). My hope is that by setting up the class within a context of respect and equality you will start to pick it up too. This class is information that you'll use on rare occasion in your clinical life. If start to understand the context you'll be moving closer to becoming a healer, which, really, is what many of us are seeking.

Wednesday, April 15, 2009

Interesting Article on Addiction

http://www.cnn.com/2009/HEALTH/04/15/addiction.cold.turkey.pill/index.html 

LSD as a sacrement

I heard that LSD was originally administered as a spiritual sacrament. Bill Wilson, co-founder of alcoholics anonymous, is said to have experimented with it so see if it could be used to bring about a sudden spiritual awakening in newly recovering alcoholics. Supposedly with supervision and proper spiritual preparation the LSD experience was quite liberating. Many of those who partook eventually left their professional lives to become full-time seekers of spiritual truth.

Sunday, April 12, 2009

Love and Hate

The opposite of love isn't hate, it's indifference.  Hatred is the word we use for deep, deep victim-anger.  You were victimized, so anger makes sense.  If we were working together I would counsel you that anger is an important part of the grieving process, but one in which people sometimes get stuck.  

"That which we do not own, owns us."  Carl Jung. My hunch is that what you're talking about here is a profound grief process that will open itself to you when you're ready for it.  There is no rush, though your anger may continue to "own you" until you are willing to let it become pain.  The tough part about pain is that it's vulnerable – anger feels much safer.   In your life I'm guessing that safety was a rare and much needed commodity…

The AA's wife

She might consider attending al-anon for a year or two, though I'm sure she's been told as much.  I've frequently seen situations where the spouse attending al-anon faithfully for a year or two serves as the catalyst necessary for the cessation of drinking for the alcoholic
 Well, attending is a good start, but in order for it to work she has to attend, get a sponsor and work the steps.  Attending a meeting is like going to the emergency room; it's worth the trip, but only if you talk to the doctor.


Addiction's Start

 My experience is that almost all addicts start their addictions during junior high school. Some transition to other stuff later (i.e. the kid who has her first drink in seventh grade but doesn't find meth till 17) but generally an individual who develops an addiction will have their first use during junior high. In fact, whenever I find someone who has an addiction who doesn't report it starting in junior high I look for a behavioral addiction. With men I ask about compulsivity in their masturbation habits and look to see if it's blossomed into sex addiction, with young women I discuss body image issues and see how those have played out in their lives. Almost always the addiction gets going during adolescence in one respect or another...

Drinking and Diabetes

I love the diabetes example as a metaphor for the disease model of alcoholism. If I find out I'm diabetic, I learn quickly that I am powerless over the condition and need to modify my lifestyle or face some disappointing consequences.

I also apply this idea when clients say "well, I'm an alcoholic. That's why I drank." No, that's not true. If I'm a diabetic and I eat a donut and go into a coma, did I go into a coma because I'm a diabetic? No way! I went into a coma because I ate a donut. Once I know I'm an alcoholic, if I drink, it's because I chose not to take care of myself and do the things I needed to do. I chose not to call my sponsor, go to therapy, eat right, sleep enough, etc. Drinking prior to understanding I'm an alcoholic isn't a choice, but once I see that I have a disease, the decision is mine.

Genetic Predisposition to ETOH

I liken it to having a genetic predisposition to become a professional basketball player. Is it required? Well, not necessarily... Mugsey Bogues was 5 foot, 3 inches tall. (here's a picture of him guarding Michael Jordan). He probably didn't have a genetic predisposition to being a basketball star, but managed to find a way to make it happen anyhow. That said, most NBA players are taller than that. Yao Ming of the Houston Rockets is 7 feet, 6 inches tall. I'd say he had pretty high susceptibility. ;-) 

Addiction in the family

I too struggle when I see young people who have no guidance. It is a lonely way to grow up and profoundly damaging (see my post on the "lost child" syndrome for more info on that).

Also noteworthy is that alcoholism frequently will skip a generation. I cannot tell you how many times I've seen clients whose parents didn't drink or use, but who have grandparents on one or both sides who did so to excess.

This is because we, as human beings, during our process of individuation (which usually starts in our early teens) will make a list of some things our parents didn't do well that we want to correct when we're adults. But here's the trick - we will almost always over-correct. Ask any 15 year old "what's the worst thing about your parents?" and you'll find in what area they're going to be sure to over-correct.

Kids whose parents are alcoholics or addicts tend to go one of two ways. Either they repeat the cycle, or the become angry, judgmental and uptight in their determination not to do so. They succeed in avoiding drinking, but they're often fear-based, which leads them to be hyper-controlling fixers of their loved ones. Such individuals sometimes marry alcoholics, and frequently find their progeny turning that direction.

That's part of why I always, always, suggest that family members of addicts I see pursue counseling, an al-anon family group, or both. The inversion of the cycle is still the cycle, it just looks different.

Shame existence Binds

Adoption is almost always worth looking into with a client. Often, but of course not always, a child who was given up for adoption will have a subtle but deeply felt "shame-existence bind," which is a situation where I feel ashamed to exist. The client is sometimes aware of this, but frequently they are not. In either case the shame bind will manifest itself in either overt or covert suicidality; including risk-taking, using drugs or alcohol to an excess, or self-sabotage just when their ship is about to come in. <p>Shame-existence binds don't just show up with clients who were adopted - I'd say they are actually relatively common clinically. If you find one it's best treated in a group setting where rapport has been established by the client with both the group and the practitioner. Have the client affirm "I have the right to exist," making eye-contact with one individual in the group at a time going all the way around the room. The reactions vary, but often there will be tears by the fourth or fifth person, and it will "break" after six or seven. If you don't have a group to work with, have the client practice "I am worthy" and "I have a right to exist" as affirmations hundreds of times daily for a month. For many the chance is significant and measurable.

Saturday, April 4, 2009

Test Anxiety and the Importance of Doing Your Own Work

As far as test anxiety goes, you're right on in terms of noticing that your limbic system getting keyed up feels a bit like a stimulant use. As I understand it (remember, I'm a therapist, not a biologist) your limbic system is that part of your old brain which controls your fight or flight mechanism. If you're exposed to a situation that replicates a previously experienced traumatic event your amigdala gets pumping and releases a bunch of adrenalin into your system and you will feel like you just had 2-3 cups of coffee. The difficulty with that is that when that happens to us, some of our ability to reason logically gets impaired as well. But it's normal.

A quick word to everyone on test anxiety: Relax! ;-) Obviously it's important that you learn a lot from your experience in graduate school, but don't get too stressed out. The fact is that being a therapist is like being an electrician: Education is provided mostly to lay a foundation that prevents you from hurting yourself or someone else. The real learning of the art of psych-therapy takes place on the job.

This is for everyone (not just you Brittany) - I think that a lot of us have some unresolved school trauma and perhaps some severely shaming experiences related to success, or lack thereof, academically. If you're feeling strong discomfort about papers, tests, and the like, it may be a sign that you have some perfectionism tendencies to look at clinically. If this is an issue, consider addressing it with a therapist.

For all of you, please, please, please get your own therapy before, during and after the process of becoming a therapist -what you don't see in yourself you won't see in someone else! This is particularly important if (like me) you come from a family system with addiction - there's usually a lot to undo there. Therapists without insight are not just unhelpful; some are just plain dangerous because they reinforce (rather than challenge) distorted belief systems in their clients.

Greg