Thoughts on Religion and Existentialism in Counseling

Zulay said:

I like that spin on it all because you can give the proper insight on such a subject because you are actually in the field. I believe that as a counselor practices and does his/her job, they will have to make judgment calls. I want to make sure I am understanding what you said. I understand that as a police officer, therapist, or anyone within the social field, we should not ever judge, we should make an ethical decision based on theory, law, or whatever legally applies. So is it not ethical to have a discussion with a client who brings up the topic on religion? I personally don't entertain it in my field because it is what is best. I do lend my ear, listen and give facts based on law and city ordinances written by the City in which I work.

Hmmm.  This is an interesting question.  I think the answer is "maybe"?

First, this has turned out to be a very long post.  So if you're going to read it, I'd suggest setting aside some time.  The readers digest version is this; Remember, if you get nothing else out of this class (or this massive post); speaking the Truth as best you understand it, helping a client see that fire burns and water gets wet, is not judgment (unless you do it from a place of "I'm better than you.)  In fact, in most circumstances, it's your job. 

The big benefit of having a theory or law to make a decision from is that there's less risk of harming the client.  So that's a significant plus and it's one of the reasons I have respect for those who choose to avoid personal disclosure in a therapeutic session.  There are some schools of thought that allow for little or no personal talk with clients.

In my experience excellence in a therapeutic context is about learning to make truth and love work together.  In conjunction these two things lead to health and healing 100% of the time as far as I can see.  Separate from one another they are somewhere between useless and dangerous.  

Truth without Love is easy to spot, because it typically is accompanied by awful pain.  Take a look at the word "disillusion"  How many of us wake up int he morning thinking "gee, I hope I get disillusioned today"?  Usually no one, because most people don't like pain (if you do like pain, we should probably talk).  Since most people do their best to avoid pain they'll generally also try to avoid disillusionment.  And yet, look at the word.  What does it mean?  It means "to remove illusion."  Well who doesn't want to see illusion fall away? Who doesn't want to see the truth?  ... Unfortunately the answer is "all of us."  Because the truth hurts.  Sometimes horribly.

One of my favorite books (even though I haven't actually read it) is called "He's just not that into you."  It's a great example of truth told without love.  I think it's a universal human experience to discover the "he (or she)" isn't that into me after pining away for him (or her) and to feel totally awful about it. 

The point is that truth told or discovered without love is often quite painful.  When someone tells me a truth in a loveless way (and this has happened to all of us) I will typically react by experiencing shame (which is always about being seen) and then go to a place of defensive anger and denial.  In fact, if you tell me the truth in a way that brings up shame I will actually be less likely to ever look at that area again.

Now let's look at Love without Truth.  How many of us have ever made a decision based on love that we later came to regret???  (Pssst...  if you're not raising your hand right now, reread the previous three paragraphs).  Love in this context is "sticky," glomming on to anything.  It can also be quite dangerous!  All of us know someone or are someone whose fallen hopelessly in love with another person who turns out to be very different than what we were thinking at the time...

Effective counseling is learning to blend these two elements; to tell someone the (sometimes horrible) truth, and to do so in love.  At the Meadows I'd get patients all the time who'd come in and say "my childhood was great. I have no trauma."  This is someone who is in denial of a truth (most people with no trauma don't require multiple grams of cocaine a day), but needs to learn this in a context of love in order to have the opportunity to possibly accept it.

So does this make sense?   Effective therapy is about teaching someone truth in a loving way.  That's what we're learning here.  These theories are useful in that they take human nature and attempt to distill it into some essential truths, which can then be shared with clients. 

Also, is anyone else impressed that I've managed to get 1000 or so words into this post without actually answering Zulay's question?

So, for Zulay, the question of the appropriateness of discussion religion in therapy and it's relationship to judgment... 

First, it's helpful to consider that religion might be thought of as a collective expression of man's attempt at grasping truth.  It's an answer to the (existential) question "why am I here?"  Some folks are keenly interested in going there in session.  I know for me, this question was what drove me to a therapists office at the age of 22, and the experience of grappling with it nearly killed me.   

One of the reasons I teach - one of the big ones actually - is that when i was going through school this discussion of discernment vs. judgment never happened - well, more likely it did and I ignored it because completely dropping what I perceived to be judgment but which most consider morality was so darn convenient.  I loved to wage verbal war with absolutist students who wouldn't buy what I was sure was an obvious fact; "perception is reality."  Never mind that Plato disproved this irrefutably while he was arguing with the sophists 4300 years ago, I was going to stick with it come hell or high water.  

One of my favorite co-workers ever, Doug, was 72 years old and too stubborn to retire.  He was a family therapist at The Meadows for the offender sex addiction group.  These were some pretty challenging clients, and their families (particularly their spouses) could be a handful too.  On his wall he had a sign that read

"There really is nothing you must do. 
There really is no one you must please. 
There really is nowhere you must go... 
But... 
Sometimes it helps to remember
That fire burns
And water gets wet."

What it means is that actions have consequences.  And that, folks, that's a timeless Truth.  There's no getting around it - believe me, I've tried and tried and tried...  It's also the central truth that we teach our clients.  Consider REBT as an example.  The central tenet is that if I change my thoughts, it will change my emotions, which will in turn change my behavior.  That means that I am ultimately responsible for my thoughts, which means I'm responsible for my feelings, which means I'm responsible for my behavior, which means - darn it! - my mother-in-law is off the hook.  Get it?  Actions have consequences. 

So I would posit that every therapy session that's in any way useful (which requires that the clinician have a model based on truth and deliver it in love) is existential in nature.  Ultimately counseling is about teaching clients that at some level they must take responsibility. 

I think I mentioned this earlier, but the world religion comes from the Latin word relegare, which means "to bind" as in to bind together.  A person's religion is what binds their world together.  I would also argue that much of counseling is religious in nature.  Every human being on this earth has a higher power, a thing or things around which they organize their lives.  It might be their mother (one subtle but common example might be "I'll never be like her!"), it might be the opposite sex, it might be the Buddha (well, technically that's not a good example since Buddha never claimed to be God), it might be their checkbook (I heard once that if you're wondering what you're higher power is, you check register will tell you) or it might be beer.

Just as an example, how many of you reading this would change your higher power if I wrote a really compelling post?  Anyone?  Usually most of us are pretty set in this part of our thinking.  In fact, history is full of names of people who've gone to fiery, excruciating deaths to avoid changing or even speaking against their Higher Power.

Does this apply to addiction?  I think it may...  Think about the case of the terminal alcoholic, the person who drinks until they die.  Is this not one of the best examples of zealotry we can find in modern culture?  This is a really hard way to go!  Of course there's jaundice, where the skin turns yellow because the liver has stopped removing toxins from the blood.  But that's just getting started.  After jaundice we have esophageal hemorrhaging, wherein the patient gushes blood out of the bodies major orifices.  Acute pancreatitis happens as well, which is when the pancreas, which secretes the most powerful of the stomach acids - bile - starts leaking acid into the stomach cavity.  This is supposedly one of the most painful experiences a human can have – supposedly more painful than childbirth… 

And that's before you die.  Do you know that when the medical team does an autopsy of an alcoholic they have to wear special masks because when they take off the scull to examine the brain the smell of alcohol is so pungent that most folks – even these professionals - will get sick? 

It's all quite horrifying to be sure.  But… let's consider it from another angle for a moment.  Is this not, in some respects, absolutely incredible dedication?  The alcoholic who drinks until they die is someone who is willing to go to a grizzly, miserable death rather than surrender booze.  How many of us have something in our lives that we're that dedicated to?  How many of us would walk through that for our religion, whatever it may be?  I bet there are some reading this who would, but not many (By the way, my thanks to the three of you who've actually gotten this far in the post ;-))

This incidentally, is a big part of why AA works.  Alcoholism has been around since ancient Greece – that's the earliest record we have of it.  The most successful treatment program prior to AA was the sanitarium.  Lock 'em up and throw away the key.  That's the farthest medical science had got with the chronic alcoholic prior to the late 1930's.  So why did AA work where so many others had failed?  Because Bill and Bob, the two guys who founded the program, were alcoholics themselves and understood first-hand that their higher power had been booze, and they needed to find a different one.  To this day AA doesn't tell the alcoholic which Higher Power they need to believe in, but they've stuck to the idea that they need to find a new one because the booze doesn't work.

So, does religion have a place in counseling?  Directly or tangentially, I think it does (though it probably depends on how you define the word).  Sometimes it's as simple as helping the client understand what their religion really is.  Other times it's being open and taking some risks with the client, sharing some of my own experiences and mistakes, is what's necessary

Man, that was a long post.  My fingers are tired! ;-) 

By the way, I should mention that much of this comes from Pia Mellody's work, and I'm pretty sure she got a bunch of it from Cloud and Townsend.  There's a bit that comes from Lou Marzeles' "Life for the Reality Impaired" also. 

 

Birth Order Birthday Party

Yes, the birth-order characteristics are quite useful in certain circumstances. If we were in a face-to-face setting I'd teach this the way it was taught to me. I'd ask, by show of hands, how many first borns, how many middles, how many youngest and how many only's? Then I'd devide them up into groups based on birth order and say "plan a birthday party." <p> The oldests wouldn't let me get away with this for very long. They need details and directions - how can you be successful if you don't know what the professor expects? When they ask for clarification, I would deflect and say "that's all the instruction I can give you." <p> Here's the exercise would typically end up. The one of the oldests who had mobilized and lead their group discussion would present to us larger scale party that included a budget, timeline, delegated task list, guest lists, invitations (including contact information for a printer one of them knows who will get them a good deal), web site... There would be a good deal of communication in the oldest's group and probably more than a little interrupting, but it's not likely that they'd get to concerned - unless the interruptions compromised productivity. Also, the oldests would probably be the first group to finish and the ones to ask "when are we going to present?" <p> The middle children... God bless the middles. No interruptions here. There'd also be an awkward silence when I asked "what did you come up with" since they hadn't agreed on who would be the leader and no one would want to go first as it may hurt the others feelings... When one finally did reluctantly volunteer to go he or she would pleasantly explain that the birthday party would be a gathering of a few close friends and family where everyone would have a great time and no one would be excluded. If there was some delegation it would be very fair to everyone involved, because middles do prefer things to be fair.<p> The youngest children will have been laughing and joking for the majority of the group time. If they do have a plan, it will not include a budget. Once i saw a group say "we're going to rent out the stadium and invite the whole city." Generally they will have spent approximately 10% of the alloted time planning and the remainder talking, telling stories and laughing. <p>The birth order stuff isn't perfect, but it's usually a pretty solid guideline.

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...

 

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. 

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.

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...