Clinical thoughts

Who said?

2009-08-21T10:37:00.000-07:00

This week I heard men on a radio talk show talking about punishing children. Their concern was that they couldn't "take the belt to them." Beyond the fact that people still believe that hitting a child with a belt is okay, I thought about all the people hearing this that would be influenced by the remark. Does it give people permission to use a belt?

The real question is, What did I know about the guy talking on the radio? Nothing! What did the child do to deserve such a punishment? Unknown!

Negative thinking

2009-08-12T13:11:00.000-07:00

Negative remarks seem to be a a large part of depression. Sometimes the depressed person makes them and sometimes the people around the depressed person make the negative statements. The end result is defensiveness. Once defensiveness kicks in all communication stops and depression runs wild.

Strangers

2009-08-06T12:35:00.000-07:00

For some reason it is easier to talk to a stranger than it is to talk to a spouse. I don't understand, that before people get married they can talk for ever. They will talk for two or three hours every night, on the phone, and never run out of things to talk about. But after they have been married for a while they stop talking.

Men and women who have affairs will eventually realize they find it easier to talk to the the third person than their spouse, even though they have no intention of getting a divorce.

I'm Amazed

2009-08-05T11:58:00.000-07:00

Yesterday, when I decided to write in my blog, I chose to talk about "forgiveness" as the missing component in secular counseling. Well within a very few minutes I received an email that talked about Jesus' death on the cross and how it forgave all of us for all of our sins.

It is almost frightening the way God works in our life.

It's been a while

2009-08-04T08:44:00.001-07:00

Lately, I have had a problem with time. It goes along with the statement, "The faster I go, The behinder I get." Imagine from March to August. That's five months. During that time I realized why I became a Christian Counselor. Its summed up in one word, "forgive." So often in working with a client it comes down to the fact that someone hurt them. No matter what they do it won't change that fact. The only action left is to forgive.

Being released from our past is the only solution to some of our old nightmares. While it is true that we can't change our past, forgiveness is one way that we can avoid reliving it.

Mental health

2009-03-17T08:32:00.000-07:00

I never cease to be amazed by the people who are afraid to get well. In treatment I will ask what it would be kike if they no longer felt angry or if they were no longer depressed. There seems to be a lot of comfort in being miserable. Sometimes people even give positive meaning to negative behaviors, like saying to a child that I am spanking you because I love you. I'm not sure but there are probably better ways to express love. The fact is that we spank children because they broke a rule and we abuse people as a way to control them.

Maybe removing misery and pain is only good if we replace it with something more positive.

Obstacles

2009-02-25T08:11:00.000-08:00

I don't mean to get Freudian on everyone, but last night I had a dream that made me feel extremely frustrated. Since I ask clients about any unusual dreams, I decided to see what my dream meant. The dream coincided with the early morning and my need to find a toilet. In the dream I was also in need of finding a toilet, but I was in a strange entertainment center. After waiting in a line forever, I got to the door. When I opened the door there were several people in a large room doing many different activities. The man I needed to pass was in an inner tube in a very small pool just a little larger than the inner tube. Some how I had to get past this man, who gave me an evil stare. Once I got past him I found another door. Upon opening the door I found another woman running to this unusual looking toilet. An argument ensued.

The message was loud and clear that life is full of obstacles. These obstacles are creating considerable frustration for me and everyone else. Most of the obstacles we are faced with make very little sense, much like in the dream.

Because I can

2009-02-24T07:40:00.000-08:00

The new thought for living seems to be, "Because I can." This is a great answer to the question, "Why?

The economy

2009-02-17T08:12:00.000-08:00

It seems that in many of my sessions the economy becomes an issue. Clients are feeling a considerable amount of anxiety in regard to the current economic climate. This is even worse for the clients suffering from an anxiety condition. Worrying for no apparent reason can be a problem, but it gets worse when it's combined with a real reason. Even the wealthy are being careful with their money and the uncertainty of what is to come tomorrow.

"Behind every great man..."

2009-02-10T08:54:00.001-08:00

There is an old saying that goes, "Behind every great man is a great woman." The Internet indicates that the earliest time it was in print was in 1945. At that time it was said in such a way that indicates that it had been around longer than that. With the current economic problems it would seem that internal motivation is hard to come by. Between house foreclosures, unemployment, and factories closing how does one stay optimistic and motivated? This is where someone getting behind us becomes so important. Moral support and acceptance is so important when things get bad.

In marriage counseling it is often obvious that one of the partners is making a good impression while the other is doing all the work. Maybe the solution to a great marriage is to know what your partner does and have respect his/her work.

People helping people

2009-02-05T08:25:00.000-08:00

The economy continues to be a problem. Yesterday I received a brochure from my Congressman. It had a check sheet included that I could use to indicate if there were any problems I thought were important. Being in the health care professions and having clients cancel appointments because they can't afford their co-pays, I wondered what planet he was from. If he doesn't know what problems his constitutents are having, my imput is probably not going to help.

My father lived through the Great Depression. He told stories about not having any money, but since they lived on a farm they always had food. People driving by on their way to finding work would stop in for help. Though they had no money to give, no body left hungary. Americans are an interesting breed. Only when people decide to do something about their condition will this economic problem get solved. Business people can't help because they are busy trying to find a way to get their share of the billions of dollars congress is giving away.

The goodness of people

2009-01-29T11:30:00.000-08:00

This winter has been cold, with almost record breaking snow. It reminds me of how people come together in times of disaster. On September 11, 2001 people were somehow able to unite and work to the common good. To some extent in the aftermath of Hurricane Katrina people were able to help each other. People are still in 2009 going to New Orleans to help rebuild the city. Sometimes it seems, that once the disaster passes everyone goes back to their self-centered, egotistical selves. Or maybe these are not the same people.

Many times in my career, I have worked with people dedicated to helping others. These include volunteer and professional firemen, Emergency Medical Service workers, ambulance attendants, policemen, nurses, counselors, and case managers. These clients come to counseling
because of the politics in these professions. They express a deep concern for their fellow man, but feel their hands are tied by the constraints of business and finance. We need to find ways to allow that goodness to surface.

Truth

2009-01-26T14:35:00.000-08:00

What is the truth in today's world. We find information on the Internet and believe it without question. For some reason information found in print has some kind of credibility. I receive e-mail all the time that proves its credibility by saying go to another website or by reading another quote from someone else I have never heard of.

After the election for president in 2008 many questions concerning who said what, became a problem. Information given on Saturday Night Live, was attributed to one of the candidates. In Ohio people on the news programs reported rumor and gossip as fact. So much of the news today is so unbelievable it is hard to tell truth from fiction. Political "spin" is so institutionalized that we no longer can believe what we see for ourselves.

EMDR vs. traditional therapy

2009-01-22T08:30:00.000-08:00

I have again encountered traditional therapy and how it clogs up the EMDR process. EMDR consent rates on one issue at a time. Once that issue is reprocessed and the corresponding self belief is installed we move on to the next issue. Many times in resolving one issue several other issues become insignificant (its the generalization effect). In traditional therapy there is more a tendency to allow the client to deal with what ever they want to deal with at the time. While EMDR is viewed as client centered, the focus is to deal with one issue at a time.

Sometimes it is hard to break the habits formed in traditional therapy. The client can never resolve an issue because they have been trained to allow their brain to spin out of control. Always worrying and never able to develop a sense of closure.

Hope

2009-01-20T07:57:00.001-08:00

This is inauguration day and everyone on television sounds so hopeful. People saying they have been waiting for this day their whole life. It is almost like a rebirth of a nation. Well nothing has changed. We are still in two wars, the economy is still a disaster, people are losing their homes to foreclosure and unemployment is climbing everyday. Yet people are hopeful.

Hope is what counseling offers patients. So often when people come in for counseling they feel that all is lost. When a spouse asks for a divorce the person feels like a failure and that no one will ever love them again. Through counseling they realize that life goes on. Eventually, they meet someone and realize they have a chance at happiness. When hope is restored their feelings of depression lift.

Hope is important to everyone, so when everything looks glib look for something positive.

Spiritual

2009-01-17T16:42:00.000-08:00

When I opened the paper this morning I found an article about a Clinical Psychologist that wrote his second book on spirituality in psychotherapy. In this time of so many people denyiung the existance of God, it was refreshing to find someone who recognizes he healing power of the spirit. He was Jewish. He pointed out that peple who atend church live, on average seven years longer than non believers.

2009-01-15T15:07:00.000-08:00

Communication s one of the most identified problems in a relationship. I believe the real problem is listening or more importantly hearing what the other person said. In Anger Management it is suggested that a person waits five seconds after a person completes their statement before they respond. The reasoning is that you respond to the complete thought rather than the first part. Once you determine what you are going to say you stop hearing what is being said. For example if someone says, " I was very disappointed in your comment until I realized you were trying to help me." If a person became defensive about the disappointment they would miss the true meaning of the statement.

The idea of communication is to develop understanding which means hearing what is being said, not just listening to the words.

2009-01-13T07:52:00.000-08:00

For many years counselors have been telling clients to forget the past because nothing can be done about it. While it is true that we can't change the past, it certainly tells us where behavior patterns started. What is more amazing is that behaviors that don't work are more comfortable than the risk of trying a new behavior. Maybe that is the reason people do the same things over and over, rather than the expectation of different results.

One of the biggest challenges in therapy is to get the client to try something new. The excuse we use for people not trying new activities is that is is incongruent with their personality. The objective of going to counseling is "change."

2009-01-09T13:38:00.000-08:00

Recently I was questioned by a client about the scientific support for theories in psychology. This person happened to be a scientist and couldn't understand how conclusions could be drawn by such small samples of population. This issue is especially true when it comes to measuring the success of any therapeutic treatment approach. One of the bigger problems is the drop out rate for any given therapy. Once the client gets what they want out of therapy they stop.

The other day I saw a new client who had an obvious mental health issue. While she acknowledged the problem, that wasn't the reason for her visit. She wanted advice and counsel for a current situation that was causing her some anxiety. Once the session was over she left satisfied with the results of the session. As a therapist I would see her as a person who dropped out of therapy. On the other hand it is her life and her misery. Thank God for medication it sometimes makes life tolerable.

2009-01-08T14:55:00.000-08:00

Well it has been a long day. I have spent much of my day working on my computer. My computer is a necessary evil. One of the latest concerns in the counseling profession is cyber-addictions. I once knew a lady who raced her husband home each night, because the first one home got the computer for the night.

The main concern is that people are not relating to others very well. Maybe I'm old fashion but given the choice between text messaging and talking on the phone, I'll take talking. Actually most of the adolescents that are hooked on video games, when given the opportunity, choose hanging out with their friends in person.

2009-01-07T20:29:00.000-08:00

I finally had an EMDR session where the client just couldn't get into the process. Upon questioning it was discovered that the client couldn't use the free association of thoughts. As a remedy for avoiding the intense feelings he had created enough activities that he ended up blocking out his emotions by producing spinning thoughts.

I have seen this phenomena in the past where clients living in a threatening environment would develop coping strategies to avoid feelings. The results were quite disturbing. They would get violent with little remorse.

2008-12-29T12:53:00.000-08:00

An interesting question we always need to ask is: "Who's problem is it?" In school a child acts out, causing all kinds of chaos. The teacher just doesn't know what to do. Kick the child out? Send him to the principal? Call the child's parents? (There are probably more possible solutions than that.) The problem is that the child is not having the problem, the teacher is. The student is getting the attention he wants, so how does he have the problem? The teacher, on the other hand, is all stressed out.

This happens many times to people who go to therapy. They come in and talk about someone else and the bad choices they have made. They will go on and on about this other person's problem and never get around to how it effects them. When the counselor finally asks how the client deals with the stress, they become defensive. They are so busy complaining about the other person they completely ignore "Who's problem it is."

2008-12-24T11:31:00.000-08:00

Here it is December 24 and I realize I have not entered a thought for some time. With company (family) and all the joyful office staff, it seems difficult to have insight. Clients continue to have their problems and make appointments, but many of the appointments are cancelled. This time of the year many things are put on hold because of time limitations. Actually when people are busy their problems seem to disappear or are put on hold.

Maybe the true insight is that when people have concern for others, their own problems disappear. I think relationships and being involved with others fulfills many of our needs. When the joy of the holiday season takes over we find the happiness we are looking for.

2008-12-18T11:28:00.000-08:00

Yesterday, I wrote a "blow-off" blog about changed behavior creating change in people around us. To my surprise, while looking at my Time Magazine this morning I found an article about happy people and their influence on the people around them. A study indicates that happy people will have happy people around them. It then talks about their friends; their friends', friends; and their friends', friends', friends. The indication that the happiness is as infectious as any communicable illness.

One of the major problems in the science of psychology is the cause-effect relationship. The question is: "Does a happy person make the people around them happy" or "are happy people just attracted to other happy people?" My personal belief is that people like to be around people that make them happy.

2008-12-17T17:36:00.000-08:00

I talked to the EMDR facilitator who supervised my experience leading to certification. It was insightful and helpful. I enjoy working with enthusiastic people. I have realized that telling people about EMDR is almost exciting. As I said in an earlier blog it is neat to have a treatment that works, even though I don't know how it works.

Counseling is all about change. The best change is in a persons behavior, which is then reinforced by other people. It is interesting that when a person starts acting in a new or different manner people notice and react appropriately. Even strangers react differently. Smiling can be infectious. As you walk down a street smile and nod at people and see what happens.

2008-12-16T08:09:00.000-08:00

Everybody seems to be talking about the state of the economy. So far the government has given away 350 billion dollars. That seems like a lot of money. The worst part is that I, as an avid newspaper reader, have no idea where it went.

Educators have us convinced that the way to wealth and prosperity is through education (talk about self serving). If we were better educated our economic problems would vanish.

My challenge to everyone is that the next time you go to a nice restaurant, not fast food. Ask the waiter or waitress about their education. I think people would be amazed at the results. There are many college graduates waiting tables because there are more graduatres than jobs. As I recently heard a man say, "I didn't go to college to do manual labor." Maybe we need to develop a need for college graduates rather than producing more.

Picking a partner

2008-12-15T08:21:00.000-08:00

Recently, I became aware of a real concern with professional women. They tend to concentrate al their energy on their profession, but eventually they realize that something is missing in their life. At that point they start looking for romantic and intimate relationships. Too often, for various reasons, these relationships become a bust. My first exposure to this problem was with a pharmacist. She had worked very hard at getting through a very difficult college pharmacy program and then went on to be very successful in a retail business. As a starting pharmacist she worked long hours which included evenings and nights. Once she was established she became interested in a more romantic relationship.

Where does one go to meet people? Unfortunately young female adults find themselves in the local bars, where they are able to meet some of the least stable men they can find. The pharmacist met her significant other in her apartment complex. Against her families' best advice she married him, only to find out her family was right.

Mood is based on involvement

2008-12-12T11:08:00.000-08:00

The word "egocentric" is very meaningful to counseling. Most behaviors are self serving. Even counselors have a strong need to be needed. I am seeing that people look out for themselves first and then consider others. There is a theory that if you can get someone to take an interest in community it takes the emphasis off of the self. Once they become interested in other things their mood improves. That's enough rambling for today.

Politics and economics

2008-12-11T08:04:00.000-08:00

I don't like to make political statements but the anxieties being created in the current economic climate leaves me no choice. Most accountants will tell you that the purpose of any business is to make money. So the product is of no consequence. The "Big Three" American auto manufactures objective is to make money. The last great Automobile Man to run a company was Lee Iacocca. He built cars that people wanted to buy which incidentally made money for the company. The current plan of these companies is to close plants, layoff workers, and close dealerships, which might make sense for making more profit, but it doesn't make a car people want to buy. More importantly with everyone being laid off who can afford to buy a car.

Obviously, over the last three or four decades very few people can afford to buy a car so people turned to leasing. Now the financial markets are so messed up it's almost impossible to buy or lease a car. What a sinister web we weave.

Private Practice

2008-12-10T10:48:00.000-08:00

This is it. The presentation is tonight. This has given me a reason to rewrite my Mental Status exam. Actually just add to it. Most of the clients I see in private practice have an adjustment condition. For the most part they are able to function pretty well. Depression is the most common problem. The most severely depressed clients have difficulty getting up in the morning and taking care of their hygiene. The other common condition I see is anxiety or high stress.

Today people who watch the news find themselves feeling extreme amounts of anxiety. this is an impending feeling of doom and hopelessness. I actually had a client who felt responcible for the Korean War. The problem was that he wasn't born until after the war was over.

Bad Mental Health

2008-12-09T11:01:00.000-08:00

Well, I continue working on what is important to know about mental health. The problem is that people who have never experienced mental health issues first hand or by observation have difficulty grasping how dysfunctional a person can become.

One important element is how the mental condition effects the person, such as the person's consentration or their distorted view of the world. A second element is the length of time the disturbance lasts. Depression that lasts a couple hours or a couple days, while painful, is the one where you just pick yourself up by the boot straps and get on with living. The last element is the one that measures how well a person can functioin. This could be as little as a feeling of anxiety before a test or stage fright before a performance, or as much as severely hurting one's self or the inability to maintain personal hygiene.

Best Practices

2008-12-08T07:52:00.000-08:00

During the weekend, out of curiosity, I decided to see how many times articles on EMDR were seen in the Toledo Blade Newspaper. It was just once and the emphasis was on a scientific explanation on how it worked. As an EMDR therapist I thought the fact that it did work was somewhat over shadowed by humor and scientific explanation. This brings to mind the thought that if people needed to understand the interaction of protons, neutrons, and electrons before they turned on a light bulb, most of us would still be sitting in the dark.

For some reason the research community dictates 'best practices." "Best practices" is a concept that certain theraputic approaches should be used for certain diagnoses in mental health. It is like generic medication should be used rather than name brands. For example in mental health practice, "Cognitive Behavioral" is the treatment of choice for depression. In my experience, when a technique is appropriate you use it. The objective of therapy is to help the client.

Counselor frustration

2008-12-04T10:22:00.000-08:00

So often counselors (I) forget that not everyone is aware of treatment possibilities. I would guess that few people receiving counseling would know what theoretical approach the counselor is using. Most patients pick their counselor based on comfort level and a feeling that the counselor has some expertiese.

From the counselor side, there are times that I have felt very positive about a client after the first meeting. So positive that the treatment approach is developed with all the appropriate goals and sub goals between the first and second appointment. Only to have the client cancel the second appointment and are never heared from again.

Still defining Mental Health

2008-12-03T12:29:00.000-08:00

I continue to try to define "Mental Health." I remember working in small community where I also lived. The church minister asked if I knew "Smoking Joe." He thought that "Smoking Joe" was a client of the agency I worked for. Of course confidentiality prohibited me from talking about the person, even though the person he described didn't sound like any client I had at the time. The description included the fact that he was always smoking cigarettes, always had a five day growth of facial hair, slept on a park bench, and appeared to talk to himself. When he talked to people he seemed to make guttural sounds that made little if any sense. It appears that this person has mental health issues.

Another client of mine at the time was outgoing, spoke fluently, owned rental property, and hung out at the local bar. His only negative characteristic was being large and intimidating. This person though was diagnosed with paranoid schizophrenia.

Strange behaviors may be a part of mental health, but social functioning is still a major issue.

Getting out foxed

2008-12-02T13:11:00.000-08:00

There is an old image of "a fox in the hen house," but recently I encountered the opposite. Imagine the "hen in the fox house." Someone always thinks they can out fox (smart) the fox. These people put themselves in dangerous situations or situations with potentially negative consequences. For example, people who have extramarital relationships that think they will never get caught, because they know how to cover it up.

Another such situation is a child playing one parent against the other. In my book, "One Part Therapy, Nine Parts Parenting, " I talk about the three kinds of rules parents have for their children. The first set of rules involve the child's safety and the third kind of rules involve lifestyle. The kind of rules, in this case, involve making rules because the child lacks the maturity to make appropriate decisions. The choice between doing homework or watching television is a simple choice for a child. Or the choice of following a strict parent versus a lenient parent could also be problematic.

The point is that the hen will never out smart the fox and sometimes when we get what we ask for the result is a disaster.

EMDR

2008-12-01T07:34:00.000-08:00

Well its been a week since I first considered keeping track of my thoughts. I guess Thanksgiving interfered with my good intentions. They say four days in a row will become a habit, so Lord willing here goes.

Last week I was re encouraged by my EMDR clients' progress. I am always amazed to see the change in my clients' facial expressions during the processing. Additional disturbing memories surface instantly once a level of relaxation is established. The intensity of the session is extremely emotional, yet most clients are motivated to continue because they can see real change.

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a mental health treatment that reprocesses old disturbing memories. Unfortunately, disturbing events are usually accompanied by nevative beliefs about ones self. Somehow during the processing these beliefs change into more appropriate positive beliefs.

Talk about crazy

2008-11-24T11:23:00.000-08:00

November 23, 2008
I have been asked to give a talk on mental health. And after many years of treating people with mental health problems I find it very dificult to describe. Maybe the most realistic approach is to consider how it limits a person's ability to function. People like to use the word crazy. When asked what "crazy" means they become very vague. Most observent people have known someone who acts bizarre. For example a person use to drive around our neighborhood with all kind of reflectors attached to his car. He had both red and amber reflectors covering most of his car. I neveer talked to him to get an explaination but I know most cars do not look like his. If these reflectors were attached to ward off evil spirits or martians it is probably working. Its probasbly keeping away most people also. As long as he drives that car he probably does not get colds from other people.