Archive for the ‘Therapeutic Philosophy’ Category

Introspection Part 5, Your inner narrative

Sunday, February 18th, 2018

Now that you have some tools for accessing your inner self (See the previous blog post, Introspection Part 4), what are you supposed to do once you are “in there” (looking around within yourself)? Answer: find your “inner narrative”—the story you tell yourself about you and your world. That’s really it. Sounds simple, and it can be, but it can also be very difficult to identify the parts of the story that matter to you, that influence your outlook, your feelings, attitudes, values, and your responses to various situations. The good news is that you get to explore these stories as often as you want and as long as you want because you are constantly full of stories!

We all tell stories. All the time. We tell stories to others. We tell stories to ourselves. We do it so often, we mostly don’t know we are doing it. We also constantly revise our stories. The further we move from any given moment, the more our story of that moment is likely to change, as it becomes integrated into the larger story of our lives. You tell yourself stories about what you did today, yesterday, last week, last year. The story you tell yourself (and others) about what you did earlier today is slightly different than the story that was running through your head earlier today. The story you tell yourself now about yesterday is different than the story you told yourself about your day while it was still yesterday. The stories you tell yourself about last year are considerably different than the stories you were telling yourself during last year. See what I mean? Memory is a funny thing. It is complicated. Memory is partly retrieval of our perceptions in any given situation and partly pieces of a larger puzzle we edit to make fit the larger story of our lives. How we feel about that memory, the information it provides us now, which parts of the situation we retrieve—these are all very dependent on the story we tell ourselves about that situation, why it happened, why it is important, and our place in it.

One of my favorite stories about the importance of stories comes from a time when I was a trial attorney. John, a more senior colleague, and I were meeting with the executives of a company, pitching to them the ideas we (John) had about how we would conduct this large case if they gave the case to us. I was fairly young in my career then, essentially John’s “Sherpa” (carried the stuff and got it set up for him). I sat in silence as John made his presentation. John spent the better part of two hours or so going over in fine detail all the likely and possible twists and turns of how the case would proceed to trial once we filed the lawsuit. The meeting was almost over. The presentation was complete.

The executives had asked all their questions, and seemed satisfied with John’s answers. We were wrapping up. Then the CEO asked a final question. He did not ask John. He directed the question to me (remember, up until this point, I hadn’t said much of anything). He asked, “Michael, if you were me, is there anything you would you ask that we haven’t already asked?” In my ignorance of the politics of being subordinate to John, I made the mistake of giving an honest answer. Looking back, I can now see I was supposed to say “I can’t think of a single thing—I think John covered it all brilliantly!” The problem was that John hadn’t covered it all. John had actually failed to cover the most important part of what he should have been explaining to them: the story of their case! I told the CEO (something like the following), “I would want to know, once we get to the trial, how are you going to win this for us, what story will you tell the jury to convince the jury they should decide in our favor?” Silence. Oops! The client redirected my question back to John. John recovered well, as I recall (or at least that’s the story of this situation I tell myself now). He then spent some time explaining how he would reframe the complexities (it was a very complicated case) in a way the jury could digest, understand and believe. The point of my story here is that John had become so focused on the details of the lawsuit, he overlooked the client’s basic need —to be able to get in front of a group of people (the jury) and tell a story about why the client had been wronged and needed to be compensated (given substantial sums of money) to make things right. FYI, we did get the case and the client did get the money they needed to be satisfied.

What is a “story?” At its most fundamental level, a “story” is nothing more than a link between two causally related events. I just took a break from writing this post. Here’s the story of the break. I was feeling shaky, typing with more typos than usual. I had begun to lose track of my thoughts. Something was off. I kept going, though, because I was on a roll and didn’t want to lose my momentum. Things got worse, to the point that I could no longer ignore what was happening. I realized my blood sugar was low (I have Type 1 diabetes). Then, I remembered when I woke up a few hours ago, my blood sugar was at “almost perfect” (perfect is “100” and mine was “113”) and I’d had nothing to eat or drink other than coffee. So, I got up and grabbed a small glass of Mango juice. Now I am back writing. This is the story of my break. In it, I have described to myself (and now you), what prompted the break. I have also told myself the perceptions (more typos), feelings (annoyed), physical symptoms (shaky and weak), observations (memory of earlier normal blood sugar), and attitudes (I didn’t want to stop until I had to). These are the “inner states” I was having during the time of the story. I have made causal connections between those inner states and the likely causes (low blood sugar), and then what I did to respond to and modify the cause (drink mango juice) and the effect (my stability). The result: satisfaction after an interlude of minor difficulty.

You tell yourself similar stories all day, every day. They are not always so mundane or casual. They are most of the time though—mundane and casual. As time goes by, stories become connected to each other. We integrate the stories. We give them greater meaning than they might have had in the moment, as they become part of a larger whole. We form attitudes about them. And then those attitudes in turn change the stories we tell, the parts of the stories we recall. Over time, these attitudes, coupled with the patterns we remember, help us to form meanings about the stories, what those stories mean to us in our larger lives, as part of what we are, who we are, the kind of person we are and the kind of lives we have. I can’t say I will remember this one particular story about needing to take a break to get a cup of juice. I can say that this kind of story is one that occurs daily, sometimes several times per day. Over time, it wears on me. I add up the annoying aspect of having to “always” take breaks, check my sugar, etc. Of course, I am not “always” having to do this. It is a nuisance, to be sure. The way I tell myself the story of my diabetes effects the way I remember the important parts of each of the isolated incidents like the one that happened just now. The way I tell that story and the parts of each of these related I remember then can have a profound affect on how I feel about having diabetes, and even what it means to be “me” as a person with diabetes.

Nearly all therapy approaches have in common getting at the way you tell yourself stories of your self. Three of the most popular therapeutic approaches come to mind that will demonstrate this: Cognitive Behavioral Therapy, Narrative Therapy and Psychoanalysis. Cognitive Behavioral Therapy teases out the logic you use in making causal connections between your perceptions to test your capacity to recognize “mistakes in thinking” that can then be “corrected” once identified so you don’t continue to make those “mistakes” to your detriment. A simple and very frequent example of this is when a client takes an “all or nothing” approach to a situation. Say Jennifer has been told by her supervisor that she is getting a promotion, but it will mean changing locations. She fears that she may now lose her job because she doesn’t want to change locations. Jennifer has made the “mistake” of assuming that she has only two choices: take the promotion (and transfer) or lose her job. It hasn’t occurred to her that she could very well just say to her supervisor that she’d prefer to stay in her present position if it means she can stay in that location. The story Jennifer is telling herself about her supervisor’s announcement, what it means, and how it will affect her, all have a significant impact on how Jennifer thinks she can respond to this situation going forward, even to the point of having considered taking a position she doesn’t want due to the way she has told herself the story of her situation.

Psychoanalysis focuses on the way your childhood development, including the relationships you formed during early and later childhood, continues to influence your way of being in the world now. Narrative therapy takes this a step further (and closer to the point of this blog post) by emphasizing that it isn’t only the actual way you developed as a child that influences you now—it is also the story you now tell yourself about your development—that profoundly affects the way you see and feel about yourself and your life now. I regularly use narrative therapy in my practice. It is consistent with my belief that the stories we tell ourselves about our whole lives, all the way from our early childhood to the lunch we had today, become part of an integrated story of ourselves that directs our perceptions, attitudes, values, interactional patterns, choices, and behaviors—everything we are and everything we do. How’s that for a unified theory of the self!

Let’s get back to the point of this post: once we figure out how to look inside ourselves (Introspection, Part 4), what are we supposed to be looking for? Stories. Messages. Linkages. Connections. Plot lines. Subjective experiences and your reflections on those experiences. Ways of seeing the world. Ways of seeing yourself in the world. Ways of seeing yourself interacting with others. The stories you tell yourself about those relationships, those patterns of interactions. Start asking yourself, in any given situation you might remember: “Why do I remember it this way?” “Are there parts to this story that I might not be remembering, or remembering fully, or accurately?” “How do I feel about this story?” “What does this story I am telling myself about this situation tell me about myself, about the situation, about the other people in the story?” “Can I change the story?” “Can I change the way the story tells me about myself?” “Why do I tell myself this story and not another story about this situation?” “How is my story the result of influences from others, now, and in the past?”

A story has many events in it that follow one another in a sequence. This is the plot of the story. The specific events are “plot points.” We chose which plot points to focus on and which to dismiss. How we make these choices is dependent on many things, including previous similar stories and on how we are told by others to identify and connect the plot points. Once you begin to see how you do this internally, you will have a much greater chance at directing this process going forward, instead of continuing to allow the messages others have given you about how to do this to control how you do it. The most important point in this whole discussion is this: just because you do not know you are telling yourself a story doesn’t mean you are not telling yourself a story. So, if you are telling yourself stories about you and your life (and you definitely are), it would be a very good thing to know what stories you are telling yourself and why.

Here’s a possible story.  It could even be about you (but maybe not). Let’s say it is Sunday afternoon. You recount your morning. Your morning included getting up, getting the kids to various activities (sports, gymnastics, etc.), then you picked up around the house, did some laundry, and prepared a nice lunch for the family. A productive morning. Something to feel good about. But you don’t. At first, this morning looks a lot like yesterday morning, and yesterday you felt great about the first part of your day. Now, let’s say you were raised in a family that went to church every Sunday, without fail. It was a really big deal. Your spouse doesn’t care about church. It’s an argument if you insist. So you don’t insist. You go to church now only on the holidays. Your mom and sister tell you they miss seeing you at church, wish you would start going again. So, you feel bad about your morning. You did many good things, but in your mind, you didn’t do the one important thing you should have done: gone to church. This is an important part of your story about your morning. It is the thing you are focused on—the one thing missing, the one plot point that should be there, but isn’t. Now that you know this, you can begin to think about which is more important: going to church or letting go of that as an influence on how you should feel about Sundays, and therefore about your life. Knowing this will also influence your behavior. Will you now risk more conflicts with your spouse, or will you resign yourself to the differences you each feel about church and just go to church alone. Either decision is fine, but at least you have greater awareness of something that has meaning for you that has been missing in your life.

Here’s another example. It’s the story about Theresa and her body. Theresa is 48. She is relatively fit. She takes a “spinning class” (stationary bike) twice a week at the gym. She eats fairly healthy, allowing herself only a few desserts per week, and tries to stay away from processed foods when she can. At her recent annual physical, her doctor had only good news about her health, including her cholesterol levels and blood pressure. She has much to feel good about with her body. She doesn’t. She doesn’t like to look at herself in the mirror, especially without clothes on. She fears the scale, and weighs herself once per week, only because she thinks she must. Robert, her boyfriend, tells her she looks great. She thinks he means it. But, still… she feels bad about her body. It isn’t up to her standards. Whenever Theresa thinks of her body, when she sees herself in the mirror, or imagines what Robert sees when they are in bed together, she almost becomes queezy at the thought, shrugging it off as quickly as possible. She is dreading spring break with Robert in a few weeks because she will need to find swimwear that doesn’t look terrible on her. Theresa doesn’t realize that, with each of these thoughts—of herself in the mirror, with Robert, on the beach—she is superimposing on that image what she looked like twenty-five years ago. Theresa thinks she should still look like she did when she was 25. Of course it isn’t rational for her to compare herself at 48 to the way she looked at 25. More than that, though, is the standard she held for herself when she was 25. Back then, she ate very little, went to the gym three or four times per week, and was thinner than what was really healthy. Back then, and now, she held herself to the standards set by Victoria’s Secret, Hollywood, and billboards adorning our freeways with photoshopped women less than half Theresa’s age, all telling her, “if you don’t look like this, you are not how you are supposed to be [insert many other very negative messages].” If Theresa could see more clearly how she is telling herself the story of her body and age subject to the influence of marketers who want her to feel this way so she buys their products, she could begin to accept her body and her age with more grace, and without terrible and unnecessary guilt and shame. This is a simplistic explanation of a complicated problem for many people, especially women, in our society, so I don’t want to trivialize it. Yet, more awareness of this complex set of stories are part of recovering from these constant negative influences.

Sometimes the stories we tell ourselves can reveal reasons we have certain kinds of lingering moods. Someone who tends toward depression might simply tell stories that are overly focused on the negative aspects of their experiences. Someone with anxiety might focus mostly on those possibilities that could be potentially harmful outcomes. If either of these people were able to fill in their stories with more balanced perspectives, their moods might begin to improve quickly and dramatically. A client just helped me think about this (you know who you are).                                                                                    .

When you “go inside yourself” through introspection, look for your “inner narrative.” Start looking at what happens in your life and how you feel about what happens. Start identifying the plot points you remember. Start figuring out why you choose those plot points as your focus, including how you relate them to each other. Think about plot points in the situation that you are not including in your story. Once you have done this, you can ask yourself if your choices about the plot points you remember and connect are choices you want to continue to make. Are they really “your” choices, or are they choices others have told you to make? You get to decide, but only if you know what you are deciding. Your stories become “intentional” (it is your intent that informs how the story should be told, not the intent of others). Once you engage in these practices on a regular basis, you won’t merely have an “inner narrative,” you will have an “intentional inner narrative.” An intentional inner narrative allows us to throw out things like debilitating shame, inappropriate guilt, useless bitterness, and longstanding resentments. When we do this, we begin to clear a path toward accepting ourselves as we are, not as we think we must be or how others want us to be. This is the ultimate goal of introspection and an intentional inner narrative: self-acceptance, which is the topic of the next post in this series of blogs on introspection.

 

Copyright, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

Introspection Part 1, What is introspection?

Wednesday, December 6th, 2017

A friend recently read my book, Firewalking on Jupiter. He liked it. He thought it was useful in a variety of ways. He thought the book did a pretty good job of explaining how to address different issues you might need to address depending on who you are and what you discover about yourself—things like guilt, anxiety, anger, shame, loss, lack of meaning, and identity. I do not take it for granted that someone who reads my book will enjoy it or find it useful, so it was nice to hear all of this. Then he said something I hadn’t heard before, or thought about really at all. He told me the book made the assumption that those who read it already know what introspection is, how to do introspection, have sufficient self-awareness to identify their issues, and are fairly far down the road of believing in the value of both introspection and self-awareness.

I will admit, I was stunned. I realized right away that there was no part of the book that actually went through the process of what introspection is and how to do introspection. My oversight is based on two circumstances. First, I had been engaged in the various acts of introspection for so long in my own life, I made the mistake of assuming those reading my book would already be well acquainted with it. My long history of doing introspection goes all the way back to when I was a teenager, in drug treatment, learning about the 12 steps of Alcoholics Anonymous (I’ll get back to that in a later part of this series of blog posts, as part of my explanation for how to do introspection). The other reason is that I had been practicing therapy with clients for 10 years when I put the book together, so I made the mistaken assumption that my audience would be people already engaged in therapy, either with me or someone else, well on their way to understanding how to incorporate introspection into their daily lives.

This, then, is the first in what will be a series of blog posts that will explain the basics of introspection, including what it is, how to start, how to maintain it, various tools you can use to help you along, and also the benefits of introspection, which is greater self-awareness, hopefully leading to positive change and growth.

Let’s start by defining “introspection.” Dictionary.com defines “introspection” as: the “observation or examination of one’s own mental and emotional state, mental processes, etc.; the act of looking within oneself.” In its simplest terms, introspection means “self-examination” (on an emotional, mental, and perhaps spiritual level). At some basic level, we all engage in self-examination all the time. We must. We are constantly having conversations with ourselves inside our heads. By participating in these conversations, we are at some level “looking within one’s self.” Are we really paying attention to the conversations though? Are we asking ourselves why the conversations we are having at any given moment are headed in one direction, and not another? Have we considered other aspects of our inner self that might help explain why that particular conversation is happening at all? Only when we take the time, the energy, and the “stance” of stepping outside of our internal conversations to look more closely at them are we truly engaged in the act of introspection. We aren’t just “having” the conversation with ourselves. When we are introspective, we are “examining” that conversation and the other inner states that underlie or influence that conversation.

It has always seemed helpful to me to think of our minds as having at least two primary layers: the conscious layer (what we are aware of at any given moment) and the unconscious layer (the murky place where thoughts and feelings come from before we are aware of them). When I think of these layers, I also like to think of thoughts and feelings, ideas, moods, and perceptions as things that “percolate” within us. Think of the conscious part of yourself sort of hovering above some water. The water is murky, not clear. You can’t really see too far under the surface of the water, but you can tell there are things moving around under the water. There are constantly bubbles “percolating” to the surface, and then ideas and thoughts and perceptions and feelings inside these bubbles emerge, coming to the surface for you to consider, to explore further, or ignore.

A related idea for how we exist within ourselves is to think of two kinds of selves within each of us. There is the “observer” self and the “observed” self. The observer self can sort of see or watch what we are thinking, feeling, or doing. The observed self is the part of us that is doing the thinking, the feeling or the doing. Imagine any activity you’ve done, and this will be true. Let’s say you are gardening. You are planting a small tree. You are completely engrossed in it, thinking and feeling little else other than the act of digging a hole, putting the dirt aside, putting water in the hole, removing the roots from the container, separating them a bit, putting the roots in the hole and adding soil around them. This whole time, you might be having momentary and fleeting thoughts about other things, including how you will spend the rest of your day, a walk or a bike ride later, dinner plans, but they come and go with little attention. Your mind hasn’t even been paying attention to your thoughts, either about the tree or anything else. The observer part of you has essentially merged with the observed part of you. There is something even sort of relieving about this kind of work due to the very fact that it is so engrossing. You are giving your observer self a break. Then, you pause from your work, you assess what you’ve been doing. You realize your back is aching, wondering if you should have asked for help in light of the size and weight of the tree and the difficulty of maneuvering it into the hole and holding it upright while refilling the hole. You begin to wonder why you didn’t ask for help, what this says about you, and your relationships with others. Now, the observer part of you has kicked back in, or it has left its merger with the observed part of you and become separate from it again, where it begins to assert to you what it observes.

In both of these ways of describing our “inner conversations,” the percolating idea and the “observed” and “observer” self idea, introspection is about paying attention with intentionality. In the percolation idea, introspection means intentionally deciding which of the bubbles that just percolated you want to pay attention to, to follow, to understand, to expand upon, and which bubbles to ignore, and thereby also gain an understanding of why certain bubbles should be attended and others ignored, for your own personal growth and change. Similarly, in the “observer” and “observed” self analogy, introspection means actively and intentionally deciding what you are observing, of bringing back to your conscious awareness the various acts of planting the tree, why you are doing it, how you are doing it, rather than passively allowing your observer self to fade out and then back in at will. If we decide when we want to pay attention or not pay attention to how we are thinking, feeling or doing, we are doing what some call “mindfulness” practice, which is an important part of introspection. If we are paying attention to our thoughts feelings and actions in order to explore these things and gain a better understanding of ourselves, we are engaged in the act of introspection.

In the next part of this series on introspection, I will discuss the benefits of introspection. Later, I will discuss more about how to actually do introspection, including various tools to help you improve your capacity for introspection, like writing, creativity and deeper conversations with ourselves and others.

 

Copyright, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

Defining Morality

Sunday, January 31st, 2016

In a recent blog post I discussed the process of “Defiant Morality” leaving for another blog the related process of “Defining Morality,” which will be the topic of this blog post.

Defining Morality might be described as the opposite side of the spectrum from Defiant Morality. Defining Morality is this: “in any given situation, do my choices (in thoughts, words, or actions) involve any moral principles that I need to apply to become closer to a version of myself I can imagine would be the best person I can possibly be (without getting into perfectionism).” Depending on your own sense of who you are as a moral person, these kinds of principles could include things like, “Honesty is the best policy,” or “I know that all my feelings are valid and should be considered and embraced even if I also think they are sometimes based on my own misreading of a situation,” or “the starting point of everyone’s lives are random and arbitrary, not chosen, so I will never assume that anyone is inherently better or worse than I am or each other outside of how they and I act in our lives (e.g. racism is wrong).” These kinds of ideals (and many others) can then be used to start to form a way to “define yourself” as a moral being, using outside influences where you deem them appropriate, but only intentionally, after thinking about it, and deciding for yourself which principles apply to you, not merely because they have been handed to you.

In some ways, I am already applying the ideas of Defining Morality in my therapy process by encouraging clients to incorporate ideal moral versions of themselves in the way they think about their personal growth and emotional well being. Near the beginning of therapy, I use a set of questions (areas of inquiry) to get to know a client. I call the questions, my “Diagnostic Interview” (for more information about my therapy process overall and the Diagnostic Interview specifically, see my chapter, “The Therapy Process” in my book, Firewalking on Jupiter). One area of inquiry in the Diagnostic Interview is simply: “Personal Values.” I ask the client to give me a list of their “personal values.” I try to leave the inquiry as undefined as I can, to avoid creating an answer for the client. I want them to be as open to the question as possible, to get their very individualized sense of what matters to them most. If they need some guidance to make sense of the question, “what are your personal values” I sometimes add, “just tell me what you think is important about being a good person, about living a good life, of the kinds of things you think people should do?” See how this relates to “Defining Morality?” In asking them this question at the beginning of therapy, I am asking them to keep in mind what kind of person they aspire to be, regardless of the particular mental health issues they may have come to therapy to address.

Here is a visual of the layout between Defiant Morality and Defining Morality:

ßStarting Point———————————————————————Life’s Goalà

Defiant Morality————————————————————–Defining Morality

(What I won’t Do)————————————————————–(What I will do)

(Who I am not)———————————————————————–(Who I am)

(Wrong/Bad)———————————————————————-(Right/Good)

So, what does Defining Morality have to do with Mental Health? Quite some time ago, in one of my first blog posts (“What is Mental Health?”), which is now a chapter in my book, Firewalking on Jupiter, I defined mental health as “a state in which a person is able and willing to address every aspect of their inner life, regardless of whether they experience difficult feelings, including fear, while addressing those aspects of their inner life.” I have also said in various places, and often explain during the first few sessions of therapy, that the primary source of nearly all mental health issues is this: adverse psychological and emotional consequences that result from a person’s attempts at denying some aspect of themselves, which could include their identity, personality and history. I will now add this to the equation: they are often running, hiding, denying, or avoiding their sense of moral acceptability.

All of us have a very deep and basic sense of the kind of person we should be. This is not quite the same as our identity, which I define as who we think we are. What I am talking about here is our sense of moral idealism applied to ourselves as we are right now, and how far that is from the kind of person we think we should be. It is our “aspirational self:” what do we aspire to be in order to be able to say we are who we should be. Now, let me add one last ingredient, to ensure we are talking about morality as something more than merely what we do: the aspirational self asks the question: “how do I need to be in my life in order to say I am a good person, rather than a bad person?” I know this almost sounds like something a child would ask themselves, which is just about right, because I said that this a very basic and deep set of questions we ask ourselves. The very deep nature of the questions stays with us our whole lives, from early childhood to our deaths. These questions about ourselves, about what we need to do in our lives to be a good person, they never go away. They are always there, in the background of every decision we make, from the big ones like what kind of career do I want, to the small ones like budgeting our finances. That is partly what makes these kinds of questions so troubling, and why avoiding them can cause so many problems. This is also the reason moral aspirations applied to ourselves is at the heart of mental health, and mental health issues.

If we have to constantly question whether every decision we make leads us toward being a better (good) person or a worse (bad) person, you can imagine the cumulative effect if you have a nagging feeling that there is a lot of cumulative unanswered, unresolved, or worse, suspiciously troubling decisions over time a person might have made. It can be a long, frightening and often shame-filled trip from, “I am a good person who has great ideas of how I want to live my life” to “I have not lived the life I thought I would or should and have become a kind of person I didn’t want to be and never thought I would be.” Often, clients will not want to look at this journey, this path, this set of decisions because they have concluded it is too late to retrace all their steps, to significantly change their course, that it is hopeless. You might think I am exaggerating the problem. Think of the millions who would rather continue escaping their lives through the relationships they have formed with alcohol, or drugs, or casinos. Think of how often you are surprised reading in the news that someone who seemed at all levels like they really had their act together, gets arrested for having committed fraud for years in their business. Think of all the unfortunate people who take these issues so seriously, who have come to the conclusion that they will never be the kind of person they want to be, think they should be, that they take their own lives. What so many of these people do not realize is that they do not have to retrace every single decision they might feel bad about and somehow resolve them. Their attempt alone at tackling the larger decisions that continue to plague them, along with making new decisions along a path more consistent with their ideal moral self, will go a long way toward helping them feel so much better about themselves, so they can begin to forgive themselves for their past moral transgressions by recognizing they are human, we all make mistakes, and the most important part of healthy self-worth is the attempt toward doing the right thing, whatever that may be and however individually defined.

When I am meeting with a client who is suffering from all the emotional turmoil that necessarily follows someone they know having committed suicide, I tell them suicide is based on at least one simple, tragic mistake: the person who killed themselves had come to the mistaken conclusion that whatever was causing their intolerably deep pain would never go away and there wasn’t going to be anything they themselves or anyone else could do about it. I suppose the only exception to this might be an assisted suicide when someone is terminally ill, but that isn’t the kind of suicide I am talking about here. I am talking about suicide that occurs with someone who is otherwise physically healthy. This kind of suicide is often, if not always at some level, the result of the person concluding they are not the kind of person who can overcome whatever emotional circumstance they have either encountered or created. From a morality perspective, think about it this way, it’s pretty unlikely a person would commit suicide if they thought, “I am a good, strong person, just the kind of person I want to be, should be, and I have the capacity to deal with whatever life throws my way because I am not afraid to face all aspects of my inner self and I know how to make good decisions for myself and the people I care about.” In other words, morality is at the core of being mentally healthy because it gives us a profound sense of our capacity to address any kind of adversity, any circumstance, without losing our ability to be the kind of person we think we should be. What makes this so important to being mentally healthy is that if we feel this way about ourselves, we will have no reason to believe we need to run, hide, avoid or deny any part of who we are or how our lives are going because we will know we have the capacity to address it and still feel good about ourselves no matter how difficult the issue.

Now that I have established a brief but (I hope) solid basis for the belief that morality as we apply it to ourselves is a fundamental aspect of overall mental health, let’s get back to the topic at hand, which is what I mean by “Defining Morality.” We can begin with some questions that can help us understand how to apply the idea of Defining Morality in our lives. For any decision you face, you are already asking yourself, “will doing (this or that) get me closer to the kind of person I think I should be?” You might think you are not asking this, but I believe you are, always, every time, somewhere in the background. You may not know you are asking it, but it is there. In order to be able to answer this question, regardless of the nature, the magnitude, or the immediacy of the decision you face, you must first know what you mean by “the kind of person I should be,” which is exactly what Defining Morality is all about.

Try this, imagine yourself, right now, being exactly the kind of person you think you should be. Forget about whether you think it is possible. We are shooting for gold here, for perfection, knowing it is not possible. This is the ideal of who you are as the best person you can be. What comes to mind? What kinds of things about being a good person really matter to you? There are the usual suspects that we all (okay most of us) would include. Things like “I’d be honest all the time” and “people would remember me as someone who cared deeply about them.” For you, it might be more specific, like a goal for a legacy.   Some people want to be remembered for their accomplishments, which is perfectly fine. The only caveat I’d add is this (and this comes dangerously close to the kind of moral pronouncements I said I would not make in my writings on “Defiant Morality”): whatever you want to accomplish, even if you believe it is for the greater good, must be justifiable on it’s own, not just based on what it gets you. Or, as Immanuel Kant put it, at least when dealing with other people, you should always treat them as an end in themselves, never as only a means to an end. I would add to this that we shouldn’t be treating people or anything that can feel pain (e.g. animals) as solely a means to an end, but I digress. Whatever kind of questions you can create to get a better sense of your ideal moral self is the very process of Defining Morality.

I may have mentioned this elsewhere, but I can’t remember now, and anyway it’s good for illustrating the topic of Defining Morality, so I will risk repeating myself. When my son was about 12 he asked me, “Dad, what do you want me to be when I grow up?” Although it was a typical question for a child to ask their parent, I was completely unprepared. I know, lame. Anyway, I told him it was an important question and I’d need to think about it. Some time later (we are talking hours, or maybe a day or two), I had the answer I wanted to give him. I told him pretty much in these words, “When you grow up, I want you to be as compassionate as you can with yourself, any other person, and any animal that can feel pain; I want you to be as honest with yourself and others as you can be as often as you can be; and I want you to be interesting. How you do these things is up to you, but if you do all three of these things, you will be what I want you to be when you grow up.” In telling him these things, I can now see I was giving to him my own sense of a broad but fundamental version of my own Defining Morality. I can now see that these are the very basic aspects of what it means to me for me to be a good person, the best person I can be, and was just telling him I wanted the same thing for him. The closer I can get to “perfect compassion,” “perfect self-awareness and honesty,” and “being meaningful,” knowing all the while I will never completely get there, that I will stumble along the way and do things I later recognize as more wrong than right, continue to be strong principles in the decisions I make. Of course these are my values, and you need to find yours. That’s the whole point of Defining Morality. Maybe I should have called it “Defining Your Morality.” A morality, or moral structure that is part of how you define yourself, is what I mean.

Being aware of whatever defines you as your ideal moral self, forcing yourself to keep this in mind for as many of the decisions in your life as you can, even and perhaps most importantly when doing so is particularly difficult, will help you grow stronger, and believe more fully in your capacity to overcome any adverse situation without losing the most important parts of who you think you should be. Keeping questions of Defining Morality in your mind as often as you can will help you eliminate the need to engage in all the unhealthy behaviors that come with avoiding yourself. In the process, the picture of your ideal moral self will become increasingly clear, and hopefully easier to believe in, all the while knowing it is an ideal, and therefore never completely attainable. Lastly, having this goal, this ideal you are trying to achieve, is also a great way for us all to come to a better understanding of what gives our life meaning, of what really matters and what doesn’t. Knowing this will not only help us become “better” versions of ourselves (however we choose to define what that means for each of us), it will almost certainly help us attain more satisfaction with our lives. What could be a more meaningful goal than this for yourself: “I want to be the best, most good, person I can” (especially when you get to define what that means for you)!

Copyright, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

Defiant Morality

Sunday, January 10th, 2016

I have for some time been considering how to approach more directly my thoughts on morality—on what is “good” and “bad” when it comes to human decisions, including their behavior, beliefs, attitudes, and judgments. I have wanted to write about this topic directly, but have hesitated. The problem has been that is in my nature to mistrust any pronouncement of moral authority. I can very much relate to those who tell me they have been subjected too often or with too much intensity or self-righteousness the moral thinking of others in their lives–sometimes it is a parent, or an older sibling, a preacher, or, God forbid, a previous therapist! I abhor the idea of hypocrisy, and even more stingingly, I abhor the idea of myself as a hypocrite. Put this all together and I have set myself up for what will be a very difficult, and maybe impossible task: to write about my own sense of right and wrong, while completely avoiding any normative statements (“you should… or should not…”) and thereby forcing my own ideas of right and wrong onto anyone else.

I feel an even keener sense of responsibility to refrain from espousing my ideas of right and wrong within my position as a therapist for fear that clients and others will give it far more credence than it deserves, because after all, it is just my opinion and I am just some guy. So much of my work as a therapist hinges on my strong belief that people have it within themselves to make much better decisions for themselves and the people they love than I or anyone else could decide for them. The last thing I want to do after all these years of doing this work with others is to then suggest, “oh by the way, in addition to having it within yourself to make good decisions, you should also listen to me about what is right and wrong and adopt what I say as the answer for you.” Obviously, that just won’t do.

As a beginning to addressing this dilemma (of wanting to address ideas of right and wrong without telling others how they should be), I have come up with some guiding principles; a skeletal framework for myself in how I should go about resolving this self-imposed dilemma.

  1. No moral statement or precept from me should contain this kind of definitive moral judgment: “you should do this or not do that if you want to be a good person.”
  1. I make a strong assumption that no one wants to hear what I think they should be like. Or rather: I don’t want the reader to care what I think they should be like. Or even stronger than this: I want them to not want to care what I think they should be like and to resent any attempt on my part in telling them who I think they should be.
  1. All reasoning should be able to withstand a new moral imperative: can I imagine that all people would want to be or act this way? Only then is it a moral precept or structure worth writing about or considering. (This is actually a paraphrase of the “categorical imperative” created by Immanuel Kant).
  1. A rule of thumb to test the above imperative is this: if in viewing your life as a whole does the proposed action or state make it more likely that a person will feel good about the kind of person they have become and are becoming?
  1. Ideas about morality I share should be able to appeal to an individual considering such thoughts as a way to improve their overall sense of life satisfaction. In other words, an individual reader of my thoughts on morality should be able to imagine themselves implementing the ideas in their lives in a way to achieve positive personal growth, regardless of the extent to which the moral thoughts might also benefit others or be “good” in some other respect. (See my chapter, “Selfishness and Love,” in Firewalking on Jupiter.)

The generalized nature of these guiding principles will suffice as a cautionary starting point for the time being and can act as a set of self-imposed limitations for sharing my thoughts on morality in the future.

For now, though, I want to mention, just mention, a thought I’ve been having about how to fit a way of thinking about morality within this kind of framework—what to call it and think about it. Here’s a preliminary thought I’ve been toying with: I call the idea “Defiant Morality” (note the capital letter for extra and ironic authority). Defiant Morality begins with this proposition: if we could jettison, and I mean completely rid ourselves, of all external influences about right and wrong, about what kinds of actions, decisions, ways of being in our lives are morally okay and not okay (I know we can’t, but just for the sake of discussion assume we could), what would be left in our thoughts about what makes a thing morally right or wrong? For each of us, I assume the answer would be at least slightly different—but maybe not quite as different as we think.

For Defiant Morality, a way to move beyond a thought experiment into a way of being, of acting, of deciding is this: first decide what you are not willing to do, before deciding what you are willing to do. What lines will you refuse to cross? No matter how someone else might try to compel you? In the extreme: if handed a rifle in Nazi Germany and told to shoot innocent civilians or be shot yourself, what would you do? Closer to home (and reality): if your supervisor at work tells you to do something you know, and he or she knows, is blatantly dishonest, will you refuse? Will your answer change if your only other option is to be fired? Will it matter if being fired could be a career-ending decision, or you have a family to support?

When I used to work in the prisons, a short-handed way of describing a morality that begins with only you and your thoughts, and what you will not do, was this: “if it feels wrong, it probably is, so don’t do it.” Of course, it isn’t always that easy though. If it were, there wouldn’t be a need for books and discussions going down through the centuries trying to figure all this out.

As a family therapist, I have encountered something like the following many times. Jenny comes in to see me because her marriage to John is failing. She tells me she is having an affair and feels very conflicted about it. I ask her to tell me how she got to this point. She tells me she’d been dissatisfied with her marriage for years, that she’d met a guy at work who felt the same way. She didn’t want to leave the marriage because they have two kids, and she thought she should just stay in it and be lonely, dissatisfied, and put up with it until the kids were out of the house. After a few years, this began to wear on her. When she discovered Dave at work was suffering the exact same dilemma, the solution seemed easy for both of them. Now that the affair has been going on for more than a year, she finds herself suffering from increasing symptoms of both anxiety and depression. Not surprisingly, some of the anxiety is about her husband or Dave’s wife finding out or even worse, that her kids would find out. The depression is more confusing to her. She likes Dave, but doesn’t love him. She enjoys her time with him as much as she can. Through therapy, she hopes to find out why this isn’t enough, why she is increasingly depressed. There could be many reasons, all of which we will explore together.

Most of the time, people who have long-term affairs end up suffering from some level of depression if the affair doesn’t end or the marriage doesn’t end. Why? The affair doesn’t solve the original problem, which is an unsatisfying marriage you’ve given up on but refuse to leave. The affair just makes the initial problem worse, by adding guilt, fear, and broken trust with your spouse to the equation. Most of the time, when people have affairs, like Jenny, it is a slow, evolving, unintended process. They might spend years lonely, isolated, feeling trapped before they cross any lines beyond the marital boundary. Then, an unanticipated situation presents itself: Dave, or Jenny, depending on your perspective. Someone you know, or meet, seems like a possible solution to the dilemma you’ve been facing—whether to stay in a marriage and be lonely and sad or leave the marriage and cause untold pain and financial hardship to yourself and others. They make a rash decision, or they slide from an emotional support to something more, and then into the affair.

What if, in each of these cases, the lonely married person said to themselves, before the “unanticipated event” (they meet either Dave or Jenny): “One thing I will not do is have an affair, it is not open for consideration.” People do this. And when they do, they force themselves to either do what can be done to fix the marriage, or they often leave, because no other choice is available for finding the kind of attention, sexual satisfaction, and connection that is not coming from the marriage. By telling themselves what they will not do, they force themselves to make only a narrow set of decisions that might be more difficult at the time, but less onerous down the road. They also prevent outside influences (a disappointing marital relationship coupled with a discrete opportunity to obtain affection and connection) to make their decisions for them.

There are many similar situations we encounter in our lives that might actually be easier in the long run to deal with if we were willing to exclude certain choices that seem easier in the moment. How many people do you know, maybe you yourself, who have stayed in a job or career they hate for years and years, because they let themselves think things will get better, that either they will eventually accept it, or something will change that will make the job easier (a nasty boss retires). What if that person (or you) said to herself or himself, “I will not let myself be miserable for extended periods of time, not for any job!” (and you said this before you were miserable). Then, if you find yourself in a job that is untenable, and not likely to change no matter what you do, you won’t stick around. You will start looking for another job, or go back to school. You will seek out support for change from those in your personal life. You will already have announced to yourself and those in your personal life that this is the kind of person you are: someone who has self-imposed limits on what you are willing to tolerate in any job. You will make a better choice for yourself because you’ve already told yourself what you will not do. You will exercise Defiant Morality.

The idea of Defiant Morality is a work in progress. Not only is it incomplete in my mind as I write this, I can see ways that it cannot be a complete way of deciding what to do in many situations. That’s okay. It’s just supposed to be a starting point. Even more than that, it’s just something to consider as a way to put aside all kinds of potential external influences on the way we think about right and wrong, good and bad, all of our moral judgments, until we decide for ourselves, intentionally, which of those influences we want to adhere to and which are not appropriate for us as individuals based on who each of us is and how each of us decide we want to live our lives.

If “Defiant Morality” is a starting point for developing a moral structure for yourself that is not dependent on external influences making those decisions for you, then maybe an end point, or goal to move toward, is another set of moral principles I call “Defining Morality” (note the nice alliteration between the two principles). Defining Morality will be the specific subject of an upcoming blog post.

 

Copyright, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

The Location of Morality

Saturday, January 3rd, 2015

I am in the mood to offer a very ambitious thought and then try to explain it, knowing the thought is far too broad and complex to have any hope of an adequate explanation in just a few pages. It is likely that the subject will occupy my thoughts to some degree for the rest of my life as I try to noodle out the implications of it. This is a work in progress, and this is my first attempt to put it to writing. So don’t be too surprised if my thoughts about it change quite a bit over time. I might even decide to contradict myself on some points I currently believe. I am open to rethinking this from scratch.

Just so you know where this is going before we actually “get there,” I had originally planned to call this post, “The Location of Morality in Mental Health.” I couldn’t get past what I thought my reaction would be if I came across an article with that title. I might think, “hmmm, a therapist squaking about morality, sounds kind of religious or self-righteous to me…” Or, I might think the title meant, “how ‘morality’ fits within the mental health field.” Both sound like pontification to me, which I find repugnant in the extreme, regardless of the source, and most especially if I am the one doing the pontificating! I don’t really mean either of these things. To avoid these interpretations, I extended the title to “The Location of Morality Within a Person’s Mental Health.” That was too long for Google, so I left it at Morality and a Person’s Mental Health, hoping it doesn’t sound grandiose. The topic is the way a person’s moral structure fits within her or his mental health and overall life satisfaction.

Here’s the the thought. The basis of all emotional concern is this question: “Do I have the capacity to cope with the difference between how things are and how they should be?” For the purposes of this writing, I will refer back to this as “the question.”

Let’s break the question down into its various parts. It is a question about yourself “Do I….” The next part is about your “capacity to cope.” I chose this particular phrase very specifically for two reasons. It is not just a question about how or what you are. It is a question about whether the kind of person you are has it within you to “cope” or deal with reality as it is, precisely when you recognize that reality is not now how you think it should be. I used the word “cope” instead of “change” because the question is meant to cover both those situations in which you might be able to change reality to make it what you think it should be and also those situations that cannot themselves be changed, which means it is you that must somehow change in order to address reality that seems wrong (for example, coming to accept the death of someone close to you as part of your grief process). Finally, the last part of the sentence, “the difference between how things are and how they should be” is actually a question about morality, or about what we do when our personal morality (how all things in our world, including people and our relationships with them, “should” be) collides with our current way of being in the world (a world “as it is,” which often doesn’t seem to care much about our personal brand of morality).

In the context of mental health or mental illness, this question is usually observed as a version of self-doubt. I’ve said this about many other emotional states, and it bares repeating here with self-doubt: all human emotional states exist because they are effective ways to respond to some kinds of circumstances, and are therefore healthy in the right context (See my book, Firewalking on Jupiter, Part Two: Choose Your Feelings). Self-doubt is also no exception as an emotional state that is prone to becoming excessive, or to occur in situations in which is not only ineffective, but destructive. Everyone asks “the question” in some form or another all the time, maybe many times a day, whether or not they are conscious that the question is being asked. It is imperative that we ask the question. Without doing so, we risk ignoring adjusting our responses to a reality that is not acceptable, or which, at the very least, needs to change (according to us) if it is possible to change. In that sense, self-doubt forces us to find whatever internal resources we possess to adequately address a situation that might seem at times difficult to the point of perhaps being insurmountable. Taken too far, though, this kind of self-doubt can become devastating when it turns inward and spirals into feelings of worthlessness, despair, shame or prolonged inadequacy (when we tell ourselves we should be able to change reality or ourselves to cope with reality, but conclude that we cannot).

Now let’s go back to the phrase at the beginning, right before “the question.” I said something very bold—that the question (“Do I have the capacity to cope with the difference between how things are and how they should be?”) is the basis of “all emotional concern.” I do not mean that every emotion invites “the question.” Joy, happiness, contentment, satisfaction, peace, bliss, relaxation, and serenity all imply very strongly that the question is not appropriate to whatever circumstances give rise to those kinds of feelings. These feelings imply there is no “difference between how things are and how they should be.” We experience these kinds of feelings when we believe things are exactly how they should be! That’s why I added the word “concern.” We are not concerned when we are happy. By “emotional concern,” I mean experiences that are typically called “negative emotions.” I don’t like the connotation that emotions that cause us concern are necessarily “negative.” So I just leave it at “emotional concern,” because those feelings we normally call “negative” should cause us concern—in fact, that is their purpose—to make us concerned, to get our attention and in that sense are not “negative” (unless they become so extreme they become debilitating or limiting) and are in fact crucial to our overall well-being.

Now, here is the whole point of this topic—the location of morality as it relates to mental illness (or emotional distress). Wondering if “the question” is at the base of all emotional concern, I have slowly begun to form the opinion that human existence carries with it three distinct but interconnected layers to address the question and what it means for us. At the “top” is the layer of thinking or rationality, which is the process of interpreting perceptions to describe reality or how things currently “are” and for strategizing about how to move toward how we think things “should be.” At the bottom layer is “morality” which is a set of beliefs or attitudes about how things “should be.” In the middle layer are “emotions,” which are internalized subjective mental states that tell us how seriously we should take the difference between how things are and how they should be (or in the case of “positive” feelings, telling us there is no difference—that we and the world are exactly where we and the world should be).

The beginnings of this way of thinking about emotions, thoughts, and morality first appeared when I wrote the chapter, “Choose your anger,” in my book, Firewalking on Jupiter. I wrote that anger is a “moral feeling”—that we feel anger when we perceive someone has done something to us that we think is wrong, when they have caused us a “moral injury.” After putting the whole book together, I took a break. I took a step back. I wanted to get a big picture look at my work as a therapist, the work of my clients, not only as individuals working on individual issues, but as a group, of all of us working toward something that makes us better, makes our lives better. So, what’s the commonality. Is there a way it all fits together? I think there is, and I have a glimpse of it. Just a glimpse, but maybe also a framework, a skeletal structure to tie it all together. I will continue to need the help of clients, friends, colleagues and many others to help me fill in the details of this skeletal structure.

The basic ideas for the layered framework of thoughts, emotions and morality came out of a text exchange I had with a friend after I finished Firewalking on Jupiter. We were discussing the origins of emotions; their source and purpose. I mentioned anxiety and self-doubt as two examples of emotions that seem clearly to provide us with information that things are not well in our world at that time and prompting us by their very discomfort to try to figure out how to make things better for ourselves. I plan to write more specifically about the advantages and disadvantages of self-doubt as part of this framework in future writings. Immediately after the text exchange with my friend, I began to think about all feelings and their purpose. I cannot yet think of any feelings that do not fit into this framework of emotions sitting in a middle layer, mediating our thoughts and our morality. Like I said, though, this is still a work in progress. It is admittedly half-baked and not really quite ready to “pull from the oven” (of ideas). Still, try it for yourself, think of any feeling that gives rise to emotional distress—guilt, sadness, loneliness, anger, resentment, boredom, grief, etc., any “negative feeling;” I think you’ll find just like I have—they all tell us something very important about how we need to change our situation or change our response to our situation. By “situation” I mean just about anything you encounter in your life: a new relationship, a job, a fight you had with your mother, someone cutting you off on the freeway, a grave social injustice, a perceived slight by someone you consider an important friend. Feelings on the positive side tell us there isn’t anything we need to do to change our situation or responses and they reward us (with feeling good) for having created or finding a situation which is (for the moment) just as it should be.

Before I finish, I want to say a word about how to view emotions along a spectrum. As an example, anxiety is at one end of a spectrum toward “urgency” or “very serious”—we need to do something right now so things quickly become the way they should be. At the other end of the spectrum might be acceptance or serenity—the difference between how things are and how they should be is serious, and there may even be a desperate desire to change things, but we conclude we do not have the requisite resources to make the change, so all we can do is change the way we experience the situation internally.

As I said at the beginning of this post, these thoughts are a work in progress. I will need to think about this some more and will keep you posted as I do. I hope you will think about it too and let me know what you think. If you are a current client, feel free to bring it up in therapy if you feel so inclined. Or, whether you are a current client or not, feel free to send me an email with your thoughts about this topic (my email is listed on the “Contact Us” page of this website).

 

Copyright, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

Empathy

Saturday, October 4th, 2014

Empathy is a very important part of my role as a therapist. Without it, the therapy relationship would feel and even be, robotic, mechanistic. What makes therapy human, connected, real, interesting and therefore valuable to the client (and me) is my ability and willingness to try to imagine what it would be like to be my client, as they are, in their situation. This is what makes empathy different from compassion, as I define those terms. Compassion exists when we say to ourselves “I feel bad for that person because they are… (in a bad situation, etc.).” Empathy exists when we say to ourselves, “I know what it is like to be in that person’s situation and can imagine how it would feel to be in that situation.” In therapy, I try to take this a step further, knowing full well it isn’t really possible. Like I said above, when I empathize with a client as their therapist, I am trying to imagine what it would be like to be in their situation, with the added element of imagining what it would be like to be them (not me) in their situation.

This is more difficult than it might seem. In order to really be able to imagine what it would be like to be someone else in any variety of situations, you have to really know and understand someone. People are complicated. No matter the context in which you meet someone, it takes a while to get to know a person. When that person is a client in therapy, they want to be known, by me, the therapist. So, they are nearly always far more open and candid than they would be if they were not in a therapy session. Still, trying to imagine what it would be like to be someone else, especially when that someone is suffering from some kind of serious emotional turmoil (as they are in therapy) is difficult, but necessary. Clients often tell me that to trust a therapist, they have to conclude their therapist “gets it,” which I take to mean that they feel known and understood by the therapist, that the therapist “gets” what it would be like to be them in their situation.

Why is empathy as I describe it essential to therapy? If a client doesn’t think their therapist can imagine what it would be like to be them in their situation, how can the client believe the therapist really understands their problems, their unique and valid difficulty resolving their problems, and how to help them solve problems they have not been able to solve themselves. Without this trust, I don’t think clients can accomplish much of anything in therapy. I am not alone in coming to this kind of conclusion. In graduate school, we read a book that reached a similar conclusion. The book is called “Escape from Babel: Toward a Unifying Language for Psychotherapy Practice” (written by Duncan, Hubble and Miller in case you are interested in buying the book). It is a “meta-study” (a study of other studies) about what makes therapy successful. The rapport between a client and their therapist is the second most important factor for success in therapy (second only to the client’s level of motivation for change). In other words, does the client feel a connection to therapist such that they believe their therapist “gets it” (understands the client and their problems)? If the answer is yes, therapy stands a much greater chance of success. Oh, and by “success,” I mean the client thought the therapy was valuable in helping them achieve their goals.

Another interesting point came out of the meta-study in Escape From Babel: the kinds of “techniques” used by the therapist were far less important to success in therapy than the relationship the client and therapist were able to form. Prior to reading this book and being in graduate school to become a therapist, I had been a therapy client with several different therapists using many different approaches. When I read that conclusion in Escape From Babel, I knew it to be true from my own experience. I don’t mean to suggest that therapeutic approaches are completely unimportant. They are just less important than the connection between the therapist and client. Put another way, in my experience, and as implied in the book, no matter what approach a therapist might take, and how good they are at implementing that approach, if the client doesn’t feel a connection to the therapist on a basic human level, chances for success are not great, especially if the therapy work that needs to be done runs pretty deep and can’t be resolved in a few sessions.

Where does empathy come from? In general human terms, we are born with the capacity to empathize (except in very rare circumstances). Our willingness to cultivate empathy depends on how safe we feel within ourselves and in our relationships. The more secure we are with who we are, the more we will be able to move past ourselves to reach out to others, not just to care about them, but to get to know them at a deep enough level that we can imagine being like them. It might be easier to put myself in an empathetic state in therapy because I feel secure as a therapist most of the time. I am able to risk the emotional vulnerability that comes with empathy in therapy because I know empathy is a central and basic need my clients seek in therapy and I trust my ability to “be them” in my mind while also staying grounded in myself so I can simultaneously “see them” from my perspective.

As a therapist, I am always asking myself questions like this: “based on what I know about David, would he have the ability to recognize his unconscious motivations for the way he reacted to his boss in the story he is telling me?” I then imagine being David in an argument with his boss, who is a woman. I imagine what it must be like for David to have a boss that reminds him of the wife that just left him, taking the kids with her. His boss doesn’t know this, and therefore may have no idea why David reacted so disproportionately to her criticism of his work, which, while seemingly unreasonable, didn’t warrant David’s vehement response. I come to the preliminary conclusion that David may not have understood his own reasons for reacting so strongly (in the session, he is aggressively describing the negative personality traits of his boss). I ask him if his boss sometimes reminds him of his wife. He disagrees, says they don’t look or act anything alike. I then compare criticisms his wife had given him before she left (which he had told me in previous sessions), which are fairly similar to those his boss recently leveled against him. He recognizes the connection, starts to talk about how he fears his boss will fire him, in much the same way his wife did. He tells me he fears going through the grief and loneliness of his divorce all over again if he is now fired. David cries a little, and so do I. We share memories of the pain he experienced and expressed in previous therapy sessions leading up to and through his divorce.

David now has a better understanding of his own emotional landscape. David’s ability to trust me is also sustained because he could see me trying to imagine being him in his argument with his boss after going through the recent and painful divorce. It is precisely because David trusts my understanding of his pain and anguish that he is able to listen to my suggestion that his emotional reaction to his boss might have been misplaced, or at least exaggerated. He decides to tell his boss what he has learned about his reaction, hoping that, by letting her know, she may be willing to let go of any residual resentment she feels for the way he reacted. David can do this without expecting her to recant her criticisms because he understands how he needs to change, regardless of whether anyone else around him (including his boss) changes.

Empathy is vital to therapy. Yet, empathy is also very much one-sided in therapy. I empathize with my clients, actively, regularly, and out loud. I do not expect or want my clients to try to empathize too much with me. A little bit is good because I am after all not just a therapist. I am a man. At a minimal level, when I expect a client’s consideration of my needs, this can be good role modeling for a client to step outside of herself or himself. Beyond that, expecting or allowing a client to become too empathetic to a therapist’s needs can get in the way of the client’s ability to stay focused on their issues, so I try to contain it to a modest level. We are, after all, in therapy to meet the client’s emotional needs, not mine. If I need empathy to the extent I want it from my clients for my own emotional needs, I will find my own therapist.

Empathy is clearly not just important in therapy; it is important for all of us because it teaches us how to be more flexible, adaptable, and to predict how we can improve our relationships with others. It must, because empathy requires us to step outside of ourselves (in our imagination) and remove from our considerations (as best we can) what we would do, and instead focus on understanding why others do what they do. When we read a book, watch a movie or play, or listen to a friend tell us about characters, relationships, and behaviors that are foreign to us, yet capable of being understood, we grow as people because we try to imagine what it would be like to be those characters in those relationships, engaging in those behaviors. If this were all there were to empathy, it would be little different than fantasizing about how others live their lives. Empathy comes into play when the thing we are imagining is difficult, difficult and painful for the person(s) in the situation, and difficult for us to truly comprehend their situation—because it causes us to feel something like the pain we imagine they feel. Yet, we do it anyway, despite the discomfort, the pain. We do it because we care; we care about that person, or at least care about their situation, and want to help them get out of their situation. This is also what makes empathy more compelling than compassion. Compassion tells us to care about the suffering of others, which is beautiful. Empathy goes further, and tells us to force or allow ourselves to experience something like the experience we imagine others feel, even when that is painful, difficult, and avoidable.

The difference between compassion and empathy is illustrated by a compelling parable told on the TV show, The West Wing. I saw it quite a while ago, so the details are fuzzy, but it goes something like this (truth be told I might be unwittingly modifying it a bit): A guy finds himself down in a hole and can’t get out. He yells to a stranger walking by, “Hey can you help me get out of here?” The stranger says as he keeps walking, “I feel for you down there, but there’s nothing I can do.” A priest walks by, the guy in the whole says, “Hey Father, can you help me get out of this hole?” The Priest says, “I will say a prayer for you.” The Priest keeps walking. Then a friend walks by, sees his friend down in the hole, jumps down into the hole. The guy in the hole says, Why’d you do that, now we are both down here and are both stuck.” The friend says, “I’ve been down here before, and I came down to show you the way out.” The stranger and priest show limited compassion. The friend shows empathy by “being with” his friend down in the hole.

Empathy is such a good thing, it is difficult to imagine when we should not empathize with others. All that comes to mind is limiting empathy when we ourselves feel nearly overwhelmed, or when our empathy is being exploited, as in a co-dependent or abusive relationship. If empathy is such a good thing, then why is it not as common as it seems it should be? I have two thoughts on this. First, true empathy is difficult, even emotionally draining at times. It is even more difficult if we don’t really know ourselves very well. We can’t really imagine what it would be like to be someone else in a given situation if we don’t know and understand them pretty well. How can we expect to truly understand someone if we don’t know ourselves? We can’t. So, empathy requires self-knowledge, compassion, and a willingness to risk emotional vulnerability within ourselves, so we can stay “grounded” within ourselves while also reaching out emotionally to “be where they are.”

The connection between a client and therapist can run very deep if there is adequate understanding, vulnerability and risk taking on both sides. The benefits of successful therapy are amazing, truly amazing. I say this both as a therapist and as a previous therapy client who knows from both sides what success in therapy can mean. So, if empathy in the context of therapy, where it is almost completely one-sided ( the therapist empathizes with the client, but not the other way around) is so important, just imagine what the benefits are for having deep and genuine empathy in a two-sided relationship, like with a good friend, your partner, sister, or colleague.

Real empathy also requires a good dose of humility. Humility means that we realize that we have limits, we are not necessarily any more important than anyone else. As I’ve said in other writings, humility to me means “I am just some guy.” If I want to be genuinely empathetic, I have to be able to tell myself, “I could have ended up being just like this person, in their situation, even though I am not, which means I am no better than they are.” Only then can we really imagine what it would be like if we were in fact just like that person, in their situation. Once we are on their level, whomever they are—spouse, co-worker, sibling, friend, stranger—we can much more easily relate to their experience and allow ourselves to be truly connected to them and their situation. What if you could bring deep and genuine two-sided empathy to all of your important relationships? You can. And I hope you will for your sake and for theirs.

Therapy with couples, Part 2, the process

Monday, November 25th, 2013

As a Marriage and Family Therapist, it probably comes as no surprise that a significant portion of clients are couples who want to resolve issues in their relationships. Although the kinds of issues that couples bring to therapy vary greatly, there are certain common elements to the process of working with couples that are quite different than the process of working with individual clients.

During the first session, I ask, “what is the primary issue that brings both of you to therapy?” 90% of the time, the answer from both is the same: “communication.” This is probably always true. Really, when you think about it, all couples at some time or another have “communication issues.” Communication is also pretty much never the whole story or even the main issue.

I often tell a couple in their first therapy session that I am very reluctant to focus mainly on communication. Here’s why. I learned a lot about communication issues in my legal career and in graduate school to become a therapist. I also learned some highly successful tools to use with couples to help them reduce hostile arguments, increase effective communication, and feel better about how they are able to talk about things. Some of the tools I learned were “time outs,” “avoid ‘mind reading,’” stay away from “you” statements by starting with “I,” and use a “talking stick” when interruptions become frequent on either or both sides. I am reluctant to put much faith in these tools as the way to help couples with communications issues. Don’t get me wrong, these tools actually work, and some of them work really well. The problem is they work in the wrong direction because they don’t actually get at the real problems. They just make the surface issues look a lot better without solving anything substantial. Focusing on communications issues as the primary goal in couples therapy is like cutting off a dandelion without getting at the roots—for a little while your lawn looks better (all green) but the problem (the dandelion) is just going to come back. In therapy, when a couple does good work on communication without resolving the underlying issues that made communication difficult, they will end therapy thinking things are fine. In a few months, they will be right back where they started before therapy. Except it’s worse now, because they could (understandably) look back at therapy as a complete waste of time and won’t want to try it again.

I will illustrate the point. A couple, let’s call them Chad and Melanie, comes to therapy only after realizing they cannot solve their issues on their own, they are frustrated, maybe even ready to give up on the relationship, or at least resigned to being in a relationship plagued with intractable seemingly unsolvable issues and conflict. As a last ditch effort, they finally come to therapy. This is unfortunately all too common (coming to therapy as a last ditch effort). They focus on communication. It works. They are talking more easily, more often, less fighting, less conflict, less tension, maybe even their sex lives improve, they go out more, and this all seems really great. It is really great. But, it isn’t enough. Chad is not interrupting Melanie as often when she starts to talk about his family. Melanie is more aware of how talking about his family with “you” statements is a trigger so she is doing it less often. Chad still feels hurt, though, about Melanie’s “cool” reaction to his mother last year when they were at her house for Mother’s Day. Now that Melanie is a mother too (they just had their first child, Ian), she resents having to go to Chad’s mother’s house like they always do. Melanie wanted the focus to be on her, not Chad’s mother. Even worse, they find it really difficult to discuss Mother’s Day due to unresolved conflicts that predate their marriage. Chad and Melanie met in college in Boston. Chad is from Minneapolis. Melanie is from California. During senior year, Chad found a great job back in Minneapolis, so when he asked her to marry him, it was assumed that they’d move here. They never really considered living anywhere else, even though Melanie never wanted to move to Minneapolis, and now lives 2,000 miles away from her parents and her sister.

Melanie has never told Chad that she is sure her family felt betrayed by her decision to follow him to Minneapolis instead of moving home after college. Melanie wants to talk to Chad about it. Melanie wants to ask Chad if he’d consider giving up his job, his hometown, his family close by, to move to California. She doesn’t bring it up. Melanie doesn’t say much about anything that might encourage conflict, that’s the way she was raised. Chad is the opposite, willing to talk about anything, especially if it really bothers him. That’s the way he was raised. So, he assumes (wrongly) that Melanie is glad to live in Minneapolis, which is why he gets so confused by Melanie’s cool behavior toward his mother. Chad had thought Melanie liked his mother. She does. But she resents Chad and can’t bring herself to talk about it. Melanie never mentioned any of this in therapy. Instead she hoped that, by working on the communication issues with Chad, they’d get to it later. They didn’t. Now, Melanie doesn’t want to go back to therapy. It didn’t work. She tells Chad she’s leaving, moving back to California, without him.

All of this could have been avoided if it had been addressed more directly in therapy—if Melanie and Chad had been willing to go deeper than just talking about how to talk, about communication. Communication is a necessary part of improving a relationship in trouble, but it is only a start. I often say communication is to a relationship like gas is to a car. Gas won’t do you much good if the car’s engine is misfiring and won’t run. Below is a table I created for couples to help them understand a more layered therapy approach to working on their issues.

 

Communication

 

What?

(what did he/she say, posture, tone, behavior?)

 

Immediate issues

 

Why?

(why is this an issue right now?

 

Underlying or hidden issues

When?

(when did this issue arise for each—before the relationship even began?)

 

 

Identity, belongingness, trust

 

 

Where?

(where are the boundaries between us and around this relationship)

 

 

Personality

 

Who?

(Who am I in this relationship)

 

 

I explain that we start with communication. I suggest some ground rules, like no verbal abuse (see my blog, “What is verbal abuse” for more information). I also often suggest they avoid threats of leaving or ending the relationship for the time being. I might ask them to identify any “hot-button” issues one or both of them do not think they can address without serious and damaging hostility. I ask them to avoid discussion of those issues wherever possible until they have some trust built back into their ability to resolve conflict.

When we have worked our way down the table for each person, they come to understand how they as individuals bring to the relationship specific issues and personality traits that limit their ability to resolve issues as they arise. We come up with coping skills to change these negative influences. At this point, we begin to work our way back up the table, to see the direct connections: how their individual personalities frame their sense of belongingness and trust, which in turn creates underlying semi-permanent unresolved issues that make it nearly impossible to resolve less protracted issues, which is why they haven’t been able to communicate.

Let’s go back to our example of Melanie and Chad. If Melanie could see that her conflict-avoidant family of origin relationship style is so engrained in her, she often fails to assert her needs, and did so long before she met Chad and worked on being more assertive, taking more risks and more responsibility for asking for her needs, she is likely to be less resentful. Meanwhile Chad increases his awareness of his tendency to ignore the needs of others if they are not communicated boldly and directly to him, which has also caused problems in his relationships prior to meeting Melanie. Chad asks Melanie if there is something underlying her resentment of his mother. She begins to disclose to him her feelings going back years to their decision to move to Minneapolis instead of California. She tells him she knows it isn’t fair to him to hold it against him since he didn’t know how much she resented moving to Minneapolis. Chad tells her he is open to reassessing where they should live. He’d rather stay, he says, but he can see how forcing her to stay if she doesn’t want to be here is not fair to her either. What they decide has little do to with communication. It has to do with a very different way of seeing themselves and each other in the relationship and their lives. They can begin a lifelong process of discovering more about each other’s personality, family style, and how to build a better sense of belongingness in the relationship.

This might sound too good to be true, especially in just one paragraph. Not all couples are able to make this kind of very significant turnaround. Some are though. The point is that almost no couple can do this in therapy unless they are willing to dig deeper than communication issues, to pinpoint why communication became such a difficult issue in the first place, and this requires at least some exploration of who each person is and how their own issues influence and limit conflict resolution. Put another way, couples therapy doesn’t work when either one person or both are unwilling to look at their own issues, their own self, or they are not interested or able to see the other person as a separate and distinct person who has their own issues as well.

Couples therapy works because it creates a place for both people in the couple to reassess their ability to feel safe in addressing issues that have become stuck in a flawed process of conflict resolution. If a couple is willing to do what Melanie and Chad did—both of them willing to take responsibility for the kind of person they are in the relationship and become more aware of who the other person is in the relationship—there is a good chance they will be able to work through some very thorny issues. My role is to facilitate the creation of a safe place for their exploration of themselves and each other. I also encourage them to gain more self-awareness while imagining what it is like to be the other person in the relationship. When both can do this, they are well on their way to completing couples therapy.

 

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

Therapy with couples, deciding on the structure and format

Saturday, November 2nd, 2013

In this first of a two-part discussion of therapy with couples, I will explain some of the options for arranging the structure of the couples therapy. The second part of the discussion will delve into the process of working with couples in therapy. I will explore some thoughts about why couples therapy works and sometimes why it doesn’t work.

The structure of working with couples in therapy depends on three issues the couple must decide up front. Does the couple want to use insurance or pay out of pocket? Do they want to designate one of them or the couple as the “client?” Does one of them want to see me for individual issues in addition to the relationship issues they want to resolve in therapy?

My role as a Licensed Marriage and Family Therapist also plays a part in the structure of couples therapy. Consider the difference between a “counselor” and a “therapist.” You might never have thought about the difference, but in my mind there is one, and it is important. For nearly 15 years, I was a lawyer. Another word for lawyer is “counselor at law.” This meant that I not only represented clients in court, but frequently gave my clients legal advice. I advised them about their options, telling them what I thought they should do to address, pursue and resolve their legal problems. As a general rule, I never do this as a therapist. I do not give advice to therapy clients, whether they are individuals, couples or families. I am not a marriage and family counselor. I am a Marriage and Family Therapist. The reason I do not give advice is simple: the likelihood and the stakes for me being wrong are too high. As an attorney, I had no issue giving legal advice because I could fairly easily obtain a sufficiently complete picture of the situation (the facts and evidence) and research the legal options that surrounded a client’s legal issue. So, when I gave them options, I had a pretty good idea that my advice was sound, and pretty likely accurate (but no guarantees). In therapy, working with people’s emotions, mental states, life histories, family histories, relationship interactions, and countless other variables, I just never know enough to think I am in a position to tell them what I think they should do. Maybe more importantly, even if I were able to really “put myself in their situation,” what if I am wrong? Suppose I tell a client I think they should stay in a relationship, move across the country with their partner, and then it ends up being the worst decision that person has ever made in their lives, and they regret it for the next two or four decades? Yikes. I do not give advice to therapy clients about how to live their lives because I do not have to live with that advice if it is wrong, they do.

I bring this up in the context of couples therapy because it so often comes up in this context. Couples often come to therapy because one or both of them are thinking about ending the relationship. Naturally, they will sometimes ask if I think they should stay in the relationship, end the relationship, or insist on conditions (like a timeline for making a decision about whether and when to get married, have children, etc.). This issue is so prevalent for Marriage and Family Therapists, our licensing board specifically mentions it in our professional ethics. “A therapist must respect the right of a client to make decisions and must help the client understand the consequences of the decisions. A therapist must advise a client that a decision on marital status is the responsibility of the client.” When I am asked this question, I give them some version of the previous paragraph to explain why I don’t give advice, why I don’t tell clients what they should do with their lives, including their relationships. I also tell them I firmly believe everyone is fully capable of making good decisions for themselves, and they are in the best position to make decisions that could have deep and lasting effects on them for years. Sometimes, people just need help asking the best questions to come up with the right answers for themselves. That’s where I come in, by helping people focus on the best (and sometimes very difficult) questions, so they can sort through the often very confusing, complex, and difficult issues to make the most appropriate decisions based on what is important to them. In fact, the only time (very rare) I am willing to tell a client what I think they should do in their lives is when the client, someone else they know, or particularly when children, are in danger. If a person is in a physically abusive relationship, I am plenty willing to tell them to get out, and will (and have) helped them find the resources they need to exit safely.

Couples come into therapy in two ways. They decide they want to go to therapy as a couple right from the beginning. They agree they have important issues they have been unable to resolve on their own and would benefit from the facilitation and insights of someone else (me). Or one of them comes to therapy to address individual issues and somewhere along the lines that client decides it would be helpful to their own mental health to also resolve issues they are having in a primary relationship. I am fine with and completely open to either approach. However, if I am seeing an individual client who then wants me to see their partner with them for couples therapy, I restrict my willingness to change the designation of who is the client.

For instance, Let’s say I am seeing a woman named Dawn as an individual in therapy. Dawn is in a heterosexual relationship. She wants to bring her fiancé Doug to do couples therapy that will help her accomplish the goals we were working on her individual therapy. We can do that, and even add some relationship goals Dawn and Doug both come up with after he starts to come to therapy. Here the thing, though: I am not willing to make Doug my client, even if that’s what Dawn and Doug both want (as might happen if Dawn and Doug agree she has worked through her individual issues, but Doug has not). The reason is pretty straightforward, but Dawn might not have considered it: what happens if somewhere down the road, Dawn wants to come back to see me for individual therapy? Can I see both Dawn and Doug separately for individual issues, and also see them together for couples issues? Some therapists are willing to do this. I am not. I think it would be too confusing for me. I also think it would invite some problems with trust. Dawn would wonder what Doug was telling me, and Doug would wonder what Dawn was telling me. See what I mean? Now, to throw another wrench into it, what if I agreed to see both as individuals, and then they broke up, and they were embroiled in a protracted legal dispute over finances or custody? Too complicated for everyone, don’t you think? Maybe some therapists are able to do this, and that is fine, but I don’t think I can, so I don’t. Besides, there are plenty of therapists around for Doug to find his own therapist. He doesn’t need to see me. Dawn is already seeing me.

So, let’s say I am seeing Dawn as my individual therapy client. She has a mental health diagnosis of moderate depression. She brings Doug, hoping that improving their relationship will help her improve her struggle with depression. This makes sense. And it often is helpful to do some couples work in addition to individual work. Dawn is still my client. Doug is not my client. He is primarily there to help Dawn. Hopefully Doug will derive some benefit from improving his relationship with Dawn and by helping her in her struggle with depression. In this situation, if I see Dawn alone, what she tells me is confidential, so Doug is not entitled to know what we talk about, unless Dawn wants to discuss it with Doug. I might also see Doug alone on a few occasions to make it easier for him to open up. What he says though, is not confidential—he is not my client. Dawn is likely to respect his request to keep it private with me, but if she asks me to tell her what he talked about, I don’t have a choice. Dawn is my client. Even though I am not likely to just blithely blurt out to Dawn everything Doug tells me, I can’t guarantee she isn’t going to want to know. I avoid this kind of issue as best I can by reminding Doug that he is not my client, so if he doesn’t want Dawn to know something, it is best he not tell me.

If instead Dawn and Doug had come to me together to work on relationship issues, and neither wanted to be my individual client, then it is up to me to decide what I think the other person would benefit from knowing what I was told during an individual session, unless they both agree ahead of time that they do not want to know what the other one says. Again, I make this clear up front. If later, one of them tells me something that they really do not want the other person to know (which they can do because they are both my clients and therefore they are both entitled to confidentiality), I might decide not to continue therapy if the issue is likely to prevent success in therapy or it puts me in the position of feeling like I am hiding something important the other person would expect to know if I knew. Let’s say Dawn tells me she is having an affair and plans to continue it while we work on the relationship. I would not tell Doug about the affair (due to confidentiality), but would probably discontinue therapy if Dawn didn’t want to tell Doug or stop the affair pretty quickly. I could imagine Doug being rightfully hurt and ticked off if he later discovered she’d been having the affair and I had known about it for some time and continued to do therapy as if there was nothing going on.

As you can see, the structure of couples therapy can be pretty complicated. Not all therapists handle it the same way, and there does seem to be pretty wide latitude in terms of what is acceptable practice in working with couples. These are just some of my methods for addressing the more common issues that come up when trying to decide how to proceed with a couple in therapy.  My main goal is always to do what I can to make sure my client is benefitting from therapy, whomever we decide is “the client” (one of the individuals or the couple itself).  I also want to make sure that I can create as much trust as possible, so I try to make things very clear right away about how I handle confidentiality, and that I do not see it as my role to tell people what to do with their lives (I don’t give advice), except when someone’s safety is involved.  Once these issues are discussed and understood, the couple is ready to make a decision on how they want to structure couples therapy, and then we can focus on helping meet their relationship goals, which will be the topic of part 2 of this exploration of how couples’ therapy works (with me anyway).

 

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

Therapy, Part 3, the process of therapy (with me)

Monday, June 24th, 2013

The process of therapy is different for every client.  All clients have different needs, goals, issues, personalities, levels of development, self-awareness and expectations.  It is important for me to cater my approach and processes in therapy to the individual needs of all unique clients.  No one approach fits everyone. At the same time, there are common elements to the overall enterprise of therapy, or “how it works” (when I am the therapist) that I will try to share here. I have provided some of my thoughts on exploring symptoms, identifying causes and proposing and implementing solutions in the blog: “Acknowledging the problem isn’t enough.”

At first, I consistently use a couple of tools and a general structure to enhance the intake process in therapy, which can then set the stage for ongoing therapy. For the first two to three sessions, I prefer a free-flowing conversation with a client.  We talk about what is particularly causing them distress right now in their lives. I want to make sure they are more or less okay, that they are not in danger of hurting themselves or being hurt by someone else.  Also, I want them to know how it is going to feel for them to be able to talk to me about what happens to be troubling them at any given point in therapy.  I want the whole thing to feel as natural as it can.  This is how most of our sessions are going to be down the road, so I don’t want the first few sessions to be too structured.

During the third or fourth session, I engage in a more structured “diagnostic interview.” This is one of the rare times I use a form—one that covers many specific areas of a person’s life. Usually, this interview takes about one session, but it can sometimes take up to three entire sessions, depending on the depth of the information the client wants to provide and whether the interview brings up issues the client hadn’t previously considered.  The point of the interview is two-fold. First, I need it for my licensure ethics (I need to have in everyone’s file a diagnosis with some objective basis to make sure my diagnoses are accurate and appropriate).  Second, it compels me to cover a wide array of topics, to make sure that in my zeal and curiosity to get to the heart of the client’s current problems I am not overlooking something very important in some other area of the person’s life.

The first question on the “diagnostic interview” asks about the “presenting problem,” which essentially means: “tell me what was happening in your life and inside you that made you decide to come to therapy when you made the decision.”  Although I also ask this question on my client intake forms, the way the client describes the problem often changes quite a bit by the time they’ve had the chance to discuss it with me in the first few therapy sessions. Reviewing the presenting problem helps us move into the second structured part of the therapy process: goal setting.

I can think of many examples when I have discovered something that informed the rest of my therapy work with a client that neither they nor I had thought about until I asked it during the diagnostic interview.  A common example comes from one of the areas I ask about: “developmental history.” During this part of the interview, I ask the client if anything significant happened to them as children that might be an important influence on the issues that brought them to therapy, or just something they think I should know about them from their childhood.  It could be an accident, a medical illness, a traumatic event.  If I didn’t ask these questions, I might not find out that a client who’s married to an alcoholic grew up without their father around because he died of alcohol poisoning, or that my client was adopted, or spent time in a foster home, or was diagnosed with ADHD in the third grade.  Any of these kinds of issues could end up playing a role in the cause of the client’s problems and also be a part of the solution.  There are also many times when clients report nothing unusual in this area of questions, so we just say “nothing noted by client” and move on to other areas.  I do not make assumptions either way—that a client does or does not have significant childhood issues that might be relevant to the therapy they now seek later in life.

In addition to providing information I might otherwise miss without it, the diagnostic interview also includes more positive areas of inquiry.  I ask about spiritual beliefs, social life, and personal values.  A person might have had some kind of spiritual connection or social community in the past that they found very important but have lost touch with it. These could become valuable tools for them to consider when we start thinking about specific ways to improve their current situation.  I also always ask clients to think about internal strengths they might have that will help them achieve their goals in therapy.  If they can’t come up with anything (and sometimes they cannot) I help them.  In the process, they begin to see themselves as equally important in the process of therapy. They begin to see themselves as their own therapists, even if they wouldn’t say it this way (I do).   I ask clients to tell me about important personal values as well. They may consider things important in their lives that are very different from the way I prioritize things in my own life.  It is important that I be open to and ready to consider their lives from their perspectives, not from my perspective.

Actually, there is a third reason I want to do this “Diagnostic Interview” with every client. It helps the client see me as a collaborator, as someone who is not “conferring” upon them some kind of therapy voodoo.  I am just some guy. We are in an office. We are talking about a client’s real problems. We are both doing our best to come to terms with their problems and solve them. There is no mystery here.  My “diagnosis” is just a best guess to what we should call the problem.  Is it “depression,” “anxiety,”  “ADHD,”  “Bipolar,” “substance abuse,” or some combination of these, or should we call it something entirely different.  I make my professional opinion known, it is out in the open for the client to see, and then we discuss whether it is accurate, whether I’ve made a mistake, and need to rethink the problem and what to call it. We do this together, so there is less chance of a misunderstanding, so the client is an equal participant, so there is no therapist (man) standing behind a curtain pretending to be the “Wizard of Oz.” There is no curtain, there is no wizard.

As we move through the diagnostic interview, I read back to my clients the answers I have written on the form so they know exactly how I am describing things.  We even often look together at the Diagnostic and Statistical Manual (the book insurance companies require us to use to diagnose client mental health issues).  This is a further way for me to be transparent, so clients can take ownership of and contribute to their own understanding of one way the mental health profession might view the issues they have come to address.

Like a diagnosis, my ethical requirements as a Licensed Marriage and Family Therapist also require me to have some kind of a “treatment plan” for all clients. This is a stupid name for the form, but I didn’t create the requirement, so I have to use this kind of language.  It is stupid because I don’t really view therapy as a way to “treat” people, like I am a doctor with some “medicine” to “treat” a skin rash. Client issues in therapy are serious, and can even be life threatening, so I do not take my role lightly.  On the other hand, the idea of therapy as “treatment” seems to invite a lack of humility and an “above (me) and below (client)” mentality that I find offensive and destructive.

We create the treatment plan right after we complete the diagnostic interview, usually in the third or fourth session. Like the diagnostic interview, I use the “treatment plan” form as another way to involve the client, to encourage the client to take ownership of her or his own therapy, to create with the client in their own language specific goals the client wants to achieve.  We both co-write them. They give me ideas, I share with them possible ways of writing the goal that is consistent with what they want, and then I write what they tell me sounds accurate.

The most important part of the goals sheet (“treatment plan”) is called “Discharge Criteria.” Again, stupid language, but it invites a very important question, maybe the most important question in therapy.  “How will you, the client, know you are ready to be done in therapy with me at this time in your life?”  I add the “at this time in your life” to leave open the possibility that the client could find themselves ready to be done in therapy with, but then later decide they want to come back for some other issue or because the issue has recurred in some way.  Either way, when a client answers this question near the beginning of the therapy process (around the fourth session), it gives us both a guide, a direction, a point to reach, like a lighthouse in the fog.  It tells me and the client the direction we should be headed, so we don’t end up in a quagmire, a swamp, a therapy wilderness spending countless sessions heading nowhere. This is not good for the client, and would be frustrating for me.  I want clients to know they are making progress in dealing with their problems, by giving them something they can use to measure their progress, whether the issues they brought to therapy take a few months or a few years to address.

Every once in a while, in between sessions, I look at these goals sheets and ask myself what I am doing to help the client move toward the place that will tell them they are ready to be done.  I also bring it up from time to time in session to ask the client to tell me how they feel about the progress they are making and whether we need to be doing anything differently for therapy to be more effective for them. Sometimes we come up with ideas about how we need to revisit goals we’d left behind. Sometimes we add goals that will help them achieve completion of therapy.  Sometimes the client realizes they have accomplished a goal and are close to being done in therapy.

After completing the Diagnostic Interview and the Treatment Plan, sessions are (mostly) as free-flowing as they were for the first two to three sessions.  I try not to bring any preconceived ideas of how any given session should be structured.  There are exceptions, but in general, I want to know at each session what the client wishes to discuss. A client might want to bring up a specific situation that occurred since their last session. We might spend the entire session on this one situation.  In the back of my mind, though, I will try to see how this situation fits into the overall therapy goals we’ve created, which is a kind of structure we might not have had during the first couple of sessions before we created goals.  Sometimes the topic of the session will fit neatly into a pattern the client wants to change. Sometimes it doesn’t seem to fit at all.  In either case, I view it as part of my role to connect dots in the clients issues during each session to try to find patterns they might not see or recognize.  When we talk about these connections, the client will often have an important insight that I hadn’t seen at all. This process of self-discovery wouldn’t happen if I didn’t encourage an open free-flowing process.  Part of the reason I am simultaneously paying attention to the client’s needs in the moment and thinking of the big picture of the client’s goals is that I don’t want to fall into the trap of losing track of why the client is in therapy.  Not every session will or needs to be directly related to the goals we created, but in general I want to know and want the client to know that we are steadily working toward change they want to bring about in their lives, the change they sought when they first came to therapy. I want the client to view every session as a valuable opportunity to move forward in their process of personal growth.

In the end, when clients “graduate from therapy” (I don’t know what else to call it), they are able to articulate how they were able to get to the place that tells them they are ready to be done. It is a wonderful thing to watch a client come to the conclusion that they are ready to be done in therapy. I am gratified when a client can say why they are ready to be done in therapy—they can then look back at our therapy work knowing they accomplished important new self-awareness and change in their lives.

Along the way, from first session, through the diagnostic interview and setting goals, and ultimately to the point of knowing they have reached their own “criteria for discharge” (they have done what they came to do in therapy), clients struggle through issues that I have touched on in many different blogs on the process of therapy in general and with respect to many different therapy issues. These include blogs on Fear (Fear and Safety Part I and Fear and Safety, Part II), Shame (Part I and Part II), Permission, Acknowledging the problem, Client History in Therapy, What “I don’t know” means in therapy, the concept of mental health (What is Mental Health Part I and Part II), Solutions, Process and Substance, taking on new perspectives and thinking “outside the box” (Thinking in Thirds), Co-dependency, Conflict, Part I, Part II and Part III,  What is “verbal abuse,” Situational Identity,” and many other topics that clients often find helpful in thinking about how therapy works for them.  I have also written several other blogs about my ideas of my role as a therapist. These include, The Relief of Humility, My experiences as a therapy client, and 12-step Recovery and Therapy.

If you read these or any of my other blogs, you will quickly learn that I do not make a distinction between what I think works in therapy for my clients to make their lives better and what I think works for me in my own life.  How could I?  I firmly believe in the proposition that I would not ask my clients to do anything to solve their problems that I wouldn’t be willing to do to solve a similar problem in my own life.  It just so happens that I have had many of the same kinds of problems in my life that my clients experience in theirs.  This shouldn’t be surprising.  Just because I am the therapist and the client is the one coming to me that day with a problem, doesn’t mean I wasn’t in their shoes as a client.  I was.  And I might be someday again.  I am just some guy and I am not standing behind a curtain.  I am not the Wizard of Oz.  No mystery.  Just a guy who brings care, concern, education, and trying my best to be valuable, helpful, supportive and careful with clients who come to me hoping to make real change in their lives.  This is the process of therapy, at least it is what the process of therapy is with me.

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

Therapy Part 2, the kind of therapist I am

Thursday, May 16th, 2013

What kind of therapist am I? There are many different kinds of “therapy.”  There is “physical therapy,” “massage therapy,” “art therapy,” and the list goes on.  Technically speaking (and I do not like this term because it is sounds so weird), I am a “psychotherapist.”  Would you want to call yourself a “psychotherapist?” I am not a psychologist or a psychiatrist, but much of what I do is similar to some of the things they do.  Unlike a psychiatrist, I cannot and do not prescribe medications.  Unlike a psychologist, I do not administer psychological tests (I suppose I could if I wanted to, but I am not trained for it, and am not interested in it).  Of course, not all psychiatrists prescribe medication and not all psychologists administer tests, and even those that do, don’t necessarily limit there activities to just these things.

So, I am back to “psychotherapist.”  Yikes.  Okay, well my professional background calls me a “Licensed Marriage and Family Therapist.”  Some people think this means I am essentially a “marriage counselor.”  Not true. Sure, I see married couples pretty often, but I don’t do “marriage counseling” with them (counselors give advice, and generally speaking I do not give advice, I ask questions that help clients find their own answers). I will discuss this distinction between “therapy” and “counseling” in more detail at some other point. Besides, although I am myself married, and I think marriage can be the basis and definition of a beautiful and deeply meaningful relationship, as long as the right to be married still in most places excludes some people who love each other and wish to be married, I find the word “marriage” in my license kind of offensive.  At least it is legal here in Minnesota now. That’s something.

I could call myself a “family therapist.”  Actually, this is what I usually say when someone asks, “what do you do (meaning, I suppose, “how do you pay your bills and spend your weekdays”)?”  I say, “I am a family therapist.” Sometimes, the person who asked me what I do will give me a vaguely confused look, but seem to be more or less satisfied that I answered the question.  Here’s the problem: while its true I am trained as a family therapist, and I do see families together, most of the time I see just one client at a time. This is not “family therapy.”  It is “individual therapy.”  The reasons I see mostly one client at a time are somewhat complicated, and have something to do with the way our society treats therapy as a medical intervention (which means insurance companies view therapy as treating something medically wrong with the individual I am seeing and it is my job to find out what is wrong with them and “fix” the problem).  I go along with this because it is partly true—most of my clients do have serious problems they want to resolve in therapy—and because most of them couldn’t afford therapy unless insurance were willing to pay for most of it.  So, I am a “family therapist” who sees some couples, some families, but mostly individuals.  For the rest of this discussion, I will restrict my thoughts to how I view individual therapy and reserve for separate discussions how I view therapy with couples and  therapy with families.

When I went to school to become a therapist, I had to decide, do I want to become a psychologist?  A Licensed Clinical Social Worker?  A Psychiatrist?  Or a Licensed Marriage and Family Therapist?  These were the four main kinds of credentials that would allow me to practice therapy in the widest possible venues (including being able to submit claims for my sessions with clients to their insurance companies).  I decided on Licensed Marriage and Family Therapist in part because the basis for the “approach” or the philosophy behind it seemed to make the most sense in the context of “psychotherapy” (there’s that word again).  Marriage and Family Therapy is a field that basically believes that the best way to help people achieve a psychologically and emotionally healthy way of living their lives is to incorporate how we function in our family relationships, or put another way, how well our families function as units, and how well we function within them.  That’s a very broad and generalized statement, but seems to capture the gist of the underlying premise of Marriage and Family Therapy as a way of seeing therapy. Anyway, this seemed pretty legitimate to me.  I just “made sense” to me.  I mean, doesn’t it make sense?  Its not the whole story of how well we function in our lives, but it seems to be a good starting point.

There are many different “schools” of family therapy, each with its own ideas of how to gauge whether a family is functioning well and how to apply different ideas and techniques in therapy to bring about changes toward more healthy functioning.  I found some of these approaches and ideas helpful, some were bizarre, some seemed useless, some I still use today, after practicing therapy for over ten years, including family systems theories, narrative therapy, cognitive behavioral therapy (CBT), experiential therapy, existential therapy, and solution focused therapy.  I still believe I made a good choice in deciding to become a family therapist for my credentials.  It has served me and my clients well, but it is only a small part of what I have come to know is important for providing clients the help they need in therapy.

I am the kind of therapist who tends to be pretty engaged, talking a lot, asking a lot of questions, probing, curious, even directive when it is appropriate and might be helpful. This is just the kind of person I am.  I am not going to and do not want to change this part of myself in order to be a therapist. That would be fake. And I would fail.  I have participated in many sessions with clients in which I said almost nothing the entire session because during that particular session, the client needed to talk most of the time.  If a client needed that to be the case during most of our sessions, that kind of therapy approach wouldn’t work for me, and so I wouldn’t be a good fit for that client.

If a client really doesn’t want the kind of approach that is consistent with who I am as a person, it is better for them, and for me, if they find someone who is more passive, quiet, taking a more reflective stance.  This is why I am up front about this on my website, other marketing materials, and it is also pretty obvious right away when you meet me.  I say things like “I tend to be more direct and proactive than most therapists….”  How do I know this?  Clients tell me this.  They repeatedly tell me their previous therapist(s) were far more passive, mostly listening, encouraging, supportive, but not adding a lot or giving too much feedback.  I make no judgments about this kind of approach.  It is probably helpful in many cases.  It just wouldn’t work for me.  Fortunately, most clients who come to see me already know this from my materials so when they contact me they have probably decided this kind of approach is something that they think will be a good fit.  On the other side of the equation, if a client doesn’t want, need or like this kind of approach, I will likely never hear from them because they see it in my marketing materials and then will contact someone who fits their needs better. I think this is just fine.  I want clients to find what works best for them.

Many of my past and even current clients would probably be surprised to here me say this: I bring a considerable amount of self-doubt into most sessions. I am always a little nervous every time I leave my office to go out to the lobby to greet my client for that session.  I have doubts about whether I will know what that client needs from me on that day, whether I will know what to say, how to feel about myself and them, how to be present for them in a way that is real and open to whatever they might happen to have going on with them. I am often not even sure how to start the session, how to open up the dialogue, whether I should say something or let them speak first.  I really mean that I go through this thought process most of the time before and at the beginning of sessions.  This is still true after ten years of doing therapy.  Here’s the thing, though:  I want it to be this way.  I wouldn’t want it to be any other way.  I trust my doubt.  I find it inspiring.  It isn’t fake.  I don’t “try to be doubtful.”  It is not some kind of contrived state, the “not knowing” mindfulness thing.  It is real, natural, and actually sometimes pretty uncomfortable. The (usually) slight anxiety I bring into each session keeps me alert, honest with myself, appropriately humble and open to my limitations, my lack of knowledge about that client on that day.

There is a scene in John Steinbeck’s “The Grapes of Wrath” (it’s in either the book or movie, I can’t remember which, or maybe it’s in both) that captures this sentiment of not knowing so well.  At the beginning of the book, the main character, Tom Joad, runs into the local town minister. They walk together for a bit, catching up on what’s new since Tom went to prison.  Much later in the book, they run into each other again at a labor protest.  The minister is there as a protestor, a labor agitator.  Tom asks him why he isn’t preaching.  The minister says (I’m paraphrasing based on my memory of the scene), “A preacher man, he got to know, know the answers.  I ain’t got the answers no more, Tom, alls I gots is questions, so I can’t be a preacher man no more.” Like him, I am no preacher.  I do not have “the answers” to anyone’s problems.  I have ideas.  I have questions.  I have care, concern, and curiosity.  I have limited but helpful knowledge based on education and experiences about human behavior, motivations, and interactional patterns in relationships.  I use these ideas and knowledges as a basis to observe and listen to clients tell me about themselves and their life situations. I offer these observations to clients to see what fits for them.  Much of the time, my questions, ideas, and knowledge are right on the button.  Other times, they are not.  It is always up to the client to decide what fits and what doesn’t.  I actively encourage clients to feel free to tell me when my ideas and observations do not fit with their understanding of themselves.  Being wrong and being right are both important parts of getting to know the client.  When a client tells me I am wrong, it helps us both understand the client in a different way by exploring why it is wrong.  I try very hard to not let my own ego (thinking I need to be right to be okay with myself) get in the way of what the client needs to increase their understanding of themselves and create new coping skills for whatever bothers them. After all, as a therapist, I am not in the session for me, I am there for the client.

 

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

Therapy Part 1, what is therapy

Monday, April 29th, 2013

What is therapy?

As a therapist, I continually ask myself basic questions about therapy.  What is “therapy?”  When does therapy work?  How do I know it is working?  What is the ultimate point of therapy?  Am I doing all the things I should be doing to help make the process as valuable and beneficial to my client as it can be?  What kind of therapist am I?  These are important, complex, and not easily answered questions.  I am sure I will need to repeat these questions to myself and my colleagues for as long as I am a therapist.  I hesitate to think what might happen, how inattentive, lazy, or just plain ineffective I might become if I decided I knew the answers to these questions completely.  Let’s just say I know myself well enough to know this is not very likely! I don’t trust and am not all that interested in definitive answers to these questions.  I trust an evolving process which keeps me attentive and interested in my own internal processes and the process of doing therapy with clients that teaches me every day in every session something new about therapy, myself and my clients.

So, then, what is “therapy” (by this I mean “psychotherapy” not any of the other kinds, like physical therapy, etc.)? Therapy is a process in which therapists and clients (individuals, couples, and families) engage in private meetings that are comfortable enough to allow them to work together to explore, identify and propose possible solutions to emotional and mental health issues faced by the clients which the client considers, modifies and implements all to bring about the changes desired by the client.

This simple description means that therapy has the following basic and essential components:

1)   Therapist(s);

2)   Client(s);

3)   Privacy;

4)   Trust or “comfort;”

5)   Client desire for change;

6)   Therapist expertise in facilitating helpful process

7)   Exploration of problem;

8)   Identification of causes;

9)   Proposed solutions; and

10) Implementing solutions.

It is surprising, isn’t it, that what seemed like a fairly straightforward process has so many parts.  I could probably even identify more details, but this list seems to illustrate the point: therapy has many varying and important components.  Like I said, the questions at the beginning of this discussion are complicated and difficult.

None of the other components in therapy make any difference at all unless the client both wants to make change in their lives and has some basic level of trust or comfort that the process is likely to lead to the kind of change she or he is seeking.  Now that leads to other questions, like how does the client know what kind of changes he or she might want in their lives?  How can the client begin to trust the therapist has the kind of skills, knowledge, abilities to help the client identify those changes, and how they can be achieved?  A client could, for example, trust that a therapist is genuinely interested in their well-being, is passionate about their work, will keep things confidential, will not judge them, cares about them, but still not know or be sure or trust that this particular therapists understands their issues well enough to really help them.

The best I can say for now is that, first of all, and obviously, not every therapist is going to be right for every client.  Second, therapy is an evolving process. At one point in a client’s life, he or she might benefit from a therapist who is “client-centered,” who is mostly a sounding board, offering little feedback, and offering mostly care, support, and quiet empathy.  This might be just “what the doctor ordered” when a client is in the middle of a transition period.  This approach might be woefully inadequate later on, when the client has moved beyond that transitional or emotionally traumatic situation, and now wants to look back at it in detail to understand why it happened, and how they need to do things differently to avoid a repeat of that situation. At that point, they might want a therapist who is far more probing.  The same therapist could do both, but maybe not. The client needs to be as open and aware as they can be to determine what their needs are, and whether their therapist can meet those particular needs.

Hopefully, the therapist will be equally aware and open about how they approach therapy in general, and what ideas and methods they might be able to utilize to help clients find the solutions that work best for them. Just as not every therapist is going to be able to meet the needs of every client, not every client’s problem is the kind of problem any particular therapist might be well-suited to help solve. I tend to avoid working with young children, knowing there are those therapists out there who are better able and more interested in providing such services. Don’t get me wrong, I like children and always enjoy when clients bring their children into sessions so I can meet them, or in case they are part of the issue, or the client couldn’t find a sitter.  After working with children in the first several years of practice, I found myself not being all that good at it, not knowing how to help them in ways other therapists seem to know.  Part of knowing what you do well is knowing what you don’t do so well.  So, when someone asks me to see their child under the age of 14, I refer them to therapists who are better able to meet those therapy needs. I also refer to other therapists those whose primary therapy issue when they contact me is an eating disorder.  Again there are specialists out there who really know what they are doing with this issue, and I am not one of them.

There are studies that show the therapist’s technique is definitely not the most important factor in determining the success of therapy.  Before learning about these studies, I had found this to be true when I was a therapy client, so I had some personal observations that confirmed the truth of this.  Those studies show that the most important factor is client motivation for change.  Check!  The second most important factor is the nature of the relationship between the client and the therapist. Check!  A distant third factor is the kind of techniques or approach of the therapist. Check!  In my years in and out of therapy (see my blog on my experiences as a therapy client), the most effective by far was a Licensed Marriage and Family Therapist. Not because he focused on how to help my family function better—he never met anyone in my family, only working with me as an individual client for several years.  My therapy with him was effective because of the kind of therapy relationship we established. The rest, his training, his therapy approach, his ideas about psychotherapy, were a very minor part of what made our therapy so helpful.  He was open-minded, sensitive, didn’t try to tell me who I was, and he also seemed to just “get” me.  This was exactly what I needed at that time in my life with those issues I brought to therapy.

A good match between the client and the therapist means the client believes that this particular therapist is well suited to be able to understand the client, their problems, and the therapist will have some good ideas about how to help the client move through those problems so they can understand themselves better and make the kinds of changes that they deem necessary to solve their problems. This will also reinforce the client’s motivation for and belief in the possibility of positive changes.  Maybe, then, a partial but pretty good answer to the question, “what is therapy” is this: Therapy is a relationship between a client and a mental health professional in which they are both invested in exploring the client’s mental health issue in a way that feels safe and productive so the client can try different ways of resolving the issues with the help of their therapist.  It’s not a complete answer, but it’s a pretty good start.

 

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

The Gift of Therapy: My own experiences as a therapy client

Monday, April 9th, 2012

 

During one of the first few sessions, clients sometimes ask me if I have been in therapy myself. Not surprisingly, they find the question awkward because they both want an answer and consider it important and because they are not sure if it is okay for them to ask. As with almost anything in therapy, I think a client should ask what they think is important for them to know about me, and then I will hold myself responsible for telling them whether I am willing to give them an answer. Sometimes the answer is no, I do not want to share that information. That exchange itself can be a good therapeutic moment, even if the client didn’t get what they wanted, because I try as hard as I can to ensure that they know I still wanted them to ask, because they couldn’t have known I didn’t want to share the information they wanted from me until I told them. And much of the time, if I think sharing the information will be good for the client, I will gladly answer their question So, this blog is a way to avoid all of that awkwardness, if possible, by answering the question about me and therapy in advance of the first session of all future clients (that care to read this blog): yes, I have been in therapy. In fact, I have been in therapy multiple times, at several different points in my life. Sometimes the therapy has not been helpful, and has even been a real turnoff, and at other times, it was a godsend. I have no magical answer about why it worked sometimes and at others did not. I can give you some clues though, in case you want to know.

 

First, let me share with you a couple of real turnoffs that will tell you a lot about when and why therapy definitely did not work for me, and which still inform much of what I do in my own therapy practice—to help my clients stay as far away from those kinds of experiences as possible.

 

When I was 11 or 12, my father took me to a therapist. I can’t tell you what prompted my dad’s exercise in self-help. If I had to guess, someone else told him to do it (like a school or the county). I didn’t want to go, I remember that. It didn’t seem I had much choice though, so I went. I think I thought it was like going to the doctor (first mistake). The guy gave me the whole speech about confidentiality, telling me everything I told him would go no further. I trusted him (second mistake). After telling him all the kinds of things my dad had been doing to me (basically, beating the crap out of me), this guy didn’t believe me, told me he thought I was making it up, and then told my dad (third mistake). Guess what my dad did to me when we got home? Yup, he beat the crap out of me.

 

Fast forward four years. I’m 16, trying to stay off drugs. Back in school after dropping out for almost a year. Depressed. Bored with school. Hating myself. Not wanting to go back to drugs, but not sure what I wanted to do. I had a good foster mom (bless her heart, for real). She strongly suggested I give therapy another try, knowing what happened before. I trusted her (not a mistake). I went. Nothing terrible happened. Nice guy. Good looking, I think. Nice hair, nice smile, nice office, nice compliments toward me. I didn’t buy it. Seemed to good to be true, or just not very helpful. So, I went for a while, then started missing appointments, then stopped going. Good in a way, because it helped me get over my fear of therapy, and therapists. It also left me feeling therapy was pretty useless.

 

Okay, one more lame therapy story (I’ll try to put you “there” by telling it in the present tense, like it just happened). I was going through a very painful breakup in my 30’s. I was really sad. I call a clinic in Uptown, Minneapolis. They have several therapists, one is available for a session that day (hmmm….). Okay, I need to talk to someone, anyone. I go. I start to tell him what’s grieving me. I want to say he interrupted me in mid-sentence (doesn’t that sound dramatic), telling me I smelled like cigarette smoke. Um, yeah, I say, cause I smoke (I did back then). So? Well, he launches into this ten minute lecture about how smoking leads to depression, and all kinds of health issues, finally suggesting the answer to what ails me is smoking. He kept at it, despite my assurances that this was not a topic I wanted him to talk about. I knew smoking was bad, and I didn’t care. That was the problem, not the smoking, but the not caring. He wanted to set up an appointment but asked me to promise to quit smoking immediately. I didn’t do either. I never went back, and smoked at him in my mind for about two weeks. By then, I’d gotten a grip on my grief.

 

Along the way, though, in my late twenties, I had the very good fortune to meet a great therapist, who also seemed to be a great person. Craydon worked at a nonprofit therapy center for poor people in the skid row part of San Francisco (which is where I lived when I was a poor student living there). At the end of our second session, after telling him some details about my childhood, and that much of it was from what others had told me because I could remember virtually nothing from before I was about 12, Craydon paused, looked over his notes nervously. Then he said, “Okay, Michael, I need to tell you that I just graduated with a Master’s Degree in therapy, and I don’t even have my license yet. Based on what you’re telling me about what has happened to you, I do not think I am qualified to work with you. You really need someone with a lot more experience and education. I will need to talk to my supervisor, who has a license, and a Ph.D. I think you should see him, he will be much more able to tell you what you need to do to get a handle on all of this.” (I am paraphrasing here).

 

His complete sincerity, compassion and humility were so refreshing, like nothing else I’d seen in a therapy office before. I told him I thought he would be perfect. I said I wanted to work with him because he didn’t try to tell me who I was, what I needed to do, he just wanted to listen, to talk with me, and that was exactly what I needed. He smiled, and agreed to try. I saw Craydon every week for an hour and a half for three years, until with a license, his own office in a nicer part of town, more confidence, and no less compassion, he told me, “I think you are close to ready to being done in therapy, Michael.” He was right, for that part of my life, for what I was trying to do then, which was to make sure I understood how the violence inflicted upon me as a child still worked its way through my mind. I’d just become a father before starting therapy with Craydon and was very worried that I would do to my new son what my father had done to me. Now that my son is an adult, I wish I could find Craydon to tell him how much he did for me and for my son—I did not end up becoming to my son what my father was to me, cruel, mean, or violent. This is the power of therapy, and is part of the reason I am now a therapist, because I have seen what it can do at the right time with the right person in my own life.

 

I have since then, from time to time, sought out therapy to address more specific situations. I have been more selective about who I see because I have learned the importance of the kind of connection you can make with a therapist, either positive or not. Sometimes even when the connection is really good, and the therapist highly competent, the work doesn’t go well. Some time ago, I saw a family therapist to try to save my marriage. The therapist was highly recommended by someone I trusted very much, who is herself a really good therapist. Despite our marriage therapist’s insights, knowledge, and skill, she was not able to help us figure out how to save the marriage. My sadness about the end of that marriage might never completely go away, but I still feel very satisfied that I found a good therapist to work with us. I can look back and honestly say, if she were not able to help us, that’s a pretty good sign that the marriage needed to end, despite my sadness about it.

 

It doesn’t take a long time to obtain the benefits of therapy if you know what you want, and are willing to do the work to get it. I saw a therapist during a very difficult time in my son’s life, when I was struggling to figure out what I was supposed to do to help him, feeling both helpless and some despair. I saw a sharp attentive solution focused guy. After three sessions, he said, “what seems to be bothering you is that you know you are in a ‘no-win situation’ but won’t accept that is how it is. So, my suggestion is that you remind yourself as often as you can by telling yourself, ‘this is a no-win situation.’” As simple as it sounds, he was absolutely right about what I was doing, and his suggestion worked very well, as long as I kept telling myself the truth—that I was in a no-win situation and had to accept it for what it was. I did not need to return to that therapist.  I had gotten what I needed in a short time because what I needed was very specific, very contextual.

 

As a person who now provides therapy to others, I feel very fortunate to have had a well-rounded basis of experience as a therapy client. I have learned from these experiences some basic and powerful ideas about what works and what does not work. I try to use these experiences in the therapy I practice with my clients now, so I can help them avoid the foibles of my predecessors while hoping to give them some part of the almost miraculous benefits that have been given to me by some of my therapists over the years. Who I am as a therapist now, and what I have learned works for me as a therapy client, does not apply to everyone, and that is how it needs to be. We need to find what works for us, for whatever issue and whatever time in our life we decide to seek the help of someone else in therapy.

 

Copyright, 2012, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.

 

How important is your past in therapy?

Tuesday, June 7th, 2011

Clients are often (justifiably) concerned about getting stuck or dwelling on their past for months or years as part of the therapy process. Sometimes clients have a concern that therapy might encourage them to rely on their past as “an excuse” for whatever their issues might be in their current lives (“I can’t get my life together because, when I was a kid all this bad stuff happened to me…”). This blog will explain that this is not how I practice therapy, and is not the experience clients have in therapy with me.

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