Where Have I Been???? SELF-CARE!

It's been, undoubtedly a long time since I posted anything. I am certain that my three readers have been biting their nails while checking their blog feeds and emails just waiting for my next comments. Well, here it is...

Over the past 16 months I have had the opportunity to see many clients, attend great conferences (i.e. The Evolution of Psychotherapy 2017 convention), teach multiple classes, provide supervision to 24 different students, road over 1500 miles on a mountain bike, went on several trips (some successful, some not), and much more. In other words, I got even more busy. But, I digress...

Today's brief message is about the results of professional counselor burnout and secondary trauma, and how to work through it. A counselor who works with trauma is at risk for developing pathological symptoms by virtue of exposure to clients with trauma and difficult life scenarios. This can happen due to the severity of the situations and stories shared in sessions, or even because of similarities of the clients' stories and experiences to the counselor's own life. The signs for secondary trauma are not unlike post-traumatic stress, anxiety, depression, and more. Ultimately, a professional counselor can begin to feel tired at the thought of seeing clients. Sessions may be interrupted by internal counselor struggle (countertransference). Ultimately, it can lead to compassion fatigue and/or burnout. Cynicism tends to be the final stage of burnout, which ultimately affects the client's ability to remain objective and to demonstrate empathy or compassion to their clients or even personal relations.

I know what you three readers are asking--how can I avoid this? The answer is very simple. Self-care. This means putting yourself personally and professionally at the forefront. Take time off periodically rather than waiting until you're exhausted. Focus on personal spirituality by maintaining a relationship with God or the Divine. Be physically active in any way. Check your attitude to see if it is adjusting towards being negative towards others. If it is, engage in your own personal introspection and practice for change. Or, see a counselor for yourself. Try to see people from a person-centered perspective--that all people are inherently good and trying their best; that they are worthy of affection and attention (yourself included); and be congruent and genuine with yourself and others.

Hopefully, you three will find some of this helpful. If not, file it away for a time when things feel rough.

Until next time...

To Hate Or To Forgive...That Is the Question

Reality Show: 19 Kids and Counting

This reality show was recently brought to my attention, more specifically, the news that is rapidly spreading throughout social media regarding Josh, the older child of this family. It was indicated that a few years ago he had admitted to molesting a few of his siblings, and in turn, received counseling services. Furthermore, it was also stated that the survivors of the incident also received treatment. These types of scenarios are not ones that any one person enjoys reading about, as it opens up a realm of ridicule, doubt, judgement, and fear. I was amazed at many of the social media responses and comments made about Josh, as well as the survivors in addition to their family and religious beliefs. Therefore, I, like many others are undoubtedly doing decided to write a few remarks on scenarios such as these. 

It is difficult to be an outsider looking in when we hear about children having been sexually abused. As a counselor, I have heard over the years that one in four or even as high as one in three girls are sexually abused. One in four boys are, as well. It seems to be more commonplace than we know, yet it continues to be the frightening elephant in the room. Rather than look at it from a judgmental place, I’d rather look at it from a place of understanding. 

First, not all people who act out sexually in an inappropriate manner have been victims themselves. There can be a small correlation to this idea, but it is not a cause-effect relationship. There are many factors that play into a person acting out. Therefore, jumping to a conclusion that someone does this because it was done to them is not accurate. Also, religions that call for sexual purity or sexual abstinence do not lead to someone acting out. There is no cause-effect relationship, though on social media I have seen this said. Research does not support statements like these. Third, saying that the victims must come out into the open and tell their story is not always helpful, nor is it therapeutic. In fact, it can do the opposite. It can foster hate…and we all know what happens when hate is encouraged. 

Now, on to the victims or survivors of sexual abuse. Sexual abuse can be a developmental life changer. I want to reiterate what I just said—it CAN be a developmental life changer. That means and implies that other factors must be involved such as support, age of the individual, psychosocial stage of development, cognitive development, etc. Sexual abuse introduces a very mature idea into a small mind and body that is not cognitively or socially ready for it. It also introduces strong physiological responses in a small mind and body that may not be ready for it. This can lead to confusion about sex, relationships, identity, and much more. However, it doesn’t have to be a game changer. Again, it is not a cause-effect relationship. Much can be said about the victim/survivor who comes out and talks about it, though it doesn’t necessarily mean that they are more or less healthy than those who keep it quiet. Much can be said about those who keep it quiet and work on it on their own without creating an environment of anger. The reason I say that, is because one social media responder indicated that the victims need to have a voice and be represented and speak out loud. This type of behavior can actually lead to ongoing symptomatic and behavioral problems, as well as fostering self-loathing, hatred, and mistrust. Anger and hate beget more anger and hate. Helping a person find meaning in their life after the abuse can foster inner peace, healing, understanding, and forgiveness. Yes, forgiveness for the one who did the abuse. 

In the many hours I have spent working with people who have suffered through many types of trauma, I have yet to meet a person who fully healed that did not forgive. Forgiveness doesn’t mean that one is okay with what happened to them or what they did to someone else. Forgiveness means letting go of all hope of a better past (not my saying, but a good one), and allowing the pain, sorrow, and suffering to go. Holding on to the pain and suffering only brings more pain and suffering. Again, I return to my prior statement that we all know what happens when hate is encouraged.

Finally, true healing can happen for both the victim/survivor and the perpetrator. It requires empathy on both sides. Empathy is being willing to walk with the individual, side-by-side, and to support them, not to enable them. Empathy can empower a person to have hope for a better future. A better future does not mean that they will be free from the memory of what was done, but rather that they can grow and develop into something stronger. They can find meaning from the suffering (yes, that is a very existentialist statement—for more information read Victor Frankl’s “Man’s Search for Meaning). The path to recovery from victimization or perpetration is not comfortable, but it is doable. Most of the time, you won’t find those stories in social media. Those people keep their stories to themselves, because they are sacred and personal. If a story fosters hate and confusion, there won’t be much healing there. 

If anyone has questions or comments, feel free to leave them…if they are negative and degrading, they will be deleted. My blog is not a place for that.

Negative Psychology? Or Is It Focusing on People?

A few nights ago, I was up until a far too late hour with a sibling discussing various topics regarding mental health, addiction, trauma, etc. As can happen, I found myself going into a monologue about the subjects. This happens due to a passion that I have for them. Over the years I’ve had opportunities to attend trainings and supervision on various subjects. What I find fascinating is when two seemingly unrelated subjects or ideas come together in a correlational fashion. Therefore, I was discussing these types of experiences with him. As we continued our discussion, I did not find myself enlightened by the topic as I had heretofore experienced; but, rather, I found myself becoming saddened and despondent. I remember the moment when I was aware of my mood change when I had finished talking about the effects of pornography and other addictions on the brain and my brother asked, “Is it possible for the effects to be reversed? Or for the person to experience some kind of full recovery?” At that point was when I had realized that I had backed myself in a corner. I had been focusing on the psychological research that I had studied, which is very negative. In fact, that is one of the complaints of the psychology field is that it can be negatively focused, which is why Positive Psychology became a movement. We finished the conversation and I went to bed. The next morning I was still feeling despondent. I meditated on the “why” of my mood and realized that I had, once again, focused so heavily on the research that I forgot about the human aspect of this field. The study of people does not take into account the people as it looks for correlations in variables. Now, I’m not saying that research does not carry importance, as research is highly beneficial, but the people no longer become the focus as the variables and how they interact with other variables carry more weight. But, I digress. 

As I was reflecting on what we had discussed and the sense of sadness it brought due to the negative results of mental health problems I had a very strong impression come to my mind. It was simply put “What are you going to do about it, Jamison?” At that moment, the sense of hopelessness disappeared and I experienced a feeling of empowerment and I asked myself the question, “what can I do about it?” The answer, then, was simple. I can keep trying. I can keep trying to work with people to help them see that despite their struggles, traumas, addictions, disorders, negative experiences in all of their forms that they have inherent value just by virtue of being alive and being a member of the human family. Is that not what counseling is about? Our clients struggle with various maladies of the human experience which bring them to question their value. We call these struggles disorders as a means to classify and measure. But, at the end of the day, do we not all have moments of depression, anxiousness, traumas, addiction, behavioral outbursts, etc.? Therefore, what I can do is engage anxiously in a positive cause to try to help where I am able and hope that my interaction and interventions will result in an increase of self-awareness. I can provide treatments that are intentional and purposeful that help give others an idea of the direction they hope to go that they might liberate themselves from “disorders” with which they are plagued. And, maybe, along the way I too can learn more about myself, have more self-awareness, and learn (piece by piece) of my own value as a member of the human family.

OCD: Obsessive Type and Scrupulosity

A few years ago I had the privilege of speaking to an expert in Obsessive Compulsive Disorder. I was informed that there are sub-types of OCD that the Diagnostic Manual did not address at the time. The two types that really stuck out to me were the "Obsessive Type" and "Scrupulosity."

In order to understand either, let's talk briefly about OCD. OCD is an anxiety disorder that has a few distinct symptoms: anxiousness (emotional, cognitive, and physical); and compulsion (can include rituals, outward and inward behaviors to decrease the anxiousness). There must be both of these symptoms in order to have a diagnosis. Anxiety is obsessive and continuous worry that has little or no foundation or reason to it (i.e. stressing over finances because you're broke does not count). It is worrying about things that may not be true or rational. However, to the person with OCD, it feels real in every sense and evidence is often sought to support the obsessive thoughts and worries. When the anxiousness increases, the individual can get stuck in an anxious thinking loop; then, the desire to decrease the anxiety begins and the individual engages in compulsive behaviors. We have all heard of the obsessive hand-washing, counting, touching objects, etc. compulsions; however, with the other two types, the compulsions may be different. The "Obsessive Type" is when the anxious thinking is tied to the compulsion. The individual gets stuck in a "thought loop" where they feel compelled to continue thinking about the anxious thoughts in order to control them or to change them--or perhaps to come to a new conclusion. The thoughts feed on themselves and the compulsion to think more and to analyze more feeds anxiousness. It results in heightened anxiety and can even lead to depression.

Scrupulosity is an interesting type as it can be a part of perfectionistic patterns of behavior and to spiritual and/or religious beliefs. For example, an individual can believe that if they do not pray enough or long enough or a specific amount of time, then God will smite them or harm someone else or will not bless them. This can lead to trying to live "perfectly" without flaw or fault, which ultimately can lead to disappointment, depression, and disillusionment with beliefs of who God is.

Now, the main issue is how to deal with OCD in all of its complexities. First off, if you struggle with it, remember that it is a diagnosis and not a label. It's interesting how people will say "I'm OCD" as if it is a name or an identifying feature. Typically speaking, obsessive thinking and compulsions actually have more to do with biological processes in the brain than the person or their personality. Secondly, when an individual is engaging in the obsessive and compulsive thinking and behaviors, it means that the brain is "stuck" in the loop and needs to be redirected. The expert I spoke to indicated that the brain can only focus on one thing at a time. Therefore, focusing on something else (such as reciting a long poem from memory) will pull the brain out of the loop. This may need to be done more than once, and that's okay! After the individual is out of the loop, then they can begin to think rationally through the process that has just occurred. Cognitive Behavioral Therapy can be a big help at this point, as well. OCD requires management and maintenance. The goal of treatment is to decrease the symptoms over time, but this requires consistent work on the individual.

If any of my three readers are interested in more information, feel free to leave a comment.

Jamison Law

A Brief Spiritual Reminder

For a short time I had the privilege of working as the director of a 12 step-based inpatient facility with clients who were in substance dependence recovery. I had never worked with the 12 steps before as I had been inundated with Cognitive Behavioral Methods for several years. What attracted me to working at this facility was the idea that I could combine a spiritual-based approach with trauma-focused treatment. The prior director had begun developing a trauma-focused spiritually-based approach for recovery. It was fascinating! What I found to be very helpful for clients was the following:

1. Client needed to learn to give up control and surrender themselves to a Higher Power. It didn't matter what their idea of a Higher Power was, either. This could result in a state of humility (i.e. teachability) and trust (in their Higher Power, the facility, the other clients, and the clinical/administrative staff). It was a fascinating process to see clients with severe problems, typically co-morbid disorders, to begin to progress and recover.

2. Clients focused on the 12 step process and were required to go through the steps in order to complete treatment. This forced them to focus on others rather than themselves. It's amazing what happens to people when they forget themselves and work to help others.

3. The trauma-focused portion involved multiple methods such as Eye-Movement Desensitization and Reprocessing; Ego-state-based therapy; Trauma-focused CBT; Mindfulness Meditation and more. The goal was to help a client recover from the trauma they had experienced which ranged from childhood abuse in all of its forms, domestic violence, rape, neglect, etc.

What I most enjoyed was the sense of peace that a client could experience, as well as the staff, in knowing that a Higher Power was in charge of their lives and that they could ultimately put their trust in a Being or Idea that was greater than themselves.

Just food for thought!

Dr. Jamison Law

Psychodynamic Therapy, Narcissism and Shame

I have been slowly reading a book on Skills of Psychodynamic Counseling. Psychodynamic counseling theories and methods stem originally from Freudian Psychoanalysis; however there are some inherent differences. The book is interesting as it focuses on the foundations of the theory. One really great quote about this style of therapy is "Psychodynamic therapy involves the interaction of two minds which influence each other both consciously and unconsciously" (Howard, 2010, p. 15). The book talks about the therapeutic alliance being important to the method, just as it is in other methods such as Person-Centered Therapy. The difference is, that it indicates that there are two relationships occurring simultaneously. The first is the relationship between the counselor and client as adults. The counselor honors the client for coming to them and provides an environment where trust can be encouraged and fostered. The second is the subconscious relationship which involves the counselor as an adult and in a position of authority and the client's subconscious, which can be likened unto a child. In order for the client to have a positive counseling experience and to process childhood subconscious issues, the adult-adult relationship must be well-established. Where narcissism and shame come into play has to do with the relationship. A client who comes to me may have feelings of shame due to the fact that they have not been able to deal with their problems on their own. This can result in a hurt ego, and narcissism itself, is damage to the ego which resulted in shame; then, the ego overcompensates for the shame by inflating itself and becoming grandiose. Therefore, in order to heal, the issues of shame must be addressed at a child-like level which cannot happen unless the first relationship is established. I find these ideas fascinating and wonder how often we try to exert power over others due to our positions of authority and how it affects their own childlike egos. Just some food for thought. Dr. Jamison Law Howard, S. (2010). Skills in psychodynamic counselling & psychotherapy. California: Sage Publications, Inc.

What Do Counseling and Heavy Metal Have In Common?

Hello everyone, The title, this time, does have something to do with the article! A recent situation got me thinking about the use and necessity of therapeutic confrontation. Much of it stems from having been at a training where individuals are trained in therapeutic relationship skills. One of the techniques that is taught is therapeutic confrontation. This technique means to demonstrate discrepancies or to point out discrepancies or dissonance that a client is experiencing. I particularly like the term dissonance, as it is a musical term. When two notes that are typically 1/2 or one step from each other are played together, it sounds “off.” They don’t fit together like a typical chord and it can sound “grating” on the ears. A lot of music such as heavy metal uses dissonance as a means to excite or bring an anxious response to the crowd. If you've been to a concert before, you know what I’m talking about! People do the same thing internally. They may believe one thing, but behave in an opposite fashion. This creates anxiousness. Or, a client will feel one way about one thing, and yet go against it. I.e. An abuse survivor may be afraid of the abuser, but seek out love and affection from abusers as a means to compensate for a feeling of unworthiness or inferiority. As a counselor, we can point out the discrepancies in a following manner: Counselor: “For the past few minutes you’ve been describing to me quite a difficult event. You reported feeling guilty for what happened and for how you responded, yet on the otherhand, you continue to do it. What can you tell me about that?” The point is to bring the client to a greater level of awareness of their behaviors, cognitions, and affects that are not adding up. Many counselors believe pointing out the client’s flaws is a means of confrontation; however, pointing out flaws can actually increase the client’s anxiousness, guilt levels, and even cause damage to the therapeutic relationship; thus, slowing down the process with the client and inhibiting growth and change. Therefore, it is important to learn appropriate methods of confrontation before engaging a client in their discrepant behaviors. Motivational Interviewing can be a good method to help with confrontation. Youtube has multiple examples of what it looks like. If you have any questions, let me know! As always, it is a pleasure to chat with you all! Dr Jamison Law

Carl Rogers' Counseling Skills CAN WORK!

I just returned from a week long Residency experience with a National University. During this Residency faculty members are assigned to train Mental Health Counseling students in basic counseling skills. Many of the skills are based on, though not limited to, skills that Carl Rogers suggested. Much of Rogers' Human Centered counseling approach was based on the idea that all people are inherently good, and that if individuals are provided the opportunity to receive unconditional positive regard from a professional, then the chances of personal growth increases. Carl Rogers also said that the therapeutic relationship is necessary and sufficient for change. Therefore, counselors are trained to utilize methods such as reflective listening (i.e. being an emotional mirror), echoing, paraphrasing, summarizing, appropriate use of open/closed-ended questions, validation, etc. to help clients feel that they are receiving an empathetic ear to their problems; thus having the environment to promote change. If you want to learn more about it, click on this youtube link to see Carl Rogers talking about his method and demonstrating it in the all-too-familiar case of Gloria. What I find to be interesting is that the basic counseling skills can transcend just the counseling office. There have been times that I have worked with couples where they have an issue with communication. It is interesting to see what can happen if they are taught how to use these basic communication skills in their relationships. They can learn how to talk with their significant others and be able to come to a better understanding of one another. They can also be used as a teacher or instructor communicates with learners. As counselors begin their training in the field, I would strongly suggest that they study the methods that Carl Rogers and other humanist psychotherapists utilized as a means to understand how a therapeutic relationship can help a person change. Think about it, how often do we need an understanding ear to work through our own problems? Being skilled in these methods allows that to happen and can often lead to a person discovering the answer to their own questions. Thus, the client is left empowered and accountable to themselves for their own change and growth. The counselor then becomes a willing observer and partaker in their process, though they do not provide the answers, which strengthens the counseling relationships and maintains ethical boundaries. When I began as a counselor, I remember being overwhelmed with how many clients who wanted the "answer" to their problem. Can you imagine how much knowledge one would need, as well as how much responsibility one would have if they truly did have all of the answers? Also, can you imagine the liability and accountability one would have if their answers are not "correct" for the client? Therefore, a person who can competency use basic counseling skills can provide a means to help their client/learner find their own answers. See you later. Dr Jamison Law