Careful! There's A Baby In That Bath Water!

Having had some negative experience with health care, it becomes increasingly important to be able to experience care that is genuinely supportive and beneficial. Otherwise there is the very real danger that you as a client in therapy might be inclined to "throw out the baby with the bath water". In this situation that might mean closing yourself to information or strategies that could be helpful to you, because you associate them - perhaps mistakenly - with your previous unfortunate, or even damaging experience.

An example: a client has had unsupportive medical experiences regarding his very real disabling health condition. He may have been told, or it may have been implied that this condition was "all in his head", and that there was nothing "really" wrong with him. As a result of this treatment, and perhaps other previous experiences, he concludes that anything associated with the conventional medical establishment is worthless, and cannot possibly be of benefit to him. Instead, he spends years exploring and working with "alternative" practitioners, to try to get some relief from his debilitating health distress. This in fact IS beneficial, both medically and spiritually, the client feels supported and validated, and does indeed gain some measure of relief.

This same client now finds himself in need of psychotherapy, and through a set of circumstances not altogether of his choosing, finds a therapist who uses an eclectic approach, incorporating some fairly orthodox, mainstream treatment models with other, more cutting edge ones. While the more "alternative" models are appealing to this client, he has, even before meeting with the therapist, decided that certain methods, because they are "mainstream", cannot be useful to him. This is unfortunate, because some of these more conventional methods are actually very powerfully therapeutic, and can in fact be presented and implemented in ways that are comfortable, supportive and effective.

After a few sessions of therapy, when a good therapeutic relationship has been established, the therapist is able to skillfully explore all of this with the client, and the c lient is able to begin to recognize his bias, and that it may in fact be more hurtful to him than helpful in his therapy.

In general, it is the case that a black and white approach to just about anything, while in some ways understandable, will prove to be more harmful than helpful.



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A Little On Power In Therapy

It's not all that unusual for clients, especially clients who've had previous experience with therapy, or with health care in general, to come into therapy with well developed biases against what they believe to be "ineffective" or simply "wrong" approaches to therapy. At least "wrong" insofar as their benefit is concerned. This is usually the result of bad health care experiences, even traumatic ones, in which the client may have been ignored, disbelieved, bullied, or in some other way not given the full respect they need and expect.

Imagine how you might feel if you were to be treated with condescension, with skepticism, with arrogance, or with any other form of disrespect, when you are in a particularly vulnerable condition, and when you are actively seeking help. Not only will such an experience be harmful to you, but it will also tend to sour you to methods and practices which can, when done well, be of significant benefit to you.

This is where the nature of the therapeutic relationship between client and therapist is of paramount importance. Regardless of how well your therapist may understand theories and techniques, the healing potential of any of these are likely to be lost if the relationship between the two of you is insensitive, or aggressive, or in any way expresses its inherent power differential unskillfully. In short, no one wants to be treated badly.

Just a couple of days ago I happen to see Mr. Bush on TV at one of his farewell press conferences, in which he was asking, rhetorically, if it isn't "pathetic" to hear or witness someone expressing "self pity". It's safe to say that, whatever else Mr. Bush may be good or bad at, he would most certainly not make a good therapist with an attitude like this. If a client in therapy were to be related to with this kind of insensitivity, aggression and arrogance, we can rest assured that the experience would be a damaging one.



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Informal Mindfulness Practice

One of the very popular "techniques" in psychotherapy today is "mindfulness". There's the very well known and evidence based successes of MBSR, or Mindfulness Based Stress Reduction, founded and elaborated by John Kabat-Zinn; there's the "teflon mind" mindfulness of DBT, or Dialectical Behavior Therapy, developed and researched by Marsha Linehan; and there are numerous other strategies and offshoots utilizing the fundamentally Buddhist practice of mindfulness, or "bare attention".

Typically when we think of these practices, we think of sitting meditation, or formally structured periods of practice, the benefits or insights related to which can then be carried into everyday life situations. There is another approach however, which doesn't get as much press, so to speak, and that is the practice of mindfulness IN everyday situations, without, necessarily, the added participation in formal meditation periods.

Consider: a successful senior executive, now in a subordinate role as a member of a task force to which she is very well suited, and for which she is supremely qualified. Since she is not the "leader" of this task force, she finds herself observing situations which, in her former roles, she would readily have addressed and guided, but in which she now "holds back", thinking her thoughts, making her judgements, feeling the sensations of frustration and impatience, but "doing" nothing. She is "forced" to observe all of this, while not, at least at times, directly acting on any of it. This is the practice of bare attention, or mindfulness.

It is a struggle for her, because she is accustomed to being in charge, and to taking the proverbial bull by its horns in order to wrestle the "problem" into a "solution". Now, she has to "sit with" situations which every fibre of her body/mind wants to "tackle". An interesting dilemma, and a wonderful opportunity in support of her Buddhist practice.

Finding a balance between form and formlessness is an essential Buddhist dilemma, as well as, in one way or another, a meaningful therapeutic challenge.



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Whatever The Problem, You're Basically Good

This is a fundamental Buddhist tenet, as contrasted with, for example, a fundamental tenet of many (most?) forms of Christianity, which declares that we are, due to "original sin", basically bad, or sinful, or in some way damaged and in need of Divine redemption. The first view allows us to belive that we can make mistakes but that we are essentially worthy. The second view allows us to believe that we can try to do good things but that we are essentially unworthy.

I'm not a theologian, so I won't spend time trying to debate or detail the subtleties of either view. As a psychotherapist though, I see the psychological, emotional and spiritual injury and damage that the latter belief system creates for oh so many people. Whatever your religion may be, or if you have no formal religion, which system of beliefs would you prefer? What if it's actually true that we are, us humans, fundamentally good, even when we behave despicably? What if our despicable behaviors are the result of a deep seated ignorance, and not of an essential evilness? I'm also not interested in debating the question of whether or not "evil" exists. Suffice to say that "evil" behavior certainly seems to exist.

The point I'd like to make, from a therapeutic point of view, is that healing options and possibilities are considerably more accessible from the first position than from the second. If I can somehow come to believe, not simply because I want to, but from direct experience, that I am, and you are, and we all are basically whole and healthy and good, then I can take better care of myself, I can allow myself to be gentler and more compassionate with myself (and with you), and I can learn to forgive myself for the mistakes I've made and for the injuries I've caused. All of these traits contribute essentially to mental, emotional, spiritual and psychological health.

I can see myself, and you, as a fallible but good human being, and I can cultivate a level of acceptance that breeds wellbeing and happiness. Seems like a no-brainer when you think about it, yet it is remarkably difficult, often, for people to do. Old beliefs, and ways of relating, do indeed die hard. This is just one reason that it is very useful to have help making healthy changes.



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An Opportunity For 2009

First, let me wish everyone a healthy, happy, blessed and meaningful new year.

We face enormous challenges in these times, personally, relationally, culturally, as citizens of the world. There is no need to list what these are. Almost everyone now is aware. There are of course, as there always are, a few people who somehow manage to keep their heads comfortably buried in the sand. Insane Nero's, fiddling obliviously as Rome burns?

Our president elect tells us candidly, and his views are backed up by the "experts", that things will get worse - economically - before they get better, and that there are no quick or easy fixes on the horizon. "Sacrifice" is now a national theme. "Vision" is another one. We have to think in terms of sustainability regarding energy, the environment and the ecology; we must re-establish America's severely compromised moral stature in the world, by removing support for torture and other heinous behaviors, for example; we must work toward basic health care, employment, affordable college education and decent housing for all; we must be willing, whenever and wherever possible, to communicate respectfully and intelligently with our adversaries.

These agendas will be coupled with, and served by, corporate accountability and political transparency. We have seen how a lack of these qualities has created disaster, at home and abroad; disaster which has touched everyone, or which will, soon enough.

In my work as a therapist, I find the parallels between personal/relational concerns and the issues that play out on the grand scale of international and domestic politics, to be striking. I'd go so far as to say that unresolved personal issues are, to a large extent, responsible for the travesties we witness repeatedly on the world stage. How can we expect skillful, collaborative, respectful relations between countries, for example, when we can't even communicate well with our partner? We can see our personal struggles as a microcosm of the very same struggles that we see occurring politically around the globe.

I invite you to use 2009 as an opportunity to do your personal work. If you are among those who hope for a better world, you will be able to make a much more significant contribution to that world by addressing your own areas of wounding and conflict. As they say, peace begins with me.



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Meditation, Therapy And Control

A client tells me that she experiences a sense of urgency regarding the need to make and sustain certain changes. These changes have to do with being able to meditate - she's a Buddhist - something she hasn't been able to do for some time now, because of a dreadful fear that if she sits to meditate and focuses on her breath, she'll never be able to stop focusing on her breath. This will, of course, drive her insane.

We talk about this sense of urgency, and desperation that she feels. We have identified that it stems, at least in "family of origin" terms, from a childhood in which she was burdened with many adult responsibilities, because the adults - her parents - were incapable. The strategy that she developed in order to ward off chaos and immanent disaster was to be able to focus intensely, and to build psychological and behavioral structures that would provide her with some sense of order and control. These strategies worked very well in accomplishing what they were designed to do, and she in fact survived the chaotic environment, and even thrived professionally, later, using these qualities to great advantage.

Now however, the baseline anxiety behind these control strategies dominates her life in ways that no longer work for her. It has gotten to the point of preventing her from doing things she wants to do in her personal, and spiritual life. What to do?

Since she is a Buddhist, we talk about meditation regularly, and a primary goal of therapy now is for her to be able to return to the formal meditation practices that she used to enjoy, without the debilitating fear of becoming trapped in a madness of breath watching. Something is going to have to change in the way she used to approach her meditation though. You see, she used to approach it the same way she approached everything else: desperately, as though her life depended on it, and with a focus, force and harshness that enabled some experience of control, but lacked real grace or peace.

To put it simply, she's going to have to practice letting go of/transforming the control, in favor of relaxing, trusting (a leap of faith, she calls it), and bare attention to her experience. She'll have to practice being considerably more kind to herself, after all.



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How Long Will This Take?

Clients often wish to know how long they'll need to be in therapy in order to get the help they want. This is an understandable question, of course. We all seem to want to be able to "get a handle on" whatever it is we're getting ourselves into, especially when it's a strange, new, or potentially scary situation. I don't know though, maybe some therapists are able to answer this question with assurance: "We'll need to meet seven times (or 107 times), and then you'll be just fine." I don't know any of those therapists however.

My answer is usually derived from my previous experience with clients, and might be something like: "Well, that's a really hard thing to know for certain, but my experience has been that sometimes one session provides something a client needs, and they consider themselves done, while I've worked with other clients literally for many years. Let's see how things go for a few sessions, and re-assess at that time."

While this might be more vague than a client had hoped for, it is, in my experience, realistic. There are simply too many variables that go into how successful, or how quickly successful, therapy will be, to be able to provide a definitive answer up front. Some of these are: therapist skill; client motivation, willingness and commitment; the nature of the issues being addressed; client's support system, or lack of it; previous experiences with therapy; age; and
defining what it is that client and therapist think the therapy is about, or to put it more succinctly, goals.

If you're considering therapy, my suggestion would be: try to remain open minded regarding how long it might last. The question itself can certainly be re-visited with your therapist during the therapy process. Initial expectations might have shifted, goals might have changed, previously unconsidered issues might be asking for attention, and unexpected benefits might be getting realized. In the final analysis, you, the client, will decide whether or not to continue with therapy.



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