Someone to Talk To

With yesterday’s guilty verdict against Michael Jackson’s physician, we’re hearing once more about the entertainer’s battle with insomnia and chronic pain and the catalog of pharmacological solutions that were thrown at the problem. It makes me wonder: What about therapy? Did anyone attempt to address his physical symptoms as signs of emotional pain? Amid all the shots and pills, did he have a mental health professional to actually, simply, talk to?

Emotional distress can and often does cause physical problems. Insomnia, for example, is a common symptom of both anxiety and depression. Physical pain can begin from illness or injury, of course, but it can also originate in emotional pain. Either way, each amplifies the other: The more your body hurts, the more upset you get, which makes your body hurt even more, and on and on.

Having someone to talk to can make all the difference. Sometimes a friend or family member can fill the role, but if not, it’s not their fault or yours. A large part of a counselor’s training is in the basics of how to listen, how to avoid unhelpful responses, and how to create a safe space for you to speak your truths, your worries, and your pain. Medication can be an essential part of treatment for both physical and emotional ailments, but it’s often not the sole solution.

 

Quick Thought: Inspiration (and an Interview)

Have you visited the Inspiration section of my site lately? This is where I collect my favorite quotes and motivational snippets. It’s good “soul” food, and I’ve added a few thoughts recently. Check it out here.

P.S. If you’d like to hear a live interview with me and you’re free tomorrow (Friday 10-21-11) between 2:00 and 3:00 Eastern, tune in at http://www.blogtalkradio.com/networkingsquared/2011/10/21/networking-squared-with-al-crawford-and-colin-mcconnell. You can also catch up with the podcast at the same site.

 

Quick Thought: You 101

Dr. John M. Grohol makes a great point: Most therapy clients see results in 12 weeks. This doesn’t mean that every problem can be solved in this timeframe (my clients working to resolve trauma, hoarding, and PTSD benefit from more time) but 12 weeks of consistent engagement with a good therapist whom you like and trust can greatly improve your self-awareness, life satisfaction, resilience, energy, and optimism.

So don’t fear that you’re signing on for a decade on “the couch”–it’s not like that anymore. These days, psychotherapy is more like continuing education–about yourself!–and you get to decide whether you’ll enroll for one semester or go for your master’s in You.

 

Can’t Get Ahead? This Might Be Why

People have basic needs–you know that. What you might not realize is that those needs must be fulfilled in a certain order. Abraham Maslow articulated this with his Hierarchy of Needs, which in its most basic form goes like this:

1. A person’s physiological needs for food, water, shelter, sleep, and freedom from extreme pain must be satisfied before s/he can give attention to:
2. Interpersonal safety, financial security, and bringing pain down to a livable level, all of which must be in place before s/he can have the energy to address:
3. The need for love and belonging, including the ability to do his or her part in a relationship. The ability to participate in relationships is essential for:
4. The need for esteem from others and self-esteem, which include being able to become competent at something (work, school, a talent) AND feel good about it.

All of the above are the basic human needs. Not privileges, not luxuries: needs. These are the needs articulated as the rights to “life, liberty, and the pursuit of happiness” in the U.S. Declaration of Independence. Only when these are satisfied can a person address the final, highest level need: Actualization, which in regular language means striving to be all you can be.

Right now Congress is dickering about money, as they so often do, and it’s come to the attention of my clients who receive Social Security that their payments might be affected by this debate. Now, on top of the issues they’re working on in counseling, they’re worried that their income might stop. Instead of spending our session time moving forward on problems in level 2, or 3, or even 4, they’ve plummeted back to Level 1: They’re afraid they’ll be homeless and hungry.

With a fear like that, all higher-level progress stops until it’s resolved. Clients who could have been two to four weeks further along in their growth spent that time plateaued at best, and some regressed.

Social Security income allows people to, at the very least, work on their level 2 challenges and hope to progress to level 3, 4, and ideally 5. For people on Social Security due to disability, that stable income allows them to concentrate on regaining their wellness. Cutting Social Security payments should not have been an option at all, and even if the debate is just posturing and they know in the end they will resolve it, that very debate process has done harm to the people whose incomes hang in the balance.

These folks have been forced to not only watch but participate in yet another installment of the soap opera we know so well: As the Legislature Turns. The actors–congresspeople who obviously have their level 1 and 2 needs met–put on expensive suits each day and perform their most ostentatious linguistic convolutions, disrupting their constituents’ pursuit of happiness while satisfying their own level 3 and 4 needs for love, belonging, and esteem. Meanwhile, their viewers–my clients and millions of others–languish in their level 1 hell until the ending is finally revealed.

So if you ever go through a period when you can’t seem to get ahead in life, get ahead of your troubles, make progress in counseling, make progress on a project, etc., have a look at Maslow’s hierarchy. It might be that you’re trying to, or being forced to, do things out of order.

 

Knowledge Heals

Identifying the problem is half the battle.

The other half is

• learning about it through books, articles, websites, podcasts, and videos;
• talking to people who “get it” (including others with the same problem and professionals who treat it);
• deciding what you believe and don’t, and what you agree with and don’t, so you can know your own mind about the problem;
• and making peace with the problem so you can keep living your life while you work at resolving, reducing, or managing it.

This is why education is such a big part of what I offer my clients, and it’s also why I’m committed to maintaining an ever-growing resources section on my website.

 

Mission Accomplished

Here’s something I wrote circa 2007 in “counseling school”–I found it as I was cleaning out old files. In this essay, I was talking only about chronic disorganization, not hoarding, but both were on my mind throughout the degree program. Four years later, I’m happy to report that this vision is now my reality.

As a mental health counselor, I intend to work with the same clientele I see now as a chronic disorganization consultant, but I will be able to address their mental health needs directly rather than always referring them to someone else. I have not yet met any counselors who focus on chronic disorganization as a specialty; many therapists specialize in AD/HD or OCD, and these conditions among others often cause chronic disorganization, but to my knowledge there has not yet been a person who began as a professional organizer and pursued a counseling degree in order to better serve the same clients. Therefore, as the first, I have the privilege of defining the mission of a chronic disorganization counselor: To provide chronically disorganized clients with a multimodal change experience by combining

• the extensive theory and accumulated wisdom of psychology,
• the empathic and client-centered emphasis of mental health counseling, and
• the practical time- and space-management techniques of professional organizing.

Since chronic disorganization is not a diagnosis but rather a non-clinical description of the symptomatology of a number of conditions, I will need to be well-versed in all of the mental health conditions that cause or co-occur with the phenomenon identified by the professional organizing industry as chronic disorganization. With this knowledge, I will be able to provide a complete psychotherapeutic treatment while retaining the paradigm of chronic disorganization as the definition of the problem.

As a counselor for chronically disorganized clients, my role will be to perform all of the functions of a counselor, including intake and assessment, treatment planning, and psychotherapy, but it will also include advocacy and psychoeducation for clients, families, and the community. I have extensive experience as a speaker and writer, so I will also continue to utilize those modalities to deliver my message.

One way in which my approach will differ from standard psychotherapy is in my intended working environment. Although I am duly warned of obstacles including managed care approval, I intend to work in my clients’ environments in addition to having them come to my office for counseling. The benefits outweigh the disadvantages, and as an organizer who has already worked this way for over 10 years, I am uniquely qualified to adapt my experience to the provision of psychotherapy in the field.

 

Too Much Therapy

Most of the time, my clients work with me once every two weeks. Some situations call for more frequent sessions and some clients prefer more time between sessions, both of which are fine. When a client asks to meet weekly or twice-weekly, though, I usually decline, and this is why: It is possible to have too much therapy.

Of course, this is mostly a luxury available to people engaged in private-pay therapy (or coaching or consulting), which puts it in the category of “nice problem to have.” Many people can’t get any therapy at all, and those who rely on insurance to cover the bulk of the cost are usually constrained by a limited number of sessions or the need for a “qualifying diagnosis.” If you’re among them and you suppose that wealthy people receive better mental health care because they see the therapist more frequently, here’s a new perspective.

Too much therapy gives you the same problem as too much food or drink: No time to digest it. The spaces in between are what make the input usable. When that input is cognitive–a therapy or coaching session, an article read, a class taken–the information is useless until your brain integrates it with everything you already know. Change doesn’t happen at the point of exposure to the idea; it happens when your brain knits that information into your existing neuronal structure AND you begin to use it.

Two weeks between sessions allows adequate time for this integration. You can start to use what you’ve learned, try out new behaviors to replace unwanted habits, notice what’s working and what isn’t, and take your head out of Therapy Land for a while (it’s a place we’re meant to visit, not live in). Then you come to our next session ready to make another step of progress in the areas you’re working on with me.

At the right pace, you’re driving the bus and choosing the destination (I help you with the route). When it’s too fast, you’re simply a passenger staring at whatever landscape the therapist/coach/consultant chooses to show you.

 

FAQ: Are therapy, counseling, and coaching different?

Yes, they are different. Want the short explanation or the ridiculously long one?

Here’s the short version: The terms “therapy,” “counseling,” and “coaching” can each refer to one or more specific disciplines, or to innumerable nonspecific practices, AND they can all refer to something either inside OR outside of mental health which may or may not require credentialing or licensure. So if you aren’t sure what a person means when s/he uses one of these terms, ask, and don’t feel bad if you’re still confused. Keep asking. It’s that person’s job to make it clear.

Here’s a longer explanation (grab a snack and get comfy):

“Therapy” is short for “psychotherapy,” which is a general term for a service provided by mental health clinicians. Outside of the mental health world, “therapy” can also refer to physical therapy, occupational therapy, rehabilitation therapy, and more. When I say “I’m a therapist,” people often (rightly) ask me, “What kind?”

“Counseling” is frequently used synonymously with “therapy,” but be aware that it can mean “mental health counseling” (a specific discipline) or any number of other types of counseling, within or beyond mental health and with or without licensure. For example, attorneys (a licensed field) are frequently referred to as counselors and their work is considered legal counseling. On the other hand, I’ve met a number of people who self-identify as counselors and then quickly backpedal when they realize they’re talking to a real one. When I say “I’m a counselor,” people are once again correct to ask me what kind. My answer is “mental health”; a few of the many other legitimate answers are “marriage,” “family,” “pastoral,” and “addictions.”

Another source of confusion is the names of specific types of psychotherapy, many of which you’ve probably heard of, such as “cognitive-behavioral therapy” or CBT (and then there are “cognitive therapy” and “behavioral therapy,” both of which are different from CBT), “psychodynamic therapy,” “insight-oriented therapy,” “talk therapy,” and on and on. Some of these are umbrella terms for others: talk therapy and insight-oriented therapy cover most types of psychotherapy for adults, and CBT and psychodynamic are two of hundreds of approaches that a therapist can use.

Some therapists use one approach exclusively; others use several according to the clients’ needs in what is called an “eclectic” approach. If I were to say “I’m a Gestalt therapist,” that would mean I practice psychotherapy using only the Gestalt model (which I don’t; I’m eclectic.) By the way, “eclectic” can mean that the therapist has the ability to draw from several approaches skillfully and spontaneously, similar to a person who can speak multiple languages, or it can mean s/he is a jack of all trades and master of none. (Great, more ambiguity.)

Coaching is another term that can mean a specific discipline (e.g. athletic coach) or something more nebulous (life coach, performance coach, financial coach, etc.). There are people who have achieved coaching credentials, and then there are people who refer to themselves as coaches by virtue of their experience or training in a field relevant to their coaching (which might be legit, although it often irks those who have paid for formal coaching training). Unfortunately, there are some who use the term with no educational or other legitimate basis, because it’s an easy-entry type of self-employment and there is no law against it. Wanna be a life coach? Poof, you’re a life coach, which is a huge misfortune for legit life coaches.

Coaches are not therapists. Some people are BOTH a coach and therapist, but being one does not automatically accord the use of the other title. A properly skilled, trained, and credentialed coach is a helping professional whose role is different from that of a therapist: A rudimentary distinction is that coaches focus on the present and future, while therapists also consider the impact of the past. When I’m working with business clients within the scope of my industrial psychology degree, I call it either consulting or coaching … but not psychology, which would confuse it with therapy.

If you think this whole thing sounds like a combination of “Who’s on First?,” a Seinfeld episode, and a fever dream, I’m with you.

 

Naked ADD

AD/HD, or just ADD as it’s often called by those who have it or treat it, is one of those conditions that causes people embarrassment or shame until they learn to accept it, work around it when necessary, and even find its hidden advantages. People with ADD learn, through often painful experience, to mask it when they’re among non-ADDers–to try not to fidget, interrupt, talk too much, talk too little, or forget things.

Tall order, and exhausting.

Which makes ADD-focused events such a treat. CHADD chapter meetings, annual events like the Michael Golds Memorial AD/HD Conference–these are places where it’s safe to let your ADD show, kind of like taking off your clothes at a nude beach. Nobody will point and laugh, or judge, or act superior, because everyone is equally, and voluntarily, exposed. When people who have it, treat it, or otherwise accept ADD get together in a group, the fun aspects can come out: spontaneity, flights of creative thought, exuberance, fresh ideas, witticisms … conversations that sound more like improvisational jazz than the orchestrated exchanges typical in the wider world. People don’t have to apologize or take offense for talking over each other; it’s not rudeness, it’s just ADD.

The normalizing, confidence-building parts come out too: Stories of things forgotten, things said and regretted, opportunities missed, feelings hurt … confessions that are most often met with “That’s happened to you TOO???” No one is “the only one” at these events. Then the stage is set for sharing ideas for managing the condition (tricks for being on time, getting your to-dos done, under-promising and over-delivering, deciding whether to use meds) and advocating for your needs and rights.

Over the past decade or so, there has been an increase in the number of adults diagnosed with ADD. Many of them come to suspect it when their children are diagnosed and they realize that they themselves had (and often still have) the same symptoms. The diagnosis can be life-changing: You see your entire life in a new light. Sometimes there is grief–”If only I had known this back then…”–and often there is relief, like the book title says: “You mean I’m not lazy, stupid, or crazy?” And there are many more great books and websites on the subject, offering the newly diagnosed adult a wealth of comforting perspective.

I help my clients with AD/HD to integrate this reality into their self-image, understand how their brains work, and find the organizational techniques that will best serve them as they learn how to manage its challenges without losing its creative and motivational blessings. Along with all of that, I encourage them to join their peer community–their neurochemical soulmates, you could say–and soak up some much-needed acceptance and support.

And since I do all of that, I get to share in the revelry at ADD events. As Katharine Graham said, “To love what you do and feel that it matters–how could anything be more fun?”

 

National PTSD Awareness Day

Today is National PTSD Awareness Day. Seems like everyone has heard the acronym “PTSD,” but do you really know what it is?

• Post-Traumatic Stress Disorder
• Caused by a (or more than one) traumatic event that generated intense fear, helplessness, or horror.
• In the news often in relation to veterans, but many civilians have it too.
• Occurs in about 8% of the general population and 10-30% of combat vets (varies by war). Chances are you know someone struggling, possibly undiagnosed, with PTSD.
• Common causes include any form of assault, victimization, disaster, or situation that put the person in fear for his or her life or someone else’s.
• Symptoms can mimic depression, other forms of anxiety, AD/HD, sleep disorders, learning disability or conduct disorder in children, and other physical and emotional conditions.
• Not a character flaw or weakness.
• Treatable.
• More info: http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
• And more info: http://www.ptsd.va.gov/index.asp