Relationship, Balance and Connection with Authentic Spirituality

I identify myself as several things.  I am a mom, a wife, a marriage and family therapist, a trauma therapist, a friend, a Christian.  With each part of me a commonality among all, is relationship.  I can’t seem to get away from it.  It shows up in all I do, and every part of who I am.  And at the center of every relationship I find me.  And the me that shows up varies with each relationship.  Sometimes that’s necessary sometimes it’s not….but it is what it is.  The same is true for us all.  The things we do in the presence of others, comes up….in the presence of others.  In PTI we refer to these things that we do as The Answer.  The Answer is those things we do to stay safe or stay connected in relationships.  And if we use those answers over and over, we tend to get really good at them.  And a pattern of relating to others begins.

In my work over the years I have seen another triadic relationship emerge with all my clients, the triadic relationship of emotion, physicality and spirituality.  Some clients come in dominant in one over the others.  Some come in disconnected from all three.  The use of EMDR therapy is such a natural organic tool that when used, seems to balance out this triad and clients experience more connection to their whole selves.

Many Christian clients come in disconnected from their emotions, their body, and God.  I could go into all kinds of theories and rants about why that is the case in this modern church age; but I wont.  What I will share is when we begin to integrate their spiritual concerns, worries, blocks, into the EMDR process, more happens than what they came in for.  They experience an emergence of the natural order of the triad.  They begin to experience healing in their relationships. They begin to feel connected to their emotions and their body.  And they begin to experience growth and authenticity in their relationship with God.

For a Christian, living out of their faith system means to learn how to Love God, love self, and love others.  The EMDR process is a beautiful tool that allows this to be attainable for Christian clients.

In my practice I also see a lot of people wounded by the church or by others who have identified themselves as Christians.  Sometimes these wound experiences were violent and extremely abusive.  Other times it’s pervasive emotional wound experiences that confuse and overwhelm a system with doubt.  These clients present extremely guarded and hurt in therapy.  The slow climb to trust is tedious and often times feels insurmountable for them and me.  At times it can be a struggle to even identify, “where do we begin?”.

In all scenarios though one thing remains the same; relationships.  Relationship with family of origin, caregivers, present friendships, present intimate relationships, relationship in their current place of worship and relationship with God all carry patterns.  As we notice the patterns emerge we begin to see the imbalance.  And from there, the treatment process can begin. 

In PTI one of the core principles is non-violence.  This concept of non-violence in therapy means we do not impose on our clients, we are collaborative, we are patient, we ask permission.   In my personal relationship with God, I find the non-violent principle as Biblical.  When I can keep these principles as the foundation of how I walk with people in the therapeutic journey, healing happens.   All that to say, the healing process is done in relationship.  And that starts with me.  Before they come in.  My foundation is set.  My ability to be grounded in my own trust in my relationship with God allows me to be in the present moment, in a non-violent way, with them.

My passion is to share what I have with others.  On September 7 and 8, 2018 I am launching a training on ‘Working with Spirituality in EMDR: A Christian Perspective'. In this 2 day training I will share a way to conceptualize a case through the lens of relationship. I will share tools I have used with clients that help balance out the triadic system.  And I offer a way to see and work with clients from the core Biblical Principles of non-violence.

Therapist will experience many of the tools I use throughout the training, because what I have learned through my own journey, is when I can authentically live out of my own spiritual connection, my relationship to clients is the starting point for change.  In our relationship they experience safety, security, authenticity, and a genuine care.

My guiding principles are: Be Still and Know God, love thy neighbor, let your gentleness be evident to all, trust in the Lord with all your heart, see people as a creation of God.  I hope you will join me. 

Alice

Getting Your Money's Worth

As I move into different seasons of my life I have reflected on seasons gone by to see if there is anything I can glean from my time there.  It’s interesting that as I am now more in the supervisory role I reflect on my time in the learner role.  I have often asked myself, “did I get my money’s worth?”  For me it’s a value thing.  Did what I walk away with equal what I invested into it.   I have realized it’s more about what I personally invested vs. what I monetarily invested.  The experiences where I allowed myself to be vulnerable, (not knowing), showing up in my mistakes and insecurities were the most valuable of all.  So it’s interesting that it wasn’t necessarily about the supervisor I worked with, but what I brought into the supervisory process, that made it valuable. 

Now on the giving end of supervision I see the same truth.  Those supervisees who come prepared with hard questions, wanting to explore their mistakes, who are willing to show up and be taught in their uncertainty are the clinicians who grow so much.  The value of our time together is time and money well spent.  On this end of the relationship I so enjoy the invitation into another clinician’s growth process. 

When continuing to grow as a clinician and move through hard things, get your money’s worth!

             A) Be vulnerable-  what are you unsure of, what are mistakes you may have made, what are                      uncertainties about moving forward.

             B)  Be prepared- write out your case in a conceptualizing way: history, facts, clinical opinions,                 safety concerns, legal and ethics, treatment goals, where you are stuck.

             C)  Be Teachable- take in the feedback and be curious about it. Ask questions about how to apply             the feedback. Write down the feedback and form a plan.

We are always learning and growing in our profession and often have limited time and resources set aside for this growth.  To make the most of what you have, invest wisely with vulnerability, preparedness, and teachability.

Becoming a good therapist

How do I become a good therapist?  I remember asking myself this while I was in school (truth be told I still ask myself this). Of course this is part of who I am….all about being good or even the best I can be at something.  Sometimes in my life this drive can get in my way, but in my profession it’s really helpful.  It helps me keep being better at what I do, moving forward, changing what I do and looking for different ways to do good therapy.

The longer I work in this field, the more I know “not all therapists are created equally”.   You may be saying….well duh Alice…but really, the community doesn’t always know this.  When you are hurting and you are desperate for help, you reach out trusting you will get that help.  The truth is, there are some in our profession that are not helpful at all.  And then there are some that are very helpful.  Luckily, there are researchers out there who have looked at the difference between the two.   Wampold and Imel give us a body of information in their article The great psychotherapy debate: The research evidence for what works in psychotherapy.

What Doesn’t Matter:

Theoretical Orientation – They all work

Experience – Therapists earlier in their career are actually better than those with more experience

Therapist characteristics of age and gender

Therapists rating

How many of us spend time trying to get more experience, or working hard to find the best theoretical model?  We spend a lot of time and money here.  Research tells us, at the end of the day, these things don’t matter when it comes to being a good therapist. 

What Does Matter:

Alliance - Learn to form a collaborative working alliance with a range of clients (even challenging clients)

Make it Simple – Can explain aspects of therapy effectively and succinctly

Attuned – Can recognize metacommunication happening as it happens (example picking up on body language, seeing facial expressions that are in discord with words)

Grounded- warm, accepting, empathetic, modulate own emotional response while staying focused on client and his/her problems

Humble- questioning our own effectiveness and work to improve

Understanding- offering an explanation for client distress and a means to overcome it. (why do they do what they do and how do they minimize what is limiting them?)

So if you are like me, and you want to be the best therapist you can be, spend less time doing what doesn’t matter and more time doing what does.  If you are not sure about your ability to build an alliance with all clients, get training in that.  If you struggle taking hard concepts and making them simple, get coaching on this.  If you are not very good at being attuned to clients, consider extra learning in that area. 

To summarize, to be a good therapist, evaluate how you do on what matters. Spend less time and money on what doesn’t matter, and more time and money on the things that do. 

Wampold, B.E. & Imel, Z.E. (2015). The great psychotherapy debate:  The research evidence for what works in psychotherapy (2nd ed.). New York: Routledge.

Wampold, B.E. (2016 September/October)  Can we become better therapists? Yes, we can!. Family Therapy Magazine, 15(5), 16-19.

Taking it Home

“This client is really driving me crazy.  I don’t know what to do with them anymore.  No matter what I say they have a reason or an argument for why it wont work.  I find myself dreading the session”.

Anyone else been here?  At some point in our careers we all find ourselves in this place.  Sometimes it’s with the ‘resistant’ client.  Sometimes it is with the client who is really good at asking for help….over and over and over….and only from you.  Sometimes it’s with the client who is in so much pain and hurting that it’s hard for either of you to see any light at the end of the tunnel.  What do all of these have in common?  No matter how hard we try, these are the clients that follow us home (figuratively…I hope). 

So what do we do with them? Respond vs. React.  More often than not, when these clients are in our room, one of them triggers us into our own stuff, which causes us to react out of our old patterns.  This reaction sets off a chain of events and before we know it we are in really deep, feeling what they feel, imagining what they imagine, carrying what they carry.  All of these are reactions.  For us to do our best work, we are called to empathize without taking it on.  The best way I have found to do this is with the notion of response vs. reaction.  So here are some tips on how to respond…

11)      Setting up the internal awareness- Take a moment to close your eyes, center yourself, and then imagine an object out in front of you that represents what it is with this particular client that seems to stay with you.  As you get an image of this object, keep it out in front of you and notice it’s shape, size, texture.  As you take time with this, notice if there is a color.  Then take a moment to position your arms around the object as you currently feel like it is positioned in relation to your body.  Notice how uncomfortable that feels.  When you are ready, push the object out away from you so that it is just the right distance out. Where ever you place it in the room is just right.  Now hold your hands up like a boundary and position them just how you need them to be so that the object stays out from you vs. on you.  Anchor in that position to where it feels ‘known’.

22)      Get perspective – Consult with a colleague, see if they can offer any insight on counter-transference that you may be experiencing that pulls you in.

33)      Prepare before the session – Prepare in a way that allows you some time before the client comes to ground/center yourself into the most professional and wise self you have to offer.  Do your internal awareness exercise to put the object in it’s place. Remind yourself of your clinical goals for the session.

44)      Consider your own therapy – If the issue continues, consider exploring what it is about this particular client dynamic pulls you in.  Having the perspective of a therapist to help you work through this pull can benefit you and your current and future clients.

We are all human, and with that humanity brings the pull to connect with others.  Sometimes that connection is a reaction which is unhealthy for us and the client.  Choosing response vs. reaction is a hard choice and sometimes not one that comes easy.  However, this choice lessens the consequence of ‘taking it home’ which is something I know many of us strive for. 

The Power of Why

The Power of Why?

One of the things I have realized I do in my practice is ask myself “why?” This is really a powerful question.  I remember in school they always said avoid the question why.  So my starting off with this simple but complex word my trigger some of you or completely put off others.  If you can stay for just a few more seconds maybe an opportunity will open up for you. 

When a client comes in my office I immediately start an internal question of “why are they here?”  Really this word is motivated by curiosity, and curiosity keeps me grounded and objective.  Then as they share in the initial session of why they are here I’m asking myself “why is their problem a problem?”  Then as I form a hypothesis about this I ask myself “why are they sharing what they are sharing?”

All of these ways of asking why begin forming a hypothesis in my mind to help inform my exploration and treatment with clients. As treatment begins, I continue with the “whys”. The “why” helps me with evaluating countertransference, transference, resistance, success.   Consider curiosity to help ground you in the following treatment steps.

·       Setting client goals: “why are they here?”, “Why is the problem the problem?”, “why does the problem continue to be a problem?”

·       Client Stuck Place: “Why is the client stuck in this specific way?”, “How could this problem be helpful?”, “Why would this problem have been helpful to them at some time in their life?”

·       Countertransference: “why does this client bother me so much?”, “why do I dread this client?”, “why do I look forward to this client?”, “Why am I bothered when the client doesn’t meet treatment goals quickly?”, “why do I feel relief when the client does this?”

·       Transference: “Why am I the one the client keeps calling?”, “why is the client yelling at me?”, “why did they choose me as their therapist?”, “How is what they are doing right now normal for them?”,  “What purpose doe s this serve for them?”

·       Success: “Why did they get better?”, “Why did this work for them?”

Asking the question of why and staying in a curious place can help inform every phase of treatment.  If you ask the question why and are struggling with the answer maybe be curious about that, or call a colleague and see if they can help with exploring why.  If “why” is just too difficult for you,  try “How” or “what” inserted in the same type questions and just see what happens in your treatment process. 

The Complexity of DID

The Complexity of DID

Dissociative Identity Disorder (DID) is such a complex and highly controversial diagnosis in the field.  There are many in the medical community who deny its existence and even some in the field of mental health who are skeptical.  Despite the skepticism, it continues to find its way into the DSM and into our offices.  As a professional, I admit having a mostly healthy fascination with this disorder.  Early on in my career I began focusing most of my practice in trauma, and therefore have probably seen more than the average number of clients who would fit into the category of having DID.  Once you’ve seen this disorder play out, it’s hard to hold on to the skepticism and disbelief.  Believe me!

I find it so unfortunate that a lot of the individuals with DID who come to my office, have been through years of facilities, multiple diagnosis, and various therapies which has been in so many ways more harmful than helpful to them.  Clinicians who work with trauma, specifically complex trauma, are ethically bound to know the signs of DID.  This will allow for quick, accurate diagnosis that can then make smooth the decisions of treatment planning, treatment placement, and scope of practice.  Colin A. Ross, recently published an article in the Journal of EMDR Practice and Research, about how to notice the signs of DID and accurately diagnose.  Below are the early indicators Dr. Ross identifies for when to suspect DID.  For diagnosis, I have referenced the article below for further reading.

When to Suspect DID

1.       Trauma History  - A reported history of extensive, severe childhood trauma (which does not have to be corroborated).  This trauma does NOT have to include sexual abuse

2.       Borderline Personality Disorder – Prior diagnosis of BPD, criterion for BPD currently met or subthreshold.  It is common for depression and PTSD to be comorbid with  BPD.

3.       Voices- Auditory hallucinations which are usually chronic.  The voices may or may not have names and ages and often meets DSM-IV Criterion A for schizophrenia.

4.       Blank Spells- Discrete periods of missing time lasting anywhere from minutes to days (without use of drugs, alcohol, or medical condition).

5.       Switching- Sudden changes in behavioral state

6.       Prior Diagnoses – Extensive history with the mental health system, numerous prior diagnosis often including: BPD, bipolar disorder, schizophrenia, schizoaffective disorder, PTSD, substance abuse.

Ross, C. A., (2015) When to Suspect and How to Diagnose Dissociative Identity Disorder.  Journal of EMDR Practice and Research, 9(2), 114-118.  

As you continue in your practice, learn to see the signs that further assessment is needed for the possibility of DID.  Some helpful assessments include the Dissociative Experience Scale (DES),  Dissociative Disorders Interview Schedule (DDIS) , and for children/adolescents the Child Dissociative Checklist.

Accurately recognizing and diagnosing DID can be such a relieving experience for clients.  It also helps you, the clinician, make the best possible decisions for the client about treatment moving forward.  For more information on this article see Ross, C. A., (2015) When to Suspect and How to Diagnose Dissociative Identity Disorder.  Journal of EMDR Practice and Research, 9(2), 114-118.  

The ‘Stuck Place’

One of the most frustrating things that can happen in therapy for clients and clinicians alike is getting into a ‘stuck place’.  That place where the client is reporting no progress, the therapist is running out of ideas, and a camaraderie of hopelessness can be born.  The ‘stuck place’ can also be a petri dish for clinician and client shame (also known as transference and counter-transference).   The clinician may cycle into blaming self; ‘I’m not good enough’, or ‘I’m just too new at this’, or ‘I’m a failure and should change jobs’.  Alternatively the clinician may cycle into blaming the client ‘they are not trying hard enough’, or ‘they have a personality disorder and can never change’, or ‘they just don’t want it bad enough’.   The ‘stuck place’ is that place that everyone wants to avoid, but finds themselves on occasion throughout their career. 

I’ve found that when a client and I land in a ‘stuck place’, getting back to the basics in counseling help us get movement one way or another.  Below are some strategies to help you and your clients if you ever find yourself in the ‘stuck place’.

1.       Call it out!-  Meaning begin your next session with “I feel like we are in a stuck place, and I’m wondering if you have noticed the same thing?”.  Get the client’s thoughts and feelings about where they may be stuck and strategize together on getting movement. 

2.       Reassess Client Goals – I’ve learned that one of the fastest ways to move through the stuck place is to go back to the client’s original goals.  If I cannot clearly identify what the goals are, then the next session is spent working with the client on identifying specific measurable goals. 

3.       Evaluate therapeutic Alliance – Have a conversation with the client about how they feel about coming to therapy.  Ask if they feel like the current relationship is working for them or if they may desire something different.  Strategize with the client about other options that may be out there that have not been tried (e.g. medication, other treatment modalities, more intensive services if needed).

4.       Consult – Our profession can be a lonely profession.  Having a small community of professionals whom you can meet with regularly and staff the ‘stuck places’ with, not only helps you professionally, it benefits your clients tremendously.  We are never so seasoned that another perspective can’t be helpful.

So the ‘stuck place’ doesn’t have to be a scary place, or a petri dish.  The ‘stuck place’ is actually an opportunity for growth clinically and personally as it challenges us to get back to the basics of good ole fashioned therapy.  The ‘stuck place’ creates space to slow it down and reevaluate.  So remember the next time you find yourself there, return to the basics 1) Call it out, 2) reassess client goals, 3) evaluate therapeutic alliance, and 4) consult.