The following was written by my colleague at Phoenix Offices, Liesl Bauer Judah, LISCW. Liesl retains all rights.
Bill wrote a “why I do what I do” and asked if others wanted to do something similar….I do find I enjoy the sound of my own voice so why not! Haha here is my semi stream of consciousness-because when do I ever do anything that isn’t stream of consciousness….
So why do I do what I do?
I believe that there is wisdom in the world. I enjoy finding it, I enjoy sharing it, I enjoy listening to and helping others find what wisdom connects with them. I would even say this is the way I connect best with others. Sharing stories meanings and wisdom. We all have stories, I like to share mine, hear others, and help people write their stories. This wisdom isn’t the same for all, and people don’t always recognize their own story or recognize that they can decide on their story-who hears their story, what the themes of their story are/become. I guess these two things are what being in this job boils down to for me. Does believing that my input and perspective (wisdom and ability to help others figure out their story) make me sound slightly big headed or holier than thou- dare I say slightly narcissistic? I would like to think it isn’t that; but confidence, belief in science, and feeling competent within my own abilities and finding a path in life that just makes sense to me. The times that I think or feel “I don’t know what the hell to do with this client” makes me pretty sure it’s not me just full of myself. Although ultimately I do believe I am pretty darn good at my job.
Everything in school (college, not before!) just made sense! Of course! Given what we have learned over the past century of scientific (?!) study of psychology and personality this is what we know to be how the brain works, how our experiences and genetics all collide to create how we operate in the world. How we experience our emotions and thoughts, and behaviors. If I could go back and re do college-and yes I know I can go back and continue my education- I would have spent a great deal more time in neuropsychology and child development. No matter how many different CEUs I go to or books I read I find they all seem to say the same thing in a slightly different way, with a slight variation on the wisdom they share. The jargon and the slight variations on saying similar things seems more about how each person or group makes sense of the wisdom, makes sense of their stories, and what resonates with those who are listening. This is not to say that the different modalities we all have are not useful, it is important to have a method that makes sense to each practitioner and it is helpful to be able to share and help others develop and examine their stories in different ways because ultimately just cause it resonates with us doesn’t mean it will resonate with our clients.
Ultimately, I do what I do because there have been times in my life where I needed someone elses guiding hand to find my story, make meaning out of experiences or share their wisdom and help me find my own. Not all of these times was it in therapy, often times it was wisdom picked up here and there from my parents, teachers, friends. Through challenging times and good times but going it alone isn’t an option and I want to be that option for those who want to utilize me. I don’t know if this is what exactly you meant Bill when you asked if others wanted to write something out but here it is.
Here are the nuggets of wisdom I come back to time and time again in my practice and own life
It is what it is, it will become what we make it. I like this one so much it’s on my wall-and I have a t-shirt…
This is not to say we cause our own suffering, or choose it, as some things are more difficult than others to make them what we want. But if we practice, we may be able to work towards this acceptance of what is and acceptance of what we make of it. This is boils down to emotional management for me. We have the emotions, we should have the emotions, but we do not have to become the emotion-sometimes this is easier than others. Sometimes the emotions get in the way or interfere in ways we don’t want. Sometimes we should become the emotions and really sit with it and experience the good and the bad.
Everyone is doing the best they can at any given moment. Even if in that moment they know a better way and are just not able to do it. Motivation, ability, and opportunity provide the chance of behavioral changes-all three are necessary, all three change and shift given the circumstances and context of any given moment.
Our behavior thoughts emotions and other bodily sensations are interconnected and influence each other. We can be “in” them or we can be standing back and aware of them. There are times when it is beneficial to be in them and times when it is beneficial to be aware of them.
We get better at what we practice, our brain is built to make pathways and connections, find patterns, and act automatically. These pathways can be beneficial and adaptive, or maladaptive and unbeneficial depending on the situation. And what is adaptive for one person or one situation may not be for a different person or in a different situation. But as I said above, everyone is doing the best they can at any given moment.
Validation. Validate, validate, validate, stop validate some more. Understand that validation is not agreement, relating, or even understanding why someone did a thing. It is expressing and believing that that person had very good reasons for doing the thing, feeling that way, thinking that way, etc
Everything is on a spectrum. Depression, anxiety, dissociation, hell maybe even hallucinations. Who hasn’t thought they heard something or thought they saw something? If I was to start talking about lice, would you not be slightly more aware of how your scalp feels, perhaps imagine feeling something crawl or itch or….? I have absolutely ZERO sense if this is correct in a scientific way btw, but even if it is a long way from the neurological basis of psychosis, is it still on the same spectrum? Maybe closer to one end than the other but still experiencing stimuli that are not there? Does anyone know if there is any research on this? How would you research this. I imagine psychedelics are involved…
FIT- one of my first jobs was for FIT (Family Integrated Transitions) but I think the word FIT is extremely important for therapy. In fact it is one of the things I make sure to talk about in every first session. If for some reason, we don’t “fit” as a therapist/client it is important to speak up. I will not take it personal, and we will find someone who does because it is important to believe that your therapist is a good fit for your personality, problems, communication style, availability, culture, modality, and, and, and I could go on and on. Not every therapist is for every client, and there are different purposes to therapy at different times and I believe that it is possible to be a good therapist for someone at one point and not the right therapist at another point. Working with kids and youth, sometimes I think my main purpose is just to provide a foundation for them to return to-with or without me- in the future.
Values- Going to an ACT training was one of many moments I have experienced where it became clear that I was in the right spot. The discussion on mindfulness and living a values led life resonated with me greatly and I look forward to a time in my life where I have more time/energy to put towards training than I do right now. I liked the idea that values are a direction we move towards, not reach. They shift over our life time depending on ages and stages we are in, they inform our decisions and can help us heal. Within this framework, so many things make sense to me.
After writing this-or most of it- I stumbled across an article about communication styles, labeled high involvement vs high consideration. Apparently back in the 80s someone identified these two patterns, which seem slightly misnamed as both styles believe they are being considerate but just show and operate it in different ways. This article was exciting and resonated with me strongly and I dug into Google to see if I could find more. It was like someone had watched me from afar when I am talking with someone and wrote down what I do. It described and gave a name for something that is inherently a part of who I am, but has also been something I worry about doing and people (three total in my life) have criticized me about. It was so wonderful to feel seen in this whole new way, to gather new wisdom to pass on and share, and to understand something about myself in a new way previously unknown to me. THIS is why I do what I do, what excites me about what I do. Those moments, where I can give someone this experience. To be seen, gather wisdom about the world and to understand themselves in new ways, and old ways, to hopefully help heal a hurt.
Journaling be very helpful in understanding who we are and as a result it can foster better mental health.
Journaling is the process of recording your thoughts or activities on a regular basis. The value in doing this exercise is it often provides clarity in thoughts that may be in our minds or it allows one to visually experience and see the words that clutter the recesses of our brains.
No matter the reason for practicing journaling daily, there are many ways to do it. Some people put pen to paper. Others use electronic media to type or draw. Some people paint or make things (think of art as therapy).
Images have often been used to record important historical events. Petroglyphs depicting a successful hunt were created with charcoal from a fire. Later sharp stones were employed to make images on rocks (petroglyphs).
One of this country’s founding fathers, Ben Franklin, used a daily journal that he called a “scheme.” As part of this scheme, every morning he asked himself, “what good shall I do today,” followed by “what good have I done today,” every evening.
Successful business owners document events that take place within the business. This was a natural routine of Virgin Group owner Sir Richard Branson who used a book style journal to capture written events, drawings, and doodles.
From a mental health perspective, it can be very helpful to engage in a routine of self-reflection. Your emotions, thoughts and behaviors change and journaling is a good way to see how those changes have taken place over a lifetime or a period of time. Much like how a photo album reveals how your physical appearance has changed over time, a hard copy journal shows how your interior world has also changed.
In my personal family tree, several family members were diagnosed with schizophrenia. For one of these individuals, I had the opportunity to see drawings they completed over the course of several decades. When reviewing these it really struck me that what they drew and how they drew seemed to parallel how they lived life over time. This really helped me understand their interior world much better.
I recommend journaling to many of the clients I see in my therapy practice. Many of these clients report that they benefit from a routine of self-reflection while journaling and when shared in a counseling session there is an additional benefit to the work we do together. Journaling also helps cement the connection to and recall about important events or thoughts.
To get the most out of your journaling practice, consider incorporating three things: images, felt-sense, and words.
Images. Researchers have shown and psychological theory supports the belief that images allow for better recall of events compared to using only words. Artistry and artistic talent is not necessary so add the drawing or doodle. Any doodle will do. Thin and thick. Bold and subtle. Single color or lots of colors. Abstract and detailed. It really doesn’t matter.
Felt-sense. As you draw, doodle, or write, pay attention to your body. What body sensations, breathing changes, thoughts can you identify? Maybe a song pops into your head? What is important is what you notice and can observe without getting distracted.
Words. You may find if you combine images and your felt-sense, then words will flow easier and this will lead to deeper self-understanding or connections and aha moments. This is because you are engaging both sides of the brain. And that leads to more meaningful writing.
I recommend hardcopy journaling, that is pen or pencil to paper. For those people who are more comfortable with electronic media, there are several apps that allow various ways to record your thoughts, emotions, and felt sense. These apps can be just as helpful for some people, but they are not for everybody.
Whether you use a hardcopy journal or an electronic version, consider journaling on a daily basis to enhance your mental health and to help you make sense of your life journey.
You can learn a lot about people (and therapists) based on what organizations they belong to. Now during the time of COVID 19 pandemic, I have some time to reevaluate, why I belong to a particular organizations. I ask myself: am I getting my money’s worth? Does this membership help me become a better therapist? Are there other benefits?
Here is my attempt to answer why I joined this organization and what I need from its members.
This year, I will have circled the sun 66 times. I have been a licensed therapist since 2010 and opened my private practice 4 years before that. I have two master’s degrees. The first degree is in Public Administration. It served me well during a quarter century of developing health care policy and setting payment rates for two different state agencies.
Before that I was a Registered Nurse (oncology, and when I first started personal therapy), before that I was a member the United Auto Workers, Aerospace division as a utility worker, before that food service worker at $1.35 an hour, and before that I was a lost soul who didn’t do well in school or social situations.
Nixon’s escalation in Viet Nam and Cambodia bombing was tearing this country apart, while Timothy Leary, the High Priest of LSD was called the most dangerous man in America. The movie “Refer Madness” was my parent’s mantra and party entertainment with my friends. I just couldn’t make sense of the world and there was no one was there to help. Four Dead In O-H-I-O.
Time passed. Got married, had a baby, drove a minivan, my father died. I earned a second Masters in Counseling that qualified me to take a licensing test and now I am legally able to see clients as a therapist and bill insurance companies. A good therapist follows the law, don’t they?
Every work day I receive numerous learning opportunities. These arrive via: email, US Postal mail, FAX, or a recommendation from a colleague about a new book, a free eBook, a workbook, stress reducing coloring book, blog, YouTube video, Netflix series or movie, Pod cast, LISTSERV, and on-line training. Am I a misinformed therapist if I am not up to speed on the latest video? The latest blog? The latest lingo? Remember in person training? (meeting new people was part of the experience).
I am sure that these authors, bloggers, trainers, directors, actors, Pod casters, and Zoom hosts mean well and probably have a worthwhile message. I cannot possibly learn it all. If I could, would I remember in the moment what that grain of insight and compassion is needed? Maybe, maybe not.
To prepare for my work day, I start by pulling charts for established clients. I’m old school, I keep hard copy notes (try and hack that!). Most days the pile of charts is about 4 or 5 inches high. It reminds me of some research I once read that showed the best predictor of readmission to a psych hospital is the weight of the chart: the more the client’s chart weighed, the higher probability of readmission. What does this say about me if my clients have thick charts?
My client’s lives are not simple nor straight forward. It seems regardless of what I list on my Professional Disclosure, website, tell the insurer, or discuss with the client before scheduling an intake, I often end up in territories for which I have no or limited experience.
A few clinical examples.
A client tells me during a pre-intake interview that they have communication issues at home and at work. Seems straight forward, until during the 2nd or 3rd session when I suspect they are in an abusive relationship or religious cult and can’t get out. They self-identify as gay and BIPOC. I identify as hetero, white, and male. What do I say or not to say?
Another client tells me they have PTSD from their childhood. Between sessions they decide to move forward with bottom surgery by saying “hey, can you complete these forms..? “ I have had no clinical or legal training on what it means to put my signature on these forms. Should I refer the client, which could further contribute to their isolation? Put their PTSD treatment on hold, while I educate myself? Do I sign to forms (as other therapists do)? If I don’t sign the form will the client walk?
Another client comes in for sex and porn addiction. As it turns out they are highly dissociative and different parts have different acting out behaviors. Do I prioritize treatment for addiction? For dissociation? For developmental trauma and an attachment disorder? Where do I start? How do I coach the client to have a conversation with their partner?
Or the client who called me in crisis after their partner discovered the extent of their sexual acting out. The partner indicated some of the websites visited should be “illegal.” Turns out the client’s hypersexual behavior was part of the bipolar mania. Now the client was experiencing severe bipolar depression and was prescribed a “new” bipolar antidepressant. Based on a blog they follow, they ask about the appropriateness of the medication. I am not a prescriber, and the client has major trust issues. Can I help them navigate the Bermuda Triangle of getting conflicting information from the prescriber, the blog, and myself?
One client self-referred based on recommendations from their recovery support group. They state I am the only one they trust, yet I am unqualified to treat their presenting complaint. I worry about self-harming behaviors if I don’t continue to treat them. I worry about them because I care about them. Maybe we’ll just sit and talk and hope for the best. She asks if we can chant.
Then there is the business side of the business we are in.
Sometimes I hear: oh you lost your job and your insurance?, oh, you were paying out of pocket and now you can no longer afford my rates (partly because of your spending/gambling addiction)? Do I have to forgo income to be a therapist? Would I expect my own therapist to work for free?
Sometimes I have to say: “your last check to me want not honored by the bank”, or “you are apparently no longer covered by that insurance,” or “to continue as my client, you need to pay for session(s) for which you no called, no showed.” By seeking payment, is my middle class privilege showing up? Does it matter that the client told me they “lost high six figures” at the casino. Maybe they are being evicted.
Our profession is all about ethics, and ethical questions are everywhere. Do I terminate treatment for payment issues, when my clients ask for help? What are the ethical and legal considerations when I try to balance compassion with good business boundaries for myself?
All of this reminds me of a few guide posts that have served me well.
So to answer the question, what do I need from the members of this organization:
I visited Sigmund Freud’s London office (now a museum). One of the displays contained Anna Freud’s typewriter. In that typewriter was a letter to “John” (I’ve got the photo). Here is the content of that letter, it seems to be consistent with my thoughts.
"Dear John ..., You asked me what I consider essential personal qualities in a future psychoanalyst. The answer is comparatively simple. If you want to be a real psychoanalyst you have to have a great love of the truth, scientific truth as well as personal truth, and you have to place this appreciation of truth higher than any discomfort at meeting unpleasant facts, whether they belong to the world outside or to your own inner person.
Further, I think that a psychoanalyst should have... interests... beyond the limits of the medical field... in facts that belong to sociology, religion, literature, [and] history,... [otherwise] his outlook on... his patient will remain too narrow. This point contains... the necessary preparations beyond the requirements made on candidates of psychoanalysis in the institutes. You ought to be a great reader and become acquainted with the literature of many countries and cultures. In the great literary figures you will find people who know at least as much of human nature as the psychiatrists and psychologists try to do.
Does that answer your question?"
From a letter written by Anna Freud in. Kohut, Heinz (1968). "Heinz Kohut: The evaluation of applicants for psychoanalytic training". The International Journal of Psycho-Analysis And Bulletin of the International Psycho-Analytical Association
I would add to Anna’s list; the need for flexibility, resilience, acceptance, and comfort with not knowing.
Having said that, my question to Anna is: how do I follow your advice, while trying to make a living and cultivating self-compassion? Can you help me?
Can the members of this organization help me? If yes, I’m all in.