A professional colleague just sent me a link to a very nice, simple but not simplistic explanation of how our nervous systems are affected by everyday life and by trauma. Let me know what you think.
Trauma and your nervous system
Category: Feeling bad
Discharge to Recharge
You can make your self-soothing activities a lot more effective by doing one simple thing first.
Most people are a little more stressed and tense now, during the COVID crisis, than usual. Some people are a lot more distressed. Everywhere you look there are articles about how to calm yourself, how to soothe yourself and your children, and how to cope and take good care of yourself.
It is a good idea to manage our stress. When we are stressed, we are not our best selves. We are less able to make good decisions. We are less flexible in our thinking. We may be short of temper or spacey and dissociated. None of these will make self-isolating, physical distancing, or working from home any better.
We can do a lot to help calm ourselves. We can breathe more deeply, do relaxation or meditation, take a warm bath, read or do crafts. All of these can be soothing to the over-stressed nervous system.
However, you can make your self-soothing activities a lot more effective by doing one simple thing first.
Think about your body’s energy system. I’m not talking about some esoteric or cosmic energy. I am talking about that energy that you use to live. You take in food and turn it into energy that keeps your tissues healthy and growing, allows you to move and think and dance and run, even to sleep and regenerate. When you are stressed your body is recruiting your energy to be prepared for the emergency. Energy is tied up in keeping your muscles tense, your gut disrupted, your thoughts racing. Your energy is being used to be prepared.
In this case, you are prepared to fight or run away from a virus.
However, that is pretty useless. No amount of fighting is going to vanquish this foe. Running away isn’t possible either. The energy of preparation is caught up in your system keeping you stressed and distressed. This is a very real manifestation of energy being blocked from moving through your body. You can turn it into obsessive thinking, excessive news consumption, overeating, body tensions and rigidity, and irritability. It can erupt in bouts of rage or crying or excessive cleaning.
Calming that distress is needed. However, you need to free up some of this energy for your self-soothing, calming activities to work effectively. You need to create an opportunity for discharge.
Please note! I am offering these simple ways to discharge energy for you to use at your discretion. Please remember that everything isn’t useful or recommended for everyone. Be self-aware and monitor yourself as you practice. You can use these with kids, too, but remember that you’ll be monitoring yourself AND them.
Effective and easy ways to discharge
Shake Your Body
Shaking your body all over is a way to discharge energy that is simple, effective, and feels good.
Start from a grounded standing position. Stand up with both feet solidly on the ground. Feel your feet on the ground, and make sure you are standing solidly on both feet. Soften your knees, so that you can feel your whole leg from the sole of your foot up to your torso. You might need to bend and straighten your knees a few times before this is clear in your mind.
Think about your feet being deeply rooted in the earth. Just for a moment, imagine that your feet have grown a long, strong taproot connecting them way into the earth like an oak tree. Imagine that you are rooted so deeply that you may bend and sway in the wind, but you will never fall over.
From this deeply grounded place, start to shake your body. You can shake starting from your arms and shoulders, shaking your head, bouncing a little in your knees. Monitor yourself; you can do a little or a lot, and what works best for you will depend on you. Shake, shake, shake, and then shake some more. Notice any parts of you that want to shake and then shake them. Shake like you are in a big wind and then let the wind settle down into a small breeze, and finally, let your shaking come to stillness.
Check in with your body and mind. What did this discharge exercise do for you? Go to How the End Any Discharge Exercise, below. After this, move into your self-soothing and comforting activities.
Twist and Growl
Start from a grounded standing position. Stand up with both feet solidly on the ground. Feel your feet on the ground, and make sure you are standing solidly on both feet. Soften your knees, so that you can feel your whole leg from the sole of your foot up to your torso. You might need to bend and straighten your knees a few times before this is clear in your mind. (You might notice repetition here…that’s for a good reason. Being grounded helps us to discharge. Every discharge activity begins from being grounded.)
Holding a hand towel or dishtowel out in front of you, begin to twist it. Let your hands really work that towel. Hold it up at eye height, look right at it (or beyond it), and twist. Narrow your gaze and stick out your jaw. Maybe make a growling noise. Grrrr! Damn towel! Damn coronavirus! Damn working from home! Allow yourself to think and say whatever angry thoughts might come to mind. Damn stress!
What else could you do with that hand towel? Shift your feet so that one is ahead of the other, shift your grip on the towel so you are holding one end, and use the towel to hit a bed or couch. Really get into the swing of it, using your whole arm, and keeping your eyes and jaw focused outward. Try it with the other arm. What is that like for you?
Then drop the towel and shake out your arms, your jaw, your neck. Let everything shake.
See if your body wants to do another round. If you are finished, head to How to End Any Discharge Exercise.
Stompa Your Feet
Start from a grounded standing position. Feel your feet on the ground, and make sure you are standing solidly on both feet. Soften your knees, so that you can feel your whole leg from the sole of your foot up to your torso. You might need to bend and straighten your knees a few times before this is clear in your mind.
Now stamp one foot. Just smack it into the ground. Notice what that feels like.
Stamp the other foot and take a moment to notice what THAT feels like. Similar? Different?
Now try stamping your feet one after the other. Really PUSH those feet into the ground, feeling your legs all the way up.
Check in and see what your hands want to do. They might want to form into fists, or even if they don’t, you can try that. Stamp your feet and shake your fists.
Now take a moment to rest, breathe in and out, and notice what you are noticing in your body and in your mind.
This might be enough discharge for you. You can check in on yourself and notice. Does my body want a little more of this? If so, continue. You can always stop whenever you want to.
To continue with discharge, re-engage the stamping and fists. This time stick out your jaw and narrow your eyes. You can say or think something like, “I don’t like this!” *
Depending on your level of privacy and how this exercise is sitting in you, you can go to town. You can stamp and shake and shout as much as you like. You can also do it just a little to try it out. Either way is effective and you are in charge.
How To End Any Discharge Exercise; forward bend
This exercise allows your body to integrate and assimilate what has been happening, and gives your mind a chance to catch up. See if you are able to stay attuned to body sensations before letting thinking overwhelm your body experience.
You will stop, rest, breathe and take in your experience by doing the forward bend. Keeping your feet planted, allow your body to hang over, letting your head hang loose, arms not quite touching the ground, and breathe into your belly there. Stay in this position as long as it feels right. When you decide it is time to come up, push your feet into the floor and allow your spine to straighten very slowly with your head coming up last. This way you minimize the likelihood of getting dizzy.
Once you come back up to a standing position, take a few moments to notice how your body and mind are doing. You may be more agitated, or angry, or you may have uncovered some sadness, or you might notice a different lightness in your shoulders and arms. Whatever you notice is your body’s response to the exercise.
Now is a good time to engage your self-soothing activities. Try lying down on the floor and letting your body rest deeply. You can use your hands to gently stroke your face, shoulders and arms, saying soothing things, or you can just let yourself be. Notice how your body naturally lets down after discharge. You may feel the impulse to turn on your side and curl up; follow that impulse, watching your body’s response. This time is about settling in and settling down.
* An important postscript about vocalizing and verbalizing while doing discharge work
It is okay to make sounds or shout out words: this is a way of discharging energy. Stomp your feet, shake your fists, stick out your jaw and narrow your eyes and say the words you want to say about this situation.
People often struggle to say out loud some of the things that they are saying in their minds. They judge themselves for the words that they say. Vocalizing is a helpful way to discharge. Use your discretion if there are other people in your house.
What should you say? Well, only you know what is in your mind, but if you want to discharge, here are some tips.
Short, declarative statements work better than long explanations. (“Stop it!”) (“Get out!”)
Stretching out the sound helps you to breathe more deeply. (“Stooooooop!”)
A long, drawn-out, loud “Nooooooooo!” will make you breathe more deeply.
I Wanted to Bake Cookies for You
I know that it is very hard to be living in this world right now. It is hard to live with such uncertainty and such rapid change. It is stressful to think about the future and to think about the past. It can be difficult to live with other people who are feeling stressed and anxious.
While I am so grateful that we have tele-health options available for our sessions, I am also disappointed and a little angry that the choice whether to use tele-health was not mine to make. I can hold those two feelings, gratitude and disappointment, and notice that it is really possible to feel both.
When I think about what you may be experiencing in this turbulent time, I want to be able to help. The very real desire I have been feeling is about taking care. In my mind, I wanted to bake you some cookies….bring you a pot of soup…..offer connection and caring and a moment of peace.
However, I can’t do everything that I would wish I could do. I cannot see you in person, and I cannot bake cookies for you. However, what I can do is offer the telehealth visits, and I can also offer a message a couple of times each week. If you are interested in seeing those messages, you can head to my resurrected blog and sign up to get a notice by email when I have posted something new. This is a small gift to you, something else to help you get through these potentially difficult days while we adjust.
It isn’t cookies but it is something.
Leslie
Who’s in charge of your life? on not letting mood dictate your behaviour
I wonder how often I attribute my choices to my mood? “I wasn’t in the mood to do the dishes,” for example. Or, “I’d exercise more, but I’m just not in the mood.” When I think this way, it is almost as if my mood is something outside of me, or something that comes over me without my awareness, knowledge, or permission. And then I give it the power to decide whether I’ll do the dishes or exercise.
Or maybe (MAYBE) I let my mood dictate my behaviors because I don’t want to take responsibility for my choices. Somehow it would not be as okay to claim the choice to sit on my couch and not do something.
We often feel like we are subject to the whims of our internal lives, as if our moods and emotions rule us. I don’t think we were constructed that way: I think that moods and emotions are information for us but they are not masters and we their slaves. But when we just react our way through our days without even really noticing our inner life, then it may feel like our feelings are running US.
How do we get out of that? How do we get to take charge of our own lives?
We first have to have awareness of our thoughts, our feelings, and our body sensations. We need to be able to notice our vitality affects, for example (energy level), and notice sensations of prickling, tightness, openness or lightness, whateer sensations are present. We need to be attuned to our own selves as well as to the world around us, and that means that sometimes we have to turn down the stimulation and just check inside ourselves.
Pay attention to the shift in your emotion, no matter how small. When you notice yourself getting more upset or distressed, ask yourself, “What am I telling myself right now?” or “What is making me feel upset?” It is likely a thought which has occurred to you. But how might you feel if that thought had not occurred to you?
In other words, how would you feel if you didn’t believe that thought?
Ah….maybe I’d feel just fine, thank you very much.
Conversely, the body can give us messages that we interpret to mean something. The other day, I felt fabulous…had just finished a long walk with a little running, was working a positive inner dialogue about my progress, was able to notice the trees, the air, the birds…all those things that contribute to my personal sense of well-being (your list will be different). Suddenly I found myself irritated at some minor frustration, very irritated. Wait! How did I get from feeling fabulous to feeling irritated? I checked in on my thoughts, my experiences, and by body sensations and yes, there it was…the tiniest little bit of aching in my groin from running. The endorphin flow had slowed, I could start to feel the work that my joints had done, it was painful though only slightly….and suddenly I was easily irritated. And probably underlying that body ache was some automatic thought…”Oh, this again,” or “Ugh, I hurt,” or “I don’t feel so good,” and so irritation happened.
Mood is a number of things but whether we let our moods dictate our lives is a personal choice. If I only did things when I felt like it, well, I’d have some pretty severe limits on my life! So I choose to watch my thoughts and remember that thoughts, mood, and feelings are all part of my body, and they all are fluid and shifting…so I might as well live my life and let my mood catch up with me.
Ephmeral Happiness
Last week, against a backdrop of horror and despair generated by the apparently premeditated shooting of RCMP officers in a nearby city, I noticed that I was able to feel happy. I was digging in the dirt, moving weeds out and seedlings into a little plot for which I have taken responsibility. I felt the sun hot on my skin, the work and fatigue warming my muscles, the damp cool earth soiling my fingers. I saw the little plants going into the ground, smelled the mulch as I spread it over the bed, felt my own sweat sliding down my back. I felt myself entirely alive, breathing, sweating, moving, thinking and aware, always aware, of the backdrop of loss and pain and suffering of the young families who lost their fathers, husbands, brothers, and sons. I felt happy.
It might seem paradoxical or just plain wrong to be so aware of my own happiness, my own contentment in the moment in the garden, with so much else happening alongside. Rather than insensitivity, I think it is being exquisitely sensitized that allows us to feel deeply into our own lives. Instead of taking on those garden tasks as jobs that had to be done, interruptions in my train of thought, I experienced them differently. I felt fortunate to be able to work in the garden, with my partner nearby, safe and healthy. I was grateful to have mundane chores to complete. I was delighted to have the strength to do the work, and the senses to take in the experience. The shootings in Moncton brought me to the edge of awareness of the fragility of life, the temporary nature of our existence in this world, the sense of impermanence. That edge allowed me to go deeply into my experience of physical well-being. Here I am, world, me, breathing and sweating and moving and digging in the dirt. Here I am, planting flowers for a future that may not even happen. And I can feel my own good feelings doing that, even though at the same time I am aware of my sorrow on behalf of others and the horror of the event itself.
And in the moment of awareness of happiness, I felt it slide out of my experience as other feelings, thoughts, and sensations took its place. I remember wondering if perhaps I “should” be feeling sad or angry or horrified, but also remembering that I don’t have control over that. I am sad, angry and horrified, and also, for that moment, I was brilliantly, exquisitely happy.
May you experience the fullness of your feelings just as they are, today, tomorrow and onward.
Traveling through time
We cannot return to the past; we can only go forward.
I had that thought this morning, pondering my life, my career, my current state. But I think it is likely that both parts of that thought are untrue.
We can go back and we can go forward, always and sometimes obsessively, in our minds. We do a lot of both. Sometimes I spend a lot of time in one place or the other, and sometimes just waffling in between. Remembering, for example, my mother’s death, or then her life, and wondering how much of my memories of her are based on “reality” of actual events in the world, and how much based on the reality of my child’s experience. And then flipping into some future where I have written about my life, and made sense of it all. And then flopping to another new future where I leave therapy as a career and do nothing, nothing at all. Or write, but somehow make a living at writing. Or reshape my therapy practice so I focus on groups and have more free time, or then I wonder if I don’t really embrace some idea I have for work, well, then, will I die feeling incomplete???
The point is that I am returning to the past over and over. I am slipping into the future again and again. And when I spend my days in those places I miss being alive. I miss what is actually going on.
Where can I find a balance so that I am living my life here and now, and also creating a future that conforms to my desires? Oh, that’s a point….all of this time travel is usually about control. It is about my desire to control my future and my rage that I could not control my past. Aha, yes, indeed.
I wonder if acknowledging that I want to CONTROL my future will help me let go of that deep desire. Actually, I don’t really want to control the future….I just want the outcomes to be the outcomes I want. It reminds me somehow of the prayers I was taught as a child. I was taught to ask God to bless parents, friends, the dog, and to keep everyone safe and happy. Somehow I believed that my supplication would protect people and keep outcomes the way I wanted them. That’s a pretty long history of wanting to control how things work out.
Maybe all I can do right now is try to limit my time traveling. Here and now can be a pretty good place. It can also be boring, sad, angry, irritable and cold. But the more time I spend in the present, the more life I am getting in my life. I guess I’ll try for that.
The meaning of anxiety
More and more, I am thinking that anxiety is about trying to cover up your feelings. You don’t want to feel whatever it is that you are feeling, so you try everything in your arsenal to stop feeling. You tense your muscles, constrict your breathing, start thinking obsessively, focus on external sensations or fill your body with too much food or alcohol or other chemicals to numb whatever is happening.
But the body doesn’t buy it. Instead, it sends you a message that something is wrong. Tense muscles, upset digestive processes, shallow breathing, racing thoughts, pains in gut and head, shakiness or trembling….all of these body experiences can connect to anxiety. Anxiety isn’t exactly fear. Fear is cleaner, has a more specific focus. But fear can be one of the emotions we try to cover up…and that can result in anxiety.
How can you recognize anxiety? It can show up as body symptoms: tensions, pain, nausea or other digestive upsets, headaches. It can show up as shakiness, foggy thinking and an inability to concentrate. Or it can appear in disguise. This is what happens when our defenses against anxiety are working to keep us from feeling it. So, for example, I tend to make internal lists, develop complex plans for my future, create diet and exercise and frugality hell for my body to live in. I have learned to recognize that my mind uses these tools to defend against my anxious feelings. When I am doing a lot of rigid planning and programming for myself in my mind, I know (in some other part of my mind) that I need to look deeper. This is one way that I manifest anxiety.
You might have racing thoughts. Or worrying. Or obsessive ritualistic behaviour such as around cleaning, or working out, or making contacts with people. Or avoiding contact with people. Many different behaviours can be manifestations of anxiety because we learn very quickly to make associations. That is, if we engage in a behaviour and experience a lessening of the uncomfortable feelings of anxiety, then we are pretty likely to engage that behaviour again. Sometimes it is almost as if the behaviour IS the anxiety; so we think our racing thoughts ARE anxiety. But really they are an attempt to cope with the body sensations that are unpleasant.
Learning to live with emotional discomfort is just as useful as learning to live with physical discomfort. We don’t have to happy, contented, or relaxed ALL of the time. Allowing ourselves to feel what we feel, experience what our body is experiencing, and just being present to it….well, that’s a great way to be really alive.
How do you do that when you have only ever run away from your feelings? Yes, that’s the hard part. It helps to remember that you are just going to be FEELING something…and feelings, like thoughts, come and then then go. And it helps to remember that nobody ever died from just feeling something. Watching out for catastrophic thinking helps too….thinking thoughts like “I can’t stand this” won’t make it easier to actually stay right with that feeling. So when you feel a bit anxious, see if you can give yourself some time and space to just ask what might be there under the anxious feeling? What else is there? Allow yourself to breathe into your belly, and feel your feet on the ground, and ask….what is this about? What do I notice in my body? Oh, yes, this sensation in my belly, and this one in my chest….oh, THIS…this is sadness….(or anger, or fear or whatever…). Then watch that felt sense with kindness and compassion and some curiosity…oh, yes, this is what I am experiencing right now….THIS is it. And watch it as it shifts and changes, and notice what that is like for you. Giving yourself time and space and permission to have feelings can make a big difference.
The huge benefit to allowing ourselves to fully experience our uncomfortable, unfamiliar, or unpleasant feelings is that ALL of our feelings become more accessible. When you experience your own integrity, where you are not hiding, covering up, or showing off your emotions, you feel yourself more solidly on the ground, and more real in your body. And that’s what life is about…being here, in this body, in this moment, right now.
You are a human being. You have a whole range of feelings as your birthright. Don’t live your life halfway: feel them all!
What’s wrong with positive thinking?
Positive thinking is fine. There is nothing inherently bad about it. Usually when people refer to thinking positively, they are actually experiencing unpleasant thoughts….thoughts that might create imaginary catastrophes, thoughts of criticism or judgment, or just overt pessimism. Those thoughts generally don’t lead to better outcomes, so people want to change them. And that’s okay.
If all it took to recover from traumatic stress was positive thinking, we’d probably all be just fine. And therapists like me might have a lot less to do at work.
There is a lot that happens in our thinking. And there is also a lot that happens in our minds apart from our conscious, word-based thoughts. That’s where the over-simplification of “positive thinking” starts to fall apart.
What else is in there? If you sit, quieting your body and breathing and just noticing your mental activity for a period of time, you’ll become aware of the constant overlapping parade of ideas, words, memories, anticipations, and images that are flowing through your conscious mind. Then you might be able to start to notice the spaces: can you find space between the discrete items in that steady parade? Then, over time and practice, you might notice specific types of items in your continuous mental flow, or you might focus on paying more attention to the empty space, allowing stillness to come into your mind as well as in your body.
This practice helps us to become more acquainted with the contents of our minds, and helps us to access some things that we may have been avoiding or simply not noticing in the chaos of the untrained mind.
The danger of “positive thinking” is that we might use it to avoid looking deeply into ourselves, to pack away uncomfortable feelings and memories, to try to keep ourselves from feeling sad, for example, or angry or afraid. While there is certainly some short-term utility to that approach, in the longer term we end up cutting off parts of ourselves.
Wow, that sounds brutal! But what might it actually look and feel like, to have cut off parts of yourself? Well, one example might be that you have very poor memory for parts of your life. Or you may only experience a very restricted range of feelings: you feel happy, sad, angry or afraid, but only a little bit and you wonder what all the fuss is about, when other people seem to experience their feelings more powerfully. Or you just feel slightly anxious much of the time, with no apparent reason. Perhaps you everything in your life looks just fine from the outside, but you feel like something is missing….but it is embarrassing to say that because your life is “just fine.” These are all possible indications that you are out of contact with parts of yourself.
Looking deeply into ourselves, staying with the thoughts, feelings, and body sensations that arise, can be an act of great courage. Really experiencing our experiences, whether we label them “good” or “bad,” “positive” or “negative,” or (my preferred label) “pleasant” or “unpleasant,” allows us to find the hidden parts and embrace them.
Positive thinking isn’t bad, especially if you are trying to change a pattern of catastrophizing, what iffing, or shoulds. Using it to numb us to our uncomfortable thoughts and feelings can keep us stuck in our old patterns, though. Be aware of what you most want to avoid…there is usually something of value there!
Happy Spring!
Knowing by slowing…
Body psychotherapy isn’t as odd-sounding as it once was. People are beginning to understand that the mind and body are not really separate, that there are tissues in the gut, for example, that are much like brain tissue, that emotions are experienced at the body level, and that even those classic “psychological” problems of depression and anxiety are body experiences. The mind of course is part of them; the kinds of distorted thinking that we engage in when we are experiencing depression or anxiety can most certainly make things a lot worse. But I am not sure that the chicken-egg question matters here….I personally don’t care if how you feel affects how you think, or if your thoughts are affecting your emotions. The point is that things are pretty bad, one way or another, and how can you live more comfortably?
So it is obvious, I guess, that developing awareness of what you are thinking can make a difference. You can even change your habits of mind. You can also change your habits of body, and your habitual ways of responding to situations, and those kinds of changes can be most helpful in trying to cope with symptoms of depression or anxiety.
Self awareness is the key to any kind of change. You can’t change if you don’t know what you are currently doing. And the key to self awareness is, for many of us, slowing down. Slowing our everyday experiences so that there is time for self-reflection, slowing our thinking, so that we can become aware of thoughts as they arise and fade away, slowing our behaviour so that we can become responsive rather than in the perpetual knee-jerk of reaction.
What happens when you slow down? Just take a moment to notice what happens….without judgment, without struggle, with compassion. For many of us, slowing down generates negative thoughts (“this is unproductive,” “I”ll never accomplish anything,” “Does she think I’m not a busy person? I don’t have time for this nonsense.”). For some people, the open space of unstructured time feels uncomfortable, as if you should DO something. For some, a bit of quiet allows us to feel our exhaustion, the fatigue that comes with forever and forever keeping up a front, being frantically productive and chronically stressed.
But without judgment and with compassion, what is it like for you to take time and space to just be? What do you notice about yourself? Who are you, really, when you separate yourself from the story inside your head?
Wherever you are is the place to work. Notice sensation in the body. Notice what you notice in your environment; what are you sensitive to in this moment? In the next moment? Notice thoughts as they arise and fade out. Notice which ones tug hardest on your attention. Notice more sensations in the body; try moving, and notice what that is like. Can you feel the desire to move, the intention to move, before you manifest that intention into action? Where in your body are you aware of that intention? How do you KNOW, in your body, that you want to move?
The ethics of “crisis-management” therapy
I was thinking about practicing psychotherapy. Okay, I think about that a lot, and discuss it with my colleagues, and read about it and of course I also spend a bit of time actually practicing. I recently heard Randy Patterson talking about processes in therapy, and one of his thought-provoking questions was about therapy drop-out. What proportion of clients leave therapy before attaining their goals?
Apparently most practitioners will estimate about 20-25% but they will be wrong. The actual, documented typical drop out rate is more like 75-80%. So that includes the people who come once and don’t like you or the process, and also the people who work hard in therapy, start to feel better, but leave before actually accomplishing their goals.
I was just like the rest of the herd: roughly estimated that about 20 percent of people who come to therapy drop out. Upon reflection, I can see that the drop-out rate is a lot higher. Many people in therapy accomplish a lot even though they may not meet their goals, such as to no longer be depressed, or to get through a difficult situation. So even without meeting a goal, it isn’t therapy wasted. In fact, even for people who only come once or twice, the time, money, and energy are likely not wasted. When the client leaves, it may be that the process wasn’t meeting some need at that particular time, or that competing needs pushed therapy out. And in reality, the client’s goals might never actually be discussed, or defined. So the entire process, therapy, outcomes, termination, all of that might be very murky for both client and therapist.
But all that talk is just prelude to my title thought. People do leave therapy in various ways; leave angry, leave silently, leave with congratulations and great hurrahs for accomplishments They also return, and they return in various ways. If they leave in a way that feels okay to them, it makes it easier to return. And the other circumstance that makes a return to therapy easier is extreme distress.
It is not uncommon for clients to come to therapy in distress, get some relief, and, just as the therapist thinks it is time to really begin the actual THERAPY, the client leaves. Well, she got what she came for, which was relief. The problem is that if the underlying behaviour or thought pattern hasn’t changed, or maybe even hasn’t come into her awareness, she’ll likely be in a very similar distress again. So she returns to therapy and has a few sessions; feels quite a lot better, either due to the intervention, or to a change in external circumstances, or to that old placebo, time. So she leaves again…..only to return another time. Lasting change hasn’t happened; there has been, perhaps, a series of band-aids, or (better image) a step-wise movement that may be more lateral than progressive.
Is it okay to keep using band-aids when therapy might actually generate some real change ? Who makes that call? What does the ethical therapist do with this?
I don’t have an answer. Part of me thinks that it is disingenuous to just keep on with supportive counseling when I believe that a deeper, more focused type of work will be helpful in the long term. But another part of me acknowledges that for many people, symptom relief is a good thing and is sufficient. So whose goals are important here? It doesn’t make sense that my goals for your therapy should supersede YOUR goals for your therapy. But you also have less experience with therapy than I do, and you might not know what is possible.
Reflection tells me that I probably have to be honest with clients and tell them how I see it….that there is hope beyond just immediate relief from distress…but that the immediate gratification may not be there. Longer term therapies, like bioenergetic analysis which helps to restructure personality, or trauma treatments which heals through restructuring of distorted memories, can have outcomes that make a huge difference to the person. The path to those outcomes isn’t a smooth one, though, and often the courage it requires to take that path is hard to come by. So I can understand why someone might decide to use counseling as a symptom relief measure.
So ….. whose agenda, whose goals? Is feeling better a good enough goal for therapy? or do we have a better chance of getting change when we set goals that are more clearly defined??
These are some of the things I ponder. If I don’t find an answer, I usually look for chocolate. Which, in its way, performs the same soothing and comforting role as supportive counseling. Chocolate for everyone! Then back to pondering the deep thoughts.
A Body Psychotherapist's Journal 