Stuckness

Dealing with Uncooperative clients…

As a new grad, I’m currently waiting for my PLMHP license to complete approval process by Nebraska DHHS before I can begin my new job in the meantime, I’m completing this new employee clinical training manual.   In one section it describes the uncooperative client who is unwilling to participate in treatment but often required to do so as a court-order (Capstone, n.d.).   “…Extroversion, assertiveness, empathy, honesty respect and openness, have been identified as the most important aspect of getting the uncooperative client to come around and begin working with the threapist” (Capstone, n.d.).  What follows are tips from my clinical training manual to work with involuntary clients…

  1. “Joining/Empathy: The therapist empathies with the feeling of being forced to come to therapy” (Capstone, n.d.).
  2. “Substitute a mutually acceptable goal: With the involuntary client, find something else the client does want to work on and demonstrate usefulness of psychotherapy in that area” (Capstone, n.d.)
  3. Family Therapy:  The biggest trap in family therapy is to take sides.  The therapist must remain above blaming and keep attention on how weveryone will ahve to adjust to the problem being gone” (Capstone, n.d.).
  4. What is of greatest importance is that you do enjoy your work.  Try to understand the client’s resistance, shift the responsibility towards the client for their life, don’t work harder than they are.

 Click here to read about what I learned from resistance from my internship at a substance abuse recovery center.


Click here to read a post on resistance as it is defined within the framework of motivational interviewing.


Click here to read my attempt to describe the differences between coercion and confrontation as it occurs in therapy.


References

Capstone, (n.d.) Clinical Skills & Clinical Skill Enhancement. Capstone Behavioral Health.
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An Underdog’s Credo: “Choking vs. Panic”

As I mentioned on the welcome page of this blog, it’s taken just over five years for me to get it up & running. 

I honestly can’t tell you how many times I’ve attempted to start a blog, only to stop just shy of “going live”.  It wasn’t until I actually decided to go back to school, that I finally gave up on the idea.  I reasoned with “so much on my plate”, there just wouldn’t be any time.  I shoved all my ideas and well-laid plans into a few storage bins.  They remained there until late last 2015……

My goal for this blog, has simply been to finish what I start and cross something off my bucket list. I’m proud to say, I finally succeeded in producing forward motion in the direction of this goal.

I’m actually making slow and steady progress in the direction of my goal.  I regularly dig through these old storage bins in the back of my hallway closet for another source of “inspiration”.   While I’m grateful to not be stuck anymore, its taken me some time to understand exactly what was stopping me to begin with….

FIRSTLY, “What stopped me?”

Transactional Analysis on Stuckness…

attachment 3My therapist has nesting dolls in her office, and utilizes them to illustrate various ego states from transactional analysis.  When initially considering this issue of stuckness, my therapist’s nesting dolls came to mind.   Resistance from this theoretical perspective can be “explained as a battle between inner parts: one part wants to change, while the other does not…” (Ingram, 2013, p 234).   According to transactional analysis, within us exist ego states that represent experiential realities from various stages in life.  Within each ego state is a typical coping style or pattern of relating to those around us. As I recall, two in particular have been engaged in a perpetual lifelong battle….

My Hurt Child

The child ego state can be thought of as an inner mental recording of painful childhood experiences.  When encountering triggers that remind us of these events, we’re sent back in time.  Emotionally, we can re-enact these early experiences with those around us. For example, within me lives a “hurt child” who was bullied kid and had no friends.  This hurt child asks, “I know I am bad; what’s wrong with me” (Ingram, 2013, p. 295).  She is submissive, insecure, with no sense of self.  Filled with a sense of shame, she seeks validation and acceptance from others – wherever she can get it…

My Critical Parent

The parent ego state reflects messages we receive from authority figures in our lives and standards of conduct we were taught.  My own critical parent, consists of messages from my parents that emotions were bad and creativity was a waste of time.   My critical parent consists of message from parents and teachers who ignored and overlooked the bullying.

My critical parent might say “you should take those pounds off. What’s wrong with you?! Your an indulgent loser (Ingram, 2013, p. 295).”  
My hurt child will be filled with feelings of insecurity as a former “ugly duckling”.  Shame takes over in reaction to the random characteristics that happen to define my meatsuit

Malcolm Gladwell: “Choking vs. Panic”

The insights from transactional analysis described above, are useful in developing a historical context for my history of life-long stuck-ness.  Underlying this perpetual resistance was unresolved trauma, that I would later come to understand as PTSD.  Still, I have more questions:

In particular, how can I be certain I won’t get re-stuck? After all, the PTSD isn’t going away, and the triggers are still there….

Today, after “clocking some hours” at my internship site, I decided to dig in those old storage bins, and do more blogging.  As an INFP, I find it is a relaxing activity at the end of a long day.  Serendipitiously, I happened to come across Malcom Gladwell’s titled “The Art of Failure”.  In it describes the differences between choking & panic:

“If panicking is conventional failure, choking is paradoxical failure. (Gladwell, 2000)”

In order to explain what is meant by this statement, it is important to first understand the difference between explicit and implicit learning:

EXPLICIT LEARNING:   commonly utilized with novices and involves the conscious utilization of intentional focus & deliberate action.  For example, I don’t play golf, and if somebody teach me, I’m paying attention to the particulars of how to hold the club.

IMPLICIT LEARNING:  common with experts and occurs at a subconscious level, outside one’s awareness.  An unexplainable knowing guides our process, and we’re kind of “in the zone”.  I do this when I play the violin.  I’m not paying attention to the music, I’m not really aware of how I hold the violin or bow.  My fingers somehow know what to do.  My attention is instead on the music and playing what I hear and feel within me.

Choking:  Thinking To Hard

Choking is a paradoxical failure that comes when we are expected to perform and our brain freezes. This happened to me whenever I had a violin recital.  My teacher liked to schedule them at the local churches on Sunday.  Since we lived in a small town, it was inevitable that a classmate, (or two), were present.  As a bullied child, I was pretty much a social leper.  Fear rushed through me, and I my mind completely froze as a panic overcame me.  I tried so hard to do my best, I paid attention to my fingering, and tried focusing on the sheet music before me.  It never worked, I was “overthinking things”….

Panic: Not Thinking at All

With panic the fight-or-flight system takes over and we begin acting on adrenaline and instinct.  Whereas choking is about loss of instinct, panic is a reversion to instinct.  When we panic, we focus only on our end goal, and can’t generally see beyond our fear.  It is conventional in the sense that it is a byproduct of knowing being thoroughly educated in how to handle a situation.  For example, my son went into cardiogenic shock as a child, d/t an undiagnosed heart defect.  I panicked yet somehow managed to make it to the hospital – by the grace of God….

SECONDLY, How can I know it won’t happen again?

attachment 2I’m finally reaching the end of my educational journey, and look forward to launching a new career. The road hasn’t been without its hitches.  I wonder, from time to time, if I’m hitting stuck-ness again. Recently, I started my first internship class, and found myself teaching five group therapy classes independently.  The first few weeks were quite rough and riddled.  However, I’m relaxing into the role.   I have to admit honestly, there isn’t anything  I can look to for a guarantee I won’t get re-stuck.  Only a personal commitment can do that:

An Underdog’s Credo…

I am an underdog.

An underdog is an unlikely hero who rises from “modest beginnings” despite mounting challenges.  Overcoming “less than” conditions with few expectations of success at the outset I have stuck with it like a turtle.  Slowly but surely I’ve moved towards my goals.

I stick my neck out.

As that little engine that could, I overcome self-imposed limitations, and messages from everyone who doubted me.  I choose today to meet insecurity head on with passion and determination.  This happens everytime I chose to not let past mistakes define me.  I have faith in my abilities and the motivations driving me forward.

I have everything I need to get there.

Like Dorothy and her ruby slippers, I have everything I need to make things happen, I just need to believe in myself.  I now realize the key to empowerment is self-responsibility as I decide to critically examine my own self-imposed idiocy.  I become what I believe I am, and get what I believe possible.

I commit to owning my truth.

There’s more than a grain of truth to the saying that we perpetuate what we deny.  Owning my truth means understanding how I exist as a creator of my life.  If I do become what I believe I am, what do I believe I am?  If I become what I believe is possible, what is possible?  Where did these messages come from???

I understand that stuckness is a matter of my own doing & opportunity for personal growth.

I’m not running from somewhere or going to anywhere.  I’m at peace with where I’m at.  Stuckness for me has been a byproduct of a failure to understand the motivational forces goading me forward.  When based on insecurity and a desire to prove myself worthy, I end up creating more to be insecure about.  Today, I’m in a different place.  I’m content with where I’m at.  I’m good enough as is.  My life is splendid and I have a lot to be grateful for.  I flow in the direction life takes, and face every day fully present, and see it as an opportunity for personal growth.

I choose opposite action away from old habits & towards my personal goals.

The good thing about making mistakes, is you have them as a template for what doesn’t work.  I’ve gone down that road, where old habits, and personal insecurities have taken me.  The benefit of 20/20 hindsight is the clarity that comes with m extricating my head from my rear.

I do not fear failure, it is an opportunity to grow.

Insecurity is no longer a ruling force in my life.  I don’t fear failure since it no longer equates with the idea that I’m a “loser”.  I also don’t equate success with the idea of being a “winner”.   My value is independent of any success vs. failure tally.  Failure present an opportunity to learn.  Success presents an opportunity to reflect upon the journey to “here”.

I’m not worried about the goal itself, I focus instead on the journey.

My mother has a saying she likes to repeat often that “its not the journey but the destination that matters”.  I love this statement, and live by it.  Focusing on end goals, takes us away from the present. In the end, the present is all we have.  There is too much in this moment I have to be grateful for, I hate the idea that anything might take me away from it…

References

Gladwell, M. (2000, August, 21)  The Art of Failure. Retrieved from:  http://gladwell.com/the-art-of-failure
Petriglieri, G. (2007). Stuck in a moment: A developmental perspective on impasses. Transactional Analysis Journal. 37(3), 185-194.

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Coercion & Confrontation….

This post continues with a ‘train of thought’ I left off at with my last post titled ‘Understanding & Handling Resistance’

Confrontation & Addiction Counseling…

Recently, in the ensuing stress associated with a 70+ work week, I decided to meet up with my long-time therapist (even therapists need therapists).  As I began describing my internship experiences, she gave me a cursory overview of addiction counseling’s history.  In my last post, (link above) I make the following comment:

Defined as “process by which a therapist provides direct, reality-oriented feedback to a client regarding the client’s own thoughts, feelings or behavior” (White & Miller, 2007, p. 2), therapeutic confrontation has a long history in the field of addiction counseling.  Historically, this counseling style was utilized in chemical dependency treatment to overcome denial & resistance (Policin, 2003).  Aggressive confrontational styles like “Synanon’s attack therapy” Pokin, (2003), were utilized to break down the defense mechanisms underlying an addict’s utilized to deny their problems.  White & MIller (2007) described this confrontation as a highly varied form of confrontation ranging from “frank feedback to profanity-laden indictments, screamed denunciations of character, challenges and ultimatums. (p. 2)”.

Honestly, as described above, I’m really troubled by an approach like this.  Rather than encouraging change through personal growth and increased insight, it sounds very shame-inducing.  Admittedly, there are many aspects of addiction that are infuriating for addiction counselors.   After all, Substance use disorders encompass a complexity of physiological, behavioral, and psychological symptoms.   Physiological dependence is a byproduct of alterations in brain function due to prolonged exposure to an addictive substance, which produce strong cravings and withdrawal symptoms. Psychological components can include self-destructive patterns of behavior, poor self-control and ineffective coping skills.  Treatment is rather complex as a result.  In addition to addressing any long-term health issues, it is also essential to manage physiological symptoms of withdrawal. Addressing a client’s ambivalence to addiction treatment is complicated in light of these multifactorial issues and any lingering cognitive deficits.

So what is Coercion?

“The crux of coercion is to motivate the patient to comply with addiction treatment by enforcing consequences” (Sullivan, et al, 2008, p. 36). In examining the ethical nature of such practices, it is useful to consider the instances in which coercion is used throughout treatment. An obvious example of coercive treatment includes situations in which drug users are given a choice between treatment and penal sanctions for crimes committed (Stevens, 2012).   Less obvious instances include staged interventions, contingency contracts, and pharmacological coercion via Antabuse (Sullivan, et al, 2008).

Ethical Considerations

There appears to be much controversy surrounding the issue of coercion in substance abuse treatments. Those who oppose coercive treatment techniques state that these interventions are a violation of an individual’s personal liberties, and right to informed consent (Sullivan, et al, 2008; Stevens, 2012). Advocates, however point out that “few chronic addicts will enter or remain in treatment without some external motivation, or legal coercion” (Sullivan, et al, 2008, p. 42).   At first glance, I find legitimacy in both perspectives.

Proponents of Coercive Interventions

On the one hand, it is clear that long-term use of addictive substances can produce cognitive deficits that interfere with one’s ability to participate in the treatment planning process. This fact alone seems to support the notion that some coercive efforts may be called for, (including the less obvious forms discussed earlier). Some proponents stress that it is a duty to act on behalf of those who are impaired to make treatment decisions (Marlowe, et al, 1996). From this perspective it is presumed that “once treated the individual will be grateful in retrospect for the intervention” (Marlowe, et al, 1996, p. 77).

Critics of Coercive Techniques

In addition to violating an individual rights, critics counter by stressing the fact that treatment is often ineffective if the individual is unmotivated to change. The Transtheoretical Stages of Change Model, is in fact a great illustration of this and provides a useful perspective that allows us to assess a client’s level of ambivalence to change. Instead, helping the client increase their level of motivation to change is preferred (Sullivan, 2008).

Cultural Considerations

One resource provided an interesting discussion of cultural considerations pertaining to the use of coercive techniques that is also relevant. Collectivism and individualism each provide different perspectives of one’s “self” in relation to others, that is likely to determine effectiveness of such techniques. Individualistic societies promote the idea of self-responsibility, independence, and autonomy (Sullivan, 2008). As a result, from this perspective the individual is perceived to be responsible for their addiction, and coercive techniques are often less effective. On the other hand, collectivist societies provide a different view of the “self” as part of something greater.  Individual well-being is a societal concern and coercive techniques are often much more effective. However, “collectivist families can also impede recovery if the group perceives drinking or drugging behavior as normal or an indication of weak character” (Sullivan, 2008, p. 44).

Conclusions.

Regarding the utility of coercive techniques, Marlowe, et al, (1996) notes that many of the less obvious forms of coercion, often involve forms of negative reinforcement. In fact throughout the treatment process are coercive influences that involve an “escape or avoidance reinforcement schedule…[in which] the aversive stimulus precedes the target event” (Marlowe, et al, 1996). With this in mind, Marlowe, et al, (1996) suggest that a comprehensive assessment of coercive influences may assist treatment planning. In fact, when reading this resource I’m reminded very much of behavioral therapy. The use of naturally occurring contingencies that influence one’s behaviors and decisions is common throughout treatment. If utilized in this way, I’m not against the coercive influence of a contingency contract, or staged intervention, as described by Sullivan, et al. (2008).  However, I’m very “wet behind the ears”, and my thoughts on the matter are likely to change as time progresses….

References

Marlowe, D. B., Kirby, K. C., Bonieskie, L. M., Glass, D. J., Dodds, L. D., Husband, S. D., & Festinger, D. S. (1996). Assessment of coercive and noncoercive pressures to enter drug    abuse treatment. Drug and Alcohol Dependence42(2), 77-84.
Polcin, D. L. (2003). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. SUBSTANCE USE & MISUSE, 38(2), 165-184.
Stevens, A. (2012). The ethics and effectiveness of coerced treatment of people who usedrugs. Human rights and drugs2(1) 7-16.
Sullivan, M. A., Birkmayer, F., Boyarsky, B. K., Frances, R. J., Fromson, J. A., Galanter, M., & Tamerin, J. S. (2008). Uses of coercion in addiction treatment: clinical aspects. American Journal on Addictions, 17(1), 36-47.
White, W. & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12-30.

 

 

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Understanding & Handling Resistance

As a student therapist, I am spending about 20+ hours a week at a substance abuse treatment center.  The biggest lessons I’ve learned thus far, pertains to the nature of resistant as it appears within addiction.   Since understanding this concept is critical to my effectiveness, I’m stopping to reflect upon what I’ve learned thus far….

From The Client’s Perspective…..

Last week at my internship site I was leading a therapy group for individuals struggling with addiction.  At one point, during the session, someone asked me “what do you think of all of us?” This followed an exercise on awareness that required participants talked a bit about the consequences of their addiction.  With the spotlight faced squarely upon me, everyone awaited silently for my response.  I knew what I wanted to say, but was nervous in my ability to communicate it effectively.  Starting off with a desire to put myself in the client’s shoes, this is what I hoped to convey…

I wanted to acknowledge their overwhelming sense of shame about what they had done, & how this made forward motion difficult. 
I tried to let them know I understood they were struggling without their coping tools.  I was aware of the full-on rush of thoughts & feelings came with this…  
I hoped to convey empathy for their traumatic histories as well as the daily struggles that made quitting so difficult…

A perplexing mix of empathy and gratitude filled my mind.  While my heart went out to them, a need for radical acceptance, opposite action, and responsibility lay before them.  My mind floated toward my own pathway of recovery & healing.  I was grateful for the long road to toward this present moment.  I’ve really come a long way.

Paradoxical Dualism – Subjectivity & Objectivity

As I see it, a perplexing dualism exists within the counselor’s mind while providing therapy.  On the one hand, you have a Rogerian unconditional positive regard as an essential element in the therapeutic relationship.  On the other hand, you have the sort of confrontational style found with addiction counseling’s history.  Where is there a middle ground between these extremes?  In today’s medically-based climate, objective analysis of presenting symptoms is emphasized.  Adding to this is is the attitude of individualism prevalent in Westernized medicine.   As an INFP, I gravitate toward empathy, understanding, & validation.  As a biracial individual, multicultural sensitivity is a priority.   Is the pendulum swinging away from these things as it pertains to the practice of therapy?

From clinical perspective resistance to recovery is as infuriating as it is perplexing.  Effective solutions to escape the miseries of addiction are available  What is preventing them from utilizing these tools?!?!

Not surprisingly, this question is reminiscent of the  “Why don’t you just leave?” response I got from my family during the “it years”. Its so hard to understand what it is to “live the problem”, when you’re outside it from a safe and objective distance.  Unresolved baggage from childhood traumas, produced a shame-filled reality wherein I was worthless – unimaginable to outsiders.  The “I need him” mentality brought about by prolonged ostracism was difficult to understand.  Emotionally, I felt lost with nobody in my corner.  I needed someone – ANYONE – to love me…..

…So how can one begin to step outside the empathist’s hat, and begin to develop a discerning clinical judgment on the matter of this perplexing resistance, that allows you to prolong & magnify misery when healing solutions exist within one’s reach? My first answer to this question came in the form of insights from the “SASSI-3”

Measuring Resistance – SASSI3

“SASSI” stands for “Substance Abuse Subtle Screening Inventory”.  It is utilized in intake evaluations at the inpatient substance abuse facility I’m interning at currently.  This brief self-reporting instrument helps identify those who are likely to have a substance abuse problem (sassi.com, n.d.).  Of relevance to this post, are a few “subtle scales” which don’t have a direct bearing on substance abuse behaviors, but are useful for making”inferences” (sassi.com, n.d).  I describe a few interesting subtle scales below:

“OAT” Obvious Attributes

“OAT Scale scores measure the extent to which an individual endorses statements of personal limitation…low scorerers are likely to be reluctant to acknowledge personal shortcomings. (Miller, Renn & Lawzowski, 2001, p. 3)”.  As I understand it, this score reflects characteristics of our temperament that can either function as strengths or areas of growth.  Low scorers are more prone to deny their shortcomings.  Miller, Renn, & Lazowski, (2001) suggest that “it is not useful to agree or disagree with clients’ self-appraisals” (p. 3)..  When encountering individual’s with low OAT scores, it is important to avoid being too critical since this can cause clients to become defensive.  Instead motivational interviewing is useful to build discrepancy and reduce resistance.

“SAT” Subtle Attributes

The SAT score is useful in identifying “characteristics of substance misuse that are not easily recognized as such  (Miller, Renn & Lawzowski, 2001, p. 3).”  The utility of this measure, is in its ability to help reveal information clients deny to themselves or become deluded about.  In other words, it is a measure of an individual’s degree of self-deceptiveness regarding the consequences of one’s behavior.  Miller, Renn, & Lazowski, (2001) note the “sincerely deluded” (p. 3) nature of an addict’s tendency to avoid acknowledging the consequences of continued use.  So how does one begin discussing such subjects?

“There is no point in giving people messages that are too strong and too discrepant from their points of view. On the other hand, there is also no point giving a message unless it promotes positive change. Successful feedback depends on starting from a point that clients can accept and then increasing the breadth of their understanding.(Miller, Renn & Lawzowski, 2001, p. 4).”

“DEF” Defensiveness

“The primary purpose of the DEF scale is to identify defensive clients who are trying to conceal evidence of personal problems and limitations (Miller, Renn & Lawzowski, 2001, p. 3).”  In other words, it assesses an individuals tendency to conceal of an personal or situational problems in their lives.  This is ego-driven activity, reveals how they feel about themselves in relation to others.  For example, low DEF scores indicate low self esteem & feelings of hopelessness about one’s situation.  In contrast, elevated DEF scores indicate individuals are concealing their problems in order to “fake good” (Miller, Renn, Lazowski, 2001, p.4).   Concealing problems in this way serves to protect people from something painful they wish to avoid dealing with.

So to conclude, the SASSI-3 characterizes resistance as a: (1) a refusal to acknowledge personal shortcomings, (2) a tendency to remain deluded about the consequences of one’s actions and (3) a general desire to conceal personal problems from oneself.

So How Do You Address this Resistance????

Earlier this week, in a supervisory meeting, the interns sat down to discuss the cases they were assigned.   As the “newbie” of the group, I stepped back and listen throughout most of the session.  At one point, an intriguing debate ensued between the supervisory therapist and an experienced intern who is close to graduation.  From their discussion, I noted two divergent attitudes on the utility of confrontation and direction.  Underying these divergent attitudes were two very different approaches to therapy.  What follows are two different therapeutic approaches that appear as opposite ends on a continuum.  What follows is a description of the two extremes along this continuum of variance in therapy approaches:

A Rogerian Nondirective Stance

Non-directive therapy, considers the client to be his/her own expert.  In other words, the direction that therapy takes depends on a client’s own personal judgment and not the therapist’s.  Rogers describes non-directive therapy as client-centered in the sense that they have a capacity for self-understanding and self-direction.  It is a mirror opposite of authoritarian confrontation common in addiction counseling.  This empathetic approach involves the establishment of “a collaborative partnership that respects the client’s capacity for and right to self-determination (Policin, 2003, p. 20)”

From this perspective a therapist’s job is unconditional positive regard and an acceptance of their feelings.  It excludes a need to explain, challenge, or direct (Raskin, 1948).  The client’s subjective stance, takes presidence over the therapist’s clinical judgment:

“the nondirective point-of-view on this issue is that to the extent that some other frame of reference than the client’s is introduced into the therapeutic situation, the therapy is not client-centered”  (Raskin, 1948, p. 106).

Confrontation in Counseling…

Defined as “process by which a therapist provides direct, reality-oriented feedback to a client regarding the client’s own thoughts, feelings or behavior” (White & Miller, 2007, p. 2), therapeutic confrontation has a long history in the field of addiction counseling.  Historically, this counseling style was utilized in chemical dependency treatment to overcome denial & resistance (Policin, 2003).  Aggressive confrontational styles like “Synanon’s attack therapy” Pokin, (2003), were utilized to break down the defense mechanisms underlying an addict’s utilized to deny their problems.  White & MIller (2007) described this confrontation as a highly varied form of confrontation ranging from “frank feedback to profanity-laden indictments, screamed denunciations of character, challenges and ultimatums. (p. 2)”.  This description resonates with a story my own therapist told me of her own internship experience at a substance abuse treatment facility in the 70’s.

A Comparison of Non-direction & Confrontation

Understanding of the client?

According to White & Miller (2007) the prevalent view of addicts changed somewhere between the 1920’s – 1950’s from an individual who was struggling with side effects of medications to a “‘vicious’ addict who sought narcotics as a source of pleasure” (p. 4).  Implicit in this confrontational perspective is a view of the client the cause of these problems.  This perspective focuses on an addict’s “defective, psychopathic personality (White & Miller, 2007, p. 4)”.  In contrast, a Rogerian non-directed approach, focuses on the client not as a cause of the problems, but as the solution to them.  Finally, modern perspectives point toward alterations in brain function.

Understanding Cause?

A Confrontational Perspective holds the client as the cause of his/her problems and attributes their issues to a personal defect of some sort (White & Miller, 2007; Policin, 2003).  In contrast, a modern view of addiction holds a medically based-perspective which dictates that addiction is a disease.  The cause of addictive behavior are neurological alterations in the brains reward system.  These alterations in the reward and control circuits of the brain (Inaba & Chen, 2014) are associated with addiction since they are responsible for encouraging us to engage in those behaviors that are beneficial for our survival. Our textbook calls this reward pathway the “go switch” (Inaba & Chen, 2014, p. 2.13), since it is the brain’s motivator and reinforces beneficial behaviors.  In an addict’s brain, alterations can be found in this area.  Personally, I believe an epigenetic & biopsychosocial perspective best describes the complex causal factors underlying addiction.

Understanding the solutions?

Underlying the confrontational stance common in counseling’s history, is the fact that – if left to their own devices – addicts would continue to engage in self-destructive behavior.  “…addicts avoid dysphoric affective states, anxiety, and genuine intimacy by using substances and engaging in antisocial behaviors, such as manipulation of others for their own needs” (White & Miller, 2007, p. 5).”  This observation, appears to underlie the extreme forms of confrontation described earlier.

In contrast, modern treatment approaches involve symptom management during detox alongside some form of therapy (inpatient,outpatient, group and/or individual). Motivational interviewing is useful in helping the client attain self-awareness.  This can involve helping clients gain insight into their addiction while uncovering behavior patterns and attitudes underlying their habit.  Personally, I haven’t seen a pure non-directive stance in the addiction counseling field. However, I believe an empathetic stance and collaborative approach are critical factors of successful counseling.

In the next section, I’d like to return to that internship supervisory meeting I mentioned earlier.  Here’s an overview of the two sides of the debate I listened to on that day….

Can There Be a Middle Ground Between Extremes???

Side one – Sugar Coating Truth.

The intern in this conversation made a comment on the pointlessness of sugar-coating the truth & asked the supervisor what the point was if we never confronted them on anything.  “Isn’t there a case in therapy when it is warranted to give our opinion on matters pertaining to the client’s well-being?” After all, “to sugarcoat the truth is to do a disservice for the person who is on the receiving end. You don’t do anyone favors by avoiding blunt truth (Nguyen, 2015).”

Side Two – Raising Concerns on Confrontation & Coercion….

“It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate. (White & Miller, 2007).”

“Confrontation continues to play a strong role in many treatment programs (White & Miller, 2007, p. 176).”  Obviously, it isn’t utilize in the extreme forms common in counseling’s history.  However, despite its continued research has shown this method as often less effective than supportive approaches (White & Miller, 2007).  Additionally Policin (2003) notes that confrontational styles, are shown to produce “harmful effects including increased drop-out, elevated and more rapid relapse, and higher DWI recidivism (p. 20).”  My own impression of this approach is it has the potential to be harmful, shame-inducing. It focuses on change through emotional coercion over insight or conscious choice.

My thoughts thus far?   Somewhere between these extremes lies a healthy balance.

References

Miller, F.G, Renn, W.R. & Lawzowski, L.E. (2001). Sassi Scales: Clinical Feedback. Springville, IN: The Sassi Institute.
Polcin, D. L. (2003). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. SUBSTANCE USE & MISUSE, 38(2), 165-184.
Raskin, N. J. (1948). The development of nondirective therapy. Journal of Consulting Psychology, 12(2), 92.
Nguyen Vincent (2015, February, 23).  How to Deliver Cold Hart Truth and Stop Sugar Coating Reality. Retrieved from: http://www.selfstairway.com/cold-truth/
sassi.com (n.d.) Sassi Institute – “Early Intervention Saves Lives”.  Retrieved from:  https://www.sassi.com/
White, W. & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12-30.

 

 

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My Merry-Go-Round…

Its now almost 2:00 a.m., and I’m blogging early in the morning.  I have lots on my mind & a bit of insomnia, so I’ve decided to blog some more.   Prior to starting my internships, I had intended to set the blogging aside for a while.  However, as I progress, I’m finding there’s a need to process the lessons from this experience.  At the end of a long chaotic day as a mother, intern, wife, and healthcare worker, I need to recharge my engines a bit…..

….As I may have mentioned in a recent post, I just started my internship as a student therapist.  I’m currently working at an inpatient substance abuse facility.  Yesterday during a quick lunch break, I found some interesting educational material on the cycle of addiction.  While I personally don’t have a substance abuse problem, I noticed the cycle pertained to me as well.  In the image above, I describe my merry-go-round cycle of dysfunction.

STEP ONE – An Unexamined Belief System….

Many belief systems are unexamined matters of self-perceived fact.  We don’t question them, because they often exist as foundational psychological elements that don’t require close examination on a day-to-day basis.  For example, in my recent blog post on “Arrested Development” I have some unresolved belief systems about myself as an “Oddball” who “Marches to the Beat of Her Own Drum”.  

STEP TWO:  Cognitive Distortions….

In the second step of my mental merry-go-round, you have impaired thinking which includes cognitive distortions that reflect my unexamined belief systems.  Here are a few of my favorites:

  1. PERSONALIZATION – A tendency to taking things personally, when they weren’t intended that way.  I have to admit, as an INFP, this is a tough habit to break.

  2. CATASTROPHIZING – Seeing yourself in a potentially troubling situation & making mountains out of molehills.  I end up working myself into a “tizzy” only to end up worn out & mentally exhausted.

  3. EMOTIONAL REASONING – This involves thinking with your feelings and allowing them to run the show. Failing to think through your emotions means your reality, experiences, and behaviors follow this skewed perceptual stance.    Also a tough one for INFP’s

STEP THREE – utilizing my favorite maladaptive coping mechanisms …

Maladaptive coping mechanisms involve conscious efforts to resolve an issue, that only worsen the situation.  This creates a hamster-wheel like experience.  The problem is, I’m using beliefs and unresolved emotions run the show.  These factors control my thinking, so I can’t escape the problem, until the core issues underlying the faulty beliefs and unresolved feelings.  Here’s an example:

  1. FIRST – I have an arrested developmental history as per Erikson’s theory.  This yields an inferiority complex and poorly formed sense of identity.

  2. NEXT – My thought processes based on this belief system, involve a perception of inferior worth & need to look toward others for a sense of approval…

  3. FINALLY – I make seeking approval a priority.  This leads me into an emotionally abusive relationship and series of career failures….

The thing I needed to get is I was seeking solutions in the wrong place.  Being good enough doesn’t come through approval from others….. (It took me way too long to get this idea)…

When Old Traumas Are Triggered…

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The above diagram also reflects an issue that has plagued much of my life until late.  While this comes from some information on “Arrested Development” (i.e. Erikson), I see it is an excellent explanation of how some things can trigger old traumatic emotional memories.  I won’t belabor this diagram with any unnecessary explanation.  I will however end this section with a link to a site that provides a lot of great information….

“How To Use Triggers As A Means to Recover”

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Arrested Development??? (Erikson not the show)…

Recently, I was talking with a therapist at my internship site about my therapy group in the hopes that she might share a few curriculum ideas.  One interesting subject matter she threw by me pertained to Erik Erikson’s “Eight Stages of Man” (Broderick & Blewitt, 2010, p. 9).  Erik Erikson proposed a theory of personality development that includes eight stages.  In each stage we face developmental crises in order to develop a sense of identity alongside interpersonal beliefs through interactions with significant others (Broderick & Blewitt, 2010).  Since Erikson’s theory focuses on attitudes about the self and others, it provides a useful social context to human development (Broderick & Blewitt, 2010).  According to Erikson, in eight stages of these psychosocial stages, two potential outcomes can result depending on how we address and resolve each developmental crisis:

“Individuals are pushed through these life stages by biological and social demands…Individuals will experience conflicts as they progress through these stages, but it is how the individuals handle these conflicts that will indirectly impact their lives…The unsuccessful resolution of conflict…will influence how subsequent stages unfold…These stages build upon [& this]  impacts the rest of development (Wurderman, 2015, p. 5-6).”

Interestingly, while I do recall reading about Erikson way back in my human development, this insight never fully clicked.  I remember reading, and thinking about my two young boys.  However, the utility of its insight as a means to describe my own unique life course, never occurred to me.  Below, I reflect upon key stages in Erikson’s theory that resonate with my own life history & the early arrested development

Industry vs. Inferiority

Around ages 6-12 Erikson stated that a feeling of competence is critical (Broderick & Blewitt, 2010).  Labeling this stage “Industry vs. Inferiority”, Erikson states that the “child needs to learn important academic skills and compare favorably with peers in school.” (Broderick & Blewitt, 2010).  As a bullied child, I always felt very inferior to my peers.  I remember loathing recess, since I had nobody to play with. I recall lingering by the front door, hoping would notice me out of fear they would call me a loser or something.  The shame of complete friendlessness was overwhelming.   Inevitably, the nuns noticed me and encouraged me to stop lurking by the doorway & “get some exercise”…

As time progressed, things never did get better, I was the girl with the cooties.  I clung to the few friends who were willing to associate with me and was grateful for some form of meaningful interaction.  My grades never did go above a “C” average.  Everybody knew about my abysmal performance in this small private Catholic school.  One of my first bullies liked to wear this t-shirt to school with the “I’m with Stupid” logo on it.  Since he sat right next to me, everybody thought it was hilarious.

Developmental Consequences:  Insecurity, Poor Self-Esteem & An Inferiority Complex…

Identity vs. Role Confusion

“…during early to middle adolescence…the crisis of identity versus identity confusion…represents the struggle to find a balance between developing a unique…identity while still being accepted and ‘fitting in.’ Thus, [a] youth must determine who they want to be, and how they want to be perceived by others. (Oswalt, 2010).

During the ages of 12-20, individuals enter the Identity vs. Role Confusion Stage.  During this stage we develop a sense of identity: a sense of who we are, and where we fit in the world.  Broderick & Blewitt, (2010) describes the positive outcome of this phase as “fidelity”.  I associate this concept with the idea of commitment, or an ability to commit to something greater than yourself.  I suppose its not surprising that I have difficulty opening up to others & tend to isolate myself.

It’s also worth noting again Erikson’s assertion that each stage builds on an earlier one.  As a bullied child, I left the previous stage with an Inferiority Complex.  Against this developmental backdrop, I entered  a new stage of development only to lose my best friend who moved out of town at the end of sixth grade.  With her gon, I was now alone and completely friendless, “The Girl With the Cooties”.  My sister thrived as the popular girl, my parents were focused on their careers as doctors.  All were emotionally MIA.  I retreated into my own world…

“Ego Identity means knowing who you are and how you fit into the rest of society.  Too much ego-identity can result in fanaticism [i.e. my sister] where the child believes his way is the only way, and no one is allowed to disagree…A lack of identity can result in repudiation [me]

Intimacy vs. Isolation

During this stage, I notice a an intriguing turnaround.  Broderick & Belwitt, (2010) describe this stage as involving a willingness ‘to share identity with other[s] and commit[ing] to affiliations and partnerships”. During this stage of my life, I had met “IT”.  After a horrendous four year F-D up relationship, I left and never looked back.  My personal development took a “turn for the better” as I entered counseling, and eventually met my husband.  I guess this just goes to show that just because one stage goes bad, that doesn’t mean they all do……

….As I reflect on these stages of my life, I’ve had to come to terms with a loss that’s hard to describe: arrested development….

Coming to Terms w/ “a loss”

There are times when this arrested development “rears its ugly head”.  There’s something called “normal” that I just can’t do.  I missed so many opportunities socially and in terms of my sense of competence and identity.  I have worked to fill in the pieces in adulthood, but still.  I’m not quite like those who never had to deal with this sort of arrested development.  Its hard to explain, but maybe I’m like a blind person.  You can’t describe purple to a blind man.  I’m like the blind man, and the “normal’s” are trying to tell me how great purple is.  I looked at them perplexed, not knowing what the hell they are talking about…..

….and as I continue with this forward motion in life, the big question on my mind is, how does this affect my future career development????

All of who I am comes out in my efforts as a therapist.  The “Kathleen-ness” of my nature is inevitably there at some point.  I can’t hide it.  Can I possibly catch up in some way that allows me to be as effective as those who didn’t get a full 14 years of stagnation??

References

Broderick, P. C., & Blewitt, P. (2010). The life span. Human development for helping professionals. Upper Saddle Creek, NJ: Pearson.
Oswalt, Angela. (2010, November, 17). Erik Erikson and Self-Identity. Retrieved from:  https://www.mentalhelp.net/articles/erik-erikson-and-self-identity/
Wurdeman, M. (2015). Impact of Abuse Throughout a Child’s Psychological Development.  Retrieved from:  https://www.winona.edu/counseloreducation/Media/Impact%20of%20Abuse.pdf

 

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Defining Goals for This Blog

I initially decided to start this blog after cleaning out our hallway closet.  At the bottom in the back corner were old letters, journals and piles of notebooks.  The letters presented a series of exchanges with family members and unresolved issues.  The journals provided a snippet of me at that a point in time.   The notebooks, were my well-laid plane for a blog I hoped to launch.  As a therapy student, my curiosity was piqued, so I spent that morning reading through them.

One troubling pattern in all these materials, is a consistent tendency to develop well-laid plans, only to fail in consistent follow-through.  Life got in the way, my kids were young, I was busy, there wasn’t enough time.  These are my “excuses”.   Therefore, I decided, at that moment to make myself a priority, and enact slow and steady action towards my goals.  I was already working on completing a masters degree, working full time, and raising a family.  However, I felt slow and steady progress is better than standstill.  If I just took consistent action, at least there would be progress…

I am now working on losing weight and sustaining an average weekly loss is around 2 pounds.  I’ve also worked on this blog.   The progress was quite slow at first, since I didn’t know much initially about the technological aspects of blogging.  However, I’m glad I took time to set things up as I like.  The visual aesthetic is just as I like it.   I have created several substantial blog posts.   As I review my progress thus far, I note my early posts have been just random brain dumps, of what is going on at that moment.  However, I have to admit, while this brain dumping can be “cathartic”, that doesn’t mean it is always the best choice, (at least from the standpoint of personal growth).

My long-term goal is  improvement of my overall well-being, and expansion of an adult ego state, as described in this video: (Theramin Trees, 2010).  Since this similar to Marsha Linehan’s concept of wise-mindedness, I feel it might help to review both of these concepts below:

Wise-Mindedness – A Guiding Principle

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In a Dialectical Behavioral Therapy (DBT) Skills Group, mindfulness is taught to clients so they can learn tools to improve their ability to regulate emotions (McKay, et al, 2010).  It can also help us to make sound judgments and decisions (McKay, et al, 2010).  Deeply held valuees are just as important life as the pragmatics of daily life and utilization of basic logic.  In order to provide clarity to the notion of mindfulness, three concepts are introduced: reasonable mind, emotional mind, wise mind (McKay, et al, 2010).  The emotional mind, is best thought of as a state in which you think with your feelings and not through them.  A skewed reality overwhelms us based on our unique experiences, (McKay, et al, 2010).  In contrast, the reasonable mind, is ruled by intellect, the principles of logic, and empirical facts (McKay, et al, 2010). While, a comprehensive and logical analysis of facts has occurred the monkey wrench in life which is overlooked are others feelings.  You see, acknowledging others emotions means you understand comprehensively the nature of life experiences as reflective of ones perceptions and values.  Failing to understand this, means you enforce upon others a pragmatic solution that fails to consider what’s important to them.  Finally, the wise-mind sits at the intersection between facts and feelings.  “Wise mind is a decision-making process that balances the reasoning of your thoughts with the needs of your emotions….” (McKay, et al, 2010, p75).

In his video, Theramin Trees, (2010) provides another slant on this notion of wise-mindedness.  From this theoretical vantagepoint, ego-states can be thought of perceptual mindsets based on early childhood memories, resulting in protypical patterns of behavior.  My own favorites appear to be the hurt child & critical parent.  The critical parent provides structure and control in an uncertain role, while the hurt child is a perpetual victim.  Merging these two, can allow me to function more effectively, in the present.  Letting go of past baggage is needed to deal with things in the present in a balanced and holistic manner.

A Goal – Pulling My Head Out…

The problem with old traumas, is when they are triggered, the emotional onslaught can be tough to endure.  It happens rarely nowadays, (and usually with family).  I work through the emotions and process them in a healthy manner, then re-acclimate my “higher cognitive functioning” to daily life.  In the aftermath, I end up frustrated with myself.  How is it mountains become molehills, and stuff I’m so “over” are still “not over”??!!  In moving forward, I will make use of this blog as a place to vent and purge.  However, I feel it is important in a manner that allows a processing of emotions that heightens my well-being.  If it strengthens my hurt child and inner critic, I will need to let it go.

With all this in mind, if I bring up a triggery or painful experience, I will make a point of reading it later in “the cold light of day”.  My prediction is, when reviewing these old posts , I will discover my reactions don’t match the situation which triggered it.  Or sometimes I might just be acting on a misunderstanding and creating problems where they didn’t exist before.  In either case, I intend – from here on out – to take time and make use of these blogged experiences by learning from them. What follows is an example of how I will structure this processing.   In this example, I will utilize an email my sister sent me after notifying me she had breast cancer.  In this email she provides a link to a to an article on how to provide support to those with cancer.  I discuss my reactions to this email in the post titled “…and cancer trumps PTSD”  

First The Context….

For my own purposes, the first step in processing “triggery” events, will be to acknowledge and describe my my emotions.  After finding out my sister has cancer, she updates me in a quick email about the surgeries and treatments in her future.  At the bottom of this email was a link to an article titled “How Not To Say The Wrong Thing” by Susan Silk, breast cancer survivor and psychologist.  She describes an “Comfort IN and Dump OUT”  (Silk & Goldman, 2013) rule for those in the midst of crisis in the following quote:

“Draw a circle. This is the center ring.  In it put the name of the person at the center of the trauma…Now draw a larger circle around the first one.  In that ring put the name of the person next closest to the trauma…when you are talking to a person in a ring smaller than yours…the goal is to help…but if you open your mouth ask yourself if what you are about to say is likely to provide comfort.  If it isn’t don’t say it.” (Silk & Goldman, 2013).  

This quote essentially stresses the importance of providing comfort to those going through a crisis, but avoid dumping your upon them anything you’re dealing with since this only adds more stress in their lives.

Next The Processing….

Describe The Bodily Emotions…

My mind is on fire, and my body tingles with quickly burgeoning panic. This unexpected trigger, reminds me of a time, when I needed my family to be there and they didn’t.    Old memories of aloneness, desperation, and hurt enter my mind.  Anger sets in, as I remember being blamed, having to apologize and provide comfort, at a time when I needed them.  I hug my husband and he holds me as the tears pour out uncontrollably for about thirty minutes.  I go to the gym to work out and let go of the pent up energy which drives me crazy.

 Identify Your Thought Processes…

The next step in my processing will involve identifying the thought processes that occurred at this time.  When overcome with old memories, it is hard to see beyond them.  My thought processes are like a snowball that rolls down the hill and gets bigger on its way down.  While I’m grateful for my ability to maintain some “metacognitive awareness”, I still struggle.   Part of me knows these emotions are related to old memories and not current events.  However, despite my best efforts my mind repeatedly floats back to unresolved issues with family and I began to ruminate.  The viscious rumination cycle starts when memories intrude my mind.  It then causes old feelings of anger and hurt to pop up.  I ask why they couldn’t be there? Why can’t they acknowledge they weren’t there?  And the cycle continues as memories pop up again.

Examining The Evidence “For and Against”

So what is the evidence?  On the one hand, my family wasn’t there.  They weren’t there then.  Yes, in fact if I were to look at evidence of what happened, this truth can’t be ignored.  If my own “hurt child” wishes to hear this, there you go.  However, in order to move forward into the adult state, I need to let go of the past.  From this perspective it is clear these emotions are byproducts of a “trauma fog” that hits occassionally with family.  In thus respect, my perceptions aren’t reflective of what is happening now.  Instead, they are responses to a trigger.  When I look at what my sister said in her email, this is a clip of her intentions at the time she sent it to me.

I wanted to include a link to an article that I wish I had read a long time ago in ministering to friends/family who are in the midst of a trial. It talks about having circles or rings around the person in the center of the trial and to be mindful of how we speak to those affected by the trial. Very insightful.

It is worth noting, that I respond to this email by putting my foot in my mouth and dumping upon my sister and sharing about how this email is triggery, but thank her for the email.  She acknowledges how I feel, but simply “I hope you can get the help that you need.”   My mother, chimes in regarding this misunderstanding and makes the following statement:

 “I agree. I do not fully understand the pain that you suffered as a child. I also was not there to hold your hand. I am sorry………Mom”

Cognitive Restructuring

The final step in this process involves identifying and disputing irrational thoughts.  What are my irrational thoughts & how do I need to pull my head out?  Here is the list:

  1. I AM PLAYING VICTIM Click this link for 14 signs that indicate you’re playing victim…
  2. I AM REACTING TO PAST EVENTS – What happened was a reaction to a trigger of an old painful memory that set off a chain of events inside me that took a while to resolve themselves.
  3. COGNTIVE DISTORTIONS the two cognitive distortions standing out to me in this specific instance include overgeneralization and magnification.
  4. HURT CHILD EGO STATE – Eric Brene describes this ego state as an experiential perspective based on unresolved issues from our childhood.  Memories of old wounds as a vulnerable child take over and you can’t think beyond them.  

Boy, do I need to pull my head out or what?!?!

References

Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the client. (2nd ed.). Hoboken, NJ: Wiley. ISBN: 978-1-118-03822-2
Mckay, M., Wood, J., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. New Harbinger: Oakland, CA.
Silk, S. & Goldman, B (2013, April, 7). How not to say the wrong thing. Retrieved from: http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407
Theramin trees [screen name] (2010, June, 10) Transactional Analysis 1: ego states & basic transactions Retrieved from: https://www.youtube.com/watch?v=nKNyFSLJy6o

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“Getting Unstuck” & Why I Started This Blog…

20160214_111134000_iOSThe purpose of this blog, is to address directly a strange and inexplicable “stuckness” that has plagued much of my life.   In fact, when I originally sought out counseling just over five years ago, my primary complaint was that I “felt stuck”.  A review of my journals from this time are filled with complaints of Hamster-Wheel experiences and unresolved hopes for my future. Vivid descriptions can be found throughout these journals of what I wish I wasn’t and who I’m not right now but want to become.  The familiar variety of this complaints included most often are: (1)  a desire to lose weight without the follow through to back it up, (2) a desire to start a blog, but an explicable fear of failure, (3) a desire to make friends and overcome my isolative tendencies, (4) a frustration with my job as a source of ongoing stress in which I leave feeling depleted shell of my old self at the end of along day.   Underlying these frustrations and desires was a narrative perspective that had skewed my perception of life events.  Unbeknownst to me, this problematic narrative was what caused my “stuckness”.   As I have stated repeatedly:

“the problem had nothing to do with what I was looking at, but I how chose to look at it.”

Defining “Stuckness”

In a research article I read recently titled “Stuck in a Moment”, I uncovered an intriguing perspective on the nature of “stuckness”:

“Transactional analysis often regards the experience of ‘ feeling stuck’ as the manifestation of an impasse or an intrapsychic conflict or interpersonal roadblock…my own aim here is to broaden the theory of impasses, exploring whether and how ‘stuckness’ may constitute a developmental opportunity” (Petriglieri, 2007, p185).

When I read this quote, I decided it was worth “blogging about” .  The idea that stuckness isn’t a roadblock but instead developmental opportunity is not only inspiring, it reflects my own experience.  As someone who has progressed from stuckness into gradual forward motion, I see my own stuckness as a reflective byproduct of unresolved traumas, missing pieces, and a shame-based identity.  These personal “monkey wrenches” existed as self-fulfilling prophecies until I was willing to face them head on.  In retrospect, I see oppositional mindsets fighting for “control”.   On the one hand, an “inner critic” fills my mind with  shame-based messages of what “good enough” means.  The effective solution according to this inner critic is to work at “being good enough”.  This may have meant weight loss or getting a new job.  In response to this mindset, I believe there was a “hurt child” who held an unacknowledged wisdom all her own by reflecting the emotive consequences of this thinking.  After all, how is it that “good enough” means something that I am not now based on messages from others growing up?

An overview of Transactional Analysis….

matryoshka-970943_1920Before I begin discussing how I “got unstuck”, I’d like to provide an overview of transactional analysis.  Utilizing insights from this theory, my therapist keeps nesting dolls on the coffee table in her office.  Utilizing them in conversations from time to time, they have been productive tools for reflecting on the opposing ego states underlying my stuckness.  it seems my own “inner critic” and “hurt child” are fighting for “control” and as a result I’m getting nowhere.  Now that I’m a student, and reading Eric Brene’s works, it may be useful to quickly review some essential concepts.

According to Eric Berne, “The human brain acts in many ways like a camcorder, vividly recording events.” (ericbrene.com, n.d.).  While not necessarily remaining available for conscious retrieval, the emotive consequences of these events and our experiences of them remain.  It is only when interactions and events, trigger these memories that the effects of these events arise.  This cognitive process is much more complex in an individual with PTSD as you might imagine.  In an effort to provide convenient constructs to discuss the transactional process between these ego states, Eric Brene created several key concepts in this theory.  For example, structural analysis involves an examination of the various mental states I described earlier (“inner critic” vs. “hurt child”).  In contrast, transactional analysis examines the dynamics of social interaction and how these elements of our psyche play their role.  The nesting dolls in my therapy sessions provide a convenient method of illustrating Eric Brene’s concepts of ego states.  Rather than conceiving of these ego states as Freudian structures in the brain, Berne states they are “phenomenological realities” (ericbrene.com, n.d.), that represent consistent patterns of reacting to life events.   For example, my own “hurt child”, reflects Eric Brene’s child ego state in which past experiences are experienced from the standpoint of their emotive impact.  In my specific instance, this is where most of my unresolved traumas exist.  In contrast, the Parent ego state, represents my own “critical parent”.  The critical parent’s camcorder provides an overview of early life experiences and the implicit messages they contained.  Finally, as I understand it, Berne’s adult ego state, reflects closely Marsha Linehan’s wise-mind concept.

Getting Unstuck – First Steps…

In retrospect, two key sources are most effective in describing how I became unstuck: (1) Rising Strong, by Brene Brown, (2) and Petriglieri’s article on the stuckness as a developmental opportunity. Combining insight from these readings with my own journal, what follows is a description of how “getting unstuck” happened for me.

Radial Acceptance…

In his article, Petriglieri, (2007) states the following as an underlying cause of stuckness:  “…we feel unstuck instead of accepting & allowing ourselves to feel that we are not, at the present moment able or willing to change” (p. 187).  Early on in my therapy, I was encouraged to participate in a DBT Skills Group.  Throughout my participation in this group, I kept a journal, and recorded my progress….

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As I noted in my journal, like the concept of forgiveness, accepting something doesn’t mean you’re saying its okay that painful things have happened to you.  For that matter, it also does not mean that you’re “giving up” or “giving in”.  Finally, it also important to note that refusing to accept something doesn’t effectively change things.  Instead things remain the same and a painful experience morphs into unbearable suffering.  As I have learned personally, letting go of my need to “fight reality” means I’m turning an unbearable trauma into something I can at least cope with.  Admittedly, this is easier said than done.   After all, coming to terms with a truth that appears unbearable at first, is often like a grieving process.  The loss, while not readily visible, creates a before/after experiences: events have profoundly affected you, and you will never be the same.

Today, I find myself viewing this old journal entry with two mental states.  An adult-oriented wise-minded self, acknowledges the hurt that acceptance requires us to face yet is able to provide the coping tools necessary to move forward and face truth.   In time, this choice to “turn my mind” toward acceptance, has been truly transformative.  Today, I’m grateful for everything that brought me to where I am today.  Honestly, as crazy as it sounds, if granted an opportunity to change anything from my past – I wouldn’t change anything.

“Bob, like almost all the other POW’s we got to interview and got to know very well, said in response to the following question: ‘if you could have eliminated the POW experience from your life would you do so?’…and Bob like many of the others said ‘No’ because I learned things about myself during that experience, and I learned tools – psychological tools, tools in which to handle my life, that I probably could have never learned any other way…”

Owning My Story…

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For a course I’m taking on career counseling, I have to complete a paper on a self-help book.  Naturally, as a “Brene Brown Fan”, I picked her latest book, Rising Strong.  In it are insights on the process of getting unstuck and what is required to “make things happen.”    Utilizing insights from Narrative Therapy, Brene Brown (2015)  describes “The Rumble” (p77) as an essential turning point in “getting unstuck” that requires us to examine the perceptions and meaning systems weaved throughout our lives.  Developing a sense of clarity about our personal history is critical if we are to understand what got us where we are today.  As the saying goes, you cannot change what you’ve refused to acknowledge.

Facing Unresolved Trauma…

“…Impasses occur each time we encounter a situation in which our current adaptations cannot make sense of or handle meaningfully….our cognitive framework, emotional capacity, and behavioral repertoire, do not allow us to make sense of…and deal with our present reality” (Petriglieri, 2007, p187).

Petriglieri’s (2007), view on “Stuckness” as a byproduct of trauma, hits home for me, since I lived for much of my life with symptoms of PTSD while undiagnosed.  Its surprising how much these unresolved issues have managed to pollute all areas in my life. Fortunately, I’ve always had an intuitive wisdom to move in the direction of continued growth.  As I reflect on my life’s course, any forward progress, has occurred, only after I came to terms with how these unresolved traumas have affected an area of my life.  For example, I couldn’t be in a happy marriage today, if it weren’t my efforts to overcome the aftereffects of an “unhealthy” relationship in college.  For that matter, if I hadn’t resolved unresolved issues within my family of origin, I wouldn’t be the mother I am to my kids.  Finally, resolving underlying motives has been important in my ongoing efforts to lose weight and switch careers.  While these issues may seem disconnected, the underlying common cause of “stuckness” is unresolved trauma, that kept me where I didn’t wish to remain:

“Hurt doesn’t go away simply because we don’t want to acknowledge it  In fact left unchecked, it festers, grows and leads to behaviors that are completely out of line with whom we want to be.” (Brene Brown, 2015, p59).

Concluding Remarks…

Having discussed my own experiences of “stuckness”, I’d like to revisit the subject of why I’ve decided to start this blog.  As I mentioned earlier a series of a troubling hamster-like replay of failures originally brought me into counseling.   These failures began as I found myself finishing a degree in a field I had little interest in, due to a controlling and dysfunctional relationship. These “missteps” continued when a rental business I worked hard to build, resulted in a series of foreclosures and bankruptcy.  In between these stumbles my career history was peppered with a series of “dead-end” jobs.  My academic efforts didn’t fair much better after college, as I found myself attempting to enter field after field, only to quit in frustration.  The final stuckness experienced occurred just prior to therapy and revolved around a desire to start a blogging.  I had worked hard to prepare, read lots of books and even outlined many ideas that have filled several file cabinets.  However, a fear of failure held me back just prior to any efforts to begin taking action and establish an online presence.   This blog, represents a big step for me – a journey towards “unstuckness”.

What did I not get through this history of  “missteps?”

Underlying my stuckness history are misconceptions of what success and failure are and the pathway leading in either direction.  At the time I entered therapy, I would have described success as a preconceived idea of shame-based messages gathered throughout my life.  In this respect, success became a preconceived cure to heal past unresolved hurts.  Success became a desire to avoid what I was, and become what I defined as “good enough”.  In other words, a pervasive resistance and unwillingness to accept what I was, motivated all efforts to create success.  In this respect, failure was defined as what I was currently.   The path to success meant, running away from my story, myself and what hurt to much to face.

What do I now understand about getting unstuck?

Today, I understand success is a byproduct of my own desire to live an authentic and whole-hearted life.  In this respect, I realize taking ownership of my story is critical in order to move forward. Creating forward motion happens only when I follow the insights of the serenity prayer: changing what I can and accepting what I can’t.  Last but not least, healing old traumas was a final critical piece in my own journey toward “unstuckness” and slow progressive forward motion.

As a result of this view of success, I’m now prepared with a clear perspective on the journey required to work towards my goals. Having examined carefully the underlying motives of my life goals, I now realize that the “reckoning, and rumble” Brene (2015) speaks of are part of this process. I am no longer engaging life with an unresolved desire to cure to trauma, pain, insecurity, and avoid shame.  Instead good enough happens now in which I’m at peace with the journey it took to get to “here”.

References…

Berne, E. (1961). Transactional analysis in psychotherapy: A systematic individual and social psychiatry.
Brown, B. (2015). Rising strong.  Random House:  New York.
ericberne.com (n.d.) A description of transactional analysis.  Retrieved from:  http://www.ericberne.com/transactional-analysis/
Petriglieri, G. (2007). Stuck in a moment: A developmental perspective on impasses. Transactional Analysis Journal,  37 (3), 185-194.

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