Disclaimer:

Disclaimer:

1) My posts are not intended to replace or act in place of a counseling relationship.

2) If you are in crisis you should go to your local hospital or police station for assistance.

3) I can not guarantee confidentiality if you choose to become a follower or if you post comments on my blog.

I hold a masters degree in counseling and I am a licensed professional counselor in the state of Idaho. My intent with this blog is to post my perspectives on different mental health topics. This blog is NOT intended to replace or act in place of a counseling relationship.

I take confidentiality very serious and have taken steps to afford each of you the opportunity to remain anonymous if you choose. There are two things that will increase the chance of you being recognizable by others; 1) becoming an official follower of my blog 2) posting comments to my blog. If you don't want to be identified, I encourage you to avoid doing these two things.



Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Sunday, September 18, 2011

Cutting

Due to a recent suggestion, this blog will cover a few key elements about the behavior of cutting. Cutting is not a new topic but an ongoing issue that raises great concern. I’ll be taking two perspectives on this topic because I feel it is helpful to view cutting from the perspective of a person who cuts as well as a person who cares about a person who cuts, often a parent or friend. The language and structure is my attempt to inform people who may not know what cutting is or who have little experience in working with cutting. If it doesn’t seem academic enough but it is extremely informative and helpful, I have done what I hoped.
Though I have an abundance of experience working with many people who cut (notice I stay away from labeling a person a “cutter”), also known as self-mutilation, there are things I learn every time I work with the issue. The most important thing I believe I can say is “make no assumptions”. A person who is cutting is a unique person. They are NOT cutters, they are people who cut. What it takes for them to stop cutting is unique to the individual. In my opinion, anyone who tells you they can make someone stop cutting with a specific technique that “always works” is full of crap.
Definition
Cutting is a form of self mutilation or self injury in which a person typically uses an object that is capable of leaving a scar and/or making themselves bleed. There are physiological concerns as well as psychological, sociological, cultural and even moral concerns with cutting. A teen cutter, for example, often has plenty of reality training from caring adults and friends about the physiological concerns of cutting. However, I suggest we ask what psychological, sociological, cultural and moral(maybe religious) understandings of cutting are? Chances are, there is a lot less understanding of these areas than the physiological. Please know that I have seen people who cut due to moral pressures as much as I have seen people who cut because they lack moral structure.
The Person Behind the Cutting
A person who cuts often does so out of a feeling of need. They get something they deem necessary and positive from the cutting experience. I’ve been told things like, “I have to do it” or “I can’t stop myself”. No matter how difficult this is for a caring person to understand, it is the reality of the individual that they feel a great need to cut themselves. This does not imply a need or desire to die. The reasons for cutting vary and depend on the person. In many cases, there are multiple factors working simultaneously. An analogy I like to think of when working with any client facing a potentially dangerous problem is the analogy of a key. This is how the analogy goes:
Let’s take the key to a house or car as an example. First and foremost, the process of making the key only matters because the key does something in the end that is useful. Without a need, there is no reason to open the door. The house or car might keep a person warm, dry or give a sense of safety. At some point the process down the path of cutting started from a point where the behavior was useful.
The next step in forming a key is by giving it exactly the right shape. Only with the exact right shape will the key be effective and open the door. Emotionally, the behavior has to be reinforced multiple times (the ridges of a key are being formed) in order for the shape to take hold and the behavior to become a pattern. For example, a person who cuts the first time and they feel no relief or comfort will likely stop cutting. There is no need to continue a behavior that doesn’t serve the individual.
The final stage of the key is being able to use it when you want and know that it will work. If a person goes out of town and returns three weeks later, the key still opens the door, starts the ignition or gets you in the house. A person can emotionally have no need for cutting themselves for hours, days, weeks or even years but the ability to access that place still exists. Once a key is made, it is very difficult to unmake the key. In some cases, it isn’t even possible to unmake a key. There is a position of hope though. In situations that don’t allow for destroying the key and starting over, we make a new key that is more effective and less dangerous. Thus, we replace a dangerous behavior with a healthier behavior that fills the same psychological, sociological, cultural and/or moral void that is being filled with cutting.

***What is healthy for one person may not be for another. There are many factors and it’s a good idea to seek wise counsel before making major changes. Wise counsel may or may not be a professional counselor but for the sake of my profession, I hope you would find professional counseling to be a great experience.
Caring other
Anyone who hears about someone cutting or behaving in a manner that doesn’t appear to be healthy and chooses to care is a “caring other”. It seems to be unusual, at least in my experiences, to have a person who cuts come out and say so before I hear it from someone else. Often times, there is a fair amount of shame behind the act of cutting. To make things simple, I am going to highlight what I often teach parents and guide caring people through when dealing with a person who is doing any act that is dangerous like cutting.
- This isn’t a time to run away from or become afraid of the person even if it is a bit scary.
- There is a reason for the behavior but you may never know what that reason is so be prepared to accept that you won’t know. (If you learn why, then that’s just a bonus!)
- The person is what’s important. They are NOT the problem.
- Show the person respect because the feelings are REAL and the behavior is probably only a less typical way of processing something.
- Don’t assume you know how to fix the problem. Chances are, the only one who can truly fix it is them.
- If you don’t know what to do, say or think, then be open to setting the example for them by seeking good counsel yourself. There are good counselors out there who would love to know you.

Monday, August 15, 2011

What does “person-centered" mean?

In my practice, I identify myself as a person-centered counselor. I’ve had people ask me what that means on many occasions and I thought it would be good to blog about it as a way of getting the information out to anyone interested in my condensed version. This is not the only theoretical perspective and it is not the only perspective that has research supporting it.

The following is what it means to me to be person-centered. Many people have written books on this material. This is my attempt to distill the research available in a concise manner. My attempt to be concise may leave you with many questions. If so, please discuss it with your counselor, family and friends. You can also feel free to post questions on here but please know that I can’t guarantee anonymity if you do so.

The person-centered approach is a researched theoretical approach to counseling clearly defined by Carl Rogers (Wilkins, 2010; Ellis, 1948; Kearney, 2009). The underlying theme throughout the person-centered theory is that change is always happening. Carl Rogers states “it is our design to self-actualize” and he goes in depth about the process (Rogers, 1942; Rogers, 1951; Rogers, 1957; Rogers, 1975). The key is that it happens whether we want it or not and whether we actively participate in it or not.

~If change is going to happen regardless of our desire, should we participate actively in how and what changes occur?

The person-centered approach to counseling suggests six guiding elements called necessary and sufficient conditions by Carl Rogers (1957:96). Those conditions are:

1. Two persons are in psychological contact.
2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.

If all these elements are present, there is evidence that significant and positive change will occur in the client (Stiles, Barkham, Twigg, Mellor-Clark & Cooper, 2006). If you are anything like me, you make question what “significant and positive” means. In counseling language, significant is based on statistical significance. This means a person is statistically a number of percentage points more likely to be happy, fulfilled and content if they have a relationship with a counselor as described above. Positive change is a measure of how a person perceives their life before and after a therapeutic relationship that contains the six elements Carl Rogers described. I view this as the more subtle, but not less important, perspective of viewing the world from a half full perspective as apposed to a half empty one.

~Can seeing the world from an optimistic perspective make a person happier?

Yes. There is an entire category of psychology called positive psychology. I’m not going to go in depth with this right now but it is important to know that the research supports the idea that thinking positive matters immensely.

~okay, you gave us the components but now what?

You’ll notice the first thing on the list is the necessity of a relationship. As a professional counselor, I take this to mean I have to be authentic in the relationship. For example, I can’t expect a client to work on the things that brought them in unless I too am willing to be attentive to and work on things in my personal life. It’s a way of life, not just a cool idea.
The second and third components assume that brokenness is part of each and every person and health is also a part of each and every person. If we work with the assumption that we all have brokenness and we all require relationships with others, then the difference between relationships that improve our well being(are healthy) and those that harm our well being(are unhealthy) is simply the judgment to know what information to share and what to withhold for the sake of the other person. In this way, a counselor must be aware of and filter personal influences that may negatively influence the relationship while the client must attempt to be honest with the counselor or risk slow progress or stagnation.

The fourth component of unconditional positive regard is how a person-centered therapist maintains the attitude that “I am in this with you no matter what”. To be in a relationship with someone who is “in it no matter what” builds trust and encourages the growth process. Having unconditional positive regard does not imply taking on every relationship. Sometimes unconditional positive regard means handing off a relationship to a person more capable of working with the person where they are. That’s why I am willing to refer people to other counselors when my skills don’t match up with a client’s needs.

More and more research is being done that shows the importance of empathy in relationships. For our purposes at this time, we won’t go into a lot of depth. However, I think it’s essential to know that empathy is a set of skills that can be learned and improved. There are many techniques that can be taught to even the most rigid or chaotic people that will project the sense of togetherness. I may go into more depth about empathy in another blog.
The final component is all up to the client or the person who wants to improve their life. The ability to receive empathy and unconditional positive regard (trust) takes a willingness to admit areas of weakness and areas of strength. As the relationship grows and points out such areas, clients often feel a desire to avoid the growth because it hurts. Maintaining a positive direction is not easy and can only be encouraged. It is still up to each of us to stay focused on our progress and growth. The pain is part of the process.

The reason I choose to call myself a person-centered counselor is because it fits me and I fit it. I see it as a way of living as much as a theory because it applies to all relationships whether personal or professional. If you are interested in learning more about the details of a person-centered approach, I provide a few resources below. The Wilkins book called Person-centered therapy is one of my favorite because it has historical perspective as well as current research.

Ellis, A. (1948). A critique of the theoretical contributions of non-directive therapy. Journal of Clinical Psychology, 4(3), 248-255.

Kearney, J. (2009). Rogerian principles and the writing classroom: A history of intention and (mis)interpretation. Rhetoric Review, 28(2), 167-184. doi:10.1080/07350190902740034

Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton-Mifflin.

Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin Company.

Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.

Rogers, C.R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2-11.

Stiles, W., Barkham, M., Twigg, E., Mellor-Clark, J. & Cooper, M. (2006). Effectiveness of cognitive-bahvioural, person-centered, and psychodynamic therapies as practiced in UK National Health Service settings. Psychological Medicine, 36, 555-566.

Wilkins, P. (2010). Person-centered therapy: 100 key points. New York, NY: Routledge Taylor and Francis Group.

Wednesday, September 15, 2010

Counseling Religion

For all those who are returning, thank you for taking the time to read my blogs. For all of you who are new to my blog, welcome.

As part of my educational experience at George Fox University, I have been challenged by several instructors to learn how to get to a place where I am comfortable talking about religion in sessions while simultaneously holding my personal values aside so the client doesn’t feel judged or criticized. I’ve been thinking about this lately because it is a real and, at times, difficult thing to do. Some questions that come up are as follows. 1) Can a counselor have a different belief system than a client and still be the right fit? 2) Can a counselor truly set aside their view of anything, let alone religion?

I would like to make a point of clarity for the sake of neutrality. I view religious perspective and the belief in any specific deity to be different things. For example, a person can believe in God and still have misconceptions about God. The misconceptions would be what I call religious perspective, while the fact that the person believes in God is their decision. As a counselor, I think it is very important to make this distinction. I believe it’s my duty to challenge religious perspective when it is causing dysfunction but I believe it is completely inappropriate to challenge someone’s belief in God. One of the great things about living and working in the United States of America is the fact that we have the right to peaceably assemble for religious purposes without persecution. Plus, who am I to judge someone else’s life as right or wrong. Being a counselor doesn’t give me the right to judge people. It gives me a platform to challenge inconsistencies in people’s lives. This applies even if the inconsistency is a client’s religious perspective.

Now we’ll take a closer look at the questions that came up earlier. The short answer to question one is yes. Many people believe that a counselor needs to have had their experience, in this case religion, in order to provide insight. I don’t agree with this thinking. In many cases similar thought can keep people in ruts that they otherwise might be able to find their way out. For example, it’s often seen as advantage to go to a marriage therapist who has experienced a long marriage. Though there are times where it is helpful to have the insight of someone experienced in marital endurance, the fact that they have stayed married doesn’t necessarily make them more qualified to handle any specific kind of marital issue. The same is true for religion in counseling. If you find a counselor who matches up with your religion and is still able to challenge your religious perspective then that’s great. Just remember, counseling should not be comfortable all the time. If it is comfortable all the time, you’re probably not progressing at a rate that you are capable of.

Question two is one of the hardest questions to answer from my perspective. The truth is, I don’t believe a counselor can be authentic in the relationship and set aside all their views. Nor do I think they should try to. In everyday life we set things aside in order to make other things possible. At times a counselor should and will do so. First and foremost, a counselor should feel like they can be in an authentic and professional relationship with the client. When it isn’t possible to set aside personal emotions in order to learn about the client’s struggles and successes, then it’s probably time for the counselor to seek consultation or to refer the client to a counselor better suited for their needs. For example, a client who was raped at one point in their life may, at some point, need to describe the rape in detail or draw the rape artistically in order to relive the experience and feel the empathy they didn’t feel from people shortly after the original trauma of the rape. If they are seeing a counselor who was also raped earlier in life and has not processed it at length, possibly in their own counseling, the counselor might re-experience their personal rape. This could be a problem for the client and for the counselor if the counselor is not very careful and attentive to their own care. So, I feel like I’ve talked around the question a little so I’ll try to make sure I’m blunt for those whom that works best for. I think a counselor can set aside their views on things and stay focused on the client’s reality. It requires purposeful attention by the counselor in order to do so and often times is very difficult because counselors are people too, which makes it easy to fall back into the trap of the idea that “it’s just who I am”. If I were to suggest a type of counselor to you, I would always suggest a counselor who strives to learn about themselves as well as their clients.

Tuesday, August 24, 2010

Frequency, Intensity & Duration

For those of you keeping up with me each week, you'll notice I didn't post last week. I was doing some self care by doing some camping. My supervisor at Fairview Clinical Services recently drew my attention to a process this week described by Ray S. Anderson in his book “Self Care”. The process was described like this:


Beginning at the bottom with any event that comes to mind, it is explained that we experience a trigger which gives us an internal sensation that becomes a feeling. From the feeling state, we have the option of going down the thinking path or the emotion path to the application phase. For the purpose of this blog, I’m not going to go into much more detail than that. Instead, I would like to take a moment to focus a little bit on the part in the middle that is bold and in red. I added this piece based on what I learned in Research Methods and Statistics a couple years ago. I’ve found it very helpful.

Frequency-Intensity-Duration

As part of our design, we are intended to measure subtleties. It helps us survive and thrive in our world. When we encounter a trigger that leads us to “thinking” or “emotion” it is sometimes helpful to slow the process down. Slowing down the process gives us the opportunity to more clearly identify the trigger before we get too far away from the trigger. Ultimately, growth or healing is easiest when we can identify what causes us to respond in certain and sometimes unhealthy ways. Could we wait for the behavior (Application Phase)? Sure we could. What I’m suggesting is that when we find ourselves moving from the observation phase to the application phase, we consider three things.

1) Frequency
2) Intensity
3) Duration

These three things provide us great insight. With insightfulness, we can be more purposeful in our decisions and actions. The truth is, people are often hurting others or helping others without even knowing it. Through insight, I believe people can maximize how much good they do for themselves and others.

Monday, August 9, 2010

When I find the right person, I always seem to screw it up.

For those who have read my blog before, welcome back. For those who are new, I hope you enjoy. Please feel free to click on the archives to the right if you are interested in seeing previous posts. I welcome comments and followers but it’s important to read the disclaimer prior to doing either.

Why do couples work so well together only to irritate the heck out of each other shortly into the relationship? How is it that people lose patience so quickly with the one they love so much? Have you ever seen behavior from yourself that shocks you? Maybe you broke something or threw something in anger because you were mad at your relationship? Maybe you’ve even been physical with your partner out of anger and you never thought you would be like that. Are these problems solvable?

Whether these questions are solvable is up to the couple. The key factors that I look for in a couple who wants to be together is 1) the couples approach to communication and 2) the amount of individual work each person is willing to put into the relationship. I find four subjects very useful in revealing a couples style of communication and how much work each person is willing to do. I have also never yet met any couple who line up identically about religion, sex, politics and money. These subjects can bring out authentic individuality and through individuality within the relationship, I can most easily identify a couples motivations.

Before proceeding further, I must confess I don’t subscribe to the definitive labeling processes often used in therapeutic settings. It’s my opinion that labeling people with disorders or highlighting only the less functional parts of a person can be cruel and inappropriate. Who wants someone to point out all their flaws? However, I learned from a professor by the name of Rand Michael, Ph.D. that identification and classification are important in the process of identifying differences and therefore critical to helping us decide who we are. For this reason and only this reason, I will explain some identification and classification provided by the book titled “In the Quest of the Mythical Mate” by Ellyn Bader, Ph.D. and Peter T. Pearson, Ph.D. The insight gained is not to label anyone as superior or inferior but to identify differences that will strengthen understanding of yourself and those you care deeply about.

Bader and Pearson offer us four phases of a couple’s relationship. They call them symbiosis, differentiation, practicing and rapprochement. A couple can be in different phases at the same time or they can be in the same phase together. Each scenario presents different kinds of struggles and excitement.

Symbiosis – The early phase of a relationship is described as the joining phase. It is natural to highlight similarities and minimize differences.

Differentiation – The second phase of a relationship highlights differences. The identity of each person in the relationship is no longer defined by the other person, which is typical in the symbiotic phase.

Practicing – This phase is where an individual has differentiated enough to remember their own dreams and aspirations and is devoting themselves to agendas that are outside the relationship. It requires a lot of practice to manage the needs of the relationship, one’s self and aspirations. Trust is essential at this point because time apart is more common as goals require time and energy. This stage is often very scary for many people because their past often influences their ability to trust in a healthy way.

Rapprochement – In this phase, an individual would be learning how to manage closeness and independent distance within the relationship. It’s more a matter of learning to shift in and out of the relationship without feeling guilt, anxiety, etc.

So, what does all of this mean? It means what most things in the mental health arena mean, it depends. That’s right, “it depends”. What I have found very useful about these categories is that they provide some normalizing to the complexity of relationships. For example, a couple in symbiosis is often referred to as “fake”. They may even refer to each other as fake if they break up in or near this phase. The reality is they are acting perfectly natural to highlight similarities and minimize differences. We would all look a little fake if we responded in this way all the time but it doesn’t mean that we are. It also means we all have the potential within us to have a long term relationship if we choose to do the individual work and put in the work as a couple.

What I would hope for all of my readers is that they may gain a little perspective about themselves that would allow them to look at their partner with a bit more patience and empathy. If any of this is new knowledge for you and it is used to point out superiority or inferiority of one individual in the relationship, my words have been in vain. The descriptions, as I provide them, are intended to create improved empathy for where you and your partner are in life as a couple and in life as unique individuals.