Thursday, October 15, 2015

Overt Assumptions

“What makes earth feel like hell is our expectation that it should feel like heaven.”
― Chuck Palahniuk, Damned
     For nearly 5 years, I grew up in Hendersonville, TN. Then, in my 4th grade year we moved to High Point, NC. Both states had many similarities. Food, family, and freedom were important to everyone. A few outsider, like ourselves, shared some insights into living in North Carolina: 1) "Yankees" are like hemorrhoids: If we come down and go back up, we're alright. If we come down and stay down, we're a real pain. And 2) Southern people are the nicest people you'll never get to know. This isn't to imply they're inhospitable. Traditionally, and culturally, Southerners tend to have large and close-knit family systems. It can be difficult to get into the culture without a blood relative.
     Another slight difference was sports. When I lived in Tennessee, soccer was not even on the radar. If it was popular, I missed it. In North Carolina, it was unavoidable. Everyone played, watched, and lived soccer. Because the last 5 years had provided me very little exposure to soccer, I was not adequately prepared for this cultural shock. Still, I wanted to fit in, so I jumped in and tried to play whenever I could. I was awful.
     Part of my awfulness was due to the fact that I'm just not gifted in coordination. Some people are kinesthetically brilliant. I was kinesthetically blinded by that brilliance. To that, add a lack of general exposure to the sport. I never practiced the mechanics and fundamentals of the game. The physical act of kicking a soccer ball was a mystery to me! The ball may as well have been made out of cement. It didn't seem to matter to anyone else that I was also completely unfamiliar with the rules of soccer! A game would be mid-half and suddenly, WHISTLE! Everyone, nearly in unison, would turn to look at me. Even the kids who didn't know me looked! Took me three seasons to figure out what off-sides was.
     There had been a break down in communications. The other players began learning these things they were very young. The rules were taught alongside the mechanics. As they developed their mechanical skills through kinesthetic repetition, they strengthened their overall knowledge of the game. I missed these developmental milestones and was thrown into a game where nearly everyone knew all the rules; and they assumed I did, too.

     Blended (and blending) families often present to therapy seeking assistance in how to make two families into one. I've seen families adopt or foster children when they have had no children of their own. That's one of the nice things about having kids: They (somewhat) ease you into the process of parenting. Slowly, they learn to roll, then crawl, then walk, then run like wild animals! It's fine when we've been with them for literally every step of the way because our parenting skills have grown with them. Imagine having a 2 year old dropped off at your house if you've never had children before! What's normal? Are their noses supposed to make so much snot? Do they really have no volume control? Do they really have no sense of privacy when I'm going to the bathroom?
     Sudden baptisms into parenting are incredibly difficult. A healthy response is to cut ourselves some slack and realize we're going to be playing catch-up for a little while. But what happens when there are sudden shifts in family functioning? Isn't that what therapy is supposed to provide? New insights, awareness, and skills which a family will implement and change their pattern of relating.
     Sometimes, therapists can make the mistake of assuming the family understands the rules of relationship. Instead, we need to make the new rules (and they ARE new) overt. This can be done through verbal or written contracts, reflecting current changes in the process, modeling/coaching, and even through paradoxical injunctions. Regardless of the means, we have to take time and make the assumptions clear. This way, we prepare the family for change and mistakes, accidents, and regression becomes part of the learning process instead of demoralizing failures. Communicating this can relieve a great deal of anxiety associated with change and encourage open discussion among struggling families.
     Have any suggestions on how your therapy or therapist has helped people adjust to change? Leave a comment below!
Fragile Soccer
Nathan D. Croy, (c) 2015

Monday, September 28, 2015

Truth or Care.

“I took a test in Existentialism. I left all the answers blank and got 100.”
― Woody Allen
     Nearly every morning when I come to work, Mr. Ben is working diligently to make the office look pristine. As he was cleaning a window he paused, took a step back, inspected his work from several angles, and then touched up a few missed spots. I couldn't help but be reminded of how therapists need to do this in their work, and also teach this skill to families. How often do we need to step back from the process to gain perspective. To reassess our goals and focus on what is meaningful? If we never step back from the process, we can become hyperfocused on minor smudges and miss large spots all together.
     Often times, the therapeutic process can be distracted by seeking for specific truths. This post will share a few types of "truth seeking" which can derail treatment, how these can be clinically addressed, and an alternative way to provide authentic treatment which is true without being burdened by seeking "truth".

Validation Seeking

     The first, and most common, form of seeking of truth which can distract from therapy occurs when affirmation of convictions become more important than the truths themselves. Nietzsche is attributed as saying “Convictions are more dangerous foes of truth than lies.” This plays out many times in group and family therapy. People will become hyperfocused on being "right", or verbally bludgeoning another person into admitting they were wrong, lied, cheated, or failed them in some fashion. This is completely normal. This reaction happens when people assume their perception must be valid in order for their emotions to be valid.
     To an extent, this is not wrong. If we see a car being driven dangerously fast down the highway, it would make sense for us to be startled, afraid, and angry. However, throw a set of spinning lights on top and add a siren, and suddenly, we pull the car over, allow them space, and are relieved to discover we weren't their target. In this example, the setting is nearly identical (fast car on highway). Technically, we were just as unsafe with the police car speeding as we were with the civilian car. Sure, the police should have more training, but accidents happen! So, why were we less afraid? Because our perception and expectations were different, so our emotions were different.
     We expect our loved ones, friends, and family to be safe. When they drive down our emotional freeway, dangerously fast or out of control, we feel it is important for them to understand they scared, hurt, and frustrated us. The reaction often looks like anger (punishment) and control (prevention). The "truth" we're seeking is the validation of our own rightness. If it existed, the best word may be "rightittude". We're so concerned about being right in regards to being right, we fail to see why we want to be right: Validation.
     Ultimately, in these situations, people want to be validated. Their existence, their perception, and their emotions regarding a situation. If we fall victim to the false belief that our rightness and validation are synonymous, it will no longer matter if we even are right. The victory will feel hollow. A symptom of this is when people consistently bring up previous examples of times they were right, I-told-you-so's, and other people's failures. This assuages the internal fear of an existential incorrectness. What we want is to be right and be validated. What we forget is the harmful assumption which accompanies this belief: If I am wrong, I'm no longer worthwhile. This type of belief slowly dissolves confidence and personhood. The irony being that, the very process of seeking external validation fosters deeper fears and anxiety of rejection.

Concrete Seeking

     Therapists often hear families say something along these lines: "If we just knew how this happened, or how we got here..." The ellipses can be filled in with just about anything. If they only knew why, when, where, how, what, or who was the source of their stressor resulting in treatment, they could specifically address that thing and be better! While identifying community supports and/or providing case management services is often a necessary part of therapy, these should be future based supports rather than salves to address past wounds. 
     Concrete truth seeking reminds me of the old southern adage because it's like nailing jell-o to the wall. It really doesn't matter how many nails you use or how hard you hammer, it's just not going to stick. As people seek power and control, they look for facts and concrete evidence that will allow them to argue specific points.
     How often has therapy degenerated into a pale reflection of itself: The argument. It's exhausting. Trying to figure out who's right and wrong, who to support and who to refute. It's easy to get caught up in and certain clients are better at this than others. Clients with Cluster B traits regularly use this line of thinking and rhetoric to avoid talking about themselves, their emotions, or their therapeutic needs. It turns the therapist into a referee and forces them to "pick sides". Once in this position, it becomes very difficult to be a non-reactive presence and, more often than not, we accidentally feed into the systemic distress rather than address it.

Ethereal Seeking

     As an existential therapist, I enjoy philosophical discussions about the afterlife, personal meaning, and the validity of social norms; to mention a few. There are times when clients will state their primary concerns are broad existential concerns just like these. When it happens to me, I never fail to get excited. This is my milieu, my passion, and someone is going to pay me to have a conversation with them about the very thing I love! However, I have to be cautious about secondary gains.
     The questions may be exceedingly important. What we must never fail to address is why these questions are important to the person. If they only want to discuss these issues to discuss these issues, we are doing them a disservice. It's like teaching someone to drive in a golf cart and then expecting them to perform at the Grand Prix. Without real world application, these questions can be little more than a diversion! Failure to address this results in decreasing relational knowledge which relegates any answers divined by processing these questions to nothing more than esoteric knowledge.
     Initially, it may be refreshing to work with these clients. They seem motivated, intelligent, and capable. Some short-term treatment, identification of coping skills, and they'll be on their way. Yet, the short-term goal comes, goes, and we find ourselves sitting in our chair after the 20th session unsure what just happened. If this is the case, a therapist may have made the assumption they know why the client is seeking treatment. If it's solely for conversation or self expression, that may be just fine; as long as this is overtly stated and understood. Otherwise, the secondary gains of philosophizing may actually encourage problem behavior and reduce therapeutic efficacy.

What To Do Theoretically

     All of these truth seeking actions share one commonality: the truth being sought is external to self. There is a lure to this behavior. The safety and assurance of an external truth. However, the safety an external truth provides is inherently unstable due to its locus. It necessarily deprives people of will, freedom, or power. It prevents people from being confident because their truth is really faith in other people's beliefs. For these people, there is no confidence or experiential knowledge to which they can refer. Rather, their truth, peace, and safety reside in the hands of others. That is a scary world.
    Internalized truths based on perceptions and healthy experiences foster opportunities to accept responsibility, establish intentional boundaries, and maintain healthy relationships. Many religious people raise objections about existentialism and relativity stating these ideals deny the existence of God. Yet, the Christian Bible clearly states that external laws and truths are meaningless if they are not internalized (Proverbs 3:3, 6:21, 7:3, Deuteronomy 11:18, Jeremiah 31:33, John 1:17). If we fail to look at the intent of the laws and truths, we will quickly bend them to our own will and make them expressions of self rather than expressions of healthy relationships and love (Matthew 23:3, 7:12, 2 Timothy 4:3).
     Instead of spending our valuable therapeutic time on trying to discover "truth", it can often be more productive to seek "reason". Why is it so important for the client, for the therapist, to discover truth? Do we think it will make life, therapy, or relationships easier? Are we seeking reconciliation and healing? Authenticity and genuineness? In that case, let's not spend so much time trying to figure out who's right and focus more on how to reconnect. Finding ways to acknowledge our relationship is more important than our knowledge. Failure to do this will encourage division rather than unity.

What To Do Practically

     In each of these cases, it is prudent to acknowledge the desire to know, then move directly to the expected outcome. If we had validation, concrete, or ethereal knowledge, what would that do for us or how would that make us feel? Asking these two questions (an oversimplification of Socratic Dialogue) can help clients and therapists establish robust treatment goals. These are crucial if therapy is to weather uncertainty and avoidance.
     Family Sculpting, an intervention created by Satir, is a dynamic way to allow every family member the opportunity to communicate their desires in a non-concrete way. It removes many of the barriers to verbal communication between family members. It leaves room for experiential interpretation rather than static answers.
    Identifying the very need to be "right" or find "truth" should overtly be addressed by the therapist if the client or family is resistant to change. Finding out if this behavior is a primary contributor to the reason they are in treatment can be very valuable. If this is the case, we can simply practice being wrong through gradual exposure. Once clients can control their anxiety enough to process being wrong, address 1, 2, or all 3 reasons a client may be seeking truth.
     Lastly, normalizing a clients inability to have or control truth, along with their desire to do so, may allow the client to feel at peace about struggling. This can help the client be less anxious about their process and, paradoxically, become more calm about being able to acknowledge their compulsive need to identify truth. In this case, treating the desire using OCD interventions (like the 4R's).
     If you have experiences with "truth seeking", please share them in the comments! Remember to maintain confidentiality!

Thursday, April 2, 2015

Child Abuse Awareness & Prevention

“The most painful state of being is remembering the future, particularly the one you'll never have.”

         The following content may be uncomfortable for some. If you have young children, please read. Otherwise, go on about your business, there's nothing to see here. This is about helping prevent and catch child abuse.

          At a place I use to work, there was a child who told a teacher her uncle wanted to play with her purse. Spotting a teachable moment, the educator encouraged the child to share and take turns. The child became sullen, said ok, and slowly walked away.
          Turns out, "purse" was a family colloquialism for vagina. Because the child didn't have the right vocabulary, she was unable to communicate what was going on and received very conflicting messages from a very well meaning adult.
          April is child abuse awareness month. Most parents work very hard to keep their children safe. I'd like to provide three simple things you can do to help your kids advocate for themselves, maintain safety, and encourage healing if something were to happen. Most of these can be done at home, with your own children, and can help educate and empower them to protect and/or report abuse to themselves or others.
          First: be as comfortable with the words penis, vagina, and anus as you are with the words eyes, ears, and nose. Some people use bathing suit area" or "privates" to describe genitalia. While not wrong, they can lead to miscommunication and potentially teach children these areas are shameful or dirty. While this may not be an issue for young children, the message can become problematic when they're older, curious about their bodies, and don't feel comfortable enough to ask questions because "we don't talk about that". This leads to the second point.
         Second: avoid shame. It's easy to accidentally shame children about sexuality when discussing abuse. It can be confusing to know the difference between "it's not ok to have anyone touch you there" and "that part of your body is not an ok place". This may sound trivial, yet it goes hand-in-hand with the first point. In addition, it begins to help children learn that what happens to us, does not define us. 
         Third: don't abuse children. This one could go without saying, but let's be honest! Children are most often abused by adults. All abusers aren't malicious or evil. More often than not, they're simply overwhelmed, under-equipped, and out done by the vast amount of energy children have. If you need help, ask. If you can help, offer. We want to help kids, so let's start by helping their families.
         Lastly: when in doubt, call it out. Teachers, doctors, therapists, social workers, health-care providers, and child-care providers are mandated reporters. This means if we even suspect abuse in children or adults/the elderly, we have to report it to our state child care protection agency. There are state specific agencies, but there is a national hotline and website you can start with here in the United States.
          If you suspect, even without proof, a child is being abused, please call 1-800-4-ACHILD or visit ChildHelp online. Thank you.
By Nathan D. Croy, ©2015