What Becomes of the Broken-Hearted?

 

Please play: 

As I walk this land of broken dreams,

I have visions of many things.

Love’s happiness is just an illusion,

Filled with sadness and confusion.

What becomes of the broken hearted

Who had love that’s now departed?

I know I’ve got to find

Some kind of peace of mind

Maybe.

The fruits of love grow all around

But for me they come a tumblin’ down.

Every day heartaches grow a little stronger,

I can’t stand this pain much longer!

 

I hope you took time to hear the great Jimmy Ruffin singing this

timeless hit. The brokenhearted represent a very special type of client we’ll see from time to time, and a special kind of frozen grief. We know that most people will progress through several relationships in life, even marriage and divorce, and painful though the endings are, they recover, move on and eventually meet someone who fits for them. But we know as therapists there are some for whom the end of relationship is a

kind of trauma. They get lost and seem stuck. As Ruffin sings, “Always moving, and goin’nowhere.” They show some of the markers of trauma: numbing and derailment of life direction, dysphoria, intrusive thoughts, repeated flooding of sensory data at triggers connected with the relationship; but unlike the avoidance we see in other types of trauma, we see rounds of painful rumination and replay; gravitation back toward the relationship even as it remains a source of pain. A tremendous pain keeps roiling around under the surface of everyday life. I’ve seen the brokenhearted keep texting, calling, emailing, like songbirds throwing their call into the air for the lost mate.

 

Without lengthy explanation, I want to round up a list some of the main principles from RRT and hit some of the life-changing conversational tactics used in transcripts with actual participants. This will both focus and improve our practice.

 

Ghost bust seminal events the participant’s mind will bring. Especially harsh endings and rejections. I recall a woman who remembered trying to rescue her alcoholic dad from a dangerous situation as a child, only to be decimated by his withering criticism when she told her mother, the only adult in a position to act. She had been daddy’s little girl, but that special relationship came to an abrupt halt. She veered away from her dad in fear, and remained fearful, over-conciliatory and accommodating to the men in her life from that point forward. She entered new relationships in a fog and didn’t get over them easily when they ended. She came wanting to break out of this pattern.

 

Clear distorted meanings. Especially the idea that one needs someone else to complete them, and can only be okay if with someone else. There are several transcripts in which Jon shows the way to be okay with someone is to be okay without them. He demonstrates the effect of clutching on the arm in a needy way. People instinctively back off from this. He points out the reaction of the other is not even a conscious choice. You can’t hold the attitude that your life can’t work without the other in it and not produce that effect on someone.

 

Enroll people throughout the session in the view that transitions are a normal part of life. The amount of conncection and closeness with people shifts, comes and goes like the tide. Construct a model that is at peace with this, able to go with the flow of it. It’s no more personal than rain on some days or sun on others. It’s not about them.

 

Instill acceptance of the expiration date on some relationships. Here we have the story of the guy forcing down sour milk and then vomiting it back up. He has to make it work. When asked why, he pines for former times when the milk tasted so sweet. A simple fact of life is this: sometimes relationships can’t work between two people, no matter how hard they try. The relationship comes apart in time. The answer is to get more milk.

 

Get the participant to see that missing the person is a misfire. When something seems threatened or in jeopardy our inner mind attaches great value, indeed, makes it seem exceedingly valuable to get us to do something to protect it, even to the point of causing incredible anguish. The mind is working hard to get the person to move toward something when it would serve no purpose. Now the mind bringing something to awareness that it would be good to avoid is useful even when unpleasant–say like keying up fear when the house is on fire. But it sometimes turns on emotion when it’s worse than useless and doesn’t elicit any useful behavior–like the guy going into a panic because the lady next to him in the elevator sneezes. Missing someone is the mind dysfunctioning like that. The question becomes, does all the obsessing, missing, ruminating lead to any useful behavior? If not, it’s a misfire. What’s more useful and positive is for the participant to be moving toward being close with someone when it’s interesting, meaning, the conditions of it being beneficial and possible are both fulfilled and reciprocated.

 

For a treat, and as a contrast to Ruffin’s song, check out To Whom it May Concern, by Sixto Rodriguez (aka Sugarman).

http://www.youtube.com/watch?v=Q0PxN0XVfYU

 

 

When treating the heartbroken in the context of addiction recovery, get them to look at the impracticality of getting into a romantic relationship at this time. It’s sort of like white water rafting where every move needs maximum attention and commitment to navigate the course and the person paddling starts musing, “Gee, I guess right about now would be the time to fall in love.” The only thing crazier would be if another person in early recovery started thinking and acting in tandem with this, as so often happens.

 

There are many things in our oral and written materials that can assist in guiding the

brokenhearted to being present rather than grief-stricken, tuned-up rather than needy, and enlightened rather than opening to more heartache or expoitation. I hope you look through them and develop your own repertoire.

 

 

 

 

Overwriting

margie-beijing

 

 

In 1865 Lewis Carroll wrote about a little girl, Alice, who follows a white rabbit down a hole and enters a whole other world where a host of strange characters regularly turn logic on its head. She winds her way among them intermittently struggling with her own size and identity. Eventually she runs into the Queen of Hearts, whose vengeful demeanor and favorite saying, “Off with their heads!” has everyone intimidated. In the finale, Alice faces the Queen’s wrath and calls her and her minions out as just a pack of playing cards. As they rush her, she awakens to find not playing cards but leaves all over her face, and safe back in her own world with her sister just in time for tea.

 

Overwriting is a term Melinda Paige coined for the powerful clean up that is done in RRT relative to participants’ destructive meanings. Some of us might say, “Oh, that’s just reframing, “ but I think what we’re onto may be something more. Let’s take a brief look at the way overwriting is used in our work.

 

Overwriting is typically used after a powerful connection has built up. In looking over many transcripts, I find Jon reserves most of the best overwrites for the end of the process, sometimes following ghost busting, sometimes intermingled with it. In other words, overwriting understands our work is not done until dysfunctional meanings are cleared. It assumes a substantial amount of collaboration and momentum toward target is already underway. This is set up by the first stages of the method (including, possibly,  induction work) which open up access to the participant’s inner mind, as we talk to it in ways it understands.  We can understand why connection must build first, as we would only incur defensiveness or disagreement if we swung the wrecking ball right at the outset.

 

Reframing, as it is conventionally used, might leave the participant still thinking it over or debating an alternative view in their mind as they leave.  In RRT we invite the participant to not only look with us through another lens but, if we are artful, to step through the lens and experience themselves differently as they see how life events haven’t negatively defined them after all and in fact could be construed in a very different way. Overwriting seems a much more powerful form of reframing as we combine it with the participatory aspects of connection. It’s the difference between stopping a movie at several points in the theater to discuss it with the audience versus sitting beside the participant in the theater while the whole movie runs. A movie so compelling and totally involving that we both forget the popcorn on our lap. Totally into a new movie that ends much better than they ever thought it could.

 

Some examples come readily to mind. Changing internal geography and identity is a huge overwrite, as we lead her through to the realization that the core of her was never touched by the abuse. This is so powerful as survivors often feel soiled or tainted by abuse. There are many overwrites in our lexicon relative to shame. One of my favorites is the girl and her father:

 

“Get it outside of you for just a moment. A woman told me her father once kicked

her across her room and left her locked in her closet all day. She said that was

the moment she knew she was worthless. I said, ‘I don’t get that. If you and I saw

a grown man beating up a kid out in the parking lot and I asked you why these

things are happening, your first answer wouldn’t be, ‘Well, isn’t it obvious, the

kid is worthless?’ It wouldn’t, would it? Maybe you’d say, boy, we just learned

something about that guy. But we wouldn’t have learned anything about the

little kid’s worth, would we?”

 

This overwrite, which also uses dissociating the story, usually has massive beneficial impact, as deeper mind gets how shameful behavior was located in the perpetrator from beginning to end and never got in even skin deep to the survivor. It is then free to just sluff off.

 

We all know the overwrite of science over moralism. It starts with the story of the tree branch that is down and casts the participant as teacher to a younger person, teaching a scientific view of causality versus preference, moralism, or blame.  The younger person in the story is our participant who is still trapped in those viewpoints. It ends with the participant getting how gratitude replaces pride but also things like guilt, regret, resentment, and blame. They get it through and through that they did past events in the only way they could have at the time and things couldn’t have possibly transpired in any other way. Moreover, those events are no longer in existence. The much better course is to be present, tuned up, and causative in the here and now.

 

A final example is often found on the tail end of clearing abuse when we clear stories of parental neglect. I’ve always liked how Jon will frame the parent’s inaction or hurtful responses as neurologically disconnected at the time. It isn’t that mom got up one morning and thought through the best way to screw her daughter up for the next 30 years. She just couldn’t connect the dots at the time the participant-child came to her with the bad news of molestation. Jon paints an accurate picture of the severe click-off that denial does in the mind when confronted with overwhelming bad news. “It’s like you tell this guy, ‘Your house is on fire,’ and he says, ‘That’s a very valuable house, I’m choosing not to believe you.” The parent’s mind literally couldn’t take it in, therefore they couldn’t connect the dots and couldn’t have taken effective action. This often enables massive relief and a sense of peace for participants. Similarly, in other transcripts, physical beatings, suicides, rages while on drugs, all manner of out of control behavior is pictured as a neurological storm, chemicals running around in a badly disconnected brain. This overwrites the long-carried notion that the behavior was personally directed at them or meant something about them.

 

Like Alice of old, we powerfully wake participants up from the walking nightmare that came from the meanings their mind attached at the time. We overwrite that story quite forcefully,  but artfully,  with proper timing. Listen and watch for when Jon starts a sentence, “Let me tell you what happened there…” You may just pick up something that will help your participant step back through the looking glass into a more positive world, into a more positively embodied existence.

 

 

 

 

 

 

How to Learn RRT

 

 

imagesA few years back I was struggling to jump free of the printed musical page and start creating improvisations of my own. I love the way the saxophone sounds and I loved some of the beautiful take-offs the jazz greats could do on time-honored melodies. It was nothing less than the ability to compose music in the moment, while keeping within the overall chordal framework of the tune.  It was what Billie Holiday could do with her voice and what Stan Getz and John Coltrane did with their horns.

 

 

 

But I just didn’t trust myself. I got concerned about the ratio of sounding lousy about 98% of the time and only sounding passably “correct” the other 2%. Even when I heard something pleasant in my head, I noticed my thoughts fearfully returning to fundamentals right in the middle of a passage–the equivalent of asking myself out loud  if I was doing it right or not. Needless to say, this is not conducive to improvisation. It’s the condition in RRT we call “headlights turned in” and it’s the opposite of the creative freedom that comes of being tuned in to what’s going on.

 

 

 

I think the same thing happens after many of us come through Level I, Level II, and even Level III trainings. We go back to the confines of our office and start to stumble around and doubt ourselves.  We fall into shame about not being able to always hit the right note and begin comparing ourselves to the towering prowess of a master clinician, like Connelly or some illusory template. We forget that what we saw in trainings was the distillation of hundreds if not thousands of hours of searching and stumbling; that he is constantly trying out new stuff, throwing this away, but keeping that,  refining it even further. Improvisation for Jon is the normal process, and is exactly how RRT came into existence.

 

 

 

I’ve noticed on the teleconference calls so many of us are asking questions about why Jon chose to clear a client with one combination of interventions and not another.  Why did he put the induction at the end or not use one at all? Why did he pass over an initial issue the client voiced and go with a different, more central one? How does he know to do what he does? Why cant we have a simple template that will fit our clients in every situation?

 

 

 

The answer lies in what Jon has put right at the heart of the whole method–a certain confidence in the connection and the centrality of continually reading the participant. He is constantly reading a person’s responsiveness, looking at the effects he is having, while keeping his intention for the participant clearly in mind. An avenue that worked nicely with the last one starts to not work with this one, so he switches up to a different tool. I once heard him say in response to a slight miss in a live demonstration,  “That’s all right, there are a lot of keys on the keyring.”  While working within the rubrics of keeping the intention at all times, he is not afraid to experiment with what comes to mind.

 

 

 

We need to trust the vast storehouse of our own unconscious which is packaged in stories and metaphors. Though not an example from RRT, I experienced this in action just the other day. I was with a shamed husband, shamed because of not being able to keep his wife happy at all times. He got triggered by her tears and so distressed was he that he suddenly bolted out of his chair,  ready to quit the session. I was at a loss for what to say as he was already half-way out of the room. But all of a sudden a memory from my wrestling days flashed back. It was 1972 and I was team captain, enjoying some celebrity in my high school. One day the athletic director and coaches brought in a blind kid who was interested in the sport. It was some sort of interface with the parks and rec program and they wanted him to experience a team practice and a live bout so they paired him with me for one two-minute period. I remember his name was Jimmy, and he wanted so badly to do well. But when he went to perform the basic moves he’d learned in the parks and rec program, I was able to block him easily. Frustrated, he burst out in tears. With a lot of people looking on, I was sure I’d blown it. His display became a statement about me and connoted my failure to successfully introduce him to the sport. I was sure everyone was looking at me as some kind of jerk. Embarrassed, I rushed out of the practice room and stormed into the locker room, kicking stuff around in a half-hour shame attack. It was not my finest hour.  Back in the session, I told the husband this story quickly, ending with, “I think I understand something about what you just went through a moment ago as you saw your wife’s tears.” He sat back down nodding his agreement.  I’d say that was the turning point of the session. It felt like a tremendous risk, but by going with it, I connected with him. And by not talking about but showing vulnerability, helped him get to back into connection with her.  Needless to say, I didn’t have time to consult any manuals or review teaching tapes to weigh the wisdom of such a disclosure. And notice this: I had not thought of that incident in over 40 years. But at precisely at the right moment, my mind showed it to me and how to use it.

 

 

 

I think the way to learn RRT is a lot like learning jazz. Yes, we have to practice our basic scales by listening to tapes and watching video of various sequences to learn the scaffolding of the method. There are many new principles in RRT that overturn what we learned in graduate school and it takes awhile to assimilate this. But with enough listening and watching, a storehouse builds up from which we can draw. There is no boilerplate formula or a map that will guide every case. Instead there is a songbook of  basic tunes with many possible touches and flourishes that we can make our own and add to as the situation calls for it.

 

 

 

We return to our offices and face real people in the midst of real pain, ready to have an interaction that has never appeared in history before.  It is time to go live with whatever we’ve got and trust that the words will be there. It’s time to trust the intention we have for the client who is yearning to be understood in his or her uniqueness and following us all the way to target. It is time to take out our instrument and play the music of RRT. And when,  inevitably, we face choices about where to go next,  to simply trust whatever comes to mind.

 

 

 

 

 

 

 

addiction

Shame in RRT

 

 

This month I want to poke around in some of the dimensions  of shame as it relates to problems we may encounter in practice, particularly with some persons who have suffered deep wounds of victimization, denigration, and humiliation and for whom making contact poses a major hurdle.

 

The Contours of Shame

Deep shame is not about making mistakes, but being a mistake.  Therefore, a person comes in with a sense of being defective, inferior, and needing to hide. The compulsion to hide and get away from shame is crucial, and modulates the ability to meet, as the person is on the lookout for further hurt, perhaps determined to not be seen, to not show up. For the shamed person, relationships are dangerous. If you are unacceptable, and that becomes exposed, you could be further shamed or cast out or left. We have to recognize that deep attachment, and therefore, survival fears are being activated at this point. What the old mammalian brain knows is that social rejection is tantamount to death. If you don’t hide and let the threat pass over,  it may cost you your life.

 

So, clearly, for some, there is a far more debilitating experience underway than we might ordinarily suspect. Shame is a powerful force. It drives intention and behavior, which is to remain hidden and safe. It becomes paramount to prevent too close physical proximity to another and to thwart the discovery of unacceptable parts of or facts about the self.

 

The Client’s Dilemma

 

As we think about it, the person is in quite a bind. If they answer our questions, they risk exposure and the realization of their deepest fears. But if they go the other way and dodge or refuse our questions, they risk activating our administrative option to discontinue the meeting. They understand we are in authority and they are challenging our protocol. They risk disobedience, our displeasure, and termination of the relationship right at the outset. Nevermind that most counselors wouldn’t end a relationship simply because of a client not answering. A deeper part of the mind doesn’t think on that nuanced a level. It’s in survival mode and intent on getting the threat to stop. If I don’t comply, I’m screwed, but if I do comply and disclose the unacceptable, I’ll be screwed and lose the relationship anyway. Checkmate. The urge to withdraw or a paralyzed shutting down usually wins out.

 

As a side note about counselor questions, one can never know what will trigger shame. Loaded questions like ”What did you go to prison for?” “What led to your divorce?” “How is your sexual intimacy? are obviously tricky under the best of circumstances.  But I’ve seen people shut down when asked even relatively benign questions, such as,  “Are you and your children in contact?”. “How much school have your had?” “ What is your family like?” “What do you do for work?”  We may feel as if we are just doing our job in good faith with non-judgmental acceptance, warmth, and genuineness. But indeed, the very process of being questioned can feel to some folks like dental surgery without anesthesia.

 

Shame’s Effect on Process: Incoherence

 

Shame is among the most negative and disruptive of feelings. It fragments and de-stabilizes our ongoing experience. Alexis Johnson writes, “At the most severe level of shame, we are afraid of any kind of self-expression because to be seen is to be seen as dirty, disgusting, worthless and unloveable. “

 

The result in counseling is a progressive shutting down and  incoherence. Johnson traces the following four steps in a sequence:

 

  •  The first sign is a shift in eye contact. We lower our eyes and break off our gaze. We lower our heads and droop our shoulders.

 

•  Second, our ability to perceive reality shifts. We become unable to see, orhear clearly, what is going on around us.

 

•  Third, shame interferes with thinking and we automatically defend ourselves in various ways.We try to get away from this noxious feeling to the extent thatwe cannot think, cannot problem solve, and certainly cannot be creative.

 

•  Fourth, shame interrupts our emotions and emotional communication, limiting intimacy and empathy. Shame can interfere with anything and everything from the joy of sex to the joy of ideas.

  • Fifth, I would add the explicit element of incoherence. The client may start a sentence two or three times, may show high ambivalence, may repeat out of context phrases or mix historical narrative with painful realizations and self-critical commentary, may shift contexts without a conversational point of reference, or use ‘I dunno’ excessively. The variants are endless, but the growing incoherence is telling.

 

 

 

Shame is a Powerful Tuning Fork

 

In the delicate business of forming a container for our work, we are using the self as an instrument of connection. This containing relationship must support both parties for a meeting to take place that may be transformative. Shame hits a note that shakes this delicate formation unlike any other and can quickly reverberate,  like two tuning forks in close proximity. Counselors must be aware of the power of shame in the room and of their own shame issues and not be hypnotized by any of it.  Often it will register with the therapist as a sense the session is not going well. We can escalate,  in that moment or afterward, our feelings of incompetence, stupidity,  or not up being to the task.  These are variants on the experience of being ashamed. I like Johnson’s observation that more often, our response is subtler. We do not feel a huge inner jolt, but a vague sense of being confused, uneasy, wierd, helpless, and so on. It is helpful to know when those words pop into consciousness, we are in the vicinity of shame. If we don’t recognize we are carrying shame about the success of the relationship, or perhaps other personal matters the client’s story or behavior touches on, we are likely to slip into the trance of self-preservation. We may develop unhealthy polarizations, like the “healthy-therapist-and-sick-patient” (p.235).  Overt or covert pathologizing is a sure signal that we’ve lost our way.  And if we aren’t aware of what’s happening, we can surely become poisonous in our need to defend ourselves. I find in such moments the thing that always brings me back on track is my single-minded intention for the participant.

 

Conclusion

 

The implications of shame and its workings in the first sessions are many. A discussion of all its aspects are beyond the scope of this short blog article. In RRT we are taught several ways clearing shame. But here I simply want to hold the spotlight on how disruptive to forming the connection that shame can be. The person may not “get” your question about what they want to accomplish. They may not “get” a lot of things you are saying to them.   As cognition and the emotional ability to read another breaks down and shame ramps up, you’ll see a rising discomfort or a confusion about steps of the method or your statements. You’ll notice the incoherence, both expressively and receptively.  They may stumble with the request to form a design or not catch hold of the model because they are cognitively narrowed, overwhelmed, and intensely concerned with how far short of the model they fall, and how they’d appear, particularly if they did it “wrong”. They may feel easily offended by some of our metaphors and stories, such as wolf and rabbit or references to the goat part of the brain. They may not be able to trust an induction procedure, for fear of losing control.

All of these are signs to drop back and take care of the connection.  It’s good to develop a repertoire of ways to get the client present, such as kidding with them, with gentle warmth and humor, to get with you or check out if you are  treating each other okay. You can give them the upper hand by casting them in the role of teacher to a hypothetical younger person whose thinking is held hostage to one of the forms of stuckness or other disturbing beliefs.

 

At it’s extreme, shame can form a fork in the road. If the Rapid Resolution Therapist plows ahead through the steps of the method, he or she goes down one road  and risks dragging a participant along for the ride who remains silently scared or stiffening into their habitual mindset, which ultimately doesn’t let the shift occur. You risk tripping on the hoop of disagreement and your client sitting there with an internal IT’S NOT HAPPENING mindset.  If the counselor takes the other fork, the session or progression of sessions may take longer, because of the need for safety.  We may have to “slice it thinner”, i.e., move toward tiny, provisional targets that are within the participant’s bandwidth of tolerance. Or spend some time just building up experiences of successful understanding.  We may have to drop back at various points and take care of the alliance and provide safety, through our humor, reassurance, uplift, and repeated demonstrations of interest and understanding.

 

 

 

(Alexis Johnson. Healing Shame. THE HUMANISTIC PSYCHOLOGIST, 34(3), 223–242

 

Copyright © 2006, Lawrence Erlbaum Associates, Inc.)

 


LifeForce

What’s Our Role?

Consider the following sentence: “There are thousands of people in the United States just itching to (insert a verb of violence) somebody.”

Notice if you insert verbs like hit, slap, insult or even verbs like run over, hang, drown, or stab you don’t get as immediately concerned as when you insert the verb “shoot”. We get concerned because we know instinctively about the lethality and availability of high power semi-automatic and automatic firearms.  Our brains use negative emotion to get us to do something about it, get it to stop, because the oldest, most instinctive part of us recognizes it’s in range. The danger is real. Hence there is no doubt the immediate and serious problem we have with controlling some guns has arrived at our door. We have to do something effective about guns in this society.

But this is only part of the problem. Take a look at the sentence again. Something is terribly wrong in our society if indeed thousands or even hundreds are in such a state of mind. We hear story after story of distraught parents or teachers recognizing troubling signs in a child or student and being at a loss as to how to find effective answers or means of intervention in their communities to head the problem off. They run into a collapsed mental health system whose power has been neutered and policies have long since been warped by insurance companies and lawmakers who lost the political will to find funding for them. And they run into a statute that defies logic by setting the bar at “dangerousness to self or others”. In other words, before municipal authorities or mental health professionals who do know what to do can act, the situation has to reach those proportions. It’s like telling someone whose bleeding is severe and life-threatening, “We won’t see you in our emergency room unless you are dumping at least two quarts on the floor per hour.”

We live in a society of disconnection where neighbor is afraid of the ethnic or religious background or lifestyle of their neighbor, where differing political views become grounds for vilifying or terminating relationship. We live in a time where people are failing to know each other and to soothe each other by plugging in emotionally. It has become an ingrained habit to avoid, disconnect from, and pretend others who are different don’t exist. In the on-line world we don’t really connect so much as do a drive-by, virtual presence through an avatar. The trouble with this strategy is that the laws of attachment state that when we don’t connect, the situation becomes inherently more threatening. When we fail to know each other we become strangers and an old part of our brain recognizes the peril of being cut off or being the one cutting others off. When we fail to know and relate to each other we create and perpetuate our own worst fears. And this is happening at a time when technology and the speed of information and immigration patterns are forcing us ever more tightly together into one big village.

So what can the response of the mental health community be in such a time as this? I’m sure it’s manifold and multiplex. Society has perhaps never needed us as badly as it needs us now. One thing I’d suggest is that we initiate and model what we’re supposedly good at–how to talk to one another. I’d be in favor of the return of town hall meetings in every neighborhood, precinct, parish, or town in America. But they’d look a lot different than the flurry of insults and innuendo, misinformation and stonewalling positions that we see in Washington or in the media.  A guy named William Isaacs wrote a book back in 1995 entitled “Dialogue–The Art of Thinking Together”. It’s an impressive and inspirational book and a manual for how to do it right.  I’d like it if everyone with a mental health license in the country was required to read that book. I’d like it even more if as a second step government would fund mental health professionals trained in the Isaacs approach to spearhead town hall meetings for a 3-5 year period.  Could you imagine it–wherever we live, training others to listen as if the other’s plight were one’s own and to talk non-violently? For trained professionals to begin a process where people meet regularly with each other and get familiar with their neighbors’ hopes, dreams, problems and fears again.

I’d like to live in a country where participating in such small group dialogue was considered a regular part of one’s civic duty. Where indoctrinating one’s children, once they were of appropriate age, into such participation was considered a routine part of how you raise a child.  I’d like to have it so the voices of the young and the very old, with all their experience, and everyone in between, were gathered once a month into the same community space and people just listened to each other.

To be sure, this wouldn’t solve all our problems. But the fact that we face many and they are complex, is, as the President recently said, no excuse.  It’s time to take whatever steps we can. I see it as one way that would likely cut down on some of the forces currently in place that produce the degree of  alienation that in turn gives rise to festering rage or despair that drives some of the weakest of us to finally wreak havoc as a way of signaling their distress.

Forget Self-Esteem

 

 

Some people pursue feeling good about themselves like a hobby. It reminds me of the little boy  prodded by his mom to kiss his aunt at the family reunion.  As far as it’s contrived, forced, and not genuine, neither the aunt nor the little boy get anything out of it. It seems self-esteem comes through other means than by grasping for it or trying to manipulate it into being. I’d like to share this excerpt from Ron Siegel’s contribution to NICABM which was recently posted online. Siegel, a Ph.D, and one of the leading lights on mindfulness studies said,

 

“There has been a lot of work done recently – Kristin Neff has probably done the most research on this, and Chris Germer has done a lot of work with this – basically showing that self-esteem doesn’t contribute to happiness.

 

So, I work with folks a lot to try to help them see how the whole quest for self-worth is actually a doomed enterprise, and that seeing the way the mind creates these feelings that either I am worthy, or I am unworthy, or I am good, or I am bad, or I’m capable or I’m incapable – that these are just an endless, narrative report card that keeps passing through the mind.”

 

In Rapid Resolution Therapy, we zero in on this disturbance as we consider with participants how a wolf thinks while chasing a rabbit. The wolf, whose mind can’t consider itself, like a human mind can, would never think, “Oh, I wonder if my coat is glistening today?” Her mind is totally tuned-up, present-focused on what she’s doing. If the wolf catches the rabbit she doesn’t pause to feel good about herself, either. She actually doesn’t feel anything about herself at all.

 

If you ask a concert pianist how he feels right after a magnificent performance, he might say that he feels exhilarated, but when you ask him why, he’d explain it was because he was totally into the music. He got absorbed in it, he gave himself to it. But it wouldn’t be because he was appreciating his own qualities, like his finger dexterity, as he played. The whole question of how he was feeling about himself during the act of performing would strike him as absurd. Likewise, if you were to interview an Olympic sprinter right after running a career-high time or an NFL pass receiver making catch after catch as his team marched downfield, the answer you’d get about how they felt would be something like, “I dunno, I was just in the zone, it felt great.” There is an exquisite, joyful awareness of time, movement, the act of creation, and intense involvement as the play or the symphony develops, but it is not about one’s self. At the height of this kind of experience, the self actually disappears. The headlights are out not in.

 

Some  get stuck on the notion that they don’t feel good because of how someone else once treated them. It’s a done deal, they think. I was mistreated, therefore I missed out. Or they think it’s a mysterious puzzle that they and their therapist must solve in order to feel good again.  I like Jon Connolly’s story about the psychiatrist who showed one guy an inkblot. The patient said, “The family is all in the garden. How nice.” He showed it to the next patient who reacted, “My God, get that man away from that little girl. How horrible!” Now what did the psychiatrist learn about the inkblot? Nothing. He already knew about ink and forming ink blots. He sure might have learned something about the two patients, however. We need to help people get it that when they bump up against certain people in life, they are the ink blot.  We can’t learn anything about them through the actions or reactions of others.

 

I listen closely to the language of troubled people. Somewhere along the line they bought into the mistaken idea that there is a hole within them that has to be filled, some experience, talent or trait that other people have in an unknown quantity, that if they just had enough of it, they’d be happy. Now they have to go out and get it, as if it’s outside somewhere. What they’re after they often call confidence or self-esteem. It’s a bunch of hogwash. It’s not how it works.

 

Keeping the headlights out is a truth we ought to be transmitting more and more to clients who come in our doors. There is a mountain of pure baloney out there, promulgated through popular literature, self-appointed “coaches” and traditional counseling theory that would send people in the wrong direction. They read or listen to all the pap and become experts in analyzing themselves, measuring themselves against some ideal, going further and further in manipulating and thus objectifying themselves. There is an implicit unfriendliness in this, a rejection going on here that deeper mind does not miss. They are getting further away from the joy of participation, of giving oneself unselfconsciously to the task at hand, the creation of  beauty in the moment.  That, it seems to me, is what paves the way to mastery and confidence,  happiness and deep contentment. Just ask any wolf.

 

 

addiction

A Man Convinced

“A man convinced against his will, is of the same opinion still.” This old quote is one of my favorites and a favorite of a dear colleague of mine who has been in the addiction field 43 years, Trey Cryer. I’ve been in the field 30 years, so between us we have 73 years and have come to the same conclusion embodied in the quote. You can’t force someone’s motivation to change.

Almost weekly some distraught mother or wife will call me seeking the BIG secret to get her son, husband, or daughter into treatment. Alcohol, drugs, tobacco, sex, spending or some other substance or process is running the show and moving the person perilously close to a cliff of destruction. What’s really going on is the caller is on high alert to the imminent danger and they are in full response mode to make something in the world stop–in this case, the addict’s behavior and more generally, the hold the addiction has on them. But what’s being overlooked is the fact that no one can force another’s motivation. The addict is not yet convinced and is of the same “opinion” still.

There is a decisional balance going on deep inside every addicted person. And there is a time when this balance can start to swing toward the side of the ledger labeled: “the negatives about addiction plus the good things about living life clean and sober”. But it follows its own timing and trajectory in each person. It can’t be manufactured, manipulated, or willed into being by another, no matter how close they may be. And it’s unpredictable. The yo-yoing can go on for quite awhile. Witness the resistance to going for treatment or going back into treatment or needing many treatments to finally stop. Addicts will often try to sidestep or bargain with the necessity of coming off the drug. They’ll try to reduce consumption, they’ll leave programs early, they’ll avoid professionals and do their own jury-rigged regimen; they’ll substitute a less harmful or more justifiable drug in place of their drug of choice (which merely develops a cross-over addiction). They are moving up and down the ladder of motivation, between pre-contemplation (my life is fine), contemplation (part of me would like to get sober, part of me thinks I’m OK with what I’m doing), and preparation (I know I have to change, but I’m not sure how to go about it). This can go on for some time, always stopping short of action–actually getting into treatment and ceasing intake of all drugs and addictive processes.

It takes awhile to develop an ear for where a person is on their motivational ladder and many professionals know how to match their wording to the stage. Teaching how is beyond the scope of a short blog article. But I would encourage family members to sharpen their ears to the following: the gathering awareness of the need to change, the readiness for it, along with the downside of staying impaired. Listen for these starting to show up in an addict’s language apart from being prodded or goaded by others. It is not something under your control. Just remember, “A man (or woman) convinced against their will is of the same opinion still.” This is your best guide for getting through the crisis intact. Do not get swept up in either pessimism or optimism. Just reaffirm your support whenever the addict’s sees it more clearly and their emerging plan to move ahead toward health. Meanwhile, take care of yourself because there’s no one who can tell you for sure how long the yo-yoing will continue or whether the addict truly has reached the top rung on their motivational ladder and that this will be the time that sticks.

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How RRT Prevails Over Most Therapy

 

 

All therapists have the common experience of sitting in a first session intake with a distraught client and learn that they have tried therapy three, four, five, half a dozen or more times before for the same issue. Some therapists might look askance at the client, and start asking themselves, “What about this client has made it so hard for others to help them?” That is the wrong way to look.  It doesn’t usually occur that the reason this client has not found relief is that  their prior therapists didn’t know how to fix what was wrong.  You see, clients are in pain and their pain makes them very persistent in their search for relief. They will abide being viewed as a walking pathology but will not tell their therapists about the toxic effect that is having,  or the fact that the therapy really isn’t working. They are on our turf and they know it, and even the boldest will keep it to themselves. They will simply cancel their appointment one day and stop coming in.

 

So what is going wrong? I didn’t really  understand it until I studied and became certified in something called Rapid Resolution Therapy. RRT clinicians are taught to pay very close attention to the  connection that is forming from the very first moments. We are taught to speak with our intended effect always uppermost in our mind. If we can’t help the client, we make it plain it’s due to our lack of skill and not some defect in them.  We don’t put it on them or make it about them. But happily, most of the time we can help, usually within the first few sessions.

 

My purpose here is not to explain the technical side of how this is done, but rather to show what’s usually going on and contrast it to what I consider a qualitatively better experience. Not long ago, I watched a tape of a therapist of another stripe working with an Iraqi war vet with severe PTSD. She had been with him for a whole year of sessions and yet he was still flooding, having nightmares, unable to work, drinking episodically to manage intense distress, mired in deep shame about his condition and the effect it was having on his marriage. She was trying her best in a conjoint session to improve the connection between the vet and his frustrated, scared spouse. The discussion that ensued among mental health professionals in the room assumed this man was unfixable and that he would have to live with his condition forever. That at best, a stronger relationship with his partner could possibly buffer the devastating effects of PTSD and marriage counseling would aim at helping them manage it together. However beneficial a good marriage might be,  I saw right there with the technologies on hand to address some of the more difficult conditions, many of us therapists have lost hope in our own craft. They continue to meet with clients, as this therapist had, under the cloud of knowing they have little to offer for the problem at hand and think they are doing well with at least offering “support” or redirecting goals to a different target of care.  But that crucial shift is seldom directly disclosed.

I stopped to consider what a curious thing this is that might only be happening in our field. If a dentist couldn’t fix a tooth or a mechanic couldn’t repair a car system, they would say so in the work-up phase, and either refer to a more qualified colleague or break the bad news without delay. The wouldn’t go tinkering with a different system.

There is a basic dishonesty going on in mental health. I can’t say for sure why it occurs. My guess is it occurs unintentionally because of a confluence of complex causes that exist in our field, among them shame for not having an answer, the need to be needed,  sharp ideological divisions, and of course, the need to keep money coming in. I couldn’t help but wonder what effect meeting under this cloud would have on both therapist and client through time.

I imagine it like this:

This vet would continue to come in for his weekly supportive meeting with his individual therapist. He would be looked upon as an especially problematic (read hopeless) case and everyone right out to the receptionist at the front desk would view him that way.  He would be strongly recommended to go on regular doses of prescribed medication and warned he must stay on his regimen. He would pay his copays and assemble and submit the documentation necessary to stay on disability, which would now be incentivized and protected because it’s his only means of income. He might be funneled into a support group with other vets who’ve come to see themselves as broken and be encouraged to sit with them once a week and talk about it–the misery of living with horrific symptoms and just struggling to stay alive. This is the current state of the art, with few exceptions. I’m thinking if I’m that vet I’d go anywhere, to the ends of the earth if necessary to escape this fate, and that I would avoid like the plague anyone who would see me that way or recommend that dance card as my primary treatment plan. I’d want to start fresh with someone who believed I could get well.

 

I’ve been trained in a way that is more effective than most and looks at clients as people who can get well. I’m aware as I write this we in the RRT community haven’t done a good job of getting the word out. We have to do better. We have to let those with broadcast abilities know that we’ve left behind our traditional training and the dead ends it leads to, and that we do therapy in a much different way, from a much different orientation.

We don’t just care, we actually repair.

 

 

 

Resistance

A young guy with everything going for him sits in front of me arguing the harmlessness of marijuana. He thinks he has thought the matter through and has covered every base to come to his position. He doesn’t know a more primitive part of his brain has overruled all logic and warped the process of thought itself so the real presence and operation of something else is disguised– protective denial and the fear generated by addiction is running the show. Addiction operates in a way to protect itself and steals the long view–he literally can’t see the end of the movie.

A young woman arrives 15 minutes late for the second time. This time her apology is more profuse and heartfelt than her first lateness. She smiles sweetly as she paints a picture of herself as helpless before the coalescence of so many of life’s variables. It’s as if her own causality doesn’t exist anymore, her actions are really not a choice, but merely the result of other people and events. She is a pure dependent variable in a universe of much stronger forces and therefore cannot be blamed for any of it. She uses charm and her delusional innocence to skate through life with special privilege and would adamantly deny that she has any hand in setting it up in this way.

I give another young woman a perfectly good tool to take home and practice. This tool actually brings down her level of physical pain from an old injury. We practiced it in my office and she felt the relief and saw that it worked.  But she goes home and never uses it. Worse yet, shame takes over and she cannot bring herself to call me and withdraws from therapy altogether, cutting off the opportunity to get help with getting past her stuck point.

Resistance is about fear and hidden conflicts that we bring into the therapy situation. It’s not so simple that we can say someone just wants to remain ill. That is looking at it in a simplistic, moralistic, blaming way. But it is accurate to say inner mind is using its immense power to thwart change and keep the status quo, sometimes for very good reason. We have to remember inner mind often confuses the past with the present and doesn’t distinguish between what’s imagined and what’s actually happening. The move toward health is being blocked by the fear of an imagined catastrophe that inner mind is convinced would occur and may have at one time occurred. The resistance keeps them safe against that eventuality. As seen above, people signal their resistance in sometimes obvious but also not-so-obvious ways.

The proper attitude toward resistance is captured in the Aikido master’s statement. The art of Aikido is not, as commonly thought,  about using an opponent’s power against him. It’s really about learning to use an opponent’s power to prevent him from hurting himself.

The therapist has many Aikido moves that may move the client forward. We can use surprise, shock, confusion, and planting doubt in various ways. We focus attention on the present and invite the client to join us there. We may prescribe the symptom, tell a paradoxical story or use language that amplifies and extends the resistance to an absurd conclusion.  Sometimes we can take charge of the resistance, which is to say, if it is going to be there anyway, we as therapists might as well bend it to a therapeutic end. For instance, I remember counseling a mom and her 13 year old son. The son, as is usually the case, got dragged in and refused to answer any question or respond to any attempt to join. What he was interested in was hearing his mom’s version of things, so furious with her was he, so he could be there to counter her every charge of his recent misbehavior.  I forbade this, granting it was okay for him to not participate, but he’d have to sit in the waiting room and wait for his mom to come out, and I asked him to leave.  He practically spat at me, demanding an answer as to why he couldn’t just listen in. I calmly said that’s not how I run my office. If people come in, they have to answer my questions and really participate. He ended up speaking for himself, asking his mom some very intelligent questions about her divorce, and reestablishing his tie with her. What got relieved was his honest terror of being collateral damage in her five year war with her ex and growing up with no one.  In this case, I used what he was giving me, what he couldn’t stand– being left out and being talked about–as a way to redirect his own force so he wouldn’t further hurt himself.

Responding to resistance is a matter of careful observation, timing, and utilization of what the client or the situation gives you. Whatever I do, I don’t forget to listen to the resistance as a signal of some inner fear that might be there for a good reason. Milton Erickson explained that it’s okay for the client to resist. Sooner or later in some way they will resist. He said we’ve all grown up with the feeling we are not going to be anybody’s slave and no one can tell us what to do. As therapists we should let them, for they are saying right at that moment they need something to hang onto. The ultimate goal is to get into a position where we can show them what they can do–usually much more than they’ve ever dreamed–and not go round and round with them asserting what they won’t do.

We can only achieve this with focused attention on the client and aliveness to the moment. And the Aikido master’s concern for the client’s ultimate well-being. We cannot do it if we take resistance personally, get hypnotized by superficial content, or get lost in defending our approach or our credibility. Our headlights have to be out, tracking what predicament our client is actually in.

Using Attachment Figures

In Rapid Resolution Therapy we use attachment figures as the cornerstone piece in relieving what we term as “frozen grief”.  Frozen grief is the disturbance left in a person’s mind after the impact of the physical passing of a loved one. An abiding sense of loss, sadness, regret, or being cut off from the person is the common experience of so many for whom the impact couples with the limitations of our five senses to create this special kind of pain. Frozen grief is accentuated by circumstances of a passing that leave the survivor with the sense that the departure was too early, unfair,  abrupt, could have been prevented, or that enough wasn’t done.

What do I mean by an attachment figure? An attachment figure is one with whom we share a special kind of bond, the attachment bond. We only form these with people our minds recognize as crucial to our survival, some think with only a few people in a lifetime. They are those whom we know have our back, can always be counted on to be there for us. They literally form the secure base and safe haven that we need to launch into the world to explore our identities and capacities as we make the journey through life. They could be a parent, a grandparent, a sibling or some other central figure early on, and later, in adulthood, a spouse or partner. No wonder their passing or even threatened separation is often felt so traumatically.

But years later these figures can serve as valuable sources of inspiration and strength, as inner guides with timely support to get through troubled times. Their wisdom and unique talents live inside us, unless frozen grief  blocks our access to them. Or it happens that we may have simply forgotten the learnings they gave us that we still possess.

I’m thinking of a case where a very downtrodden caretaking man couldn’t shake his chronic depression and the feeling he could never do enough for the wife who had long since detached from their relationship, but with whom he still lived. The therapist tried to use reasoning, empathy, insight, a host of tools,  and was getting nowhere. She then asked him who was the one person he could go to with his hurts and needs as a child. He indicated he could go to his mother. She then brought mother imaginatively into the room with considerable therapeutic preparation and skill. When the man was ready to listen, the mother told her son he’d done enough, that he was dying inside this relationship, and that it was time to take care of himself.  He responded to a source of wisdom and support that he had inside all along, but that he’d forgotten how to access. He eventually moved on to a better life with a total remission of his depression. Attachment figures can be used in this way by skilled therapists.

I was initially certified in Gestalt Therapy, and we used the double chair technique regularly to call upon the qualities of a beloved figure to help the participant through some current life dilemma. It would often go well, but just as often I’d get a participant who just couldn’t connect through dialogue. They’d say something like, “This just feels too weird talking to him like this, can’t we do it some other way?”

I didn’t understand it then but I know now, I was trying to do an end run around the critical, logic-oriented conscious mind without the proper preparation. In RRT we’ve solved this problem through some special procedures that access the unconscious mind and unleash its power to follow a therapist into new connections. We regularly see Jon Connolly, RRT’s creator, successfully get grieving persons back in touch with the experiences they’ve never truly lost and not just with their memories, but the attachment figure’s essence, in a way that is healing, relieving, and life-giving. People come out of session with the color back in their faces, a lighter heart, and able to feel all their feelings again, once energy is no longer trapped in needless grieving.

In private moments when I’m troubled by something, I now practice what I’ve been taught. I get myself into a relaxed state where my conscious mind with its clumsy steerage isn’t running the show, and I get back in touch with my grandfather’s tender care, or my dad’s dry wit that could bring any problem down to size, or my mom’s incredible generosity which is my north star for getting back on track in relationships. They are all inside. It’s just a matter of getting out of my own way.