Office Treasures

Office Treasures

What kinds of useful treasures do you keep in your office?

Aside from the boring box of things-I-might-need-or-have-forgotten-at-home (headphones for ADHD assessment, bandaids for strange emergencies, deodorant because I’m sometimes in a rush, etc.), I have a box in my office of useful treasures that I pull out in therapy sometimes. It has mostly been populated because I really wished I had something in session and didn’t! I thought I’d share a few of those items with you:


  • Heart rate monitors
    • I keep two inexpensive heart rate monitors (the kinds that clip gently on clients’ index fingers) in my office, along with extra batteries. I use these in the Gottman way, when couples have a tendency to escalate (to help them see when they need a time out) and I also use them with individuals sometimes when we’re learning relaxation techniques
  • Copies of therapy-pics I’ve made
    • I like to make “take homes” for clients using stock photography, either for use in session exercises or to reinforce special ideas. I try to keep a few copies of my favorites so that I have them available and can send them home with clients
  • Bubbles
    • I use the small tubes of bubbles that are popular as kids party favors. That way it’s easy for them to be single use. The primary way I use these is to teach unpanicked breathing. Attempting to blow one large or many little bubbles is an easy way to get across the basic principle of “exhale longer than you inhale,” and clients seem to like the interactive nature of the activity. I also occasionally have couples use them when they need to discuss conflict calmly. And they’re part of my “emergency protocol” when an adult has brought a kid to session with them who I wasn’t expecting!
  • Small flag
    • I keep small plastic flags (the 10 for a dollar kind) in my office to use mostly when I am doing communication training with couples. After we’ve talked about whichever “rules” we are working on, I literally wave the flag when the rule gets broken. It makes for less of an interruption than actually interrupting, and clients seem to feel less “criticized.” (If I have a really high functioning couple, I may send them home with two flags to use during homework practice!) I will occasionally do the same thing with an individual, if we’re monitoring something together (e.g., yes-buts, self deprecation)
  • 8” inflatable beach balls
    • They take up almost no space, and (along with also being good for visiting kids), I like to use them with couples and individual trauma clients in the Bessel Van Der Kolk kind of way – creating a reciprocal, socially engaged, dynamic-yet-predictable interaction that can help to regulate the nervous system! Also, it can give clients a way to do a semi-dissociation while they talk about difficult things, kind of like how they do their best processing while knitting or petting a therapy dog. They’re the perfect size the be easy to throw and catch, even for not-very-coordinated people, but not so big that they take over the space.
  • Blank paper
    • I know, this sounds so ridiculously simple, but this is hands down the item I use most often. There are many times that I want a client to make a quick sketch, or co-create a visual metaphor with a client, or draw an explanatory diagram. I never know when that urge is going to pop up, and I really like not having to use the back of their progress note or the regular lined paper I keep I around, and not even having to get out of the chair and break the mood.


Comment: What do you keep in your office to use during therapy? Tell us how it works!





Slowing Way Down

Slowing Way Down

I really like having couples for double-length sessions, at least 90 minutes. There’s just SO much work to do! And how often does that dream come true? Almost never. Which is one of the reasons I use this technique, even though – I warn you! – it’s going to seem counter-intuitive.

Couples are infinitely complex and unique…except in the beginning. Because in the beginning, they all have some of the same problems. In one of those problems is a basic difficulty with saying what they mean and hearing the other person. I’m sure you had the all too common experience, to; it starts out reasonable, then there speaking over each other, saying the same things over and over, getting louder and louder. When that happens, I quietly stand up, go over to my box of supplies, and pull out a pack of index cards. Then I sit quietly, and wait for their quite confusion.

Next I hand them each one index card and a pen.

Rules are pretty simple: First, take your time – because you get the front of this one index card to save the most important things that you want your partner to hear. (It’s surprising how much event held by the size of fonts they write with during this exercise!) After you’re both done, switch cards. Read the card as many times as you need to. Quietly; no speaking. As best you can, write what your partner told you in your own words on the back. After you’re both done, switch cards.

The next step depends on your intention in using the exercise. You might take both cards, read them both and help them make corrections on their interpretations of what the other person said. You might have each of them read their partner’s interpretation, and then use a new index card to write their initial statement more clearly. If they’ve done well, and the point was mostly just to cool the temperature in the room down a little bit, you might invite them to speak again about what they’ve just written (I use a random number generator to decide who goes first).

Yes, this takes basically an entire 50 minute session. For one note card. And you know what? They usually have communicated more during that session that may have in any session before we used the technique.

Bonus: this is a relatively easy task to then assign for homework!


Comment below: What pitfalls can you imagine using this task with a couple you have now? How would you handle them?





Rule of Three

Rule of Three

I want to talk about the idea of false dichotomy, because they’re both so easy and so destructive.

The tendency to falsely dichotomize (AKA splitting, black-and-white thinking) has been a central issue in psychotherapy since Freud, Kernberg, and Klein. You’ve got two hands and two eyes and two brain hemispheres. There are “two sides to every story.” It so often seems like there is yes-and-no, for-or-against, right-or-wrong. Worse…. Conservative-liberal, masculine-feminine, us-them.

And that’s probably because our brains – beautiful, complex systems that they are – often use dichotomization to help us live faster in the world. (More on this in a future post.)

This happens often, and to our detriment. (Serious statisticians seem to be the only people who really know this!) Clients limit their own options, we constrain our therapeutic directions, and we stifle our diagnostics and conceptualizations.

And the trick to not falsely dichotomizing is oh-so-simple. Just make the rule of three. All questions have at least 3 answers. Don’t do an ethical decision making model without at least 3 choices of possible actions to evaluate. Put at least 3 empty bullet points on your treatment plan template. Make a deal with your consultation partner – not just playing devil’s advocate (which is a great role for them), but playing the role of horizon-broadener. When you create counterthoughts in cognitive work, make at least three. Prep all of your clinical worksheets to match. When you evaluate the “B” in the REBT method, identify at least 3 possible beliefs. When you delineate clients’ values in ACT, make 3 the minimum magic number for actions-in-pursuit-of-values. When you and a client are interpreting a dream, include at least 3 hypotheses.

Don’t worry… you won’t end up limited to just 3 and end up unwittingly stuck again. Three gets you out of falsely dichotomizing and things really open up from there.


Comment: When have you noticed false dichotomies in session?




Preposterous Quote – Moon


No. No. No. If you shoot for the moon and miss, you’ll actually burn up in the atmosphere as you fall back to earth. This is a great (missed) opportunity for a cautionary tale… if you’re going to shoot for the moon (i.e., set a goal) and you don’t prepare well or have a good takeoff, you’re in for an unhappy ending. 

If we must use the metaphor, we need to shoot for the stars (i.e., have enough planning and motivation to get to the goal, preferably), on a trajectory that passes near to the moon (i.e., subgoals that would be valuable in and of themselves, in case we change course or run out of fuel), and with adequate resources (e.g., provisions and gear to last awhile, communications with support systems) so that if we shoot for the stars we may land on the moon and at least survive for awhile. 




Sleep Deprivation

Sleep Deprivation

Here’s a fun little (billable!) diagnosis I ran across recently. I’m always looking for just the right diagnoses to use that “get the job done” in terms of professional communication and clinical research that ALSO honor the individual’s experience by describing them faithfully. (See the previous post on Diagnosing Well). See if this one might add to your diagnostic repertoire!


Z72.820 Sleep Deprivation

Approximate Synonyms

  • Lack of adequate sleep

Clinical Information

  • Lack of the normal sleep/wake cycle
  • Prolonged periods of time without sleep (sustained natural, periodic suspension of relative consciousness)
  • State of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder.
  • The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder.

Comment: When is this truly useful and appropriate and when might you choose not to use it?