Month: November 2020

Three Rules for Couples Counseling

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Rules for Couples Counseling

I have three rules for couples’ counseling. Sometimes, I say them overtly, in the first session, sometimes they come up as we go along. I don’t really think of them as “my” rules, exactly, as much as I think these are pretty well required for couples’ counseling to go well. 

(1) A true, actual, capital-R “Reality” may exist, but neither of you (nor I) actually know it and it is not knowable.

So, we will not be spending much time arguing about how things actually happened or who is Right. We will spend a lot of time talking about how you each experience(d) things and how to effective co-construct your world. (Sometimes this has to be followed up with psychoeducation about perception and memory.)

(2) Relationships aren’t fair and that’s not the goal.

We will not be measuring out love. We will not be counting resentments. You are different people and we will not compare you  (your needs, desires, pains, etc.) to each other. We will absolutely NOT be doing a tit-for-tat scenario. If you want the relationship to improve, you will have to commit to your part of the work regardless of whether the other person does their part. 

(3) Your relationship is Your relationship. 

We will not be comparing it to your parents’ relationship, or the relationships you’ve learned about from romantic comedies, the relationship your growing-up church told you that you must have, or the relationship of your best friend on Facebook. We will focus on building the relationship that works for Y’all. 

 

You’d think they run away, but they usually don’t. 🙂 

 

Comment! What kinds of rules or guidelines do you find useful working with couples?  

 

 

 

Great Books Volume 4: Books for Certain Clients

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Great Books Volume 4: Books for Certain Clients

This is a list of books that are definitely accessible to clients/laypersons, but I don’t think they’re right for just anyone. 

 

  • Barkley’s ADHD books
    • These book are filled with great behaviorally-based strategies. Only give them to conscientious clients who actually do their homework, though. (Note: This is sometimes harder to find in families with AD/HD!) If the strategies aren’t implemented well and consistently, clients will only get frustrated. You might consider a self-compassion kind of strategy if you think that might happen.
  • The Gifts of Imperfection (Brene Brown)
    • For myself, I find Brown a bit saccharine. However, there’s definitely a population of clients for whom her writing is needed and timely. Especially, it’s useful for those clients who have a very strong inner critic and who have a tendency to over-extend themselves on behalf of others. She seems to speak especially well to women. (Of note, this might be a good option for supplementing that self-compassion strategy mentioned above)
  • Come As You Are (Emily Nagoski)
    • This is, hands down, my absolute favorite book about sex, ever. Nagoski is hard science with a delightful and relational writing voice. Every client (individual and couple) I’ve ever offered this book to has had a good experience and gotten something from it. It’s incredibly validating and normalizing, and gives couples great language for talking about the dual-control model of sexuality. Really great in terms of diversity of sexual normalcy without being overwhelming, even for conservative clients.
  • Authentic Happiness (Martin Seligman)
    • I honestly didn’t like this book (or the one that came after it, about PERMA). Though I love strengths-based counseling, Seligman isn’t my kind of writer, and is a bit surface for me. BUT… this is a great book for some clients – when you want to use a strengths based approach with clients who like to do their own “research” (i.e., who tend to find too much awful stuff on google!) or those who have limited time/money to come into the office, this is a great book to give them a shared vocabulary to use with you. I’ve also found it can be really useful in couples’ work, when clients need help identifying and being aware of partners’ strengths, and for setting them on an upward trajectory, focused less on problems.
  • Twelve Rules for Life (Jordan Peterson)
    • Peterson is a controversial character, I admit. I think that’s more because he speaks in a brash and provocative, uncompromising way. But he has some good science behind him, and in it, clinical wisdom. He has a very strong grounding in Jungian psychology. His book speaks in an accessible way to the existential concepts of meaning, purpose, freedom, and responsibility. I think the reputation he has for speaking most eloquently into the lives of men (esp young men) is deserved. But the message isn’t only useful for young adult male clients. I’ve had a lot of clients enjoy and have success with this book, especially around issues of depression and demoralization.

 

Comment if you have other books to share that you’ve (1) read yourself, (2) recommended to clients, and (3) had good experiences with!

 

 

 

 

Preposterous Quotes – Winners

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I have so many issues with this. 

Even to keep the same basic meaning, it should probably say something like “Winners are not people who never fail, but people who don’t quit until they win and then quit immediately.” Otherwise, they very likely turn into “losers” again very soon, when conditions aren’t perfect or someone else comes along who outperforms them.

Also, winners quit a lot of things – anyone who pursues everything equally doesn’t win much, if at all. We have to choose to quit most things in order to give our time, attention, effort, etc. to something we might win at. 

How worthwhile is “winning,” anyway?!

 

Comment below and Fix This Quote! 

 

 

 

 

Phrenology

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Phrenology

If you aren’t familiar with phrenology, it’s a frankly brilliant pseudoscience from the early 1800’s that we completely dismiss now. But, today, I want to talk about how it’s brilliant.

The basic premise was that different parts of the brain handled different tasks/ personality structures and therefore you could determine a person’s faculties or traits by examining the shape of their skull. Of course, we know that’s not true now – growth in a certain area of the brain doesn’t make it bigger, but rather more densely populated with neural connections and/or better myelinated. But WOW… why do we summarily dismiss the outrageous assertion that the brain is an organ with many parts that serve different functions?! That’s basically the birth of neuroscience right there!

The reason I feel so passionately about phrenology (and why I like to keep a phrenology bust in my office), is because is science is always valuable, never perfect, and continually growing. And that’s a message I really, really want all of my clients (and all of us therapists) to know! Not just about science, but in the larger sense of the message “not to let the perfect be the enemy of the good.”

Comment! What’s something in psychology that we don’t really give a lot of credibility to anymore that has still helped you?

 

 

 

 

Psychological Factors Affecting Medical Conditions

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Psychological Factors Affecting Medical Conditions

Psychological Factors Affecting Medical Conditions

 

  1. A medical symptom or condition (other than the mental disorder) is present.
  2. Psychological or behavioral factors adversely affect the medical condition and one of the following ways:
    1. The factors have influenced the course of the medical condition shown by a close temporal association between the psychological factors in the development or exacerbation of, or delayed recovery from, the medical condition.
    2. The factors interfere with the treatment of the medical condition (e.g., poor adherence).
    3. The factors constitute additional well-established health risks for the individual.
    4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.
  3. Criterion B is not better explained by another mental disorder

Specify severity

Mild: Increases medical risk (e.g., inconsistency in taking meds)

Mod: Aggravates underlying medical condition (e.g., anxiety aggravating asthma)

Sev: Results in medical hospitalization or emergency room visit

Extr: Results in severe, life threatening risk (e.g., ignoring heart attack sxs)

***

This includes things like psychological distress (e.g., chronic overstress at work), patterns of interpersonal interaction (e.g., utilizing the sick role), coping styles (e.g., denial of seriousness), and maladaptive health behaviors (e.g., treatment noncompliance due to psychological reactance).

Remember – be careful making judgments about culturally sanctioned healing practices – if they don’t harm, don’t worry about it.

In concert with the medical diagnosis, this can be billed as F54: Psychological and behavioral factors associated with disorders or diseases classified elsewhere.

Some other diagnoses that you may consider in these situations, or in a differential diagnosis:

  • 3 Unavailability or Inaccessibility of Health Care Facilities
  • 1 Nonadherence to Medical Treatment
  • 0 Problems Related to Lifestyle

 

Here’s to treating the WHOLE person in the context of a team of health/wellness professionals!

Comment below: How have you seen psychological factors impacting clients’ physical symptoms? How have you convinced them to treat the psychological parts as well?