Start School Later


Start School Later


I know it’s been awhile since I last posted, and it’s because I’ve been working on two pretty big projects. I thought I’d announce the first one here, as it’s ready to at least begin…

Soon, I’ll be starting a public education project to share the research about the benefits of starting high school at 8:30 or later. (I even got back on Facebook for this purpose. I hadn’t been on Facebook since my 10 year old was born – HA!) 

The body of research is huge and well established – teens go through (like all mammals do!) the adolescent sleep phase shift – a natural, developmental, biological delay in sleep drive and change in circadian rhythm that means they get sleepy later and become alert later. (See… you really WEREN’T just being lazy or undisciplined!) Teens also need more sleep than adults, or even older children – an average of about 9.25 hours/night! 

So, asking teens to be alert for driving or school at 7:30 is really like asking adults to be alert for driving or work at 3:30am! 

Research shows that delaying high school start times until 8:30 or later:

  • improves academics (less tardiness, fewer absences, higher GPAs, higher standardized test scores, better graduation rates, etc…)
  • improves teen physical health (healthier BMI, less obesity, less screen time, more physical activity, better dietary choices, reduced substance use, reduced risk taking, fewer accidents, fewer injuries, etc…)
  • improves teen mental health (less depression, less suicidal thinking and planning, less anxiety, improved mood, better emotional regulation, better coping strategies, improved teen-family interactions)
  • improves teen behavior (better decision making, less risk taking, less juvenile delinquency, fewer suspensions, better classroom behavior, less risky driving and sexual behavior, etc…)

Here, you can read a research summary that I put together specifically for my district (FBISD), but that is full of research relevant to any school district. 

And here, you can watch some videos (2-12min) that I put together, fleshing out some of the research a bit more, as well as addressing myths/misconceptions and common concerns/possible solutions. 

I’m still working on finishing up one other big project, and then I’ll get back to regular posts – I have tons in my mental queue, but just don’t have time to get them written out just yet. 

Comment below: Do you know any additional research I’ve missed? What time did you start high school? What time do your kids start? What other concerns do you think parents/teachers/etc have? Is there anything else that deserves a video that I don’t have posted yet? 

 

 

 

 

 

 

What’s Not Gaslighting?


What’s NOT gaslighting? 


I’m a little bit alarmed with how this word is so quickly changing in meaning. And especially because we only have one word for gaslighting – to cause a person to doubt his/her sanity through the use of psychological manipulation. (You’ve heard of the play for which the term is named?) So, it’s using your power to actually change the other person’s ability to experience the world with reality, and then to lie to them about reality so that they question their own ability to function in the world.  

Here are some examples of gaslighting proper: 

For example, if your partner secretly took money out of your account, and then you overdrew it not knowing the money was gone, and they punished you for not managing your money well, and you pleaded with them saying that you were sure the money was there, and then they lied and blamed you, saying if you didn’t do it then your wicked mother/corrupt employer/secret lover/etc. must have taken the money, that would be gaslighting.  

If you drugged your partner’s dinner, and then you went to a kickboxing lesson, and got a bunch of bruises, then told your partner the next day “Look what you’ve done!” and your partner denied it, and you told your partner that they did it in a manic, alcoholic rage and just didn’t remember, and pointed to the empty bottles you hid in the trash, that would be gaslighting. 

(Granted, they’re a little extreme, but that can be helpful for clarity’s sake in the definitional stage.)  

But we have lots of words for the other things that gaslighting is beginning to be used for, like lying, manipulation, misuse of power, dysfunctional communication, etc. So, in the interest of reserving the utility of the vocabulary for as long as possible, let’s talk about what gaslighting is NOT.  

 

  • When the other person actually perceived, experienced, or remembered something differently than you did 
    • Given the outrageous amount of research literature on these topics, along with everyone’s actual experience of the world, it puzzles me so much that we all STILL think that we perceive the world “correctly,” that our experiences are “the valid ones,” and that we remember things with ANY degree of “accuracy.” Because we don’t. Brains are not made to perceive the world accurately or to remember accurately – brains are made to predict the future, and they consciously process only a tiny fraction of what’s experienced, and that is always affected by their own history, their language, their biases, their mood at the time of the experience, and about a thousand other things. This is compounded when it comes to memory, because it’s not just the error in encoding reality accurately… but all the same issues come again when memory is retrieved, so the problem is at least doubled (and more than that if you’re remembering something more than once!) (Let me know in the comments if you want a post on the perception or memory literature.)  
    • So, most of the time, what’s called “gaslighting” has at least something to do with the fact that people are different, experience the world differently, remember the past differently, and are pretty sure they’re the ones who are right.  
  • When there is a misunderstanding or miscommunication 
    • As bad as we are at experiencing the world accurately and remembering it accurately, we’re worse at communicating it accurately to another person (or perceiving accurately what they intend to communicate). We lose almost all of the richness of an experience when it has to be boiled down into language, and then we almost all use language differently than everyone else. Oh, and all that stuff that gets in the way of accuracy when perceiving or remembering something gets in the way AGAIN when we listen, and not necessarily in a predictable way!  
    • Try this… imagine, REALLY imagine, in all the detail you can – your own bathroom. How it looks, smells, is configured. How it feels to be there, both physically and emotionally. Get a sense of the whole thing, including how it is different at different times of day or depending on your purpose there. Remember when it’s been steamy, and notice how the experience of reading the word “steamy” changed your memory of your bathroom in this exact moment, either bringing a new image or new emphasis to your steamy bathroom. And realize how much more likely you are to think of your bathroom as steamy next time you think of it. Paint it in your mind and let yourself see it like it’s in a movie and let yourself move through it like virtual reality and then fill in all the little details of how it  REALLY is. Now, with as much accuracy as you can… write down or say out loud everything you can about someone else’s bathroom. HA! Oh come on, try it! It’s hard enough when you’ve actually BEEN in someone else’s bathroom, but also try it with whatever you know that you’ve just been TOLD about someone else’s bathroom. If you can’t think of a bathroom you’ve talked about but not been in, call someone and ask them to describe their bathroom to you! Do it! It’s a really fun way to experience this difference between what we experience and how little of that we can communicate, and even more the lack of richness and accuracy we are limited to when hearing something from someone else! 
    • So, a lot of the time, what’s called “gaslighting” has a lot to do with how poorly we are able to communicate with each other about our internal and external experiences.  

I think those two bullets cover most of what comes up in therapy around “gaslighting,” but here are two more things that come up occasionally, that also are not gaslighting.  

  • When the other person is lying or manipulating and you know it 
    • If you KNOW the other person is lying, you have not been gaslit. Implicit in the concept of gaslighting is that the other person has enough power over you and your circumstances to convince you that you are the crazy one, and that they are trustworthy arbiters of reality. So, if you still have enough agency to know or even believe that they are lying or manipulating, then what they are doing (at most) is lying or manipulating, not gaslighting. 
    • That’s actually something that can be worked on in therapy, even if the first response is still denial!   
  • When you rely on the other person for reality testing and you trust them because they’re trustworthy  
    • This one comes up occasionally, and I actually like it. We are all relying on each other to do reality testing all the time. “Do you hear that sound?” “Oh yeah, it’s someone’s car alarm going off outside.” And things like that.  And it’s really good and useful. And it’s helpful when there’s more than one person to rely on. That’s another key to gaslighting – it’s really difficult to do if the target of the gaslighting isn’t completely isolated from other sources of potential information about the world.  
    • Sometimes, you might know you’re not great at a certain part of reality testing. For example, I’m really bad at remembering what I’ve said in the past. I rely on my husband a LOT for that. Is he always right? I’m sure he’s not. It’s just that he’s better at it than me! COULD he gaslight me if he wanted to, at least in that way? Oh yeah. But I don’t think he is…everything keeps turning out ok.

Here’s a potentially controversial thing to say (what’s new, Ellis!?)…  

Gaslighting, by definition, seems to include an intention on the part of the gaslighter. Can we compare it to sexual harassment? Sexual harassment has some clear behavioral definitions, but in any ambiguous situation, it is defined by the person who “feels harassed.” (There’s a topic for another day… is it possible to “feel verbed?”) Because the gaslighter has to change reality, because they have to “psychologically manipulate” – doesn’t that imply that they have to intend to gaslight someone?   

Can you “feel gaslit?” If you feel gaslit, does that mean you WERE? This is why I want to make sure we have a good variety of language around relational communication… Once a person feels gaslit, there’s no way for the other person to be part of the conversation anymore. If they were actually gaslighting, they’d be trying to explain how they weren’t. If they weren’t gaslighting, they’d be trying to explain how they weren’t.  It leaves no room for the other person’s experience, and then what? That’s a 100% power transfer to the person who feels gaslit. Maybe that’s what they want? But it doesn’t work in the therapy room, at least. 

Look, I’m usually a BIG proponent of using client’s the language. I’m a champion of the idea that it is the therapist’s job to mirror, tailor, and otherwise adapt their own presentation in order to build a comfortable and usable space for the client and facilitate empathy and connection! (Rather than this new notion of “authenticity” that seems to mean “do and say everything exactly the way it makes sense to you, and if other people don’t accommodate you, that’s their problem” – hmmm, maybe a rant on this in another post! Ha!) 

I also know that increasing the granularity and specificity of language helps improve cognitive flexibility and emotional recognition and regulation! So, I will absolutely offer new vocabulary to clients when it might be helpful and/or help them to clarify their vocabulary to increase their ability to communicate clearly both with others and inside themselves!  

 

Comment below: When has vocabulary shown up in your sessions as something important? In what ways? As always, especially comment if you disagree!  

 

 

 

 

Introducing Diligent Page Publications


Introducing Diligent Page Publications


So, if you’ve read the blog for awhile, you know I can get ranty about some stuff in our field. And nothing gets me on a soapbox faster than talking about how EXPENSIVE therapy is and how much that prohibits so many people from accessing good resources.  

I love therapists. I am a therapist. It’s not that I don’t want us to make a fair wage and maybe even have nice things. I do. 

(Side note: Here’s a little experiment for you to try. First, go to the bank and get $150 in one dollar bills. Then, find a therapist-colleague. Set a timer for 60 seconds. Now, every time the time goes off, give them three $1 bills. Or have them do it to you, or both. Do it for the WHOLE 50 minutes. Just notice what that’s like for you. And discuss.) 

So, I’ve been channeling that rage-energy that gets worked up in me sometimes (usually when someone at my office says something like, “But can’t they pay the full rate?” or “We’re increasing everyone’s rate by $5”) into writing. So, I started Diligent Page Publications as a place to publish low cost, super high quality, empirically-supported resources for clients. (It’s just in its baby stages; don’t get TOO excited.)

My favorite piece of this is a little ebook that teaches clients how to do therapy efficiently, saving them time and money and making more space for new clients, while not reducing therapist rates! 

And then I have a few guided journals that I made for clients and decided could be a useful resource for people who are doing life transitions (instead of therapy or as an adjunct to help therapy go faster/less expensively), because it turns out there really aren’t good, inner-world-focused books for people doing life transitions! 

I have a few other projects in the works, and of course I’ll post about them when they’re ready. But I want to share Diligent Page with you, because there’s a chance as a continued reader of this blog, you might share some of this desire with me!  

 

 

 

 

 

 

Big Pharma & Non-conditioning Shampoo


Big Pharma & Non-conditioning Shampoo


 

I’ve been promising a “Big Pharma Rant” for a long time, and today I’m really inspired. Well, I’m inspired enough to start – I think it’s going to end up being a few mini-rants, which is probably better anyway. 

 

Here we go. See this conditioner bottle? (Yes, this post is born from an honest-to-goodness “shower thought.”) These folks did research, so that they could print the results on their bottle and get you to buy it. 

97% less breakage*

With an asterisk. Geez, at least they put an asterisk and then tell you right then and there what it’s compared to…. the mega-super-ultra-anti-breakage-shampoo-plus-conditioner-used-as-a-system vs. a non-conditioning shampoo. 

Listen, that’s not a super fair comparison. Using a non-conditioning shampoo is probably actually even worse for breakage than using no shampoo at all, but does anyone who is looking for super-ultra-mega-anti-breakage conditioner not already use conditioner? Don’t you really want to know if this conditioner is better than your regular conditioner?! 

(Side note: They pretty much all do this, and so I’m not really calling out a specific brand. If you recognize this bottle, I actually happen to love it and would highly recommend.) 

Ok, how does this relate to Big Pharma? Well, pharmaceutical companies often will compare their active medication product to a placebo. And that’s certainly better than not doing that. But that’s not REALLY what you want to know, is it? Don’t you want to know if an antidepressant (with all of its attendant side effects) improves depression more than, say, a 10,000 lux lamp that costs $40 and you only have to buy once? Or more than walking 3x/week? Or 16 weeks of CBT? Or, heaven forbid – a course of psychodynamic therapy?! Don’t you really want to know that before you spend thousands of dollars out of pocket getting transcranial magnetic stimulation? Or before they add an antipsychotic medication to your regimen? (This isn’t even getting at things like how long the benefits of medications vs. therapy last and how much they cost over time. Spoiler alert – therapy’s better on both metrics!)

But they’ll never do that. In the same way that the Uber-Fancy-Conditioner won’t ever make a comparison to The-Other-Uber-Fancy-Conditioner… because they know they won’t come out on top, or they know the differences will be so small that it won’t be worth the money they put into the study. So, we have to go find that research ourselves (I’m back to pharmaceuticals, btw – I don’t imagine you’re actually going to find conditioner-research!), and sometimes help our clients evaluate it, too. 

There are at least 4 more mini Big Pharma rants to come, so stay tuned! And, believe it or not, I’m not actually against the use of effective, well-prescribed, thoughtfully-considered psychotropic medication. Maybe I should I do a post about that, too.

 

Comment below: It would be awesome if you were to post here any additional research you come across about non-pharmaceutical treatments for depression and how they compare. There are just way too many for me to include today! Or any other comments, as always! 

 

 

 

 

 

 

Preposterous Quotes – Worry

 

Actually, worry is a PERFECT use of imagination. In fact, it may be the most evolutionarily sound reason to have an imagination at all! The ability to “predict the future” accurately as it relates to potential dangers and obstacles is incredibly valuable, and that’s what imagining is! How else could we planfully navigate the world? 

Of course, lots of other wonderful and more pleasant uses for imagination. And overusing imagination to predict dangers/obstacles that are highly unlikely can be problematic. (That does happen quite a bit – in fact, in clients with GAD, 92+% of worries don’t materialize!) And catastrophizing… usually not helpful. 

But I have found that it can be helpful to clients who struggle with worry to both learn why their worry (in realistic quantity) is valuable, as well as learning to harness their imaginations for other productive and pleasant purposes! 

 

 

 

 

Preposterous Quote – New Years

 

New year’s day – or any day of our lives – is not the beginning of a new book. It might, maybe, possibly be the beginning of a new page or a new chapter (although why that would happen exactly on this particular day of the year baffles me!). But we can’t escape the fact that pages, and chapters, and VOLUMES have already been written (in our own lives, yes. And we are also chapters and pages in the lives of many other books, past and present!). We are the same characters that we were on the last page, and thank goodness for that continuity! Otherwise, how would we actually learn, grow, and change?

You can’t be the hero of a story that starts today. But you ARE the hero in the story you’re a part of. Take all those pages, read them carefully, then author your next pages well.   

 

 

 

 

Dingbat & Darling


Dingbat & Darling


 

Let’s get real about self talk for a minute. Whether or not you’re into the IFS craze, we almost all at least treat ourselves as if there are multiple little versions of us inside. And pretty much everyone has a readily accessible part that will berate and punish us for any perceived mistake. (Critical parent, anyone?) And they NAME CALL. Because that inner critic often has the vocabulary of a 9th grade bully, some of that name calling is really awful. In fact, I won’t even write some of the terms my inner critic has at the ready!

I don’t share my personal experiences that often, but I think it’s worthwhile here. So, being the good little girl that I sometimes have inside, I did my self compassion work and changed some of my internal language. I gave myself a name for that sweet little kid who sometimes needs nurturing, teaching, or encouragement – she’s “Darling.” But let’s face it – there’s still a part in there that does dumb stuff, and needs something a little more corrective – and in my effort to be self compassionate, I renamed her from Those Awful Things I Won’t List to “Dingbat.” Maybe that’s not the ultimate perfection of internal parenting, but it’s a heck of a lot better. And I can interact with Dingbat in a much sweeter, bemused kind of way. It makes a big difference!

And I don’t think that we need to pretend that everything gets completely smoothed over inside, even with good therapy work. And honestly, I think there’s a space for a critical parent in there, too. But she doesn’t have to be a Raging B*tch. (Oops! did that come out?!)

Comment below: What is some of the really harmful inner language you’ve heard clients use? And how have you helped them turn it around into something that keeps the purpose without keeping the vitriol?

 

Side note: Image above is of an actual “dingbat,” which is apparently decoration on a page to make bland text more inviting! ha! 

 

 

 

 

More than Five Love Languages


There are More than Five Love Languages


I don’t love the “five love languages.” I don’t love the book because it stresses me out when books about mental and relational health aren’t grounded in research. I don’t love the concept, because I find it very limiting and prescriptive. There are clearly more than five love languages! (Although when couples have already read it/heard about it, I won’t put it down, I’ll just try to “stretch it out.”)

I do like that the idea that couples are made of two people who are different from each other, and I do like the idea of shared vocabulary for shared understanding. One of the most important things for couples to learn in this kind of empathy work is understanding that the other person might experience something differently than you do – maybe even oppositely! 

That being said, here’s a slightly more comprehensive list of ways that one person might feel loved/validated, that the other person might not understand well – or might understand in a completely opposite way! (Note especially the blank bullet points at the bottom. I like the visual assumption that clients will add their own!) 

 

  • Being helped (my partner assumes I’m worth helping/ they assume I’m not capable)
  • Being asked for help (my partner needs me because I’m worthwhile / they don’t want to do their fair share)
  • Being complimented (my partner thinks nice things about me / they’re flattering and they want something)
  • Being given gifts/money (I’m valued / they think they can just buy my love)
  • Being sexually pursued (I’m desirable / they’re just using me for their own gratification)
  • Hugs/cuddling (they love to be near me / they’re clingy and smothering)
  • Doing things together (they like spending time with me / they can’t stand being alone)
  • Introducing to friends (they think others will like me / I’m too much for them to handle alone)
  • Giving advice (they care and want to help me / they think I’m stupid)
  • Monitoring behavior (they care and want me to be safe / they’re invading my privacy and autonomy)
  • Inviting to share interests (they think I’ll also enjoy that / they don’t care what I like)
  • Letting me make decisions (they trust me / they don’t want any responsibility )
  • Making me part of their FOO (wants to include me deeply in their lives / wants to take away my individuality)
  • Encouraging me to grow in xyz way (wants me to be my best self / thinks I’m garbage and wants to change me)
  • Emoting strongly (I’m a safe place for them / they can’t handle their anger, etc)
  •  
  •  
  •  

This kind of thing can help couples do that work of perspective taking and empathy, like when they realize they didn’t marry someone Crazy, Stupid, or Awful.

Comment below: Any others you can think of or that have come up in session? How have you used the “love languages” concept to good effect in couples’ work? 

 

 

 

 

Preposterous Quote – Pain Quitting

 

Hmmm… no. Pain isn’t always temporary. Pain is often chronic, especially when we overuse our bodies in a relentless pursuit of unhealthy goals. Or when we don’t recognize and honor legitimate limitations. Or when we don’t respect the need for rest or a healing process after injury. 

Also, why would we think that quitting lasts forever? That’s such a genuinely peculiar assumption. What about going back to something you previously quit? Especially after you are well rested or better conditioned or more equipped? Also, I’m not sure it counts as “quitting” when you mindfully stop something and choose a different path? 

I’m noticing that a fair percentage of the preposterous quotes I run across have this mad (hyper-American?) theme … do more, push through, no quitting, be everything, don’t suck! I don’t like it. 

Comment below with some healthy language for encouragement to challenge oneself! 

 

 

 

Book Announcement


So… I did a thing…


Here’s a book! I wrote it. 

ROUTLEDGE published it, and the level of fanciness I feel saying that is not measurable. 

It’s a lot like this blog, only you can get it in paper and you have to pay for it. Oh, and it has no pictures. 🙂

Actually, it’s much more comprehensive and better structured than the blog, though the writing style is a lot the same and the idea is the same – let’s BE BETTER THERAPISTS. Let’s use theory and research and our colleagues to help us do that. 

Therapists, in general, I think will really like it and get a lot out of it. So will advanced practicum students and interns. 

At any rate, I’m supposed to tell important people. So, there you go! 

It is available at Routledge and through Amazon! Oh, and if you go to the new Book page on the blog, there’s a coupon code! 

 

 

Avoidance Sucks


Avoidance Sucks


Here’s what I mean by that: 

  • Avoidance of feared stimuli increases rather than decreases fear. So it perpetuates itself at your expense. This is approximately 35% of all therapy, possibly. 
  • Avoidance is painful by itself. Every time you avoid, you’re having a measure of the pain you would have in confronting. But you avoid it over and over and over… so you have a partial measure of pain over and over and over, which almost always ends up being more painful over time. 
  • Avoidance narrows your options. I mean this in small ways, but also in the very big, existential way – like the “untimely deadness of a too narrow existence” 

Some caveats, in case you’re thinking any of these things:

  • Staying away from genuinely toxic or dangerous things/people/situations isn’t avoidance, it’s wisdom. 
  • If you believe you benefit from a “change of scenery,” you need to give a good think about if it’s escaping/avoidance or something else. A lot of that is how you use that time. If you just get away from stressors and enjoy that, it’s avoidance. If you use the time away to actively work on stuff that will improve your life when you’re back, ok. 

Comment below: How have clients sometimes gotten in trouble by avoiding? How have you?? 

 

 

 

Preposterous Quote – Courage

There are two levels on which I want to address this preposterous quote. 

(1) I dislike, in general, inaccurate measurements. Specifically, in therapy, I dislike the idea that our own limits are not knowable. I believe that’s part of what is fundamentally useful about therapy – building accurate self knowledge and self awareness!

Look, I don’t want clients to live in a constant state of not-fulfilling-their-potential because they underestimate themselves. I don’t want them to reduce themselves to chronic-victimhood because they aren’t encouraged. I don’t want them to choose avoidance as a proxy for safety, when they could choose skills and strength instead. I don’t want them to suffer from the “untimely deadness of a too narrow existence” (Gendlin, 1973).  

I also don’t want clients to be shamed or feel shame because they actually do have limits. I want us all to know and honor the limits of our bodies, our strength, our coping. That’s when we know to access additional resources! That’s how we keep ourselves functioning for tomorrow’s challenges! 

When you’re drowning, yes…. you do usually have more oxygen available than you’re afraid you have. And use it all, please! You do usually have another half hour in you to work on that project that’s due, even though you’re really tired.  You probably do have a little more self control left over to speak kindly to your partner even though you’re stressed out from your work day. You probably do have more strength than you are afraid you have, more than you initially believe you’re capable of.

Let’s learn our REAL limits, so we can grow at our true edges. 

(2) I don’t mind the definitions of courage than rely on fear (“It’s not brave if you’re not scared”), but I really prefer the deeply existential understanding of courage – that you willingly act without knowing the outcome. And we never really know the outcome! We pretend we know the outcome, we relax into that lie sometimes, but we don’t ever really know how anything is going to turn out – our action or our inaction. That makes pretty much everything you do “courageous,” if you’re doing it willingly and acting in “good faith” (i.e., with knowledge of your own personal responsibility in living). 

 

 

Comment below: As always… your thoughts? Your definition of courage? 

Telephone = Telehealth


Telephone = Telehealth 


You might remember my rant about telehealth, fondly or irritably, but here is a little follow-up. One of my suggestions to clients when they begin telehealth is to mention any tech issues (e.g., lag) immediately, rather than waiting and tolerating that relational discomfort. I am willing to spend up to five minutes (but no longer!) working on a tech issue for telehealth. (Consider that, at some point, they’re paying us for IT work, which is definitely outside our boundaries of competence! Haha!) After then 5 minute mark, or after exhausting the typical fixes, I do something wild… I just call them on the phone.

Besides a large body of data indicating the usefulness of telephone consultation, and the history of telephone as the primary form of telehealth work, I came across a delightfully interesting study, with this main finding: 

Voice-only communication elicits higher rates of empathic accuracy relative to vision-only and multisense [voice and picture] communication both while engaging in interactions and perceiving emotions in recorded interactions of strangers. … Voice-only communication is particularly likely to enhance empathic accuracy through increasing focused attention on the linguistic and paralinguistic vocal cues that accompany speech. (Kraus, 2017)

That’s cool, huh?! Addresses one of the (apparently imagined!) 

Note that this research did not address the difference between voice only and face-to-face communication, which still has a lot of benefits over not being present, including client mimicry (e.g., Salazer-Kampf et al., 2020), interpersonal synchrony (e.g., Rennung & Goritz, 2016), neuroception of safety and social engagement cues (e.g., Porges, 2004), etc. So, I’m not suggesting that telephone is better than being in person together. Just that, if telehealth is necessary, phone might be an acceptable, or more than acceptable, choice!  

Comment below: Have you had great/not-so-great telephone sessions? What helped you have a good experience? 

 

 

 

 

References

Kraus, M. W. (2017). Voice-only communication enhances empathic accuracy. American Psychologist, 72(7), 644-654. doi: 10.1037/amp0000147

Porges, S. (2004). Neuroception: A subconscious system for detecting threats and safety. Zero to Three, 24(5), 19-24.

Rennung, M., & Göritz, A. S. (2016). Prosocial consequences of interpersonal synchrony: A meta-analysis. Zeitschrift für Psychologie, 224(3), 168-189. doi: 10.1027/2151-2604/a000252

Salazar Kämpf, M., Nestler, S., Hansmeier, J., Glombiewski, J., & Exner, C. (2020). Mimicry in psychotherapy – an actor partner model of therapists’ and patients’ non-verbal behavior and its effects on the working alliance. Psychotherapy Research. Advance online publication. https://doi.org/10.1080/10503307.2020.1849849

Why do we yell? (Just a theory!)


Why do we yell? (Just a theory!) 


Specifically, this idea came to me during some couples’ work. Why do people yell at each other (and this probably goes for parents/kids, too…) 

Here’s a theory I have. 

Animals vocalize in lots of ways. But when do they “raise their voices”? What does the animal research say about this? (e.g., Seyfarth & Cheney, 2003) First, there are two issues here with my reading of the literature – one is that I’m not super familiar with the comparative (i.e., animal) psyc research and the other is that animal research is always observational and about making inferences – can’t ask them any questions! Just bear that in mind. But from what I can glean, animals probably get loud in three circumstances/for three reasons:

 

  • To demonstrate aggression, especially when they feel underpowered (i.e., actual predators who are about to eat prey are sneaky and quiet, but an animal that is afraid it’s about to get killed or eaten may get loud to try to discourage a predator)
  • To sound an alarm, either to warn others of their kind that there is a danger approaching or to call for assistance
  • As part of display meant to push another animal of its kind down the social hierarchy, in a competitive way 

So, whether or not this is precisely accurate, it has been an interesting topic of conversation with my couples. I explain this idea and then make it a little human…

“Is it possible that when people raise their voices, it’s because they’re feeling underpowered and they need a show a vocal strength because their argument isn’t strong enough on it’s merit? Might they get loud because they feel like they’re in danger and actually crying for help from their partners? Or sometimes maybe they just want to diminish their partner – try to shut them down by proving they’re more important, stronger, or otherwise farther up in the hierarchy?”

Then, after there is some buy-in, I bring it to the personal/situational level: “So when you raised your voice just now (or last night, etc.), which of those reasons resonates most with your experience?”

  • Sometimes they reluctantly identify that they lost their cool because they could tell they were losing the argument. That can open the door for looking at the merits of both positions in the less-intense therapy environment. 
  • Sometimes they reluctantly identify it as feeling in danger and crying for help, and that opens a door for softer emotions from them and softer responses from their partners. 
  • Sometimes they reluctantly admit that they wanted to push their partners down, they just wanted to win. And sometimes they try to wiggle out of that by saying “I raised my voice because they just weren’t listening to me!” (Which is a sneaky way of saying the same thing… I deserved to be heard more than they deserved to be heard.) 

Yeah, no one seems to really jump enthusiastically into any of those explanations. But they give clients food for thought, sometimes they come around later or bring it up in a later session. At the very least, it prompts a discussion about the process of the conflicts, and that’s usually a therapy win! 

 

Comment below: Do you happen to know more stuff about animals (esp mammals) vocalizing loudly? I’d love to hear it! (Not including the monkeys that scream for sex – haha!) Or, how do you help couples begin to address the process rather than just the content of their conflicts? 

 

Seyfarth, R. M., & Cheney, D. L. (2003) Meaning and emotion in animal vocalizations. Ann N Y Acad Sci., 1000, 32-55. doi: 10.1196/annals.1280.004. PMID: 14766619.

Photo credit – Joshua Cotten

 

 

 

 

Preposterous Quote – Plans

 

Frankly, this seems like a great way to alienate people and to accomplish less than you’re capable of. 

First, research is clear that sharing your individual goals (even if you don’t want help with them) improves outcomes, especially if you tell a friend or mentor. 

Second, other people can offer all kinds of support -not just encouragement and emotional support, but instrumental and tangible support! 

Third, the people who are going to be pleased by seeing your results are probably the people you want to tell, who want to help you. The people you don’t want to tell – unhelpful jerks? – aren’t going to be impressed. They’re still going be jerks.

Could we just change this one to say “Don’t tell unhelpful jerks your plans?” 

 

 

 

 

Preposterous Quote – Rules for life


These always get me riled up…


  1. Let all of your experiences influence your future… lessons learned are valuable, and ignoring them is just as likely as not to earn you repeated negative experiences. 
  2. Surround yourself with healthy, supportive people and absolutely listen to them. Your relationships are the foundation of a satisfying and productive life. Don’t alienate important others by ignoring their opinions. 
  3. Time can dull some things, but especially painful things – unprocessed – get worse with time rather than better. Regarding things like loss and grief, assume that you need to make a place for that in your life, rather than “getting over it.” 
  4. Social comparison is important – it is one of the main ways that we manage out behavior in order to be acceptable to society and generally keep things running. Competition, when you are able to admire or be inspired by those who are “better” than you, is a valuable experience in teaching you which goals you might want to pursue and how to go about improving. Comparing yourself only to yourself is a dangerous game… closed systems accumulate errors and self-destruct. 
  5. Being calm is generally more effective than being all worked up, except when your accurate anxiety can motivate you to prepare for danger, your accurate fear can motivate you to move away from danger, your accurate anger can motivate you to rectify injustice, your accurate disgust can motivate you to move away from bad influences, etc… Also, the only thing the passing of time advances by itself is your age. It doesn’t inherently help you figure things out, get wise, make better decisions, improve any skills, etc. 
  6. That level of internal locus of control is inappropriate and inaccurate. Though I am the FIRST person to say that other people and/or circumstances don’t MAKE YOU FEEL, and that most people have more control over their internal, emotional experiences than they believe they do, ignoring reality-based external stimuli is not a good recipe for functioning well in the world, building an environment that supports your growth, etc. 
  7. Smile, Frown, Laugh, Cry… Your life is meaningful and valuable even when it’s not happy or traditionally “enjoyable.” Feel free to be present for all of it. 

Comment below and give us a HEALTHY “Life Rule,” if there is such a thing! 

 

 

 

First, do no harm.


First, do no harm. 


Despite the DoDo bird’s insistence, not all therapies are created equal. 

This won’t be a post explaining evidence based practice, or common factors, or how diagnostics should impact our therapy plans, or how psychodynamic therapy gets an undeserved reputation just because CBT is easier to manualize. (All possibilities for another day!) For today, I think it’s worthwhile to talk about how sometimes we had really interesting ideas and they turned out to be wrong. Some therapies have evidence demonstrating not just that they don’t work as well as other therapies, but that they don’t work at all or they actively damage clients! YIKES! 

Examples that might surprise you?

  • Critical Incident Stress Debriefing for PTSD
  • Grief counseling for normal bereavement
  • Relaxation treatments for panic disorder

Check this article by Scott Lilienfeld out here

 

Comment below if there’s one of those other topics you’d like me to write about, or if you have ever gotten training in any of these harmful therapies, or (heaven forbid!) you know someone who uses them. 

 

 

 

Phrenology


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?

 

 

 

 

Not About Pedicures


It’s Not About Pedicures


I’m quite alarmed by the way that we treat self care, both for ourselves as mental health professionals, but also for our clients. We think about self care the way we think about hunger or sleep – we let ourselves get way overstressed and then we thinking that dropping off the plane in a withdrawal state or going on a self-indulgent binge is the way to somehow repair this.

(Without dismissing the importance of the basic physical health aspects – hydration, good nutrition, regular exercise, adequate sleep…) I’d like to propose a way of thinking about self care that is largely grounded in Csikszentmihalyi’s concept of Flow. The short explanation of Flow, if you’re not familiar with it, is that “zone” we get into when we’re involved in an activity that is just the right balance of challenge with our skills. It’s a balance, because if we’re engaged in things that are too easy, we get bored. If we’re engaged in things that are too difficult, we get stressed/anxious. If you’ve been in that zone, you know what I mean. In that zone, you don’t really run out of energy – the energy just seems to self-replenish.

 

 

I believe in our clinical work, we often get ourselves (or find ourselves) out of balance.

 

We take on too much – too many clients, too long of days, clients who are legitimately outside our boundaries of competence but we don’t want to admit it, expecting to have the same therapy-stamina as the most productive person in the office.

 

Or we take on too little – get into a therapeutic rut and don’t challenge ourselves to build new skills, we are in an overly systematized job and function as automatons rather than clinicians.

 

Sometimes, it’s that we feel we have no control – we’ve given up our autonomy to a harsh internship director for the sake of getting hours (oh, how you’ll regret this!), we’re so burdened by rules and paperwork that our actual clinical work is only a handful of minutes per hour or day.

 
And sometimes, it’s that we know the work isn’t meaningful – we can see that clients aren’t improving, our setting won’t allow for the care clients need, etc.

 

Real talk: if you are exhausted at the end of a perfect clinical day – engaging, moderately challenging clients with a diversity of experiences and concerns who you can have some degree of independence in working with – this might not be your calling. But I’d say that’s probably not most of us. And once you become aware of the ways your clinical work is pulling you out of Flow, you can begin to correct it!

 

Comment, please: Which way do you find yourself leaning out of Flow? How can you see this also working in clients’ lives?

 

 

 

 

PreposterousQuotes – BeYourself

I’m sure they meant this to be nice, but I don’t think they read it.

What a horrible reason to be yourself! Not that you are infinitely unique and valuable. Not that you have tons of creative and productive potential that no one else has. Literally, this says it’s too bad you couldn’t be any one else (implication – anyone else would be better), so you might as well be you (that’s the only choice you’ve got, so settle for being you). YUCK! 

Dr. Seuss does it better: Today You are You, that is truer than true. There is no one alive who is Youer than You! 

Carl Rogers does it WAY better: “People are just as wonderful as sunsets if you let them be. When I look at a sunset, I don’t find myself saying, ‘Soften the orange a bit on the right hand corner.’ I don’t try to control a sunset. I watch with awe as it unfolds.”

 

 

 

 

 

 

Childrens Melatonin


1 milligram!


I found this at my nearby Walgreens, and I was unbelievably thrilled! Children’s melatonin!

“Now, wait,” you’re saying. “That doesn’t sound like the Ellis I’ve been reading.” (And if you’ve ever heard even a small piece of my “Bad Pharma” rant, you’re especially confused.)

The reason I’m excited is NOT because I think we should be giving kids melatonin. I pretty frankly don’t think we should, at least unless all the other behavioral/psychological/family issues have been worked out and the problem is still there. Unsurprisingly, I’ve never had a family committed enough to go through that process.

Also, it doesn’t do very much, in children or adults. Here’s a meta-analysis for you – increases sleep time by 8 minutes. (It might work better in older adults?) 

I AM excited, though, because there’s an easy-to-access 1mg dosage that adults can choose. I consistently have clients asking me about using melatonin. Of course, the first thing they get is a talk about sleep hygiene and a sleep hygiene info sheet! But, if they insist that they’re going to use it, they get a secondary talk about how the typical 3mg and 5mg dosing wildly, outrageously increases the amount of melatonin in your system (I mean 50x and more!). And when we flood our bodies with something that our bodies already make, our bodies quit making it. (This is how hormonal birth control typically works, btw. And it’s why testicles shrink when men are given supplemental testosterone.) Do clients with sleep problems want to shut down their bodies’ own melatonin production?? I doubt it.

Get this – I put “melatonin supplement” in Amazon and the first option was TEN MILLIGRAMS! I’m so pleased to at least have a less insane option to point clients toward.

You may want to read the National Sleep Foundation’s article about sleep and melatonin, as well.

Comment below with sleep tips, or general pharma rants. There will be more posts to come in this area, of course!

 

 

 

 

Preposterous Quote – Moon

WARNING: PREPOSTEROUS QUOTE AHEAD!

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. 

 

 

 

Blank may be better…


Blank may be better…


I know there’s some kind of marketing value in having lots of “letters” behind your name and on your business card. 

But please, let’s stop the madness. 

Paying $59.99 to be a “Certified Life Coach” does not actually add anything to your practice. Becoming a “Certified XYZ Therapist” for a few hours of training that doesn’t help you do anger therapy any better than basic counseling training is a bit shameful. Mediation and anger and wellness, oh my! I’m sort of willing to go the distance on this and say that these kinds of credentials are actually unethical and misleading (APA Ethics Code 5.01 & ACA Ethics Code C.4)

Not convinced? Read this article about how a middle schooler can become a “Certified Clinical Trauma Professional” and then come back. Here’s the tl;dr…

Mental health professionals typically represent their competencies by earning a diploma and obtaining a state license to practice. Some practitioners choose to further represent their expertise by acquiring specialty certifications. We review the broader landscape of these certifications and provide a case study of a program that illustrates current problems with specialty certifications. Specifically, we demonstrate that an 8th grader with no prior mental health education or training can pass a test intended to assess expert levels of knowledge obtained from a workshop. Implications of these findings on the validity of specialty credentials and the public’s trust in them are considered.

Rosen, G. M., Washburn, J. J., & Lilienfeld, S. O. (2020). Specialty certifications for mental health practitioners: A cautionary case study. Professional Psychology: Research and Practice. Advance online publication. https://doi.org/10.1037/pro0000324

 

Let’s not chase the appearance of expertise. We don’t need to compete with 8th graders. Own your real credentials; clients will respond to your actual expertise. 

 

 

VERB Your To-Do List


VERB Your To-Do List


VERB your to-do list

I’d like to share with you a cool and random idea I had with a client that is really working for me personally.

See, I know that a lot of people, when they “can’t get motivated to do what they need to do” have maladaptive ways and reasons. They are perfectionists-who-procrastinate (and it’s worth working on their shame-related core belief), or they have their priorities all out of whack (and it’s worth taking the conversation to values and meaning), or they or maybe have subconscious resistance (and it’s worth discovering it!). Or whatever.

Some people (and I suppose I’m one of them) are just kind of internally inconsistent. I don’t always wake up in the morning with the same kind of “energy” and the kind of energy I have fluctuates during the day. Honestly, it often doesn’t matter. When it’s time to teach, it’s time to teach. When it’s time for therapy, it’s time for therapy. (Those are easy – I have internal access to my teaching and therapy energy almost all the time. I haven’t yet sorted out whether I believe that’s natural, and I just found the right occupational place for myself, or if it’s something that develops with value-oriented-time-and-practice. Or both. Or something else.) When it’s time to turn in grades, or work on a grant proposal, or have a meeting with colleagues I disagree with … I rarely have the right kind of energy, but it doesn’t really matter. It must be done.

But there a lot of things that sort of fall in the middle – writing, cleaning, reading, etc. And there are some times (and I know this is a luxury, but it’s likely that you have at least some measure of it as well) when my day isn’t demandingly structured by an outside authority. And, yet – I’ve spent most of my life trying to demandingly structure my own time! (I sort of understand why, but it’s a long Family of Origin tangent.) Here’s what I do now:

I’ve chosen to group the items on my ongoing to-do list by type of energy. Generally, these are all things that don’t have hard deadlines or involve other people.

My current categories are WRITE, LEARN, CREATE, CLEAN, WORKPREP, THINK, and RUN-AROUND.

Under the WRITE category, I have things like make more blog posts and work on articles and workbooks I have in progress. The LEARN category includes reading one of my stack of not-yet-read psyc books, doing continuing education, etc. The CREATE category has more personal items – my kids’ photo books, hypnosis recordings, painting the bathroom. The CLEAN category literally just has every sub-divided space in my house listed! Under the WORKPREP title, I have things like advocacy research tasks and handouts I want to make for clients. The THINK category is where I put those random thoughts I have that I don’t have time to pursue when they pop in. And the RUN-AROUND category is everything that requires me to get in my car – typical errands.

So, when I have a bit of unstructured time, I can just check in with myself and see what kind of energy I have, then I can go to my list and choose something. I can’t tell you how much more productive I have been since I started this!

As a bonus (and this came up with a client, as well, and then also is now important in my own life…), I added REST and CONNECT categories. 

Comment below: How about you? How do you structure your own productivity when someone isn’t doing it for you? What kind of categories might you have on a verb’d to-do list?

 

 

 

 

 

Diagnosing Well (Rant!)


Diagnosing Well (rant!)


Diagnostics are tricky, right? We want to honor the human person, so we sort of hate the idea of diagnosing. And who wants to put clients in “a box”? Although, we need to get paid, right? And that means billable codes. What are we to do?

 

Rethink diagnosing. It honors the client when we can describe their conditions and situations in clear, useful, holistic ways. (Warning! Here comes the ranty part…) But that’s not an excuse to do it haphazardly, to give everyone adjustment disorder, or to get in the habit of using the same five diagnoses over and over. To really do it well, you might need to change the way you think and behave. You might start by trying some of these tips:

  • One of the lovely things about diagnostics is that it gives us clear definitions in order to do treatment-related research. So when you do diagnose, make it really count by accessing that research literature and translating it into effective treatment strategies, client handouts, and more.
  • Remember to use all of your specifiers! It’s no wonder we feel like we’re dumping clients into diagnostic categories if all we put is just “MDD” or “GAD.” (Remember that a few conditions, like “with Panic Attacks,” can be part of any diagnosis!)
  • Recall that “unspecified” diagnoses are really for ERs and quick intakes. Never leave one on a client’s chart. Go back and get the phenomenological data you need to update it.
  • When you give an “other-specified” diagnosis, remember to actually specify it in a brief narrative form!
  • Use your “Other Conditions” codes to paint as clear a picture as possible with your diagnosis, even when they aren’t billable (you may remember them as “v-codes”). Like these:
    • F50.4 Overeating associated with other psychological disturbances
    • F62.0 Enduring personality changes after catastrophic experience
    • F55.6 Abuse of herbal or folk remedies
  • There are more billable codes than you realize. You don’t need to use adjustment disorder for everything. Here are some fun examples:
    • F42.1 Obsessive-compulsive disorder, primarily compulsive acts
    • Z62.898 Birth of a sibling affecting child
    • Z70.8 Sex counseling
    • Oh, and if you hated that Asperger’s left the DSM-5, it’s available in the ICD-10 – F84.5. So is Dysthymia, and the Schizophrenia subtypes!

 

Let’s honor clients by doing excellent, thorough work. Maybe this will also be helpful to you? It’s a free PDF version of the Mental and Behavioral Health section of the ICD-10.

 

Leave a comment! How do YOU do diagnostics like a rock star?

 

 

 

 

Teletherapy Rant


Teletherapy Tips (but mostly rant)


(This is a bit long, and you may want to just skip to the end, where there is a client resource that you can check out!)

I’m not particularly new to teletherapy – I’ve done it for a couple of years, though only at need (for example, with a client who traveled out-of-town but in-state to care for her dying father for several weeks). Like it has for many of us, teletherapy has taken a larger role in my practice in 2020, and – as a result – I’ve solidified my relative distaste for it. It’s taken me some weeks to really get a handle on what bothers me about it, and I think I have.

 

  • It’s just not clinically appropriate for some clients.
    • For some clients, coming into the office is literally part of what is therapeutic – for depressed clients who have difficulty getting out of bed, for social anxiety clients who “feel safe” behind the screen, for clients with autism spectrum disorder whose work involves building social skills, for clients with dependent personality disorder/features
    • For some clients (those above, and those with almost any other kind of anxiety), staying sequestered at home exacerbates their symptoms. Consider how many people will have added a “with panic attacks” or “with agoraphobia” specifier to their diagnoses by the end of this time!
    • Perhaps it goes without saying, but managing potentially dangerous situations (e.g., self or other harm) via telehealth is something very few people have been adequately trained in. I have a feeling we don’t really know if we’ve been adequately trained until we’re in the moment across the screen with our client who has the scissors at their elbow.
  • Privacy/confidentiality is our responsibility, and teletherapy makes that much more difficult.
    • Privacy and confidentiality are much easier to manage in our office environments. For therapists who have moved their practice to their homes, unless they live alone, this poses significant challenges (e.g., family members hearing session, Bluetooth devices nearby allowing access to sessions). Also, when records are kept outside of the office, or moved between home and office (e.g., if you use paper records), that adds risk.
    • Probably the larger issue is that we don’t have any control over the environment that the client chooses. We can ask them to provide an optimal environment, but it becomes an ethical dilemma at some point: do we provide (suboptimal!) services when a client is, say, constantly interrupted by their kids, walking through the grocery store, or under the scrutiny of an abusive partner? Where do we draw the line and say it’s not an appropriate environment for therapy? Typically, we honor those boundaries even when clients don’t – when they sit down next to us in a church pew and start to share or even try to continue their session in the waiting room, we actively prevent that and protect their confidentiality even when they don’t.
  • We miss out on the benefit of the “sacred space.”
    • Therapy is special. When people choose to come to therapy, we are supposed to offer them something that is different from their normal lives. That’s part of what helps it to bring newness into their lives. There’s a reason that sacred spaces have existed throughout time – why you build an altar in the desert, why you go to your closet to pray, why you climb a mountain to get clarity, why indigenous healers set up holy spaces. If you think that therapy is just telling people your wise thoughts or finding interesting solutions to problems, maybe it doesn’t matter. But if you practice therapy with the intention to heal, the sacredness of the therapeutic space matters.
    • In a more scientific way, we could say that our internal states are tied to the physical spaces in which they are activated. That is the reason that one of the primary sleep hygiene rules is to only use your bed for sleep – because classical conditioning is a real thing. So, our offices – where clients choose to be disclosing and access emotions, where they feel safe, where they can bring themselves to do hard work – those offices allow clients, over time, to feel safe, disclose, access emotions, and do uncomfortable work more readily. When they do therapy from their homes, offices, cars… we lose the benefit of the therapy space.
  • For many therapists, it seems like it is more difficult for them to keep their professional boundaries.
    • The teletherapy experience seems to be convincing many therapists that they should be in text-contact with their clients much more often than they typically would be. If this is not part of a therapeutic system that a therapist has been trained in (like a Linehan-style DBT program), there are a lot of risks with extending the session beyond the session time. Beyond the risks for clients in believing that you’re always available, and then sending a crisis text while you’re unavailable, how do you take a shower, sleep restfully, or drive safely without attending constantly to the concern that a client in need might be texting you right now?
    • I’ve also been reading about and hearing about the “increased intimacy” of online therapy that some therapists are suggesting is a good thing. There are many therapists who are sharing things with clients that they never would share in face-to-face counseling, like the state of their homes and allowing clients to see them interact with their family members. Likewise, they are experiencing aspects of their clients’ lives that they wouldn’t otherwise experience. My question about this is whether those clients would choose to share those things, if they were mindful about it. Would therapists? We intentionally don’t join a client’s personal book club or speak to them when they’re at the gym. When we begin to do in-home therapy services, we get training in how to interact in a client’s personal space. While I’m sure everyone has good intentions, there’s no data about whether this is helpful or harmful to clients, and it seems to me to blur the lines that we know are helpful to clients.
    • For both of these issues, how clear are therapists being? Are we honoring our professional, ethical obligations to “clarify professional roles and obligations” and “avoid unwise or unclear commitments” (Ethical Principles of Psychologists and Code of Conduct, General Principles)? To what degree are we even maintaining a professional relationship? And make no mistake, the professional relationship is part of the healing process – we have known for a long time and continue to accumulate data that the therapeutic relationship is the primary factor in positive change (not the physician-patient relationship and not “good friendships” – the therapeutic relationship).
  • It’s harder to create a growth-promoting climate because it’s harder to use the basic Rogerian skills.
    • Silence is one of the foundational skills of therapy, and the mediation of the screen and internet connection really diminishes the effectiveness of silence… especially when the client has to ask, “Are you frozen?!” The head nods that we can use to show we’re listening while silent can be problematic; for example, they often seem like agreement to clients, so we don’t want to overuse them. The “mmm-hmming” is often either so quiet that it gets lost or so loud that it breaks the client’s rhythm because they think you want to speak.
    • Eye contact, which is also one of the most basic attending skills, is frankly impossible. If you are watching the client for facial and other non verbal cues, then they can’t see your eyes. If you look at the camera, so that it appears that you’re giving them eye contact, you can’t see them anymore. If you move your camera so far back that you can “fake it,” you’re no longer close enough to see their facial changes well. Not to mention that you need to be monitoring your tiny picture at least some of the time to at least make sure that you’re on screen, clear, and well lit.
    • Pacing is more substantially more difficult online. For one, it’s virtually impossible to see and hear clients’ breathing, which is one of the ways that you know how and when to speak in session, even if you aren’t aware that you’re attending to that. Also, the conversational lag time, even when both parties have a good connection, is unavoidable – that’s why we have to say, “Oh, sorry, you go ahead” so often.
    • Attending to nonverbals is also largely impossible. There are the issues listed above, with clarity of facial expressions and breath, but it’s unusual to be able to see more of the client’s body that you get to see in face-to-face work – wringing hands, tapping feet, holding a pillow across their torso, etc.
    • And it’s less congruent. According to Dr. Marlene Maheu, the leading teletherapy trainer in the country, from the Telebehavioral Health Institute, we need to be about 10% more expressive in order to come across the medium with the same level of engagement. That means that we are either acting (in which case our internal experience will be incongruent) or being perceived as less present (in which case the client’s experience is incongruent with our intention).
  • For me, personally, it feels less rich – the same energy isn’t there.
    • Partly, this is because I am more easily distracted and it takes more effort for me to stay fully engaged through the screen (esp in hour seven!). That may not be an issue for everyone.
    • Partly, it’s because my primary theoretical orientation is existential-experiential with a person-centered foundation, so I utilize the here-and-now and the relational process more often than other therapists might.
    • I really like how psychotherapist Erika Shershun said it, in an interview for The Bold Italic: teletherapy lacks the “refreshing and energizing resonance between two people.”

I know this is going to be a controversial thing to say, but in short, I think that teletherapy is the Standard American Diet of psychotherapy: it’s more convenient, it’s cheaper for the people who provide it, and it will keep you going, but it’s less nourishing and is probably causing problems down the line that we don’t even know about yet.

Of course, it’s also certainly better than nothing. For scenarios that are more like coaching, or brief solution-focused work, I think it doesn’t make much difference. If we do it well, I think it can be helpful. And I think that, in some cases, we can use it to our advantage (e.g., using the out-of-office environment to create different exposure scenarios for clients with OCD).

So, I have tried to channel these feelings into something much more productive than just a rant, and created this tip sheet  for clients doing teletherapy our scouring the internet and my professional community and finding nothing like it. Please check it out! Hopefully, you’ll find it useful and not-ranty, and be inspired to use it or make your own!

 

Thank you so much to my lovely colleague who helped me clarify these thoughts, soften my rantiness, and upgrade the usefulness of the client tip sheet.

 

 

 

Preposterous Quote – Be Patient

CAUTION! Preposterous Quote Ahead!

Actually violates the physical law of entropy. Left alone, with just your patience, all things disintegrate, they don’t integrate. Even for things to maintain their integrity or the status quo, they have to be intentionally maintained. True for the universe writ large, but certainly true for your internal systems and relationships. If you want things to come together, patience is a nice foundation for the work you need to be doing with self compassion in yourself and your environment!

Comment with your improved version!

 

 

 

 

Preposterous Quote – No Limits

CAUTION! PREPOSTEROUS QUOTE AHEAD!

OF COURSE there are limits on what you can accomplish! There are limits associated with the natural world, limits associated with the power you have to impact your environment, limits to your own neurology, limits to your current level of functioning and talent, limits because you can’t accomplish multiple things if they are contradictory or have to be prioritized.

Thinking you have no limits is literally delusional!

How about this? Learn your limits, and encourage yourself to stretch a little past today’s limits in a valued, valuable area.

Comment with your improved version!

Existentialism – exercise


Existentialism Dessert Exercise


When you first learned about it, one of a few things probably happened. You either immediately threw up some kind of unconscious defensive wall because you heard the word Death or you started making plans to quit school, go to the beach, and drink margaritas because, well, Death.

(If you’re reading this, chances are you made it through, and didn’t take up your second choice career of selling snorkels. Great work!)

I’d like to clarify a little existential gem, if I could. And I’d like to do it with an experience. (Because, deep down, if you’re honoring the existential philosophy then your work and your life are inherently experiential. But that’s for another post.)

As you read this, it will help if you really imagine the process. But that’s NOWHERE near as helpful or interesting as actually doing this process, so I hope you do.

 

Ok, first you need to go procure your favorite food. I really want this to be your favorite food, and if you have to go to some lengths to get it (e.g., go to the store, call your mom and ask her to bake, drive across town to that wonderful restaurant), all the better.

Second, put one normal portion (normal for you) of just that food on a plate.

Third, divide that portion into tenths. (yes, 1/10ths) Then, throw away all but one tenth. (yes, throw away 9/10ths of your favorite thing that you just went across town for. YES, THROW IT AWAY. DO NOT put it in the fridge.)

Stop. You put it in the fridge, didn’t you? Go throw it away.

(Good, now take a moment to honor what it was inside you that wanted to keep it, and how it felt to throw it away.)

Now, approach the 1/10th that you have left. Check out how that feels.

Then, eat it. (Yeah, that’s it. No other instructions.)

 

After you’re done, take stock. What was it like? How did you eat it? Slowly? Did you pay more attention? Did you enjoy it more? Did you stay preoccupied with how much you threw away? Did you spoil your enjoyment by being angry at how little you had? (Or by feeling guilty that you actually left the other 9/10ths in the fridge? Good luck enjoying that now!) Did you have the urge to rush through or end the experience, which was somehow painful? Did you notice wanting to ration it, or not eat it at all? What was the experience like?

There you go. The finiteness of life helps us to focus our intention, live meaningfully, enjoy more fully. Feel free to practice this as often as you like, and just notice what changes.

Leave a comment if you really did this and want to tell about your experience!