One Simple Thing, a note to therapists

One Simple Thing to Remember

Dorothy Smith, LCSW

     As a therapist I take time to contemplate what is ultimately important to my clients which allows me to improve my therapeutic approach. And I find It is more often than not the simple human things that are most needed in therapy. The relationship with the therapist has been shown to be one of the common factors in good therapy. Where there is a trusting, safe environment, there is the chance to tell the story. And it is that story that brings a client to therapy. So the story is my one simple thing.

    If you blank or are having a day where therapy seems disconnected, just remember that you are there to hear the story, to validate, and to reflect and guide so that the client may start to understand and view their story without emotional flooding. You are there to help them understand how they physically and emotionally connect to that story. When they can begin to process what is happening and to see the patterns and strengths that they want to reinforce and learn how to make changes, then they begin to have successes and we build on those successes. Sometimes we are the wider lens for them opening the narrative, pointing out patterns that may be challenging for a client. But always it is the story, so when you are stuck go back to the story, ask how they are doing emotionally, what has changed, check on where they are on their journey and where they still want to go.

     I recently was reminded of where I strayed from the story by a client. During a session while listening to something they had discovered about themselves, I tried to cleverly explain how it related to a therapeutic process, I even went on to say it was a process that was only a piece of a picture and not to be viewed as a whole. I disconnected them from the story and in doing so I invalidated their experience of discovering it for themselves. It was unintentional on my part, but I did not stick with the story. I went off on a tangent … so when I do this, and it does happen in therapy at times, I apologize and I return to the story.

     We therapists are just humans, who care enough to go into the difficult spaces, and we make mistakes. I allow myself room for this and have compassion for my own fallible nature and I understand that I genuinely intend to be there to be a support. But most of my fails are in pushing the story or in forgetting to remain on the story. So my best advice is to notice when you have strayed, note when a client seems pulled off the story, and remember to find the thread again. Although we are not going to be foot perfect, therapy is a messy process, we can pay attention, and we can get back on track, back to the story. This is when my client’s thrive and this is when I feel connected and able to utilize both evidence-based practice and intuition combined as their guide.

Mindfulness

Mindfulness for Mental Health

As a therapist I use Mindfulness quite often to help my clients shift their focus. In the article “Effects of Mindfulness on Psychological Health: A Review of Empirical Studies,” the authors found that “mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679190/). Getting a little less technical, I like to describe it as setting down the weight of the past and the future, to focus on the now.

Think of the origins of many of our anxious or depressive thoughts. These thoughts may originate from negative experiences we have had in the past and may become fears about future negative experiences. If you think of each of these thoughts as a rock that you add to your backpack, we can end up lugging a quarry about on our shoulders. Bowed under the ever-increasing weight, we stumble about distracted and exhausted.

Mindfulness is a meditative practice that brings our attention to what really is happening in the here and now. Imagine you are taking a walk beside a wide flowing stream on a sunny path. Now imagine that you are worried that you may be losing a major client at work and quickly your mind leaps to the fear of losing your job. Now all you see is the path, you are present enough to keep from tripping, but your mind is focused on fear. Your chest or head may start to ache and your feet feel dragged by the weight of your growing fears. You are lugging both the weight of the experience that led to the possible loss of the client and your future fears along that path. You are more connected to your inner existence than to your outer experiences. But by practicing Mindfulness regularly the brain often is able to shift away from those heavy places and onto the present and a much fuller connection between body and mind.

Now imagine that you have learned to refocus on the present. You are able to acknowledge your fear, it is there, you are not attempting to push it away or bury it, instead you are aware that it is one of many obstacles in life and can be looked on with curiosity. You lift your gaze and take in the sun as it flashes across the water and you notice a heron has just caught a fish. Your attention is fully present as you walk along and you feel engaged possibly more energized. This is Mindfulness and it can fit into so many of our daily activities. Fishing, basketball, cooking, gardening, bowling, riding, running, painting, walking, observing nature, communicating, almost any activity can be done mindfully. A therapist who utilizes mindfulness can guide you on your journey and there are many resources easily found on the internet to help you better understand Mindfulness. As for myself, I think of Mindfulness not simply as a useful form of therapeutic intervention, but also as an important wellness practice, a tool to help support ourselves in our daily lives.

Dorothy Smith, LCSW 571-207-7650

Wellness Arts Counseling, LLC

This blog is not intended to offer advice or to be used as therapy. I encourage you to seek out professional help if you are experiencing distress. I utilize CBT, Mindfulness, EMDR, Narrative, and Solution-Focused therapies and specialize in anxiety and work with related disorders such as PTSD, social anxieties, depression, communication or relational problems. I am an out of network provider, but can offer a superbill for you to submit to insurance

Give Yourself Space

When in the middle of an argument, what's the go-to reaction? Is it anger and an immediate reactivity? Is it running away? Is it blanking and silence? If this applies to you, you are not alone. These are reactions that are often associated with our fight or flight response. One of the best ways to change communication, especially in an argument, is to be able to communicate that one or the other person needs some space and a little time to think things over and that both participants agree they will come back and address the problem soon.

Maybe someone thinks they will win the argument if they stay put and fight hard enough. It might work for the time being. But what happens with the other person when they leave the argument feeling bruised and like they lost? Or maybe one person chooses to run away and hopes the argument will just go away, if they don't say anything more about it; but what happens the next time an argument comes up and that person once again just runs away and the other person does as they want? In that case often the power starts to shift in the relationship.

Clear communication, asking for space when an argument is elevating, will hopefully allow both participants to understand that the conversation will continue and that one person or both need to calm down and think through what they have to say. This gives each person time to really look at what they were arguing about. Often when somebody becomes angry the argument expands to other areas that don't have anything to do with the actual problem . Then the argument could end up in an endless loop of arguments about the same thing over many, many years.

Giving one's self space allows time to decide exactly what is being argued about, what point a person wishes to make, or if they even care that much about what the other person is asking for. It gives the ability to walk away and breathe without the other person feeling like they're being given the silent treatment or like they can do as they like without further discussion. And eventually good communication will hopefully lead to calmer communication.

Self-talk

What is self talk? It is our own internal or sometimes external (out loud) talk about ourselves. It can be negative, positive, or neutral. Self-talk is actually an under-researched area, however the research we do have indicates it can have significant effect on performance and mental health.

Many mental health models of therapy address self-talk, including CBT, which refers to some forms of negative self-talk as cognitive distortion. Examples of this include inflated thinking “Everybody has left me, nobody cares”, thinking which may focus irrationally only on the negative “I failed the test, today is stressful, and it’s raining”, or thinking that is all or nothing “If I don’t get this job, nobody will ever hire me.” CBT examines change through a model of challenge, refocus, reframing, and examination of core beliefs and behaviors. Mindfulness focuses on a curiosity about the here and now, a focus of discovery, allowing us to be present without judgement, perhaps “going with the flow” is a good description. Negative self-talk tends to pull us out of the flow and may change our experience. For instance, imagine you are at a party and someone comments on your clothes “that’s a great bold print.” Negative self-talk may chime in with “ they are saying I look tacky” or “oh wow, it must be really bad if they said something.” suddenly your whole experience at this party is painted by judgment and not in a good way. Mindfulness helps us step away from our negative self-talk and refocus on what's really happening. We might notice that our friend actually turned back around and smiled at us. We may feel engaged or energized and we might actually notice sensations, sights, sounds, smells, touch, or tastes that are a part of that engagement and energy.

In one study the results of self-talk training (increasing positive/decreasing negative) were noted as:

“As expected, ST training led to (less) somatic state anxiety and (higher) state self-confidence, self-optimization, self-efficacy, and performance.”

(Sports (Basel). 2019 Jun; 7(6): 148.Published online 2019 Jun 19. doi: 10.3390/sports7060148)

In a study of chilfdren and adolescents anxiety and depression symptoms showed significant correlation to negative Self-talk.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899011/#__ffn_sectitle)

As a therapist, I like to tell my clients to think of it like two people that you know. One of them isn't very pleasant to be around and says things like “I can’t believe you did that, idiot, waste of space,” the words are painful and distracting. Then there’s the other kind person “You’ve got this. You worked so hard and you are good with people, go for it!” Self-talk can go hand in hand with self-compassion, as a support, a confidence builder, and a wellness practice, but it takes time and patience and often guidance to build in such supports.

As always a Blog is just informational and is not intended as therapy. If you are experiencing symptoms of depression, anxiety, or any other mental distress please do reach out to a provider for help.

Am I Normal?

Mental health

What is normal?

As a mental health therapist, a lot of people ask me what is "normal," followed by (often with great anxiety) "am I normal?" This is the root of the fear that keeps so many in need away from seeking help. Because at the bottom of that question is the fear of being perceived as weak or abnormal. I will clear that up, you are not weak, you are just experiencing a condition which is both important to acknowledge and to care for if you have a mental illness or are in mental distress.

So back to the question "am I normal?" my answer is yes and no. Why? Isn't it normal to be normal? Again, the answer is complicated, because normal is just a perception or a set of observations from our perspective at this point in: history, culture, and scientific discovery. I encourage you to read the) Miriam Webster definition of normal to get a bigger picture https://www.merriam-webster.com/dictionary/normal.

Definition 2 has an example about butterflies and pollen on genetically modified corn, which is a statistical norm that wouldn't even have existed before genetically modified corn, or butterfly interaction with the corn, or the study on it. That is to say, the information on butterflies and what's "normal" has completely shifted with new knowledge in a very short time span. Normal is a moving target. So something which is normal here at this time in history may not be normal in other societies in our same time frame, would not be normal in past decades, or may not be normal for any number of other variables such as age, preference, or even birth order. So for those concerned with their mental health, it is much more important to look at what is causing distress or interference in a life than it is to fit it into the impossibly complex boxes of normal or abnormal.

And the next thing to contemplate is do you want to be normal? While you might be normal in many areas, you may be far at the top or near the bottom in other areas. Is it the norm to be a top scoring hockey player (the NHL updates nightly), or to have red hair (1 to 2% of population), no it isn't. If you could, would you want to be (or are you already) a gifted musician, artist, cook, caregiver, baseball player etc. We are unique and individual, gifted with small and large differences in appearance, ability, and personality. And were everyone to strive or be pushed towards normal, (ala many Dystopian movies) we would lose the richness of difference and the texture of culture.

So ask yourself if it isn't more helpful to look at what is distressing you? Isn't it better to care for your needs than to worry about the perception of normalcy? And if the worry is that it isn't normal to be sad, confused, anxious, (or any number of other symptoms) here are stats from the CDC. So even the fear that it isn't normal doesn't actually hold water. Think of seeking help as the same as keeping up with your physical health, because pressure to be normal should not be the determining factor in seeking either physical or mental health help As you can see below, you are not alone in having distress in your lifetime.

Excerpt from CDC statistics

How common are mental illnesses?

Mental illnesses are among the most common health conditions in the United States.

More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.

1 in 5 Americans will experience a mental illness in a given year.

1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.

1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.

https://www.cdc.gov/mentalhealth/learn/index.htm#:~:text=More%20than%2050%25%20will%20be,some%20point%20in%20their%20lifetime.&text=1%20in%205%20Americans%20will,illness%20in%20a%20given%20year.&text=1%20in%205%20children%2C%20either,a%20seriously%20debilitating%20mental%20illness.

As always, this is just a Blog it is not meant as guidance and it is not meant as therapy. If you need help or are in distress please contact a mental health professional.