More times than I can count I have been sitting across the room from a client who is troubled and confused and had them state, “just tell me what to do” or “just give me some advice”. Hmmm, this is a sticky situation because while I am thrilled that this client has come seeking change, I also don’t want them to adopt the belief or expectation that this is all there is to it, just come in, ask for advice, go away and everything will be better.

Therapy is about sitting still enough for you to tap into your own thoughts and beliefs about something and then have the therapist support you in whatever machinations are involved with facing or editing or managing that insight. We don’t sit across from people and tell them what to. Sometimes we do tell them what they are already doing and wonder how that’s working for them, but we don’t tell anyone what to do.

It’s so much more important for any individual to come to the conclusion or insight themselves and then access the belief or perspective or tools to do something different of their own accord and not because “the therapist told me to”. Because then the process is theirs and no matter how it evolves, it was their choice. If it were just us telling them what to do, how is that any different than other relationships in their lives?

In my experience, when people are told what to do they often rebel. Now, in some cases that may be an effective therapeutic intervention but I don’t believe we ever tell anyone what to do. We suggest. We wonder. We highlight options and possibilities. We clarify. We challenge and encourage and support. We do not give advice. Let’s save that for the syndicated columns.

Knowing when it's time to quit

It’s hard to say goodbye even in the best of circumstances. But at the end of the day, essentially it is the end goal of every therapy relationship to ultimately end. Yes we are seeking goodbye from the first time we meet.

Sometimes this is done in a beautiful, Hollywood-worthy way when client reaches stated goal and is healed of the problem and therapist and client come to a collective agreement that yes, it is indeed time for us to part, sad but joyful, accomplished, healed. It can be hard saying goodbye to a relationship where you have shared your deepest secrets, fears, hopes and have grown to trust in this other person, the therapist. Sometimes the therapy relationship is the only honest and healthy relationship a client has ever encountered. Yet even then, especially then, it is important to say goodbye.

Sometimes clients say goodbye in less than flattering ways. Sometimes they just stop answering their phone. Sometimes they feel the need to yell at the therapist to aid in making the break. Sometimes they even need to vilify the therapist because they might have exposed too much, there are still some unresolved raw spots throbbing in pain.

Sometimes a therapist has to essentially fire a client, kick them out of the proverbial nest, launching them into this new world that they are now ready for. Or, sometimes, into a new therapy relationship that will hopefully address the as of yet unmet needs of that client.

Regardless of how or when we say goodbye, it is always emotional. The success stories are bursting with pride and accomplishment in both parties. The bad breakups feel bad, at least to this therapist, only in that it didn’t have to end that way. The vilified ones are awful, hopefully rare, and the fear is that the client will see the whole profession through hurt lenses and never get the healing they obviously need.

Sometimes it happens on a comfortable timeline, sometimes it feels too fast, or in the case of those being pushed out of the nest, too long.

But in the end every therapist is ready and well prepared for the goodbye. The issues arise when the clients aren’t on the same page. So take this lesson and share it – saying goodbye is hard and good, especially when done with mindfulness and understanding.

And just because the issue that brought you to therapy is resolved doesn’t mean that you can never go back. Life has a way of giving us multiple challenges. Know that it is a therapist’s highest compliment when a satisfied client returns in the future, new issue in hand. We’re here to help, ready when you are. And, ready to say goodbye again and again.

(cue Julie Andrews in The Sound of Music…)

not-so-scary dragon

Dragons are all around us, it’s just that we can’t see them. Well, we can if we redefine them properly. Fire breathing dragons are the hosts of addiction. Yes addiction. And, unfortunately, addiction is all around us.

Addiction can take many forms and the most obvious are of course the worst examples. When we discuss the term “alcoholic” in session we have to work hard to eradicate the instant image of someone who is dirty, homeless, toothless and living under a bridge. As one client put it recently, “alcoholism” wears a suit and takes the train to the city every day.

Addiction is the term we prefer to use because it has fewer stereotypic images associated with it. And addiction is easier for people to associate to things other than alcohol or drugs; it doesn’t take much to illuminate how behaviors like gambling, shopping, cutting, bulimia and workaholism are all forms of addiction as well. This helps open up space to embrace new definitions of addiction, to make it more personal and easier to relate to for many.

Once we clear that hurdle, then comes the dragon. I use a fire breathing dragon as my visual analogy for what addiction really is. Addiction starts, for everyone, with the simple yet dangerous statement of, “I can’t handle _____”. This phrase, spoken from our innermost place, is the calling card for the dragon. Now, the person in pain or despair or fear has a new buddy, a fire breathing dragon. The dragon appears at one’s shoulder and says, “Hey, I hear you can’t handle _____. Well guess what? I’m a fire breathing dragon and I can handle anything! So let me help you.” To the person in turmoil this seems like a gift, a blessing, a quick fix, and so they entertain the idea. But then, the dragon adds, “Well, you see, I can help protect you from _____, but you’ll have to do something for me too.” (play the Jaws theme here). “I’ll need you to provide me with [alcohol, shopping, gambling, heroin, bingeing, etc...] to give me strength to battle the _____ that you can’t handle”. Ut oh. Remember that there’s no such thing as something for nothing, right? And folks, once the person agrees, just like that we now have addiction. Yep, it’s that easy, simple, small and harmless, on the surface, at the beginning. Unfortunately, things change rapidly as the dragon has a much more voracious appetite for the “thing” that it needs to fuel itself to battle the _____ of the person. And as time goes on the person, who has had to lie, cheat and steal to satisfy the dragon, feels that they have sacrificed so much to the dragon that, well heck, I guess we’re in this for the long haul, the dragon is the only one I can rely on, yadda yadda yadda. (In addiction we call this minimization, rationalization, projection and denial)

ALL dragons are scary

Addiction is very gentle and loving at the beginning but it evolves extremely rapidly. Nobody wakes up one day and says to themselves, “I think I’ll become and addict today!” But it happens everyday. If you slow down enough you will see dragons all around you.

Good thing that therapists are trained to see and slay dragons. (yes, hard to put on a resumé, but results don’t lie)

There is an adage that comes from the world of addiction recovery but it’s one that I use with every client. It states that “Change will not happen until the pain of remaining the same is greater than the pain of change”.

In session, I hold out my hands and gesture that in one hand we have the pain of remaining the same and in the other hand we have the pain of change. Clients now have to choose a pain. Clients are typically in my office because the pain of remaining the same has reached a point of being greater than the unknown pain of change. So we discuss this and contract together to move into and through the pain of change.

There are few guarantees in therapy. What I can guarantee clients is pain, they just have to choose which one they are willing to embrace. If they choose the pain of remaining the same then they do not need my assistance, they are already familiar with what it is they do or tell themselves to manage their everyday. If they choose the pain of change, well then here we go. The second thing I can guarantee in therapy is work.

My style and approach may be different from the author’s but I would then challenge him to possibly embrace some pain of change and see how he can offer his patients a new experience.

The truly amazing thing about this profession is that the therapist is never done learning either.

But what some may see as adversity can be seen as a wonderful opportunity through a different lens. Mother Nature has us in her clutches, we are truly powerless over the weather. Yes, one may have 6 or 7 apps to keep abreast of the comings and goings of the weather, but all in all we are still ineffective at doing anything about it. We can whine and grumble and complain or we can embrace the fascinating opportunities each change holds for us.

Plan for that day off, gather friends and ingredients and make forts and later have cookies and hot cocoa, gather together and just be with one another. Relish all of nature’s strength and beauty, even down to the smallest delicate details of a snowflake.

I have been reflecting on recent sad events in our world; the Arizona shootings and the suicide of a popular web personality, Bill Zeller. What do these two sad events have to do with winter weather? Well, powerlessness of course.

When we are confronted by what we believe to be unchangeable or overwhelming events or stimulus, sometimes the human being can retreat into a state of constant fear and panic. Interestingly, the best way to manage powerlessness is to embrace it. No, we don’t have power over the weather, or what others may do to us, but that doesn’t make us powerless over how we handle it. I wish Bill had found some good therapy, I wish the shooter had done the same. We do have power over what we tell ourselves these random events mean. We always have the power to find help, to invite in another person and “share our rocks”.

If you or anyone you know seems to be struggling with darkness and despair, please help them find help. Whether at MFT3 or elsewhere, the most important step is the first one, into a therapist’s office.

Oftentimes in therapy I use analogies and terminology that becomes part of the new communication style of the clients, as it is meant to be. One particular term I use is called “kind regard” and it refers to the idea of keeping your partner and their attributes high in your mind, kind in your heart, reminding yourself that this is your favorite person who deserves all of the benefits of your doubt, not just your negative frame or scorn. In the process of therapy this term gets referred to time and again, often to illustrate ways to ride out “the dip” as Seth Godin may call it, or sitting with the discomfort of not knowing, as I like to refer to it. Either way, it’s trusting the process to become something different in time. Usually we draw upon this tool in the toughest of times, when things seem their darkest, as a line of hope to the other side.

Today in session one couple told me a story in which a dream was recounted and in that dream a character approached one of the partners through a sea of people and when the character reached the client, she said to him harshly “WHERE’S MY KIND REGARD!?!?” This was the magical, spontaneous belly-laugh producing moment. I am still giggling at the thought of it, heck I’m sharing it here! What a perfect example of the embrace of a new tool and then its internalization revealing itself in the form of a vivid dream. I am so happy for this couple, for their progress and for the future that lays ahead of them. They have made it through the dip, sat with the discomfort, and have arrived at the side of understanding and acceptance. There is no better day for a therapist, not in my definition at least.

So if you are waiting for a session in your therapist’s lobby and you hear a true guffaw erupt on the other side of the door, know that great things have transpired and that you too can get through the dip, maybe even with the use of some kind regard.

Summertime

I know, I know, who wants to think about therapy when it’s beautiful outside and there are so many other fun things to do like chase fireflies and play in sprinklers and read a book in a hammock? But relationship and emotional issues don’t go away just because the temperature reaches 80-degrees. Sometimes the unstructured time can add to the problems and discord, and that’s where summertime therapy comes in.

So the kids are at home more now, your husband has “golf with the boss”, your neighbor’s windows are open and you can hear little Johnny’s drum set even more clearly, and let’s not forget the extra alcohol consumption that the hot weather seems to invite.

Coming in for sessions in the summer may seem like a drag at first but in reality it’s a great time for therapy. First, there are usually more slots open in a clinician’s roster due to all of the above reasons so getting a time you want is probably easier. Second, having a weekly appointment can help to keep some semblance of a routine which may be helpful if not downright necessary for kids (or adults) who function better with a steady, predictable routine. Sometimes summer can be a time to dread rather than celebrate for families with this issue. Third, having your budding teen learn about safe dating practices is always a great idea but now with more free time on their hands and skimpier clothing, this education may be a lifesaver. And finally, setting aside a block of time like “the summer” to focus on building new interactional skills, practicing intimacy building tools, resolving old haunting memories, really slow down and focus on yourself – summertime therapy can be a gift for a lifetime of better functioning.

So come on in and enjoy the air conditioning, the fireflies and s’mores will be there later.

Erica Cannata

Please join us in welcoming our newest associate, Erica M. Cannata, LADC, MFT, CCDP-D, to Marriage & Family Therapy of Trumbull (MFT3).

Erica joins both Katherine Allen, M.A., LMFT and Laura Petiford, M.A., LMFT at the Trumbull location. Erica, a seasoned expert in addiction disorders and adolescent issues, is a Licensed Addiction Counselor and Certified Co-Occurring Disorders Professional Diplomate in the state of Connecticut. Erica will begin taking new clients starting June 28, 2010.

At MFT3 we understand that life can come at you fast, and that’s why we’re here to help. MFT3 can be found online at http://www.mft3.com. Visit our blog at http://blog.mft3.com or join the Facebook page at http://www.facebook.com/mft3page.

Our office location is at 2 Corporate Drive, Suite 211, Trumbull CT 06611. Phone: 203-416-6008, or by e-mail.

Wishing one and all balance and peace.

The New York Times Magazine had an interesting article this past weekend titled “Is Marriage Good for Your Health?” and as many can surmise, yes, marriage does have many positive side effects. If you have recently looked into purchasing health or life insurance, being married has a major impact on the rate that gets quoted (i.e: married rates are lower than single ones). This article was particularly interesting in how it goes a bit further and looks at the effect of a bad marriage, too.

I was at the CTAMFT Annual Conference on April 9 and the keynote speaker was Dr. Sue Johnson, the author of “Hold Me Tight” and the creator of Emotionally Focused Couples Therapy in 1985. My insufficient summary of her field of study is that of adult attachment, especially after trauma.

During her presentation she referred to her own research study, of which a coincidentally similar research study is referred to in the Times article:

Researchers have also started to examine the salutary health effects of social relationships, including those of a good marriage. In one recent study, James A. Coan, an assistant professor of psychology and a neuroscientist at the University of Virginia, recruited 16 women who scored relatively high on a questionnaire assessing marital happiness. He placed each woman in three different situations while monitoring her brain with an f.M.R.I. machine, which offers a way to observe the brain’s response to almost any kind of emotional stimulation. In one situation, to simulate stress, he subjected the woman to a mild electric shock. In a second, the shock was administered, but the woman held the hand of a stranger; in a third, the hand of her husband.

Both instances of hand-holding reduced the neural activity in areas of the woman’s brain associated with stress. But when the woman was holding her husband’s hand, the effect was even greater, and it was particularly pronounced in women who had the highest marital-happiness scores. Holding a husband’s hand during the electric shock resulted in a calming of the brain regions associated with pain similar to the effect brought about by use of a pain-relieving drug.

What the article does not mention is the fourth effect – the one when the woman holds the hand of an abusive husband. Dr. Johnson’s research illustrates that when the woman holds the hand of an abusive husband, the shock is felt as extreme, the neural response is high and even a placebo calming effect of hand-holding is entirely absent.

So then how do we redefine the “marriage effect” in a more realistic light? So many couples that seek therapy are under the impression that staying together “for the sake of the kids” is the best choice, “Our parents did it and so should we”. Is it best to change the relationship first, to do the hard work of therapy, before considering leaving a marriage? Yes, absolutely. An in-tact healthy family is still the best model for successful growth, health and stability for all members. But abuse and violence are very different situations and must be handled differently as well.

The new research highlights this exact experience. Toxic environments; from the water and food we consume to the office to the home and the relationships within them, have real and lasting effects on our brains and well being in every way. Discord cannot be ignored.

Things aren’t always what they appear to be from the outside, just look at the MRIs.

Take A&E’s Intervention. An amazing show, filled with the real pain and trials that addiction submits to everyone in the system. There is no such thing as an addict in a vacuum, loved ones and the community are ultimately involved and harmed in the cycle of addiction no matter how you look at it.

They have introduced some new episode formats, like the one highlighted in the pic here, that are in-depth looks at specific types of drug classes and their impact. This particular one highlights Huffing, something that astoundingly far too many parents are not educated about or aware of. This was a powerful episode featuring not only success stories but some tragic endings as well.

I rate Intervention with 5-stars as far as its content, therapeutic viability and integrity and the educational information that is shared.

Next there is the new A&E show called Hoarders. Also touted as a therapeutic type intervention show focusing on the very real and shame-surrounded illness of hoarding. I find the show to be a bit less sound in its strength regarding therapeutic education and demonstration and a touch too voyeuristic as far as the many repeated scenes of piles of trash and belongings can be.

Although I praise A&E for their bravery in shedding light on this very real and very serious illness, I only would give it 3.5-stars due to the mild gawk-fest that it can sometimes feel like and the fact that some of the “experts” are nothing more than Professional Organizers. I would like to see more credentialed therapists and fewer Got Junk? garbage truck shots.

I would also rate the show higher if at the end, instead of posting a message along the lines of, “with the aftercare funds provided, person X plans to attend therapy”, if it stated that they are currently working in therapy. As a trained addiction professional, I see “funds provided” as a pitfall for the afflicted to go out and replenish some of the regretted losses. The lure of the old way, the pull of the “familiar bad” is more powerful than any of us truly admits.

And finally, the tragedy of what our definition of reality TV and its possibilities has fallen to, shows like The Biggest Loser and Jersey Shore. I cannot admit to having watched more than two episodes of The Biggest Loser and only one of Jersey Shore, but that was all I needed to be saddened to the core.

NBC’s The Biggest Loser empire is obviously a huge money making success, but again therapeutically, I believe it has taken far too long for this show to become serious about the very real illness of overeating, an illness that is exactly the same in its severity and life threatening potentiality as anorexia or bulimia. But our society still views individuals with this disorder as just being weak or lacking in self control, being lazy or sloppy or stupid (none of which are true). Ask any severely overweight person if they wouldn’t give anything to be healthy and the answer is a universal yes.

One particular episode I recall had the contestants battling over a “challenge”, and the challenge consisted of a huge banquet table piled high with all of their self-admitted favorite foods, their achilles heels, and the contestants were filmed struggling between their desire to win, their knowledge of being filmed, over the desire for their drug. Yes – drug.

Imagine if A&E’s Intervention used this same gimmick, and had an alcoholic presented with a table overflowing with their favorite drink, or a cocaine addict presented with a table covered in piles of glistening white flakes. The outrage would be epic, akin to torture and abuse, if not actually illegal then outright abysmally immoral.

In real life, real studies have been done somewhat along these very lines and in all cases when a severe addict was presented with the choice between $10,000 in cash or immediate access to the drug, invariably they chose the drug every time. Remember that a major tenant of addiction is immediacy.

I understand, by NBC’s trailers, that the show is now touting itself as “the only show on TV that is focused on saving lives”. While I admire this change of characterization, please refer to the above shows first and possibly rephrase that representation.

Just when you think the realm of reality TV has sunk to its lowest, along comes MTV’s Jersey Shore. The show is just actors playing out a ridiculous and insulting stereotype, there’s nothing “reality” based about it at all. Just to state the obvious, it has no therapeutic content or claims as well. There was the incident, though, where “Snooki” was punched in the face by a man in a bar, I could create an educational post about domestic violence out of this. Seriously.

Visit msnbc.com for breaking news, world news, and news about the economy

Needless to say, neither of the final 2 shows even qualify for my rating scale, it doesn’t go that low. As a person committed to helping real people make lasting change to better their lives, I cannot stand by quietly with public displays like these.

Let me know your thoughts.