That’s obvious!
That’s obvious! A lot of therapy is about working with the obvious in a new way. Only rarely do my clients come up with something unknown about themselves. The real work is in coming to a new relationship to what they already know. Sometimes the work of the therapist – and the client – is to state what is in plain sight, in a way that clarifies the situation. The strange thing is that sometimes it takes some exploration to find the obvious. A recent example: I was working with a client about their relationship to their spouse. As we got deeper, I said, you would like to be with them in a new way. This brief sentence caught our attention. It summarized what they were wanting, and became explicit in the moment. Because it arose out of very personal material, it was tailor made for this person. I offered this phrase to the client in an invitational way. I was pretty sure it was significant, but I never really know until the client checks it for themselves. This one was a fit and I am sure it is a theme we will return to. But it took some effort to find this guiding...
Read MoreMemory
“The past is never dead. It’s not even past.” William Faulkner, Requiem for a Nun Memory is the alpha and omega of therapy. People often come into therapy because negative memories are affecting their present happiness. They may even blame themselves because they cannot “get over” the past, even the distant past. Perhaps the feeling of not being able to get over something is an internal message, telling us that something is incomplete, or that something about our memory needs to move in some way that is not yet known. It is alive, and wants to move. Memory is dynamic. As we live, we are constantly interpreting our present experience through the framework of the past, and what we learn changes the meaning of memories. Sometimes people say the past cannot be changed. This is true in that past events cannot be changed, however, and this is a big however, it is entirely possible to change the way a person holds the memory of the past. So, there is not just the memory, there is an inner relationship to it. When we live with our memories in the right way, we are more able to be in the present moment, because we are in the right relationship with our aliveness. Being stuck in the past is not pleasant, but neither does it serve our lives to “just close the door”. There is a middle way between these two alternatives (being stuck or closing the door). Current research tells us that every time we recall a memory, it is subtly changed. We are not computers – we are makers of meaning. We expect a computer to quickly and accurately recall a piece of data in exactly the same form as it was stored. But a human being is in interplay with the world, taking in ideas and experiences, all of which becomes context for re-experiencing memories. What is memory? We are mostly taught to think that a memory is something linear, something about which you can narrate a chain of events, but this is only one kind of memory. There are different kinds of memory: explicit and implicit. Explicit memories are those that we are aware of as memories. For example, you may remember that five minutes ago you got up to get a glass of water, then you had a conversation with someone. This is a narrative memory – you remember certain events and can recount the narrative of the events. Implicit memory is something else entirely. Implicit memory is formed like a fishing net that catches everything in its path – your thoughts and feelings, your bodily experience, sensory impressions in the environment, and it is re-experienced as “the way things are”. It’s based on emotions, impressions and evaluations, sensory information, and it often cannot be located in a specific time and place. All of this gets transformed inside you, through the process of making sense of things. Most often, when we are in the middle of an implicit memory, we are not aware of it as a memory. The way we see the world, the way we make sense of our experience, our “filters” and values are based on implicit memory. In your life, how did you learn what kind of person to trust (or not), and how do you apply that learning? That is implicit memory at work. Very often, when we find ourselves in a mood (whether positive or negative), we are actually experiencing an implicit memory – but the point is, that we do not experience it as a memory, like we do with...
Read MoreStepping into the shame zone with ADHD
“I don’t fit in.” It is a common experience for people with ADHD to feel misunderstood, like something unexplainable is wrong with them. And the feeling that goes with that – which is often barely recognized – is shame. Attention Deficit Hyperactivity Disorder. What a mouthful! Over the last ten years, our understanding of ADHD has changed quite a bit, and if it were to be named today, it might not even be called a deficit or a disorder. It used to be considered a childhood problem, but now it is acknowledged that it affects adults. Like shame, ADHD has many faces, but they all seem to stem from one constant – an impairment of executive functioning. Executive functioning is the ability to track and manage sensory and mental input, making moment by moment decisions. It relies on short term memory– you can think of executive functioning as the air traffic controller of the mind. When executive functioning is impaired, the person has trouble getting things done, that “normal” people seem to accomplish without great effort. Shame can arise from feeling “I should be able to do this”. The person feels something is wrong with them. They feel different from others and often frustrated with themself. Not knowing how to address the problem can also lead to a feeling of powerlessness. What is shame? At its core, shame is the sense that something is fundamentally wrong with me (contrasted with the belief that I have problems to work on but that I am fundamentally okay). Shame is an emotion that blends with other emotions, such as sadness and anger, and almost any behavior. Shame is a real chameleon – and to complicate the picture, not all shame is bad. But the shame we are talking about here is painful and debilitating. Factors that may further complicate the picture (keeping in mind that ADHD is both under and over diagnosed, and that many people feel “everyone has ADHD”): The ADHD person may not be diagnosed. Without a diagnosis it is difficult to address the practical and relational issues. Remember, in a shame state, the person thinks it’s their fundamental identity that’s flawed, not what they do. The ADHD person may be diagnosed, but may feel stigmatized, or may feel that it is an “excuse” diagnosis. This indicates that in the past they have not gotten proper treatment, and support. This can happen when people are medicated as children but haven’t received therapy, coaching or social support to deal with the negative self image that can result from ADHD. ADHD often co-occurs with other conditions, such as trauma, depression, anxiety, substance abuse, bipolar disorder, learning differences and sensory processing disorders. All of the above can lead to feeling – and being – misunderstood. While hyperactivity is part of the name of ADHD, there is also an inattentive type. Because they tend not to attract attention to themselves, people with the inattentive type often do not get help. In school these students are often told that they do not perform up to their abilities. (Noticing that others are disappointed in you leads to shame). Both types hate being bored, and you could interpret both the daydreaming and the hyperactivity as an avoidance of boredom. People with the inattentive type may be shamed by labels such as “bad at following instructions”, unmotivated, disrespectful, or even rebellious. People with ADHD receive repeated negative messages about their ability or willingness to perform according to expectations, as Dr. William Dodson explains. This usually starts in school and often continues into the workplace. Many people with ADHD...
Read MoreHow to find a psychotherapist in the East Bay
Finding a therapist can be a daunting task, especially in an area where there are many to choose from. First off – if you are in a crisis, call the Alameda County Crisis line at 800 833 2900. They do crisis counseling and can give referrals. It is available 24/7. There is also a special line for teens: text “SAFE” to 839863. Otherwise, the rest of this article describes what to do if you can take some time to look around. I’ll suggest a two step process: Get yourself ready to look. Describe what‘s going on for you. Consider what kind of therapist would suit you Write a list of questions for the therapist. Search for therapists. Talk to people you know, if you feel comfortable doing so. Do some on line research Call those you want to interview. 1. Getting ready to look Logistics – time, place, and money Sometimes people just choose a therapist by their office location. Of course convenience is important, but if this is your primary criterion, this is probably not the choice that will serve you best! Most therapists prefer to meet with clients on a weekly basis. For this reason you should look at your schedule and your budget to determine how much you can spend and when you are available. Insurance The Affordable Care Act has brought many changes to health care. Contact your insurance company to find out what your co-pay is for in-network providers, and what they reimburse for out of network providers. Don’t think you are covered for mental health? Check again – parity laws require that mental health coverage be on a par with medical coverage. What to say about yourself, and what questions to ask Interviewing therapists is hard! You’ll be talking about deeply personal topics with a stranger. It’s usually not necessary to go into extensive detail. Describe your situation, using your own words to say what is causing you to search for a therapist. You don’t need to use psychological jargon or a diagnosis, just what you are experiencing. Make sure to say who the therapy is for. Do you want couples or family therapy? If you are having issues with your partner, realize that sometimes your individual therapist may or may not work with you as a couple. It’s a good question to ask when you are interviewing the therapist. Here’s a suggested list of questions to start with. Add your own as needed. I am looking for a therapist because_____________________ or to help me with_____________________________for (myself/my child/me and my partner?other). My current situation is________________. Where is your office? What are your fees? Do you take my insurance? Have you dealt with my problem or issue before? Can you describe your approach? Do you have openings? When you talk to the therapist, pay attention to how you feel as you interact with them. Do they return your call promptly? What’s your impression? Do they seem to understand you? For one reason or another, it may not be a fit. If it’s not, you might consider asking if they can refer you to someone. It’s perfectly ok to tell the therapist that you are talking to multiple therapists to find out who is the best match for you. What do all those initials mean? There are several different types of licenses issued by the state of California that allow the person to practice psychotherapy. They vary in their emphasis, and training, but all have a minimum of a master’s degree and 2 years of internship. MFT or LMFT stands for Licensed Marriage and Family...
Read MoreBook review: Mindsight, by Dan Siegel, MD
Book Review: Mindsight, Dan Siegel, M.D. Where does the ability to sense our own inner world come from? Dan Siegel explains this in his book Mindsight. He says that the quality of early relationships “lights up” our sense of self, and creates an ability to perceive it. The first step is the contact between two people, and the second step is the inner perception. He names the ability to perceive ourselves “Mindsight”. Let’s take a moment to take that in. Our contact with early caregivers becomes internalized as a sense, a faculty comparable to vision or hearing, except that instead of sensing light or sound, mindsight is the sense of our experience. You might say to yourself, I know what he’s talking about – that’s thinking! But that would be a misreading of his meaning. When he coined the term mindsight, he was pointing us toward something both familiar and new. Mindsight includes thinking and much more. To Siegel, the mind is embodied, and relational and dynamic. We do not perceive ourselves in a vacuum, but rather through a web of feelings, bodily processes and mutually derived meanings. Or as he jokes, “there is no immaculate perception”. It’s not like a computer or … what might be called “mind” but in truth is much more than mental. So, why do we care? Why does that matter? For many reasons: The most important relationship you have is the relationship with yourself. Mindsight is the ability to perceive it. It tells us how early relationships affect us in the present. Mindsight is developed, and refined over the course of life. Some people get a great start with it, others less so, but no matter where you are now, it is a skill that you can develop to promote well being. Using tools of mindfulness in the present time can help. We don’t have to live with whatever circumstances we were born into. The connection with self is a kind of knowing. Not so much the accumulation of facts as how you put things together, how you synthesize the totality of facts, prior experience, and intuition. Much of our internal processing is automatic and unperceived. Yet it controls the way we see things, the meaning we make of our lives. If it’s working, that’s great, but if it’s not, then this is one way to initiate change. Mindsight turns our attention towards inner processing and thereby begins to give us the power to remodel the meaning we make of our experience. Siegel unravels the mysteries of implicit and explicit memory in a particularly illuminating way. It’s a truism to say that therapy looks to the past to explain the present. Both kinds of memory color current experience, causing us to see things in a certain way. But the distinctive difference about implicit memory is that we do not experience it as something we recall, merely as the way things are. The work of therapy often involves making implicit memory conscious. “When we are on autopilot, our awareness “believes” what it perceives. There is no mindsight…”(p.202). It’s a great book, and if you’d like to work on some of the things he writes about, please give me a call or text at 510 863...
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