Saturday, August 24, 2013

Taking Good Care of Yourself


When working with clients or living with someone who drinks/uses or used to drink/use and/or struggles with mental illness, there is a pull and a risk of falling into a codependent relationship – a danger that may lead to stress, burnout and disease.  In order to understand this phenomenon, here is an excerpt from Codependent No More:  How to Stop Controlling Others and Start Caring for Yourself by Melody Beattie: 

"Codependents were a necessary nuisance.  They were hostile, controlling, manipulative, indirect, guilt producing, difficult to communicate with, generally disagreeable, sometimes downright hateful, and a hindrance to my compulsion to get high.  They hollered at me, hid my pills, made nasty faces at me, poured my alcohol down the sink, tried to keep me from getting more drugs, wanted to know why I was doing this to them, and asked what was wrong with me.  But they were always there, ready to rescue me from self-created disasters.  The codependents in my life didn’t understand me, and the misunderstanding was mutual.  I didn’t understand me, and I didn’t understand them.

. . . I saw people who felt responsible for the entire world, but they refused to take responsibility for leading and living their own lives.

I saw people who constantly gave to others but didn’t know how to receive.  I saw people give until they were angry, exhausted, and emptied of everything.  I saw some give until they gave up.  I even saw one woman give and suffer so much that she died of “old age” and natural causes at age thirty-three.  She was the mother of five children and the wife of an alcoholic who had been sent to prison for the third time.
I worked with women who were experts at taking care of everyone around them, yet these women doubted their ability to take care of themselves.
I saw mere shells of people, racing mindlessly from one activity to another.  I saw people-pleasers, martyrs, stoics, tyrants, withering vines, clinging vines, and, borrowing from H. Sackler’s line in his play The Great White Hope, “pinched up faces giving of the miseries.”

Most codependents were obsessed with other people.  With great precision and detail, they could recite long lists of the addict’s deeds and misdeeds: what he or she thought, felt, did and said; and what he or she didn’t think, feel, do and say.  The codependents knew what the alcoholic or addict should and shouldn’t do.  And they wondered extensively why he or she did or didn’t do it.

Yet these codependents who had such great insight into others couldn’t see themselves.  They didn’t know what they were feeling.  They weren’t sure what they thought.  And they didn’t know what, if anything, they could do to solve their problems – if, indeed, they had any problems other than the alcoholics.

It was a formidable group, these codependents.  They were aching, complaining, and trying to control everyone and everything but themselves.  And, except for a few quiet pioneers in family therapy, many counselors (including me) didn’t know how to help them.  The chemical dependency filed was flourishing, but help focused on the addict.  Literature and training on family therapy was scarce.  What did codependents need?  What did they want?  Weren’t they just an extension of the alcoholic, a visitor to the treatment center?  Why couldn’t they cooperate, instead of always making problems?  The alcoholic had an excuse for being so crazy – he was drunk.  These significant others had no excuse.  They were this way sober.
By then, I had been sober for a while.  I was beginning to understand myself, but I didn’t understand codependency.  I tried, but couldn’t – until years later, when I became so caught up in the chaos of a few alcoholics that I stopped living my own life.  I stopped thinking.  I stopped feeling positive emotions, and I was left with rage, bitterness, hatred, fear, depression, helplessness, despair and guilt.  At times, I wanted to stop living.  I had no energy.  I spend most of my time worrying about people and trying to figure out how to control them.  I couldn’t say no (to anything but fun activities) if my life depended on it, which it did.  My relationships with friends and family members were in shambles.  I felt terribly victimized.  I lost myself and didn’t know how it had happened.  I didn’t know what had happened.  I thought I was going crazy.  And, I thought, shaking a finger at the people around me, it’s their fault.

Sadly, aside from myself, nobody knew how badly I felt.  My problems were my secret.  Unlike the alcoholics and other troubled people in my life, I wasn’t going around making big messes and expecting someone to clean up after me.  In fact, next to the alcoholics, I looked good.  I was so responsible, so dependable.  Sometimes I wasn’t sure I had a problem.  I knew I felt miserable, but I didn’t understand why my life wasn’t working.
After floundering in despair for a while, I began to understand.  Like many people who judge others harshly, I realized I had just taken a very long and painful walk in the shoes of those I had judged.  I now understand those crazy codependents.  I had become one.

Gradually, I began to climb out of my black abyss.  Along the way, I developed a passionate interest in the subject of codependency.  As a counselor (although I no longer worked full-time in the field, I still considered myself one) and as a writer, my counselor was provoked.  As a “flaming careening codependent” (a phrase borrowed from an Al-Anon member) who needed help, I also had a personal stake in the subject.  What happens to people like me? How does it happen? Why? Most important, what do codependents need to do to feel better? And stay that way?
I saw people who were hostile, they had felt so much hurt that hostility was their only defense against being crushed again.  They were that angry because anyone who had tolerated what they had would be that angry.

They were controlling because everything around and inside them was out of control.  Always, the dam of their lives and the lives of those around them threatened to burst and spew harmful consequences on everyone.  And nobody but them seemed to notice or care.

I saw people who manipulated because manipulation appeared to be the only way to get anything done.  I worked with people who were indirect because the systems they lived in seemed incapable of tolerating honesty.

I worked with people who thought they were going crazy because they had believed so many lies they didn’t know what reality was.

I saw people who had gotten so absorbed in other people’s problems they didn’t have time to identify or solve their own.  These were people who had cared so deeply, and often destructively, about other people that they had forgotten how to care about themselves.  The codependents felt responsible for so much because the people around them felt responsible for so little; they were just taking up the slack.

I saw hurting, confused people who needed comfort, understanding, and information.  I saw victims of alcoholism who didn’t drink but were nonetheless victimized by alcohol.  I saw victims struggling desperately to gain some kind of power over their perpetrators.  They learned from me, and I learned from them.

Soon I began to subscribe to some new beliefs about codependency.  Codependents aren’t crazier or sicker than alcoholics.  But, they hurt as much or more.  They haven’t cornered the market on agony, but they have gone through their pain without the anesthetizing effects of alcohol or other drugs, or the other high states achieved by people with compulsive disorders. And the pain that comes from loving someone who’s in trouble can be profound.

‘The chemically dependent partner numbs the feelings and the non-abuser is doubled over in pain – relieved only by anger and occasional fantasies,’ wrote Janet Geringer Woititz in an article from the book Co-Dependency, An Emerging Issue.

Codependents are that way sober because they went through what they did sober.

No wonder codependents are so crazy.  Who wouldn’t be, after living with the people they’ve lived with?

It’s been difficult for codependents to get the information and practical help they need and deserve.  It’s tough enough to convince alcoholics (or other disturbed people) to seek help.  It’s more difficult to convince codependents – those who by comparison look, but don’t feel, normal – that they have problems.

Codependents suffered in the backdrop of the sick person.  If they recovered, they did that in the background too.  Until recently, many counselors (like me) didn’t know what to do to help them.  Sometimes codependents were blamed; sometimes they were ignored; sometimes they were expected to magically shape up (an archaic attitude that has not worked with alcoholics and doesn’t help codependents either).  Rarely were codependents treated as individuals who needed help to get better.  Rarely were they given a personalized recovery program for their problems and their pain.  Yet, by its nature, alcoholism and other compulsive disorders turn everyone affected by the illness into victims – people who need help even if they are not drinking, using other drugs, gambling, overeating, or overdoing a compulsion.
I’m not an expert, and this isn’t a technical book for experts.  Whether the person you’ve let yourself be affected by is an alcoholic, gambler, foodaholic, workaholic, sexaholic, criminal, rebellious teenager, neurotic parent, another codependent, or any combination of the above, this book is for you, the codependent.

This book is not about how you can help your alcoholic or troubled person, although if you get better, his or her chance of recovery improves too.  There are plenty of good books on how to help the alcoholic.  This book is about your most important and probably most neglected responsibility:  taking care of yourself.  It’s about what you can do to start feeling better."

What it is

Spirituality and mental health is not about proselytizing or religious rules. 

It's simply about the fight in the dog, playing with heart, passion, spirit.

It's that je ne sais quoi element that turns the dark horse into a winner.

It's about engaging and integrating the mind, body and spirit - parts of us that are inextricably linked anyway.

It's about acknowledging who we are and understanding how we're built.

We are meant to be whole - it is our birthright.

Go on and get yours.

Friday, August 23, 2013

Spirituality & Mental Health 5

"An increased interest in the effects of religion and spirituality on health is apparent in the psychological and medical literature.  Although religion in particular was thought, in the past, to have a predominantly negative influence on health, recent research suggests this relationship is more complex.  This article reviews the literature on the impact of religion and spirituality on physical and mental health, concluding that the influence is largely beneficial.  Mechanisms for the positive effect of religion and spirituality are proposed."

Seybold, K & Hill, P.C. (2001).  The Role of Religion and Spirituality in Mental and Physical Health.
http://cdp.sagepub.com/content/10/1/21.short

Spirituality & Mental Health 4

Corrigan et al., (2003) suggest that spirituality holds unique promise in fostering recovery from psychiatric disabilities.
 

Corrigan, P., McCorkle, B., Schell, B., & Kidder, K. (2003). Religion and spirituality in the lives of people with serious mental illness.  Community Mental Health Journal, 39(6), 487-499.

Spirituality & Mental Health 3

"Emerging evidence about the beneficial impact of spirituality on recovery outcomes suggests that the successful incorporation of spiritual approaches into clinical practice has the potential to contribute to the next quantum leap in the development of effective, person-centered systems of care."

Psychiatric Rehabilitation Journal, 2007.  Volume 30, No 4, 247-249.

Spirituality & Mental Health 2

"Spirituality has been cited as having a positive effect on mental health outcomes. . . .Results suggest that age, gender, having psychotic symptoms, having depressive symptoms, and having a higher global quality of life, hope and sense of community were all significant correlates of spirituality."

Psychiatric Rehabilitation Journal, 2007.  Volume 30, No. 4, 287-294.

Spirituality & Mental Health

"In the past decade or so, researchers across a range of disciplines have started to explore and acknowledge the positive contribution spirituality can make to mental health.  Service users and survivors have also identified the ways in which spiritual activity can contribute to mental health and well-being, mental illness and recovery."

Cornah, D. (2006).  The impact of spirituality on mental health:  A review of the literature.
(http://www.rcpsych.ac.uk/pdf/Mental Health Foundation spirituality reportx.pdf)

Wednesday, August 21, 2013

Affirmation

You are beautiful and a gift to anyone's life.

-- Goddess Tauheeda

Cause & Effect

Do not stand in the way of a person and their natural consequences. 

The Law of Cause and Effect is an important lesson to learn. 

Allowing someone to learn this lesson is more loving and respectful than attempting to buffer them from their natural consequence.

Self-determination means we value a person's right to make their own choices (cause) and be responsible for the consequences of those choices (effect).

The hands-off approach may feel cruel - like leaving a fool to their folly.  That assumes that people are foolish versus acknowledging that people have agency (power, capacity).

 


Monday, August 19, 2013

Saturday, August 17, 2013

Affirmations

". . . words that you deliberately choose, such as affirmations - can be an amazing tool for installing new beliefs and attracting new thoughts and ideas that are in line with your dreams.  Affirmations are not only helpful in installing new beliefs, but like our acts of faith, they can also help us make strides in eroding invisible, limiting ones.  In case affirmations, which are sometimes called mantras, are new to you, they're simply short, empowering statements that you repeatedly say to yourself.  An example would be a statement such as "I am surrounded by wealth and abundance," or instead of "wealth and abundance," you might choose "friends and laughter" - anything at all that you want to be surrounded by (stated as if they already surround you).  There's no format and there are no magic patterns; it's just a short phrase or two (or three) that you repeat again and again, usually out loud but sometimes silently."

Mike Dooley

Examples of affirmations:
  • I am happily married to my best friend.
  • I have a harmonious family life.
  • I am doing God's work efficiently and effortlessly.
  • I eat and move daily to maximize my good health and attractiveness.
  • I maintain a love-work-play balance that nurtures my radiance, sensuality and good mood.
  • I am beautiful and a gift to anyone's life.
  • I am present with myself right here and now.
  •  I know exactly what needs to be done and I do it with ease.
  • I deserve to receive good in all ways.
  • I attract all the people and opportunities that I need, when I need them.
  • I am open to all experiences and all people.
  • I am free to be myself in all my relationships.
  • I have an incredible capacity to manifest.
  • My wisdom is my wealth.
  • I make money easily and effortlessly.
  • I am decisive and focused.
  • I radiate positive energy and abundance.
  • I give thanks for ever increasing health, youth and beauty.
  • I say everything I need to say with ease and honesty.
  • I love and accept all of myself and all that I see in my partner.
  • I am destined to achieve true wealth.
  • It is safe for me to love and be loved.
  • I enjoy being loved.
  • I eat nutritious foods that fill me with energy and vitality.
  • I invest my time in becoming healthier.
  • I have healthy relationships.

Underlying Beliefs

". . . words spoken spontaneously provide an excellent roadmap to your beliefs, which is why I always strive to pay close attention to everything I say.  When we listen to ourselves as we converse with others, we can catch ourselves espousing our beliefs, as was true about observing our actions.  For this reason, it could be said that our words are simply our thoughts that will become things soonest.  But by following those words back to the beliefs they were drawn from, we can begin identifying which ones either support or deny our dreams."

Mike Dooley

Infinite Abundance

"The truth is that there is enough for everyone, and your receiving your heart's desires does not mean others are going without theirs."

Mike Dooley

Wednesday, August 14, 2013

Show Up

"Intent, or thought without action, is not enough. 
But as you open your mouth to speak, as you put forth your leg to walk, as you pry open the pages of any book to read, these physical gestures overwhelmingly imply that you believe your intent will be matched with results. 
All this adds to the energy of your initial thought sufficiently enough that a tipping point is reached; critical mass is achieved, allowing the Universe to grab the baton and take over, all for the seemingly feeble actions we initiate
You don't even have to know how to complete the processes started, yet starting the process clearly demonstrates a belief that it will somehow be completed. 
The original intent (vision, desire, dream), bolstered by the expectation and empowered because of the action that follows, is sufficient to cause the necessary articulation, muscle movements, and idea formulations invoked by life's magic via the thoughts become things principle for there to be the corresponding manifestation."
--from Infinite Possibilities by Mike Dooley
It is said that 90% of success is just showing up.  Where's your next baby step headed??  I'm officially ABD - I'm almost there...

Tuesday, August 13, 2013

Exploring the Ambivalence with Families in Children's Mental Health

When I was a beginning school social worker, I noticed that only half of the families showed up to their scheduled intake assessment appointment.

In school, 50% earns a failing grade.

So I ran to my clinical supervisor, Reevah Simon.  She schooled me about how what I said right over the phone might keep families away.  I changed my introductory rap and more parents started showing up to their appointments.  Eventually, I reached over 90% family engagement, even at the high school level.

Since then I've read family engagement in children's mental health is about 50% - across the country.  It turns out that I wasn't the only one failing.

Mary McKay, LCSW PhD, is pioneering research to improve family engagement in children's mental health (that's what happens when clinicians become researchers - studies with practical application that can improve our practice get done).

She developed a script based on structural family therapy principles that can be used at first contact - like when clinic staff schedule an appointment for families over the phone.  One of the elements in McKay's script reminded me of what Reevah taught me - explore the ambivalence.

Often we think we need lots of water under the bridge before we go there - what are your concerns, doubts, questions about coming in for this appointment?

Research and experience shows that if you don't go there in the phone conversation (granted, you may save it for the end of the conversation), then families are not likely to show up.  If you do go there, then they are much more likely to show up.

If it makes everyone feel better (and normalizing usually does), then add:  "families usually have concerns, questions or doubts about coming in for their first appointment - is this true for you?"

Exploring the ambivalence is one of those clinical tools that has helped me in every setting, with any client population and presenting problem.

In fact, it is so universal that I find myself exploring my own ambivalence when making decisions.  Thanks, Reevah.

Exploring the Ambivalence with Chronically Homeless Veterans

My research interest is trauma, PTSD and resilience, particularly how attachment security moderates the relationship between these variables.

I'm funding my last year in the program with part-time work as a clinical supervisor, so I am supervising MSW clinical case managers working with chronically homeless veterans.  This is a new population for me but the issues of trauma, PTSD, resilience and attachment security resonate.

I had dinner with my clinical supervisor of many years, Reevah Simon.  Now semi-retired, I run to her regularly when I need her wisdom.  She was on fire.

One of the most important clinical concepts she taught me was the power of exploring the ambivalence clients have about change - even if the change is positive.

Implementing a program that attempts to fast-track housing for chronically homeless veterans seems like a no-brainer but the challenges are numerous and mostly invisible.  That's where clinical assessment and interventions come in handy.

Exploring the ambivalence

Reevah recommends that clinicians imagine that they are homeless - what are the advantages and disadvantages?

What's the best thing about being homeless?
  • Freedom from rules and regulations
  • The street is an unstructured setting
  • People that are homeless form networks - pairs look out for each other
  • Avoid feelings of paranoia and feeling trapped within four walls, feeling suffocated
  • Can move on when feel they feel like it
  • Can hide in plain sight - hard to locate
  • Form families and are willing to give up their life for each other
  • Taking care of their buddies motivates them - gives them a sense of belonging, community, and purpose
  • They have a place on the sidewalk
Having an apartment may mean that everyone knows where they are - like a sitting duck.

For chronically homeless veterans, traumatic experiences probably date back to childhood.  Insecure attachment to primary caregiver may have left them vulnerable to PTSD.

As a veteran, they may feel like
  • they don't belong anywhere - don't have a job
  • miss the structure of the military
  • miss the identification of their position/role/rank - someone always told them what to do
  • civilian life is individualistic vs. military life is group oriented
Any change, even for something seemingly better, provokes feelings of ambivalence.  We feel ambivalent about everything.  So when veterans don't show up to appointments or don't return phone calls, exploring their ambivalence about moving into stable housing is in order.  We all feel ambivalent about everything - so we either explore it using language and words or it goes underground and we act it out behaviorally (missed appointments and other forms of self-sabotage).

More questions for exploring the ambivalence:
Why wouldn't you want to move into stable housing?
Do you feel you would be giving something up?  What would you have to give up to move in?

Explore ambivalence with empathy - by putting yourself in the place of the other person and imagining what it would feel like to you.

What we, as clinicians, bring to the conversation is that we know the alternative.  We know the situation that veterans are in (assuming we have asked and listened well) and know what could be, that is, what is possible.

First, establish the way things are and then bring in the alternatives.

What do you do to prevent feeling claustrophobic?
What are the advantages to living in an apartment?
Are there difficulties living with another person?

Scheduling appointments

When scheduled to meet at a certain time and place, veterans may feel trapped.  "I'll catch you around" vs. commitment to time and place.

What are you comfortable with?  What do you think you could live with?

Keeping appointments carries with it symbolic baggage - feeling controlled.

Who's goal is it?

We've taken on the goal when the goal is more important to us than to the client.  The more we want it, the less likely they are to show up.  They take pleasure in screwing us especially if we act like we know better.

Understand who they are

What do they like about their current life?
What are the negatives about moving in?
Tell me what you like about living on the street?
If I was gonna live on the street, what would I need to know?
You are not trying to get them to do anything.
No matter what it looks like, they are immersed in a community.

When client may be acting like it's all our problem (as clinicians):
What are you planning to do about this?
How did you think I could help?
I notice this is the second time that this happens on the first of the month.  Do you run out of money?

The Centrality of Emotions

"Emotions give our lives meaning and reason, and the unpleasant ones serve us by hinting at how we can get back on track with life's truths."

Mike Dooley

Hope after Evil

"...evil always inevitably self-destructs."

Mike Dooley


"When I despair, I remember that all through history the ways of truth and love have always won. There have been tyrants, and murderers, and for a time they can seem invincible, but in the end they always fall. Think of it--always."

Mahatma Ghandi

"...you know a lot of secrets about him but don't spread gossip.  It's good for your character. Let his undoing be his own doing."

Babalawo

Monday, August 12, 2013

Our Dark Side

When I came home from college to visit my mom, I found her watching Spanish-language tele-novelas.

In my most annoying tone I told her:  "Oh. My. God. Mom, why are you watching that ridiculous soap opera?  It's not even real."

She countered:  "No, you are ridiculous if you think people don't really act this way."

Now I'm 44 and the protagonist in my very own tele-novela (sans the TV audience unless facebook counts) replete with melodramatic villains.

We really do act this way.  Well, not all of us and not all the time.

Growing up in mind, body and spirit means that we see life as it really is and not as we wish it were - eyes wide open and not in denial. 

We all have a dark side (the baby part, the id) - villainous and melodramatic with murderous impulses.

But we don't all act on our dark impulses. 

We also have a mature side (the adult part, the ego) and a good side (the parent or God part, the superego). 

Even if we identify with those of us that choose to hurt, lie, cheat, steal and kill ("I can see why he or she would do that"), what we mean is we have had the same thoughts and feelings.  However, we would not do the same thing. 

The baby part wants revenge for the pain - even if the pain is self-inflicted, like envy or jealousy.  The parent part tells us to do the right thing, take responsibility for our feelings and actions, think of the consequences.
The adult part then decides what to do based on the impulses of the baby part and the rules/principles of the parent part.

Sometimes the baby part wins, sometimes the parent part wins and it is the adult part in us who decides.
Out of envy and jealousy, I have seen people compelled to spread rumors and gossip in order to take someone down that is identified as a threat.  Battles may be won this way but not wars.

Out of insecurity, I have seen people lie to everyone - including themselves - in order to maintain a certain image.  It's much easier to maintain an image than to do the work to build character.  My money is on the latter - it's a long-term investment.

In families, sibling rivalry (primal envy and jealousy) runs deep:  fighting over the shot-gun seat in the car, parental love and attention, the bigger piece of cake, bragging rights, and so on.  Physical and psychological warfare is employed in order to prevail.   In the workplace and life in general, sibling rivalry continues but without the limits usually set by mom & dad or the limits of blood and love.  That's when physical and psychological warfare gets really ugly.  

We also have a side that believes in love, hope and truth.  It wants the best for us and the greater good.  This part of us struggles with our dark side.  The tension is what makes us human - not pathological.  It is how we resolve this inner struggle of good and evil that shapes our character, our lives, reputations, and relationships.

Our beliefs about ourselves, others and the world influence which way we go on this.  If we don't acknowledge the dark side in all of us - we are naive and vulnerable to exploitation by others.  If we only see the dark side in all of us - we become cynical, paranoid and bitter.  Tension is good - it keeps us from either extreme.

What are your beliefs about yourself?
What do you think of people in general?
What do you think of life in general?

Our beliefs influence observations about our reality and ourselves.  Do we have the eyes to see?

Believe It

"Whatever it is that you now want, give what you can of it to yourself...Enjoying your life today, by living your dreams to the degree you presently can, is perhaps one of the most powerful things you can do toward expanding your belief system, while disabling limiting, even invisible beliefs."

Mike Dooley