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...

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

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