Helping Clients Cope with Love Expectations

Therapists consider the winter holidays as being the roughest time for our clients. This includes Valentine’s Day. The heavy commercial marketing creates expectations, that if not met, can cause self-doubt and even deeper depression for those already troubled by these issues. There is a real possibility that these feelings could manifest for some clients, and therapists should be prepared with strategies to discuss difficult questions about love and companionship that clients might ask, either out loud or to themselves.

• How do I/we define love and how does that compare to personal experience?

This question might not be phrased in this way, but it’s often lurking in the back of clients’ minds. To help the client[s] organize their thoughts and fears around this question, gives them the opportunity to consider the dissonance they experience around this issue and define for themselves what real love looks and feels like to them. For so many with attachment issues and trauma, this kind of discussion is imperative to repair damaged thoughts and beliefs about love.

• How do I/we practice a loving relationship?

What are your clients doing in their love lives, or pursuit of them, that is serving them well or isn’t? This is topic a little tricky because it is not meant to create more angst for them, but to help them to have a clearer understanding about what they’re bringing to the table in loving relationships. As they begin looking more deeply at this, it’s wise to encourage them to acknowledge all the positive traits they offer as well as those they want to approve upon.

• How and where am I/we aware of being loved?

This is such an important question to highlight with clients. So many times, the focus in therapy is on the lack of love in their lives, often for good reason, but the reminder that somewhere in their lives there likely is at least one other individual who has shown them love. Whether it’s a grandparent, teacher, a child, or even a pet, someone has love for them.

• How do I/we show love to ourselves?

This is the most critical question in terms of personal growth and resilience. Therapists need to frame this as being fluid, but something to be built upon—foundational to emotional strength and endurance. Exploring ways to express genuine self-love will provide discussion about the differences between vulnerability and shame.

• How do we navigate in the love world without getting deeply hurt?

Again, this is all about gaining self-appreciation and respect that allows the client to set appropriate boundaries protecting him/herself from legitimate harm. Yet they should also able to more freely give love to others without unrealistic expectations that set up an emotional let-down.

All of these questions have the potential of leading clients toward genuine healing and growth. They also have the potential for deepening wounds and despair if they are handled without intentional care and respect. Therapists should remain diligent in keeping respect (the core component of real love) present and available for our clients to hold on to and grow into.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

De-escalating Clients Using RFT

At some point, most of us in the mental health field encounter clients who are emotionally escalated in tone or volume. Frequently, these escalations occur in couples or family counseling, when arguments get particularly heated, but they can also happen with individuals when discussing trauma or perceived threats. De-escalating these situations can be a tricky, if not frightening process.

When caught in a situation where de-escalation of emotion and subsequent action becomes necessary, there are several tips to keep in mind.

• The first and most critical step in this situation is to calm ourselves in the moment. Breathe, and remind yourself that you have the knowledge and experience to set the tone in the room. By your quieted posture and voice you can help regulate and reset the level of safety for everyone present including yourself.

Personal space and body language are important in this process. Heightened tension follows triggering cues, such as moving in too close or appearing too authoritative or demanding. It’s best to stay at least one leg distance from the agitated individual(s) and stay at an angle in relation to that person, so as to not appear to be responding to a confrontational standoff. It is also not typically wise to touch a person in an agitated state unless you know the person well enough to know that the touch will be welcomed and soothing, rather than cause for further irritation.

• The next step is to assess level of agitation or aggression you’re witnessing. Things to watch for include: fidgeting, rocking, heightened pitch, volume and speed of speech; pacing; rapid breathing and tightened facial expressions. These can be signs of potential danger, particularly if combined with any verbal or non-verbal threats, such as clenching fists or getting into someone else’s personal space. Signs of  aggression often happen quickly, so it’s best to be alert to any signals as early as possible.

At the same time, it’s really important to stay calm, because our job is to de-escalate the situation as soon as possible. Our demeanor and tone of voice are essential to lowering the tension in the room. Eye contact, as much as possible, along with a smooth, soft voice often offers comfort and helps soften the moment. From there you can gently and respectfully guide the dialog toward a peaceful resolution.

Therapists may not always be able to resolve the conflict, but hopefully we can restore some safety and trust with our clients by respectfully remaining present.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Black Keys on the Piano

Someone recently sent me one of those blast emails with this title. Turns out that it was about some concert at Carnegie Hall, but my mind went directly to the most recent derogatory statements made against primarily Black populated countries such as Haiti and African nations. “Black Keys on the Piano” is the perfect illustration of how integral and necessary these countries are to our world, along with the people living in them or those who are from them. Without their history, we’d have deep depletion of culture and humanity in a far more inferior world.

But the suggestion that this segment of our human population is not worthy of our consideration is severely troubling on its own. Yet this very pretext plays out every day.

Within the realm of therapy, it is noted that the African-American population is vastly underserved by mental health services in this country. Trust is one of the largest barriers to such services, along with the lack of financial resources.

Trust is critical to any therapeutic positive outcome, yet it seems to be undermined so frequently in a myriad of ways. Very often, it is missed without intention or forethought. The purposeful attention to the existence of racism in our society and the permeated value that it has in each of our lives is the only way we have to counter its damaging effects in our current interactions at work or in our personal lives.

This paradoxically means that we need to be able to trust others as well. Our own vulnerability is required to genuinely trust, and our ability to take the step toward trusting those in our midst is required in order to be trusted.

I believe that we owe it to ourselves, our clients, and to our greater global community to rigorously investigate any and all strands of bias or other blockades we hold that impair trust in either direction. To do this takes courage, strength, and untarnished honesty within ourselves to be able to delve deeper and present our most authentic selves in the most trustworthy manner possible.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

In Faith and Science

On New Year’s Eve, I was sitting in church and heard Rev. Cheryl Broome speak about neurotheology, a term I have not heard before. I am, of course, familiar with neuroscience and neuropsychology. Research tells us much about the brain, and particularly about the ways the two hemispheres of the brain work in tandem with each other and how they differ. Rev. Broome spoke more about the differences, specifically about how the right brain operates in connection with others more freely and creatively, while the left brain works more compartmentally and less in connection with others, often getting stuck in boxes of fear. Her connection to theology was about being more right brain aware, using its ability to connect and relate positively to others and to the Divine.

That same afternoon, I was reading Phil Cain’s blog and was struck by this sentence:

“A scientific outlook, and the healthy skepticism that goes with it, are no reason to ignore the need to form beliefs we can apply. Such beliefs provide us with a rugged, reliable and reassuring guide, like a pocket compass.”

I have long believed that there is room and compatibility for both faith and science. In psychotherapy especially the merging of the two seem to have significant capacity for healing. As a therapist, I need to be consistently mindful of where I am both spiritually and professionally, keeping abreast of the latest scientific literature in psychology and yet growing into my spiritual self. At the same time, I need respectfully pay keen attention to where my client is on the continuums of each measure.

It is my sincerest belief that respect, at its most rudimentary core, is the right brain connection for which we all strive and in the process of learning to connect more  fully in that way, we become stronger, healthier and more fully human.

Wishing everyone the best new year ever for growth and connection!

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Do No Harm

Do no harm is a common phrase in the mental health profession. It is understood to mean, at the very least, don’t hurt anyone. The Hippocratic Oath in medicine essentially states the same. Of course, it is also expected that we in both professions will do much more—that we will help people in significant ways.

This is the most basic, simple statement of ethics and to most of us, seems like a no-brainer. We are in a helping profession. To do contrary would be the antithesis of our entire purpose.

And yet, we are human beings—fallible and far from perfect. We make mistakes. Sometimes we do so unwittingly, without malice or forethought. We make ethical miscalculations. Or do we know and forget? i.e. leaving confidential information out on our desks or entering into a dual relationship by participating in a lengthy conversation with a client in a grocery store? These are the mistakes or ethical dilemmas we encounter, especially as young professionals. Hopefully we catch these faux pas before it’s too late.

That’s what HIPPA and our Code of Ethics are there for, to keep us aware of and accountable to not engaging in such behaviors. Rules are good; they tend to keep us out of trouble. But I believe there is more for us to consider.

For me, it is even more important, not in place of, but in addition to such rules, to be ever cognizant of the quality and tenor of the relationships we have with our clients. What do really offer to them? My hope is that we offer our most genuine concern, compassion and respect.

In our current culture, it seems as though the concepts of compassion and respect have greatly diminished. As we learn more and more about the scope of sexual harassment and abuse, racial violence and mass killings, not to mention increased marginalization of the poor and disabled, it becomes even more pressing that these basic values of humanity are restored and maintained. As therapists, our opportunities to contribute to this end are particularly abundant. My greatest hope is that we rise to this calling. To do no harm and bring respect back into our world.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Navigating the Holidays Therapeutically

We know that the clinical data and real life clinical experience clearly support the unfortunate truth that these seasonal holidays bring many clients heightened anxiety, depression, and thoughts and actions of harm to self and others. This phenomenon has been occurring regularly for decades, if not centuries. While we know that some is related to the nature of the actual season itself (i.e. the shorter days of daylight), it is thought that the holidays themselves also contribute to this rough period of time experienced by so many. The expectations of joy and giving often becomes burdensome to those who feel limited on material funds or sources of happiness in their personal lives.

Another area that creates tension for many is the interpersonal context of the season, or more specifically, family. The holidays bring with them some Hollywood, picture-perfect ideals of family get-togethers and, as we know all too well, they’re not always that way. Conflicts and feuds, old and new collectively, intensify and heighten the probability and noted occurrences of domestic violence in the midst of attempted festivities. Illness, physical or mental, or losses, such as divorce or death of a loved one, in the family can produce clouds of sadness and despair. Many do not have any family at all. So trying to create joy around these real life situations are increasingly challenging, if not seemingly impossible, depending on the freshness and intensity of the circumstances.

So therapists have a greater responsibility during these times. It rests upon us to have keener awareness to the possibilities of more difficult and, perhaps, more dangerous times for our clients. We need to more diligently assess for suicidal and/or violent ideations and be prepared to intervene swiftly and effectively as needed. Obviously, this season can and does also cause more stress for us as healers. Therefore our wellbeing is even more vitally significant than usual. As we teach our clients how to be more kind and gentle to themselves and those they love, so should we carefully listen to our own words of wisdom. May this season bring all of us peace and calm reassurance that we are valued.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

The Continuum of Violence

Over and over again, in the last few weeks, months, years and decades we continue to be overwhelmed by the news of horrible acts of violence. Most recently, in a small, quiet town in rural Texas, where “you would least expect it,” it happened again: a mass murder in an unassuming country Baptist church. More than fifty people were killed in cold blood, including children and the elderly. An unfathomable act for most of us trying to process such terror, even as it becomes more and more a part of the norm.

While many are asking why and debating the gun control issue, therapists realize that these news stories that are becoming much too frequent are really only the tip of the iceberg. We see in our practices the wider spectrum of violent acts, including spousal and child abuse, which are physical, sexual and verbal in nature. We see victims of trauma routinely who present complex, long term symptoms of anguish and pain, sometimes leading into generations of further pain and maladaptive behavior.

It seems as though there may be no end to this stream of inhumane behavior. This may indeed be true, that violence prevails no matter what interventions are attempted. But I believe that as a therapist I have a duty to try to intervene, even if only on a case-by-case basis.

With over four decades in this field, I can’t help but notice the continuum of aggressive and violent behavior. On one end it seems small, almost trivial, maybe “teasing,” or passive-aggressive in nature. Like bugging someone about wearing their favorite baseball cap or the way they wear their hair or calling them names just to be funny. This can grow into more full-fledged bullying, like playground bullying, cyberbullying or workplace bullying. There is a distinction between bullying and abuse, the latter crosses the line into physical harm and violence, but I would contend that this wider range of behaviors can be considered to be those of disrespect and ultimately harmful to some degree or another.

My point here is not to exaggerate the lesser of these acts into major problems on their own, but to recognize the larger picture so that we can more completely study and begin to understand this phenomenon of violence in our culture, our neighborhoods, our families and ourselves. I believe that the lack of respect, or disrespect, can behave like a cancer and grow to become a devastating story, sometimes told on the news. Therapists have an opportunity to intersect and intervene in these stories in a way that few do. I believe it’s our responsibility as professionals and human beings to do so with as much respectful clarity as possible.

Over the next weeks and months I will be returning to this topic of understanding and intervening violence and welcome your input into this discussion.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Texas Clinical Supervision Conference 2017

On November 3, at 1:30 PM, I have the honor of presenting at the Texas Clinical Supervision Conference at The University of Texas at Austin, Thompson Conference Center.

My topic will be Helping Supervisees Work with Highly Complex Clients Using Respect-Focused Therapy.

Related Articles: Preparing for Difficult Clients

Texas Clinical Supervision Conference PowerPoint November 3 2017

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Dealing with sexual trauma in therapy

We have reminded in the news once more that sexual harassment and abuse are very prominent issues in today’s society. The latest controversy around a famous movie producer for decades of sexual harassment and assault only adds to a long list of known cases of people using their positions of power to abuse others.

Of course, what we also know is this horrific phenomenon is not restricted to the rich and famous. Many therapists see the results of sexual trauma play out in our practices on a fairly regular basis. The range in behavior is vast, but the overreaching message of disrespect for another human being is resoundingly the same. In a therapeutic context, the victims of sexual misconduct are wounded deeply, mainly because of the serious lack of regard for their innermost sanctity and personhood.

This goes far beyond the physical acts themselves. It is the robbery of emotional and spiritual safety. It is the denigration of personal value. The damage done is ultimately repairable, but not before the pain is fully recognized and experienced.

Therapy is about this very process. It is the full recognition of what has been taken away without self blame or shame. Most often, the healing process involves self-forgiveness for being broken by the event, even though there is really nothing internally to forgive. A violation occurred externally, but struck so privately and personally that it frequently feels like a stain on one’s soul or psyche. With this understanding, it then makes perfect sense that coming forward by the victims may be indeterminately delayed, for fear of being seen with such a stain and/or having to endure more disgrace and humiliation because of it.

Cleansing and healing the wound made by someone else’s invasive or attacking behavior is the task that therapists are asked to assist with. Respect-Focused Therapy suggests that the best, most effective way we can do that is by concentrating our full energy and focus on truly respecting a person’s pain as well as the whole person completely. With the experience of receiving such depth of genuine respect, it is hoped that these individuals will have the platform on which to begin building, once again, their own self-respect as well as respect for others around them.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Exploring Beneath Addiction

In the last several years it has become more and more clear in the media as well as within the mental health profession that addiction has become an out-of-control epidemic, especially addictions to meth, opioids, and heroin.

I supervise post-grad interns who work with this population (addicts of all substances), many of whom are homeless and/or ex-incarcerated. Most of these clients have years, if not decades, of addictive patterns of behavior well established, such as lying, cheating, and portraying some level of aggression or passive-aggressive behavior. Many are dually diagnosed with other mental illnesses and have suffered various traumas during the course of their lives.

These entrenched behaviors often become like masks or shields for the people living inside of them, seemingly impenetrable to those working with them. So many layers of harm from others, self harm, and harm done to others are woven into the horrific disease of addiction, that it seems extremely difficult to unravel and find the human being strangling inside.

Exploring beneath this quagmire of addiction requires the willingness to suspend judgment and presumptions about the limitations of hope placed on or by this person. Societal norms and personal records of misconduct have put boxes of low expectations on addicts. To find the real people hiding in these boxes is the primary challenge of therapy, as I see it. As we go about the careful process of doing so, we need to help that person exposed learn to not be afraid of who he or she really is, but to have the courage to heal and embrace the broken goodness within.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.