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Finding a Mental Health Therapist

September 21, 2010 by

“It is only when you exercise your right to choose that you can also exercise your right to change.” Dr. Shad Helmstetter

This week, with input from the internationally known psychologist Barry Duncan, I describe how to choose a psychotherapist.

There are lots of us out there; how can you know who best for you? Underlying the opinion of this blog is research of the last 50 years. Research is clear — therapy is helpful. We know that people who get therapy are better off than 80% of those that do not. Therapy is helpful in dealing with depression, anxiety, variable mood, trauma, attention concerns. It is also helpful for pain and physical problems that are exacerbated secondary to struggle to recover from stress. Working with a therapist that fits with you is the key. Also know there is great variability in clinician effectiveness.

Many therapists now have a website offering you the advantage of learning a bit about the person before contacting. Many will also offer, at no charge, time to get acquainted. Following are guidelines for that time.

First, trust your gut. If you find a therapist that you do not like, try another. Getting along reasonably and communicating well with your therapist is a key to success. Similarly, if you sense the therapist does not like you, move on. You need to know the counselor you work with is on your side. You can, of course, discuss your concerns before leaving but do not do this session after session. It is important to note that the number one predictor of success in therapy is client rating of relationship with the therapist early in contacts.

Second, you and your therapist should have agreement on goals. If that is not the case, work with someone else. If the therapist’s approach to your problem does not make sense to you, talk with him about trying a different approach. There are nearly 400 different approaches and he should know more than one or two. If he does not shift approach, find someone else to work with.

Third, research is clear that hope must be a part of the relationship. If no hope, what is the purpose? If a therapist treats you or your situation as ingrained or hopeless, look around and find another.

Fourth, look for change early in your sessions. You should notice positive change in 3-6 sessions. If not discuss with your therapist and if no change persists find someone else. It was just a match that did not work — no reflection on you or on the therapist. Keep trying for improvement. It is fair to expect positive results sooner rather than later.

Therapist effectiveness is also widely different. The most effective mental health professionals show significant gain with 70% of their clients. The least effective show gain with only 20%; this difference is dramatic. It is fair to ask about success rate. Even working with the most successful therapists there can be a mismatch for you. While change can still happen by using a different approach, often a change in therapist is indicated.

Whoever you work with, you should expect and notice positive change. Remember you are the boss. You get to choose and your being actively involved in the process is vitally important. Pick someone with a good track record.

And if you wonder: Over the last 6 years, 67% of (800 or so) clients that I have seen more than 1x, have surpassed the 50 percentile of change based on national norms.

Bill

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Showing Up

September 13, 2010 by

Running with Rob and Steve.

On Fridays I run with former work buddies Steve and Rob. I was looking forward to the run last Friday and thought “perfect day – perhaps a 10.” As I unlocked the car door I realized my gym bag was at home without enough time to get it. I could call and tell them I goofed; instead I decide to just go and at least touch base before they run.

They don’t seem to understand that I can’t run without my gear. They simply set about finding a way. Rob offers an extra pair of (really big) running shoes, Steve has a Reds tee shirt and my old work locker contains a towel and clean baggy socks. What about shorts? Steve goes to his truck and we scrounge the other lockers. No luck. Rob remembers a pair of shorts in the other locker room – way too big but with a draw string. I make the run and, even with shoes too big, baggy socks and baggy pants, do not hurt myself. It was a memorable run, a “happily ever after” lunch hour.

Steve and I have now run together most Mondays and Fridays since 1991, the year we moved to the same building at Comprehensive Mental Health Services (now Meridian). Rob joined us in 2004. I’ve run over 4200 miles with Steve; we have spent over 1600 hours of getting ready to run, running and getting clean to go back to work.

At some point in the process, we became friends . . . very good friends. I learned with Steve how to make friends. In part, it is a process of showing up. Did we become friends at mile one, 10, 100 or 1000?

I don’t know; it just happens when you learn to trust that someone will be there and eventually, you talk and share. Showing up in a reliable way is under rated. It’s a job skill, a responsibility skill and yes, a friend skill.

People often tell me they want close relationships and it seems they are in a hurry. They want them now. I suppose it can sometimes work that way, but suspect more often the process is, in part, showing up and getting to know and trust in a gradual way.

I now think of this time on Monday and Friday time to be with my buddies. It just happens that the way we do it is running.

Find people you like showing up with and do with them activities that are legal, moral and ethical and that you enjoy. Be patient and something good is likely to happen. You may even have “happily ever after” moments.

Bill

Filed Under: General

“Smoke! Smoke! Smoke! (That Cigarette)”

September 6, 2010 by

http://www.youtube.com/watch?v=dbKQklwNScA

Song Written By Merle Travis sung by Tex Williams

This hit song is said to have saved Tex Williams career. The sarcastic content made it clear, even in 1947, we knew that smoking was bad for health. Of course we should not smoke. If you smoke, stop! If you don’t smoke, good for you; don’t start.

At the same time, we often approach smokers as if they are dim-witted. That is not the case. While smoking has significant detriment to our health, we can know there are reasons that people smoke and we can learn from them. Below are 4 lessons.

  1. TAKE BREAKS. When I teach stress management, the first step is to learn to take breaks, to recover. Smokers take regular breaks while nonsmokers often trudge on task after task. One day looking out of my office on a 95 degree summer day, I see 4 women in the back of an SUV; they were all smoking and it seemed from my perspective rather enjoying the break they were taking. Meanwhile I was doing some paperwork that I rather dreaded…and thought “maybe I should take up smoking.”
  2. SOCIALIZE. These women were also socializing. I thought I bet they are talking about how much they are picked on and how together they are as smokers. Perhaps this mutual point of view would make their friendship more solid. Meanwhile I was becoming friendly with a treatment plan. Sigh. Having friends and taking time with them is quite healthy.
  3. ATTEND TO YOUR BODY. Smokers change their body chemistry. They get the immediate hit of nicotine and feed the addiction. They have it wrong though. Our task in reality is to add fruits, vegetables, water, protein, vitamins to our body. The energy and benefits from good nutrition is long term not brief like the hit of nicotine, caffeine or sugar. Take a break and eat an apple or yogurt with a friend.
  4. BE INDEPENDENT. Some smokers have this sense of independence. They demonstrate “you can’t tell me what to do; I’ll figure this out for myself”. Many started smoking as teenagers, a time for some rebellion telling adults “stick it in your ear” we can do what we “should not do.” One 50 yr old, trying to stop smoking, told me “I do not want to lose that sense of independence I feel when I smoke.” The point is how can we honor that sense of independence in a way that also honors our physical and mental health?

In short, take breaks, be with friends, put healthy substances in your body and find useful ways to honor your sense of independence.

Learn from smokers and manage stress using tools they use…but don’t smoke.

Bill

Filed Under: Stress Management

Mental Health and Money

August 31, 2010 by

Everything we do seeds the future. No action is an empty one. Joan Chittister

As a mental health therapist, I have advantages of many opportunities to learn and grow. I learn from peers, clients, reading, teaching and attending workshops. I have done this work since 1977; there is much evidence of effective work. Yet, I often skimmed the recurring theme of money. In hindsight, I now recognize that many couples had a central concern on how they would handle finances. They had avoided talking money. He had his checking account and she had hers; often there was too much debt with secrets of spending. Similarly many depressed or anxious individuals reported filing for bankruptcy and had serious credit card debt. I listened and while job or debt, was included in the work, it was often in a broad sense and not specific.

Enter Reeta Wolfsohn. Reeta essentially started the field of Financial Social Work. I met her in October 2009. Her work is highlighted in the article “When You Clash over Cash” for Women’s Health Magazine, September 2010 issue (www.womenshealthmag.com). The article notes the most frequent argument that couples have is about money. It further states that people who “fight more than once a week” about money are “30 percent more likely” to split up. A couple’s views of money are often grossly different, thus can raise questions of trust on a daily basis. There is frequently secrecy involved. The other side of this coin is that cooperation on money can increase trust and intimacy. When couples can learn to openly talk of their differences in points of view and come to reasonable cooperative plans, relationships, of course, improve. Similarly individuals, who improve monetary aspects of their life, can significantly improve their mood.

In April of this year, I completed Reeta’s coursework and received Certification in the field of Financial Social Work. This extended work provides more in depth understanding on the recurrent importance of money issues with couples and individuals. In working with clients, “listening financially” brings added value to them. While money is unlikely to be the only concern, it is often major, being a symptom of a marriage or depression that can be addressed. It also can provide specific outcomes that couples can agree on (i.e. eliminate credit card debt or fund an IRA), that both can understand and work to accomplish.

Talking about financial concerns is different than working with a financial planner and different than consumer credit counseling though referrals to either might be indicated. The essence in Financial Social Work is addressing thoughts, feelings and attitudes regarding money, facilitating sustainable, long-term financial behavioral change while working towards specific attainable outcomes. Financial Social Work is a welcome and needed addtion to the field.

If you are struggling with your marriage or struggling with depression and also with money, consider finding a Certified Financial Social Work expert. You can contact me through this blog or at 765.288.7939. Or you can contact Reeta at 800.707.1002 or reeta@financialsocialwork.com.

Bill

Filed Under: Financial

What is Solution Focused Therapy?

August 24, 2010 by

“ My interest is in the future because I am going to spend the rest of my life there.” Charles F Kettering.

“When you discover you are riding a dead horse, the best strategy is to dismount.” Dakota Tribal saying

Now that I am in business as the Solution Therapy Center, I am frequently asked “What is Solution Focused Therapy (SFT)?” I am glad to be asked.

Solution Focused Therapy is uniquely positioned in the field of psychotherapy. By some estimates there are over 400 models of how to do therapy. There is ongoing debate and research about which models are most effective in helping clients change. Through research of the last 50 years, it is clear that people who get therapy are better off than 80% of those that do not. There is also agreement that for effectiveness hope must be a part of the therapy.

Finding hope and growing it is a key to SFT. The essence of SFT is ongoing conversation with the client about what is needed for progress. SFT recognizes that clients want to change; this is in contrast to approaches that are set on the idea that clients resist change. SFT recognizes that therapy can be done briefly and that small change can lead to large change. Search for identification of realistic hope is a key and ongoing process.

As part of finding and working with hope, Solution Focused therapists make particular effort to find client strengths and highlight those strengths in a way that encourages more use of what has been helpful in the past. The search for these abilities is centered on the client point of view. The client, not the therapist, is the expert on their life.

People come to therapy when some aspect of life is not working; the effort is to change gears. John Weakland, a well known Brief Therapist said, “The purpose of therapy is to move from the same damn thing over and over to one damn thing after the other.” Consider thoughtfully his words.

The work then is to get out of the rut of the current situation or the rut of the current feeling and to begin moving on with life. The therapy is a pit stop for the current stress, not a cure for life. Some therapies, at times get bogged down in the so called “whys”; the whys are often both bottomless and debatable. SFT notes people can, and do with some frequency, solve problems without understanding the whys.

As focus remains on solutions it is also the case that other (399+) psychotherapy tools can be called on. You have probably heard of some of them: Cognitive Behavioral Therapy, Social Learning Theory, Family therapy, Stress Management, Marriage Therapy, Financial Social Work and many other ideas? SFT is not dogmatic but rather flexible as it includes ability to shift focus and use the other tools to be on board with what the specific client needs.

If you consider therapy, stop and think about what your needs are and what you want to accomplish. How will you know therapy is done? Consider SFT and make sure you interview the therapist and have a sense that the therapist is a fit for you. Maybe the focus that is right for you or your family will include the hope and strength basis of Solution Focused Therapy.

Thanks for asking.

Bill

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Road Trip with Ben

August 16, 2010 by

“We don’t know what’s going to happen in our lives-we just think we do.” Richard Carlson

“Just do it” Nike

In 2006 my son Ben and I decide to take a road trip. We were going to Cooperstown, home of the Baseball Hall of Fame. Our White Sox had won in 2005 so they would be featured; that was a great excuse to do what we had promised for some time. I thought Cooperstown with Ben would be great.

At the same time, it was 600 miles in the car. I dreaded that. I could foresee back aches, fatigue, too many trucks. I figured Ben would drive too fast and tail gate. I wondered how I could listen to his music for 600 miles. Oh well, that is just the price of the day in Cooperstown with Ben, I thought.

So we drive to Cooperstown. He drives better than I do. He teaches me about Bela Fleck and about Bare Naked Ladies (THE ROCK GROUP!). We talk of Jimmy Buffet and the Beatles and we talk and take turns napping and driving… and we talk. We remembered, we told jokes and we talked of our lives. The trip was most pleasant.

Cooperstown was fantastic. We saw all of the Hall of Fame and talked to many. We even made friends with Yankee fans. (In Cooperstown it seems everyone is just a baseball fan) We toured the quaint city and ate hot dogs and fries.

Then we got back in the car for the long ride back to Indiana. We talked of life and Bare Naked Ladies and slept and took turns driving. We told jokes and talked of our lives. We remembered…now including Cooperstown.

In Ohio, as we neared returning home, I realized that the best part of the trip was the time in the car. I did not want it to end. With a tear in my eye and a quiver in my voice I shared that with Ben. With a quiver in his voice he agreed the journey was for him was the best part too.

We now do a baseball road trip every year. This year we will drive to Busch Stadium in St Louis and Kaufman Field in Kansas City (and include the Negro League Baseball Museum). Some ask if our goal is to visit all the ball parks. That would be ok…but baseball is just an excuse for us to enjoy the trips. I am pleased we have learned to do so.

Make effort to enjoy your journey.

Bill

Filed Under: Stress Management

Improving Marriage: a 5 to 1 investment ideal

August 9, 2010 by

“Remember working briefly on your marriage everyday will do more for your health and longevity than working out in a health Club.” John Gottman

“No deposit, no return” words on a coke bottle

The preeminent marriage therapist of our time, John Gottman, reports couples that are positive at a ratio of 5/1 are more likely to have healthy relationships. He is talking about making nice gestures and saying nice things to the one who is most important in our life. He notes these couples “turn toward” each other and appreciate partner intent even when the deed may fall short. He speaks of a kiss on the cheek, a smile or a thank you. A so called “deposit” in contrast to a “withdrawal” every time the same spouse says “you didn’t turn the light off” or “you left the drawer open.” If a couple does this at a 1/1 ratio, Gottman notes the relationship is quite unhealthy. Makes sense when you think about it. Who, in fact, do we generally like and want in our life? I’d say people that generally appreciate us for who we are and what we do. Additionally, when these friends, or family offer critique, we are more likely to hear it and thus adjust and improve (if we agree) about our behavior.

Oddly sometimes we take the opposite point of view, sort of a higher standard for those we love thus when they don’t meet that standard….here come the critiques. The thought seems to be “if I criticize, remind you enough you will improve.” Couples sometimes, with a bit of embarrassment, tell me they are doing 5/1 in the other direction…5 complaints for every appreciation. They seem to think it is their job to bring every point up as if their job is to be the best critic possible. Turning this around can be a key to improving the relationship. The comment that “my partner should know” that they are appreciated is often a clue to significant problems. Make sure your partner (and kids and friends) know they are appreciated. It also feels good to notice the pluses of others, to appreciate. Making the “deposits” is not only good for receiver but also for the giver.

One way to do this is develop habits, especially at recurring times. So that when you leave for work in the morning there is a smile, kiss on the cheek, an “I love you”. Similar habits can be developed at times of reuniting and at bed time. These are good habits. Ironically the feedback needs to be genuine, not just habitual. If 5/1 is not happening with your significant other you will find that the change may be difficult…and I expect worth the effort.

Another part of the plan may be to decide about the small things that your partner does (or does not do), at least for some of them, maybe it is really just your job. Can it be your job to turn the closet light out or close the drawer? So many of the small things just do not seem worth making a “withdrawal.”

By the way, don’t keep score. While you may want to keep score, don’t; just be sure you make your deposits. Keeping score seems to turn into another way to critique.

Give this a try with your partner, kids and/or friends.

Bill

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Who Are Your Friends?

August 2, 2010 by

“You are the average of the five people you spend the most time with.” – Jim Rohn

This quote has long been one of my favorites. In June I attended my 40th college reunion at DePauw University in Greencastle, Indiana. Amidst the nostalgic beauty of the old campus, was the renewal of contact with Bill and Bob. For the 5th time in the last 20 years we climbed on the Boulder and had our picture taken together. While the boulder has somehow grown taller the relationships remain rock solid. This reunion reminded me, with a feeling of gratitude, how friendships have helped pull me forward.

In that significant undergraduate time of my life, my friendship with Bill and Bob and a few others helped me advance my life, at times in spite of myself. If you hang with people that are legal, moral, ethical and pursue worthy goals, it is likely you will be doing similar activities.

The opposite is also true. We intuitively understand this point with people that over use substances. Most frequently they hang out with people that do similar destructive behavior. Then there is an ongoing pull to act in similar negative ways. This becomes, in some cases, a “fatal attraction”.

The college relationships remain important. While Bill and Bob are currently more present in my spirit, than day to day, their influence remains profound.

But the principle remains today as I engage with colleagues and community. Who do I spend time with and communicate with? They are good folks- legal, moral and ethical and pursuing worthy goals; they pull me forward, sometimes in spite of myself. I am interested in people that add value to church, community, their family or their own self growth. These topics then become part of the conversation and influence me to ask myself how I can do similarly. I thus grow similar interests. At one level, because of who I spend time with, I have little choice but to take this direction.

Consider who you have been spending time with in the last few weeks. If these people are not pulling you forward, consider adjusting your relationships and activities

You are in other people’s lives too. Understand that you influence others too. When you strive to be a good influence…that further helps you! This modeling seems particularly important for parents as you are likely to be one of the five in your children’s lives.

Choose your friends wisely and make their choice of you similarly worthwhile.

For me, I am grateful for those friends and role models, (the number is well over 5) that have pulled me forward.

Thank you.

Bill

Filed Under: General

Psychotherapy and Happily Ever After

July 30, 2010 by

“I just want to live happily ever after every now and then.” Jimmy Buffett

I think Buffett shows great wisdom in this quote. At one level we would like to live happily ever after but our experience is reality intervenes. So Buffet makes it doable with the “every now and then” addition to the fairytale ending. I try to notice when this happens in my life. Recently, as Katie and I sat at Bub’s, an outdoor café next to the Monon bike trail in Carmel, I noticed. We had ridden a few miles and the bikes sat against the rail while a mother chased her 18 month old daughter between the chairs. We munched on our sandwiches and were drinking lemonade; I asked “are we having one of those ‘happily ever after times now’?” I like noticing…though sometimes it is later, and I can look back and see it from the present but often have been so involved as to miss it as it happened.

Do we get moments of this every day or every week and not notice? I often ask clients “how are you doing now?” My intent is to bring them into the present which is often much better than all those past and future places our mind perpetually tries to take us. Usually as a client sits with me, in the now, it is at least “ok”.

Mihaly Csikszentmihalyi (pronounced cheeks sent me high!), author of the best seller “Flow” speaks of the concept of flow. It is in this state of flow that we function in the moment; perhaps, if we asked ourselves then are we “happily ever after” the answer would be “yes”. In the state of flow we are not going over and over either what has happened historically or “what ifs” of the future. In flow we are just occupied in what we are doing…now. While flow can be related to pleasure it is more likely to be connected to being productive and being involved. Often flow will happen as we do work that we are good at and that we feel good about. Time just passes and we are present in the now.

I like it when I notice”Happily Ever after” in the moment or later. It happens for me with family, exercising, or during a therapy session that is connected. By the way, Katie agreed that time was one of those for her too, and apparently noticing did not stop the episode!

Make effort to appreciate those “happily ever after every now and then” times. They may happen more often than you would guess. Maybe you had one today? Maybe now?

When, typically, does “happily ever after” happen for you?

Bill

Do you have favorite Rock and Roll quotes that you believe are with wisdom? If so please share them with me.

Filed Under: General, Stress Management

Interviewing Red

July 20, 2010 by

I recently observed a grandson (30ish) “interviewing” his grandfather (mid 80s). It was most tender. The grandson would, with great interest and gentleness, ask grandpa about the distant past. He focused on the first, and then the second (and so on) car grandpa drove. While grandpa was initially reluctant, he warmed to the task. Eventually gramps would, with a twinkle in his eye and a smile on his lips, remember color and make of each car, size of the engine, how fast it went. Gas he said was only pennies a gallon. He noted the reputation he had as “Red”. Grandpa relished, it seemed, being a bit of a “bad boy” in these memories. Their relationship became closer as the old man could remember his youth with dignity and was energized with being a little out of his more recent “grandpa” and “great grandpa” character.

It occurred to me that often, when the old ask the young these same questions, it is seen as prying or criticizing. This interview had quite the different perspective. Part of the difference was the grandson asking honest questions. The grandson was genuinely interested. He wanted to hear of his grandfather; criticism was not part of his agenda.

Often when the older ask the younger the same questions, it is dishonest with the real meaning being “you were driving too fast” or you are being reckless. If too many dishonest questions are asked, then even when honest interest is intended, the questions become heard by the young as ongoing statements of criticism or prying. Communication shuts down.

What a nice conversation for this young man to have with an elder.
Real interest that nourished both. The foundation of honest questions and genuine interest was involved. These are great tools of communication.

Filed Under: General
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