Coming to Counseling

 "People don't come to psychotherapy when the pain is too great. As human beings, we're actually really good at enduring pain. We come to therapy when we have exhausted all of our known options to remove the pain."

Elliott Connie , PhD, LPC in the course "Solution Focused Therapy For Couples: An Evidence-Based Approach"

Anger

Your goal is not to "never yell" or "never get angry." Your goal is to learn the signs in your body that lead to anger and then be on guard for anger-inducing situations, prepare your heart, and side-step improper anger expression, such as yelling, drinking, or other "self-soothing" behavior you are trying to stop.

Good Enough

Enjoy, but don't believe my own "press." I'm not as awesome as people think, but my awesomeness is often "good enough."

My "good enough" is often just right.

A Facebook State of Mind: Boundaries to depression and anxiety.

 Facebook is the only social media platform I regularly use.  There was a time when I used Twitter. I use Viber to video chat with a close friend through her mobile phone in Ukraine. I have a Skype account, in case I need it (almost never). I used to have a LinkedIn account. I started using Facebook to keep in touch with our children and with friends, and it used to bring me joy. 

Recently, with COVID-19, Black Lives Matter, and the increasing tension around the upcoming elections in the US,, Facebook is more stress-inducing than enjoyable. I decided that something had to change.

I seriously thought about deleting my Facebook account. Right after I wrote those words two competing thoughts popped into my mind.  The first, "Oh my goodness!" as if it was a major life-altering decision. The second, "Who cares? It's just Facebook." And here I am.

I started out by unfollowing  people. Those I unfollowed would see my posts, they could contact me, we were still "friends," but I would not see their posts.  I would cut down on the background noise of Facebook. I did this without prejudice. The question I asked was, "Does he, she, or it spark joy?" I also loosely applied the acrostic "THINK." Is it True, Helpful, Informative, Necessary, Kind?  And not just for what I write, but what or who I read. I reminded myself I do not need to read everything everyone writes. If I chose to ignore a person or even "block" him or her it just means that: I chose not to listen to the person. I am establishing and enforcing boundaries for myself regarding how I spend my time and chose what I will allow into my brain. And I'm not doing this to suppress myself from hearing differing opinions. I hear plenty in my usual day-to-day intercourse.

Proverbs 26 verses 4 and 5 say, "Answer not a fool according to his folly, lest you be like him yourself. Answer a fool according to his folly, lest he be wise in his own eyes." Can both be correct advice? Yes, in different instances with different people. I want to be discerning. Is a particular "debate" worth the effort. What is the probability I will sway the other's position? Does it really matter to me what he or she believes? Certainly, for many discourse on Facebook the answer is "no." Nothing personal.

After the "unfollowing" I felt much better. When I look at Facebook I see things from family, real friends, people I am connected to  by years or close relationships. I may prune or purge more as time goes by. But I know what to do without losing the benefits I still get.

And the beat goes on.

Interrupting during the work day

Couples counseling during a pandemic exposes some unique stressors than in "normal time." Many of my clients are, like my wife and I, working part- or full-time from home. In "normal time," communication problems during the work day are often limited to checking in with each other, who takes off to attend meetings at school, who stays home with a sick child, or calling the other if one is going to be late for dinner or to communicate "remember the milk."

Under "COVID-19 time," a couple with which I am working has what is probably a common problem. Both work full-time from home. Both use the Internet. One needs to be able to occasionally talk on the telephone (isn't that a quaint phrase?) with coworkers.  The other's main job is receiving calls from customers with user-level problems or "how to" questions. Those calls can last between 10 to 60 minutes. Because they are customers, he is "on" with the customer a majority of that time, although he can put a customer on "hold" to research something or to handoff the call. 

They found that they needed a protocol for what I used to call, in a previous career, "servicing an interrupt." It was a major tension-point, but easily solved. We brain-stormed.

1. The sky is falling! House fire! Tornado! Duck and cover (Cold War reference)!
   Both agreed there are some situations in which they agreed to dispense with protocol.
2. Longer question, answer required.
   Sticky-note on desk or computer screen. Don't wait around for an answer.
3. Quick question, "Yes" or "No" answer needed. Sticky-note on desk or computer screen. Wait for answer or a wave-off. Both agreed to tolerate a wave-off.

Your plan may vary, of course. Just plan and talk about it.

In Support of Video Counseling

As many of us, I have seen more than a few comments regarding Zoom Video Communications, Inc., and the wistful thought, “If only I would have bought stock in Zoom® …” (When it went public it opened at $36, close that day was $62, and it hovered around that mark when this pandemic started with 1 confirmed case on January 13, it was $74.  At the time I write this it is  $256.80 a share.)

This is not about that. This is about video counseling, my experience, my clients’ experiences, and why I am considering limiting my practice to providing counseling only through video.

Before COVID-19

When I first started providing mental health services after graduating in 2012, my work was location-specific. I saw clients at specific locations, at times when the specific location was open, and when no one else was scheduled to be using the counseling room. For 6 years I worked at the Helping Up Mission in East Baltimore with an assigned office, office hours, and saw clients Monday through Friday 40 hours a week. When the HUM was closed for holidays or weather-related days, I did not see clients. When I left and became a contract worker for Safe Harbor Behavioral Care, I saw clients at a different location each weekday. Each had a private and inviting counseling room. Outside of those location-based office hours, I had regular video-based telehealth clients constituting 10% of my caseload. Some had signed up for the convenience of fitting in regular therapy sessions without having to leave their office or home. A few were homebound due to medical conditions or physical limitations. And when there was a location closure–typically snow- or ice-related–some of my “non-video clients” would switch to meeting over video.

COVID-19

After Governor Hogan declared a state of emergency in Maryland on March 5, anticipating what might be coming, and wanting my clients and me to be prepared, on March 15 I emailed all of my clients, saying in part:

Everyone who receives this email has the option for telehealth, using a computer or smartphone to meet me for a counseling session. I regularly meet that way with 1/10 of my clients who chose that option, During the current COVID-19 disruption, I am reaching out to you to ask whether you would consider this over the next few weeks.

None of my locations had shut down, nor had the law yet required it. I wanted to try it out with every willing client, "just in case." Some clients said they would wait it out, but most agreed.

Two days later came limitations on large group gatherings and the recommended shutdown of non-essential businesses. The very next weekend, the shut-downs started. My Monday location was the first, but the rest followed. I had guessed right. That was 3/16/2020.

Disadvantage, client

Prior to this year, some of my clients just preferred “live and in person” sessions. Some weren't comfortable with technology, some wanted to get out of the house for privacy reasons, one because he was on Zoom® meetings “all day” for his job and some just because they weren't used to it. One did not have a computer at home nor did he have a smart phone. 

Advantage, client

As I mentioned earlier, I have always had video clients. Some were home-bound.  Others worked from their  home–this before COVID-19–and did not want to have to drive somewhere. Still others, had schedules so busy that they did not want to go out again after a day of work or on the weekends. 

Meeting from the comfort of home is an attractive alternative for some  Some meet me from work—whether home office or outside office—before the workday or during the lunch hour. Others see me after the work day, with the convenience of staying home, without concern for or having to deal with the weather.

Advantage, counselor

Working at one location on a given day, like all counselors, I had to cope with gaps in my schedule. Working from home, gaps in my schedule are (sometimes) welcomed breaks. I was able to open up my schedule to be available for longer periods of time because I did not have to share the location with other counselors. I could work as many hours as I wanted. I did not have to commute. 

Gaps in my schedule due to missed or cancelled appointments are less of a hassle. I no longer have to leave home early to make it to an 8am appointment 30 miles away sometimes to find that my client had car problems and had to cancel at the last minute. I may get the same text, but now I can read it when it arrives and plan on other office work, and I have only "commuted" from the coffee pot in the kitchen to my home office.  This provides convenience and flexibility for me, financial savings (I used to fill up my auto gas tank weekly, now it is more than monthly), and the associated environmental  benefits.

A big win for me is since I am not sharing a location with ot others, I can see as many clients as can be scheduled. The bottom line is

It's not for everyone

As stated earlier, some clients cannot handle the tech no matter how "error-proof." Some are technophobic, and fear making errors or "breaking the Internet." Some do not want the technology that makes video counseling usable and useful. For others, it may not feel like a "real; therapy session,' and they will often feel a little put-off by the rate.

I have heard some counselors say, “I just can’t be ‘present’ with the client over a video connection.” I think they haven’t tried, but fine. Know your limitations. I don’t find it very limiting. And for me, the benefit of seeing someone in the comfort of her or his living room or bedroom may offer other opportunities for insight. 

It’s worth a try 

What could go wrong? When things “go back to normal,” whenever that is, what if some or all my clients want to switch to “live and in person” counseling?  “What if?” If it happens, it will not happen all at once; there will be time to reevaluate and regroup. Second, now that everyone has tried video, more see the benefits I expect more to ask for it.

It's worth  try. 

Communication in relationship: Avolio's Rules of Engagement

An area in which I specialize in my counseling practice is couple's counseling. One of the biggest problem areas in couple's relationships is interpersonal communication. Because of that, I thought about all of the areas I have failed in the past and I wrote them to be guides, or guard rails, or warning alarms of typical maladaptive behaviors into which we can, and often do, fall.

In the future, I will expand on each of these, but for now, here are Avolio's Rules of Engagement

1. Do a “heart check.” Ask, "What is going on inside of me to lead me to feel or react in the way I do?"
2. Remember, “The person is more important than the problem." (Good PhD, Mark C., Real Talk: Creating Space for Hearts to Change . Deep River Books.)
3. Remember, none of us is a mind-reader. “When I don't know, I will ask."
4. Do not hyperbolize. It is almost never, “Never”; it's almost never, “always.” Even if it feels like that. Maybe it is “Rarely,” or “Sometimes,” or even “Often.”
5. Do not just complain (“express dissatisfaction or annoyance about something”). Discuss (“talk about something with someone”).
6. It should go without saying, but: no name calling, raging, yelling, cursing. Take a time-out.
7. Do not blame-shift or make excuses. You are in this together.
8. Do not defend yourself. Defense often becomes offense. You are not in a battle. The other is not your enemy. The same man who said, “Love your neighbor,” also said, “Love your enemies.”
9. Admit when you are wrong. And seek forgiveness for your wrongs. More than just, "I'm sorry."
10. Do not bring up already discussed past hurts or old arguments if they have been addressed and forgiven.
11. Ask “what” questions rather than “why” questions. “What makes you say that?” Is often less challenging than, “Why did you say that?” Try it.
12. Do not assume malicious intent.
13. Do not take advantage of an exposed weakness in the other person. Even in prize-fighting, you cannot hit your opponent when down and there’s "no hitting below the belt.”
14. “You may be right.” (Try it.)
15. Communicate with words, not hand signals or “looks.” (See #3.)
16. Do not be the other person's conscience.  The job is taken.
17. Do communicate any expectations you have. (See #3!)
18. Take turns talking. It can be frustrating when one of you monopolizes the conversation.  The goal is to communicate, not to win an argument.
19. We tend to compare ourselves to other broken people, especially anyone who seems “worse than me.”  You are worse than you think you are, but perhaps you are more loved than you ever dared hope.
20. Do remember, we are all works in progress.