We therapists get trained in self-care and logically, I get it. But this week, my body/brain are clearly telling me something needs to happen soon because I keep fantasizing about getting in a car someone else is driving, turning up the music, cruising out to the ocean, putting my toes in the sand, watching the skateboarders in the Venice bowls go round and round, and hopping on some tall swings that will let my feet touch the clouds.
This is what I used to wonder, when I contemplated seeking therapy in my 20s. What could a therapist tell me that I didn’t already know about myself?
I spent a LOT of time journaling as a kid, observing, contemplating, feeling, processing. I figured I didn’t need (and couldn’t afford) to pay someone to listen to me talk.
Fast forward, many therapy hours (my own, and in practice with clients) and years later to this morning, as I’m FINALLY nearing the end of a 4-5 month journey reading Gordon Wheeler’s Beyond Individualism. This book was recommended to me by the head of the Pacific Gestalt Institute, Lynne Jacobs, after I took an intro to Gestalt course sometime during graduate school. I was skeptical about Gestalt back then, having only watched Fritz Perls in the [in]famous Gloria tapes. Fritz made Gestalt look awkward, uncomfortable, irritating. Which, it can be, because people, and moments, and relating can be awkward, uncomfortable, and irritating.
This morning I was reading on intimacy. (Talk about awkward, uncomfortable and at times, yes irritating). As Wheeler described it, intimacy is, “the exploration of subjectivity…our inherent longing and seeking for resonance and response to our inner experience.” Being close to others seems lovely, yet it can also feel conflicting and treacherous. Wheeler poses – in therapy the most helpful thing is when therapist and client meet and it’s the “contrast of expectations and feelings about a particular incident or theme between the therapist and client” where conditions arise for there to be “an articulation of new self-experience for the client.” Put simply, people bring things out of us that we might not ever experience were it not for relationship, interaction, and most importantly, curiosity. Wheeler called it, “conducting exploration.” I can get behind that – therapists as explorers, making “useful, richer, interconnections among clients’ feeling, values, thoughts, beliefs, perceptions, interpretations and the outer world.”
Maybe when people ask me what I do now, that’s what I’ll say. I’m a conductor.* Let’s go exploring. And I CAN’T tell you anything about yourself that you don’t already know, but I’ll go with you to any depth to discover what’s waiting still to surface.
One reason I got my Masters in Clinical Psychology is because I could see, 14 years ago when I was cooking in the San Francisco County women’s jail, that the cooking and nutrition classes I was running were inherently therapeutic. Women who spent their days in small cells making “spreads” – meals made from a mix of canned and plastic wrapped processed commissary foods – would come alive when we rolled into the classroom with our fresh veggies. Once before we all sat down to enjoy a meal we’d prepared, one woman, then several more, broke out in song – GOSPEL. They let us know – we are grateful for this food we prepared together.
Fast forward. A group of kids invited me to South Central Los Angeles in 2007 to help them up their peer-to-peer nutrition education game. We ended up forming a non-profit, RootDown LA, through which high school students now learn to grow, cook, promote, and sell healthy food in their community.
Last Friday, we hosted a group of elementary school kids at RootDown’s HQ. In the past, I would have been the one in the kitchen, managing the cooking class. NOW, I leave that to others and instead get to move about the kitchen and garden, connecting more closely with our young students. Two in particular stood out last week. One was SO intent to be helpful yet had tremendous difficulty holding onto instructions (auditory processing issues? ADHD?). Another was EAGER to make his presence known, mostly by firmly letting us know he would NOT eat veggies, nor would he follow basic seed planting directions from farmer Joseph (oppositional defiant?).
I was raised by a mother who devoted the majority of her career to developing more comprehensive special education program in central Ohio. She put me in tune with other kids’ various “other” abilities when I was just a kid myself. That early exposure, paired with my more recent psych training has given me a multi-layered lens through which I now take in the kids I encounter, via RootDown and in therapy rooms.
I feel honored and lucky when I’m given the time to really focus on a kid whom others may find exasperating. Usually, I find that it’s what ANY kid needs most to feel a bit calmer – someone to focus on him/her for a little while. Working in the garden with these two kids last week, it took 150% of my focus/attention to engage them to get just two rows of peas planted in some organized fashion. At one point, I was SO tempted to wrestle peas from the hands of the one kid; he defiantly dropped pea seeds at random and tromped over the others kids’ pea plantings. Deep DEEP BREATH. PATIENCE.
It’s a luxury as a NON parent – I was determined to see that by the end of my short time with these kids, both would have experienced an adult’s patience, firmness, boundaries, humor, and forgiveness. Both kids left that night, smiling and feeling accomplished. It’s scary. It’s exhilarating. It’s exhausting. These little people are so impressionable. Parents, all the more reason to enlist others to help you raise your children.
“Authenticity” is coming up a lot lately in my work and training. I’ve long held that authenticity is important to me. I don’t like to be asked to join in something that feels inauthentic to me. I have clients who feel the same – at times they don’t want to respond to questions they feel won’t get at what they are trying to explain, or partake in activities if they can’t see where it’s all going. The tricky part is when I feel I am picking up on something “inauthentic” in someone else. Several times in my life and career, I have gotten really riled up, feeling like someone is not being authentic – that they are saying one thing but likely feeling another. What is that?
Gestalt is teaching me to not go to that place of assuming a lack of “authenticity” in someone else; when it comes to human behavior, authenticity is so relative. Rather, I should assume that someone else’s own experience, how that person is acting in any moment, is always authentic for him/her. More instructively, I can take such an opportunity to look closely at myself in relation to that person and then get curious about why my own reaction to this person feels incongruent with what I imagine this other person or I might expect. My thoughts and understanding on this topic aren’t clear yet. Others can feel welcome to weigh in here!
Early in my training, an adolescent client* came to me with such significant mental health challenges AND strengths, at first it was difficult to identify his obsessive compulsive thoughts. 
The client was extremely intelligent and engaging in conversation. He had worked through a lot of his early resistance to treatment and was working hard to address some extreme social anxiety and PTSD. The client’s sense of humor and ability to identify and poke fun at his own resistance to change is what nearly masked his obsessive thinking.
In the weeks as he was nearing discharge and getting ready to go to a new school, the client started stating jokingly that he was never leaving. The joking gave way to irritation and anger and eventually, he was repeating his statements about not leaving treatment and started insisted that he was being treated unfairly. We clinicians are trained to validate clients’ thoughts/fears and to support the client to work through them. Week after week passed however, and I found myself having the same conversation with the client. His father reported the client was cycling through the same conversation at home as well.
One day in a session, I had an instinct to be somewhat absurd and change the topic. I stated to the client, “This conversation is starting to feel repetitive to me and today I’d rather talk about something else. What can we talk about – clowns? Monkies? Global warming?” The client didn’t as I feared, get angry at me for not validating him. Instead, he seemed perplexed and laughed. Then he relaxed and engaged in a next conversation. In our final sessions together, the client’s thoughts about leaving continued to come up yet he accepted it when we acknowledged them and then changed the subject. Before I did, he started realizing that he appreciated something about the shift in gears and even thanked me for initiating the shifts.
I ran this situation by a supervisor more recently, and she said that what had happened with that client sounded familiar; she recommended this book I am now reading – Brain Lock. Author Jeffrey Schwartz, a UCLA psychiatrist, explains the brain chemistry behind OCD behavior and describes a four step process where OCD clients benefit from 1. Relabeling thoughts 2. Reattributing the source of the thought 3. Refocusing attention to more constructive thoughts/behaviors and 4. Revaluing obsessive thoughts to give them less value and space in your mind. For anyone challenged by repetitive, ruminating thoughts, this book’s a good read and useful tool.
*Identifying details of clients are changed to protect privacy.
I’m reading up on anger this week. This, because I have been thinking a lot about a very ANGRY young dual diagnosis client I worked with early in my training. She would come into our clinic hissing like an alley cat, dropping F-bombs left and right. She would say vicious things without remorse and kept her cool – ALMOST – always.
This therapist can go down deep research rabbit holes. Tonight’s reading is titled PREDICTING DRINKING LAPSES IN ALCOHOL USE DISORDER: THE TOXIC COMBINATION OF AGONISTIC STRIVING AND POOR ANGER REGULATION.* It is interesting reading. It looks at the Social Action Theory (SAT) of chronic stress, which provides a framework to investigate which social stressors combine and interact with emotions and cognitions to trigger relapse. The SAT says that people who suffer stress related to Agonistic striving (i.e., seeking to control others) may be more likely to relapse than those who are working with two other kinds of striving “Transcendence striving (i.e., seeking to control the self) or Dissipated striving (i.e., lack of goal focus)”.
In trying to apply this reading to my client, I can see clearly that she was certainly challenged by Dissipated striving. She lacked significant life skills and along with that confidence so it was hard for her to develop any sort of goal focus. Her desire for sobriety was weak and so then was her desire for Transcendence striving, to control herself. What was harder to see was that my client was also engaged in Agonistic striving; while at first it seemed the client was using her anger to control others at the clinic, it soon became clear this anger was more a part of her desperate attempts to control her parents. This client had loving parents yet they were in a dense holding pattern, dealing with many of their own challenges, so they had little energy left to focus on this client, whose acting out behaviors had become dangerous at times. The client’s anger it seemed, was an effort to shake up her family system and demand that her parents get out of their rut so they could be more available to help her get out of hers. According to the SAT theory, this kid may have been suffering from a triple whammy in over-striving.
The challenge in working with young people is that their worst behaviors are often closely linked to their critical strengths. Control for instance, can be an important protective skill for a young kid to develop if they are raised with significant real or perceived adversity. The energy spent trying to control others however can be exhausting. It was no surprise when one day my client, having relapsed again, finally collapsed, sobbing. When she was finally able to get words out, she said nothing about her own pain, she only kept repeating that she didn’t want to keep hurting her parents.
*Journal of Social and Clinical Psychology, Vol. 35, No. 3, 2016, pp. 235-254
Why do I particularly welcome very resistant clients to my practice?
My own life-long inherent draw to the study of psychology was thwarted during my undergrad years, due to my own resistance to the field. I was a kid who always thought too much. I didn’t want to spend my college years gathering more tools for self/other analysis. It was only years later, when I was facilitating nutrition education programs with inmates in the San Francisco County women’s jail and high school students in SF and South Central Los Angeles that I began to see – when you get resistant people to let their guards down for even a moment, unbelievable new things are possible. I got curious about resistance. It led first to my own study on developmental trauma, reading works by trauma experts such as Peter Levine. Eventually, I enrolled in a Clinical Psychology masters program at Antioch University, where I focused on trauma and community psychology.
Why do we resist? For the past few weeks I’ve been trying to comprehend Harry Guntrip’s Schizoid Phenomena, Object Relations and the Self. Finally this week, everything I sort of know about object relations, including what I’m reading in this book, began to organize itself the way I like complex information to do so…simply, and digestibly in my brain. When you strip away the complex terms that creep up in object relation theories, you get this – if we don’t get good enough caregivers when we are tiny, we begin to build defenses to protect ourselves. We tend to develop enemies in the external world and in our own minds. We struggle, simultaneously craving the nurturing parent while fighting fiercely to maintain our independence. In a perceived hostile or unpredictable world, we do what we can to maintain something that feels like a stable self.
It can be scary, getting right in the face of someone who’s highly resistant. Particularly, adolescents. As therapists, we need to be careful as we go about dismantling the defenses that keep kids safe. We need to build up new scaffolding to hold these kids up, when their brick and mortar baby-walls fall down. The more I work with resistant kids however, the more I become clear that those who are most resistant are often the most ready to experience change. They are pushing boundaries, looking for a new experience, craving something that will reshape or clarify their worlds. Working with resistance can be exhausting. But, when you can hang in with it and with that client who, before a first session is fuming in the waiting room, declaring loudly he/she will NOT f***ing talk to a stupid therapist… the positive outcomes can be wildly surprising.
Megan Hanson Psychotherapy 