Have I lost a client (to suicide)?

This is going to be a work in progress.

So clients ask me – have I had a client commit suicide?

(Some initial thoughts/questions from a therapist who works in the addiction field and has been asked this question more than once…)

Yes, I have lost (a former) client to suicide.  But would he have shot himself if he could have kept drinking?  He’d stated to his dad that he didn’t want to live if he couldn’t drink.

Do you consider an overdose suicide?  If I tell you my client OD’d but I know he didn’t want to die, would I have to convince you, (or myself) that my client truly OD’d but he definitely did not want to die?

Some family members assume and tell me, that I likely knew their son/daughter better than anyone else – better than they did.  What if that were true?  And how do the law/ethics of my license curb what I could even say about that?

That’s about all I have to say at the moment.

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I may be a licensed therapist but…

 

A I'm not judging you

I just posted a question on a Facebook forum that asks other therapists how they handle the phenomenon of having other people (non-clients) ask if we are analyzing them or telling us mid-conversation, “Oh, you’re doing XYZ because you’re a therapist.”  This can feel particularly daunting when we therapists are just getting to know someone.  How do we convince our friends, family, dates that our therapist hats are checked at the door?

When this happens to me, it makes me feel like the other person imagines I have SO much of my own stuff figured out that I somehow retain the bandwidth to figure out his/hers as well. Clients pay for that bandwidth. Friends, family – dates?!  Do not.

Non-clients – rest assured! We therapists are still figuring it out, just like you. It takes energy to do the work we do well – staying aware of OUR stuff, while paying attention to and being curious about our clients’ stuff.  I’m lucky to have had amazing therapists and teachers and mentors who remind me – there IS an art and a SKILL to what we do, and we can’t do it, 24/7.  We certainly aren’t aiming to do it when we’re unwinding at happy hour or going on a date with you. I personally relish the time I spend with the non-clients I choose to bring into my life. I look more forward to what they can teach me about themselves and ME, than what I might be able to analyze about them.

 

Kermit the Frog as Higher Power?

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Have you avoided 12-step programs because of all that “God stuff”? Developing a sense of Higher Power doesn’t have to be about praying to a personified god. Rather, it is a cognitive act – choosing to tap into a more wise, kind, or sane voice in your head when you start to feel overwhelmed or lost. Particularly for those of us who tend to get monkey mind, getting stuck in internal fights or negative thinking patterns, taking a break to check in with that higher voice – “Hey, it’s me here. My monkey mind won’t shut up. I could use a little help.” – can be quieting.

Yesterday I was communicating with a client* who’s new to 12-step programs. She’s got a Christian orientation and was having difficulty thinking about Higher Power because she feels she’s in a “weird place” with God, as though God is not a fan of what she’s been up to lately. I suggested, “Maybe HP’s aren’t here to give us things. They are here to watch over and be a supportive ear, no matter what we are doing. Picture an HP just sitting in a chaise lounge, sipping ice tea and loving us and we can just pull up a chair if we need a chat. HP may not even care if we come hung over and stinky.”

She promptly sent me this:

 Kermit

And we both LOL’d and I wrote “Kermit the God! Maybe Kermit will be your idea of HP and help you keep your sense of humor on your path?”  I sent back that image above –  Kermit’s feet by the pool – and my client said YES she was going to try meditating by the pool and be twins with Kermie.

#clientsarecreative #higherpower #selfcare #mentalhealth #meganhansontherapy #12step #la12step

*When it’s clinically indicated, I have some text communication with clients between sessions. All clients mentioned in posts agree to have me share stories from our work.

 

 

The LA River, Field Theory & Gestalt.

IMG_20170823_193106-2In preparation for year 2 of the weekend training at the Pacific Gestalt Institute, I’m reading Gary Yontef’s Intro to Field Theory. Field theory in Gestalt relates to the complexity of determining variables that inform a person’s experience in any given moment. It’s related to the process of how we perceive, think, and react to the circumstances surrounding us.  How does this relate to the LA River?  Read on…

I’ve spent the majority of my non-profit and therapy careers working in jails, inner city high schools, underserved neighborhoods, and addiction treatment centers. My students and clients know, I’m a systems person. I don’t look at my individual clients as isolated entities. Rather, they are products of their own complex biology, chemistry, and the forces that have surrounded them since conception. Many have experienced and caused havoc in their own and other’s lives – it’s not what they wanted or intend. My goal is not to “fix” clients, but rather to understand how their own creative and intuitive abilities have helped them survive and navigate their own complex systems so far. We then work to figure out how their best ideas and instincts can be utilized so they can establish new, healthier systems and thrive again.

Last summer, while contemplating some life changes I want to make, I spent a lot of time sitting by the LA River. YES! We do have a river in LA and yes, it’s filling back up with water and wild life. Once free flowing, the river wreaked havoc for the region with sporadic flooding until the 1930’s when the Army Corp of Engineers encased the river’s beds in concrete.  However it left the river seeming less than alive. The LA River now has been taken under the fold of various non-profits who are working to figure out how, even with the concrete encasement, the river and it’s surrounds can thrive again.

Yontef likens the Gestalt “field” to a river:

The natural organization of the field is like a river finding its natural course by interacting with the other forces of nature, as opposed to concrete pathways being added to force the water into rigid and predetermined pathways. When there are problems or dysfunctions in the organization of the field, the solutions are also present in the dynamics of the field (Wertheimer, 1945)

When I read that, I think of how many of us struggle to change ourselves before better understanding ourselves. It’s hard to change what we don’t understand. As hard as it can feel to look closely at our most challenging patterns, it’s really where lasting change begins.

One warm night, I took a grieving friend to the river and we put our toes in and felt our feet carried by the currents. The water was at once, refreshing and probably carrying trace contaminants. Much like therapy can feel at times, the water felt kind of slimy but also healing and hopeful.

 

Self care. Now I get it.

A cloud swings

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.

(Image from pinterest: https://www.pinterest.com/pin/173388654376742154/)

How can you tell me something I don’t already know about myself?

A lucy BLOG

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.

*As in (to my physics-curious mind) a material or device that conducts or transmits heat, electricity, or sound, especially when regarded in terms of its capacity to do this.

 

 

 

ADHD, ODD, or just KIDS in the garden?

 

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.

 

Who am I to say what’s authentic?

 

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“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!

Shifting brain gears to alleviate OCD

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. Brain Lock 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.

What’s behind that anger?

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