Too Hot To Write

People have been emailing me to ask why the gap in blogs during the last week. For those of you who don’t live on the Eastern Seaboard of the United States, let me tell you that we have been embroiled in a horrendous heat wave over the last week or so. While the bedroom in our house is air conditioned, the rest of the house has not been up until now. Writing a blog would have necessitated sweating my socks off in my un-air conditioned study. Having been raised in the United Kingdom where in my formative years 70 degrees Fahrenheit, without humidity, was considered a heat wave, for a delicate Northern European soul such as myself it is hard to breathe let alone form a coherent thought when the mercury rises to 90 degrees with humidity. Yes, I know that there are places in the world where you can fry an egg on the hood of a car and people still survive, (my brother, Mark, lives in the Sultanate of Oman which I understand has such a climate) but you’ll notice that I don’t live in one of those places! Regardless, I am happy to report that I am now fully air-conditioned and reporting for (blogging) duty.

While we’re on the subject of hot and cold weather, I must freely confess that I am one of those human beings who thrives in cold climates. There is a good reason why I live in Massachusetts…I love frigid weather! While I could happily do without icy roads and sidewalks, I love plunging temperatures and the bristling nose hair sensation that accompanies the aforementioned downward slide of the mercury. (Those of you who live in icy climates know exactly what I mean about nose hairs that feel like they will freeze up and drop off.)

In my therapy office, the air conditioning belts out frigid air throughout the summer (which is one of the reasons why I keep a blanket on the back of the couch for my poor shivering clients). In the winter, I am happy to wrap myself in a wool shawl (my constant office companion) and keep the heating down lower. Like most human beings on the planet, my mother’s words still ring in my head, yea these many years later. “If you’re cold, put on a jumper, dear!” (Jumper = Sweater in UK speak). So put on a jumper I do! Now that I’m thinking about it, it occurs to me that I like to wrap myself in a wool wrap no matter whether the temperature is artificially icy in my office due to the wonders of a/c or because it’s winter and frosty by natural means. My mother was a great believer in swaddling her infants (all four of us or so I am led to believe) so the therapist in me believes that this is where my passion for being “wrapped” comes from. It feels comfortable, cozy and safe for me to be swathed in fabric, even if I am now responsible for my own swaddling. (Witness the power of self-psychology, folks!)

This lengthy piece of therapist self-disclosure was to thank those people who have emailed me to ask why I wasn’t writing, and to explain the reasons for my brief absence. More later…

How Do You Prevent A Client From Giving Over Too Much Power To You As A Therapist?

This is one of the questions that I was asked the other day and I thought it was an interesting and fascinating one. What does power really mean in the context of the therapy office, and what steps can (and should) the therapist take to make it knowable?

A client often arrives in my office feeling some combination of confused, embarrassed, depressed, bewildered, hopeless, isolated, anxious, shy and scared. They may or may not have some idea of the origins of their discomfort, but they are frequently in a state of extreme vulnerability.

Unfortunately, many therapists often have little awareness of just how much authority we have when we meet with the client who walks through our door in such a state of susceptibility. From the (oftentimes) big desks, to the psychology books on the shelves and the diplomas on the wall, all these things conspire to convey authority and power. That power has in turn often been sanctioned not just by educational institutions, but by State licensing bodies, institutions that the therapist is employed by or affiliated with and referring bodies and collateral agencies that a therapist is allied with.

But our real power lies not just with the physical accoutrements of our profession, but with our ability to define reality for a client. Given that clients arrive in a state of vulnerability, I am imbued with a huge amount of power to recognize the struggle facing an individual client, and to assist them in defining how they could navigate the complex world differently in order to re-emerge in better psychological shape. How powerful a skill-set is that in the face of a client’s fear that there is no way out of their predicament?

Whether it is our intention to convey this perspective or not, clients will often hears our words as, “I, the therapist, know better than you. Lean on me only. Trust me only.” Our job is to help a client understand that it is they who have the power to change, by changing their perceived relationship to the world/people/things they fear. Until that goal has been achieved, the therapist is seen as the conduit, as having the power to accompany the client through what they believe to be an impasse; it is part of our work to help our client to challenge their prevailing belief system. (“I am weak. I will always be at the mercy of my mother/husband/lover/friend/foe. I will always feel this way. I will never be free of self-defeating thoughts. I will never have a partner. I will never have what I want in life. I will never figure out how to identify and achieve what I want in life, etc.”)

So, in answer to the question, “How do we prevent a client from giving over too much power to us, as therapists?” I think the obvious answer is to talk about the nature of the perceived power in the room.

In practical ways, how this can translate is to:

* Have a conversation about the ways in which the client sees the therapist as powerful. How does this power translate for each client? In what ways does the client feel dis-empowered in the therapy room? In what ways do they feel that their power is being marginalized or minimized by you, the therapist? Does the client feel that this is the only place in their world that they are, and will ever be, successful? What changes can be made so that the power imbalance is made known and is constantly factored into the therapy?

* Foster an environment of relational equals. The therapist needs to be clear that there are limits to his or her power and knowledge, and that this needs to be communicated to a client. Beyond the level of that power and knowledge, lies a whole world of learning for each therapist – some of this learning happens in the context of therapy with that client. The client should understand that their job is to begin to rely increasingly on their ability to think independently and to trust their internal experience and rely on their internal judgments. The therapist’s opinions, view and ideas are no substitute for those of the client, who is the real expert on their life.

* Help a client understand how therapy is important, but it is only just one of several important supportive tools that can be used to grow the life that you truly desire. There are other supportive mechanisms that can be used: community groups, support groups, improving friendship networks, 12 step groups, interest groups, faith-based groups.

* Restrict the number of sessions a client tries to attend. For most purposes, attending therapy once a week is more than enough time for an individual client to make substantial changes in their life. Unless there are extenuating circumstances in a client’s life, entailing substantial emotional upheaval (i.e. severe depression, imminent loss of parent, divorce, miscarriage, etc.) I usually restrict the number of therapy sessions a client attends to one per week. Permitting more sessions than is needed sends a message that it is only through the therapist that the client can re-emerge into their life fully. This idea can and should be challenged by the therapist.

Lie Much?

Okay, this blog might be controversial, particularly with other therapists, but here goes….

I believe that lying, to self and others, and being lied to is the fundamental reason why people end up in therapy.

Husbands have affairs and don’t tell wives the real reasons why. (“You gained weight.” “You won’t have sex with me often enough.” “You spend too much of my money.” “I’m too scared to talk about how I really feel and maybe this (affair) will make you throw me out so I don’t have to.”)

Wives have affairs and don’t tell husbands the real reasons why. (Ditto all the above)

People come to therapy ostensibly to work on their relationships with family members but aren’t willing to be honest, either with their therapist or ultimately their family members/parents, about their experience of growing up in their families and how this impacted them.

Women won’t tell men what they really like and don’t like about having sex

Men won’t risk telling women what really turns them on

Men and Women leave husbands and wives rather than hurt their feelings and tell them the truth about their diminished interest and hurt feelings about the state of their marriages.

Adolescents act out and lie to their parents to avoid the consequence of their actions.

Adult siblings who harbor long-time lies about events in their relationships would rather put up with diminished emotional connection and intimacy rather than ‘fess up to their deceptions.

People lie, cheat and steal their way through life and won’t authentically tolerate the release that comes from finally being real and getting honest.

Parents won’t be honest with their children about the mistakes they made.

Children won’t be honest to their parents about their mistakes.

People even (gasp!) lie to their therapists.

In fact, people even lie about lying. Here are some of the lies they tell:

“It was a white lie.”
“It was the partial truth.”
“It would kill him if I told him the truth and I’m hiding the truth to save his feelings.”
“I didn’t lie. I just didn’t say anything when asked.”
“I’m not an habitual liar. I just lie when I need to.”
“I don’t lie. I just withhold.”

Lying to yourself and lying to others causes:

**Stress (anxiety, elevated blood pressure, coronary problems, etc.)

**Depression and lethargy

**Exhaustion (due to the amount of tap-dancing you have to do to prevent the truth from being revealed!)

**Feelings of inauthenticity in yourself and in the people you’re lying to

**Distance and emotional disconnect in personal relationships

**An inability to really take the reins in your own life and assume responsibility for how you would truly like to live the rest of your life

**People to feel manipulated and deceived

Here’s my recommendation for folks who lie (that’s all of us by the way!):

**Read Dr. Brad Blanton’s book, “Radical Honesty: How to transform your life by telling the truth.”

**When you’ve done that, read, “Practicing Radical Honesty: How to Complete the Past, Live in the Present and Build the Future with a Little Help From Your Friends,” also by Dr. Brad Blanton. (www.RadicalHonesty.com)

**Start telling people in your life the truth and be willing to face the consequences and get real

**Tell your therapist the truth. This means all the places you hide, lie, deceive and manipulate the facts about your life in order to prevent your therapist from seeing the real you. He or she can’t help you if you hide yourself in a web of dishonesty and deception. Take a risk and find the truth.

Top Ten Pitfalls of Being a Psychotherapist

Caution: Taking this seriously may be dangerous to your mental health!

1. You forget how to conduct small talk and can empty a room at a party in 30 seconds flat!

2. You’re constantly biting your tongue around friends and family (arm-chair therapizing of family is particularly de trop!)

3. ….and on the other end of the spectrum, running screaming from the room, after a 9 hour day in your therapy office, when your family wants to tell you about their marital challenges/office politics/boyfriend troubles/aches and pains/parenting dilemmas, etc.

4. Your hairdresser tells you all her problems. (Isn’t it usually the other way around?)

5. When you tell people you’re a therapist, they either (a) look scared and clam up or, (b) look grateful and unburden themselves or, (c) they ask if you can read minds and then test you, Verizon style, on your skill. (“Okay, can you read me now?”)

6. Your head is permanently tilted quizzically to one side.

7. You use the word “feel” so much it makes you want to slap yourself.

8. Having to hang out around other therapists.

9. Coming to the ghastly realization that your bottom is creeping out to the edges of your therapy office chair.

10. Comprehending with horrified astonishment that clients think you’re what passes for sane!

It's a Wonderful (Psychotherapist's) Life!!

If I had been writing this some time ago, my “Wonderful Life” blog would read very differently. At one time, I worked full-time at The Family Center in Union Square Somerville as a family therapist (http://thefamilycenterinc.org/), and also had a small part-time private practice operating out of a shared office in Cambridge, MA. While the work at The Family Center was emotionally rewarding and the mission of the center entirely congruent with my personal and political philosophy, the hours were long, stress levels amongst clinicians were high, the paperwork overwhelming and the salary inadequate. My health suffered and my family life and friendships bore the brunt of the strain and stress I was carrying around with me. I was constantly tired and drained with little energy left over for anything outside of my work. I decided that despite my reluctance to leave The Family Center, my health demanded that I make a change and take better care of myself. So it was with much trepidation, I decided to move into an office of my own and grow my private practice from very part-time to full-time. The two concerns I had initially were financial and collegial. Firstly, I had heard horror stories of therapists not being able to build clinical practices that would pay the bills and secondly, I loved and respected my colleagues at The Family Center and was heartbroken at leaving the friendship and support that I both received and gave during my time there. In my darkest hours, (oh, how dramatic!) I feared being destitute and lonely, this despite knowing that I had, in another career incarnation, successfully run my own business. I have always had a tendency to leap into leadership vacuums and there is no better place to do this than in one’s own business ventures.

Despite the challenge of being self-employed, the change in my life has been dramatic, with most of the changes being for the better. Many therapists complain that their clinical studies ill-equip them for what is ahead in terms of running a business. With very few graduate programs offering business classes in marketing and management, therapists are left to their own devices when it comes to building their practices. My father was, in his later career incarnation, a Management Consultant and despite his tendency to drink all his profits (remembers that long and not-so-illustrious line of alcoholics I mentioned in my profile?) I learned a great deal from him, albeit inadvertently, about marketing and selling. This information and my inherent aptitude was one of the very few positive things that my father gave me, and I value it immensely, despite its origins. So, with relatively little financial outlay, I launched my practice.

Initially relying on print media for advertising and marketing, I soon gave up on this as having too narrow a geographic focus and too expensive given the very little returns, in terms of client intakes, that it brought. I turned instead to the internet and put my marketing dollars into that and networking. This was a great move, and killed two birds with one stone. Internet advertising did what I hoped and gave me a much wider location lens and my client base started to build almost immediately which took away some of my financial/income concerns. Secondly, because of the decision to also focus on networking, I have begun to create some collegial relationships which have added much to my life and detract from the largely solitary nature of my work as a psychotherapist. I joined the local chamber of commerce (http://www.wbcc.org ) which has enabled me to meet other self-employed folks in the area; I became a member of The Divorce Center (http://www.divorcenter.org) and have begun to forge some helpful professional relationships which support my work with couples; I joined a planning committee to identify professional development needs with one of my professional associations, the Massachusetts Association for Marriage and Family Therapy (http://www.mamft.org ) and I joined a Peer Supervision Group with 3 other psychotherapists.

As “Mistress of my domain” I set my own schedule, and rarely does this mean that I have to get up any earlier than 8-9am. My office is positioned in a professional building between a Starbucks and a Dunkin’ Donuts, so I usually drop by Starbucks and pick up a cup of tea or Decaf coffee on my way into my office. Not a day goes by that I don’t smile at my name on the window of my office and delight in the pansies blooming merrily in the window boxes beneath the periwinkle blue lettering. Being on hi-how-are-you terms with some of the people working in businesses that surround my office has greatly added to my sense of belonging in the neighborhood; I enjoy recognizing and having a day-to-day connection with the baristas in Starbucks; exchanging pleasantries with the lawyers and dentists whose offices are above mine; waving hi to Dori in the office next door. Alex in the sandwich store next door knows that I like my Turkey sandwich with mustard, no mayo. The folks in Starbucks knows that I like an extra shot in my non-fat latte.

My work week runs Tuesday through Friday with my first clients usually arriving at 10 am on Tuesday morning. I try to plan my day so that I either have a big chunk of time off in the middle of the day or don't start until mid afternoon. This allows time to run errands, occasionally fit in having lunch with a friend, or walking my puppy, Ziggy, and sometimes even taking a nap! On Tuesday through Thursday, I tend to see clients until 8pm and by the time I have finished with my paperwork for the day I usually arrive home around 9:00pm.

During the course of my day, the majority of the time is spent face-to-face with clients. If I have an hour off in between clients, I return calls, catch up on reading professional journals, research issues that clients are facing that I may be unfamiliar with (for example, a religion that I am inexperienced with or a profession that I know little about but still understand how much it impacts the client’s functioning and recognize that not to educate myself would impede my understanding of them and the progress of their therapy), attend my own therapy and in a similar vein, attend supervision. (More on supervision in a separate blog.)

One of the families I work with is involved with an agency in the Boston area, and I attend Case Management meetings once every three weeks or so with the team of professionals who work to support the family. In addition, the family’s Case Aid worker and I meet weekly, usually mid-week, to share ideas about the family, and to brainstorm ways of being even more effective in our work with them.

Furthermore, I spend time thinking about ways to market the Parenting Journey™ Group (a 12 week psycho-education group created by the talented folks at The Family Center for parents focusing on how our own experience of being children impacts the choices we now make as parents) that I, as a Certified Parenting Journey facilitator, am planning to co-lead in September with another therapist, Isa Mattei, LMHC. This involves emailing Isa, passing ideas backwards and forwards, and occasionally meeting face to face with her. I also belong to a Business Planning group and have regular meetings with John Badalament (buy his wonderful PBS video, “All Men Are Sons,” or bring him to your school or community to do the incredible work he does with Fathers and Sons and, at the very least, visit his website. www.AllMenAreSons.com ). John and I brainstorm ways to support the growth of our businesses, particularly as I begin to think of ways to creatively branch out into other ventures, such as public speaking, the creation of an eTherapy site, www.JassyTimberlake.com which is currently under construction and begin work on a radio program which will focus on a variety of sex therapy and mental health issues. And, just for the pure enjoyment, I have also been spending time with other mental health professionals seeking to start their own private practices by helping them figure out marketing strategies for their particular niche.

All licensed mental health professionals require the completion of CEU’s (continuing education units) in order to maintain our licenses and keep current with unfolding developments in the mental health field. As a clinical member of the American Association for Marriage and Family Therapy (http://www.aamft.org ) and a member of the American Association for Sex Educators, Counselors and Therapists (http://www.aasect.org ) I have a professional development training to attend on average once every 3 weeks. The topics for these are many and varied. In the last 6 months, for example, I have attended the following trainings:

8 day course in Radical Honesty (http://www.RadicalHonesty.com )
Sex and Addictions
Same Sex Couples: How do our values affect whom we treat?
Fad Diagnoses: The effects of a Bipolar Disorder diagnosis on children, adolescents and their families
Online Therapy Skills Training
Conversations about Marginalized Coupleships: Challenges and Opportunities Supporting Clients in their search for a mate: a cognitive behavioral approach Sexuality and Developmental Disabilities
Update on Reproductive Health: Focus on males and females
Sexual Development and Behavior ages 0-8 years

When I’m not in the office, I phone in and check my voicemail every 2-3 hours up until 11pm at night, so that I can be on the ball about returning calls, and getting back to clients who may be in crisis.

So, that in a nutshell is my wonderful life!