The Imprisoned Brain: Psychotherapy with Inmates in Jail

Posted on by Psychotherapy.net Team

Officer Smith

There’s a strange smile I get from one of the correctional officers at the county jail where I do psychotherapy with inmates. The correctional officer?—?let’s call him Officer Smith?—?presides over the maximum security wing where one of my clients is housed. Officer Smith is not a talker. None of the small-town, yessir/nossir politeness or the jocular workaday chit-chat of some of the other COs. Just that smile?—?every time he buzzes my client out of his cell, shackles him up, escorts him to the multipurpose room where we do therapy, right up until he locks us in and steps away.

It’s an iceberg kind of a smile?—?the only visible portion a slight jut at the corner of the mouth; the rest of it looms somewhere beneath. And it conveys something different to me every day?—?anything from benign fascination to good-humored skepticism to impatience, disapproval, or even outright disdain for what I do (some COs refer to the jail counseling program as the Hug-A-Thug program). When Officer Smith smiles, I find myself smiling back, and I find myself feeling those same things?—?ranging from fascination to disdain?—?for what he does too.

It occurs to me that Officer Smith and I have been smiling at each other for months now across some kind of unbridgeable rift, and I’ve gotten to thinking about what that rift might be. We are alien to each other in so many ways. But strip away titles for a moment, his of Correctional Officer, mine of Psychologist-in-Training. Strip away disparities in age and physical stature. Strip away hierarchy and authority. Strip away every other superficial difference and I’ve realized that what really stands between officer Smith and me is this:

Mario

My client. His inmate. We’ll call him Mario. A lifelong addict who nearly killed a cyclist during a meth-induced paranoia. A man facing 25 to life for a third strike offense. A survivor of horrific, repeated, unchecked sexual and physical abuse since the age of four. A gentle, remorseful, introspective man who would almost certainly use and hurt someone again if he were to be let out of prison. A man who has sought professional help since his teens to no avail. A criminal and a victim who embodies the saying “Hurt people hurt people.”

And this is the rift: Every week Officer Smith and I smile at each other across Mario. And Officer Smith’s smile is saying “You think you can change him, but you can’t.” And my smile is saying “You think he can’t change, but he can.”

And my intractable fear is that Officer Smith may be right.

During a recent session Mario presented me with a thick document compiled by his public defender. The document presents a detailed, chronological account of the sexual and physical abuse Mario endured as a child, as well as his early exposure to drug-use by his own mother. Mario wanted me to read it because he didn’t feel comfortable talking about it. He sat there as I flipped the pages and I don’t know if my expression changed when I read the phrase “screws and bolts forcibly inserted into the anus,” or any of a dozen other phrases like it in the document. And then there were the accounts of his own crimes. His addiction and extreme aggression. The police report describing the raw and bloodied face of his ex-wife. The abject deeds done to support his habit.

Beautiful and Precious

Sometimes life just boggles the mind. It can so quickly overload our meaning-making engines?—?“hope” is one of these meanings, just like “justice”?—?that we are left slack-jawed and blank. During so many sessions Mario talked about what he would do if he got out?—?how things might be different for him. But at the end of each session Officer Smith would be there to unlock the door, and his smile would be there too, saying, “This guy?—?he’s gotten out before. He’s used again, hurt someone again, and gone to prison again. You think talking is going to change that? Talking?”

He has a point. And after reading Mario’s file I’ve felt the searing truth of that point?—?the cold, hard biology that I believe is the real mass beneath Officer Smith’s iceberg smile: that the human cerebral cortex doesn’t stand a chance against the reptilian brain. Reason, Abstract thought, symbolism, language, complex planning and executive function?—?the mainstays of talk therapy, and the very things that we insist set us apart from and above the rest of the animal kingdom?—?are imperfect and meager evolutionary tools in the context of our animal condition. My inability to make sense of the horrors of Mario’s life; Mario’s repeated relapses into drug use and violence. Inevitably?—?Officer Smith’s smile would surely insist?—?the higher brain fails to explain the world, and it fails to legislate our behavior in it.

Of course as a therapist, I’m trying to give Mario an emotional experience, not just a cerebral one. But it doesn’t change the fact that my tools for doing so are words and gestures. Mario’s own limbic system has far more potent tools?—?tools that can make even our highest, most uniquely human endeavors seem trifling. We revel in the fact that art can move us to tears, churn our stomachs, increase our heart rates, make us laugh, fill us with desire. But the limbic system can evoke these sensations with less effort and a great deal more intensity. A breathtakingly attractive person could walk by. A spider could scurry from beneath the blanket. You could be beaten, isolated, drugged, fed, fucked. Threat, reward, pain, appetite?—?art is nothing compared to this. Art is the neocortex trying desperately to emulate its older, more successful sibling. In the process it squawks and hollers about truth and meaning and humanity. But what do we generally know about the loudest ones in the room? They’re usually the weakest. The mammal in us is a quiet, ancient, powerful force. Our cortex is a small, yipping dog, ever making threats and pronouncements it can’t back up.

“Life is precious,” it insists. But I’d guess Mario has had a decidedly more animal experience of it; to the criminal justice system, to his community, to his own family?—?life was and is cheap, violent, and appetite-driven. “Life is beautiful,” our meaning-making machine cries. But it is also ugly and terrifying and senseless and painful. Nor, as we would sometimes like to believe, is even ugliness the sole domain of human behavior. Reading about Mario’s childhood, I was tempted to think, “Only humans are capable of such atrocities.” But this is just another way of setting humans apart, of maintaining our own centrality in the tapestry of life. Copernicus might have warned us of the unfolding truth?—?that the great discoveries have been a series of decenterings, of dethronings. The Earth is not the center, nor is the sun. The possibility of life beyond this planet is now a probability. And everywhere there is life, there are atrocities. Sea otters rape baby seals to death for sport. Chimps kill and dismember their own kind. Infanticide, gang rape, and physical and sexual abuse of the young and helpless are practiced?—?in the complete absence of any threat to survival or territory?—?by all manner of mammals including lions, dolphins, penguins, and meerkats. Put a rat in a cage with a lever that dispenses an opiate, and the rat will choose that lever over food, family, and ultimately, survival. We are distinctly human, yes. But far more damningly than the human condition, we inhabit the Animal Condition.

That is what Officer Smith’s smile tells me. “Let it go. They’re animals. We all are.”

And I’m almost convinced.

Except that when he smiles, I’m smiling too. And what’s that about? Defiance? Wishful thinking?

The validity of Officer Smith’s skepticism of psychotherapy is not lost on me?—?and in fact it’s helpful. When we attempt to impose the will of the higher brain, we should know what we’re up against. Any addict in recovery will tell you: taming the mesolimbic pathway?—?the brain’s reward system?—?takes a cortical feat of immense, sustained, almost unbelievable proportions.

And yet people do it.

In the overwhelming majority of significant battles, the animal brain may win; but every now and then, for some reason, it doesn’t. A torture victim finds a life beyond nightmares and flashbacks. A serial abuser tames the animal urge to hit, to hurt, to maim, and talks instead. An addict finds a way to stay sober in the face of blaring environmental and emotional cues to use.

But the thing is, the vast majority of these people?—?the ones I know of anyway?—?were only able to pull off their supermammalian feats in the context of relationships. Healthy, loving relationships. And that is what Officer Smith is missing?—?that therapists bring something decidedly animal to the table, something that a man like Mario has likely never experienced, not even from his own parents. Call it what you want: attachment, safety, nurturing, connection, love. This is not a higher function. It is basic and mammal and ancient and powerful and adaptive, just like fear and aggression.

And this, I hope, is why I smile back at Officer Smith. Because at the end of that session with Mario, after I’d finished reading his file, it so happened I had to inform him that I would be missing the next week’s session due to a medical procedure. And he’d responded, “You gonna be okay, man?”

And I’d said, “Yeah, Mario. Nothing serious. I’ll be back in two weeks.”
And just as Officer Smith opened the door to let us out, Mario said, “Well, shit, take care of yourself, brother. I’ll be sending you good thoughts.”

And in that fraction of a second?—?it was just a flicker?—?I saw Officer Smith’s smile falter.

Note: I have grossly simplified the structure of the human brain in service of clarity and meaning. And of course, personal details have been altered to protect confidentiality.

Spencer Niles on the Latest Developments in Career Counseling

Posted on by rezendevknowfully.com

There's Got to Be a Better Way

Greg Arnold: Spencer Niles, you’re an expert in the arena of career counseling and are the star of our new video, Career Counseling in Action: Tools & Techniques. You currently serve as dean of the school of education at William and Mary, after many years on faculty at Penn State. Have you been focused on career counseling throughout your career?
Spencer Niles: Career counseling has pretty much been my gig for the last several decades. It’s what captured my focused interest, and I’ve been surprised at how my interest in it has stayed with me all these years.
GA: You thought it was a phase?
SN: Yea, I thought it was a phase. And maybe it is a phase, a very long phase. But I’ll tell you what happened with me.

GA: How did you get interested in career counseling in the first place?
SN: Well, my first graduate school experience was at a very liberal protestant theological seminary that was very much focused on social justice and social action.
GA: Wonderful.
SN: Theology was a great way for understanding how people make sense of the things that happen to them in life. And I still believe that’s true, but working in a religious institutional setting wasn’t quite right for me. It was way too restrictive and not inclusive enough, so I decided to go get some career counseling for myself. I was about twenty-three at the time.

Somebody referred me to this career counseling center, which was actually a vocational assessment center, they weren’t actually doing career counseling as it turned out, but they called themselves that. I was living in Rochester, New York, and it was in Lancaster, Pennsylvania, so I called them and they said they could work with me for a fee of $600.

At the time I had dropped out of graduate school and was substitute teaching in Rochester city schools and working in a gas station kiosk collecting money from people after they pumped gas. That was my life at that point. Just barely getting by and kind of desperate.

A standardized assessment arrived in the mail, and I filled out the bubble sheets, sent them in, and then about six weeks later, drove down to Lancaster, Pennsylvania where this assessment center was and had a series of meetings over several hours, culminating in a meeting with the sort of lead person in this center. $600 was more than a couple of weeks income for me. I was really desperate.
GA: Sure, that’s a chunk of change even by today’s standards.
SN: I was living in a house with about four other people in a little room, having pop-tarts for breakfast and on a good night, a TV dinner for supper.

But I’ll never forget walking into this guy’s office. He had an impressive office, a nice big mahogany desk and he sat on his side of the desk and I sat on my side of the desk, and he proceeded to debrief me and go over the assessment results.

I remember him saying, “If you do anything in psychology, make sure it’s clinical psychology—don't think about counseling psychology, clinical psychology is where it’s at.” But he honed in on speech therapy for some reason. At one point, he asked me a question and I turned to my left to think about it, looked out the window. It could only have been a few seconds, but when I turned back to answer, he had fallen asleep! And I think “oh shit, what the hell do I do now?”
My self-esteem at that point wasn’t all that great, and now I had managed to put my career counselor to sleep. That’s how boring I was.
My self-esteem at that point wasn’t all that great, and now I had managed to put my career counselor to sleep. That’s how boring I was.

Luckily, he woke himself up and went on with the interview, but I was too meek and insecure to say anything to him, so I just pretended nothing happened. And that was it. I left there thinking, “There’s got to be a better way to do this.”
GA: I would hope so! Besides him falling asleep, which is an obvious empathic failure, what else went wrong with that scenario?
SN: Well, to begin with, they used this very rigid, narrow set of assessments that had nothing to do with me. They were just generic questions with no tailoring whatsoever, which was the norm at that time. This very dry, routinized, mechanical directive process.
GA: Impersonal, disconnected.
SN: And the active/passive, expert/novice dichotomies that get set up that are not very empowering.
The truth is that there’s no assessment in the world that can tell you what you should do. It just doesn’t exist.
The truth is that there’s no assessment in the world that can tell you what you should do. It just doesn’t exist. There’s an illusion of precision with these assessments. We pretend that they have more power than they really do. So I’m not a big fan of that style of intervention at all. It’s grounded in my own experience.

The Psychology of Possession

GA: Your style is actually quite personal in the video we’re releasing this month. Can you explain how your approach differs from this old-school style and how you’ve refined it over the decades?
SN: Well, first of all, we start with the belief that there are few things more personal than a career choice and we link career development with human development. We’ve often treated it as if it were isolated from human development rather than a key component of human development.

If we think about setting it in a context of developmental competencies, for instance, then we look at how careers unfold across the lifespan. It wasn’t until the 1950’s when theories that were more developmental in their orientation began to emerge in the work of people like Donald Super, who is a very well-known vocational psychologist who used a developmental perspective. He was on the faculty at Columbia for years and I was part of his research team toward the latter part of his life. It was people like Super that began to say we have to look at longitudinal expressions of career behavior. We can’t look at it as a single-point-in-time event.

For too long the focus on career intervention has relied upon the psychology of possession. What do you possess relative to specific traits that are relevant for career orientation, career decision-making, career planning, etc, relative to a normal curve. So what that guy who fell asleep was doing was looking at the percentile ranking of my aptitude test results and deciding for me what the implications of those ranking were for my career possibilities.

But most of us do not think of ourselves as locations on a normal curve. Nor are we static in our capacities. A psychology of possession focuses on how much we possess of certain traits and qualities, and what our probability for success is relative to others on the curve in particular occupational fields.
GA: Which, as you say, is a very static way of looking at people.
SN: And what it ignores is the psychology of use. How do I use those traits, those qualities, those experiences I’ve had in my life and how do I translate those qualities and those experiences into meaning and purpose?

Now I’ve been interested in career development since about 1980, and I still love it. It hasn’t died. Why the heck is that? There are times I kind of reflect upon that and I think why do I love this stuff so much?

Getting Out of Our Predicaments

GA: Yeah, why do you love it so much?
SN: Many people would say it’s very boring and they don't want to have much to do with. But most people are thinking of an anachronistic version of career counseling when they think that. It’s very exciting work.

In response to your question of how my model is different and more personal, I use an Adlerian-based model that hypothesizes that we’ve all had particular experiences in our lives that capture our attention. And when it comes to our careers, often what captures our attention are the things that happen to us early in life, and more than that, it’s events that were painful. These painful early events create predicaments for us in our lives. And at whatever level, we seek ways out of our predicaments in living.

We seek to make meaning, to turn an early life pre-occupation to a later life occupation, to hopefully make a social contribution.
We seek to make meaning, to turn an early life pre-occupation to a later life occupation, to hopefully make a social contribution. In that process what we do, even at a very subconscious level, is identify role models. Heroes, heroines—real or fictional characters that we see as guiding the way for us out of our life predicaments. As people who have actively mastered what we are passively suffering.

So if you identify an early life hero, heroine, role model, however one wants to frame it, we’d ask the question, what is it about that person that attracts you? In what ways are you like that role model today? What are the solutions you think that role model offered you, given your early life predicaments?

I remember when I was five or six years old—so this was about 1960—my mother calling my sisters and me together to tell us that she was going to get a divorce. I didn’t even know what the word meant, but my sisters immediately started crying and my mother was crying so I knew it wasn’t good.

From that day through the next ten years or so, my life was really turned upside-down. My family was split apart, we moved every couple of years. I went with my mother, one sister went with my father and my other sister kind of went back and forth. In that period in history, no one talked about this stuff. It was a source of shame.
GA: I can only imagine.
SN: So I repressed a lot of that experience, but I remember early on wondering how people make sense of this kind of stuff when it happens to them. It was part of the reason I decided to go to graduate school in theology, to find out how people make sense of their life experiences, their purpose, their vocation. And then when I had the experience of my own career counseling and then eventually took a career counseling course, there it was.
GA: Your own vocation.
SN: Career development ultimately speaks to these questions of meaning and vocation. How do people make meaning out of their life experiences and translate that meaning into a direction, into an activity that they find meaningful and purposeful?
GA: When you couch it in those terms, it’s anything but boring. The person seeking career development is an agent in the act of self-expression, of working through their personal journey that started with these childhood experiences, and they’re informed by heroes. It’s an incredibly significant part of their health and their journey to self-insight and working through their childhood experiences.

Your path reminds me a bit of Carl Rogers, who was initially called to theology, and also Brad Strawn, whom I interviewed recently for psychotherapy.net. He had a similar attraction to theology and the way it can inform our lives and similar frustrations about what theology couldn’t provide that psychology could.

It’s exciting to hear you speak about career counseling in this holistic way. I have to admit I had conceived of career counseling as kind of boring before diving into your work. But I was wrong. In retrospect I don’t think it was boredom as much as a kind of learned helplessness, or this sense that of all the ways we can help people, helping them find the right job feels kind of hopeless to me, and we’re the bringers of hope. It’s just so hard and so informed by factors out of our control. What would you say to counselors who think of it in these hopeless terms?
SN: It makes sense that you would have felt the way given the objectifying way we usually think of careers. As if it’s about getting or possessing certain skills so that you can get some kind of occupational title.

How do people make meaning out of their life experiences and translate that meaning into a direction, into an activity that they find meaningful and purposeful?
What matters much more are the subjective experiences you have in living your life, where and how do you derive meaning and purpose and where have you been struggling to overcome that sense of hopelessness. We need to make the implicit much more explicit. We need to help our clients articulate those kinds of experiences in which they find that kind of meaning.

There’s no test that will help you identify those things, but what I can do is collaborate with you to find it. I can walk with you on that journey of clarification and articulation of how you find meaning out of the very personal things that have happened to you. But ultimately I’m bringing the same skills to career counseling as any good therapist does to therapy. All those competencies that are essential to effective psychotherapy are essential to effective career counseling.

So You Want to Be a Professional Guitarist…

GA: Is there anything over and above that or is it just using the same common factors that apply to any good therapy?
SN: It’s the common factors of good therapy with a focus on helping people make informed decisions about their career changes and choices. For example, if I were to tell you I wanted to be a professional guitarist—and I kind of do, actually—
GA: Me too!
SN: Here’s the problem though.
I didn’t start playing the guitar at all until I was fifty. And I am bad. I don’t lack for enthusiasm, but I do lack for talent.
I didn’t start playing the guitar at all until I was fifty. And I am bad. I don’t lack for enthusiasm, but I do lack for talent. I love to listen to a great guitarist, I love to play my major chords and every once in a while maybe a little bit of a minor chord or a bar chord thrown in there, but that’s about it. It’s never going to happen.

At one level, it’s important for me to have some clarity about that, but I don’t want you as my career counselor to tell me it’s not going to happen. You might ask questions about the probability of that given my competency level. And I might say, as the client, “I hear you, Greg, but this is my passion.” And you’d start to dive into that with me. What is it within that activity that you really resonate with? Is it truly just knowing where a particular note is, or the shape of a particular chord, or is it something deeper than that? Is it more about your creativity? The emphasis in that process is about clarifying and articulating that passion.
GA: Beautiful.
SN: You’ll table the goal for a bit in favor of helping me describe and name the contours of that passion. You’d encourage me not only to come up with real occupational titles, but to make some up, expand the list, really let my imagination run wild.

The process of identifying the passion allows us to connect to our passion and then to look for opportunities that will elicit that passion. We in the West are lousy at really owning the fact that when people are busy making a living, they’re busy living a life.
GA: What do you mean by that?
SN: I don't know of any occupational nirvanas. We create these false expectations for work. I think what is really important is identifying possibilities that allow us to create a life structure that we find meaningful and purposeful. One of the specialities that I’ve worked with over the years that is so effective at ignoring this is lawyers.
GA: How so?
SN: Lawyers, especially new lawyers, if they are doing their job well, they’re probably working a hell of a lot of hours each week. What happens to the rest of your life? Law is an occupation that has among the highest turnover and dissatisfaction rates.
GA: I’m not surprised.
SN:
People simply ignore the fact that work is also life; it doesn’t happen in an isolated, compartmentalized silo.
People simply ignore the fact that work is also life; it doesn’t happen in an isolated, compartmentalized silo. Work happens within a context, and if the context in which it happens doesn’t allow you to express the life-structure that you find meaningful and purposeful, then life’s not going to be good. It’s not going to last long—or if it does, you may end up compensating in ways that are highly dysfunctional.

So we ask, how does this purposeful goal that you might articulate based upon your meaning and passion feed into a life-structure that you would prefer living?

So if you’re a parent, how do you effectively parent if you work sixty hours a week? It might be possible, but I have to say that those times when I’ve worked like that, I probably was much less effective as a dad. And if I had the chance to do it over, I wouldn’t do it again that way. That’s just me.

"Positive" Addiction

GA: That’s a powerful realization.
SN: I wasn’t aware of the tradeoffs as clearly as I should have been. And of course this gets into positive addiction. We get positively reinforced for being workaholics. We get positively reinforced for achieving in our professions at a high level.
GA: Absolutely.
SN: And that’s OK, as long as we make informed, conscious decisions and we’re aware that it comes at a cost. Maybe it’s a tradeoff that we’re just fine making, but we want to be aware of it.
GA: So what you’re saying is that in the West—at least until recently—we were led to believe that we could find the “perfect” job through these assessments that looked only at static traits and matched us based on some normed statistic, which contributes to grand illusions about what is possible in our careers. And then our society promotes workaholism, which creates even deeper dissatisfaction and often leads to unhealthy coping mechanisms. Your way of working is much more nuanced, developmental, humanistic view of career counseling. How prevalent is this in our profession right now?
SN: I won’t be overly optimistic here.
We get positively reinforced for being workaholics. We get positively reinforced for achieving in our professions at a high level.
I’d say slightly more prevalent today than it was fifteen or twenty years ago. A lot changed about the work world in the last part of the 20th century. Layoffs and the notion that the workers are expendable became a fairly well-accepted ideology, which ran in contrast to what we used to think of as kind of a social contract or career ethic between employer and employee. You know, work hard, put your nose to the grindstone, be loyal to your employer and he will be loyal to you.

This translated into people relocating their families with kids in 11th or 12th grade because the company said, “We’re moving you from Poughkeepsie to Omaha.” That was the ethic, but then people began to realize as this happened more and more frequently, that no matter how hard you might work, no matter how loyal you might be, it could happen to you. People began to say, “I’m not sure I’m willing to sacrifice everything for my employer when my employer is so willing to sacrifice me.”
GA: Amen.
SN: The wounds and the challenges created by that sort of lived experience shifted things quite a bit for many, many people. It’s interesting for me to talk with millennials.
GA: How so?
SN: My son is one. He was offered a raise and a promotion at his current job. He’s 24 and he told me this after the fact. I said, “So what did you do?” and he said, “Well, I turned it down.” I said, “You turned it down? What was the job?” He said, “I’m not really sure.” I asked, “What did it pay?” and he said “I don’t know.” “How don’t you know?” “I didn’t ask.”
GA: Wow.
SN: I said, “How could you not have asked these very basic questions?” And he said, “because I love what I do.” I thought, whoa. He loves his current position and he let that guide him in this process. He’s much wiser than I’ve been throughout most of my life, because I would have asked, “What’s the job? What does it pay?” And if it paid me enough, I might have taken the job even if I loved what I was doing. It’s the old idea of propping your ladder up against the wall and then getting to the top of the ladder only to realize you propped it against the wrong wall. So many of us have done that kind of thing. I certainly have.
GA: Sure, most of us have, I think.
SN: There are just so many dimensions to this work. One of the things we’re finding these days, which is becoming more of a focus in the area of career development, is that the self-concept—what we believe to be true about ourselves and all that that entails and all that means, including our passion and purpose—evolves over time. So career development also evolves. It never stops. If we get passive about that, if we ignore that, we do so at our own peril.
GA: Lifespan development.
SN: Indeed. I took a new job at fifty-eight. I’ll probably take at least another couple other jobs before I’m done with it all.

“Busyness is an Offense to the Soul”

GA: I saw a statistic in Forbes earlier this year that more than fifty percent of people are unhappy with their jobs. A huge contributor to that is the perceived instability and the breakdown of the social contract between employer and employee. But then there’s this silver lining of millennials who are pursuing passion over logistical necessities of income or geographical location. Is this preferable in our new world? And how do we accommodate the lightning fast progress of the twenty-first century? How do we prepare for jobs we can’t even imagine twenty years from now?
SN: Those are great questions. The first question, about which way is preferable, is informed both by generational and individual factors. For example, my father was born in 1921, the WWII generation, and lived through the Great Depression. From those experiences he developed a work ethic that he then passed onto me, and, on one level, that ethic has served me well. I’m a very hard worker, I’m success oriented, always have been, and those are attributes that we get rewarded for in this society.

On the other hand, this is an ethic that focuses more on human doing than on human being, and there’s a real cost to that. For example, the notion of being reflective about our experiences and what they might mean for ourselves, of actually scheduling in time during each day to be reflective about the countless number of experiences we’ve had just that day—these things don’t come easily to folks like me. We don't really allow as much time for human being as human doing, which relates to your question. If you’re going to journal, if you’re going to engage in meditation, mindfulness activities and so forth, those activities are focused on human being; they’re not productive in the doing sense.
GA: So has your model of career development taken in more of this human being aspect?
SN: A colleague at the University of British Columbia and one of my doctoral students at a university in Morocco and I have developed a model that begins with self-reflection. The steps are all in a book we published entitled Career Flow, and the first step is engaging in activities that focus on being and not so obviously doing—journaling, meditation, mindfulness activities, however you might define those. If we engage in those activities on a regular basis in very intentional ways, they foster a greater sense of self-clarity, which is the second step in this model.

We have to elevate the importance of self-reflection if we’re ever going to be able to sort through all the stuff that comes at us, sometimes rapid-fire, each day, and that lead us to being so busy.
Our editor asked, “Why did you separate out self-reflection from self-clarity? They’re the same thing.” And we said, no they certainly aren’t the same thing, and that’s part of the problem. We have to elevate the importance of self-reflection if we’re ever going to be able to sort through all the stuff that comes at us, sometimes rapid-fire, each day, and that lead us to being so busy. One of my favorite Christian mystics, Thomas Merton, said that “busyness is an offense to the soul.”
GA: That’s deep.
SN: And I know I offend my soul every day. So the question is, how can we be less offensive to our souls and honor our experiences and who we are by being much more intentional about engaging in self-reflection? There’s a poet, David Whyte, who has written quite a bit about work. One of my favorite lines of his is, “I look out at everything growing so wild and faithfully beneath the sky and wonder why we are the one terrible part of creation privileged to refuse our flowering.”

Squirrels are out there doing their squirrel thing. Same with golden retrievers, same with trees, but we can get misdirected in so many different ways, by so many external influences and so many factors. We seek to please people in a variety of ways that move us away from who we are. Or we chase certain things that in the end don't provide much in terms of meaningfulness and satisfaction. So we have this “privilege” that often leads us in that way. I think if we were more mindful, more self-reflective, and asked the tough questions, lived the questions, we would be less likely to refuse our flowering. So finding a balance of being and doing is an important dimension of creating careers for ourselves.

The CEO of Netflix takes six weeks of vacation each year, and when he’s on vacation, he’s really on vacation. I officially get two days of vacation a month, and I’ve been in this job for three years. I don't think I’ve used more than three weeks of vacation in three years. I mean how goofy is that? That’s really goofy. I’m in a job where you get every six or seven years, you get a sabbatical. This is my twenty-ninth year as a faculty person. You know how many sabbaticals I’ve taken? Zero. These are not things to be proud of.
GA: Well thank you for airing your dirty laundry with me. This is a relic of the depression era, don’t you think? This work ethic of human doing over human being, where we’re rewarded for workaholism. It’s understandable how we fall into these patterns of busyness. So you’re not taking vacations but hopefully you’re finding time for self-reflection.
SN: I’m much better at it today than I was. It’s not something that garners external rewards, but it certainly brings internal rewards.
GA: It seems like you’re really advocating that work be considered holistically as an integral part of health and wellness. That there should be no separation of “life” from “work” in developmental terms, and that therapists need to be considering career development as a fundamental part of human development.
SN: That fifty percent of people who are unhappy with there jobs that you referred to, the majority of those people have no clue what to do about that. We as mental health professionals have done them a great disservice by perpetuating this notion of the separateness of work from other dimensions of life.
GA: So what can we do? What can practitioners do to more effectively work with career issues and actually help clients with these issues?
SN: That’s a great question and challenging question. The National Career Development Association in the United States is a great organization and some of the leading thinkers in this area attend and present workshops at their annual conferences.

I’ve done a lot of work in the area of policy as it relates to career development. I’m on the board of directors for something called the International Center for Career Development and Public Policy. One of the things I’ve learned from working with them is that here in the United States, we don't have many policies and legislation that support the provision of career intervention across a lifespan.

So even those who are from the mental health professions, who are trained in this area, aren’t addressing these issues and intervening at critical moments in people’s lives.

Take school counselors. Career development is supposed to be one of their three major areas of involvement, but it often isn’t because of other pressures that force them in different directions, but they can be absolutely critical with early-life interventions. There are research studies that show that adolescents who leave school early, at maybe seventeen or sixteen, have psychologically left school long before that, often because they see no connection between what they’re doing in their day-to-day activities and their possible futures. Being informed about career development across the lifespan and this more holistic way of approaching it could mean that a school counselor makes the difference, could connect the dots, for a kid who would otherwise drop out.

So there’s a lot of work to be done and it requires engagement from multiple perspectives and multiple stakeholders. It starts with valuing the developmental perspective that you and I have been talking about relative to helping people begin to make much more informed choices about how they find and express meaning in their lives, including within their work.

Also, I think people in our field often denigrate career counseling, but understand that the version of career counseling that is being denigrated is frozen in time and anachronistic, it’s not what many practitioners these days are doing. The National Career Development Association has a list of practitioners who people can be referred to.
GA: Thank you so much. We hardly touched the tip of the iceberg, but I for one take your call to action to put a new face on career counseling, to revise outmoded, anachronistic definitions and learn about and be a practitioner of this developmental, humanistic, optimistic, hopeful model that brings dignity, respect and a personal connection to people seeking work and wellness throughout the lifespan from cradle to grave.
SN: Well said, my friend.
GA: Any parting words you’d like to leave our readers with?
SN: Well, I’ll leave you just with one brief additional story from the poet David Whyte. At the time we was working at a non-profit, and he noticed how bored and exhausted he had become in his day-to-day experience in that work. He was trying to do poetry on the side and fit it in where he could, and he had this ritual of getting together with a friend on Friday evening to read poetry together.

He viewed this person as very wise, a person of good counsel, and so he decided to talk to him about the exhaustion he was feeling. So one Friday night, he confides in his friend and his friend reflected with him that the antidote to exhaustion is not always rest.
Many times the antidote for exhaustion is whole-heartedness.
Many times the antidote for exhaustion is whole-heartedness. Doing those things that engage us in a whole-hearted way. The conversation led him to leave that job and do work in which he felt that sense of whole-heartedness. So we have lots of clues, lots of indicators along the way. Exhaustion can be a clue. The key is to pay attention. It’s our soul’s way of telling us if something is amiss and if we need to redirect our path.
GA: That’s such an inspiring message and also conveys to our readers how inspiring career counseling can be.
SN: Thanks so much for the opportunity to talk with you about it. It’s been a lot of fun for me.
GA: Likewise, it's been a great pleasure.

A Little Girl in a Dark Corner

Posted on by Psychotherapy.net Team

Some mornings Nora would wake up, and the little girl would be there. She would always be curled up in the darkest corner of the room, concealed behind the curtains. Her un-natural white skin, her bare feet, and a part of her burgundy-red dress would be clearly visible in the early morning light.

She looked wicked, and the very fact of her presence in the room seemed uncanny. But at the same time, Nora felt a compelling desire, almost a necessity, to look at her.

The child was always silent, Nora never heard the sound of her voice.

After a while, Nora would usually choose to ignore the intruder, closing her eyes again and pretending to be asleep. Then, as she would reopen her eyes, the corner would be finally empty, with nothing to suggest that the little one had ever existed.

Sometimes, as she walked through the Parisian winter, Nora wondered where the little girl could be hiding during the day. She worked at a school, teaching English to children, usually half-asleep herself.

I was Nora’s therapist, and the only person who knew about the little scary girl.

As Nora told me her secret about the little girl, I asked whether she knew how the child was feeling.

—Scared… and very lonely.

Nora thought that the little scary girl wanted to be let out of the room. These feelings of loneliness and fear were far too familiar to her: she had grown up surrounded by parents too busy with their own struggles, leaving her without any emotional support. After school, she would usually stay upstairs, doing her homework in her room and hearing her parents’ argue. She knew something was not quite right between them. Not sure whether it was her father’s drinking or something else… She just intuited that something bad, really bad, was going to happen, and felt she was probably responsible for her family’s misfortune.

When her mother would finally call her for supper, Nora would feel a huge relief, but then her heart would sink: she was finally freed from that room, although nothing good was awaiting her downstairs. Her worst fear was to have her parents announce their decision to split.

As Nora was sharing with me her old fears, her level of despair was such that I could feel a painful knot in my stomach. And the little scary girl was there again, with me in the room, curled up on the edge of the chair, which suddenly looked too big for her frail body.

Years ago, Nora had left the little Scottish town where she was born, and her country altogether. Her departure had been abrupt, no planning nor goodbyes had been needed. As soon as she got admitted to a college, she packed and escaped from the house where she had been lonely and anxious for years.

She had little or no contact with her parents, and had never discussed with them those darks moments of their shared past, when she had been fearing they would divorce.

Putting miles between her and that “wicked” place (as she called her parent’s home) did not make the anxiety disappear. The old feelings persisted and made her dizzy at times: for several days in a row, she would lock herself in her Parisian one-bedroom flat. The worst days were those with the scary little girl. She would appear in the morning after a bad night. Nora’s nightmares had repetitive themes—doors shut tight with uncanny noises behind, and creepy creatures trying to burst out and get her. Scared to death by her own cupboards, and especially, by the ones in the kitchen, which might hide anything or anybody, Nora would stay safe in her bed, unable to make it through the tiny corridor to the bathroom. The wicked girl could be hiding in the wardrobe, between her clothes; Nora would wear the same outfit for days, too terrified to open that closet.

—I want her to go away.

I had never seen Nora so upset. The little girl was there again and looked even sicker then usual, she reported.

—What do you think she wants?

It took Nora some efforts to visualize the girl, in order to ask her what she was looking for.

“Bringing” the little one into the room with us helped Nora realize that this “phantom” was her younger self, whom she had left behind.

The needs of this child—her desperate wish for warmth, security and connection—had been overlooked for years, and had brought an unbearable distress to the adult Nora.

“Sick, ugly, and wicked” were the exact terms in which Nora used to think about herself. She was not able to feel any compassion or warmth towards that hurt part of her self.

Once Nora was able to look at the scary girl with more understanding and compassion, the little one was finally freed from her dark solitary place. And with time, she eventually left Nora’s bedroom completely.

How many of us keep this kind of scary and scared girl or boy in a closet?

In my practice I see many impressively functional adults whose realities are silently haunted by these phantom children. These scattered parts of their personalities are locked away, often back in their original homes where, as children, their emotional needs were not properly met.

In therapy, whenever we manage to get in touch with the emotional pains of this often terrified child, we help the adult to integrate these parts and to let go some old fears and hurts.

With some modelling from me, and a lot of patience and tenacity, Nora eventually learned how to better take care of herself, and also accept this care from others.

In our last sessions together, Nora shared her new dream to have a family of her own, possibly with a child that would never be left alone with his fears. And I trust her on this.

Whiteness Matters: Exploring White Privilege, Color Blindness and Racism in Psychotherapy

Posted on by rezendevknowfully.com

White Therapist as Racial Subject

Our profession is concerned with multicultural competence (I assume readers of this article are as well). Despite that, our canons of psychological theory remain euro-centric, yet are largely assumed to be universal; our assessment and diagnostic systems are biased in the same vein, while they are used as guideposts in courts of law, prison, schools, and medical venues; research largely makes assumptions of universality without qualification that population samples are overwhelmingly white; and our delivery of services, even the “culture” of psychotherapy itself, remains white-centric. Whiteness as the only representation of humanness is in the “air,” so to speak, of Western psychology, something many writers, researchers, and psychotherapists of color have written upon (see end of article for resources), and a few white authors have noted as well, Dr. Gina deArth1 among them.

In my experiences speaking and writing about racial identity and racism as a white person in general, it has most often been challenging creating dialogues with other white people. My experience is not an unusual one. More often than not, when racial identity and racism are discussed among white folks, we primarily focus upon the racial identity and racism outside of ourselves (in others, in institutions, in systems, in history, and so on) while also claiming an individual absolution from racism—well, I’m not racist. The two are contradictory and deny the socialization we have all experienced in the wider community of the United States if not in our families.

No white person can reasonably claim that they do not participate in and are not shaped by racial subjectivity and racism, yet this is one of the more common claims that arise in conversations between white folks. Nadia Bolz-Weber, author of Accidental Saints, and an anything-but-conventional white Lutheran pastor, expresses well how white folks are seduced to hide the influence white supremacy has had on us, and the impossibility of escaping the reality of being formed by that supremacy: “Like so many of us, I was born on 3rd base and told I’d hit a home run . . . the fact is, just because I don’t like racism or agree with it, that doesn’t mean it’s not still part of my makeup.”

There is not enough investigated, discussed, and written in psychology about the racial subjectivity of whiteness, that is, the varied lived experience including experience of privileges and participation in racism on levels varying from the personal to the institutional, as well as the meanings of being white. I am interested in exploring conversations about racial subjectivity and racism. I consider this a lifetime kind of practice, albeit an uncomfortable and certainly imperfect one. Engaging in an ongoing investigation into my lived experience of whiteness both on individual and relational levels is a vital part of being an ally to people of color, and to being a better therapist to all of my clients, akin to how my personal psychotherapy enhances my work with clients generally.

Stating that, past exchanges with white colleagues and friends come to mind—all emotionally charged, sometimes emotionally injurious on all sides, anything but calm. I know how vulnerable and even incendiary talking about white racial subjectivity and racism usually is, how many defenses arise, and how it can be so difficult. I brace myself already for the “review” feedback to this article, for example. I think white folks need more practice in these discussions, including myself.

As a white person, accounting for one’s own racial identity and racism, talking about the larger system of racism bestowing power and privilege, is typically a conversation stopper among white people. Attributing the suspended conversations among white folks to racism is certainly a part of the stagnation (at least in some cases) but does not entirely flesh out the sophisticated psychological dynamics in ways that can loosen up the tightness that chokes off genuine exchange. The obstacles to creating open dialogue seem to be about several factors, among them: white guilt; protecting privilege; the nature of trauma (racism and acts related to it) evoking blaming and shaming; the lack of practice white people have in talking productively to one another about racism; desires to maintain an all-good self; the lack of white racial identity development and awareness; and the significant discomfort of sitting with the realities of and felt gratitude for the enormous privilege and protection light skin brings in our daily lives.

Though white folks today may claim they did nothing to “deserve” this power and privilege, the acknowledgement alone does not give white folks a pass on critically examining our lack of curiosity regarding the lived experiences of whiteness and racism. Curiosity about these facets of our selves is one antidote to unconscious whiteness. My desire in this article is to begin pondering how the conversations about white racial identity, racism, and psychotherapy gets hijacked among white clinicians, and to explore ways I have found (imperfectly) helpful in continuing the conversation. While conversation is not enough in and of itself, it is integral to greater awareness and action.

All Good or All Bad

We cannot get away from messages that being white is not only a universal representation of human experience and authority, but also an idealized one. Even if our white family of origin was anti-racist, larger society and systems socialize us otherwise. Psychologically, this is akin to being raised in an environment where caretakers delight simply in our existence; our attachment is secure while getting bathed in that unconditional love. This becomes our baseline normative experience of relationship and expectations of other people. We know how a childhood environment like that contributes to self-perception in permeating ways that are unconscious and influence life course. White folks have been bathed in unconditional acceptance and idealization for white skin; we have to work to become conscious of how this has shaped our expectations of how we move, interact, and think in the world.

White folks interested in what I am writing about understand that it is good to be anti-racist, and bad to be racist. It’s good to be aware. No white person I know wants to be bad. An entirely individualistic focus on racism, however, essentializes the discussion and understanding of racism, it occludes exploration of white racial identity, and it raises defenses exponentially. While of course there are individual acts of racism, they are occurring within an inherently racist milieu whereby all white people are benefitting, regardless of individual actions. For example, as a profession we do not integrate in every aspect of clinical education—from intellectual inquiry to clinical training—multiple and multicultural points of view on what is pathological, diagnostic, healing, and so on. Other points of view taught in one-off multicultural competency courses are just that—other.

Talking about and thinking about white racial identity and racism as a binary good-bad is a way to ignore the complicated and uncomfortable parts. The African American scholar and filmmaker Omowale Akintunde writes: “Racism is a systemic, societal, institutional, omnipresent, and epistemologically embedded phenomenon that pervades every vestige of our reality. For most whites, however, racism is like murder: the concept exists, but someone has to commit it in order for it to happen.” Racism is not simply individual action, nor is combatting it simply about courses in multicultural competency.

In talking with my white peers as well as in my own self-reflections, the feeling of power due to racial identity is rarely consciously felt. Yet if we wait until we personally feel the social power of whiteness to validate the reality of it, nothing changes. Even if we are white and members of other oppressed groups of people on individual and societal levels such as being working-class, disabled, immigrant, or queer-identified, we may not have social power in the arena of economics, physical ability, native citizenship, or gender and sexual orientation identifications, however we nevertheless carry the robust social power of whiteness. There are studies upon studies validating the power of whiteness, let alone anecdotal evidence.

That it is difficult for white folks to talk with one another about racism or something racist that occurred in the moment (a microaggression, for example) is reflective of the positive reinforcement that silence among white people on the topic receives. The silence on racism is balanced only by the silence of white racial identity. Silence keeps the status quo; it also keeps everyone “comfortable,” and keeps white people connected to one another in “likable” fashion. When one white person breaks the barrier of silence, often he or she is shamed, ostracized, or defensively attacked by other white people. We are ejected from the group, placed in a binary of something like being disruptive, arrogant, myopic, or mean while the remaining silent members rest in being well-mannered (and defended). The white person who speaks up among white folks about racism often becomes the recipient of disavowed racism from other white people, something that has been observed in clinical encounters where white therapists disavowing their racism (and other unwanted characteristics) project them onto their clients of color.

Using Mindfulness to Notice Patterns of Prejudice

An example may help elucidate, and I will give one that begins on the individual level and then includes a group level. If I walk down the street in the evening and see a black man standing at the corner wearing a hoodie with his hands in his pockets and low-slung (sag) jeans, I might wonder about my safety—if even for a split second. That I wonder less, if at all, if it were a white man is not benign—nor is it an egregious act of violence. It is prejudiced, however, and shaped by racist socialization on a level outside of my family of origin. When I catch myself in such a moment of thinking, I don’t spiral into a guilt trip or any other self-critical trip, but rather note the manifold ways racism is part of me even though my parents did not raise me as a racist, and even though I participate in white ally-anti-racism activities, and even though I continue to educate myself about racism and have done so since I was in high school. The practice alone of mindfulness regarding racism makes it easier for me to see its ubiquity, and to talk about it as well since a mindfulness practice is also a practice of non-judgment.

My experience is that some white folks deny this kind of racism, which is impossible given socialization. When I attended a meeting of white therapists focused on racism and our profession, one of the therapists wondered if it would be a good idea for us to out ourselves to one another about racist thoughts and acts in order to reduce shame, build awareness, and enhance conversation.

The room of about 30 white therapists fell silent. After some time of silence, I spoke about a similar kind of story to the one in the example above and reflected that using mindfulness as a vehicle to uncovering racism, to me, is essential to deepening learning about racism and practicing unlearning racism on an individual level. No one else in the room spoke including the person who brought up the idea in the first place. After even more silence, the topic was changed to how “difficult” it is that the larger professional organization of which this group was a part had not considered ever focusing on racism and psychotherapy like “we” were doing, and the remainder of the meeting was a discussion focused on how the organization should change. Racism was located suddenly outside of the group of we white therapists.

DiAngelo describes similar patterns of interactions among whites such that the person breaking silence receives response from other whites ranging from attack to being ignored, and the group shifts focus to racism occurring outside of the group. It is so risky, so emotionally charged, and perhaps even threatening for white people to talk with one another about racism. Even as well intentioned as this group of therapists were, as a group we were not ready to really engage with one another around our racism.

Color blindness and the Costs of Unexamined Whiteness

“If we hold the perspective of colorblindness, it falls to us as individuals to make it on merit, on individual characteristics versus larger forces.” This means that folks who are unemployed and poor are so due to character rather than systems of oppression and the after-effects of transgenerational trauma that are set within those oppressive systems. If subscribing to colorblindness, psychologically we might consider that symptoms of paranoia, depression, and anxiety are universal and not influenced by living in a racist society, nor adaptive and normative, rather than pathological. While intellectually I think most white therapists would understand these concepts, applying them experientially is another matter.

If we are colorblind, we cannot examine both the privileges and the costs of our whiteness. We are literally blinded. Some white folks do not want to be “lumped in” with the white group, and I certainly can identify times when I feel the same, yet as it has been widely noted, regardless of our personal desires regarding white affiliation, we are not granted privileges as individuals but because of the lack of melanin in our skin. The white sociologist Dr. Amanda Lewis reflects that while examining whiteness can be challenging (because whites generally do not understand themselves as being a part of a white group), nevertheless it is vital to explore not only because of the aforementioned, but also because whiteness shapes sociological and psychological imagination.

In writing about whiteness in the psychological imagination, African American psychologist Dr. Jonathan Mathias Lassiter suggests costs of whiteness to white people; heightened defensiveness, emptiness, meaninglessness, disconnection, and loneliness are among them. I can feel all of these to greater or lesser extent along some kind of continuum when I begin to examine how white identity manifests in me moment to moment, and specifically when I am experiencing some privilege, aware of this, and at the same time feel conflicted about it. I find this is primarily a self-focused reflection, and seems wrapped up with the lack of interdependency whiteness rests upon. The maintenance of privileged whiteness requires subjugated “others,” even when we are unaware or unconscious of this. Recognizing the costs of unconscious whiteness is not an exercise of victimhood undermining racism people of color experience; it is a practice of noticing how socialization of privilege also cuts us off from greater meaning, connection, and openness.

Guilt, Shame and Blame

An African American client of mine once remarked on my shoes, more specifically how I maintained them (which is inattentively to say the least), and how if she would do the same thing with her footwear white people would interpret her poor care of her shoes as an example of laziness, as fulfilling stereotypes of African Americans. Immediately I heated up, and thoughts jumped in my head arguing with her point of view—wasn’t she exaggerating?—and then feeling horribly guilty and ashamed that I was thinking these thoughts about my client with whom I have worked and built strong attachment over years of treatment. Initially, I named the racism she was talking about and only because, I think, of our long-term therapy relationship did I feel courageous enough to share with her my internal process, feelings, and how I had to “check” myself before I spoke. It was not the first time the client and I had talked of racism and how it plays out in our relationship, and I know it will not be the last. Coming clean with my client dissipated the guilt and shame I was feeling—as well as the blame toward my client. The conversation also brought us closer together. As she remarked, she always feels she can trust me more when I take a chance in being so honest.

I cannot say that I would take that risk with all my clients of color, most likely due to aspects of my defensive process. Invulnerability is integral to unexamined white identity, and to racism. The wish to remain seen and felt in a “good,” well intentioned way, in a liberal way, in a way that is understood as conscientious, is brittle when we are not willing to also be seen as speaking or acting in a privileged or racist way—or defending and refusing to examine these reflections of self when called upon to do so. This kind of invulnerability, however, cements guilt, shame, and blame in place.

In her article describing psychotherapy with an African American client, Melanie Suchet, a white South African émigré and psychoanalyst in New York City, describes how white guilt, shame, and blame gets in the way of productive therapy with her African American client. As therapists, what is most vulnerable in us with any particular client is frequently where we falter in the process. The faltering can be productive if we can use it, process it and understand it. In terms of white clinicians, our socialized racism and lack of white racial identity development, the vulnerabilities of white guilt, shame, and blame related to privilege, power, and other facets of racism are played out in particular ways with clients of color, and numerous articles, including Suchet’s work, highlight these.

It seems to me that the trifecta of guilt, shame, and blame is also silently played out with white clients and white peers, sometimes voiced with disavowal. Among white folks, what we do with shame, blame, and guilt makes a difference. We may freeze, disengage, become enraged, or use the guilt or shame as defenses too, all allowing us to leave the conversation of racism and white racial identity behind. DiAngelo notes how discussions around racism among whites evoke common responses like anger, withdrawal, freezing, cognitive dissonance, and argumentation—in other words, quite a bit of defensiveness. She calls this white fragility. White fragility is an intimate companion of invulnerability, both inherently defensive, and both soaked in the trio of guilt, shame, and blame.

Continuing Education in Talking about Racism

In mental health professional meetings, I find it curious that white clinicians may not be interested in enrolling in anti-racism seminars such as the one I attended, nor to even take advantage of learning materials. “Some white psychotherapists have explicitly said that this kind of training is irrelevant to psychotherapy, or not concerned enough with emotional safety (of whites), and generally not necessary for therapists who are trained to listen deeply with empathy.”

Recently, a professional organization of which I am a part offered an excellent day-long seminar regarding the psychological pain of people of color. I find these kinds of workshops more or less well attended by white therapists, but they are limited in that they continue to focus on people of color as “the other”—which is more comfortable. It would be so useful for the multicultural competence, let alone for further growth among white clinicians, if we engaged in experiential (not intellectual) seminars on anti-racism such as those offered by StirFry Seminars and Consulting near where I live (I don’t work for them by the way, but offer them up as an example as I have participated in trainings there). I could see from that baseline kind of education, white therapists might develop additional seminars for further training such as countertransference racism, guilt, and shame; how to develop awareness of racism within us and how this impacts the therapeutic relationship, and so forth. If our conversations among all of us about racism are to deepen and widen, if our awareness is to expand outside the binaries of good and bad, continuing education about racism is necessary.

Uncovering White Racial Identity

Of course these stages are not abandoned once we pass through them, or at least that is not my experience. The nature of privilege is that we have a choice to not engage experientially and affectively the work of anti-racism in whatever ways we are able to do so. Our privilege as white folks is that we can dip in and out of this work, and we can choose what aspects in which we want to participate. I know that I dip in and out of the work myself, evidence of privilege and how the stages of identity development are not linear. I do this at times even while intending to further my awareness practices. I am still able to “break away” by choice, and sometimes I do. Inhabiting a sophisticated white racial identity, to me at least, is not a static state; I do not know how it could be as the nature of privilege is constant, whereas awareness tends to vacillate. I think of white racial development as a practice for this reason, and one that involves further dialogue with other white therapists, and ongoing education along the same lines.

Emotional Home

Living and practicing as a white psychologist I grapple with these questions: Have I recognized my privilege today? How have I used my privilege today, and to what do I attribute the privilege received? Psychologically, how do I hold the trauma of current and historical racism without defensively deflecting it? How do I practice daily recognition and understanding of microaggressions in which I participate? How does racism impact my clients and me, regardless of racial identity? How do my favorite psychological theories and practices possess an assumed universality of humanity when actually they are only about one group of human beings? How does my white subjectivity influence and shape my work in general?

There are no clean, clear, sure-fire answers for these ongoing questions of mine. It does seem to me, however, that psychological thinking around dynamics of defense, racial identity development, and trauma (racial, transgenerational, and otherwise), are all useful to such a vast, permeating, and incendiary topic as racism and white racial development. It would be fitting for all of us practicing in this profession of helping humanity to lend our energy to ongoing personal exploration, wider discussion, writing, and speaking publicly about these topics. It is vulnerable, yes, but within the vulnerability as we all well know is the seed of growth.

References

1. Dr. Gina deArth's works can be found here.

2. Dr. Monica Wiliams' blog, "Culturally Speaking" can be read here. 

Further Reading

Fox, Prilleltensky, and Austin (Eds). (2009). Critical Psychology: An Introduction. California: Sage.

Mesquita, B., Feldman Barrett, L., and Smith, E. (2010). The mind in context. New York: Guilford.

Nelson, J.C., Adams, G., & Salter, P.S. (2013). The Marley Hypothesis: Racism Denial reflects ignorance of history. Psychological Science, 24, 213-218

Phillips, N., Adams, G., & Salter, P. (2015). Beyond adaptation: decolonizing approaches to coping with oppression. Journal of Social and Political Psychology, 3 (1), pp. 365-387.

Salter, P. & Adams, G. (2013). Toward a critical race psychology. Social & Personality Psychology Compass, 7(11), pp. 781-793.

Photo by Gerry Lauzon, some rights reserved.

Nothing To Say

Posted on by Psychotherapy.net Team

Clair* walks into my office this morning as she does every week. She sits downs and looks up. “I’ve got nothing to say today,” she tells me. Sometimes, I say nothing. I just sit and wait. Something will come. The unconscious mind can often be counted on to send something forward into the silence. But sometimes I feel the need to help things along. “Well,” I say, “What’s most on your mind?”

Clair has been with me for a little over a year. We’ve sorted through some muck together. I’m not her first therapist. There’s been a lot for her to talk about over the years. With me, it was mostly empty nest syndrome, peeling back yet again the layers of her abusive childhood and her loving, but sexually dormant marriage. We’ve been over the sadness, the joy, the poignancy. We have been talking about making her sex life better. She is interested in this, only mildly. Seems like in these more senior years they are both okay with a collectively lower libido and comfortable companionship.

So today there is nothing pressing. We make small talk. The weather. The upcoming holidays. Less small: the anniversary of her mother’s death. A little more silence. We have an easy connection. Just sitting together is healing in its own way.

So we sit in quiet comfort for a minute or two.

“Did I ever tell you about the time I was gang raped?” She says.

I shake my head.

“I was sixteen. You know in the projects there was a lot of that.”

I nod.

“Funny. I remember it like it was yesterday. Don’t think I’ve ever talked about it to anyone before.”

“Hmm.” (me)

“There were six of them. All colors. Was like the United Nations. I was walking home from school, under an underpass. You could pretty much not be seen in there. Up closer to the bridge. It was a big underpass. One held me down. One was a look out. They took turns. ”

Silence.

“I wonder if that has anything to do with the nightmares I always have. You know, that one where I feel something holding me down. The one where I think someone’s hand is on my throat. I’ve have that one so many times. I guess I never put it together.”

Silence.

“Nah. Never mind. I don’t think that’s it. I think it’s something else.”

Nod.

Silence.

“Well. That was a long time ago. Funny. Hey, do you know that George (husband) wants to take everyone on a Disney Cruise for Christmas this year? I think the grandkids will love it. But I don’t know. The last one we went on was so crowded. The food was good. You ever been on a Disney Cruise?”

Shake.

Silence.

“I told my mother. She didn’t believe me. Told me to stop being so selfish, always trying to get attention. Well, she was drunk anyway. Time up?”

Shake. Gently.

“They had good Karaoke on the last cruise. George loves it. Of course he put on ten pounds.”

Nod.

“I should never have walked home that way. My eye was black for two weeks. I don’t even remember that part happening. Just my mother yelling at me for getting into trouble. I told her, ‘Ma, I was not fighting. I told you. I got jumped. They raped me.’ But she didn’t want to hear it.”

Nod. Slight. Gentle.

Say something Melissa. I am telling myself. Say something. Go ahead. There is so much to say. There is everything to say. There is this: Oh My God! All these years! And how did you manage? And how did you cope? And how alone you must have felt! And all those feelings! And by yourself! And your mother! And why now? And can you say more? And. And. And Oh my God. And Oh. Oh. Oh. Oh baby.

I know. I don’t think that it would have quite come out that way. If I spoke. If the words would come. But I don’t have the words. I have the feelings. I have the thoughts. I have the quiet safety of my office.

I am just here. Just with her in the story. I am back in 1966 under an overpass in the projects watching a sixteen year old girl get gang raped. And for now, just for now, I have nothing to say.

*Names and dates have been changed.

The Secret to Getting More Therapy Referrals from Smartphone Users

Posted on by Psychotherapy.net Team

The shift from desktop/laptop computers to mobile devices—especially smartphones—has progressed faster than anyone predicted. In most parts of the United States, it is now typical for over 50% of searches for therapists to happen on iPhones or Android phones. Google itself admitted in May 2015 that there are now more searches on mobile than desktop/laptop computers. And while Google commands only about 67% of desktop/laptop searches, they control over 80% of searches on smartphones.

On the surface this would seem like a bad thing for private practitioners: a smaller screen that can only show a tiny part of your website; more distractions through nearby apps; and even shorter attention spans than on computers (around 8 seconds according to a recent Microsoft study). Does this make internet marketing, already a very competitive endeavor, even more difficult to succeed in?

Not necessarily. The fact that people are searching on a phone that knows its location, and can communicate easily with the outside world is an enormous opportunity to generate even more referrals to your practice. To take maximal advantage of this opportunity, you will need to do five things:

1) Take Google’s Mobile Friendly Test—Google will severely penalize websites that are not deemed “mobile friendly” by their free test.

Google wants to see a “responsive design” that automatically reformats based on the size of the screen. They also want to see buttons that are large enough for human fingers to touch and spaced far enough apart to not be confusing to the user.

2) Be Sure you Have a Verified Google Profile—go to www.google.com/business and be sure your business has been verified and is active in the Google system, and that your address and phone number are correct.

3) Add TEXTING as an Option to Contact You for Initial Inquiries—to take advantage of the fact that texting has become the preferred mode of communication for many people of all ages, be sure you offer this option for people looking for a therapist. If you don’t want to use a real cell phone number, simply get a free number in your area code to use exclusively for texting at Google Voice and configure the settings so you get an email every time someone texts you. And if they text you, call them back, do NOT text them back.

4) Be sure options for phone, texting and email are shown at the TOP of every mobile page. People do not scroll down mobile pages very far.

5) KEY ITEM: Make sure that ONE TOUCH is all it takes to initiate a phone call, text or email to you. No one will copy and type in your numbers or email address.

TWO BONUS ITEMS:

6) If you use Google AdWords, be sure you are using Call Extensions to enable people to call you directly from an ad.

7) Get rid of those cute Social Media icon links on your mobile pages. The last thing you want to do is invite someone to socialize when they finally get to your page. The chances of someone contacting you after going to the multiple distractions of Facebook is essentially zero.

Using exactly these items, I have been generating over 60 calls and 20 texts a month to my psychotherapy practice. We all would rather get phone calls to our office than visits to our website, and this is the exact formula to make that happen. And the trend toward mobile is only going to accelerate in the coming years. Take advantage of this opportunity now!

Jill Scharff on Object Relations Therapy with Couples

Posted on by Psychotherapy.net Team

What is Object Relations Therapy?

Rafal Mietkiewicz: Jill, you are a renowned psychiatrist, psychoanalyst and object relations therapy expert. You’ve written and edited many books on object relations therapy so I’m wondering if we can start with just a basic overview of what object relations therapy actually is. It can seem like rocket science to beginning therapists.
Jill Savege Scharff: It’s an unfortunate term, “object relations,” but it was chosen in deference to Freud’s use of the term “object,” which refers to the object that the drive to be in relationship attaches to. Freud talked about the sexual and aggressive drives later in his life, the life and death drives. Fairbairn, who introduced the term “object relations theory,” talked about people’s main motivation being to be in relationship, not only for love an security, but also for a sense of meaning. Giving meaning to existence.

It’s not just the mother who gives meaning to the baby, but the baby who gives meaning to the mother, who becomes a mother because she has the baby to relate to and care for. Object relations refers to the internal psychic structure that develops from these early experiences.

RM: And as therapists our job is to search for these internal structures in our clients?
JS:
Intimate relationships provide an opportunity to rediscover the internal object relations in a new dimension—one that may help it grow and change.
You don’t have to search very far because that internal structure is written large in external, current relationships. The internal relations operate as a kind of design that leads people to repeat it in their current relationships—partly because it’s familiar, and they want to recreate what they know, and partly to have new experiences that, if they’re healthy and interesting and challenging may encourage new learning so that modifications in the original object relations can be made. Intimate relationships provide an opportunity to rediscover the internal object relations in a new dimension—one that may help it grow and change. Same is true in therapy. Does it still sound like rocket science, Rafal?
RM: Yes, a little bit. It seems like it would take a long time to unwind these long-term patterns, and that the therapy would go quite deep.
JS: It does take time to create deep character change. It can take a couple of years with couples.
RM: I am a working therapist, and I have my own experiences in both individual and marital therapy, but the idea of working with a couple for a couple of years sounds challenging, to be honest.
JS: Well, that’s more for couples who are looking for radical change. Some couples come in and just want a little adjustment. They want to settle a fight, or they want to decide whether or not to have a child, and it’s just a developmental intervention. A developmental challenge has got them stuck, and after few sessions they’re on their way. But others who have tremendous difficulties relating, communicating, establishing an intimate sexual relationship—these therapies take longer.
RM: So you distinguish between a developmental intervention and deep therapy.
JS: Well, you never want to do too much. You just want to do what people are looking for and what they need. With an object relations approach, which does operate in depth, even in a few sessions you can show a couple what that approach could offer them if they chose it, if they chose to invest in something more substantial.
RM: When you see a couple, what are the initial stages?
JS: First we do a consultation—not therapy—because I want to give the couple a chance to decide if they think we’re a good match, and I want to show them my style of working. Not every couple chooses to work in an object relations framework, which is basically psychoanalytic framework. Some are looking for a shorter-term approach, or a more structured approach, or a more direct of approach, in which case I’ll refer them.
RM: So the first stage is consultation.
JS: Yes, I’ll meet for maybe two or three sessions. Some people will meet with one partner once, the other partner once, and the couple once. But unless there’s a specific indication to do that, I usually prefer to just work with the couple.
RM: What would be the special indication?
JS: If there is an autonomous individual psychiatric problem, such as a deeply established substance abuse problem, I might want to meet with that individual to assess the extent of it and decide if individual treatment is a better option, maybe even a rehab program. Another indication is the wife or husband of a therapist. Sometimes, you’ll find that non-therapist is so far behind the one who is trained as a therapist, in terms of communicating emotional experience, that they sometimes need an individual session away from the therapist-partner in order to find the words to speak to the therapist partner.
RM: Can a couple’s therapist join these two functions, and do individual therapy with one person from a couple, while also doing therapy for the couple?
JS: That can happen as long as you’re very aware that your commitment is to the couple and that anything you do with the individual comes back into the couple meeting. That the confidentiality, for instance, pertains to the couple, not to the individual member of the couple. So let’s say the individual tells you about an affair that they haven’t told their partner, you would not reveal that personally, but you would suggest they bring it up in couples therapy. If they can’t do it, you probably find yourself unable to work with the couple because if you have a piece of information that you can’t use, it blocks you from being able to respond to all the clues that lead to that conclusion, which you can’t then make.
RM: You also can’t free associate, because you’re blocked from going in certain directions.
JS: You’re absolutely right. I was in Poland last week, and I heard that the Family Therapy Association is working on a statement about confidentiality and how it pertains to couple and family therapy.

The Couple’s Unconscious Life

RM: How do you assess whether a couple is suitable for object relations therapy.
JS: I’m looking for how they respond to any interpretations I make, to my overall presentation, to any links I make between the current struggles and the past. If I get someone who doesn’t want to deal with the past, who says “The past is the past and I don’t want to think about it,” they aren’t likely a good candidate for therapy with me.
If I get someone who doesn’t want to deal with the past…they aren’t likely a good candidate for therapy with me.
So I might say, “Well, okay, I can try to work with you just on the present, but I know that everything that happens now is informed by what happened before, so I don’t think that this kind of therapy will suit you. Do you want to try it and see it what it can do for you, or would you prefer something else?”

I always like to work with couples who can work with their dreams, but not all couples are willing to do that. Some think their dreams are very private to the individual. To me, once an individual tells a dream in couples therapy, it becomes a dream of the couple that the couple has shared with me and that helps me have access to the couple’s unconscious life. The whole of object relations therapy is geared to getting access to the impact of the unconscious on the relationship.

RM: What’s your technique for working with a couple’s dream?
JS: Well, first of all, I listen to the dream from the individual. Then I ask the individual what has occurred to them about the dream. Then, I ask the partner what comes up for them in relation to the dream. Then, as a couple, they’re now talking about this dream, and I look for their associations, my own associations, the feelings it elicits in them and myself, and I construct an interpretation of the dream and what it conveys about the current of their relationship and what they hope for, what they wish for, for themselves in the relationship.
RM: I have always found that working with dreams is great in individual therapy, but this opens a new ocean of possibilities working with couples. Once you’ve done the consultation sessions, and you’ve got the couple on board for treatment, what next?
JS: We agree on the frequency of therapy, which will be once or twice a week. I like my sessions to be 45 minutes, but for couples who come a long distance, we might work for an hour or an hour and a half, whatever suits them. But by arrangement, not just running over time; we agree ahead of time what will be the best format. I don’t do questionnaires. I just ask them to come into the room. They sit.

Can you see my room? [Interview is being done via Skype]

RM: Of course, I see two armchairs.
JS: There are two red chairs over there. They sit in those chairs. I sit back here near the desk. There is a couch down that wall, past the printer. Some couples will sit together on the couch. Sometimes one will sit on the couch in a rather narcissistic way while the other will perch on the chair. However they sit, it’s of interest how they relate themselves to me, how they relate to each other, in spatial terms.

And then I just ask them to say whatever they want to say. Just come in and start. I don’t ask questions. I just listen, and I respond. I think my manner is sort of socially appropriate, unobtrusive, nondirective. It’s not remotely analytic as we’ll sometimes imagine analysts to be. And I’m not saying all the time, “And what do you think about that?”

A Couple's State of Mind

RM: You’re not?
JS: “And how does that make you feel?” No, it’s more that we’re just having an open space conversation, really. And then, every so often, I’ll arrive at a construction of what I think has been happening and show them their repeating patterns of interaction and how they connect to their early experiences. How they treat each other as people from the past were treated or treated them. I’m very interested in helping them as a couple to develop what Mary Morgan calls “a couple’s state of mind.”

You get some couples who used to think as a couple, plan as a couple, and who, because of the strains and stresses of their life and the emergence of negative aspects of their characters, have lost that ability. And then other couples come in who have never actually had it.
You get some couples who used to think as a couple, plan as a couple, and who, because of the strains and stresses of their life and the emergence of negative aspects of their characters, have lost that ability. And then other couples come in who have never actually had it. They come as two individuals. Each one thinking what he or she is doing and not understanding that the marriage is a thing in and of itself that they each contribute to the shaping of, the nurturing of, the maintenance of. If they can learn to do that, then the marriage offers them a great deal.

It’s not just that the partners take care of and love each other, but also the partnership or marriage that they construct. I’m not saying they have to be married in a church or anything, but if they made a commitment to be together, and they nurture that relationship, it will then nourish them and support them through the life cycle and through the various challenges of having the first child, the first child leaving home, retirement—whatever comes through life.

RM: Is one course of therapy enough for a couple or do they tend to come in and out over time?
JS: I think most couples, if they work for a couple years and get to the appropriate developmental level, then they have the tools they need when challenges come up. But you can never predict what life will throw in the way of a couple, and some things might overwhelm their capacity to adapt. If that’s the case they may come back for another session or series of sessions.

The Death of the Couple

RM: What techniques do you use? Do you give interpretations?
JS: I’m a little bit allergic to the term “techniques.” It sounds like they’re little things you apply in various circumstances.
I tend to think of technique more generally as a way of listening, observing, waiting, holding anxiety, not jumping to action, not becoming directive, of always following the affect.
I tend to think of technique more generally as a way of listening, observing, waiting, holding anxiety, not jumping to action, not becoming directive, of always following the affect. It’s very important to always be listening for the feeling behind the words. We do that by listening to the tone, the rhythm of the speech, the hesitations in speech, pauses, slips of the tongue, of course. I’m always interested in any dream material that comes up that will give more access to the unconscious. Then we look for repeating patterns of interaction. We name them and ask the couple to think about why they need this particular pattern. In other words, what defensive function does this pattern serve and what is the anxiety that lies behind it? And there’s always another anxiety that lies behind the most conscious anxiety—fundamentally, the main anxiety is death of the couple. That is the main anxiety.
RM: Death of the couple?
JS: Yes.
RM: Can you say a bit more about that?
JS: Couples are usually not consciously thinking about it, but fundamentally it’s what every couple is worried about. The individual worries that his or her pathology will destroy the couple.
Every couple tries not to remember that one of them will die first.
They consciously worry that they’ll be left, abandoned, rejected, tossed aside, but fundamentally they’re worried that the couple will be destroyed. Every couple tries not to remember that one of them will die first, and no couple knows which one will die first, and no couple knows which one will be left when that happens.
RM: It’s frightening, of course.
JS: It’s very, very frightening when it begins to come to consciousness. As people, maybe in their 40s, they start to maybe lose one friend, or they’ll lose a parent, and they see what happens to the one who is left, then it starts to bear in on them, and they become conscious of that fundamental worry.
RM: How do you work on developing the couple’s state of mind?
JS: The therapist must develop the capacity to be impartial to each individual—or to be equally partial to both of them—but with an overarching commitment to the couple relationship. It’s keeping that in mind that marks the more advanced couple therapist. Someone who isn’t pulled to take sides but who remains neutral, or, if pulled to take a side, latches onto it and can interpret what has just happened. Name it as a skewing of the original intention that reflects a characteristic of the individual who initiated it and the partner who allowed it to happen—since it will likely be a pattern that happens in the relationship. And there you have it, in the laboratory of the couple therapy, where you can see it, examine it in relation to yourself, a couple therapist who doesn’t have all the investment of being a life partner.
RM: Do you have all these concepts in your head when you talk to a couple?
JS: No. I think we do all that theory as background, and if we get stuck in our work with a couple, then we pull out the theory and see if it can help us. But, there’s something very important that you haven’t asked me about, which has to do with sexuality.
RM: By all means….
JS: I’ve found that a lot of couples—or rather couples therapists—don’t actually ask about the couple’s intimate relationship. If a couple presents with a sexual problem they’ll respond to it of course, but they don’t always ask about it as part of the assessment, and I think it’s important to do that, and to not be inhibited about it. It’s just part of the couple’s life and should be considered along with all other aspects. Now, if there is a specific sexual problem, then the object relations approach, which is analytic primarily, has to include a behavioral component.
RM: I know this is hard to quantify, but can you talk about one of your biggest successes and one your biggest failures as a therapist?

JS: That’s really hard to do off the cuff. I mean, there are couples that break up—and in one way, that’s a failure of the couple therapy. In another way, that is a recognition of their differentiation and that the therapy has helped them to reach this very painful decision. Whether you call that a success or a failure is really debatable.
The couple that quits in a rage at you or in disappointment with you—that feels like a failure.
The couple that quits in a rage at you or in disappointment with you—that feels like a failure. It’s also a tremendous loss because you didn't get the opportunity to work with them on these intense feelings which, had they come back to work on them, could have been very useful to their relationship. As it is, they just go off with an idea of putting the bad object into you as if it will stay there, and they’ll be relieved of it. Of course, the bad object always returns, and they won’t have had a chance to really work on it. That feels like a failure to me.
RM: It’s painful, yes.
JS: Success is any couple that goes off, and you never hear from them again because they’re coping. You hope that is a success, but you never really know because part of our policy is not to do follow-up, not to intrude on people’s lives after they have ended their contract with you. That’s one of the sad things about being a couples therapist, is not knowing what happens with them—unless you hear about a couple by chance or unless they return as parents of a child, and they want you then to see their child. They’re doing okay as a couple, but because of the period that they went through when they weren’t doing okay as a couple, their child has built in certain personality characteristics that are hampering that child. So you see the residue of the couple problem in the child.

You can work with the child to get them back on developmental track, but at the same time, you see the couple as parents and how well they are doing both as a couple and as parents, and that’s very gratifying. You could call that a success.

RM: What’s your advice to new therapists?
JS: Get into treatment.
RM: Get into treatment.
JS: And get supervision. And then you can study and take courses. It’s constant work. And if you find a couple daunting, you are not alone. Couple therapy is the hardest work we do because a couple has such a tight bond. They are together because they fit at conscious and unconscious levels.

Success is any couple that goes off, and you never hear from them again because they’re coping.
As the couple therapist, you often feel either you’re breaking a boundary by entering the bedroom, as it were, as if you were a child in an Oedipal situation, or you feel terribly excluded because you can’t get in. You feel guilty about trying to get in. You feel confused, puzzled, rejected. It can be very uncomfortable working with a couple, and this is the reason many people don’t do it, I think. That’s why I say get into therapy and supervision. It takes a lot of personal therapy on the part of the therapist to understand how their own personality is constructed and how they tend to express themselves not only in their personal relationships, but in relation to the couples and families they work with.
RM: Jill, thank you very much.
JS: You’re so welcome. Delightful talking to you.

Hide-and-Seek in Online Therapy

Posted on by Psychotherapy.net Team

I thought we had our session today…

My client Jane was right, I had just missed the therapy session we had booked. It had not happened to me before, and I felt guilty.

Online therapists know how the virtual and body-less nature of the encounter makes it easier to fail each other, be it for the client, or for the therapist. The precious relational tissue seems even more fragile. I always attend to mending these ruptures as well as I can, but with Jane I had struggled. She had that particular quality which made her slip away from me as soon as our sessions were over.

Winnicott often came to my mind when I thought about Jane: “It is a joy to be hidden but disaster not to be found.” We all play hide-and-seek with others, and the therapeutic relationship we develop with our clients is no exception. A therapy room easily turns into a perfect place for hiding, with its couch, so inviting to hole up behind.

Jane was skilled in hiding.

The day we connected for our first session, her camera was off. All I could see was her profile picture, with her face concealed behind a pair of fancy sunglasses. It took me some time to convince her that seeing each other was essential for her therapy.

She finally switched on her webcam. She actually looked younger than her picture, her body language transmitting bubbles of anxiety.

Further on, Jane would typically connect from a poorly lit room, with a window behind her, darkening her traits against the light.

Or she would choose a place with a poor Internet connection to call me, her face blurred into a pixelated image.

Reflecting with Jane on her choice of having a therapy online, we ended-up realizing how much this was an integral part of her unconscious hiding strategy: the distance between us preventing me from getting too close, close enough to eventually find her.

She had come to see me about her binge eating and compulsive dating, but her main complain was about the shallowness of her relationships, her inability to get truly engaged with others.

When she finally trusted me enough to share her early history, I could discern its emptiness, a lack of emotional closeness with her depressed mother and alcoholic father. She never expressed anger or resentment towards her parents. She seemed indifferent, empty herself.

She was unconsciously inducing me to forget her, but what she craved for was to make an impact on me, to be remembered, and cared about. Emotionally, she was that child kept hidden behind a couch. Torn between the desire of closeness and the fear to be discovered, she felt consecutively manic or depressed.

Did she really want me to find her? Or was she comfortable and feeling safe in her dark hiding place? She would steadily turn up for our weekly sessions, and that made me hope.

Eeny, meeny, miny, moe… was I counting, every week, looking for her on my screen.

The more she pushed me away, the more I made it clear that she would always find me there for her, counting, seeking her out.

You are really stubborn. She once said, and I thought she would send me away with a simple mouse-click. But she did not, and we kept playing the old game.

My stubbornness responded to her need for consistency.

Eventually, Jane became convinced that I would not abandon the game. She had learnt to count on me. She did not completely give up her ‘behind-the-couch’ corner, but she allowed me in sometimes. Then we would sit there together, in the darkness and dust. Sharing that space with her, I often felt suffocating and anxious to get out, but at the same time terrified to be left there forever. Those moments were the hardest in the sessions with her, but they also helped me to understand how it really felt to be forgotten.

Jane’s therapy is finished for the time being. She went out of my screen, with her usual grin, and I wonder: was I able to make up for those who had abandoned her, hidden and forgotten?

I can only hope that our virtual hide-and-seek practice will have helped Jane to be finally found for real, by somebody in flesh and blood.

Statistics Don’t Lie…Except When They Do

Posted on by Psychotherapy.net Team

As I was working on my doctorate I became interested in home stereo amplifiers. Armed with a fellow doctorate student who possessed infinite knowledge in this area I began the search for the perfect amplifier.

My interest rapidly escalated into what could arguably have been diagnosed as a full-blown obsession. I visited stereo stores near and far. I read an endless stream of articles in the stereo magazines. I spoke with salesmen, saleswomen, and manufacturer's representatives. I attended stereo conventions. But most of all, I kept my eyes on the specifications of the various units. Ah yes, the statistics. Show me the evidence! My fellow grad student warned me not to put very much stock in specifications claiming that good numbers don't always translate to superb sound, but I knew better.

Statistics told the whole story. Finally, after nearly three years of nonstop research and spending at least as much time picking out a stereo amplifier as I did on my studies (okay, maybe a hairline more), I purchased a unit with "seriously good specs." A unit with triple digit distortion of .005—so low your dog couldn't hear it.

I hooked the unit up and to my chagrin, it sounded tinny! Convinced it was my speakers, I replaced them. It still sounded thin. (Stereo talk for tinny.) I bought speaker wire that cost more than my wardrobe and cables with a thickness rivaling my wrist measurement. No improvement was noted.

On a whim I purchased a used bargain basement priced amplifier for less than a twenty dollar bill at a pawn shop. To me it sounded much better than my expensive model. I could blame it on my hearing at the time except that everybody who auditioned the two amplifiers like the old cheapie with the "crummy specs" better.

While struggling with my stereo amplifier addiction I was able to secure my doctorate and a few years later I landed a job as a program coordinator at a major metropolitan suicide prevention center.

Because suicide was the one of the top three killers of teens (it still is) and one of the top ten causes of death for all age brackets (here again, it still is) I gave lots and lots of suicide prevention speeches. I often responded to crisis situations at schools, churches, and even major corporations, and helped run a suicide survivor's group for those who lost a friend or loved one. This continued even after I left the center. I stopped counting when I had lectured to approximately 100,000 people on this life and death topic including quite a few seasoned psychotherapists.

My point is merely that my lectures and professional activities allowed me to meet literally thousands of people who in some way, shape, or form, had been touched by the act of suicide or a suicide attempt.
Now one of the key points in my lectures was to tout the benefits of a suicide prevention contract or what experts and ethical bodies would later dub a "no suicide contract."

But, enter statistics or evidence-based practice (EBP) also known as evidence-based treatment (EBT). According to the purveyors of these numerical meta-analyses, suicide prevention contracts don't work. Even some major suicide prevention organizations and top experts in the world have adopted this stance.
What? Really? You're kidding, right? Tell that to the over-the-road truck driver who approached me after a public speech to share that he was only alive today because his eighth grade shop teacher made him sign a suicide prevention contract. Tell that to the woman in one of my college classes who volunteered that she would not be in my class if it had not been for a caring high school guidance counselor who insisted she sign a no-suicide contract in her sophomore year. "I'm a woman of my word," she told me. And what about the woman in group therapy with me who pulled a no-suicide contract out of her purse to show me. The white paper was yellow inasmuch as the document was now over 25 years old. "This saved my life," she said with tears in her eyes.

These are just three of the many cases I heard over the years. I could go on, but I think the point is obvious. Even if you can show me 100 more cases, or even 1000 where contracts didn't work, I will show you the ones where these simple contracts clearly did. Science is often what works and if a contract saves a single life then it was worth it.

Now in defense of the EBT crowd who renounces these contracts, many experts do recommend a beefed up version of the document called a safety plan. Others in this camp prefer a commitment-to-treatment document. Yes, safety plans and their second cousins, commitment-to-treatment plans, are possibly superior. But in the real world there are often times when a clinician does not have the luxury of drafting a long, drawn out, document.

In such instances, a therapist or hotline worker should do his or her best to get a short verbal, or better still written, no-suicide contract. I personally think it is downright unethical not to use the old tried and true contract. And my fear is that if we teach upcoming professionals this information they may well do nothing if they don't have the time or information to draft a full-fledged safety plan when a life is on the line.
If the average shoe size is statistically an 8M and you wear a 6W would you buy the 8M? Well, would you?

Statistics don't lie . . . well, except when they do. And a life, unlike a shoe size or a brand of stereo amplifier, is too valuable to base on a few research studies that could easily be refuted in the coming years.

The British Prime Minister, Benjamin Disraeli once quipped, "There are three kinds of lies: lies, damn lies, and statistics."

I think the Prime Minister might have been on to something.

Lynn Grodzki on Building a Successful Private Practice

Posted on by Psychotherapy.net Team

Vocation vs. Occupation

Rachel Zoffness: Lynn Grodzki, you are a business consultant, therapist, and author, and you recently put out a second edition of your book, Building Your Ideal Private Practice. I’m really looking forward to learning from you today.
Lynn Grodzki: Thank you.
RZ: It’s an interesting challenge that therapists face when we finish grad school because we have so much training, and yet we know so little about the business side of things. Starting a private practice can be really overwhelming. When I passed my licensing exams, I was shocked by how hard it was to find even basic guidelines for how to start a private practice. I ended up meeting with mentors and friends in the field to try to find my way. What are your suggestions for therapists to shift into more of a business mindset when first beginning their practice?
LG: Well, first of all, I just want to validate your situation. When I was getting my graduate degree as a social worker, I also was surprised that they didn't include any information about practice development, and I found that that was pretty true of a lot of graduate programs.
A lot of therapists have never been trained in developing business plans, and so they end up just making do with whatever comes their way instead of planning and working toward pre-meditated goals.
I had been in small business prior to being a psychotherapist, so there was a lot about business that was familiar to me. I started out teaching classes and courses to therapists because I wanted to see them succeed, and as I worked with them over time, I saw that there were a few fundamental issues therapists faced right out of graduate school.

One is that they don’t seem to have an understanding of the difference between a vocation and an occupation. With an occupation, you really want to do things in a business-like way, but a lot of therapists see that as an affront to their idea of a vocation. It’s almost as if they’ll run their private practice as a hobby instead of a business.

An additional challenge is that a lot of therapists have never been trained in developing business plans, and so they end up just making do with whatever comes their way instead of planning and working toward pre-meditated goals.

RZ: What’s the best way to write a business plan, if you’ve never done it before, and you’ve never been to business school? Does every new therapist in private practice needs to hire a consultant?
LG: There’s lots of information out there, including my books and other books, so that you don’t have to hire anybody—you can read and get informed. But to have a business plan means that you have an idea of the kind of path that you want your practice to take. A really quick way to assess things is to think about your business strengths and limitations. In other words, what do you think you’re good at and what do you feel like might be limiting for you? You came out of a graduate program—what did you feel were business strengths that you might’ve just naturally had, and what were limitations you were aware of?
RZ: When I came out of grad school, I didn't even know what a business strength was. I wouldn’t even know how to put that into words for you.
LG: I often have a list of attributes that I feel are entrepreneurial skill sets. I’m going to talk you through a few of these, and I bet some of these really fit for you. Okay?
RZ: That would be so helpful.
LG: Entrepreneurial people who are successful, when they look at a situation, they often see opportunity. Therapists are very good at this, too—somebody comes into your office and tells you about their situation, and a lot of times, from your perspective, you see what’s possible. Would you say that that was a skill that you might have?
RZ: Absolutely.
LG: Here’s another one. Entrepreneurs have an equal measure of optimism and pragmatism, so they can see what might happen, and they can also be very concrete about the steps that they need to take. How would you do on that one?
RZ: I think I’m temperamentally pretty optimistic, but I don’t know that optimism would’ve been the best word to describe me when I was first starting my practice. I felt kind of bumbling, like I didn't really know what I was doing.
LG: So that would be one where you might think, “that’s one that I need a little bit of help with or I need more information about.” Here’s another one. Entrepreneurs are extremely persistent, and that means that if something doesn’t work, they don’t mind trying it, oh, another 100 times or so.
RZ: I think this is really a wonderful line of thinking because when I think about my strengths, having gone through two master’s degrees and a PhD program, that certainly took a lot of persistence. And here I am in private practice, and I do have my own business, and yet I’ve never even used the word “entrepreneur” to describe myself. I love that you’re using that word.
LG: It’s just a word that means that you own and operate a business. Here’s another one that’s very clear with people who succeed in business. They’re profit driven, and they enjoy making money. How would you say you feel about that one?

Money Issues

RZ: I think you’ve hit on something because I really struggle with the money aspect of my business, in part because I went into this field because I love helping kids. I’m a child psychologist, and I really struggle to set a fee that reflects my value, and part of that is because I worry that families won’t be able to afford my services if I charge more. I don’t want to be the kind of therapist who is thinking about money over people, but that is not a good business strategy. How do you help therapists establish that balance between being a therapist who’s really focused on people and relationships and being a business-minded person who’s focused on establishing a rate that’s fair but will still allow me to earn a decent income?
LG: One of the things that I do when I’m working with therapists is talk about the importance of understanding the negative belief systems they’ve developed about money. It’s very common and it’s not just therapists that have negative belief systems about money. It’s many people. It usually doesn't matter that much if you have these kinds of emotional issues about money, except when you own and operate a business because then it tends to get projected into the business.

I’ll give you an example. Let’s say you grew up in a family where there was a lot of financial deprivation, and you grew up hearing things like, “money doesn't grow on trees.” Or you grew up in a family where frugality was really prized, and that’s the way you live, and that’s the way you are, and it’s really not an issue for you until you start a business. In business, the mantra often is, “you have to spend money to make money,” and it’s really true. You cannot run a business on total frugality and be able to expand or take advantage of opportunities, and it even affects your relationships with colleagues if you're too frugal. They will find you cheap but not understand that it’s not a reflection of your skill set or the way you might be working with clients.

It’s just something about the way you grew up financially that says that you don’t have thank you cards that you send when you get a referral, or that you don’t believe in going to conferences, or something like that. One of the first steps I like therapists to do is to at least get some awareness about any of these negative money issues that might be playing into who they are and how they operate so that they can clear those up and start to look at this as a business.

The definition of a business is an entity that makes a profit, which takes us to another really key issue, which is that therapists need to reconcile profit versus service.

RZ: What do you mean by that?
LG:
Profit means financial gain, taking advantage of and moneymaking, and service means being of assistance, helping others, and benefiting the public. When you are in private practice, you’re doing both.
Profit means financial gain, taking advantage of and moneymaking, and service means being of assistance, helping others, and benefiting the public. When you are in private practice, you’re doing both. Because it’s a business, you need to make a profit, and because it’s your service that you’re offering, you have to hold true to the integrity, and the ethics, and the values of service, and you have to have a way to reconcile this inside yourself and in your practice.

Having a Niche

RZ: When I was first starting out, people kept telling me to have a niche. I am a cognitive behavioral therapist who works with kids and teens, and I thought that that was pretty specific, but I was also afraid of missing out on opportunities or potential clients. Now my practice focuses primarily on kids and teens who have chronic pain, and I’m starting to see why it’s so important to be able to be identified as a person who sees a specific population. In your eyes, what do you think are the pros and cons of establishing a niche?
LG: Well, from a marketing perspective, it’s really helpful to have a niche because there’s so much information that’s flooding everybody that if somebody can associate your practice with something specific, it makes your practice more memorable. So for marketing purposes, it’s a good strategy. In my book I talk about the therapy services that sell versus those that don’t, and one of the services that continually sells well are services for children because most parents will prioritize whatever kind of help their children need. In terms of the kind of practice that you develop, apart from marketing, chances are you can have a practice that’s more generalized over time if that’s what you prefer clinically. But from a marketing perspective, it’s still very useful to have a niche.
RZ: Do you think you can be pigeonholed by your referral sources if you end up marketing yourself as a therapist who just does one thing? What ends up happening if a couple years down the line you want to start seeing clients who have different presenting problems?
LG:
One of the services that continually sells well are services for children because most parents will prioritize whatever kind of help their children need.
Another marketing mantra is to be a big fish in a small pond. So rather than trying to reach out to everybody, it’s good to develop expertise and a reputation within a target audience, but that doesn't mean that you can’t have more than one target market. You could be a specialist in some kind of service for children, like doing CBT for some specific area for children. And let’s say, over time, you also wanted to become a couples therapist. You could certainly target another market, and your work with children would help their parents, so it would be a smart marketing move to make.

There’s nothing wrong with having more than one specialty area or more than one diversification in your business, but you want to do it in a planned way so that you are marketing and making the best use of your marketing dollars rather than just doing things based on anxiety.

RZ: Does that mean that every time you want to expand your practice and see a different population you need to rebrand and remarket yourself?
LG: You might. It depends how you approach your marketing. It’s not a cookie-cutter approach, where one size fits for all for all private practices and all therapists. It’s really customized.

There are hundreds of strategies of marketing that all work for different therapists, so the question is, how can you customize a marketing plan so that it works for you, so that you are always in your comfort zone when you’re marketing, so that the way you speak to other people, the way you advertise, the way you use your website, the kinds of activities you do are really comfortable and feel a lot like who you are?

RZ: What are just some basic marketing tips you would give to someone who’s just starting a practice?
LG: The first thing that you want to do is to develop your business identity. You want to have a website. You probably want to have a “Psychology Today” listing or some directory listing. You want to have a business card. You may want to have white papers. You might want to have a brochure. You want some materials that you’ve developed, and the great thing about taking the time to do that with some care is that it also gives you talking points.

We know from the data that we have that

50% of referrals these days are coming online to therapists.
50% of referrals these days are coming online to therapists. So you want to have your online presence be indicative and reflective of you at your best and what you feel like you have to offer. But you also then need to start to build community around your practice. You can’t just do it online—you need to network, to show up in places where you can have some collegial referral building and sharing with others. You need to learn how to talk about your work in a way that generates some referrals back to you.

The Tall Poppies

RZ: Marketing does seem to be a particular challenge for therapists. I find that it’s very hard for me to say nice things about myself, even though I know I’m supposed to highlight my strengths to attract clients. I’m even wary about telling about my extensive training, despite the fact that it’s relevant to potential clients, and they often want to hear about my training because it gives them faith about my skills and abilities. What would you say is a good way for therapists to talk about their strengths and their positive qualities without sounding arrogant?
LG: It’s interesting, I was giving presentations in Australia one year on practice building and talking about how to talk about your practice, and somebody raised their hand and said, “Well, we can’t do that over here, Lynn, because of the tall poppies.” I had never heard about the tall poppies in Australia.
RZ: Nor have I.
LG: The idea was that the tallest poppies in a field get cut down first, so you don’t want to stick your neck out or raise yourself above the others. You want to be modest. You want to be humble so that you don’t get cut down like a tall poppy. So in Australia, as well as with therapists, we have that same culture.

But it’s important to be able to share your enthusiasm and your passion for the work that you do. What’s most attractive when you’re talking with other people is the fact that you love your work, or find it interesting, or feel very good about what’s happening clinically. You want to have a way to talk about that normally and comfortably so that it sounds like you, in layperson’s language. If I was coaching you—and you’re a CBT therapist, right?

RZ: Yes.
LG: OK, let’s say you wanted to talk to people, maybe friends who have children, and it’s not that they or that their kids would be your clients but that they might become your referral sources once they understood what you did. So if somebody said to you, “Hey, Rachel, what’s new?” You might say one of the things that was new was that you were really enjoying your work these days or that you were seeing fascinating cases. That would be a great way to let somebody know the kind of work you do. And you’d want to be able to explain what CBT is in a phrase or two so that you don’t bog down the conversation.
RZ: So language is important. Word choice is important.
LG:
You want to have some talking points about who you are, what you do, and why you love what you do so that you could turn a normal conversation into a conversation about your work.
Language is important. One of the things I often say to people who are doing CBT is to use a phrase like, “These days, it’s the gold standard in talk therapy.” That’s something that a layperson or even somebody who might be an alternative healer, a massage therapist, a nutritionist, an occupational therapist might understand and remember. You want to have some talking points about who you are, what you do, and why you love what you do so that you could turn a normal conversation into a conversation about your work. That’s what business people do—they talk about their work. We want to be able to do that, too, when it’s appropriate as therapists.
RZ: I feel very lucky because I do love what I do, and I’m very passionate about it and energized by it, and I love the kids that I work with, but I’m wary of sounding like a walking advertisement. So what are some key components to having a good elevator pitch?
LG: I have a whole chapter on that in my book, and rather than an elevator pitch, I call it your “basic message.” It’s what’s true and basic about what you have to offer. You want to keep it short, you want to keep it filled with some enthusiasm or passion or interest so that you look good when you’re talking about it, and you just want to learn to love to say it, whatever it is. It can be what you specialize in and why you feel like it’s important. It could be some kind of a metaphor about the way that you work and how it works.

It’s not so much the words. It’s how you look and feel saying this that somebody’s going to remember. They’ll remember, “ahh, Dr. Zoffness was really passionate about her work. I bet she’s good at what she does.” You just want to find the right words that put a smile on your face or put a twinkle in your eye when you’re saying them.

RZ: That sounds very intuitive and very smart.
LG: And easier, right?

Your Ideal Client

RZ: I also noticed in your book that you talked a lot about finding your ideal client, which really resonated with me because, as I mentioned, I do a lot of chronic pain work with kids and teens, and at first it was really hard for me to find out how to find the kids that need me. I know they're out there, and I know I have the training to help them, but I wasn’t sure how to reach them. So I ended up walking into pediatricians’ offices with my CV and, more recently, I reached out to really smart doctors at UCSF and Stanford. Starting to build those relationships has helped me get in contact with those kids. What would you say is the best way of finding your ideal population, if you're just starting out?
LG: I like what you did a lot. You started to build a profile of who the children are that need your services and found a way to describe this child that really needs to see you so that a busy doctor in a hospital could remember this. One way to say that is, “Here’s the kind of child I’m best for,” and you describe it almost in bullet points. You know, a child who’s suffering from this kind of pain, a child who has this kind of capacity to use therapy, a child who is comfortable using their imagination or can write in a notebook. Whatever the things are that would help a doctor or another professional start to spot those kids that were right for you—that’s how you develop your ideal client.

You're doing the work for the referral source. You’ve already thought about this. You’re pulling together the words. You’re giving them the talking point so that they can take that message and say to a parent, “I have a psychologist that’s right for you because this psychologist is really good at working with kids just like your child.”

RZ: So finding the language that describes the kind of client you want to see and also finding the people who would know those kinds of clients.
LG: Yes. And this is what belongs on your website, and maybe in a brochure so that that after somebody meets you and talks to you, if they go back to your website, they see it repeated there, which gives people a sense of security and confidence.
RZ: It’s fairly easy for me, because of my personality, to reach out to people that I’ve never met before or to walk into a pediatrician’s office and introduce myself, but I know that that is not standard. What do you think is the best way to go about meeting other professionals, doctors, teachers, pediatricians, etc. for people who may have more difficulty networking with strangers?
LG: Well, these days, we know it’s hard to get past the front desk in doctors’ offices.
RZ: Yes, that’s true.
LG: So I have a couple different strategies that I like to recommend to therapists, and all of them are based on the idea of not doing a cold call. Even if you have a very small circle of acquaintances and friends, all of them know people that might be right for you to meet.

Even if you have a very small circle of acquaintances and friends, all of them know people that might be right for you to meet.
The challenge is writing the introductory letter or making the introductory phone call. You want to script it out if you're not comfortable just talking extemporaneously, so that you can say, “Hi, my name is Lynn Grodzki, and I’m a masters level clinical social worker in your area, and Joyce suggested that I talk to you because she knew that I had a certain skill set that she felt would be helpful for your patients. Can I set up a time to meet with you? Or I can also write to you if you prefer. What would be the best way for us to contact and connect with each other?”
RZ: So, the first step is communicating with your friends and colleagues, who you already have an established relationship with, and saying, “This is what I want to do. These are the people I’m looking for. I’m looking to grow my business.” And hopefully they connect you with other professionals who might be able to help you. And then, the next step is to email those professionals?
LG: Well, it depends. You have to find out. Sometimes you have to call a front desk or make an initial phone call to find out how would they like to get information from you, because everyone is different.

Another thing that I’ve had some therapists do who want more contact with doctors is, on their intake forms, have them get consent from patients and clients to connect with their health professional team so that they can start to set up an integrated healthcare process just by reaching out to those people who are treating their patients.

For example, let’s say there’s an internist, and you’re seeing their patient for depression. You get permission from the patient to contact the internist and then send a letter that goes into the file saying, “I wanted to introduce myself. I’m working with your patient. I’ve been given permission to contact you. I wanted you to know about the work that we’re doing together so that, if at any time in the future you have any concerns about this patient, you can connect with me and contact me, and we can speak.”

Imagine that this doctor is seeing the patient and all of the sudden feels uncomfortable at the level of anxiety or depression that this patient is showing. He’s already got a letter from the therapist in the file, with permission signed to contact them. That’s what happens in an integrated healthcare facility, except in this case you’ve initiated it on your own. At the same time, it’s giving you a great way to start to connect with other healthcare professionals who might remember you when they have a referral to make.

When Your Client Count is Down

RZ: Our business is unusual in that we can’t rely on having the same income from month to month because it depends on how many clients we have. In your book, you talk about living with that uncertainty. Can you talk a little bit about that?
LG: This is true in any small business. There is no guarantee, usually, about what your income is going to be month to month unless you have some kind of yearly contract that you're working under.
I strongly encourage therapists to be tracking their finances, to be tracking their client count, so that they can know what the ups and downs are in their business, and they can start to think about what they want to do to protect their income.
So for a private practice, you need to anticipate these ups and downs and have a way to both budget for them financially and also to deal with it emotionally so that when the business is down, you have a strategy for what to do. Then you kick into your marketing strategy when you start to notice that your client count is down. I strongly encourage therapists to be tracking their finances, to be tracking their client count, so that they can know what the ups and downs are in their business, and they can start to think about what they want to do to protect their income.

It’s not unusual, for example, for someone I’m coaching to say, “I’m down this month in my client count. Let’s talk about the things that I could do to reach out to people.” When this person is very full, they don’t have the time to do that kind of outreach, so we’ll have a plan ready for when they’ve got time on their schedule.

If you’re not tracking carefully, it’s really hard to do this, and it just lends itself to getting into a situation where you're really low with clients and then feeling really desperate.

RZ: What’s a good way to deal with the fact that there are going to be times where your business has a lull, and there are going to be times when your income isn’t what you want it to be or your client load isn’t what you want it to be?
LG: I think understanding the nature of private practice, that it just goes up and down, and having some self-care ways to calm your anxiety. Private practice really isn’t for everybody. There’s a 50% failure rate in small business, even now.
RZ: That’s significant.
LG: You have to have a thick skin and a strong inner core to ride out all the ups and downs, and that’s why some people decide “I don’t like this,” or “it’s too much work,” or “it requires business and marketing skills that I’m not comfortable with and I’d rather work for someone else.” That’s a fine decision to make, but if you are going to do this, you have to accept the whole package. There is a chance for a lot of autonomy and creativity and independence and profitability, but there is also uncertainty, some randomness, chaos, and you have to be able to structure yourself.

It’s Hard to Be Your Own Boss

RZ: I really like that you mentioned self-care, and I noticed that it’s really hard to be your own boss. I constantly find myself working when I should be resting or playing. How do you establish boundaries for yourself when you're in charge?
LG: Well, I live by my calendar. I really lean on the calendar. And if you were to look at my calendar, you would see self-care is in my calendar and my family time is in my calendar.
RZ: You literally schedule it in.
LG: