Author: Psychotherapy.net Team

Psychodermatology: Understanding the Mental Health Component of Skin Conditions

Posted on by Psychotherapy.net Team

There is a relatively new subspecialty within dermatology that is of interest to therapists. Psychodermatology, the study of the connection between the “mind” and the skin—or an understanding of the psychosocial context of skin diseases—is giving many patients a new lease on life. While we’ve always known that there is a connection between mental health and certain skin conditions, we’re now finding that this connection runs much deeper than scientists first believed. For example:

  • Among patients with disfiguring, chronic skin conditions, the prevalence of psychiatric disorders is 30% to 40%.¹
  • Significant stress and anxiety have been reported in 44% of patients before the initial flare of psoriasis, and recurrent flares have been attributed to stress in up to 80% of individuals.²
  • The prevalence of psychiatric disorders among patients with skin conditions is greater than in patients with brain disorders, cancer, and heart issues combined.³
So, what can psychotherapists do to recognize patients who could benefit from seeing a psychodermatologist or drawing connections between their skin conditions and their mental health? Continue reading for tips to guide your recognition and treatment of psychodermatologic conditions. How to Identify and Treat the Symptoms Symptoms to look for in patients include any skin condition, including severe acne, eczema, pruritus (itching), psoriasis, vitiligo, and others, that may arise at the same time as particular mental health challenges. If you notice a skin condition, ask your patient to tell you about it. Find out what makes it worse or better and when they notice flare-ups. You have to become a bit of a detective at first until you can teach your patient how to start connecting dots for themselves. Certain patterns may be obvious, while others will require further investigation. But once you discover a connection between the brain and skin, you can dig deeper to better understand the nature of the connection. The goals of psychodermatology are:
  • To investigate the emotional impacts of a patient’s skin condition,
  • To help the patient work through these emotional impacts,
  • To reduce the threats posed by these emotional impacts,
  • To help the patient develop coping mechanisms for if and when a recurrence occurs
With patient-centered approaches to explore the patient’s feelings, concerns, and experience regarding the impact of their condition and with cognitive behavioral therapy, you can begin to reveal a clearer picture of what stimuli and stressors contribute to the physical manifestations of a patient’s emotional condition. For example, suppose you have a patient who you’re treating for depression and social anxiety. During one therapy session, you notice eczema on the back of your patient’s hands. You enquire—just as you would when assessing any physical behavior. Your patient discloses that ever since they started a new job, their eczema has gotten worse. Armed with this new information, you can have your patient jot down when flare-ups occur and bring their notes to sessions with you. Together, you can collaborate to spot patterns, which can help you create a timeline. From here, it’s time to focus on healing from the inside out. Working with Other Health Professionals While many conditions can be eliminated through psychotherapy alone, patients experiencing any of the above symptoms often benefit from an interdisciplinary approach. Many dermatologists understand that while they can treat the physical manifestations of a patient’s mental health condition, patients often also need mental health professionals, like psychologists, psychiatrists, or psychiatric mental health nurse practitioners, to target the source of the skin condition. One good strategy may be for therapists to seek out partnerships with dermatologists in the know.? Also, if you see patients who suffer from compulsions or skin conditions, such as skin picking or hair pulling, which you know have a psychological component, referring them to a psychodermatologist can be especially productive. While any dermatologist can prescribe drugs to treat the physical skin condition, working with someone who understands the deeper connection can be the ticket to deeper healing for particular patients. Ultimately, psychodermatology is all about improving quality of life by healing the skin condition and enhancing the patient’s emotional state. When we give our clients the tools they need to find true healing from the inside out, we show them that the journey to healthy skin and mental stability is a path they can walk. Case Application Glenda, a 21-year-old-woman, was referred to my office by her dermatologist because of anxiety that heightened when asked questions about her visibly red, scaly and raw-appearing rash on her hands and forearms. She insisted that she must be allergic to the soap she had been using and possibly the prescription cream that her primary care physician (PCP) had prescribed. Glenda had been examined by her PCP for her rash three times over the past few months and diagnosed with contact dermatitis, allergic dermatitis, and possibly eczema. Her PCP also prescribed a steroid cream and instructed to wash her hands with hypoallergenic soap and apply Aquaphor healing ointment daily. Glenda’s dermatologist took a thorough medical history and asked her about having repetitive thoughts that may be causing her distress. Glenda started to talk about the stress she has been experiencing over the past year due to COVID. She talked about staying up late at night worrying about getting infected with COVID and spreading it to others. She began to wash her hands multiple times a day. She shared that she had always frequently washed her hands, but now felt compelled to carry out a hand washing ritual—hand washing, turning the cold water on and off four times, then washing her hands, scrubbing until she counted to 30, turning the cold water on and off four more times, then applying hand sanitizer and rubbing it into her skin for 30 seconds. Lately she had been washing her hands every half hour and had been applying extra hand sanitizer to make sure her hands were clean, since washing her hands made her feel less anxious about getting COVID. She believed that carrying out this ritual had the additional benefit of protecting her family. At that point, the dermatologist explained that her skin rash and anxiety were interconnected, prescribed a hand ointment that promoted healing, and referred her to my outpatient mental health practice for an evaluation. After taking her medical and psychological history, I asked Glenda “What is your story?” to provide her with an opportunity to construct her personal narrative and share her experiences and beliefs about her current psychosocial circumstances. She opened up about her repetitive hand washing behaviors and worries about COVID that “hijacked” her brain. As a first-line intervention, cognitive behavior therapy for OCD directed at her behavior (compulsions) and cognitions (obsessions) made good sense. Sessions with Glenda included cognitive restructuring, psychoeducation, imagery exposure, self-monitoring, relaxation training, coping skills development, and self-care to alleviate her OCD-related distress. Relapse prevention was used to reduce the occurrence of initial lapses and to prevent any lapses that might escalate into a full-blown relapse. For homework, journaling was used to help Glenda identify harmful patterns of thoughts, emotions and actions and to develop techniques to help her better cope with uncomfortable feelings.

***

The collaboration between two specialties, dermatology and mental health, enabled this patient to have her psychological and physical needs treated holistically and simultaneously.  References: 1.  Goldin, D. (2020). Concepts in Psychodermatology: An overview for primary care providers. The Journal for Nurse Practitioners, 17(1), 93-97. 2.  Jafferany M. (2007).Psychodermatology: A guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry, 9(3), 203-13. 3.  Ghosh S, Behere R.V., Sharma P, & Sreejayan K. (2013). Psychiatric evaluation in dermatology: An overview. Indian J Dermatol., Jan;58(1), 39-43. 4.  Azambuja R. D. (2017). The need of dermatologists, psychiatrists and psychologists joint care in psychodermatology. Anais brasileiros de dermatologia, 92(1), 63–71.

Overcoming the Pernicious Chronicle

Posted on by Psychotherapy.net Team

Therapy stagnates when patients doggedly chronicle the events that have occurred since their last session or when they use all their therapy time to recite their grievances, bewail the injustice of their situation, and air their resentments. The therapy, in short, fails to fulfill a treatment plan. The misuse of these sessions can lead to “interminable” outcomes, where patients continue to catalog their problems but do not modify or alter how they deal with them. The therapist can be caught up in this paradigm, resigned to listening and sympathizing without making any meaningful headway in helping these patients recover.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Worse yet, the therapist may become comfortable with this covert contract: “If you tell me your troubles and adventures, I’ll listen and make occasional wise remarks, I’ll even offer you some advice, but little will change in your life due to our therapy. You’ll be comforted, and I’ll be compensated.” This arrangement can go on for years, even decades, and only end if the patient can no longer pay, by the death of either party, or by the therapist’s retirement. A colleague of mine used to refer to these patients as “psychiatric annuities.” To him, they were an income stream providing steady payments that would support his earnings “forever.” The patient will never reach the therapy’s goals (if indeed there ever were therapy goals!) and instead become so dependent on the therapist that their lives will be diminished instead of enhanced by their treatment.

Some therapists feel comfortable with this long-term arrangement. Sessions with these patients are predictable and require little or no effort. They might even grow fond of this long-suffering patient and wouldn’t want to trade for a new case with all its uncertainties and hard work. And they’re getting paid for little or no work. If asked, these therapists might argue that they are providing “Supportive Therapy.” This rationalization adds insult to injury: The patient is incapable of change? Are they so damaged they need a weekly boost from a therapist to tell them how to live their life? Does the therapist need a therapy-dependent patient, hanging onto every word, to boost his or her own self-esteem? What is being supported? The status quo?

A real regard for the patient’s benefit, not to mention simple professional ethics, requires that all of us resist the siren’s call of these cases and, instead, interrupt the chronicle, reinstate active treatment, and forego the insidious pleasure of these unworkable, so-called supportive arrangements.

A Matter of Death and Life

Posted on by Psychotherapy.net Team

Excerpted from A Matter of Death and Life by Irvin D. Yalom and Marilyn Yalom, published by Stanford University Press, ©2021 by Irvin D. Yalom and Marilyn Yalom. All Rights Reserved.

Numbness, 50 Days After

Numbness persists. My children visit. We take walks in the neighborhood, cook together, play chess, and watch movies on TV. Yet I remain numb. I feel uninvolved in the chess games with my sons. Winning or losing has lost significance.

Yesterday evening there was a neighborhood poker game, and my son Reid and I both played. It was the first time I’ve ever played together with one of my sons in a game of adults. I’ve always loved poker but at this game, at this time, I could not shuck the numbness. Sounds like depression, I know, but still I took pleasure in seeing Reid’s happiness about winning thirty dollars. As I walked back to my home, I imagined how good it would have felt to arrive home, be greeted by Marilyn, and tell her about our son’s winning night at poker.

The following night I try an experiment and place the portrait of Marilyn in plain view in the room while my son, his wife, and I watch a movie on TV. But, after a few minutes, I feel so much tightness in my chest that I again put Marilyn’s portrait out of sight. The numbness persists as the film proceeds. After about a half hour, I realize that Marilyn and I had seen this movie several months before. I lose interest in seeing it again but remembering that Marilyn had enjoyed it a great deal, I honor the bizarre notion that I owe it to her to watch the entire film.

“I notice that the numbness recedes the first few hours of the day when I am immersed in writing this book and also when I work as a therapist”. Today, a woman in her late twenties enters my office for a consultation. She presents her dilemma. “I’m in love with two men, my husband and another man I’ve been involved with for the last year. I don’t know which is the real love. When I’m with one of them, I feel that he’s my real love. And then the next day or so I feel the same way about the other man. It’s as though I want someone to tell me which one is the real love.”

She discusses her dilemma at length. Midway through the session, she notes the time and mentions that she had seen my wife’s obituary. She thanks me for being willing to see her at this difficult time. “I worry” she says, “about burdening you with my issues when you’re suffering such a huge loss.”

“Thank you for those words,” I reply, “but some time has gone by, and I find that it helps me if I’m engaged in helping others. And also, there are times when issues arising from my grief enable me to help others.”

“How does that work?” she asks. “Are you thinking of something that may be helpful to me?”

“I’m not clear about that. Let me just ramble for a minute. Let’s see . . . I know that getting involved in your life in this session temporarily diverts me from my own. I’m thinking, too, of your comment that you don’t know your real self and that you cannot know which of these two men the real you really wants. I keep thinking about your use of real. I feel this may be tangential, but I’ll just trust my instincts and tell you what our discussion stirs up in me.

“For a very long time I’ve felt that an event often felt ‘real’ only after I shared it with my wife. But now, weeks after my wife’s death, I have this very strange experience of something happening and my feeling I must tell my wife about this. It’s as though things don’t become ‘real’ until my wife knows about them. And, of course, that is entirely irrational because my wife no longer exists. I don’t know how to put this in a way that will be helpful but here it is: I, and only I, have to take full responsibility for determining reality. Tell me, does this have any meaning for you?”

She seems deep in thought and then looks up and says, “That does speak to me. You’re right if you’re implying that I cannot trust my sense of reality and that I want others—perhaps one of my two men, perhaps you—to identify reality. My husband is weak and always defers to my observations, to my sense of reality. And the other man is stronger, very successful in business, very sure of himself, and I feel safer and more protected and trust his sense of reality. Yet I also know that he’s a long-term addict who is now in AA and has now been sober for only a few weeks. I think the truth is that I mustn’t trust either of them to define reality for me. Your words make me realize that it’s my job to define reality—my job and my responsibility.”

Toward the end of our hour together, I suggest that she is not ready to make a decision and should tackle this in depth in continued therapy. I give her the names of two excellent therapists and ask that she email me a few weeks from now to let me know how she is doing. She is deeply touched by my sharing so much with her and says that this hour has been so meaningful that she didn’t want to leave.

The Pygmalion Effect and Treating Incarcerated Individuals with Severe and Persistent Mental Illness

Posted on by Psychotherapy.net Team

For as long as I can remember, I’ve always been fascinated by locked doors; what does society do with the individuals it tucks, or perhaps sends away, and why are they sent away to begin with? Prisons and psychiatric hospitals were always talked about so ominously, and as a young child I remember thinking, “I need to know what goes on in there.” Fast forward to the year 2015, when I signed an offer to begin working as a correctional social worker. I had spent the last year working in a correctional facility as an intern and made the decision that working in corrections was where I needed to be. I’ve always had a passion for mental health, and when I was offered a position in a psychiatric correctional unit, I knew I had to take it.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Upon walking onto the psychiatric unit that first day, I knew instantly that I’d found my place. This place, this “unit” was just the opposite of what I expected it to be and believed as a child they were. It was painted with bright colors, residents’ art was on the walls, groups were running, and security and mental health staff members were working together to provide treatment to the men on the unit. The air on the unit was lighter—residents were able to joke with staff and clearly felt safe in this niche of the prison. I had always hoped a program like this could exist in corrections, and somehow I was lucky enough to stumble into this in one.

***

“I never thought it would work,” Melvin* said. This is a line I’ve heard Melvin repeat time and time again in our clinical sessions as he reflected on the birth and development of an innovative psychiatric unit where he resides inside a correctional facility. Melvin is a long-standing community member in the unit, and his role is anything but benign. He and a few other permanent residents serve as institutional memory—not only do they keep the mission of the unit alive, but they also keep the cultural expectations and norms of the unit thriving.

It may be tempting to think the culture of a unit inside a correctional facility to be harsh, ruthless, and violent; but with the right balance of residents and staff, the most astounding transformations can be seen—just ask Melvin. Melvin, an individual living with psychotic illness who walked onto the unit upon its inception, will be the first to tell you he never thought a structured mental health unit would survive in corrections. Having lived a life riddled by poverty, substance use, abandonment, dual-diagnosis, and trauma, it is not surprising Melvin ended up in an institutional setting. When he first arrived onto the unit, he appeared hardened and unreachable and had just returned from a hospital trip due to an injury inflicted during the throes of a psychotic episode. “Ya, I used to sit in the corner over there (referencing the group treatment room) and just stay silent all group, purposefully choosing to stay uninvolved.” Melvin is honest in his reflections that he didn’t think a unit could exist inside a correctional facility without strong-arming, victimization, and prison politics. He didn’t know then the power of the Pygmalion Effect.

The “Pygmalion Effect”¹ describes the way individuals present themselves in a manner akin to the expectations set before them, whether they are positive or negative. The psychiatric unit where Melvin resides was able to cultivate the expectation that individuals residing on the unit would drop behaviors typically seen in the prison culture (intimidation, bullying, violence) and promote ideals such as asking staff for help, utilizing town halls to address community issues within the unit, and speaking honestly about their lives in group treatment. The vulnerability and effort to curb well-developed criminal tendencies it took residents like Melvin to exhibit was extraordinary, and over time the unit has become what Melvin describes as a “safe place” and “my family.” Although staff may have initially brought forth these ideals and stayed dedicated and consistent to the mission of providing treatment rather than simple stabilization, the therapeutic and pro-social culture of the unit now comes directly from Melvin and other long-term residents. The “Pygmalion Effect” tends to be cyclical in nature and is seen daily in this psychiatric unit. The staff members show unconditional positive regard and a belief that typical prison behavior and defenses can be dropped in the unit because the residents are much more than their prison sentence or mental illness. The residents, in turn, begin to believe themselves to be individuals who are worthy and can contribute to the world through human connection. This spreads amongst the men through groups and psychotherapy, and eventually, the entire unit is finding positive ways to support one another along their journeys with mental illness, recovery, and imprisonment. The “Pygmalion Effect” has allowed for something uncommon to occur in a correctional environment—people are actually getting well, not just stabilized.

****


Here we are in 2021, and I now hold my doctorate in social work and am the director of this unit in which I whole-heartedly believe. The evolution of the unit has been extraordinary to watch. In an interesting way, we’ve grown together. I started working in the unit as a conditionally licensed professional, left and explored other avenues of corrections, and then returned as a fully licensed professional completing a doctorate program. As I’ve gained my clinical footing and found my stride, I’ve watched the men on the unit do the same. The residents who have been on the unit since its inception, such as Melvin, have gone from being acutely ill to now being peer mentors on the unit. Throughout these years on the unit these men have developed self-esteem and practiced being able to trust; skills they struggled with for most of their lives. If this is what happens in six years’ time, I cannot wait to see the growth that occurs within the next six.

1. Chang, J. (2011). A case study of the “Pygmalion Effect”: Teacher expectations and student achievement. International Education Studies, 4(1), 198–201.

Relief or Change? Which is the Most Meaningful?

Posted on by Psychotherapy.net Team

Jack, a forty-three-year-old insurance executive, was referred to me by his family doctor for help with severe panic attacks that had suddenly begun for reasons that were completely unclear to both of them. Jack's symptoms were disabling and resulted in his missing work for several days before his initial appointment with me.

In the first session, I listened to him describe his difficult breathing, chest pains, sleeplessness, occasional choking episodes, along with his fear of losing complete control and “going crazy.” He told me that he has always been an anxious person and had contemplated entering psychotherapy for several years, but never actually did…until now.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

The initial consultation with Jack was, in my view, a mixed success. According to Jack however, it was “an unbelievable success.” We were able to quickly identify the sources of his current anxiety symptoms, which almost immediately provided him with some much-needed relief. We began to outline some of the likely goals of the ongoing therapy he was “very happy to be starting, finally,” and for which he eagerly arranged his next appointment with me.

As the session wore on, I began to feel concerned that the initial and speedy benefits of this first session might have implications for Jack's ability to fully engage in the challenging, ongoing work of psychotherapy, something I believed he needed and from which he could derive greater benefit than immediate symptom relief only. I became especially concerned when Jack described his first session as “maybe the best hour of my life!” and described me as “undoubtedly, the best therapist in America!” That's when I thought, I probably will never see Jack again.

As it turned out, Jack did attend his second session, and a third, and described the continuing benefits of the work thus far. He was hardly symptomatic, felt “great,” no longer thought that he was “losing it,” and was wondering whether or not he really needed therapy after all. Somewhat surprisingly, he asked me to tell him what I thought he should do. In order to help Jack figure this out for himself as much as possible, I did what any therapist worth their stripes would likely do as a first response to such a question: I asked Jack to try and decide independently of my input, so that we could both learn something about his attitudes, thoughts, and feelings, rather than have him simply react to mine. My input followed and consisted of my ideas about the differences between relief and change, with the latter, obviously, being the more ambitious pursuit and perhaps the more durable. I also was mindful, as always, that for some people, relief may be all they want or need. Not everyone wishes to or has the wherewithal to undertake a full course of psychotherapy, especially if they are not in active distress.

After a meaningful conversation about his dilemma, i.e. to stay or to go, Jack decided that he was quite happy with what had occurred and chose not to pursue further therapy at the time. He asked for and received assurance that my door would always be open, and we both acknowledged that we may or may not ever see each other again. He left describing himself as the “three-session wonder.” I later heard from his physician that he was doing quite well, with no further panic attacks. It led me to wonder whether or not I should revise my thinking to include the fact that sometimes and for some people, relief is change, and not necessarily something less or less meaningful.

Redesign Your Mind in an Instant

Posted on by Psychotherapy.net Team

Wouldn’t it be lovely if you were able to help clients make real, significant, lasting changes right on the spot, just by providing them with a certain frame and by inviting them to do a little on-the-spot visualizing? I have. You can.

Philosophers from Marcus Aurelius to the Buddha concerned themselves with the idea that “you are what you think.” Nowadays, this age-old notion is typically explored using ideas and techniques from cognitive-behavioral therapy. These ideas have resonated for many of my clients and have been quite useful in our therapeutic work. But there is an important next step to take.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

By providing clients with the metaphor of “the room that is your mind,” I have helped them visualize “the place where they think”—really, “the place where they live”—and help them instantly change and upgrade that “place.” This simple metaphoric frame has created powerful, on-the-spot results.

In a very few words, I explain to my client that it is in their power to redesign and redecorate the room that is their mind. Then I move right onto giving some examples of what that redesigning might look like: adding windows so that a breeze can blow through, reducing inner claustrophobia; adding a calmness switch, producing immediate calm; adding an exit door, out of which repetitive, obsessive thoughts can be scooted; or repainting the walls a bright color, so as to reduce the experience of sadness.

What is rather amazing is that my clients “get” this idea instantly. They have often said that no one had ever invited them to picture their mind room before and that, without knowing it, they had been waiting for this invitation.

I was recently chatting with an interviewer about my forthcoming book, Redesign Your Mind, in which this technique is described. Even as we were speaking—even as he was asking me questions and I was answering them—he was doing this redesign work. I could tell. Then, suddenly, he smiled and said, “I’ve just repainted the walls in my mind room and I can feel the difference.” The brain is brilliant at this sort of thing, if it is presented with the invitation and offered even just the briefest of explanations.

A few days later I wrote to the interviewer, whom we’ll call John, and asked him to share his experience. What had that felt like, spontaneously doing that work right on the spot? How was it that he had done that work without my hinting or suggesting that he do it—had his own brain instantly “decided” that it was imperative that he try out the idea and paint those walls a new, bright color? Did the change that occurred feel real and significant, even fundamental? Had the change lasted?

John replied:

“The effects I experienced when you began to explain this to me were quite profound and instantaneous. It was straightforward. You told me I could put anything into the ‘room that is my mind’ such as a ‘calmness switch’ that could be flipped whenever I needed it. I pictured a red light switch, and when I flipped it, I immediately became calm, and felt it both mentally and in my body.

“You helped me construct my ideal living room, and when I painted the walls, I immediately began to experience pleasure in the color. I put large, clean windows in the room, some open so that the breeze from the beach made the flowing white curtains dance. I felt calm and joy and peace in my body, as well as my mind. And it’s not just about calm. There's a breastplate in the corner that I can don to immediately feel courageous and ready to take on the tasks I need to.

“There's also a free speech platform I can mount when I want to privately engage in any thought exercise. And there’s a back door to exit the room. As a person diagnosed with PTSD, I can utilize this to help reframe my perceptions of past events, heal, and press on with the tasks associated with my goals in life. Thank you. Thank you.”

Clients immediately brighten up when I discuss this with them. There is something amazingly invigorating about the idea of redesigning one’s mind. Maybe it puts folks in mind of magazine ads of beautiful rooms that have stirred them and moved them. Maybe the metaphor strikes them as achingly right. Maybe their “inner architect” or “inner designer” is suddenly engaged. Or maybe it simply matches their felt experience, that there is a place where they go and that they can change the look of that place—and their experience of that place.

Rather than having to arm-wrestle negative thoughts to the ground, dream up thought substitutes, or do any of the blocking, disputing, reframing, substituting, or other heavy lifting techniques from cognitive-behavioral therapy, a client gets to smile a little and laugh a little as she zips right off to her mind room. There she can change the furniture, replace her usual bed of nails with an easy chair, install a pressure release valve for immediate stress relief, or do something else quick, brilliant, and useful.

I have found this “redesign your mind” technique very helpful in addressing many challenges clients bring to our work. For the client who lacks confidence and who is having trouble speaking up, she can be invited to create a Speaker’s Corner (like the famous one in Hyde Park in London) where she can practice saying important, dangerous-feeling things in complete safety. Whether the issue is depression, anxiety, addiction, procrastination, healing from trauma, or loneliness—whatever the issue may be—there is bound to be some simple subtraction or addition she can make to her mind room that will immediately change the thoughts she thinks and her experience of life.

I invite you to look into this technique, and perhaps into your own mind room, and even, perhaps, the one you inhabit with your clients.

Less Treatment, More Therapy

Posted on by Psychotherapy.net Team

"Yo, call me back ASAP!,” read the text message from Carl, a 20-year-old man who has self-identified as a gang member for the past seven years and who has struggled with anxiety and depressive symptoms, alongside antisocial personality traits.

I had an impulse to explain boundaries to Carl but decided against it. I knew that a dispassionate instructional ACA-type lecture would be distancing—especially via text.

Carl has been in counseling with me for three years as a requirement of his probation. He is a member of a local gang who has mentioned how his affiliation got him into trouble while growing up. He also shared his initial fear of telling me he was in a gang because of how I might “react” to him. I maintained a neutral position.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Gangs were part of the social fabric of Carl’s youth—I, too, was gang affiliated. Thus, I was personally familiar with that life, but I believe that it was because I have historically been the only Black male therapist in most of the psychiatric settings in which I worked that I was often given complex and challenging cases. This often meant working with male gang members and other males who had been charged with sex offenses (perhaps a story for another time).

I returned Carl's call because I was concerned that he had done something inappropriate with which I could help him. I was also mindful of my own insecurity. I felt as though little progress had been made in our work. Carl was also inconsistent with taking medication prescribed by his psychiatrist and in attending sessions with me. Yet he constantly told me how much he “appreciated” working with me. I viewed his text as a plea that might allow me to do something meaningful with him. I hadn’t gotten his message quite yet.

Carl answered the phone on the first ring. “I am sorry about the capital letters in my text, I don't want you to worry about me. Do you have time to talk?”

He went on to say, “I need some therapy right now.” Carl mentioned that after a domestic dispute with his girlfriend, she had been considering leaving him. “I don't know why I'm so angry” and “I wish I could get over this anger,” Carl cried.

This was refreshing and far different from Carl's usual sessions, which he tended to begin with a detached, “I'm doing good. I am safe and in good health.” Eventually, I came to realize that after being in both penal and psychiatric institutions, he was used to giving knee-jerk responses to risk assessment questionnaires. After his pleasantries, there was always a laborious discussion of his video game adventures. Today was different, although I did not understand how at that exact point.

Instead, I felt anxious in that moment. This may have been my own internal reaction to Carl's sense of anxiety. However, I also felt a strong inclination to capitalize on Carl's plea for help and felt as if I needed to come up with a clever “intervention.” I had to strike while the iron was hot. Should I use CBT? I could re-emphasize the cognitive model to Carl and how his distorted thinking contributed to his ongoing patterns of anger. No. Carl had already admonished me in the past for using “big words,” referring to clinical jargon.

Maybe, EMDR?! Could some eye movements mollify his intensity? While I am trained in both interventions—and believe they have some merit—I thought it might be better to just shut up and let Carl talk.

After a while of silent sobbing, Carl exclaimed, “I think I know what this is.” He paused.

“I used to be soft” in grade school, he went on, and after years of bullying he stood up for himself. “That's when I learned that I could fight,” said Carl, his voice cracking as he held back more tears. Carl mentioned that after a while, he learned to become the aggressor as a preemptive way of sending a message that he was a formidable opponent.

I felt stuck. Was now the time for an intervention? I fought against the impulse. Instead, I simply asked, “How do you feel now?” Carl shared that he had felt a little better and that he was glad that he could “get this off my chest.” Ironically enough, almost immediately after this revelation, the call dropped. The call dropping likely saved me from myself. I had an urge to say, “I just want you to know that you're not that little boy anymore.” I probably heard this line somewhere from a supervisor in the past. I do not actually believe it. Carl knows full well that he is not the little child who was bullied, although he might still feel like it.

I wish I could say that Carl no longer expresses anger in an unhealthy manner. I believe that it will take more than one 45-minute session for that. However, I do trust that the session was meaningful to him (and in retrospect, to me as well). He appreciated that I listened to him. I appreciated that the session felt like real therapy. It involved all of the ingredients that make therapy special: attunement, minimal encouragers, brief re-statements, warmth, empathy, compassion, the list goes on.

While still a relatively new clinician, I find myself frustrated and impatient with the mental health industry. In my brief time practicing, I have noticed that I am encouraged to quickly create and implement rigid and concrete treatment plans with goals and objectives that might say things like “decrease frequency of anger by 30% by such and such date.” I am not saying we should abandon these measures. They have a place. However, it creates a false sense of urgency to “do” something in sessions in lieu of “being” myself.

I have been in my own therapy for a few years. A secret that I have not shared is that I would cringe if my own therapist held rigidly to one treatment modality. I appreciate that she is flexible and willing to meet me where I am. However, the issues I often bring to counseling pertain to deeper questions I have about the contradictory elements of life. I do not know if the cognitive model can get me through that.

It is seductive and somewhat satisfying to have a ready list of tools and interventions that I can provide to clients. It makes me feel smart and prepared. It is not as sexy to promote the tried-and-true skills that have been empirically validated. As a disclaimer, I am not saying I reject these treatment modalities. If that were the case, I would not have spent 80+ hours learning them after graduate school—I think. I am simply saying that I should not disregard the elements of psychotherapy that have, time after time, proven themselves effective in my work with clients.

I founded a clinical think tank centered on helping gang-affiliated adolescents. It began in New York and expanded to Denver. Over the four-year course of mobilizing clinicians to research evidence-based interventions to help this population (there are none), what keeps coming up are the same principles that work with Carl.

I am reminded of how fascinating it is when I ask clients what they find helpful about working with me. I almost never hear anything about a specific intervention. What I do hear is that I am “kind,” I am “engaging,” I “relate well” with them, I am there for them during difficult times, I am “real,” and other similar sentiments.

As I look back at my three years with Carl, I can see that I have been unfairly critical of myself. I had viewed our relationship as ineffectual up to that moment I discussed at the outset of this essay. I focused on select symptoms (i.e., anger) and his inconsistency in coming to sessions (I told myself that if I were a better therapist, he would not miss sessions and he would be less angry). However, I mistakenly dismissed the fact that he often expressed his appreciation for me and had adamantly refused to work with anyone else in the past. I also ignored the fact that someone who defines themselves as “solid as concrete” is capable of being vulnerable with me.

Carl appreciates me because I strive to connect with him. For the past three years, he has known he has at least one person who doesn't view him as just a gang member or someone who is antisocial. He can look forward to my showing a genuine interest in him as a person as opposed to probing for tendencies that may deviate from the norms of society.
It is my hope that fellow therapists seek to be human with their clients prior to employing so-called standardized interventions in a reactive, knee-jerk fashion. Perhaps more of a focus on therapy and less on treatment protocols will allow for the true healing power that comes with the relationship, which I thoroughly believe is the element that heals.

A Universe Opens: Reflections On My First Session as a Therapist

Posted on by Psychotherapy.net Team

“Know all the theories, master all the techniques, but as you touch a human soul, be just another human soul.” —Carl G. Jung

As I stare down at the piece of paper holding a few clues to the vast mystery that will be my first-ever client, I feel a universe come into existence, a wide expanse full of potential and possibilities. The past year-and-a-half of didactic and experiential training has culminated here, in this very moment. All that I had previously read and thought about were finally lifting off the pages, out of my mind, and into the here-and-now in the form of a dynamic, real-life therapist-client relationship. As Sanmao, a Chinese feminist writer, put it, “What I learned on paper, I felt, was knowledge that had not yet been tested.” There I was — hours away from testing the knowledge I’d accumulated on a real-life, non-pretend client—sitting in the tension of opposing “what ifs:” “What if I forget everything I learned?,” “What if I’m terrible at being another human soul?,” “What if the theories are wrong?,” “What if none of the theories are applicable to me, or the client?,” “What if the theories are right?,” “What if it actually works?!”

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

To alleviate some of the angst-citement—a cocktail of angst and excitement I was feeling, I decided to reach out to a handful of therapist friends—some licensed supervisors, some only a few months ahead of me—and solicit tips they might offer an intern who was about to go into their first-ever session, things they wish a mentor had told them as they were stepping into their role as a therapist for the first time. Here’s a mosaic of what they shared:

  • Check your excitement and adrenaline at the door. As exciting as it is, you are ultimately there for them.
  • Be genuine and be yourself. You don’t need to be a blank slate or do anything to prove yourself. If you’re an expressive person, allow yourself to be expressive!
  • Relate to the patient and be kind. If nothing else, focus on making yourself and the client comfortable. Validate however the client shows up in the therapy session—there’s no such thing as too much or not enough. Follow your curiosity and get to know them.
  • Ask them what they want to work on or change in their life, and then work on what they are ready and willing to work on.
  • Sit with them in their feelings. Don’t try to make them feel better. Instead, help them better feel by exploring and understanding their feelings.
  • Give them permission to feel. You can say, “I imagine if I were in your position, I might feel… Do you feel any of that?” This helps them feel less alone for something they might be feeling but are unable or afraid to name.
  • Don’t be afraid to create space. If you get flustered and don’t know what to say, you can say, “I just want to sit with this for a second before deciding where to go next or what else to explore.” You can also say, “I don’t know where to go from here,” and ask them if they have a sense of where they’d like to go next. Silence doesn’t always need to be filled. Space is comfortable and useful when it is intentional, and we make it intentional by acknowledging it: “I want to take a breath around that before saying anything. That’s a lot that you’ve been holding.”
  • Less is more. Provide a space for them to share. Bear witness to their unfolding. You don’t need to interpret, fix, advise, or do much.
  • Help your client cross the river by feeling the stones. Set small, achievable goals so they feel like progress can be made.
  • Take a moment to remember it afterwards. It’s your first one, and that’s exciting!

***

Upon wrapping up my first session, I felt a tremendous sense of relief—relief that my client hadn’t asked me whether this was my first session (though if they had, I was prepared to say something along the lines of, “If it were, what does that bring up for you?”), and relief that I’d made it to the other side of what felt like a tipping point in the evolution of this career and calling. Reflecting on the random scribbles I’d made during the session, a few twinkling stars began to emerge against the dark expanse of a nascent universe—the dawning of a new constellation, of a new relationship, with all its mystery and magic.

Watch this Movie and Call Me in the Morning

Posted on by Psychotherapy.net Team

I am a self-professed “scripter,” but not in the echolalic sense. I am also quite fond of popular culture, particularly movies, and have written extensively on integrating their fruits into clinical practice, training, and supervision. Put these two peccadillos, passions, or pastimes together, and you have me, or at least part of me: someone who can seamlessly integrate movie lines into conversation. As much sense as doing so has made in my life, I must admit that dropping a line from Rocky, Downton Abbey, or Toy Story into a lecture can leave students dumbfounded, and that asking a client if they have seen so-and-so movie has often been met with a quizzical and apologetic, “Sorry, I haven’t.”

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Nevertheless, I believe in the therapeutic power of cinematherapy (the prescription of movies, or parts thereof) to help clients disentangle inner conflicts and have, at times, when therapeutically appropriate, prescribed the likes of Steel Magnolias or Ordinary People to a client who was wrestling with loss, or assigned Good Will Hunting, The Snake Pit, or One Flew Over the Cuckoo’s Nest to counseling trainees to help them better understand clinical theories and applications. While popular culture, whether art, music, or movies, has often been relegated to the basement of culture studies, I believe that its stories, songs, images, and words are non-gilded reflections of the human experience.

Oh, I forgot, I love golf, and devote a good deal of time to learning it, practicing it, playing at it, and dreaming about it (worrisome by many standards, I know!). And just today, as I was reflecting on the loft angles of the various “wedges” in my bag with my teacher, the image of Nanny McPhee came to mind. What I found interesting was that at the moment I asked her if she had seen the movie, my prescient instructor knew exactly what I meant. That is because the relationship between Emma Thompson, as Nanny McPhee evolves from the outset, when she is not wanted by the children she is hired to care for, to the end, when they cling to her as she prepares to leave them. To paraphrase, she says to them, “When you need me but do not want me, that is when I will be there; but when you want me but no longer need me, then I shall go.”

I guess at that moment I was wondering when the time would come to let go of my teacher, “who has taken me from crayons to perfume” (sorry, couldn’t help it, for all of you “To Sir with Love” fans). I have also reflected on this particular movie line when working with clinical trainees in order to help them understand the vicissitudes of the therapeutic relationship.

Clearly, I could go on and on and on about the multitude of movies that have etched themselves deeply into my neuronal pathways, and how I have used them, their characters, and their “lines” in both the therapy room and classroom, but instead I direct you to a website called Therapy Route, created by South African clinician Enzo Sinisi. There you will find a veritable cornucopia of cinematic gold which you can mine in your own clinical practice and/or clinical training.

There, and in Enzo’s words, you will find “links to pages that contains a list of films that address mental health concerns/issues [and a] brief description and an abridged version of the relevant diagnostic criteria to help the reader get a sense of how these disorders are defined and what their symptoms look like.” Enzo, in the creation of this impressive compendium, will lead you to the doorstep, but the next step will be yours, and how you use this resource in your own work will be up to you.

Don’t forget the popcorn! 

Counseling Gifted Clients: Journeys through the Rainforest Mind

Posted on by Psychotherapy.net Team

“What do you do with the clients you suspect are super smart?” You know, those who talk fast, think fast, and ask probing questions; those who are so articulate and seemingly high functioning that you can’t understand why they say they are depressed and anxious. How do we begin to understand, let alone help, those clients who are paralyzed by fears of failure and the pressures of their “great potential”; who have exceedingly high standards and expectations for themselves and others? They change jobs frequently, are continually questioning themselves, and express frustration, impatience, and confusion with slower thinking co-workers. How can we walk alongside those clients who feel such deep and unrelenting loneliness, even if they have many friends and are in partnerships, and who were perhaps bullied and bored in schooling situations when they clearly have (or had) an enormous passion for learning? How can we fully and deeply assist those clients who have an unusual number of sensitivities to sounds, textures, visual stimulation, chemicals, and emotions? Or even begin to co-construct a meaningful treatment plan with clients who feel a responsibility for making a difference on the planet, have extraordinary empathy, and feel despair and idealism about the future? And how do we stay intimately attuned with clients who have experienced serious trauma in childhood but appear to be unscathed, those who are so tuned into us in therapy that they can sense when our attention is drifting, are afraid of overwhelming us, and who, in fact, do overwhelm us with their intensity, depth, intuition, and levels of awareness?

These are some of the challenges I experience working with gifted clients. Perhaps you do, too.

What is Giftedness?

Defining giftedness is difficult and controversial. There are many theories and definitions. Concerns over justice and equality can make this discussion tense and uncomfortable. Here is one way to think about it: all humans ought to be valued and appreciated and are worthy of love and respect. All humans differ in their strengths, weaknesses, learning styles, intellectual capacities, sensitivities, preferences, talents, temperaments, experiences, cultural backgrounds, and desires. It can get tricky when we talk about intellectual differences. And yet, intellectual differences exist. Giftedness exists—in all cultures, races, religions, and socio-economic groups.

It can be easier to see giftedness in children because they are often reaching typical childhood milestones earlier. Their precocity can be apparent in their language, curiosity, interests, and questions. They often read before they get to school and have abilities and wisdom beyond their years. I consult with parents of gifted kids. Here are some examples of children I have heard about: the eight-year-old who wants to be Richard Feynman for Halloween. The five-year-old reading The Chronicles of Narnia. The four-year-old who cries when listening to Mozart because the music moves him. The ten-year-old whose favorite pastime is watching BBC documentaries. The six-year-old who refuses to eat meat for ethical reasons. The nine-year-old who rescues the grasshoppers on the playground. The ten-year-old whose poetry breaks your heart. The fourteen-year-old who’d rather read David Foster Wallace than hang out on social media.

Notice I did not describe the child who performs well in school. Gifted children may test well and get high grades, and they may not.
So, defining giftedness is complicated. But we don’t actually need a clear, concise, undisputed definition to serve clients who fall into this category in one way or another. We don’t need to give them a label. We just need to understand what they may be dealing with due to their gifted traits and how to help them.

Traits of the Gifted Client

These are some of the characteristics of gifted clients with whom I’ve worked:

  • Advanced vocabulary, existential questions and concerns from an early age, multiple in-depth interests
  • A range of deeper-than-normal emotions and sensitivities (often underground in men), advanced analytical abilities, need for precision in fields of interest, perfectionism
  • Rapid thinking, talking, and learning
  • Excessive worry, great empathy for all living things, unusual insight into themselves
  • Avid reading, unending curiosity, and passion for learning (not necessarily for schooling)
  • More complex ethical, moral, and justice concerns, insight about things that others don’t notice, tendency to argue for fun or for intellectual stimulation
  • Idealism, wit, imagination, creativity, questioning authority, and needing to understand the meaning of life
  • Loneliness, anxiety (particularly when bored or during extreme bouts of thinking), existential depression, self-doubt even with seeming successes
  • Difficulty finding friends, serious schooling frustrations, uneven development

The Rainforest Mind

I have discovered that one way to manage discomfort with the label and definition of giftedness is to use the metaphor of the “rainforest mind.” I was a teacher of gifted children before becoming a therapist, and many educators were not happy about identifying them as such. I suggested we think of it this way: people are like ecosystems. Some are like meadows, some deserts, some volcanoes, and some rainforests, for example. They are all beautiful and valuable. One is not better than the other. The client with a rainforest mind is the most complex: multilayered, intense, overwhelming, colorful, highly sensitive, full of complicated creativity, and misunderstood. I have many clients who have read my blog/books and come to me saying “I’m not gifted, but I have a rainforest mind.” These clients are often uncomfortable with the label, too, and many deny they are gifted.

You may be using your most tried-and-true therapeutic methods with these clients but feel something is not quite working. You feel you are missing a very important piece of their puzzle but do not know what. Your client says they are struggling, but they seem to be capable, compassionate, and insightful. At times like these, I have found it useful to consider that my client has a rainforest mind.

Giftedness is a phenomenon that has its own set of complications. These clients desperately need us to see all of who they are and all of who they want to be. They need to be able to feel safe to be vulnerable and to trust that you can handle their exuberance, intense emotions, questions, contradictions, complexities, fears, intuitions, sensitivities, and, yes, their brilliance.

Some of the Issues

The gifted clients with whom I’ve worked come to therapy for the same reasons most clients do. They might be dealing with depression, anxiety, PTSD, attachment issues, addictions, or childhood trauma. But there will likely be other issues that will need your attention. The following are some of the concerns I see in my office every day:

  • Unhealthy perfectionism that stems from early intense pressure to achieve. Healthy perfectionism that is often misunderstood and stems from an innate desire for beauty, balance, harmony, justice, and precision.
  • Multipotentiality, which is a desire to pursue many career paths and multiple interests. This is often mistaken for irresponsibility, inability to focus, or even ADHD.
  • Extreme difficulty with decisions due to the ability to see too many options and to worry about the implications of every choice.
  • Existential depression and despair, particularly rooted in an early and ongoing sense of justice and social responsibility.
  • Difficulty finding friends and partners because of differences in intellectual capacity and in emotional depth and sensitivity.
  • A history of bullying in school and boredom over many years in a traditional classroom where they already know the material. Great frustration with coworkers and supervisors who are less competent or less conscientious.
  • Being given too much responsibility for siblings and parents in a dysfunctional family. The tendency to be the counselor for family and friends with no reciprocation. A capacity for resilience when raised with abuse, masking serious self-doubt, self-hatred, depression, and anxiety.

What Can a Therapist Do?

These are some of what I hope will be helpful hints and strategies I have found effective with these clients.

  • Get familiar with the traits that often accompany giftedness. Explain these to your clients. Learn to differentiate the issues that come with giftedness from the effects of growing up in a dysfunctional family. Explain how having a rainforest mind can be challenging. Suggest books, articles, and websites.
  • Look for ways your clients are masking their pain because they are used to practitioners who assume they are just fine and often their friends and family members overly rely on them because they are so capable.
  • Allow them to talk a lot without being linear or chronological; take notes if it helps you keep track. Create a very large container to hold what is likely to be a great deal of intensity. Love their difficult questions, big emotions, deep dives, and quests for justice and a better world.
  • Be authentic and sensitive. Listen deeply. They are often particularly intuitive and will be able to sense when you are irritated, not feeling well, or distracted.
  • Get your own therapy. If you are also gifted, take time to explore the resources for yourself.
  • Be careful that you don’t misdiagnose—giftedness can look like ADHD, ASD, OCD, and even bipolar disorder. (Note: Some clients can be gifted and also have a mental health diagnosis or learning disability, called twice-exceptional or 2e. It will be important for you to know about this as well.)
  • Know your limits and notice if you are intimidated by their intelligence. Refer if you are frequently overwhelmed or uncomfortable.

The Case of Marilyn

For the purposes of this article, this case example will focus mostly on psychoeducation around giftedness rather than the childhood trauma the client experienced. This case description is adapted from my book, Your Rainforest Mind.

Thirty-year-old Marilyn, a graduate student in anthropology and women’s studies came to counseling because, as she said, “I reached the end of my own abilities to fix myself.” Marilyn’s mother had died a year earlier, and her intimate relationship was “faltering.” In describing her goals in counseling, she wrote, “I want to stop carrying the weight of my family’s legacy, to untangle the mess in my head, to be free.” Marilyn had a history of difficult relationships with partners and trouble finding emotionally healthy friends. Like many of my clients, Marilyn did not initially know that she was gifted.

She described a bipolar, physically and sexually abusive mother. Her father was kind and loving to her but didn’t stand up to stop the abuse. According to Marilyn, her parents were “spectacularly unsuccessful in the real world.” And when Marilyn was twenty-two her father died suddenly.

As a child in school, Marilyn was bullied. She was excited about learning, academically ahead of her peers, and a talkative extravert whom teachers dismissed with impatience and children rejected.

As with most of my clients, we worked on two main tracks. Track one was the long road to healing from severe childhood trauma. Convincing Marilyn through lots of counseling processes based in attachment theory and somatic experiencing that the abuse wasn’t her fault, that she was, in fact, worthy of love, was the more complicated task. Over time, Marilyn felt more trust in me and allowed herself to grieve the losses she had experienced for so many years.

Marilyn, like many gifted folks, had shown a powerful resilience. In spite of her rejecting, critical, abusing mother, Marilyn was a kind, loving, competent woman. The damage was evident, though, in her distorted view of herself, her existential depression, somatic symptoms, and her inability to believe she was worthy of love. It took time for her to feel safe enough in therapy to allow herself to grieve and to trust.

Like many gifted clients, Marilyn did much self-examination. She particularly enjoyed art projects and used journaling and other art forms to delve deeper. She was a big reader and was always looking for resources that would expand her knowledge, particularly in the areas of body image and women’s issues.

The second track is simpler but essential. Even though Marilyn had experienced academic success, she did not identify as gifted or understand the traits. She wrote about this: “There were—and still are—so many times in my life I felt an unbridgeable distance between myself and others, like I fundamentally see the world in a different way that I can’t even explain because we don’t speak the same language.” Even though Marilyn found friends, she felt extremely lonely much of the time. She was often the caretaker in the relationship, giving much love and support but not getting much back. She wrote, “I get hungry for people who are socially competent and intellectual and curious about literally everything and creative and broad-minded and motivated by justice…People who care and feel deeply but also think in complex wide-ranging ways.”

Even though she was an optimist, Marilyn felt despair over finding a truly loving and kind, intimate relationship. And with both friends and partners, Marilyn had difficulty setting boundaries and asking for what she needed. Being gifted, this was even more challenging, because it wasn’t easy finding other sensitive, intelligent souls. I referred her to my blog, books, and other articles about giftedness to reinforce that her difficulties with peers and her enthusiasm for learning outside of school were also typical traits of the gifted.

As time passed in our work together, Marilyn graduated with her Master’s degree. Her advisor may have been the first teacher who recognized and appreciated her giftedness, telling her she was the brightest student she had ever worked with. This was an important acknowledgement. Marilyn and I continued therapy as she looked for employment. Fairly quickly she found a job that was not in her field of study but that suited her well.

Marilyn was employed in social services as a case manager and was wildly successful. The combination of her rainforest-minded traits of sensitivity, empathy, energy, attention to detail, and intelligence worked well with the population of families she helped. She often took on extra responsibilities to keep herself busy and mentally stimulated. In meetings, she saw the big picture and solutions long before her colleagues. So she was restless in the job when she had accomplished her goals and was not recognized for her skills. These can be the frustrations of many rainforest minds on the job. It was likely that Marilyn would find more challenging, financially rewarding work as her confidence grew, but this position was satisfying her need to make a difference.

In many of our sessions, as we talked about relationships both personal and professional, I would remind Marilyn that some of her struggles were due to her complex intellect, high level of sensitivity, multiple interests, divergent thinking, very high standards, fast learning abilities, and deep empathy. In other words, her rainforest mind.

Over our years together, Marilyn made enormous progress. She could acknowledge how severe her losses had been and grew more and more self-accepting. Her self-criticism had decreased significantly, and she became able to recognize her many strengths. She began to imagine that she would find deep friendships and a kind loving partner. Eventually, she accepted the idea that she was, indeed, gifted.

Marilyn described her experience this way: “I keep hoping to meet people with whom I can relax and be just me, all of me, unafraid to let them see who I really am, in all my dorky, questing, art loving, social justice-obsessed, bibliophile, rebellious, intersectional feminist, world-changing glory.”

***

Marilyn is but one example of the many fascinating gifted clients with whom I have been privileged to work. If you can identify who among your clients is gifted, has a rainforest mind, and if you can listen to, understand, and explain the particular challenges that these folks often face, it will make a big difference in the effectiveness of their therapy. You will be seeing and knowing them in a way that very few others, if any, have. And that will change everything.

Helpful Resources

Books/Articles
The gifted adult: A revolutionary guide for liberating everyday genius™.
The Social and Emotional Development of Gifted Children: What do we know?
Your Rainforest Mind: A guide to the well-being of gifted adults and youth.
Journey into your Rainforest Mind: A field guide for gifted adults and teens, book lovers, overthinkers, geeks, sensitives, braniacs, intuitives, procrastinators and perfectionists. .
Webb, J. T., & Amend, E. R. (2016). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, Bipolar, OCD, Aspergers and other disorders. Great Potential Press, Inc.

Websites
Supporting the Emotional Needs of the Gifted (SENG)
Your Rainforest Mind
Gifted Challenges
Puttylike