Category: Blog

The “L” Word

Posted on by Psychotherapy.net Team

Lisa hefts herself heavily up the stairs to my office. She must come up two feet to a stair, like a small child. She is breathless by the time she gets to my office and has to take a few moments to collect herself. As she settles in, I realize she has gained even more weight in the few weeks since I last saw her.

She is huge, solemn, powerful, inert. Once she is seated, nothing moves but her head and hands and her big, expressive eyes. Her pace in therapy has been glacial. I wheedle, nudge, poke, prod, shove, usually with very little effect. My anxiety stimulated by her apparent weight gain, today I shove, for all the good it does me. A boulder slammed into the earth by the gravity of her rage, she is immovable.

During the session, she makes some small, wry, self-aware and self-deprecating joke about her resistance to change. I can’t even remember what she said, but flooded with affection for her—impulse and action melded together, racing along the same neurons in tandem—I burst out with, “Oh Lisa, I love you.” I am a little shocked to hear my own voice saying the words. It is true enough, but I did not expect to say it. Had those synapses fired at any distance from each other, I would not have.
She does not look shocked. She has, in fact, a small smile. I would guess that in her half century of living she has heard these words spoken to her fewer times than I could count on one hand. I can practically hear the tectonic rumble of pack ice shifting.

I have so flustered myself that I just carry on with our conversation, ignoring my own exclamation. As we talk, I ask her a question that I have asked her many, many times. “What do you imagine would happen if you stopped bingeing?”

This time she responds differently. Her eyes widen. She looks so frightened I want to turn and look behind myself. “I can’t,” she says. “You don’t understand.”

“What don’t I understand?”

“I am just like them. I am just the same.” I know exactly what she means. She means she is like her brothers, her mother.

Looking at her, I feel as though I am both seeing and imagining a child in her bed, piled high with blankets of flesh, her big, wide eyes peering out at me from beneath her coverings. She is not fully present—her eyes are shifting rapidly back and forth. She has the terrified look on her face of someone who has received a blow and is expecting another. I have been sitting with one leg crossed under me, but I shift both my feet squarely to the floor in an unconscious effort to ground her.
“No,” I say, “you are not like them. You are afraid of being like them.”

“If I wasn’t bingeing,” she says, her eyes still flicking, one shoulder slightly hunched as if to protect herself, “I could really hurt someone. I could kill someone.” Usually, she talks about how her fatness protects her from others, but she has never before talked about how she believes it protects others from her.

I speak to her in the low, soothing voice that you would use with an injured person or a frightened child. In a few moments, I can see her breaths start to even out. Her eyes stop moving and focus back on me. She smiles shyly, almost in greeting. She has been gone, but not gone. The session moves on and before the end, she commits to what is for her a big step.

I have never said “I love you” to a client before. I do not understand what unconscious imperative drew those words out of me. It felt as if I had no choice at all. I am as easily blinded to myself as the next person, but I can think of nothing in my life or day, no need of my own, that drove me to share those words with her in that moment. If my assessment of myself is correct, what then in her impelled those words from me, and what did they mean to her? Did I frighten her into a dissociated state, given that her experience of love is so deeply intertwined with violence? Did my expression of love for her provide her with some increased security so she could reveal more about her experience of herself? Did she want to warn me what a dangerous person she is to love? I am inclined to believe all of the above are true. Clinical error or simple human caring, countertransference enactment or empathy, I believe that in the session our separate continents shifted just a little, perhaps even measurably, toward each other.
 

Seeing Medusa in Every Client

Posted on by Psychotherapy.net Team

In Greek traditions, Medusa is the notorious stone-cold killer who was well known for turning people into statues. Her reputation became so brutal that she was often depicted as evil itself. However, like everyone who eventually comes to hurt others, Medusa had a life before she was the snake-haired statue-maker, but few seem to remember that. This is that story:

Medusa was a stunningly beautiful young woman. She was so striking, in fact, that everyone around her pursued her and longed to be her husband. Medusa had thick, gorgeous hair that men longed to see, and even be near. Suitor after suitor came and presented himself to her, transfixed by her beauty.

Medusa’s magnificence was so great that the gods themselves not only took notice of her, but also could not control their impulses to be with her. One of the gods, the ruler of the sea, Poseidon, became obsessed with Medusa. He sought her out while she was in Athena’s temple. There, in the midst of the holy place, beautiful, innocent Medusa sat praying to the goddess.

Poseidon did not attempt to hold back his urges, and sweeping in with a terrible ferocity, he raped Medusa on the altar of the temple. In an instant, he was gone. The deed was done. Medusa lay shattered on the floor of Athena’s house. “Why?” she thought. But she hardly had time to think. Athena was appalled that such a sacrilege would take place in her hallowed temple, and she swept in with almost the same speed with which Poseidon left.

Medusa, turning to the divine being with a look of desperation, did not receive the compassionate look in return for which she hoped. Instead, a fury overcame Athena. “How dare this take place in my temple!” she thought. Athena was enraged at Poseidon for defiling her sanctuary, but she could not punish a fellow immortal, so she turned with hatred and viciousness to Medusa.

Someone had to suffer for the atrocity to the goddess, and the victim was the target. With unquenchable anger, Athena blamed Medusa for her carelessness, for “enticing men,” and used her deific power to transform Medusa’s hair into snakes. As though the pain of serpent-hair were not enough to repel the sons of the world, she further cursed her in a way that ensured men would stay far away from her from that day forward. In a rage, Athena proclaimed, “He who looks on you will be turned to stone!”

And so a victim of rape, misdirected rage and hatred—and all for being nothing more than beautiful—Medusa, came to be known as she is today: the face of evil itself. The wrath and disgust for others that Medusa became known for were taught to her by the very figures she trusted.

There is no violent offender, no person who hurts another, and no villain in this world who does not have a story of how and why she or he came to be. We must learn to see Medusa. We must learn to see beyond the snakes and the curse that holds others at bay, and look into her deep, tragic history to get a fuller understanding of who she is… and we must also and equally do that with every client we encounter.

As therapists, we need to consistently evaluate our own personal judgments of others—not just in lip service, but in actual, in-depth explorations of who we are, and why we might hold the judgments that we do. Medusa had reasons for hurting others as she did, and so does everyone else. Our job as therapists is to assess, understand, and explain human behavior, without judgment or bias. The more we know about the past (others’ and our own), the more feasible that task becomes.

If we do not learn to see Medusa, we run the risk of remaining transfixed in our own sculptured, static mind-set: a place from which we will forever stand as judge, jury, and executioners in our own minds.
 

Treating a Couple After an Affair

Posted on by Psychotherapy.net Team

The couple in my office is connected mostly by the spaces they hold between them. Sitting on the loveseat in my office, they do not touch, although their arms, legs, and elbows and hands shift in an unconscious echo of each other’s movements. They are not so much mirroring each other as performing an elaborate dance of avoidance and retreat, their bodies’ dialogue spoken even through their many silences. On a larger scale, the same thing happens where they live: he comes home, she goes upstairs; she comes downstairs, he goes up; he enters a room, she leaves. They know if one of them tries to bridge the gap, something even worse will happen. There will be a wordless rejection, a sharp reminder of loneliness like a slap, or there will be a spark that will catch, flaring up hot and mean between them.

She can’t imagine how she is going to get over the affair. She is all the things anyone would expect: angry, hurt, shamed, frightened. He is torn between the grief of losing his wife and the grief of losing his lover. He has given up his lover in that he no longer sees her, and hasn’t for months, but he still has this backwards kind of feeling that if he re-engages with his wife—has fun with her, makes love to her, creates pleasant memories with her—that he is somehow being unfaithful to the lover he has renounced and, most importantly, all that she represented to him. To maintain what remains of his honor and fidelity he feels he must remain distant from his lover, his wife, and himself.

Today she is angry, but instead of the usual sullen acceptance on his part, he flares up in anger, and then, just as suddenly, bursts into tears. They are both startled by his emotion.

He gasps out the words, “I can’t believe how much I miss her” and I think, oh boy, she is going to explode.

I take a breath, preparing to intervene, but I hesitate when I see her face. There is anger there, but also something more like confusion or doubt. I wait.

“I don’t know what to do,” she says, “I want to kill him, but my heart goes out to him at the same time. What am I supposed to do?” In other circumstances, the bewilderment in her expression would be comical.

I would have said, if he had given me the opportunity to offer advice, that it would not be helpful for him to share this grief with her, that it would only inflame her anger and hurt and sense of betrayal, but there is no going back now. His grief is intense and visceral. He is holding his head in his hands and almost wailing.

Still looking at me, she holds her palms up and shrugs her shoulders in a mute gesture of helplessness, then turns to look at him. I have no idea what will happen next.

Slowly, she reaches across the couch for his hand and twines her fingers through his. He grasps her hand like a lifeline and clings to her as he sobs.

He chokes out his guilt—“I’m so sorry, so sorry”—but at the same time his relief is palpable. He seems more present than he has at any time since they started coming for sessions. There is no sense of anything secret or held back. He gathers her closer to him and they lean into each other in a tight embrace, both crying.

They leave, and I find I am near tears myself. What I am feeling is mostly the kind of surprised awe I feel sometimes in nature—what I feel in those rare moments, a dawn, or a sunset, when I am completely outside myself, bearing witness to beauty. His unvarnished honesty, her generosity, their mutual capacity to express love in what has been an atmosphere of despair and anger were acts of tremendous courage. Certainly it may have been, like a particular sunset, a fleeting moment, perhaps unrecoverable. But I hope—and I realize that I don’t need to go much further than that one word: hope. I hope, and I believe they will hope, that this moment of meeting holds a promise that other such meetings are possible.

Why Its Time to Take Mobile Seriously

Posted on by Psychotherapy.net Team

I was looking over my Google Analytics stats last month, and was shocked to see that 19% of my clicks in Google AdWords for psychotherapy searches were done on smartphones. People of all ages are now looking for a therapist on their phones, with almost all of the searches being done on iPhone and Android devices. And while Google owns about 2/3 of the search results on desktops and laptops, they command an astonishing 97% of all searches on mobile devices.

What's driving this trend, and what does it mean for marketing your psychotherapy practice?

Three things are driving the trend toward increased searching on smartphones:

1) Larger Screens—the recently-released iPhone 5 stretched to 4.87 inches high, while the most recent Android phones (especially those from Samsung, such as the Galaxy S3 and Note) are well over 5 inches high and almost half an inch wider than the latest iPhone. Larger screens mean more information can be displayed, so the phone becomes a viable alternative to the laptop or desktop computer.

2) Faster Input Options—with faster processors and better software, both Apple and Google have made significant gains in the speed and accuracy of inputting text into the search box. Both offer very accurate voice input, and in Google's latest operating system, Jelly Bean, they offer a rapid "swiping" option that allows users to keep their fingers on the screen while rapidly moving around the virtual keyboard. The virtual keyboard is less of a limitation than ever before in using your smartphone for search.

3) Faster, More Accurate Search Results—Apple offers Siri, who despite her limitations, can respond to many natural language inquiries with accurate search results. Google’s search software is even better, offering remarkably fast and accurate information in response to voice or keyboard input.

There are six important implications of these trends for marketing your practice online:

1. You now need to make sure your website displays properly on a wide range of devices, from smartphones to 7-inch tablets to full-size 10 inch tablets. The good news is that almost all websites look fine on full-size tablets, and most look okay on the 7-inch tablets. But most of the action is in smartphones, and that's where your website might not display properly. 

There are several ways to address this issue. The best way is to hire a programmer who will program your site to dynamically reconfigure based on the size of the screen. This way you don’t have to have two separate sites that need to be optimized for search.

Another option is to use a service such as dudamobile, which will walk you through a step-by-step process to create a mobile version of your existing site. They have a free version, but to get unlimited pages and your own URL, you need to pay $9/month. Google offers a free mobile site creator (with an awful user interface), but it does not integrate with your main website; for details click here.

2. When you send out email responses to potential client inquiries, you need to be sensitive to how they will format on a smartphone screen, since over half of all emails are now first read on a smartphone. It’s a good idea to have a short subject line. The last words of a long subject line may not be visible in the mobile phone's display. Also, consider sending plain text emails instead of HTML. The line width in text is almost always adapted to the display width.

3. Search Engine Optimization (SEO) is different for mobile searching. According to Google, a typical mobile search is only 15 characters long. Google will compensate for this short entry to using “predictive search”—when you type in only 1 or 2 characters, Google will offer suggestions based on the most frequent searches which start with those characters.

For example, someone may search for "individual counseling in San Francisco" on their desktop or laptop, but on their smartphone it might be "counseling SF." What are the most common “predictive search phrases” that are related to your practice and location? Test this out by searching for your practice on a smartphone, and see which predictive phrases Google offers as suggestions, since these are the ones people are likely to click on first. Be sure those phrases are on your site and in your meta tags.

One huge bonus to Mobile SEO on smartphones is that your phone number can be clicked on, which places a direct call to your office. This is a tremendous advantage over someone visiting your website, since on average it will usually take over sixty visits to your site to trigger one phone call.

4. Google Places Profiles—be sure you have a free Google Places profile, because they often show up near the top of a mobile search results page. You can create or edit a profile at www.google.com/placesforbusiness

5. Yelp Profile—as part of Apple's competition with Google, the Siri program will initially search for services on Yelp, not Google. Many iPhone users choose Siri over Google search. To take advantage of this, get a free Yelp business profile at biz.yelp.com

6. Consider a Mobile-only Google AdWords Pay Per Click Campaign—this may be the highest return on investment of any advertising available to private practitioners today, because of the high number of direct calls to your office it will generate for very little cost. If you do this, make the “Call” button very large and prominent on the first page of your mobile Landing Page, to be seen without scrolling.

The move to mobile is accelerating every month, so the practitioner who takes advantage of these trends will have a great advantage over those who wait. The time to act is now.

Continuous outcome assessment

Posted on by Psychotherapy.net Team

One of the enjoyable side-benefits of attending international psychotherapy trainings is the opportunity to meet bright clinicians and discover exciting new projects. At a recent training on ISTDP by Allan Abbass in Halifax, I met two British psychotherapists and researchers, Stephen Buller and Susan Hajkowski, who are starting an innovative project in the United Kingdom: the Psychotherapy
Foundation. The overall goal of the Foundation is to promote procedures that improve the quality of psychotherapy. One aspect of their project I find particularly interesting is the focus on the  importance of continuous self-supervision and peer-supervision by therapists, via videotapes of therapy sessions and continuous outcome assessment. In my opinion, it is vital for therapists to get continuous critical feedback on their work from peers or mentors after formal training has ended: your last day in school should be your first day in consultation. Work in any field that does not include  frequent objective (and ideally data-based) assessment is inherently prone to quality deterioration, and psychotherapy is no exception. Our field in particular has a propensity for isolation, with so many therapists working alone in solo practice. For example, it has always seemed strange to me that therapists are required to get Continuing Education training but not required to get feedback on their actual work. Additionally, as has been discussed previously on this blog, a side-benefit of practice-based outcome assessment is that it provides a data set that can be used to inform the public about the benefits of psychotherapy, and help potential clients make informed decisions about which therapist they want to work with.

The Healing Power of Writing

Posted on by Psychotherapy.net Team

I’ve been a writer longer then I’ve been a therapist, and so it comes to me as no surprise that writing, and narrative, have seeped into my work. What I want to share with you are some thoughts on how you can encourage clients to tap into the healing power of writing and narrative, and some good reasons (in my humble opinion) for doing so. Many clients may already be keeping a journal even before they come into therapy, but I find that people often limit themselves in journal writing to either venting their emotions, or simply recording the day’s events.

There is nothing wrong with venting feelings or recording events, and either of these uses of writing can be therapeutic. What I’m interested in, though, is helping clients to “shift their story” through writing. What do I mean by this? Many people, by the time they finally decide to seek therapy, are often in crisis and “stuck in their stories.” In the tradition of narrative therapy, I like to pay attention to what people tell me when I meet with them for the first time, and I’m very interested in how they “story” their lives. Usually it goes something like this: “I’m a horrible loser, and I keep doing the same thing over and over and I don’t want to but I can’t stop.” They usually tell the worst version of their life story.

The interesting thing is that these “stuck” stories that clients express are usually true! They simply aren’t the whole story. I often think that I wouldn’t want someone to write a story about my life with only the negative parts, and leave out any of my strengths. This is precisely what someone stuck in depression or addiction usually does—express a somewhat factual but only partial account of their lives. What I find is that when someone who is stuck like this keeps a journal, it usually only serves to reinforce their “stuckness” and goes something like this: “Well, I messed up again today. That’s no surprise, given that a loser I am.” (This would NOT be a therapeutic use of writing!)

If a client expresses that they have an interest or willingness to try writing in a journal, I will ask them to imagine the blank page as a safe space where they can try out new ideas and new stories about themselves without being judged. And this is where I feel that writing can be most therapeutic. I will ask clients to write about a success that they had during the week, no matter how small that success is, and write about it in great detail. Additionally, it can be useful to ask a client to explore who they would be if they didn’t feel so stuck in their problem. Most important, I ask the client to imagine themselves as being on a journey, where they can travel away from their current story about themselves and end up somewhere else. And through writing, they can explore that “somewhere else” in a safe manner. No one else ever has to see what they write.

More important than any particular writing technique or style is the power of allowing a blank page to become much more than a blank page. When a person truly allows a piece of paper (or blank screen) to become a safe space for exploring dreams, wishes, hidden strengths and values, an amazing transformation occurs. Suddenly the horrible story of being stuck is revealed to be just that, a story. And since stories are written, they can be revised, especially if we are the ones who wrote the story in the first place. Writing then becomes an empowering act that sparks the client’s creativity and imagination.
 

The Truth About Facebook and Your Practice

Posted on by Psychotherapy.net Team

Many marketing professionals point to the 900 million worldwide users on Facebook and say you must have a strong presence there to have a successful practice. They discuss the myriad ways you can use Facebook: your profile; a business page; advertising and frequent posts. They tell you how to get more “Likes” and “Fans” and the referrals will come. As a psychologist who has experimented with everything Facebook has to offer a private practitioner, I totally disagree with this common advice. You can waste a great deal of time and money on Facebook and have very little to show for it if you go into it naively. In this post I’ll discuss why this is so, and review one area I have found that does work well to generate referrals from Facebook.

Yes, Facebook has millions of users, and it also has the longest time per visit of any website (about 20 minutes). But monetizing those eyeballs is not easy, since few people go on Facebook with a primary purpose of seeking information. People go to search engines to find information, and go to Facebook to socialize, play games, look at pictures and videos their friends have posted, and comment on those posts. This means the only way you can successfully promote your practice on Facebook is to return to the 20th century model of “interruption Marketing,” where you do what the major TV networks, newspapers and magazines of that era did: you interrupt people's attention from what they are focusing on to check out your product or service. But we're in the 21st century, where the prevailing advertising model is “permission marketing” (see Seth Godin's brilliant 1999 book by the same name). As consumers we now get to choose what we want to see and hear. We give people, businesses and networks permission to tell us about their wares—and get annoyed or angry when this permission is violated. And on a rapidly-updating newsfeed such as Facebook, a post about your practice will usually elicit far less interest and attention than the photos from a friend’s vacation or the video of a sibling’s new puppy.

While every practitioner should have a free business page on Facebook (see https://www.facebook.com/pages/create.php), gathering “fans” for your page or getting people to “like” your posts is almost always a complete waste of time. Becoming a “fan” of a psychotherapist page or liking one of their posts is a quick, superficial action that implies a very low level of engagement with your work (aside: what does imply more engagement is when someone gives you their email address; building an email list is a very wise practice-building activity).

The one unique advantage that Facebook has over the search engines involves pay-per-click advertising. Unlike Google, who is forced by their business model to let everyone play the search game, Facebook has an exact way to segment who sees your ads. Thanks to the remarkable amount of personal data Facebook users put on their profiles, Facebook can offer the most highly targeted advertising in the history of business. Pick your target market very precisely—by age, gender, education level, city of residence, marital status, age of children or personal interests—and Facebook has a way for you to get your message out only to that specific niche of people. Specialize in working with children between the ages of 12-15? Want more referrals from women between the ages of 35-55 with a college degree who live only in two very affluent zip codes? Have a new workshop for Baby Boomer retirees? No problem; no one else but those people will ever see your ad. Combine that with an emotionally engaging photo and a problem-oriented headline (i.e. "Panic Attacks?" or "Still Arguing?" or "Defiant Teenager?") and you have a great chance of interrupting focus from the social activities to your service.

One important note: when people click on your ad, Facebook gives you the option of having the person visit your Facebook business page or leave Facebook and go to a specific page on your website. Get them off of Facebook to your website! There are far too many distractions on Facebook that greatly reduce the chances of someone focusing on your services for more than a few moments.

In summary, approach Facebook with caution and experiment with pay-per-click ads—but only if you have a very specific, targeted niche. For all others, create a business page, update it when necessary, and enjoy the social aspects of Facebook. Just don’t expect it to fill up your practice.
 

Mental Illness in Politics

Posted on by Psychotherapy.net Team

In a recent debate about mental health services in Britain’s House of Commons, a Member of Parliament paused and laid aside his prepared notes, departing from the abstractions of rhetoric, the lingua franca of all legislative bodies since antiquity, and spoke at length in concrete terms of his own past experience with debilitating depression. The very next speaker, possibly prompted by his colleague’s candor, decided to see and raise the ante on a past history of mental health challenges, revealing that he presently deals daily with the symptoms of obsessive-compulsive disorder and has done so, sometimes more successfully than others, since childhood. In the course of this rather remarkable Thursday afternoon an additional two members chipped in, relating personal stories of dealing with mood disorders.

The use of gambling terms to portray the day’s events may strike the reader as being somewhat flippant, but considering the stakes, also apropos. These four individuals each took a sizable risk in revealing information that could quite possibly effect their future electability in a negative way. Those in the political class rarely reveal weaknesses to the electorate if it can at all be avoided; and, of course, the stigma endemic in a mental health diagnosis, past or present, need not be elaborated upon. Yet, at least initially, the wager has paid off for those involved, as press accounts speak of their courage and statesmanship in dealing with such an issue so honestly. Reportedly, comments emanating from their various constituencies have been overwhelmingly favorable as well. At least one mental health advocacy group has praised the day’s events as a shining moment for the parliamentary government system.

Just now in the United States, public discourse is much noisier but less substantive. We are, of course, in the final months of one of our multi-years long Presidential campaigns and have just completed the nominating convention phase. Party conventions have largely outlived their usefulness in an age when the nominee of each party is almost always known months before they convene. Today they serve primarily as a sort of infomercial designed to sell or re-sell a particular candidate to the populace. Due to the lack of any real suspense and a general disillusionment with government at present, the vast majority of Americans may simply be glad there are so many more viewing options than there used to be when the conventions first began to be televised in 1948. Still, despite the largely ceremonial and theatrical nature of the political conventions, at the end of the process one of the two men celebrated will be the next President of the United States.

It used to be a common practice to accord the nominee’s home state delegation the honor of putting the candidate over the top in the delegate count. Typically, the state in question would abstain from awarding its delegates until the appropriate moment, passing in the roll call so that they can be returned to at the appropriate juncture. This tradition was set aside at both conventions this year. Had it not been, President Obama’s home state of Illinois would have had the honors at the Democratic Convention. Absent from that state’s delegation was a man much in the news of late, Representative Jesse Jackson, Jr. Mr. Jackson is now reportedly back at home with family but had been in treatment in a number of facilities, most recently, the Mayo Clinic since June of this year for physical and emotional issues the latter eventually identified by medical personnel as being Bipolar II.

During the time of Rep. Jackson’s inpatient hospitalization, his opponents in the fall election have somewhat predictably attempted to call into question his ability to adequately represent his district due to his supposed mental status. (Jackson’s emotional collapse reportedly occurred following his primary victory and he has remained on the ballot as the Democratic Party’s nominee.) The usefulness of this tactic seems limited, as Jackson is widely expected by observers of the local political scene to retain his seat in Congress in November. The opinions from more relevant quarters—state and local Democratic Party VIPs and prominent elected officials have generally been guardedly supportive of Mr. Jackson during his hospitalization. Similar courtesy was extended to one of Mr. Jackson’s high-profile visitors to the hospital, former Rhode Island Congressman Patrick Kennedy, when he also acknowledged and sought treatment for mental health issues several years ago. Kennedy continued to serve in Congress following his diagnose until choosing to retire in 2010 to devote his time to a brain health research initiative.

Knowing what we know as trained professionals about the efficacy of modern treatment for Bipolar illness, this optimism and slowness to judgment seems perfectly sensible. It is quite reasonable, after all, to assume that Mr. Jackson, his physicians and family have all collaborated in the best manner possible to ensure his recovery and, considering his continued status as a candidate, his ability to successfully withstand the continued rigors of public service at minimal or no detriment to his wellbeing.

The importance of this relatively new attitude of acceptance in regard to political clay feet cannot be overstated, I believe. A single generation ago the current Republican Presidential nominee Mitt Romney’s father, George, a candidate for the same office in the 1968 election effectively crippled his campaign when an offhand remark he had made to a reporter the previous year came to light in which he had explained that his prior but since renounced support for the Vietnam War had come about as a result of a “brainwashing” by Pentagon officials. In the 1972 Presidential campaign, the Democratic Vice Presidential nominee, Senator Thomas Eagleton of Missouri, was summarily dropped from the ticket after damaging press scrutiny of his history of hospitalization for depression and treatment with electro-convulsive therapy.

The turning point, when a mental health diagnosis ceased to be politically fatal, may perhaps be traced to Lawton Chiles’ 1990 campaign for governor in Florida. Rather than attempting to conceal his treatment for depression (as Eagleton allegedly had after being invited on to the ticket by nominee George McGovern), Chiles spoke openly about it and extolled the virtues of the then-revolutionary Prozac, which he felt benefitted him greatly. He went on to win his party’s nomination and won the governorship with nearly 57% of the vote in the fall election, going on to serve two terms.
Odds are that there are more than 4 members of 650-member British House of Commons and more than 1 member of the 435-member United States House of Representatives dealing with mental health issues.

Perhaps others in these august legislative bodies will now be comfortable in sharing their trials and success stories, further normalizing the experience of living with a mental illness. Those of us concerned with advocacy can possibly take heart that as the elected class comes to understand that mental illness is not an automatic disqualification for service and that it can strike anyone, and that those able to successfully avail themselves of treatment dealing with it are quite capable of carrying out tasks as important as governing large Western democracies, policy makers may begin to be more receptive to arguments on the importance of adequate funding for mental health and expansion of preventive services. Time and helpful affirmation from the ballot box will tell.

Who Cares About Creativity?

Posted on by Psychotherapy.net Team

“Who cares about creativity? I have real problems to deal with!” This is a common reply that I get from clients (and sometimes from colleagues!) when I bring up the topic of creativity. However, the more I have a chance to write and reflect on the subject of creativity, the more convinced I become that creativity is an essential part of the healing process.

I recently had an opportunity to interview Dennis Palumbo, a therapist and writer in private practice in Los Angeles, CA. Dennis brings a unique perspective to therapy, as a former Hollywood screenwriter (he was a staff writer for “Welcome Back Kotter” and wrote the film “My Favorite Year”) and now therapist to up-and-coming and established writers, artists and Hollywood executives. The topic that came up was the connection between creativity and anxiety. Dennis mentioned that his clients will often say the following: “If only I could get rid of my anxiety and self-doubt and depression, then I could finally write!” To which Dennis invariably replies:” Write about what?”

The clients I work with often don’t see themselves as creative, but they certainly also express the wish to get rid of all the things that they see as “bad”—their anxieties, sadness and losses—and sometimes express the hope that I can “fix” them. And certainly, an important part of the work that we do is helping clients achieve symptom reduction. However, there are some things in life that can’t be “fixed” or “reduced,” such as the loss of a loved one, or a chronic illness, or the anxiety that we all face knowing that we are finite beings. And sometimes, the only thing there is left to do, beyond accepting the situation, is to “use it.”

“Using it” is a term I’ve heard many times in theatre, as a direction to actors who are facing various feelings that may be coming up in their lives. So, if an actor has an angry breakup with his girlfriend prior to getting onstage to play Hamlet, he can use his anger or sadness and allow it to inform his performance. However, in my experience, clients don’t need to be actors or writers to creatively transform their painful emotions. For example, a client who loses a child to a drunk driver, and then reaches out to other parents to form a support group is using the power of creativity to transform their feelings of grief into empathy and social action. It is my experience that people aren’t satisfied with symptom reduction. Their depression or anxiety may get them into the room but the question remains: What am I going to do with myself, with this person that I am, with all of my strengths and weaknesses?

In this way, anxiety and depression become more than symptoms to be reduced. Instead, they become an invitation into the creative process, an opportunity for a client to create a new and more satisfying life. I am always interested in questions that stimulate the client’s imagination, asking them to imagine who they would be without their problem, or what message they think their problem might be sending them. And I firmly believe that if we, as therapists, care about creativity, our clients will come to value it as well.
 

Emotional Healing Through Creativity (Or: How Creativity Got a Bad Name and What We Can Do About It)

Posted on by Psychotherapy.net Team

As a therapist and theatre instructor, I hear many stories about creativity. It usually goes something like this: Creativity is something you either have or don’t have, and if you have it, you’re probably manic, anxious and neurotic. Certainly, very few clients come to me complaining that they don’t have enough creativity in their lives. However, I’ve come to experience that healthy creativity (and yes, I believe that this exists!) can help in the process of emotional healing.

For the past several years, I’ve hosted an internet radio show about creativity and healing, and this has deeply informed my therapy practice. The stories that my guests have shared go against the narrative that creativity is associated with madness and neuroticism. One guest who continues to inspire me is Ray Johnston, and I’ll share his story to illustrate the power of creativity.

Ray Johnston grew up with one dream: to play professional basketball. However, he went to a small college, was not drafted or even scouted by an NBA team, and eventually graduated from college and found himself working in real estate. However, Ray was living in the Dallas area, and would get tickets to see the Dallas Mavericks. As he began attending games as a fan, he started connecting with former NBA athletes, who encouraged Ray to try out for the Dallas Mavericks summer league. Ray did try out and was eventually chosen to be on the summer league.

If that were the end of the story, it would be remarkable enough, but that’s not where the story ends. Soon after being chosen to play on the summer league, Ray was playing a pickup game of basketball with some friends and banged his shin. The next morning, Ray woke up and his shin was swollen to twice its normal size. Ray went to the hospital and as he recalls, “It was July 2004, and I passed out in the emergency room. When I woke up, I was in a hospital bed and George Bush had just beaten John Kerry for the Presidency of the United States.”

Ray was horrified when he learned that he had been in a coma due to leukemia. He was even more horrified to learn that seven of his toes had been amputated and that he would never play basketball ever again. Ray fell into a deep depression, and wondered what he would do now that his only dream had been taking away from him. Ray could have stayed in that depression, but as he lay in his hospital bed, he decided that he was going to create a new life for himself, given his new circumstances and conditions. Ray decided that he was going to pursue his only other passion—music—and decided to start a band. His doctors and friends told Ray that the stress of creating a band and touring would be too much for his body, and they urged him to stay home and rest.

But Ray did not stay home. He went out and started a band, created music and began touring. As he did this, his depression began to lift. Ray felt like he had a new purpose and mission in his life. He began donating a portion of his proceeds towards leukemia research. And much to the dismay of his doctors, he is still very much alive and touring with his band, the Ray Johnston Band, and working towards his dream of playing in the Dallas American Airlines Center. He has been able to overcome his depression and lives a life of joy, meaning and purpose.

To me, Ray’s story illustrates the power of creativity to overcome emotional pain. Ray made a choice to create, rather than to stay stuck in his depression. Whether or not he becomes a famous singer, he is already successful. Likewise, in my work with clients, I want to know more not only about their symptoms, but also about their hobbies, their dreams and their creative interests. And for all the people who have told me they are “not creative,” I’ve yet to meet a human being who does not possess the ability to be creative in some way.

As therapists, we can be advocates for creativity, and pay attention to the ways in which our clients are already creative. We can hold the possibility of creativity as an asset that helps our clients thrive, instead of as a burden that they need to live with. Finally, we can see the therapeutic process itself as a creative practice, something which I’ll write further about in future posts!