Relationships

I was going to write about the difference between equality and equity in relationships this week, but I found others have already done a lovely job of writing what I would have, so rather than re-invent the wheel, Imma just drop some links here with a pull-quote or two:

“Equality is the access to and distribution of a set of resources evenly across people. Equity, in contrast, is the access to or distribution of resources based on need. Equality and equity are separate concepts. Both have to do with fairness and justice, but how society achieves them and what they ultimately look like are different.”

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“Equality” in a relationship or marriage often makes individuals aware of amounts, like trying to balance two sides of an equation. For example, if one partner spends an hour doing the dishes, then the other should spend an hour doing some other type of chore. This type of “tit-for-a-tat” scorekeeping corrodes relationships, especially if this type of equality becomes the measure for a relationship’s success. Far too often we use this “equality” measuring stick to determine how much each person is bringing to the relationship, which means we’re focusing on things done or achieved rather than the person as a whole.
 
     “Equity” and its attempt to make things “fair and impartial” is a very different perspective in terms of relationships. Rather than keeping score on hours clocked or items checked off lists, striving for marital or couple equity means creating an overall sense of fairness and balance. And, because equity implies being impartial, it allows us to remove our ego and selfishness, looking at the strengths and abilities of our partner in order to determine what’s best for them to bring to the table.

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I hear the wounded cry of “It’s not fair!” from my relational clients A LOT. After being raised in societies, cultures, family environments that drive home the importance of EQUALITY, it’s what a lot of us expect on the interpersonal fronts as well, only to find that people are way more complicated and nuanced than that. The biggest problem with the Equality model in relationships is the baseline assumption that everyone involved in the relationship (family, friends, coworkers, lovers, etc.) is both ABLE and WILLING to provide exactly what you do, the way that you do, with the prioritization or urgency that you do. More often than not, those assumptions get entrenched as invisible expectations we’ve projected onto others around us, without any explicit negotiations or consent. We just ASSUME that because these are OUR values, they must be universal values, right?

Most of us have seen variations of this image going around the net for a while now, illustrating the different ways we construct the value of what’s “fair”.

(Any person who has ever come to therapy because they are at their wit’s end dealing with a partner who does not seem to “pull their weight” around the house or family duties is probably screaming right about now…)

There are a LOT of reasons, legit and otherwise, why Equality does not happen in relationships:

“I don’t want to.”
“I don’t value that/I don’t care about it like you do.”
“I don’t know how.”
“I didn’t know you expected/needed/wanted me to.”
“I don’t have time to do that.”
“It’s just not a priority for me.”
“There are significant obstacles to my ability or willingness to do that.”

But the biggest struggle often happens as relational partners come up against the need to let go their Equality assumptions and look at what the other person is ACTUALLY providing, or capable of providing; will what’s being offered equitably address the desired relational outcomes? Learning to appreciate each other’s way of participating in the relationship, and explicitly, effectively navigating the places where participation doesn’t meet our expectations, is how we get to the presumably shared, presumably desired outcome of a healthy, long-lasting relationship.

This is the foundation of how Equity works. This is also, among other things, the general principle behind Gary Chapman’s Love Languages. We all need different things and bring different skills, competencies, and characteristics to the table. Even when we need the same or similar things, we can vary wildly in how we expect it to look when those needs are being met. Equity means providing each person with what they need to do their individual best in the relationship, while understanding they each may need different things, in different ways, at different times, knowing there’s no guarantee of getting exactly what they want as the outcome. It’s work, creating equity, but out of that understanding relational partners stand a much better chance of creating something stronger and more adaptable over time.

Emotional Intelligence, Mental Health, self-perception

Why are you so petrified of silence?
Here can you handle this?
Did you think about your bills, you ex, your deadlines
Or when you think you’re going to die?
Or did you long for the next distraction?

Alanis Morrissette, “All I Really Want” (1995, Maverick/Warner Music Group)

Decades ago, when I first tried meditating, I could not sit for more than a couple of minutes at a time. A dozen or so years ago, when I finally got serious about the practice, I could finally get past the physical fidgets and sort myself out around chronic pain, but I couldn’t get around the Squirrel Brain for the longest time. The silence, as “they” like to say, was deafening, and my own thoughts would often redouble their efforts to drown it out.

Often, in the silence when I’m trying to fall asleep, I tell myself stories that are half Mary Sue fantasies, and half a way of setting up semi-lucid dreaming as I transition into sleep patterns. They often run on recurring, familiar themes with recurring, familiar characters, like favourite bedtime stories read to us repeatedly in childhood.

These two pieces of information are the backdrop to an experience I had in a guided meditation last week, during a training course in working with internal Parts. As part of the meditation, we were invited to notice what aspects of our thoughts or feelings wanted to follow us on this path in towards silence, and gently encourage those heel-dogging experiences to wait off to the sidelines and give us some space. It’s a lot harder than we think to try to distance ourselves from our own thoughts and feelings; even as a relatively seasoned short-term meditator, I still struggle with intrusive thoughts that just don’t like being ignored. And I don’t mean “intrusive thinking” the way we often do in psychotherapy; I just mean the kinds of everyday thoughts we have about things we need to do, meant to do, random memories, feeling flashes and reflections on things that happened in the day—the usual jibber-jabber of mental cognitive load.

As I engaged in the meditation, I managed to get most of the regular Intruders to fall away, and I was good for a while. But there’s a part of me that shows up, especially in the calm and quiet moments, that starts to spin up stories. Sometimes I think of this part as my Muse, and like typical Muse Moments they always seem to show up when I am least equipped to make notes about what might be a good storyline to flesh out; once a Writer, always a Writer, after all. One ignores the whimsical and fleeting visits by their creative Muse at one’s own peril. Sometimes this part simply likes to provide some internal companionable distractions to the quietness around me. It’s generally a soothing presence, more in line with calming me than getting me fired up with creative sparks. The version that showed up in the meditation definitely had this latter energy. And while it wasn’t necessarily the bent of the exercise to converse with our Parts when we’re supposedly walking towards Silence, I still opted to get curious about what it was doing here.

This part of me has been around since early childhood. Since I was old enough to understand and appreciate people reading to me or making up stories. I don’t have any specific memories of either of my parents reading me bedtime stories, but I know it must have happened as both my parents were avid readers and encouraged my own reading. Both my parents were also alcoholics. Once they drank themselves into a stupor, they would retreat to their separate spaces and not talk to themselves, each other, or me. There was a LOT of silence in my home as I was growing up. Most of my memories of childhood Christmases, for example, are of them starting with Galiano and vodka in the orange juice and being separately passed out by early afternoon. I would escape into the books I inevitably received that morning or was assembling my own toys. The house would be silent, and those stories would be the place to which I could flee and find companions, and engagement, and solace. I spent a lot of time alone as a child; on a farm until I was 7, and in the small town I grew up in from 8-19 (though at least in town I could and did make friends I could spend more time with, perilous and political as childhood and teenage relationships could be).

Silence was also a herald of uncertainty and instability for me: I never knew what kind of adult was going to come out of those silences. Was it going to be “drunk and hyperfocused on me”, “sober and hyperfocused on me”, “emotionally estranged and distant”, “calm and friendly”, “angry and antagonistic at each other”, “angry and antagonistic at me”, or any one of a random number of other states common to alcoholics. Escape into the stories I could explore in the silence gave me consistent refuge, and that was so invaluable to me as a child and teen, and probably explains why some of the inner-world storylines I developed in my younger years are still so strongly with me even well into my adulthood.

Most people have some kind of Storyteller part, often an intellectual, “thinking” part. This is the part of us that narrates or describes an experience we’re having, rather than standing down and allowing us to be fully in the emotional experience of the moment. Intellectualizing an experience often feels more normal, or even considerably safer, than allowing our feelings to come to the surface. Sometimes the Storyteller is our fully human need to make sense of a set of confounding circumstances, connecting the dots (rationally or not) to create a narrative that makes sense at least to us, if no-one else, that we can run with as if it were incontrovertible FACT. Sometimes this Storyteller part is so strong that it retells the same story, over and over until it is a well-polished, almost scripted delivery.

Years ago, my friend and Dora-award-winning actor and director Philip Akin shared this piece of perspective on directing Shakespeare. He said you can always tell when an actor has no clue about the meaning of the words coming out of their mouths, because they simply seem to “drop out of” the lines, and if you know what to look for as a director, it’s an easy thing to spot. The words are there, but the presence of the character or actor inside them just disappears for a moment. I began to notice that in my work as a theatrical director and at some point, in the clinical office, I began to notice that with my clients as well. I could more readily spot when something they were saying to me felt like that polished script, because emotionally they would kind of “drop out” in the same way actors do. I started to get curious about what those words meant to them, and sure enough, more often than not I’d get variations on the theme of, “That’s just how it’s been for years.” They have created such a familiar and refined narrative that they can safely disconnect any emotional content from the words and recite the words now without any risk of recurring pain from vulnerable and tender lived experience.

Now I know that in the moment, I’ve been in the presence of their Storytellers. These are the parts of their internal processing system that carry the load of explaining their internal experiences to the outside world in ways that seem palatable in whatever ways seem necessary to that external audience. These recitations have become polished deliveries based on repetition and refinement based on the speaker’s perception of how Others are receiving and responding to those stories. We tweak the recitations to elicit some specific responses and minimize others, thus controlling the engagement and/or the environment in which we are ostensibly revealing some quasi-vulnerable part of ourselves—this identifies the Storyteller as what Internal Family Systems terminology recognizes as a Manager. Its job is to mitigate outward circumstances that could lead to harm, for example by controlling the narrative during disclosures, or (as in my case) protecting a child from the pain of isolation and profound loneliness.

It was lovely to have a few moments alone recognizing the presence, and now appreciating the workload, of my own Storyteller. It was nice to have the container of a silent meditation in which to walk alongside it and allow it to put down the work of keeping me calm and distracted and safe; I was able to show it where I was in life, and how I have learned to appreciate silence very much in my life (rampant Squirrel Brain during my own meditation notwithstanding). My Storyteller seemed to appreciate that understanding and was quite happy to walk along with me without needing to spin a yarn as if to keep a small child entertained. It was a lovely moment.

Do you have an internal Storyteller? Are there polished pieces of your own experiences that you keep reciting time and time again? Is there a part of you that prefers to think its way through experiences rather than feel them? Are there rich, old narratives that flow into those silent moments to accompany you when the silence feels somehow like it’s too much? What else might you be wary or afraid of encountering in those moments of silence?

Emotional Intelligence, Mental Health, Self-Development, self-perception

[I wasn’t going to write a post today because I’ve been sick for a week, but the kernel of this one appeared in my head at 2am two nights ago as the Ick was finally starting to loosen; as every writer knows, when the Muse shows up, you shut up and write what she tells you to write.]

The scene: a comfortably furnished counselling office on a weekday evening; seated as far as they can possibly get from each other on the tufted velveteen sofa, a man and a woman. Across from them, quietly observant, their therapist.

Woman, angrily: How can you not see what’s happening right in front of you? I am SO FUCKING TIRED of feeling like all of the relationship shit falls on MY shoulders to manage for us both! I feel like you don’t even know what it takes to be in a partnership with someone, and I’m so resentful now that I’m the only one trying to make anything better!

Man, pleading: I know you’re unhappy! I don’t know what to do! Can’t you just tell me what you need me to do??

Woman: I need you to step the hell up. Do the fucking WORK.

Man, turning to the therapist, hands dangling limply between his knees, defeated: I don’t even know what that means.

Woman: [throws up her hands, exasperated]

Most of us who have done couples work will have seen variations of this scene play out time and time again. Even if we’re working with individuals, we’ll often hear variations on statements like, “I need (or need someone else) to DO THE WORK”, or “I don’t know what DO THE WORK actually means.”

So… How is it that some of us know what this phrase, “Do the Work,” means, and some of us don’t?

Usually, it boils down to something simple: it’s a commonly used (some might suggest “overused”) phrase that has come to mean a lot of different things to different people, and while you may have an idea of what it means to YOU (whether you have even a vague clue of HOW to do the Work or not), you may have no idea what someone ELSE means when they’re shouting it at you in anger or frustration or disappointment. All you’ll know in that particular moment is that whatever you have been doing, clearly hasn’t been working.

You need something TO work. You might even need to DO work to change things, hopefully for the better. But you have no idea what that actually entails. If you’re on the receiving end of someone’s demands to “do the Work,” the message you’re probably hearing is, “Everything you do sucks and why can’t you just magically and instantaneously be a better lover/partner/spouse/friend/parent/sibling/whatever??” I can guarantee that’s not ACTUALLY what your partner is trying to communicate to you, but by the time you end up in my office (or one like mine), you’ve probably heard frustrated iterations of this messaging so often that you can’t hear them as anything else. And if you’re on the delivering end of this message, it probably means something to the effect of, “You need to change so I feel better, and you should just magically intuit what I need that to look like from you.” And I can also guarantee this kind of approach is setting up everyone in the relationship for mountains of frustration at best, and catastrophic sabotage at worst.

So… what is “the Work”?

In an introductory note to her book, How to Do the Work, Dr Nicole LePera describes, “A long, rich tradition of the work of transcending our human experience […]” involving “the pursuit of insight into the Self” and the development of “tools to understand and harness the complex interconnectedness of your mind, body, and soul.”

Or, as we like to say in The Biz, “Figuring your shit out.”

By the time someone(s) gets into a therapist’s office, especially from the perspective of relational conflict, “the Work” means “learning how to see and understand how your own patterns of thinking and acting are (negatively) impacting your life and/or the lives of those around you and changing those thoughts and behaviours in positive ways.” While it’s not entirely true that knowing is half the battle, admitting there’s a problem in what you’re bringing to the table is kind of a crucial starting point. “You can’t fix what you can’t see” is only nominally less true than the idea that you can’t fix what you WON’T see. At its core, “doing the Work” means first learning to see and accept that there IS a problem in how we engage in the world, then figuring out how to improve the ways we engage.

I often break the Work down into the following stages of personal development, each with its own subset of tools and tactics and potential revelations:

  • Self-observation (looking inward at our own internal workings with genuine, nonjudgemental curiosity)
  • Self-reflection (thinking critically – as opposed to simply being self-critical – about what we perceive when we look inward, exploring where those thoughts, feelings, behaviours come from)
  • Self-connectedness (this is a new piece of the process in my approach, because I realized the skillset for seeing and understanding how our individual existence impacts others in systems around each of us is its own piece of Work)
  • Articulation (the ability to communicate what we’re observing and learning to the Important People in our lives is a skill unto itself)
  • Implementation (navigating the actual iterative change processes within ourselves and our relational systems)

The Caveats of “The Work”

Jessica Grose, Opinion writer for the New York Times, encapsulates a lot of the current backlash against the phrase itself and what it has come to mean in pop culture, in her article, ‘Doing the Work’ and the Obsession With Superficial Self-Improvement (New York Times online, June 3, 2023; free account subscription required):

I confess a visceral aversion to “doing the work” used in this particular way. My gut reaction is: I simply decline to do more work. My life is already filled with many kinds of labor. I work full time; I cook dinner every night; I shuttle my children to and fro. I’m not asking for a medal here. This is just what’s in many people’s inboxes. But does tending to my mind and soul have to be framed as yet another job, another box to check, another task to optimize and conquer?

I asked [The New Yorker journalist Katy] Waldman over email what she made of my aversion. She also finds “doing the work” a “uniquely annoying phrase” and explained that it “can come off as patronizing.” It implies that our big issues in life “are simple and clear-cut, that everyone agrees on what they are and that the only reason a problem hasn’t been solved is because somebody isn’t working hard enough.”

Jessica Calarco, an associate professor of sociology at the University of Wisconsin, Madison, had a similar take. “This idea of ‘doing the work,’ is just the latest manifestation of the kind of self-improvement culture that has long permeated American society and that is closely linked to America’s obsessively individualistic bent,” she told me via email. Self-improvement culture can deny the larger societal issues that often cause people strain, and it “can lead us to punish people who are struggling or deny them the support they need,” Calarco wrote. Therapy is expensive, and having time in your day to reflect can be a luxury, something that’s rarely mentioned when “doing the work” is used.

These are all good and valid concerns around the way the terminology has evolved culturally over time, especially both the connotations of Yet More Emotional Labour, and the chilling divisiveness when the term is used to dismiss those who haven’t done some unclear amount of said emotional labour towards self-betterment. I remember reading a science fiction novel decades ago—I don’t remember anything else from the book except this particular plot point—that made a sharp class distinction not between the rich and the poor, but between the Therapied and the Untherapied, and all the snobbish, snubbing judgement you’re probably already reading into “Untherapied”.

The opponents to the terminological hijacking are dead right; therapy IS expensive, and for a lot of people, time to reflect IS a luxury. Being asked to take on more emotional labour IS going to be a big NOPE for a lot of people. As I have written often throughout the years in the blog, change IS hard, and some will work their asses off for literal YEARS in or out of therapy for the smallest of incremental changes. Other people can read one self-help book and suddenly seem like they’ve seen into all the deepest secrets of the universe**.

I am always honest with my clients when I’m explaining what this loaded term means in MY office, and how I approach being a guide/coach/teacher/companion/witness/emotional sherpa for my clients doing their individual versions of the Work: I have NO idea what the Work will look like for each of you. I have NO idea how long it will take you. Until we do the Gap Analysis to understand what resources are already available and which might be lacking or needed to reach the goals you set for yourself, we really have no framework in which to understand what Work is necessary. And even once we do start to fill in those gaps, a lot of the Work isn’t going to be silver bullet-level magic fixes; it will be trial and error, assessment and adjustments based on what you learn along the way and over time.

And that can be disheartening to hear for people who come to therapy believing that just walking through the door is enough to check a box labelled “Did the Work”. Therapists have a name for the broad category of potential clients who come in once or twice to try on the idea of changing things in themselves or their relationships but decline to take on the process, or maybe aren’t even ready to admit yet there IS a problem, let alone they might be the source of it; we refer to these kinds of potential clients as “precontemplative”, taken from the Transtheoretical Model of Change. Not everyone who comes into therapy is ready to change, and we must respect that. Not everyone who is ready to change comes equipped with the tools for change, and we must respect that, too. Sometimes before we can build a house, we must make the tools with which to build the house.

The onus is on us as therapists to be honest about these realities, and to be clear about both how we define the Work, and what we bring to the table to help our clients in that Work. But once we’ve gotten that straight and mostly clear… the responsibility then shifts entirely onto the client to (you guessed it) Do the Work.

(**—someday I will tell the story of how Gloria of Sainted Memory unleashed the self-developmental equivalent of The Big Bang the day she put into my hands my first copy of Bennet Wong & Jock McKeen’s The Relationship Garden. That story is not for today, but it is an excellent example of how “doing the Work” can literally become a lifelong endeavour.)

Emotional Intelligence, Mental Health

I’m a big believer in the notion that we all HAVE feelings. I’m even a big believer in the idea that we all FEEL feelings. I also happen to have a front-row seat for the myriad ways human beings try REALLY, REALLY HARD a lot of the time to AVOID feeling their feelings, especially the difficult, rowdy, dark, threatening ones.

A favourite avoidance mechanism for many of us (yes, myself included) is to subvert feelings we don’t want to have into actions that make us feel better, at least in the short term; for example:

Sad => Eat
Sad => Shop
Depressed => Sleep
Anxious => Clean

It’s the short-term, pleasure-seeking action into which we channel our temporarily imbalanced emotional state that might, indeed, work in the short term; it never seems to get at the root of whatever’s prompting those feelings in the first place, though. It turns us into what someone (I can’t now remember who) once termed, “Human Doings, not Human Beings.” How many of us recognize the phrase, “I eat my feelings”? That’s subversion.

Another common reaction to the feelings we don’t wanna feel is scapegoating:

[T]he practice of singling out a person or group for unmerited blame and consequent negative treatment. Scapegoating may be conducted by individuals against individuals (e.g. “he did it, not me!”), individuals against groups (e.g., “I couldn’t see anything because of all the tall people”), groups against individuals (e.g., “He was the reason our team didn’t win”), and groups against groups.

A scapegoat may be an adult, child, sibling, employee, peer, ethnic, political or religious group, or country. A whipping boyidentified patient, or “fall guy” are forms of scapegoat.

Scapegoating has its origins in the scapegoat ritual of atonement described in chapter 16 of the Biblical Book of Leviticus, in which a goat (or ass) is released into the wilderness bearing all the sins of the community, which have been placed on the goat’s head by a priest.

from Wikipedia

René Girard aptly describes how scapegoating becomes an outlet for feelings we can’t or don’t want to examine within ourselves for the ACTUAL source of them:

In a world where violence is no longer subject to ritual and is the object of strict prohibitions, anger and resentment cannot or dare not, as a rule, satisy their appetites of whatever object directly arouses them. The kick the employee doesn’t dare give his boss, he will give to his dog when he returns home in the evening. Or maybe he will mistreat his wife and his children, without fully realizing he is treating them as “scapegoats.” Victims substituted for the real target are the equivalent of sacrificial victims in distant times. […]

The real source of victim substitutions is the appetite for violence that awakens in people when anger seizes them and when the true object of their anger is untouchable. The range of objects capable of satisfying the appetite for violence enlarges proportionally to the intensity of the anger.

Girard, I See Satan Fall Like Lightning; 2001, Orbis Books, NY

Projecting our feelings onto others isn’t new; nothing abhors a vacuum more than the human brain, not even Nature. So when we don’t understand why we feel what we feel–or we don’t want to look at why we might feel as we do–it’s sometimes MUCH easier to scan around for an easier target and make them bear the emotional burden for us. In taking those feelings out on the unsuspecting victim, we complete the ritual of metaphorically driving our burdens out into the desert to perish somewhere far, far away from us and our shame-stirring occupancy of those emotions. It’s devastatingly destructive on relationships, however–trust me on this one, I’ve personally lost entire marriages to not recognizing this pattern in time. (I had an excellent therapist who helped me figure it out afterwards, at least.)

A third way we often create distance from our own feelings is something I recently labelled as “surrogate catharsis.” A client was telling me how they often watched episodes of “Grey’s Anatomy” for the soap-opera-ish melodrama that readily provoked great, heaving snot-filled sobfests the client could not otherwise allow themselves to express. It called to mind a lesson observed a very long time ago in the BDSM community, where I learned that bottoms/submissives/slaves can use the often-ritualistic container of a scene, or playspace, or a Dominant/submissive relationship, to express things we can’t always express in the other contexts of our lives. We can scream out the rage and pain, we can struggle hard against the bonds, we can let go of higher cognitive function and allow ourselves to fall into certain physical sensations, we can cry and sob and beg and plead and just generally let go of the behavioural constraints to which we normally cling.

A surrogate is a person or thing we substitute for another in the same role. Like scapegoating, but so unlike scapegoating, the mechanics of surrogacy are somewhat similar. For a variety of reasons, we cannot or don’t want to access our own feelings directly; this is fairly common with clients who bear the scars of profound trauma (or are still immersed in ongoing trauma scenarios). We are aware of the buildup of pressure alongside these unwelcome feelings, however, and seek to find a way to release the pressure without ever actually accessing the feelings and/or their roots directly. Unlike scapegoating, however, we don’t project those feelings onto another and then follow up with punitive measures. Instead, we actually allow ourselves to experience the feelings but in a different association than their actual origin. We can feel, and we can express, but it’s almost directed harmfully AT another… and it’s almost never connected to directly processing our internal traumas. For some of us, we achieve surrogate catharsis when we read or watch something that gives us permission to cry. Unlike the act of subversion from the top of this page, we choose acts that DO access and express our feelings, we just don’t connect them to their sources.

Some people default to a particular method of rerouting their emotional experiences. Some of us will move between all three as circumstances dictate. In many cases, these are self-defensive mechanisms designed to protect us from what we instinctively believe to be threatening experiences. In a lot of cases, these defences have become maladaptive and problematic for the person or their relationships. We create barriers between our day-to-day cognitive functioning and our emotional experiences for a lot of reasons, but chiefly because we’re taught to be afraid of, or to doubt the veracity of, our feelings. But feelings are most often just our brain’s way of running a flag up the pole to indicate, “Hey, You–something is going on here that needs tending to.” Therapy can often help people learn to connect safely with their own feelings, and find ways of both allowing them to surface without so much overwhelm, and choosing different default actions when they are present.

To borrow from Cognitive-Behavioural Therapy for a moment: Feelings are not Facts. They’re just a transient internal experience of the situation, the context, of this moment. When we deflect away from them, however, whether we subvert, scapegoat, or surrogate them, we can often give them more power and influence over us (or others) than they deserve. As a closing meditation on the transient nature of even the most overwhelming feelings, I offer my favourite poem by the Sufi poet, Rumi (translated by Coleman Barks):

This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

Emotional Intelligence, Mental Health

[Before all else, I will add this clarification: This is an opinion, albeit one informed by years of clinical observations of my own clients: those who self-identify as neurodiverse, those who self-identify as neurotypical, those who aren’t entirely certain where they fall, and perhaps mostly those who VIOLENTLY reject the notion they themselves might be on the spectrum somewhere.]

The human brain likes to organize and categorize things. Human culture likes to organize entire groups of people into “Us” and “Them”, then create entire arbitrary systems of values and rules and justifications tied to the perceived differences between those who are Us, and those who are Them. We see exactly the same kind of almost tribalistic distinctions between Those Who Are “Mentally Well” and Those Who Are “Mentally Ill”, and even when science moves to recategorize what used to be seen as mental illness into different forms or levels of executive functionality, humanity still very much adheres to those differentiating Us and Them labels.

With the re-examination of what we now term “neurodiversity” in the past decade, trying to better understand executive functionality in its much-broader-than-anyone-ever-realized scope, I often see through conversations with my clients the not-always-subtle pushback in our culture to the idea that a wide-ranging selection of behaviours tied to executive functionality might be way more prevalent than we thought. There has been a strident demarcation between the Us that can function without those disruptive behaviours, and the Them that seem persistently plagued by them; the affected neurodiverse (ND) who struggle to mesh with the world around them, and the “normies” who adhere to the notion of being “neurotypical” (NT). “I’m not like THAT,” “I’m not broken,” I’m not CRAZY”–therapists hear these kinds of statements all the time, just as we hear from the other side, “Am I broken?” “Am I crazy?” Why is this so hard for me and so easy for everyone else?”

Almost a decade since the first ND folks walked into my office, and now five years of working more closely with ND folks of many stripes, through my clinical observations and interactions I have come to a singularly compelling conclusion:

The concept of “neurotypical” is complete and utter bollocks,
a damaging, tribalistic myth of epic proportions.

There. I said it.

I deal with a lot of adults who are officially diagnosed with ADHD or autism.
I deal with a lot of adults who are self-diagnosed with ADHD or autism.
I deal with a lot of adults who regularly present with behaviours consistent with ADHD or autism.
I deal with a lot of adults who periodically or infrequently present with behaviours consistent with ADHD or autism.
I deal with a lot of adults who regularly present with maladaptive behaviours consistent with exposure to/immersion in high ongoing or repetitive stress or overstimulation (including burnout).

Guess what? One group, the first listed here, has an official diagnosis of some form of neurodivergence. The second is willing to see themselves as such. The other four? Statistically most likely to self-identify as neurotypical. You know what they all have in common? They all share the same types of dysregulated emotional reactions and behaviours when pushed past their respective breaking points. The breaking points’ locations differ for each group, but they can be mapped on a very uncomplicated two-axis graph with GROUP on one axis and STRESS on the other.

What this means, then, is that under the right set of circumstances, WE ALL exhibit the same dysregulated responses to stress and/or overstimulation.

TL;DR: pushed past certain points, WE ARE ALL NEURODIVERSE.

Take THAT, stupid tribalism!

So what’s happening for us then that puts us all on the same spectrum of executive function but at vastly different points of regulation? Turns out, the variable factor is the Window of Tolerance, or what I’ve been calling “tolerance capacity”.

The primary difference between the folks who claim to be “neurotypical” and those who don’t is their capacity to process stimulation. Stimulation past a certain point starts to exact heavier and heavier tolls, becoming stress. Stress surpassing tolerance levels starts to wear us down into a variety of hypoarousal and fatigue states (this is often where we see our burnout clients showing up). Stress and overstimulation that continue for many people into breakdown zones will eventually result in dysregulated responses; the tolerance window for NT folks is simply higher or wider, on average, than most ND folks whose overstimulation can start as soon as they wake in the mornings.

The reason why I would most like to strike the myth of “neurotypical” from the records is the damage done by any system that presents a mythical standard of high moral value, then subjugates a vast swath of the population into the OTHER group: “NEUROTYPICAL is GOOD, anything that DIVERGES from GOOD must therefore be BAD; therefore NEURODIVERSE is BAD.” Trust me when I say, it’s been a LONG struggle just to get language shifting from “Neurodivergent” to “Neurodiverse”. “Divergence” still carries the stigma of “diverging from the NORM”, which is hugely problematic when we can increasingly prove that “normal” is a mythological crock of shite. A lot of ND folks have brought in their frustrations and terrors around encountering time after time the messages that they are perceived as somehow less than, broken, crazy. They’ve been gaslit for generations into believing they are mentally ill, or at least deficient somehow; the ongoing stigma attached to neurodivergence is part of why the Tribe of Neurotypicals clings so desperately to the Great Myth of Normalcy.

Most of us have a window of tolerance, even the advanced autistics; it may not be as big as yours or mine and it almost certainly looks very different from anyone else’s window. We generally each have SOME capacity to tolerate stimulation or stress, but our ability to tolerate can shift dramatically, even from one moment to the next; it can shift up or down the Stress axis, it can grow or shrink. It is definitely impacted by the number of stress/stimulation sources in our lives. Some folks thrive in high-stress environments indefinitely because they have high-capacity tolerance windows; others are grumpy as soon as they wake to the weight or feel of their own bedsheets against their skin, and tolerance windows only shrink or move downward from there.

So instead of firmly and proudly declaring yourself in the camp of Neurotypical, I would ask you to remember a time when you maybe lost control emotionally or physically; how did you react? Did you feel overwhelmed, or distraught? Were you thinking clearly, acting your best Executive Self? How many times in your life has that happened? It’s important to reflect on these moments; these are the experiences that put us all on the same spectrum. There are a lot of great resources to help you understand how your own window of tolerance operates, starting from the seminal works of Dr Daniel J Siegal (described in the video link below), and how to be better at regulating yourself in the moments where those neurodiverse behaviours signal moving out of your optimal range. Even if we don’t bring the angle of Neurodiversity into the office, therapists are often well aware of a client’s executive functional state and capacity; we’re constantly working in various ways to help grow a client’s tolerance for a variety of stressors (whether this winds up looking like “tolerating in place” or “tolerating change” around those stressors).

Rethink your understanding of the myth of Us and Them. There are no camps here, just a spectrum of tolerance capacity and some beautiful, mobile windows into each of us on it.

Sexuality

There’s an exceptionally high, depressing number of heterosexual people who still operate under an exceptionally limited, depressing belief that “sex” = “this penis in that orifice, everybody cums like a porn star, then we all go home happy.” Occasionally, to change things up a bit, they might substitute finger(s) for penis, and even more occasionally a tongue. This might make for an okay but bland sex life in Relationshipland; at the very least, odds are good that definition of sex leads to a great deal of (maybe not so) secret dissatisfaction:

In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. While 18.4% of women reported that intercourse alone was sufficient for orgasm, 36.6% reported clitoral stimulation was necessary for orgasm during intercourse, and an additional 36% indicated that, while clitoral stimulation was not needed, their orgasms feel better if their clitoris is stimulated during intercourse. Women reported diverse preferences for genital touch location, pressure, shape, and pattern.

Herbenick D, Fu TJ, Arter J, Sanders SA, Dodge B. Women’s Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94. J Sex Marital Ther. 2018 Feb 17;44(2):201-212. doi: 10.1080/0092623X.2017.1346530. Epub 2017 Aug 9. PMID: 28678639.

Yet, many women still fake orgasm during intercourse, according to therapist Laurie Mintz, author of the new book “Becoming Cliterate.”

“The main reasons they give for faking is that they want to appear ‘normal’ and want to make their male partners feel good,” she said.

“This is one of the saddest and most common problems I deal with in my clinical practice,” added Anita Hoffer, a sexuality counselor and educator. “Women who either are uninformed or insecure and therefore easily intimidated by ignorant partners bear a great deal of shame and guilt at being unable to climax from intercourse alone. Many are greatly relieved when they learn that they are among the majority of women who engage in sexual intercourse.”

Intercourse isn’t everything for most women, says study – try ‘outercourse’” – Ian Kerner, CNN; Updated 10:32 AM EDT, Mon August 28, 2017

Porn really has a lot to answer for in having given the population a damagingly unrealistic image of what sex is and what it’s supposed to look like, but the real roots of our sexual destruction lie in the utter absence of truthful, honest, science-based sex education. Most of the clients who come into my office have never had any kind of formal Sex Ed beyond some terribly-awkward and embarrassing PE classes in high school about reproduction, and maybe some even more terribly-awkward and embarrassing instruction about avoiding sexually-transmitted infection (STIs). I’m *STILL* having to teach people that vulvas and vaginas are not the same things, that a woman’s urethra is a different opening from her vagina, that orgasm through penetration alone is something only 18% of women experience REGARDLESS of what the porn industry says.

All of this to say…

Imagine how much more interesting, and hopefully satisfying, “sex” might be for everyone if we broke away from the narrow definitions into something far, far more expansive and inclusive of a variety of sensations?

Anyone who knows me knows I’m a big fangirl of Emily Nagoski* and her work researching and presenting the sex education I wish we’d ALL had access to when we needed it. Her work has greatly influenced a movement in sex therapy away from the insular definition of sex as penis-in-vagina (PIV) intercourse and the focus on orgasm as the sole acceptable outcome of “sex”. The rallying cry of her first book, “Come as You Are” is, “PLEASURE IS THE MEASURE,” separating out the forced trajectory toward an outcome 72% of women don’t experience (as poor education and representation have led us and our equally-ill-informed partners to believe we should), and replacing it with the idea that it’s okay to focus on enjoying what DOES feel pleasurable instead. If that’s an orgasm, Great! But for a lot of folks, they want, and often need, something… different.

Defining sex solely as “PIV intercourse to orgasm then stop” is like going to a restaurant that has two items on the menu: an entree and a dessert. You might be able to vary the plating of the first, and the assumption is that the latter will (must?) be the inevitable ending for both participants. That’s a restaurant that’s likely to become boring in a Very Big Hurry, and then clients come to me wondering how, when, why they seem to have “lost the spark” in the bedroom.

Through the work of Nagoski and others, like Dr. Laurie Mintz and Dr. Lori Brotto, I’m teaching an expanded model of sexuality that breaks out of the narrow mode and expands the menu into four distinct types of experiences that can flow between being explicitly sexual, and the sensual (sensory) aspects of the moment: Desire, Arousal, Pleasure, Outcome

Desire

To desire is simply the act of wanting something. Everything from, “Y’know, I think I’d like to spend more time at the beach this summer” to “Right now I crave potato chips so badly I could chew my own arm off” falls under the heading of Desire. When most people think of Desire in the context of sex, what they mean, and unfortunately what they consciously or unconsciously expect, is Spontaneous Desire, which common sexual mythology portrays as the ability to get aroused (with all the assumed bodily reactions porn taught us to expect) instantaneously and without effort. What a VERY great many people ACTUALLY experience, however, is Responsive Desire, or a slower-building state that comes as a response to a set of often-invisible criteria that is often frustratingly fluid in nature. (To understand more about this aspect, look into Nagoski’s work on the impact of our individual CONTEXT at any given moment on our receptivity to sexual advances and overtures.)

If we look at Desire as the act of Wanting, then it’s possible to appreciate Desire in and of itself as an experience. Clients with healthy sexual connections sometimes describe how they look at their partner and experience that sense of Desire even knowing there is no time in the moment to act on it, and even if there is time, they may not feel particularly compelled to act. Simply experiencing, and perhaps even sharing, the sense of Desire, is part of that sexual relationship they enjoy. Desire as an emotional state does not require action, though a lot of us tend to forget that “Feelings are not facts”, and that “thoughts, feelings, and actions are three different things.” (When Desire becomes Compulsion, however, is an entirely different, cognitive-behavioural issue beyond the scope of this post.) Desire for Desire’s sake is an experience people can roll around and revel in all they want; it’s just a feeling.

Arousal

Arousal is physical or emotional reaction to stimulus. Wind blows over your skin and all the little hairs stand up? That’s Arousal. Allergy season arrives and pollen counts have your body on histaminic alert? That’s Arousal. Watching the footie match on TSN have you on the edge of your seat ready to cheer or rage or pounce on a ref’s questionable call? That’s Arousal. Finding your heart quickens and your breath shortens every time your partner walks into the house? That’s Arousal. Many of our intense emotions arouse us, but we can also be Aroused by a wide variety of stimulation, and not all of those arousal states are sexual (just ask any allergy sufferer during hay fever season). Anger, fear: these absolutely Arouse us. Desire can also Arouse us.

Arousal, again, is a state that can and does exist irrespective of a sexual component. In the narrow-scope mythology, the assumption is that we do/must experience Spontaneous Desire leading to an Aroused state, meaning “ready to accept sexual activity”: women lubricate and their labia engorge with blood, men’s penises get erect. Neverminding the idea that our bodies can present these signals of sexual Arousal without actually feeling ANY kind of Desire, if these limited signals are not present, culturally we’ve all been led to believe this must signal a LACK of Arousal, and therefore also a LACK of Desire. There is zero room in that mythology for the notion that Arousal and Desire both function perfectly well, thank you very much, as individual emotional and cognitive experiences even if the bodies don’t follow the mythological script. I move in and out of Desire like I breathe. I move in and out of Arousal fairly commonly, but if I look only through the tiny lens of sexual mythology, my ability to access the singular expected definition of “sexual arousal” is hampered by a lot of things I can sometimes work around, and sometimes not. Again, context is everything here.

Pleasure

Pleasure and Outcome really go hand in hand in many ways. For some people, Pleasure *IS* the Outcome. Am I enjoying an experience that feels really, really good? That’s Pleasure. And don’t overthink things here; that’s really all there is to it. Nagoski describes Pleasure as something delightful and positive that occurs at the confluence of three factors: eagerness (the emotional engine that moves us toward or away from something), expectation (the cognitive linking of “what’s happening right now” to “what happens next”), and enjoyment (the “hedonic impact” of a stimulus) (Nagoski, Come as You Are, 2015). Aversion and avoidance would be a likely and common result of the negative aspects of these three factors coming together.

Are the experiences I have with my partner pleasing to me? What experiences bring me the most Pleasure?

The research measuring how [these] three [factors] function in human sexuality has barely begun. I include them here not because I have already seen definitive proof of how they affect sexual wellbeing but because when I teach about them, I see how helpful people find it to know that “desirable,” “pleasurable,” and “sexually relevant” are not always the same thing. Your brain can enjoy something without eagerness for more. It can expect a kind of stimulation that will lead to sex, and expecting may activate desire–movement toward–but it may also activate dread, depending on context. Your brain can even be eager for something without particularly enjoying it[.]

All three are context dependent: if your expecting, eagerness, and enjoyment substrates are busy coping with stress or attachment issues […] then sexually relevant stimuli may not be perceived as sexy at all.

Nagoski, Come as You Are, 2015

The individual definitions of what feels Pleasurable will change tremendously from moment to moment as well as over the life span based on more contextual factors than I can list here. But trying to keep things in the realm of sexual/sensual pleasure, we’re looking for things that feel good in and of themselves, whether they signal a movement towards the default script of sexual activity or not. For me, massage (therapeutic or sensual) is an intrinsically Pleasurable bodily experience that is in a lot of cases DEFINITELY not sexual, even when a Lover provides the contact. Same with having my hair washed or brushed. A walk through woodlands in the fresh, warm spring sunshine is an intensely Pleasurable, sensual experience, even when I’m expecting chronic pain issue to mean it will also hurt.

All of which brings us to the last but definitely not least of the four menu options…

Outcome

If we’re following the mythology script of heteronormative sex, there are only two outcomes to intercourse: orgasm, or disappointment.

Yeah. Think about that for a moment. Especially if you’re in the VAST MAJORITY of women who do NOT experience orgasm through penetration alone, your options are really, therefore, disappointment and disappointment. Possibly with a precursor of “faking it” (especially for women), and maybe an aftermath of “frustration”. If those were my only experiences of the narrowest-possible definitions of sex, is it any damned wonder that the sexual spark falls off in the bedroom after a while??

If the only acceptable outcome is orgasm, we’re shutting ourselves off from a vast array of sensory experiences–physical, emotional, mental–that can also be seen as Pleasurable, even Desirable outcomes. We miss out on the idea that Pleasure for Pleasure’s sake is, in and of itself, a perfectly okay thing to seek within the scope of our sexual/sensual encounters. We don’t have to completely remove orgasm from the Outcomes, but maybe we can expand on this menu section by allowing that other experiences will be just as important sometimes. Allowing for sensual Pleasure, for example, to be a valid and Desired Outcome instead of orgasm takes a lot of pressure off people who can’t relax for PIV intercourse, who don’t orgasm that way, who experience vaginal dryness or erectile difficulty. It creates a vast array of sensually Pleasurable Outcomes for connection and stimulation that potentially have nothing at all to do with “sex” but may still be tremendously enjoyable and intimate.

TL;DR

Put simply:

I can and do Desire a lot of things that do not Arouse me; most of them are Pleasurable; a great many things I Desire have nothing to do with sex. Desire does not have a straight line to any particular Outcome; sometimes a feeling is just feeling.

I can be Aroused by things I do not Desire and do not Pleasure me. Sometimes what is Aroused is an emotional reaction, sometimes an intellectual curiosity, nothing whatsoever to do with sexuality. Arousal also does not have a straight line to any particular Outcome; sometimes a feeling is still just feeling.

I can and definitely do enjoy Pleasure, probably a bit more than I should. Things that bring me Pleasure I do not always Desire, and they may not Arouse me. The vast majority of what I find Pleasurable is non-sexual, but there are some very definitely sensual Pleasures that I will give myself over to at just about any available moment. Certain states of sensual Pleasure are more likely to invite the slide over into overt sexuality, but not always.

Sex, meaning the act of penetration, is sometimes an Outcome in its own right, regardless of the potential for orgasm. For some, orgasm remains the only acceptable Outcome. Others prefer the Outcome to be an intimate connection, relaxation, relief, or even catharsis. There are as many ways of achieving different Outcomes as there are Outcomes in the first place, and a lot of them are not explicitly sexual.

You can order from any one, two, three, or all four sections of this menu in myriad combinations of sexual, sensual, AND “none of the above” experiences until the band goes home and they turn off the lights. With this kind of approach and an open mind, it’s going to be awfully difficult to stay bored and sparkless in the bedroom.

The more I teach this expansive four-part model of sex, the more I find what Nagoski found almost a decade ago: people generally respond very well to understanding there is so much more to sex than just PIV intercourse, and that Desire, Arousal, Pleasure, and Outcome are NOT the same things, however narrowly we are STILL being taught they intersect. The freedom to expand the sexual/sensual menu allows people who WANT to enjoy not only their partner’s body but their own a much broader scope of experience. “The Mighty ‘O'” will always be a fun option for many people, but wouldn’t it be great if there was more than one Happy Ending to the script??

[* — In coming weeks you can expect I’m going to have gushing and gleeful Things To Say about her new book, Come Together.]

Mental Health, Therapy General

(Sitting down this morning to write be like, “Okay, what do I feel awake and caffeinated enough to tackle this morning, writing a plausibly-coherent blog post, or trouble-shooting my office technology? …Ah, guess I better write that post, then.”)

In an entirely non-scientific polling of my own personal FB feed, “what to expect from a first session” and “red flags for choosing a therapist” were two top requests. I don’t often write about the technical aspects of sessionwork simply because there are almost as many variants on the “how” as there are therapists in the field. “How” is then dependent on their individual style, possibly the modalities they practice, definitely any policies of the practice in which they work (especially applicable to groups, agencies, and larger or corporatized organizations, like hospitals and clinics). There are a lot of articles available on the topic of what to expect and on the subject of spotting red flags in your therapist.

As a friend pointed out, this being my blog, maybe it would be useful to describe a little of my own process. (I will point out the irony of running with that suggestion, given that a therapist talking predominantly about themselves is a Big Red Flag, but hey, you’re not paying me for this hour, so Imma take the mic for a while 🙂

Pre-session, there are different ways in which clients contact me in both my solo practice and through Bliss Counselling. In my solo practice, clients contact me directly, usually by email, and I get a chance to ask for a VERY high-level idea of what kind of issues they’d like to work on, so I get a sense of whether or not those subjects are in my wheelhouse, and then I will email them my own intake forms. At Bliss, our wonderful admin staff are the first line of contact, so they’ll ask those questions on the therapist’s behalf, possibly help incoming clients set up a profile in our online management system, and send prospective clients a link to the assessment form that has a ticky-box list of potential issues. I’ll review that before an intake session. Once a first session schedule is set, we’re off to the races.

The advantage of almost fifteen years doing this is that by now I have a well-practiced introduction. I’ll greet the client warmly, make sure I’m pronouncing unfamiliar names correctly, and welcome them into the conversational space whether it be in-person or virtual. I like to ask right up front whether they’ve done any kind of counselling or talk therapy before; their answer determines how much of the spiel I’ll need to give on the general therapeutic process.

If they’ve never done talk therapy before, I’ll keep it light and simple, and describe the collaborative process: them sharing as much or as little as they feel comfortable with, especially given the awkwardness of talking to a stranger, then me offering back what I think I’m hearing to make sure I understand what I can about their current situation and maybe a little about where they’re hoping to get to through therapy. I’ll describe how I use that to determine at least a starting point for whether I have a useful skillset for the work they want to do, so in the moment I might be able to offer some perspective or suggestions for potential work we might be able to do together. I suggest that depending on how much information the client wants to share in the initial session, I may or may not be able to get to that point of offering reflections, but I should at least be able to get a feeling of whether I’ll be a useful tool for them or not.

I will talk a little bit about how I work therapeutically, about my background training and the general approaches I take, but only if the client seems familiar or interested in hearing that upfront. I will explicitly offer to talk in more detail about what I can do, in the context of the conversation as it unfolds. My biggest concern is that I don’t overburden the conversation with a lot of details that might not be relevant to the work the client wants to do. I do, however, invite questions at any and every step of the process. I describe how I definitely invite a 2-way conversational approach; therapy often works best as a collaborative effort. I may bring the clinical perspective and experience to the table, but the client is always not only the Subject Matter Expert in their own experiences, but they are the “boots on the ground” field-testing and reporting back on any change processes we explore in session. I try to avoid positioning myself as The Authority; especially as a therapist, I’m much more comfortable in the role of co-author.

And perhaps most importantly, I tell the client that I don’t consider first sessions like this to be an indication of commitment on the client’s part; especially at Bliss, our admins like to ask new clients to book 2-3 sessions in advance just so they get time on our calendars (some of us tend to book up quickly and fairly far ahead). People who are new to therapy may feel like that ties them to us and obligates them to continue with a therapist they’ve only just met. I prefer to reassure them that I’m treating a first meeting like a test drive, so the client can get a feel for the process and my style; if they don’t feel like they can be comfortable with me, I’m going to wind up spending more time dealing with their resistance to me than with the issues they want to work on. So if I’m not the right partner for those conversations, I would rather help them find someone who will be.

I will tell them both at the beginning and end of the session to take a few days, a week, whatever they need to let the dust settle after the first conversation–especially if it’s been an emotional experience for them–and THEN think about how the conversation went, before making any decisions about working with me or not. I want my clients to be in the best headspace they can be in to make a choice like that. We don’t often get the same opportunity to be so deliberate in choosing who we work with in support of physical or mental health. I want to drive home the idea that the client always has the right to say NO in this work, including saying NO to working with a specific therapist.

My preamble done, then I yield the floor to them. I ask the client to tell me a little about themselves, the glossy-brochure bio details of who they are, general family or work details, any interests or hobbies or passions they have. This starts to give me an idea of the major players and influences in their lives as a whole, and background to the issues bringing them into my office. It’s the front door into the conversation about where the client themselves locates their current challenges. And at this point, I’m drinking from the firehose.

As I describe it to clients, at this point I am collecting every piece of information I can, because I don’t yet know what will be relevant and what will not. I ask a LOT of questions here, sometimes for clarification, sometimes to suss out whether I think a pattern is forming. I liken it to collecting children’s wooden letter blocks into a bag; at some point, I will upend the bag and put the blocks together to see what they might spell out. I’ll then toss that perspective out to the client to see what resonates or not. Things that resonate for the client, we stick to the mental wall as a “working theory,” a combination of what they have experienced and what I suggest from the clinical perspective as potential explanations or reframing. I’ll use these later to help me determine what tools might be useful in the context of what the client wants to change.

I may or may not do what I call the Family of Origin Snapshot, a quick relational genogram of their earliest influences and role models if it seems relevant. For example, FoO information is enormously valuable to me if the client is struggling with value conflicts, internalized narratives and self-judgments, or issues that feel like they’ve been around since childhood. (A genogram structure can also be an extremely useful tool for clients dealing with work stress, but in that case, I usually just refer to their literal Org Chart.)

And then, or somewhere in the deluge of information that is a first session, I ask my Magic Question: What does “better” look like? This is where the work begins. This is North Star by which we will set the work’s navigational compass, the point on the other side of the gap. When I do check-ins with the client down the road, the answer to this question is what we use to determine congruence in the work we’re doing: are we actually moving towards “better”, or have we come adrift of that defined goal? (The goal can change over time, but that’s not something we’re typically going to worry about in the first session.)

If I have time, this is the point where I talk about clinical approaches, what I bring to the table, and what I can offer in collaboration with those stated goals. If I don’t think I have the right tools for something that’s beyond my scope, I’ll make that very clear and offer some ideas for things I think MIGHT work that the client could look into, or assistance with referrals if necessary. But if the issues are in my wheelhouse, here is where I talk about the work I think I can help with, looking at attachment issues, stress and burnout coping strategies, internal narratives and other intrusive fiends, relational communications, intimacy issues (to name a few things in which I have been known to dabble).

There’s a lot of compassion and empathy on tap in that first session. Clients rarely come to us when things are going well in their lives, so respecting and reflecting on their challenges and struggles has to be a part of that space we create at the outset. I am a big fan of Carl Roger’s unconditional positive regard. I also try to pick out and mirror back some of the client’s own strengths, especially if they seem like they’ve become detached from them; that’s a callback to my days doing Solution-focused Brief Therapy; I try to give the clients back a sense of something positive in themselves on that first meeting. Reminding them they have strength never hurts, even if therapy isn’t something they decide they’re ready for, or I’m not the therapist they want to work with.

As we wrap up the initial conversation, I give them a chance to collect themselves if it’s been a rollercoaster first session, and we move things back to simpler, shallow waters talking about potential next steps (booking, billing, etc.). I will remind them they are under no obligation to return. I encourage them to take some time to reflect before they decide; like investing in a car, you want to make sure it not only has all the bells and whistles, but you want to ensure it has the drive handling and capacity you need. Therapy is an investment in ourselves, our health and wellbeing. We’re NOT stuck with whomever we draw in the lotto. And sometimes, making an active decision for themselves about who they will or won’t be vulnerable with, is the first self-empowering choice a client has been able to make for themselves–in a long time, or possibly ever. That idea alone deserves some mad respect.

Then I walk them out, let them know they’re welcome back on my schedule any time they’re ready, and offer them a warm goodbye. And I will always be delighted when they choose to come back and get into the work with me.

Emotional Intelligence, Self-Development

(The problem with not blogging regularly anymore is that I will get several ideas for topics a month and forget to write them down; when I finally DO sit down at the keyboard to write, can I remember any of them?? Nary a one. But the Universe sent me a sign last week in the form of some delightful, unexpected fan mail for the blog [waves to Leo!] so I am going to see how I feel about getting back into Tuesday writings. From home for now, given that I haven’t haunted coffee shops since The Before Times and I’m not entirely sure where my regular go-to even IS these days. Also, at home I can write with no pants on. Try THAT at your local coffee shop and see how that goes, I dare you.)

Longtime followers of this blog, and certainly a large number of my client base, will be familiar with my entrenched belief that psychotherapy and software development (specifically, Agile methodologies) have an awful lot in common. A big part of any change process, be it a functional change to a piece of software, or some aspect of individual or relational human behaviour involves looking at two distinct vantage points of the project: where are we starting from, and where are we trying to get to? The way I frame these to my clients: what are the challenges that are bringing you into therapy, and What Does “Better” Look Like. Once the client articulates the gist of the struggles they’re facing and gives some idea of what they want their life to look like under better or ideal outcomes, we look at the part in between those two vantage points, the gap between Here and There.

This is the Gap Analysis.

The Gap Analysis is primarily a way of assessing the resources one has available, and the resources one likely needs to achieve the desired outcome. As part of the analysis, the stakeholders in the process (in this case, the client[s] and their therapist):

  • look at the factors contributing to the gap and any implications or dependencies we might see around changing them
  • assess the effort and risk of making changes to shrink or close the gap
  • identify both the strengths and resources currently available to the client, and where possible, those resources the client will need to acquire or develop along the change path
  • create a roadmap for the changes, applying SMART factors to both the larger and interim goals in progress
  • start making the changes, with a lot of self-monitoring and tweaking the process as necessary; in Agile methodologies, this is a “constant iteration” process that promotes a LOT of flexibility in the implementation phase, because we all know Shit (just) Happens and sometimes we have to adjust expectations and plans on the fly.

I like to use this terminology because it starts with an examination of the client’s available strengths and resources, something they may have forgotten or come adrift from in the process of moving into their current stress or chaos. I don’t practice a lot of pure Solution-Focused Brief Therapy (for reasons I’ve probably documented elsewhere in my disorganized archives), but there are some good tools buried in the approach, including the strengths review. This gets the client started from a hopeful base, rooted in reminders of their empowerment.

From there we analyze what’s in the gap. From the client’s perspective, this is usually an assessment of obstacles: resources that are lacking or outright missing, fears or anxieties that obscure the goals, internal or external narratives that undermine them. Like good Project Managers we list out all the perceived obstacles; this may be a part of the process that overwhelms the client, so as a collaborative support, the therapist’s job is to steer the work towards identifying what needs to happen to manage or remove as many of those obstacles as possible, as part of the roadmap. We are the persistent reminders of the client’s strengths and resources through this part of the change process.

Encountering and dealing with those obstacles is the change process. The end result, according to the client’s original goal definition, is intended to be an improvement in some aspect of their life. Often along the roadmap, what clients learn about themselves and their skillsets enables them to deliberately push out the goalposts, and keep redefining “Better” as a constant improvement process over a lifespan. Sometimes, they reach the previously-defined goals but DON’T feel better; many a Project Manager knows the feeling of presenting a finished piece of software, only to have the client or some other stakeholder say, “We’ve changed our mind, that’s not what we wanted after all,” or, “That doesn’t look/work at all like we thought it would.” And then everyone has to go back to the drawing board, frustrated and disheartened, sometimes hurt and angry. This, too, is part of the iterative change process; just like evolution itself sometimes has to take a side-step or sometimes hits dead ends, so does a behavioural change process.

Doing a Gap Analysis and planning for the risks and pitfalls (including deliberately asking the question up front, “What happens if we get to the end of this particular process and it doesn’t do what I thought it would?”) helps ease those risks by planning for them, but as noted above, sometimes Shit (still) Happens. Gap Analysis puts as much information up front in the decision processes as we can muster, and actually allows for more fluid pivoting on those decisions when things don’t go as planned, or when new, maybe even better options present themselves.

Change is hard, but we can make it a little easier on ourselves if we take a hint from Londoners:

(I swear, I did NOT write this entire post just to be a setup for that pun. Honest! Mostly…)

Mental Health, Therapy General

A regular meeting with one of my students this morning got us looking at two different types of therapist approaches to meeting and getting to work with clients. Both are valid methods of navigating intake and the early stages of information collection, and good to have in the therapist’s toolbox. It might also help clients understand why they click better with some therapists than others, and help them define what they’re looking for if they’re currently shopping for a therapist.

Most of the time people come into therapy because they are dealing with a specific problem, or experiencing a specific set of symptoms even if they don’t yet understand why. During an intake process, they’re meeting the therapist for the first time, which means two things are happening simultaneously:

  • Stranger meets stranger
  • Information changes hands

Establishing Rapport

Many people think of therapy in much the same way as they think of medical doctors: they have a problem, they go tell the professional, the professional gives them something to fix the problem, and hooray they’re cured! (Or at least feeling better.) This is historically the medical model for feeling better, and sometimes leads people to wonder why they can’t get a fix in the same ten minutes it takes a doctor to diagnose a set of patient-reported symptoms. Talk therapy doesn’t always work like that, but some models, like Short-term Solution-focused Therapy, do aim for a similar kind of immediate relief of at least the symptomatic distress.

Therapists are trained to understand what clients come to learn with experience: that perhaps the biggest factor in therapeutic “success” is the rapport established between the client and the therapist. That rapport is all about the relationship these individuals create through the process of sharing space, information, and (hopefully) empathy. Some folks don’t want to take the time to build a relationship, they just want the fastest resolution to their current discomforts so they can go on with their lives. Some people will only allow themselves to open up about experiences once they have established a degree of trust and safety with a therapist. This leads us to approach the work with our clients through either a Problem-centric focus or a Person-centric one.

Problem-centric Focus

This morning I was reflecting with my student on how they are developing their own clinical approaches, drawing on various learning resources through their training. They currently have an intake form they use to guide the first few client conversations that is very focused on gathering information about the problem: the symptoms, their perceived severity and persistence, the level of impairment the client experiences because of them. Only after digging into the details of the problem does the form expand into more general information about the client themselves.

This kind of approach puts the PROBLEM(s) front and centre and focuses the ensuing conversations on those pertinent details. This is a really useful approach if the therapist has only a limited number of sessions (or a one-off situation, as with a walk-in clinic), and needs to understand “where does it hurt the most?” or “where is the client seeking the most relief?” It’s also an effective approach with clients who are focused on fast resolutions and strategies rather than long-term self-development. Reflecting after this morning’s supervisory meeting it occurred to me that this is also probably a useful approach for student and novice therapists who need to determine as early as possible whether the client’s presenting issues are within the therapist’s limited clinical experience and scope of practice.

On the downside, it also presents a bit of a sandtrap to therapists operating from a “just fix it” mindset. The temptation is to label and categorize the problem without digging much into context or broader influencing features in order to go straight to symptom management… and in doing so, perhaps miss a lot of important information about influences on the client’s broader condition. In short: you’ve mitigated the symptoms but potentially done nothing to address or even acknowledge the actual problem.

Person-centric Focus

My own approach to those first client conversations is to get to know a little bit about the client themselves. I’ll ask if they have any previous therapy experience, or what they think therapy as an experience entails. I’ll ask them to tell me a little bit about themselves and tell them a bit about myself in return, though I generally weave any kind of detailed descriptions of how I work into the conversations about their challenges. Especially with people new to psychotherapy, I have less risk of getting lost in trying to describe clinical interventions to someone who has zero idea WTF I’m talking about, no context for what I’m bringing to the table. So I leave that until I can find ways of showing how I might apply what I know directly to their own issues, and let the contextualization do the heavy lifting for us both. I get a good sense this way of how the client talks and how they listen, what kind of language they respond to, and I have a chance to watch and mirror some of their body language (even in virtual meetings). If I can get a basic sense of them in the first few minutes, THEN I’ll ask what’s bringing them in to talk to “someone like me.”

I’m not a doctor; I’m not trying to bulldoze 25 clients a day through my office in ten-minute increments or less; I can take my time and get to know who’s sitting in front of me. (It also helps that I’m personally someone who loves drinking from the information firehose. I often describe my process in those first couple of sessions as gathering all the seemingly random bits of information the client chooses to share, and all the information they don’t even realize they’re sharing via word choices, speech patterns, and body language. I collect it all and sort it out as we go, pairing the client’s information with my observations and clinical experience to come up with working theories I can pitch to a client to see what resonates, and what makes them feel like I’m understanding what they’re sharing.

This type of approach puts the PERSON first and foremost and helps orient the therapist towards the person having difficult experiences before digging into the issues themselves. Focusing on the person is also useful when the client is in emotional distress, if the therapist can use mirrored body language and vocal tones to calm or counterbalance the way the client’s body or voice shifts as they get worked up. It’s not that we ignore the issues so much as we establish that rapport first, a person-to-person connection to put the client more at ease. It helps create some sense of safety (hopefully) for the client to talk about hard things, and to receive compassion and input from the therapist. It’s a style of approach that very much invites the Person into the room, not just the Problem.

The Person-focus approach has its own traps. It’s easy to misread clients who really just want solutions and strategies, if they’re genial enough to engage in the “getting to know you” patter, and in doing so, leave them feeling like you’re not serious, not taking them seriously, or taking to long to get to what they came for. Focus on rapport-building is often a slippery slope for therapists falling into their own biases and risking over-association or over-sympathizing with the client; this is a space in which we run a high risk of transference and countertransference occurring between client and therapist as we try to establish connection and empathy without always having good boundaries right up front.

Not every client is going into a first session with a clear idea of what they want or need from the conversation they’re about to have. Inexperienced clients generally can’t describe what they want from a therapist, other than, “Fix me so I feel better”–the same request they’d make to a mechanic to fix their car so it runs better, or to a doctor so they can feel physically better. Therapists have to develop almost a sixth sense for what live performers call “reading the room”: the ability to suss out a client’s level of (dis)comfort with talking about their issues and asking for guidance or help. Are they here for a quick strategy session, or are they here to unburden for the very first time a lifetime’s worth of relational chaos? (I haven’t yet figured out how to teach reading the room as a therapeutic skillset. It’s just a thing many of us do semi-intuitively.) But once we have that sense we can choose the most effective approach out of the toolbox, and off we go to the races.

Emotional Intelligence, Life Transitions, Relationships, Self-Development

“I Ate’nt Dead” – Granny Weatherwax (Terry Pratchett)

Hello! Not dead, not retired, and still generally not finding enough time in the week to write blog posts, though it’s not for lack of ideas and themes crossing my plate and prodding thoughts of, “Oooo, I should write up something about that!” (I should write about the rising tide of transphobia, homophobia, and hate in general but that’s too vast and raw a topic to corral into 1500 words or less while also not working myself into a fit of rage at the state of the world these days, so…)

It’s a typical part of my process that blog motivation arises from seeing a particular theme appearing repeatedly in a relatively short period of time in conversations with clients and others. Unsurprisingly, people are constantly changing, and people who engage in change as active, conscious, deliberate choice often follow similar processes–and make similar mistakes. Some conversations therefore come up time and time again, and it’s not that blogging will make them come up any less often, but maybe the ideas and discussions can reach a few extra people before they need a therapist, or at least give them some plausibly-useful structure to apply TO their therapy.

One of the many valuable tools I brought out of years of working in corporate IT that has a crucial place in my therapeutic Change Management Toolbox is the concept of SMART Goals. A very long time ago, I wrote about creating roadmaps to move towards getting your needs met, and I have written about identifying when a plan is or is not a Plan; the missing piece of the puzzle when putting roadmaps into Plans for Change, however, is identifying the success criteria or metrics that define the actual goals for change.

This is a variation on a recurring conversation I have with a lot of clients:

Client: “I want to make this change!”
Therapist: “Wonderful! What is the goal you’re trying to reach?”
Client: “Making this change!”
Therapist: “OK, great! How will you know when you succeed?”
Client: “I… uh, will have made this change!”
(see also: Client: “I’ll know it when I feel better!”
Therapist: But won’t you also feel better if this storm just passes you by like it always does, and things go back to normal like they always do?”
Client: “I… guess?”
Therapist: “Even though nothing will have actually changed…?”
Client: “…”
Therapist: “So ‘feeling better’ is, at least by itself, maybe not a solid metric for success?”
Client: “Damn.”)

Change happens in a lot of different ways and for a lot of different reasons. Most of the time it happens because something isn’t working, and the resulting situation is anywhere from frustrating to painful to dangerous. All organic lifeforms constantly move towards getting their needs met, be it light, air, water, food, or comfort; we just don’t always know when things are changing until we’ve gotten far enough along to notice things are different. At that point we might find ourselves suddenly in a better place–and just as suddenly, we might find ourselves in a worse place.

Managing change effectively, from a project management perspective, requires knowing several things in advance:
A. What do we have to work with (resourcing)?
B. What are we trying to get to (outcomes)?
C. What do we lack/need to move us from A to B (gap analysis)?
(Some Project Managers will add a separate D here: What’s it going to cost? I generally factor cost into the resourcing details as part of establishing a baseline process.)

Once we have answers to these questions, we can generally start assembling the roadmap, and along the way, we want to look at both major goals (endpoints) and minor goals (milestones) that we set for ourselves to help see where we’re making progress and where we’re struggling or need some extra help. Both major and minor goals need to be clearly defined, however, and this is where Change Management as a personal or relational development process often falls apart for people because this kind of goal setting outside a corporate structure seems pretty alien in the hand-wavy, airy-flairy feelies of our relationships. But if we don’t have clearly defined goals and explicit metrics for success, how will we know when we’ve achieved them? How will we even measure progress towards them? How will we communicate them to others around us we may need to be involved in the change process? How will we hold ourselves (or those others who consent to participate) accountable?

We set SMART Goals.

SMART stands for:
Specific: has a clear target in a precise area for improvement (also sometimes Sustainable: a pervasive improvement)
Measurable: has clear indicators (metrics) for improvement
Assignable: has a clear owner consenting to take responsibility for the goal (also sometimes Achievable, but I find that gets covered by the next letter)
Realistic: improvement target that can be reached with the current resources or with resources discovered via the gap analysis
Time-boxed: has a specific timeframe for achieving the milestone or end goal

Admittedly, none of this is likely to spark the sense of feel-good flexibility of some primo handwavy, airy promises for change that lack concrete details. We all love the romanticism of open-ended promises that will magically be fulfilled exactly to our unspoken expectations, don’t we? Isn’t that the entire myth of how “Love Conquers All” in a nutshell??

It aten’t romantic, but I can guarantee it IS effective. The term was apparently first published in 1981, meaning it was in use in some circles well before being codified for public consumption, and it has been a standard approach of project management for more than four decades for many reasons:

  • It’s much easier to communicate expectations
  • Everyone tends to feel much more comfortable when they know not just WHAT to expect, but WHEN
  • It’s much easier to invite participation where we need it (and to communicate expectations explicitly for other participants to provide informed buy-in or consent)
  • It’s much easier to hold ourselves and other consenting participants accountable
  • It’s much easier to measure progress toward SMART goals and milestones, which also means…
  • It’s much easier to adjust course* when we stray from the roadmap and stop meeting milestones and end goals

Change isn’t always easy, but we also don’t need to make it any harder than it has to be. How we set specific goals that are SMART takes some clear idea of what we’re trying to change or move towards and why, as well as some understanding of what we already have as resources and support for those changes, and what we’re going to need to get there from here. That’s the part where some external perspective and wisdom–an experienced friend or family member, a mentor, a therapist–comes in handy, especially when it comes to keeping goals and milestones realistic, and helping with navigating the expectation-setting communications around them.


(*–Someday I swear I need to write something about adapting Agile methodologies to psychotherapy, but that day is definitely NOT TODAY SATAN.)