A Therapist's New Year's Resolution

By Concentric Owner & Counselor Jennifer Larson, LCPC, NCC

In only a few more days, 2017 will come to a close.  It will be a time to think ahead – many will ignite their New Year’s resolutions.  While I may not routinely come up with New Year’s resolutions, I do think about and write down my personal desires and goals throughout the year.  And, I have decided that I will come up with a New Year’s resolution for 2018.  Before I share my resolution, I would like to share part of my roadmap that has led me to this juncture.

As I have engaged in reflection, I found myself returning back to a perpetual theme that would emerge and re-emerge over this past year.  One particular theme is what I will name as the ‘non-self-disclosing' therapist vs. the 'self-disclosing' therapist wrestling match.  I have no idea when the sport of wrestling season begins and ends, but I can tell you this particular wrestling match has persisted season after season. And, my hope for 2018 is the self-disclosing therapist will take the lead and possibly bring the wrestling match to a close someday soon.     

Let’s start back when these 2 wrestlers first met.  Perhaps they were both first introduced way back when, before the days of graduate school as 'non-self-disclosing' me vs. 'self-disclosing' me.  In my formative years, I grappled with how much to disclose and how much not to disclose my vulnerabilities. And if I did, I chose wisely with a very select few.  Some would say this is normal as we need privacy and boundaries while others may offer a difference of opinion.  Now, let’s fast forward to when I enter into graduate school where I am confronted again with choosing and deciding on how much to disclose.  This time it is focused more on me as an emerging therapist, not me personally.  In the earlier stages of education, students learn about various theoretical orientations and the relevance and implications of non-disclosing and disclosing to one’s clients. 

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Just after the start of the millennium, I recall being enthralled with the tug-of-war game that was played during a semester course on ethics.  Our instructor was instrumental in leading the charge on getting all of us graduate students to really explore how to handle ethical dilemmas that can and will mostly likely confront a professional counselor, social worker, or psychologist.  Depending on the topic, some students would sinuously form into 2 teams, tugging and vying for one end (yes, it’s okay to self-disclose to a client; yes, it’s okay to hug certain clients upon closing a session), while the other group pulled and vied in the other direction (no, it’s not okay to self-disclose and hug a client). It was one of my favorite graduate courses as our professor and the course curriculum gave us the space and freedom to think critically and to share our perspectives and beliefs.  Some topics called upon us to unequivocally unite together whereas other topics had students participating in the game of tug-of-war, and well some (ahem) left all of us pooling together in the middle, gray area -- scratching our heads saying, “It just depends, it’s not so black-and-white.”    

Does a therapist merely act as a ‘blank slate’ allowing for one to free associate more easily? Or does a therapist offer some disclosure about their experience and feelings in relation to one’s client (countertransference)?  As therapists, do we divulge some our personal, relatable experiences, such as, “I share the same fear of heights as you do – here are tools that have been helpful to me.”  To disclose or not became even further embedded post graduate school during professional training courses and consultation. And for good reason, this particular topic warrants so much attention in the world of psychotherapy.  I understand the clinical relevance and implications – I get it. 

Over the past 15 years with greater professional and personal life experiences, I have found myself continuing to think about the inquiry of the self-disclosing therapist. At times, I have put forth a tidbit of self-disclosure when I believed it to be ‘clinically appropriate’ or when it simply felt right.  The self-disclosing therapist is not uncommon for some psychotherapists, and it's probably still one of the more debated issues in the field.  Over the past year or so, the inquiry in my mind has expanded beyond the closed doors where therapist-client, supervisor-supervisee, and consultant-consultee relationships are formed, maintained and evolve.  

Questions continue to knock on my door, such as, do I as a therapist share my story (or stories) with others publicly?  Is there value in therapists who choose to open up in a more public forum?  How about us therapists taking our practice even further by exercising vulnerability and using our voice through other outlets?  Are age and credibility in the field some of the salient determinants when choosing to publicly divulge as a professional?  What is too much to self-disclose in written form? Could casting a wider net be detrimental to a therapist’s profession?

While these particular questions have lobbed around in my head for just over a year now; admittedly, they have not been all ‘heady’ taking up rent in my mind.  Sometimes (and many times), I would simply experience this feeling inside of me – near my heart or gut – nudging me to share more and to share with more people.  Stop thinking so much and just take action.  Take the leap and have faith.  Even a call to duty would emerge from within as well.  But why and for what purpose?  The answers didn’t seem readily available to me.  And then over the past few months, it all became clearer.

Earlier in 2017, I learned about On The Table and the #BreakTheSilence initiative by The Kennedy Forum.  I was immediately pulled in as I loved the mission and purpose of this initiative.  Bring people together to give people an opportunity and space to talk about mental health in effort to reduce the stigma that still hovers around and shrouds the already cocoon existence of mental health. The idea is that when more people talk about a topic – in this case mental health and addiction – a positive rippling effect can ensue. 

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The more people talk about mental health…

  • The easier it will be for all of us to talk about it. 
  • Better yet, the easier it will be for all of us to talk about it without feeling shame, crazy, or embarrassment. 
  • The more we will feel safe and free of judgment.

The more people talk about mental health, the more…

  • People will seek out help. 
  • We will honor and view mental health as another facet of humanity and life, just as we do with other areas, such as our physical health. 
  • We will advocate for change across cultures, families, and even within the helping professional field. 
  • Opportunity for positive changes within the health care insurance industry.

The continual, cascading effect.  The more people talk about mental health and addiction…

  • The more we will become intimate and experience love.
  • The more we will be empathic and compassionate.
  • The more we will be more understood and connected.
  • The healthier we will all become and the more lives will be saved.

Who doesn’t want to experience these things for themselves and others? 

Concentric Counseling & Consulting hosted its first On The Table Discussion on May 16, 2017.  The turn out and experience was inspiring and moving. We even shared people’s stories, experiences and solutions for people to read in our blog.  However, the Concentric’s therapists served as hosts and guides – we were not active participants in this discussion.  No self-disclosing.  This is not a terrible thing, but the knocking on my door didn’t go away.  Should we have re-considered actively participating in this dialogue?  Sharing would mean ‘more people’ talked about mental health and addiction, right? 

There have been other initiatives and movements this year, including one of the more recent ones that started in October 2017. The #MeToo movement gained momentum and traction which has given people collective permission to break free of the shackles that have promoted and reinforced silence, inequality, sexual harassment, discrimination, and assault, shame, and for some, the cocoon existence of mental health. The #MeToo movement encouraged women to share their stories in effort to give people permission to break their silence to unite and to bring greater awareness about the prevalence of sexual misconduct.  The more people talk about their experiences and hardships, the same effects will occur as with the more people talk about mental health and addiction.  Movements like these promote the cascade effect which in turn promote movements – a positive feedback loop. 

All of these experiences along my personal roadtrip have touched and impacted me.  And, while I recognize that I am helping people, I have also recognized that choosing (more times than not) the non-self-disclosing therapist may just not be as helpful.  I believe in the importance of using one’s voice, honoring one’s experiences with integrity and respect, and I want to help become a part of the bigger picture.  I want to talk more about mental health and addiction publicly in effort to help achieve with many others a positive cascade effect.  It won’t be easy for me, that I know. Truthfully, I am not quite sure where to start, what I will disclose about and which platforms to traverse.  What I do know is I now have a clearer understanding of the persistent themes that knocked on my door.  My deeper desires and hopes for all by talking about mental health.

So, my New Year’s resolution for 2018 is for me as a therapist is to start leaning in, to become more of a self-disclosing therapist by sharing more publicly some of my own mental health challenges and triumphs.  Happy New Year Everyone! 

Listening to Our Inner Critic

By Guest Blogger Santiago Delboy, MBA, LCSW, S-PSB

Santiago is a bilingual psychotherapist in Chicago, where he works with adults who feel stuck, broken, empty, lonely, or out of control. He uses a relational approach to help people develop self-awareness, understanding, acceptance, and growth. Find more at www.santiagodelboy.com.

Michael is a bright and sensitive man in his 30s. He is the youngest of four siblings and grew up in what, from the outside, seemed like a happy and stable home. In many ways it was indeed happy, but Michael always felt like an after-thought to his parents. He struggled to feel seen and loved, and tried very hard, in many unspoken ways, to find his place in the family. The weight of this longing and the intensity of his efforts became overwhelming as a teenager, when he abruptly fell into a deep depression.

After college he had a number of jobs and romantic relationships, all of which left him feeling drained. For a long time he struggled to recognize his value and skills, doubted his capacity to love and work, and felt flawed and inadequate. Unsurprisingly, Michael felt constantly reminded of all this by a very loud and active inner critic.

 

We all have a voice in our head that is critical, judgmental, and disapproving of ourselves. That voice can be mild and not always present. We may hear it in specific situations or with specific people. Sometimes, however, that inner voice is constantly giving us unsolicited commentary and incessant chatter, becoming part of what Buddhists would call our Monkey Mind.

A quick Google search for “inner critic” results in advice on how to silence, get rid of, overcome, or ignore this voice. This advice usually entails a number of steps that promise quick relief. They include becoming aware of the self-criticism, conducting reality-testing to check it against the evidence, separating ourselves from the critical voice, replacing negative thoughts with positive ones, and having a realistic appraisal of the criticism’s implications and consequences.

These are basic cognitive-behavioral tools sprinkled with some mindfulness, which can definitely be helpful for some people in certain situations. I understand that if people feel their inner critic is a nuisance, they may want to shut it down. However, there is something about the notion of disproving, silencing, or reasoning away our inner voice that doesn’t feel right to me.

Not all criticism is created equal

When I hear the inner critic from people like Michael, or myself for that matter, I wonder what that voice is really saying. The messages we are aware of might be “I could never start a conversation with a stranger” or “I don’t know how to ask for what I need,” but what they really say is “I am broken and don’t deserve to be loved” or “my needs don’t really matter.” I believe that it makes a big difference whether the judgment is about our actions, or about who we are as human beings.

When the latter happens, the voice in our head is carrying a message of shame. It tells us we are not smart enough, attractive enough, funny enough, or good [fill in the blank] enough. That voice is abundant in “shoulds”, telling us that we should behave, should think, or should feel differently, and that there is something fundamentally wrong about us if we don’t or can’t.

To make things more complicated, our inner critic is not only active when we hear it and it doesn’t only manifest verbally. Michael’s depression during his adolescence, for example, could be understood as a massive expression of his inner critic. Those years were embedded with feelings of helplessness, hopeless, and worthlessness. The connection between depression and self-deprecation is not new; Sigmund Freud discussed it eloquently a hundred years ago, in his paper “Mourning and Melancholia.”

From trauma to self-criticism

I am not sure the messages from Michael’s inner critic, as a teenager and as an adult, were distortions that could be corrected with reality testing and cognitive reframing. Michael tried those things before I became his therapist, and in a way they set him up to feel more shame. There had to be something wrong with him, he told himself, if he couldn’t get better by thinking better. He started developing acceptance and feeling more compassion toward himself once he started understanding that his inner critic was an expression of the trauma he had experienced, and the feelings he had learned to ignore as a result.

The trauma Michael experienced did not require a specific event. His parents had a relatively stable marriage without significant economic difficulties, and he didn’t recall anybody being verbally, physically, or sexually abusive at home or elsewhere. However, he grew up experiencing emotional neglect, not feeling seen or loved unconditionally. He learned that no matter how hard he tried, he would remain invisible and his needs for connection would not be met. As a result, there were parts of himself that remained invisible and disconnected from his own awareness.

This is part of what is called fragmentation, which is one of the key features of trauma. Our sense of self is split and we may lose contact with some parts of who we are. These parts may hold overwhelming feelings that are too hard to tolerate, let alone accept, such as pain, hatred, terror, or desolation. Some of these feelings might turn into anger, which we may then direct at ourselves. That is often times what is behind our inner critic, anger that is really masking sadness, fear, pain, or emptiness.

Move toward, not away

If our inner critic is a part of ourselves that we disowned, seeing it as the enemy means seeing ourselves as the enemy. Trying to silence or ignore that voice means trying to silence or ignore a part of ourselves that is suffering, a part that may have already been struggling to find its own voice for a very long time. Feeling ignored, silenced, or invalidated was precisely part of the problem, as it contributed to give birth to our harsh inner critic in the first place.

Because of this, the question I try to answer with my patients is not so much how to silence that critical voice, although that might be important to address, but why is it there? What happened to them, first to feel so angry, and then to direct that anger to themselves? And, more importantly, is it possible for the two of us to keep a curious stance and an open mind toward his inner critic, to be able to listen to it with compassion and kindness, and to become willing to accept it, embrace it, and love it?

Listening doesn’t mean agreeing with what it says. Accepting it doesn’t mean taking on its criticism. Embracing it doesn’t mean believing that its judgements are fair or accurate. But unless we do those things, that part of us will remain unseen and unheard.

The judgement, criticism, and negative self-talk can be very harsh, cruel, or even hateful, but they are usually symptoms of old wounds that run very deeply. Martin Luther King, Jr. said that hate cannot drive out hate; only love can do that. Within ourselves, only love toward our inner critic can begin to heal the wounds that hide behind its harshness.

It is true that self-criticism can sometimes get in the way of our accomplishments, boycott our relationships, and put a hurdle to our growth. However, the main challenge is not really to eradicate, tame, ignore, or disprove our inner critic, but to be able to hold it with love and make space for the feelings it carries within. The more difficult and upsetting it becomes, the more patience and kindness it probably needs. Our inner critic is a part of who we are and it deserves, like every other part of us, our unconditional love and regard. The journey toward a fulfilling and wholesome life is long and worthwhile, but we cannot really take it if we cut off a part of ourselves.

Choosing a Theoretical Orientation in Graduate School

By Concentric Counselor Myron Nelson, LCPC

Excerpt from Online Counseling Programs blog:  How to Choose a Theoretical Orientation

It is easy to be awestruck by an influential author or enamored by a theory’s concepts but that does not automatically translate into successful treatment. I will pass on advice that was given to me and served me well.

Choose a theoretical orientation based on how comfortable and effective it is for you in practice. Explore the boundaries of what you understand and enjoy about using a theoretical framework beyond the textbook.  Your clinical orientation is extremely important to your work as it provides a foundation and language for therapy. At the same time, don’t let it overshadow the other critical factors of your work including how you present and relate to others.

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For more thought-provoking concepts and tips on identifying a theoretical orientation (or even orientations and models -- plural) on counseling, psychotherapy, and psychology, you are encouraged to read the entire post here.  This blog post is particularly useful for graduate students or new grads who are in the exploration phase of selecting a good theoretical fit.