“Show Your Work!”

When “solving problems” in addition to good “issue identification”, “diagnosis” (or whatever), it’s really important to examine methods/means to diminish or solve these problems, and have those methods be principled.  As Huxley opined:

“We are so anxious to achieve some particular end that we never pay attention to the psycho-physical means whereby that end is to be gained. So far as we are concerned, any old means is good enough. But the nature of the universe is such that ends can never justify the means. On the contrary, the means always determine the end.”

But even principled means don’t go far enough.  I have been discussing with a couple of clients and friends in the last week about getting from “point A” to “point B” as relates to The Work.  With these discussions in my head, have also come across a couple of psychology related blogs addressing resolution of specific problems.  What these conversations and blogs have in common, is my friends/clients complaining that when they’ve mentioned a problem to someone (anxiety, impulse control issues, depression, for example), and when given advice by some folk about how to resolve them, we have found essentially that at worst the suggestion amounted to “stop being __________ (anxious, impulsive, depressed)”, or simply suggesting that the opposite behavior/idea be employed.  Even from professionals.

Of course, the “middle part” here is really important.  There should be attention to the steps taken in the middle.  Those steps should specifically address the issue at hand, not simply be something rationalized as “good” or needed or healthy.  As some of my heroes have suggested, these ideas often amount to “activity instead of action”.

For instance, exercise arguably helps depression, anxiety and the like, but seems that in many cases does not specifically address the concerns identified that might be causing such in the first place (loss, abuse, etc).  In addition to that, the steps taken from anxiety to “calm” or “groundedness”, sadness/depression to happiness/serenity/gratitude (or somesuch) etc should be principled.  Meaning, they should be rooted in ideas that are repeatable, work for different kinds of problems, and preferably don’t create new ones in their wake.

Much of this is intuitive, but what keeps coming to me about these ideas is when observing “problem solving” from the outside, it’s often difficult to point to the work that is done.  Just like we’re encouraged in most math classes, we should be able to “show our work”.  When dealing with issues/problems/concerns, problem identification is really important.  So are means of problem solving- but what seems a good test of the effectiveness or value of such is the ability to point at the work done that specifically addresses the problem at hand.

As a simple example… telling someone to “calm down” rarely helps them behave differently, let alone feel differently.  There’s no steps to show, it’s difficult to see any principles this idea of “calming down” is based on.  While problem-solving emotional or relationship problems and the like it’s tempting to simply give advice and/or lean on philosophy, but there’s a lot of value in making such practical- something we can “point at”.

In our martial arts training group, if one of us has or is taught an idea/principle, we test that idea out in real time with a resisting opponent.  We also try to “break the idea”- see what conditions or problems it will not work with.  In some circles this is referred to as “pressure-testing the material”.  The same ideas might apply when solving other real world problems.  Clearly identifying the issue/context, having a principled means of intervention or “problem solving”, having a practical (empirical) means of determining the usefulness of the idea… showing our work and evaluating its utility.

Am advocating here for critical thinking when it comes to the utility of tools or ideas for problem-solving.  It seems that one of the places this utility is revealed is in whether or not we can show our work- make use of an idea in a way that is repeatable and observable (what we say/don’t say, do/don’t do).  As a therapist, I really endeavor (and hope other professionals) to give ideas that can be used by anyone, ideas that are practical enough to show the work that specifically addresses an identified problem, not something that simply gives us the feeling that we are doing something.

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What to Do?

From P.16 of the PDF “Statutes and Regulations” from the California Board of Behavioral Sciences (the regulatory agency that oversees MFTs, Social Workers, and etc):

“§4980. NECESSITY OF LICENSE (a) Many California families and many individual Californians are experiencing difficulty and distress, and are in need of wise, competent, caring, compassionate, and effective counseling in order to enable them to improve and maintain healthy family relationships.”

Clients as above, come to us for wise counsel.  Among other things of course.  This idea has far-reaching implications, not just for our clients, but for us.  Wisdom is hard to come by!  Oversimplifying, “wisdom” in this case is often a euphemism for answers.

Claiming (or believing) one has wisdom or answers is of course a Bad Idea, yet it seems we have a responsibility to work toward them.  There’s some great ideas and techniques supporting the principle of not giving “answers” (suggestions, direction, etc) outright to clients (or loved ones, certainly) from the therapist’s chair.  My basic mode of operation is to try to lead someone to those answers, typically only giving direct suggestions when my efforts to lead a client to their own answers have been exhausted.

We do treat several diagnoses and/or issues that have “community standards”, fundamental practices or “conventions” most therapists agree on how to treat.  Schizophrenia, bipolar disorder, and other more severe illnesses for instance almost always direct the client to: not “self-medicate”, takes the best supportive medication regime as directed, and is getting :talk therapy” and/or peer/familial support with their illness.  There are few that argue with the utility of these interventions.  There are other examples for addiction, depression, anxiety, and more.

Two things are of interest to me though.  The first is that during the therapeutic process, I often see clients get a suggestion, and dismiss the suggestion out of hand.  What I think is happening is that rarely do I suggest an idea that in a vacuum will ever be sufficient.  What I mean is, most any suggestions I have will never be singular.  It seems that the depth of our sadness or anxiety or pain or whatever often keeps us from “getting” what is offered, unable to accept the responsibility of taking several suggestions.  Summarizing: rarely is one idea sufficient to change anything in the therapeutic process.

The second thing that prompts me to mull this over is the “active” therapists versus the “passive” therapists.  In my view there is room (and each therapist I think, ought use) both styles, often with the same client.  There are times that we should be directive, and not just in terms of extreme examples like when a client is being abused.  Discouraging self-medicating, engaging a support group, ruling out medical concerns with a physician, ways to stop a behavior etc are all examples where there is little controversy over giving someone “direction” about an issue.

People come to us for answers.  We are paid to have a toolset, methods, principles of operating that in many cases should help diminish depression, stress, relationship conflicts, behavioral concerns and the like.  On the subject of not holding these ideas close to one’s chest: there is a great (and occasionally controversial) martial arts instructor who critiques traditional means of training, idealizing the “teacher” and etc.  He also critiques traditional martial arts training as being “cultish”- keeping secrets, claiming answers from some (out of touch and unknowable) “higher source”.  His “instructors” are all referred to as “coaches” or by their first names, and their focus is very simple: performance improvement.  That last idea is part of what I’m getting at here- the “answers” we give as therapists should improve “performance”, which I would argue is diminished if we are too passive.  It is very significant of course, that what is being improved, is clearly defined.  If we think something might be helpful though- there are certainly compelling reasons we should disclose it.

When it comes to performance, we should be helping people get more in touch with their emotional condition, have those feelings gracefully, diminish (but not eliminate) the intensity of negative emotions.  Our interventions should help decrease or stop unwanted behaviors.  The direction we give should help increase intimacy.  Of course this is not an exhaustive list, it may take a long time for these things to happen, and some cannot happen without the others.

My experience has been that many (arguably most) of my clients have come into my office, suffering enough, and out of enough answers, that they are willing to do most things we come up with together.  Had they been in possession of this material on their own to begin with, there would be no (or little) need for my education and experience with the issues they struggle with.

My effort is to put me out of a job and it does people a disservice I think, to have an insight that I wait for them to come to on their own… which they’ve already arguably been trying to do.  Sometimes I ask my clients if they have spent a great deal of time in their lives, saying something like this to themselves: “I just wish someone would tell me what to do about this.”  There are many things, that most(not necessarily all) people can do, directly, to diminish feelings of low self worth, sadness, struggles in relationships and most of the problems they come to a therapist.  If I didn’t go to school to learn to help people know and do these things, then what exactly did I go for?

Wanting to Stop

Have had several people in the last week ask me specific questions about wanting to stop (sometimes called “abstaining” or “cessation”) doing some “behavior”. Drinking, smoking, gambling, over/undereating (or not at all), self-harm behaviors (cutting, burning oneself etc), “codependent” behaviors, controlling behaviors, manipulating, gaming/attention to “devices”, even saying or thinking certain things and more. While some of these require more intense interventions (stopping alcohol or drug use for instance would require medical intervention), some other behaviors can be stopped or minimized by other means.

Though we (therapists) are oft charged with the responsibility of helping clients stop these behaviors, we’re not always direct about how to help someone do so. There are real-world, practical means of helping us stop these kinds of behaviors. It should be noted though: in many cases, these are caused by unresolved emotions. It’s really important to note this, because no intervention we might suggest will work if there is a sufficient mental/emotional/”spiritual” and/or physical prompt to do so.  Or more simply and by way of example, if someone is suffering enough emotionally (or otherwise), no intervention will stop the behavior.  The feelings (even if physical) have to be transformed/diminished enough for the intervention to work.

These things in mind, here’s some ideas. Some of them are direct, some of them will take hold over time:

1.  Pay attention to how we feel.


2.  Ask ourselves, “Am I mad, sad, glad, afraid, ashamed, and/or hurt right now?  What ‘possible reality’ does this indicate?”

3.  Putting off the behavior.  For example, “I’ll _________ (smoke, drink, gamble, eat, etc…) an hour/day/week/month from now.” 
 
4.  Context.  This isn’t just a principle.  It can be practical.  Asking, “What am I supposed to be, or supposed to be intending to do right here, right now?”

5.  Service.  Finding a way to be of help to another person.

6.  12 step program attendance/participation.

7.  Saying the “Serenity Prayer“.  Even if not “prayerful” people, this can be a form of self-talk (the word “God” can also be removed).  For things we’re “powerless” over, “God, grant me the serenity to accept the things I cannot change, the courage to change the things, I can, and the wisdom to know the difference.” makes us mindful of principles and behaviors that can also help with abstinence.

8.  Speaking of praying (or doing self-talk)- praying for the obsession to have __________ (smoking, drinking, gambling, eating etc) be removed, helps.  “Please remove from me the obsession to stop _________.”

9.  If that is hard, praying/self-talking for the willingness to stop __________.

10.  Calling someone.  This, to me, is one of the most powerful tools.  Having someone who knows what we are working on that we can call when considering the behavior to: pull our covers (so to speak), have them talk us out of it, and/or “be” with us as we struggle with the feelings of letting go of the behavior can be pretty powerful.

11.  A different item from the above- calling that someone as a pre-emptive strike.  Meaning, calling them when we might be in a situation this will come up, before we go do the thing we have to do.

12.  Make a list of the times these things (smoking, drinking, gambling, etc) occur most frequently.  Take that list, and either apply the things above (and below) to those circumstances if you HAVE to be there for these instances, and or use the list to avoid those times entirely.

13.  Write a list of the negative consequences of the acting out behavior.  
14.  Maybe most important, is simply identifying the issues (even by making a list, which we will also do in a formalized way) that have prompted us to operate this way, and have an organized means of getting through these (which therapists are charged with the responsibility of).

15.  Based on that list of things/people/circumstances that get us in trouble, have a list of replacement behaviors.  For example, I know I shouldn’t be __________ (smoking, drinking, gambling, eating etc), so, I’m going to go to church/support group/call my friend/read this book/exercise/take a walk/write about it and more etc.

16.  Speaking of writing: when “tempted” to do the behavior, write about it.  That’s pretty common information from most therapists.  However, I think it doesn’t go far enough, unless you read this to your therapist and/or a loving friend and/or a sponsor (if one attends a 12-step program), priest, pastor, and etc.  Maybe more than one of these people.
17.  Putting a rubber band around our wrist, and giving it a gentle snap when considering doing the behavior.
18.  Making a “fund” for the behavior- putting a pre-determined amount of money in a jar when we do the behavior (or consider it maybe), and donating it to a charity or some related idea.
19. “Play the record through.” All the way through. Consider every step of what will happen, what it leads to, and its consequences.

Again, I want to reiterate that no amount of ideas to “stop” a behavior (that we do in our heads or outside of them, so to speak) will be sufficient without working through the attendant (and/or consequential) emotions that come with them.  Those are really strong reasons pointing to the idea of having a therapist that can help use these kinds of tools (and more), and walk through the related issues.  It’s important too that many types of concerns will require medical attention by a physician with experience with the specific problem.  Good luck with any of these efforts…

Post Script: It should be noted that the soul of such things is what Carl Jung would have called “illegitimate suffering”- meaning, we do these things as an alternative to simply feeling whatever we feel when we don’t do the behavior.  One of the things we do these over is feeling “bad” (about ourselves), broken, less than, “not enough” and the other variations on that theme.  Often, if we do the behavior we’re trying to stop, we feel those very things (“bad”, broken, etc).  As we often do the behavior to diminish or eradicate feeling those things, then we feel those very things for doing the behavior.  Simplifying: I feel “broken”, less-than, etc, I do a behavior to not feel that way, then feel “broken” (less-than, etc) for doing the behavior.  It sets up a vicious cycle, a repetitive cycle.  

Where I’m going with this is, if you happen to do the thing you’ve been trying to stop, “beating yourself up” for doing the behavior may be the very thing that prompts you to do it again.

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