Therapy as an act of love

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I would like to talk today about love.  Specifically about the love I hold for my clients from my seat as a therapist.  I remember vividly a day from my internship when I threw my hands in the air and said to my supervisor with more than a dash of defiance, “I love my clients, maybe I am not supposed to, but I just do.”  His answer was simple, “Good.  You have to love your clients.  You simply have to.”  I was so relieved to hear those words but more than that, his conviction set me at ease.  I do not know how to do this work without my heart being open and present in the room.  I do not know how I would make it through the sessions where my clients expose and embrace their deepest shame without loving them fiercely through it all.  Therapist Christine Hutchison (2016) tells us, “the therapy room is a practice room, and the thing we practice most consistently is the feeling and the skills of loving.” 

I found throughout my training that no one really named love explicitly as a core component of the work we do as therapists.  There were a lot of other words used… unconditional positive regard, attachment, basic goodness, but I just kept getting the feeling that what we were really talking around was love.  So I did some research and I found that people were talking about it in a way that feels important to explore.

Let’s start with why love is important and it’s pretty simple.  We’re wired for it.  John Bowlby and attachment researchers have proven that we are genetically predisposed to be dependent on other humans, specifically caregivers (Wallin, 2007, p. 12).  The idea is that in prehistoric times those humans who were in close relationship with others were more likely to survive; essentially we have evolved to be in relationship.  At the extreme opposite end of the spectrum, researchers have found that babies without appropriate care and love will actually die (Lewis, Amini, & Lannon, 2000, p. 69).  This need for relationship carries on from childhood into adulthood and on through old age.  Wounds that we experience within our primary care relationships in childhood can follow us through our lives, often landing us in a therapist’s office. 

The next question may be, how exactly do we use love to create a healing dynamic?  The answer lies within the relationship.  The therapeutic relationship is the co-arising relationship created and experienced between two people who have agreed that one will be the therapist and the other the client.  Charura and Paul (2012) say, “The therapeutic relationship, however, is now generally accepted as being the most important factor in therapy within the therapist’s power” (p. 22).  They are saying that what a therapist does from a theoretical intervention standpoint matters less than how a therapist engages and relates to the client.  If you pair the findings from attachment research with the findings regarding the importance of the therapeutic relationship, it can be argued that successful therapy boils down to, in part, a therapist’s ability to love their client.

With all this talk of love, it might be important to define it a bit more.  One therapeutic definition of love, from an article by Charura and Paul (2015), says “Hence we propose this concept of agape (love) as being non-possessive love, compassionate love, openness to work with the other as s/he is, as well as the potential of what s/he could be.  This highlights the relational nature of the therapeutic relationship as one in which loving can take place” (p. 7).  This form of love is framed by openness and a type of relating that does not require particular behavior or reciprocation in order to thrive.  Within the frame of the therapeutic relationship, it means that our clients do not have to act in a certain way nor give us anything in order for our love for them to arise and inform the path of therapy.

It is important here to pause and think about what it means to love our clients.  There are inherent challenges in loving clients and in continuously holding a loving environment.  In all honesty, it would be impossible for a therapist to always show up in a loving way.  Therapists are human too.  To this end I think it is important to reflect on Winnicott’s theory of the good enough mother.  He proposed that caregivers do not have to be perfect but simply good enough.  His definition of a good enough mother was a caregiver who could acknowledge and repair their mistakes (Winnicott, 1982, pp. 10-11).  The repair was deemed more important and the results longer lasting than the impact of the original mistake.  The same frame must be held for therapists.  One must work from a place of being a good enough therapist versus being a perfect therapist.  One must know, and embrace, that one can still be human and make mistakes with clients.  It is the wisdom of when and how to repair that allows one to show up authentically as a good enough caregiver and a healthy attachment figure.

I believe that the reason a therapist can bring a foundation of love into the therapeutic relationship is because there is a strong relational boundary in place.  Ethical therapists set clear boundaries that the relationship will not carry on outside of therapeutic encounters.  In holding this boundary, one can provide a safe container in which vulnerability, emotional intimacy, and love can be used as agents of change.  Charura and Paul (2015) say, “… the love we are referring to is not unboundaried or unethical, but, rather, a dynamic living energy which can be safely experienced because it is therapeutically bound” (p. 7).  I believe it is the boundary itself that creates a sense of safety so that a client’s nervous systems can relax.  This relaxation and safety gives rise to connection, attachment, and love allowing difficult material to become workable.  In fact, the therapeutic relationship, with it’s agreed upon boundaries, may be the first place that a client can experience a safe and welcoming environment for the parts of themselves that they would rather hide from the world.  In welcoming difficult parts of themselves to arise, a client can learn to turn toward and eventually love these difficult or cut off parts of themselves.  

I believe that now, more than ever, therapists need to provide a field of love for their clients.  In a society that is suffering the effects of hate filled political rhetoric, a rising occurrence of hate crimes, and an increase in disconnect and disillusionment, it is important to cultivate love in all its forms. I know, as therapists, that we need to do the work of opening our hearts so that our clients can do the same.  It is an act of service to open our hearts in this way to a world that is in such suffering and pain.  In fact, it is necessary.

I am learning to meet my clients with love, and when that feels impossible, I know that it has something to teach me and I slow down and allow curiosity to arise.  Viktor Frankl (2004) says, “Love is the only way to grasp another human being in the innermost core of his personality.  No one can become fully aware of the very essence of another human being unless he loves him.  By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized.  Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities.  By making him aware of what he can be and of what he should become, he makes these potentialities come true” (p. 116). 

I believe, as Frankl does, that my love for my clients is what allows me to step into the difficult work of healing. I believe it is the only way to practice this craft of therapy.

References available upon request.

October letter from our Executive Director

I wanted to take a moment to say thank you to each of you who might be supporting someone struggling with suicidality.

You may be someone working in the field of mental health who has noticed the increasing number of people experiencing suicidal thoughts or perhaps you have personally known someone who has been hospitalized or has acted on their thoughts. These experiences are difficult and sometimes daunting, especially if we are close to the person suffering so deeply.  As a friend or practitioner we each may go through a variety of experiences.  We might get angry, upset, sad, or scared.  We might struggle to be fully present or find that we no longer want to be available for support. We could pull closer only to be pushed away or we may start to experience the overwhelm of the whole situation.  I cannot say what it might be like for you, but I know as a friend of people who have passed through this experience it has brought up many of these feelings.  For me, it has translated into a desire to be more present, to learn, and to understand how I can be a better friend and therapist in these tough times.

Not all people who experience suicidal thoughts will act.  However, in 2016, suicide was the leading cause of death in Colorado for those between 10-24 (according to this study).  This number is sobering and shows us how much help is needed. I know I do not have the perfect answer but I do want to share something with each of you.

You. You are what made me want to write about this story.  As I experience an increasing number of people with these thoughts and struggles, I repeatedly hear that connection is missing and deeply needed.  This made me think of all of you. You provide the connection and hope that help people feel cared for, loved, and part of something. I come away with gratitude to everyone who is there for the people in their life, who foster a stable connection week after week, and who help people not feel isolated. There is a way that your being there may help them know they are there too. 

As practitioners, we may be aware of the professional protocols to follow, but if you have someone in your personal life who is contemplating suicide, reaching out to crisis care at Mental Health Partners is always a good first step. If you are worried and don't know what to do, 911 can support you.  Below are good numbers to reach in case you, as a friend or loved one, need more support and want to help.  I have included resources below on how to be there for people in your life or maybe even yourself. 

I send deep gratitude to all of you who are helping and supporting friends, family, clients, and loved ones in difficult times.  I greatly appreciate all that you do.

Phillip

National Suicide Prevention Hotline 1-800-273-8255

Mental Health Partners 24/7 crisis line 1-844-493-TALK (8255)

This link is a great resource for learning more about what you can do from Lifeline.

Also here is a link to the safeTALK trainings put on by Mental Health Partners.

Supporting each other when the news cycle is impacting our well being...

The recent news cycle filled with stories of sexual abuse and other forms of hate and violence have left many feeling overwhelmed.  For some survivors, the experience of relentless news coverage can be re-traumatizing while others may experience a newfound freedom to express their voice and share their own story.  

First and foremost it is important to acknowledge that everyone’s experience is different and they are all valid.  It is okay to need support and help during this time it is equally okay to feel empowered and oriented towards action.  It is normal to feel rage, fear, frustration, sadness, or disgust.  It’s equally normal to feel strong, sure, and confident.

I would like to focus here on what we can do to support our clients or loved ones who may be experiencing the overwhelm.  It was widely reported that during the Brett Kavanaugh hearings, calls to survivor hotlines skyrocketed.  People needed and continue to need support.  Folks may not understand, even as the news is shifting, why they are feeling confused, exhausted, short tempered, irritable, full of rage, or sad. 

So where do we begin in supporting those who are suffering?  The place to begin is to encourage and support strong boundaries.  It may be important during this time to shift how one is ingesting media coverage, social media posts, and ongoing conversations within work, friend, and family circles.  Support those in your circle to make their own decisions about when, where, and how often they discuss both external events and personal experiences.  Help them be curious about what it would be like to modulate media time, at least temporarily, so that their nervous system can regulate.

Another place to offer support is to help folks understand when they are triggered or feeling overwhelmed.  Provide psycho education around how the flight, fight, freeze response may be showing in up in big and small ways.  It is important to help people understand that these nervous system responses look different for everyone.  That irritability, short temper, or frustration could be the fight response. If one is experiencing a sense of feeling trapped in everyday activities or an urgency to escape that could be the flight response. The freeze response could be showing up as a sense of feeling spaced out, forgetful, or they may be daydreaming more than normal.

Understanding that one is overwhelmed is just the beginning.  Continue your support by teaching basic grounding techniques that help bring one back to the present moment like deep breathing or the use of the five senses.  For deep breathing I like to teach the simple three-breath technique.  First, notice the overwhelm, and then take three deep breaths while trying to stay with the sensation of breathing in the body.  For the five senses technique you are teaching how to use the senses to land in the present moment.  You can have a client name colors or sounds.  You can encourage them to feel textures or temperatures.  I like both of these because they can be used in almost any situation without drawing attention to oneself.

Finally, encourage folks to come up with a self-care plan that they can put into action when they recognize that they are struggling.  This, of course, is unique to everyone so it’s helpful to get curious and allow your client, friend or loved one to come up with their own list of what feels both accessible and good to them during this time.

More support may be needed and help is available.  The following resources are available in our area:

For CU students, faculty, and staff:

https://www.colorado.edu/ova/

National hotline and website for survivors:

1-800-656-HOPE(4673)

https://www.rainn.org

Finally, I think it’s important to recognize that as we support others in our lives, we may also be feeling the intensity and the overwhelm.  This is a simple reminder that all of the techniques above are helpful for both survivors and those in a helping role. Take care of yourselves and thank you for all that you do.

A note from our Executive Director as we transition from Summer to Fall

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With August ending that means Fall is fast approaching.  At this time of year, transitions are happening for so many of us. A lot of that is centered around school either because we are a parent or a student.  With transitions come new stress on our bodies and our minds.  If we don't adjust our own routines to the transition then there is a good chance that we will feel the anxiety, stress, and even sadness that can easily come during this time of year.  

This can be beautiful and tough.  We can all do something a little different, go to bed earlier, create more mindfulness through reflection, adjust our priorities, or even watch the sunset more often.

We hope that you are finding ways to adjust to this transition and in doing so are allowing space for a little self-care.  You are important and you cannot help others until you take care of you.  This fall we look forward to seeing you at our trainings and other community events and if you need support, reach out.  We are here to support our whole community, collegues and clients alike through the fall transition.

Dealing with Grief and Loss by Stacy Shelts

Nothing in life is permanent. Seasons change, leases end, people pass away. With each ending comes a new beginning. Cliche, I know, but it’s true. Coping with the stress of any kind of loss is something everyone goes through, but that looks different in every person’s process.

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Many events can spark grief and mourning:

  • Death of a beloved person or pet
  • Ending of a relationship or friendship
  • Current events
  • Loss of a job

Grief even occurs when going through transitions, such as moving, changing jobs, starting and ending school, etc.  With these new changes comes the end of certain familiar routines, people, and places. Changes in routine can be destabilizing and stressful all on their own, and with the added component of grief, it’s more than just the blues. We’re talking about a major life events here.

The painful aspects of the human experience are exactly that - painful. The emotional pain we feel gets registered in the brain in a similar way to physical pain. It may be invisible to others, but inside, the feelings are very real. The feelings can also shift and change from one day to the next, even from one moment to the next. 

In some cultures, grief is considered an illness that the entire community must come together to heal. They perform sacred grief rituals to shed the negative emotions accumulated by the loss and restore peace to the village. 

Depending on how you’re processing your grief, it is not uncommon to experience:

  • Depressed mood
  • Decreased or increased appetite
  • Increased substance use
  • Inability to concentrate
  • Changes in sleep patterns
  • Suicidal thoughts
  • Crying spells
  • Feeling numb, heavy or empty

Sometimes, you might think you should be feeling differently. Maybe you aren’t able to cry even though you might like to. Don’t judge yourself for how you’re processing your grief. You’re on your own journey through it. When emotions surface, take it as a sign that what you lost was important to you. Grief is a normal response to a natural human experience.

Other tips on how to deal with grief:

  1. Establish new traditions and routines.
  2. Connect with your body by taking a fitness class, jogging, etc.
  3. Ask a friend for a hug 
  4. Take a walk outside in nature
  5. Talk to a trusted friend or therapist

Grief can be distressing and you shouldn’t go through it alone. Organizations like Whole Connection offer Medicaid and sliding scale counseling services so you can get through those challenging times with the help of a professional. Grief happens to everyone.

A letter from the Executive Director

I wanted to write to you all, after this long summer, to address the evolving situation with our affordable mental health care here in Boulder County.  Recently there have been cuts at Mental Health Partners (MHP), an organization that has played a large role in supporting folks with all types of insurance, including Medicaid.  For so long MHP helped cover a large portion of the mental health care provided in our community, including low income clients, which I am grateful for. There are so many people in our community that are in pain, in desperate situations, or yearning for some kind of help and most of them are not finding the support that they need. Thinking about it, I can feel the sadness of our overall situation. Boulder is no different than many other places, there is not enough help for everyone in need, especially for those who cannot afford it financially.

As the need continues to grow we, outside of MHP, are stepping up to fill the gap as best we can. We at Whole Connection have made it our mission to make sure that all people have access to therapy no matter their financial situation.  We are actively accepting clients for individual and group therapy and for those we are unable to directly help, we are happy to refer folks out to another clinic or provider. We are here as a community resource to continue to provide client-centered service, always giving attention to culture, and trying our best to continue to meet the demands of the growing need in our small community.

We hope our small, but well trained, group practice can continue to service this mission at a time of need.  Thank you all for your ongoing support for our community.

Sincerely,

Phillip Horner, Executive Director

 

How to Find the Therapist for You

Finding a therapist can be incredibly hard. There are so many things we are trying to think about.

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     What do I want from a therapist? Will they understand me? What will help me the most? Do they take my insurance? What do I want from therapy?  

Answering all these questions can feel overwhelming and because of this sometimes we don't get very far or we accept a therapist that does not work well for us.  One of the most important questions to answer is, do I feel seen or cared for by this therapist? Figuring this out prior to meeting can be tough and feel nearly impossible. There are a few ways we can try and figure this out ahead of time.  

  1. Read their profile:  You can get a small taste of what someone is like this way
  2. Talk with them on the phone (most therapists offer a free 15 minute consultation)
  3. Notice how you feel right after you talk or read the therapists profile, this will give you an indication of how you might feel in session with them

    We can read profiles on psychology today, websites, or hear about a therapist through a friend.  All of this can be helpful.  A lot of the times we won't know until we get to meet the therapist and connect with them in person.  It usually is good to give a new therapist a few sessions before making a decision as it will give you a better picture of what it might be like working with them  

     Some therapy organizations try to also help with this dilemma "who is the right therapist for me?" For instance here at Whole Connection, we try our best initially to find a therapist that will best fit a new person.  This way it is more likely you will find a therapist that will work out, rather than continuing the long and seemingly difficult search.

    When it comes down to it the most important piece is feeling you have a place you can be vulnerable and share yourself honestly, in essence, you have a good and strong relationship with your therapist.  There is research that shows the relationship between a therapist and a client accounts for roughly most of the success in therapy.  A therapist who can hold space for the relationship between them and the client, will give the therapy a larger chance for success. 

    To end this short blog we will leave a list of questions that can be useful to ask a potential therapist.

  • How  do you work with the client and therapist relationship?
  • Ask questions that might have come up for you from reading their profile
  • How much will it cost? (having an idea ahead of time what you can spend in a month on therapy will be helpful)
  • What is their availability like? If you want to be seen weekly, its good to know if they can do this.

     Lastly it is understandable that many people cannot afford therapy.  Finding someone that can accept your insurance can be difficult.  Here at Whole Connection we accept Medicaid and know how important it can be to have access to mental health care especially when you cannot afford it.  Looking through you insurance provider will more accurately show you who is in network.  Therapists can write you an invoice so you can bill your own insurance, and it will be important to check with your insurance that they will reimburse.

    Hopefully this article helps you find the right therapist in your search.  If you still are having trouble, reach out to us and we will do our best to help you find someone even if it is not us.