“Effectively”

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One of my favorite things about DBT is how every intervention makes sense for the overall goal of reducing interpersonal chaos and how that goal makes so much sense for the treatment population  it was designed to help. I’m not going to get into a debate as to whether it’s the “best” treatment; but I think it is probably the most efficient and “designed with focus” treatments around.

Again, I practice from three different modalities so it’s not like I have a horse in the race. DBT is my preference when trying to help clients develop the capacity for mindfulness because of how practical it is when approaching the topic – within DBT mindfulness has a utility that specifically connects to the core issue driving a problem. No where is this more apparent than in the How Skill – Effectively.

One common approach to teaching any skill in DBT (and CBT for that manner) are parables and, where appropriate, self disclosure. In teaching Effectively I talk to clients about an experience I had back in my 20’s.

I was working at my first management position 2 years out of grad school, saving for a wedding and working for an organization that was going through a merger resulting in a lot of downsizing. On top of all that, I had to deal with the issue of a title change. My office was conveniently located above a Motor Vehicles Agency, which I thought would make the whole thing a breeze. I ended up having to visit the DMV several times and each time I felt I was given the run around which led to me becoming more frustrated each time I had to go.

During the last visit, the agent and his supervisor basically blew me off and informed me that more information was needed, which is what I was told during each of the prior visits. It felt like each time I went, there was some other reason as to why they couldn’t do what I needed them to do which meant using a lunch hour (which was really just an hour of work) to wait on line again. But this time was different. I became so pissed off at the “injustice” and incompetence of the whole thing that I went on a 5 minute stump speech about the evils and incompetence of bureaucracies.

A very loud stump speech.

And I felt justified and right with what I was saying, after all it was their errors that were wasting my time and they took no ownership, they showed no interest or concern that my life was busy and my time was being wasted. At the end of my rendition of “Mr. Smith Goes to Washington”, everyone else there erupted in applause.

Then I was asked to leave and never come back; the manager informed me that I was “banned”.

Initially, it felt good to react in this way and to throw it back in their face. It felt good to have other people applaud me for doing that. Vengeance, vindictiveness and giving someone who deserves it a verbal beat down always feels good, especially when you’re right and everyone else knows you’re right.

But it was ineffective.

In the end, I had to restart the process with another DMV. I could no longer use the DMV that was one floor down from my office. I failed to realize that in a place like the DMV, the folks who work there are as much a slave to their protocols as I am – the only difference being the side of the counter they were on. I failed to realize that bureaucracies are numb to the consequences of their protocols because the protocols are just how its’ done – its not personal.

That is the essence of Effectively, that just because something feels right; just because it IS right doesn’t mean it’s effective. It’s about taming both logic and emotion with the realities of context and acting effectively within that context to get what you need – even if it means having to come back to the table more times than you’d like.

When Reality Bites

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I’m back from vacation and despite being away from the blog for a while, a few folks posted some interesting comments that had nothing to do with the post they were commenting on.

One had a link to a website selling table saws.

Fascinating.

A significant part of CBT work involves challenging distorted thinking;  patterns of thinking that can lead a person to unreasonable and usually negative conclusions about events, themselves and other people.  I’ve written a good deal about negative thinking and how to use Socratic methods and evidence to challenge distortions that typically lead to unreasonable distress and maladaptive behaviors.

But what happens if the negative belief or thought is true and unchangeable?  For example,  “I got written up because I played computer games at work all week and missed an important deadline.”

Contrary to the stereotype that therapists tend to push clients into endless positive affirmation mantras we actually have a few ways that can help clients think about and handle difficult situations that involve strategies other than repeatedly saying “I love myself and the world is in harmony”. Because, really, the world is rarely in harmony and if you love yourself that much then therapy needs to have a bit of a different focus.

One strategy involves consciously using the distress related to the event as a catalyst for increased awareness and knowledge about the problem and increased desire to change the behavior that either led to the problem or may be making the problem worse.  The Systems theory folks view crisis as something that can act as a catalyst for change in families and what’s true for systems is true for individuals.  Emotions are really neutral entities; “good” and “bad” emotions can both lead to negative outcomes; it’s not so much the emotion that matters as much as how you use it.  During times of distress, folks are typically more motivated to change just so that they can feel better. Changing our behaviors may not reverse a specific consequence that already occurred but it can help prevent the situation from getting worse while giving us a greater sense of control.  Changing behaviors can also have reparative effects on relationships; people tend to forgive more easily when they have evidence that someone is trying to turn their behaviors around. However, acting without awareness can leave us vulnerable and may lead us to bigger problems than what we started with.

Before pushing a client to action, many CBT therapists engage their client in a simple yet comprehensive pros and cons exercise.  Pros and cons can help us put a negative event or life circumstance in perspective.  Using the example of being in a job you do not like; there are reasons why a person may still show up – there are things about the job that have a payoff otherwise they wouldn’t be going there every day.  Going through the pro’s and cons of staying at a job, leaving a job, changing aspects of a job, etc. can, at the very least, help a person recognize the reasons why things are the way they are. Understanding the reasons for a negative event or situation can help us balance out the narrative; it pushes us to more reasonable and evidence based conclusions about the part we played, our conclusions about other people who may be involved and the situation itself.  Pros and cons can also shed light on new strategies or may correct faulty equations that make the situation appear more distressing than it deserves to be.

From here, strategies revolve around adaptation and acceptance which involves understanding that the negative that cannot be changed is only one part of many.  Using the example of a dead end job, you may want to leave it but jumping ship right now may not make sense for a variety of reasons (benefits, the market, seniority etc).  Adaptation may mean recognizing that while you may not like your job there are facets of it that are enjoyable or at least more enjoyable than others.  Adaptation could involve focusing more on the areas of your work that you find enjoyable both in what you do and in your thinking, setting up  workspace in a manner that helps you cope, making breaks more active in leisure (going for a 15 minute walk or calling a friend on a break and talk about sports instead of staring at your computer monitor endlessly repeating the word “hopeless” in your head) or taking small steps to another job or career while staying in your current job. Acceptance means letting go; if you hate your job thinking about it after you leave the office only means you’re keeping yourself in that environment longer than you need to be.  Life doesn’t have to be perfect in order for it to be worthwhile or enjoyable; having a bad job doesn’t mean you can’t enjoy your family, friends leisure or faith. Hint: mindfulness might be helpful here.

Although thought records and Socratic questions can’t miraculously change a negative event into something positive, they can be useful in helping us determine whether our reactions to the negative event are reasonable. While there may be evidence to support a negative outcome or less than positive conclusion about our behavior, thought records can help us think about next steps more effectively and can act as a brace against turning a mistake or bad judgment into a broader condemnation of our character or capacity.

If you struggle with a mental health issue like depression or anxiety, you may want to  consider that while the situation stinks the thought patterns associated with your issue may make it seem like it stinks way more than it actually does.

So therapy isn’t always about extinguishing the negative; usually it’s more about putting the negative in perspective, helping someone understand their options and that even if what’s uncomfortable doesn’t change, it does not have to define their life.

Don’t forget to enter our January Giveaway.

Resolution

Interchange section

You know how I sometimes go into something completely unrelated to the topic before actually getting into the topic?

I’m going to do that again.

The power in my house went out last night and I completely blew off my first appointment (I live by my alarm clocks…that’s right clocks-plural) and as I rushed into the bathroom to take a shower (so as not to miss my second appointment) I stepped in cat poop. Apparently I closed off access to the litter before going to bed last night. If you know anything about cat poop then you are aware that it is probably the most horrible smell ever. At least he pooped in the bathroom.

Okay to resolutions. I’m a fan of resolutions and I know most of them are not kept with but at the very least they can act as reminders of what we would like to change.

There are many reasons why resolutions or the commitments that we make to ourselves to change at any point during the year sometimes fall through; today we’re going to look at one big barrier – motivation. Motivation is a finicky thing – it comes and it goes; the thing that helps it one day can end up hurting it the next. There are a few things you may want to keep in mind when making a commitment to change and seeing it through.

Reasonable Accountability

Some folks have a hard time taking responsibility for their actions and life can provide us with ample opportunities to bail out of our commitments. Depression, anxiety, change in routine, bad parents, trauma, finances….all of these things can be reasons why the change is harder but they do not have to act as excuses to give up.  We can acknowledge that these hurdles make the journey harder but hurdles are not impenetrable and unlike the Olympics, there really aren’t any hard and fast rules as to how they should be overcome – as long as you don’t damage yourself or others in the process .

Others take on too much responsibility – they feel that everything should be in their control and create unnecessary obstacles to change by trying to take on what isn’t in their power to change.  These are usually the same folks that feel that they should be able to do everything on their own.

Being accountable is different than blaming yourself, beating yourself up or figuring everything out on your own – it simply means;

(1) Being aware of what created and continues to perpetuates the problem.

(2) Being honest with yourself about what happens when you get off track so you can avoid making the same mistakes.

(3) Getting additional support when needed.

We all have things we need to fix so there is no shame in asking someone for help.  Needing help doesn’t make you a failure or irresponsible, if that were true anyone who takes their car to a mechanic or buys produce from the grocer would fit that label.

All or Nothing Thinking

Another motivation trap is all or nothing thinking.  Sometimes when we lapse into an old behavior it’s very easy to catch the “well I already screwed up today so I might as well go all the way” syndrome.  This way of thinking assumes that our attempt at change is going to be linear and perfect when most attempts at significant change are incremental, imperfect and messy.  I’ve struggled with weight my entire life and I know this is probably my biggest trap.  There have been times where I’ve been in phenomenal shape and other times when I’ve been a complete mess.  Currently, I’m a bit of a mess. I have to remind myself that walking away from a day where I had one bad thing to eat instead of eating bad most of the time and being unaware of what I eat is a victory because it’s better than where I was. For me, not gaining weight is as important and substantial as losing it. In order for me to be successful I have to think that way because it’s true; the evidence of my experience says so. Not thinking that way has really bad consequences because it allows me to lie myself into bad behaviors.

Process Not Outcome

Goals are important but they can cause us to be impatient; it’s better to focus on strategy, on what you feel you need to do in order to get where you want to be.  If you decided to drive somewhere you’ve never been and only focus on the end point of the map instead of the red line leading up to it, you’re eventually going to get lost, frustrated and give up.  Instead, think of the change process as more of a long road trip.  Make each part of the journey enjoyable – figure out ways to make the journey entertaining; focus less on deprivation and more on what you can add to the trip so it feels less onerous.

For example, if your goal is to be more financially responsible avoid thinking about the millions of dollars you want to save up in the bank and focus your efforts more on the benefits of frugality. Think of simple ways to take vacations; figure out what you needed from the things you used to buy and look for cheaper substitutes or alternatives. Seek to enjoy simplicity vs. focusing on the fact that you’re not where you want to be and it’s already been five minutes.

Goals are end points we can look at periodically to determine whether how we’re going about the change is effective and whether the goals we originally set out for ourselves make sense.

Embrace Failure

One motivation killer is our negative interpretations of failure and I’m really not afraid of using that word. I’ve failed at a lot of things I’ve tried and I succeeded at a good number of them as a result of the failure.   A big part of keeping motivation up is rethinking what failure means and understanding that failure is a necessary part of making something better; it’s not something to be ashamed of – it is a built in aspect of anything that’s worth doing.  Failure means you’re trying, that you’re not giving up – in order to fail you have to be a risk taker and no one ever became awesome by avoiding risk.   Folks who are averse to risk tend to personalize not meeting goals ; they interpret anything less than what they set out to do as  evidence of their character.  History is full of folks who have been revered after not only failing once but multiple times; in fact many of them failed at the very last thing they were famous for (Napoleon as an example). People don’t really think about failure in considering a person’s character; we take a look at the big picture, adherence to reasonable virtue and the effort made in pursuit of a goal.

Make Not Changing Less Comfortable

Change can be uncomfortable for two reasons. The first, which we have been talking about, is the work involved with the change. The other side of the coin is the reward we get by not changing.  Going to the gym can feel uncomfortable because of the effort involved with getting there, feeling out of place among all the super humans and because if we don’t go it means more time watching Star Trek episodes while eating Little Debbie Snack Cakes. Increasing and sustaining motivation may mean re-working and re-balancing wants and needs while changing the kinds of rewards you give yourself so that they reinforce the change, not the problem. So….

Not going to the gym, eating Little Debbie Snack Cakes and watching Star Trek

can turn into

Going to the Gym and then  grabbing a cup of coffee at Barnes and Noble while reading a Sci-Fi magazine, comic or book

Make Change a Part of Your Life …. Not the Whole Thing

Sometimes when we start gaining success we start planning our lives completely around avoiding the triggers that were problematic in the first place in ways that are unreasonable.  We go to the other extreme in trying to follow the map – we abandon the little pit stops that made the journey tolerable and decide to try to get there non-stop since we have momentum.  More often than not this actually works if timed right but it’s not sustainable.  You’ll get to your goal quicker but keeping at it with the same intensity leads to extremes and you’ll either burn out and go back to old patterns because you haven’t really integrated the change or you’ll take the change to an extreme that defeats the original purpose – improved quality of life.  When considering change, you want to be clear on short term strategies (things you know you can’t do forever but you need to do now) and long term strategies (things you’ll always have to do and figure out a way to live with comfortably).

Using myself as an example, sugar is a real killer for me. Put a sugar cube in my mouth and I gain 30 pounds and sleep on the couch the whole week.  I have achieved huge success with no carb diets but I never reached a way to eat well sustainably. Once I reached my goal weight I started slipping and gained everything back because my entire plan was based on short term strategies.  My exercise routines and meals were not enjoyable because they weren’t varied, too time consuming. Eventually I gave it up altogether and found myself back where I started.

Avoid Defining Yourself by the Thing You Want to Change

If career advancement is your goal, walking around all day telling yourself what a crappy employee you are isn’t going to help.  You may not have been employee of the month 30 times in a row like your co-worker Brad (it’s always some guy named Brad) but that doesn’t mean you were bad at your job or everything you did was miserable.  You are also more than your job, you may be a great parent, wife, volunteer or masked crusader who uses the cover of darkness and a mysterious identity to help lost cats find their homes.

Keeping a balanced view of yourself makes the journey more tolerable and keeps the distortions that lead to relapse at bay.  If your attention is constantly on what you believe to be the worst of you, then you may not feel you’re worth the work that’s needed to change. You may also feel deprived during the change process as you’re constantly focused on the thing you don’t have.

So obviously my New Years resolution is to lose weight; I encourage you to figure out what change you want to make and commit to it – we’ll screw it up together along the way but we may get there.  Regardless, we’ll be the better for trying.

Mindfulness Meditation Group at HIP

A colleague of mind is running a four week series on mindfulness meditation.  Courtney is a great person to learn mindfulness from and the group is a bargain (4 hours for $99).

Here is the e-flyer-

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The Fall is about Renewal, New Beginnings, a Time to Connect and Go Deeper… Join the Mindfulness Meditation group at HIP

Does your mind often wander from the past to the present?
Mindfulness Meditation is a technique which allows individuals to reconnect with the NOW. Only when we are fully connected with the moment are we able to embrace life.

Meditation is a powerful tool in relieving tension and increasing relaxation.

A four week series, on Sunday evenings from 7-8pm at HIP Lifestyle Studio in Somerville, NJ. This group will start on September 15, 2013.

This group is facilitated by licensed psychotherapist Courtney Gregory LPC LCADC. Courtney graduated from Columbia University: Teacher’s College with an MA, Ed.M in Psychological Counseling. Courtney specializes in mindfulness techniques as a means to healing. Courtney is also a certified Yoga Instructor through AAA-ISMA.

This group is designed for both beginner and advanced mediators.

Please contact Courtney E. Gregory at (908) 399-9024 or e-mail mindfullifetherapyllc@gmail.com
to register, as the group is limited in size. Curriculum builds from one week to the next. $99 for four week series.

Suggested reading: “Real Happiness: The Power of Meditation.”
Salzberg (Please purchase book prior, available at amazon.com)

www.mindfullifetherapyllc.com
It is EASY to sign up! Simply Call me: 908 399 9024 or Email me: mindfullifetherapyllc@gmail.com SPACE IS LIMITED! CALL TODAY