So Far and Yet so Near – Video Therapy

My office setup for video therapy. I’ve had to give up my stand-up desk and think about positioning so that the lighting is right.

The whole world has changed.

How often have we been able to say that without being guilty of gross exaggeration?

I have been very fortunate to be able to continue my work in a way that doesn’t expose me and my clients to the COVID-19 virus. Secure video conferencing services for health care have been available for our use.

There has been a great deal of change in my clientele. Many people needed to cut therapy short abruptly in March due to work requirements, their children being home from school or because they simply weren’t comfortable with video therapy. Some clients continued and others have started.

The experience has been that video therapy works. That does not mean that it works just well enough or that it will do until we can get back to “normal”. (That word could be the subject of a whole blog post on its own.) It works. Full stop.

I’ve been privileged to be able to do some amazing work with clients during this time. There has been great need but at the same time people have been able to show a great capacity for vulnerability and empathy. These are key building blocks in therapy – particularly relationship therapy.

Although I am distant from my clients and working with their images and voices, there is a very real closeness that comes with video therapy. I enter their space more than they enter mine. There’s a great trust in that and for many clients there is a comfort that comes with being in their own space.

There is much speculation right now about what sort of longer-term change will come as a result of this pandemic. One thing I’m pretty confident of is that in my profession, video therapy is going to remain a more common option, even when it is no longer a necessity.

We now find ourselves at a sort of in-between stage where businesses are gradually being allowed to re-open. Phase one of the Province of Ontario’s re-opening plan includes “in-person counselling, including psychology and addictions counselling.” At the same time, my provincial regulatory college has sent out a bulletin which states, “in cases where you have the option of providing e-therapy or in-person therapy, we advise that you still choose e-therapy”.

How do we make sense of in-person counselling appearing to both be opened up and kept shut down simultaneously? Part of the reality in our society is that not everyone has access to the technology and living arrangements required to make video counselling viable. Those people need access to health care just like everyone else. Community mental health and addiction clinics are going to have some significant challenges, finding a way to provided needed care to some of the most vulnerable in our society.

My office setup for in-person therapy, with the desk rolled back towards the wall, out of the way. I’m running out of options to keep the hair out of the way.

If your circumstances won’t allow for video therapy, please be in touch to discuss the situation. If video therapy is an option, I will ask that we continue to take advantage of the ability to do our work while staying safe from COVID-19.

Video therapy has been very comfortable for some. I know that for some of you the idea takes you far outside your comfort zone. If that is the case for you and you’ve been waiting for in-person counselling to resume, I will ask you to consider how many people have been taken outside their comfort zone for a wide range of reasons during this pandemic. Please give me a phone call so that we can discuss video counselling and your reservations about it.

Working together, building stronger relationships of all kinds, we can get through this time.

You Have to Have Influence

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Photo Credit:  Al Wilson, http://www.naturespicsonline.com/

The recently deceased Barbara Bush, former First Lady, had this to say about marriage: “…you have to have influence. When you’ve been married 47 years, if you don’t have any influence, then I really think you’re in deep trouble.”

I couldn’t agree more. In couples counselling, I’ve found the word “influence” to be hugely helpful, mostly as an antidote for another word that’s almost universally problematic – “control”.

I’ve never met anyone who likes to be controlled or who likes to be described as “controlling”. Few things are as poisonous to a relationship as unbalanced power dynamics.

When both partners have influence on one another, power dynamics are fluid and have a good chance at being fundamentally in balance.

To have influence doesn’t mean you always get your way, but it does directly imply that:

  • You are heard.
  • You are understood.
  • Your thoughts and feelings matter.
  • The course of your common life together is determined together.

The control of one person by another via physical, emotional, financial and/or sexual means is abuse.

When relationship power dynamics are shifting in more subtle ways, consider asking yourself these questions.

Is a partner who is starting to seem somewhat controlling in some areas of the relationship doing so because they don’t feel like they have influence generally or in specific areas?

If your partner seems to be unfairly describing you as controlling, can you hear that as an ask for influence?

One of the best metaphors for a healthy relationship is that of dancing. In a healthy relationship we share the responsibility to lead at some times and at other times we can trade the lead back and forth seamlessly, depending on the situation. We influence one another as we make our way across life’s dance floor.

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When Fixing Doesn’t

fixingI think that before I became a couples counsellor, it’s possible that my wife said to me once or twice, “I don’t want you to give me suggestions about what to do, I just want you to listen.” Maybe it’s even happened since.

It’s a common issue in couples counselling.  One partner needs to share something and the other partner sees it as an opportunity to show they care by offering solutions or “fixes”.

I don’t like to bring gender into this, because too often we make assumptions about gender that simply aren’t true.  (Stay tuned for an upcoming blog post on sexual desire levels in relationships…)  However, in this case I think traditional assumptions about gender play a role.

We have been taught that men are supposed to fix and repair things and women are supposed to take care of emotions in the family.  This is, of course, just so much rubbish.  Women make fine mechanics and engineers and men have all the same emotions as women and can, with a little effort, even learn to do things like being Emotionally Focused therapists.

As a result of these assumptions, though, it does seem to more often be men who want to offer a “fix” when their partners are sharing that they’re in a difficult place.

The thing is, research and experience tell us that the key questions in any relationship are:

Are you there for me?

Do you approve of me?

Do I matter to you?

Do you have my back?

Will you be here when I need you?

Questions such as:  “Can you help me figure out how to deal with the coworker who drives me crazy?” and “Do you know why I can’t get this app to work?” don’t have even a fraction of the importance of the questions listed above, in relationship terms.

We have to reorient our thinking to accepting that being there, listening and empathizing aren’t just “enough”; these are the points upon which the whole relationship turns.

As with many other situations, it’s not enough to simply be putting effort into showing you care.  You need to be tuned into your partner closely enough to understand how they need you to focus that effort.

Addiction in Relationships, Part II

ratFor some time, the basic narrative in our society around addiction has been clear and simple.  It goes something like this.  Some substances are so dangerous to the human animal that once we start it is very difficult to quit, particularly for those people whose personality may predispose them to addiction. Addiction has been categorized as a disease that we can catch if we fall prey to a “gateway” substance or if, again, we just have some sort of predisposition to the disease.

The emerging science, and some important science that sat largely ignored for decades, is causing us to reboot our thinking around addiction.

Some of the first studies on addiction were very straightforward. Put a rat in a cage with two water bottles, one of which is laced with a narcotic. Which will the rat choose? Consistently, the results were the same. The rat chose the narcotic and kept choosing it until it died.

Pretty simple. It doesn’t seem like you need to be a scientist to interpret those results.

In the late 1970s, a Canadian researcher by the name of Bruce Alexander decided these results were not nearly as simple as they appeared. He asked, what if the problem is not the access to a drug but the fact that the rat is in solitary confinement in a steel cage?

He decided to perform the same experiment, except with a significant change. The rat would not be alone and it would be put in an enclosure with other rats and in an environment that rats would enjoy living in. The result? The rats rarely chose the narcotic-laced water and never died from an overdose. The rats consistently chose the plain water and enjoyed the good life with their fellow rats in what came to be known as “Rat Park“.

You’ve probably never heard of Dr. Alexander. He had trouble getting this ground-breaking research published. When it was published, it was ignored and his funding was eventually pulled. It’s hard to go against conventional wisdom and politics, even when you have science on your side.

For years, we’ve been encouraged to wonder what predisposes an addict to addiction or what bad choices they might have made that got them addicted.

Perhaps instead, we should be asking ourselves what particular sort of steel cage the person who uses has been in that has made drug or alcohol use a preferred alternative.

Does this mean that those who use don’t have to take responsibility for their actions?  Of course not.  My experience is that people want to take responsibility.  It’s simply much easier to do so if someone really works to understand you and your experience.   That can happen more readily if we have a better understanding of the nature of addiction.

Many of the assumptions that have undergirded our understanding of addiction for decades are under intense scrutiny. Some of the brands that have provided addiction support over that same period may need to check some of their fundamental assumptions.

Our ability to be in healthy and sustainable relationships may well be the best tool we have in dealing with the negative effects of addiction and other compulsive behaviours.

Relationship Truth in Song and Science

Brandi_Carlile_-_The_StoryMy previous blog entry mentioned both my love of music and the fact that I’ve been listening to Dr. Dan Siegel’s audio presentation “The Neurobiology of We”.

As a seeker of truth about relationships, I’m willing to take inspiration from a variety of sources. I’ve really been struck over recent days about how I’ve been hearing the same messages from Dan Siegel, scientist and Brandi Carlile, singer- songwriter.

I’m a little late to the game in learning about Carlile’s song “The Story”. Apparently it’s been featured in everything from an episode of Grey’s Anatomy to a GM commercial. However, it has only made it to my ears recently.

The song starts,

All of these lines across my face
Tell you the story of who I am
So many stories of where I’ve been
And how I got to where I am

Siegel describes integration as the key task of mental health. An integrated mind is one that can process its information and emotional energy in an effective manner. One of what he calls the “domains of integration” is narrative integration. In narrative integration, we become the storyteller of our own mind. Siegel explains that we don’t run from our past if we can bring it into mindful awareness. Carlile beautifully describes her own mindful awareness of her own stories.

She goes on to sing,

But these stories don’t mean anything
When you’ve got no one to tell them to
It’s true, I was made for you

This brings us to another of Siegel’s domains of integration – interpersonal integration. As Siegel’s presentation title suggests (The Neurobiology of We) he sees human relationships as being key to our well-being. Individuals are meant to integrate with other individuals – not becoming clones, but honouring differences and being influenced by one another for the good of both.

Carlile goes on to describe how this integration between human beings happen most effectively in our most intimate relationships.

You see the smile that’s on my mouth
It’s hiding the words that don’t come out
And all of my friends who think that I’m blessed
They don’t know my head is a mess

No they don’t know who I really am
And they don’t know what I’ve been through
Like you do, and I was made for you

Bringing two distinct human beings into close relationship is rarely without significant work, but Siegel and Carlile seem to be in agreement that the results can have immense meaning.

I invite you to have a listen to Brandi Carlile’s The Story, either Live at Red RocksLive with the Seattle Symphony Orchestra (with lyrics) or on iTunes.  Dr. Daniel J. Siegel’s works are available here.

What is Emotion?

Used under CC licence by Flickr user Tuckett
Used under CC licence by Flickr user Tuckett

What is emotion?

If you’re coming to see me for Emotionally Focused Therapy, this is a fairly important question.

I’ve been listening recently to Dr. Daniel Siegel, a psychiatrist who works to help us understand what the mind is and how it is connected to our experience in relationships. When he began talking about emotion, he pointed out that when people talk about emotion they often explain it by using the word “feeling” – a word that has the same meaning. Our attempts to define emotion often get us chasing our tails in a circle.

Dr. Siegel encourages us to think of emotion as something that helps us to integrate the different parts of our own experiences and something that helps us integrate our experiences with those of another person in relationships.

When he was using this language of integration, it made me think of music. At its core, music is largely about math. The different notes in a music score and their accompanying tones can all be represented mathematically. It’s only when these notes get played by a human being – a creature with emotions – that the notes become art and become the music we love to listen to. Emotion integrates all of the components of music – the notes, the instruments, the people playing and the people listening – into something we know and experience as music.

In the same way, emotion takes separate human beings and allows them to be friends, teams, couples and families. Without emotion we can communicate only very limited bits of information and we cannot create real connection.

In couples, the inability to fully communicate, process and respond to emotion is at the core when there are problems. When emotion isn’t able to perform its integrating role, everything is that much harder. We miss or misunderstand little bits of information that we try to send back and forth between one another. Our minds make assumptions to fill in the blanks in our understanding. And in this, our most intimate of relationships, we eventually fill in our blanks with our greatest fears.

The most rewarding part of my work is helping couples to integrate their individual experiences, through communicating, processing and responding to the emotions in one another. It’s a process that takes some work, but the payoff is immense.

Feminists in our own House

Scanned photo 001This August Lisa and I will celebrate 20 years of marriage.

When I look back, the strongest memory I have is of looking into her eyes as we made our vows in the presence of so many friends and family.

There are other memories, too. My parents striding purposefully into the church and both heading into a one-person washroom so that my father could apply some just-purchased static cling spray to my mother’s hand-made silk dress. My friends stealing our canoe from the roof of our car and making us follow a trail of clues to discover its location – a trail that ended with a note sewn into the hem of the wedding dress. My friend whose day started at CFB Petawawa with scrubbing the camo off his face and putting on the only non-combat clothing he had in his car (his PT gear – shorts, t-shirt and running shoes) in order to get to the church on time. Dressed as he was, and clutching a rolled up piece of Bristol board, with the words from the note that accompanied the flowers Lisa sent me after our first date, the ushers were convinced he was a crazed ex-boyfriend determined to disrupt the proceedings.

Those are only some of the highlights. It was such an extraordinary celebration that the stories seem endless. Only one sour note stands out.

As Lisa and I arrived at the hall for the dinner and reception, Lisa was intercepted at the head table by her second cousin, a freelance journalist with a passion for gender issues. Lisa was confronted about her choice to take my last name. The tone was strident, the feeling was one of judgement and we were both taken aback.

What this cousin didn’t know, and what her approach left no room for discovering, was that Lisa and I had spoken a number of times about this decision. We were both agreed that hyphenating our names wasn’t a great option, and I had offered to take Lisa’s last name as mine. In the end, Lisa made her own free choice about what she was going to do. Given our shared values, nothing else would have been acceptable.

My practice of psychotherapy is heavily informed by feminist therapy, which teaches us to deal with cultural, societal and relational forces that disempower individuals. Indeed, the only couples counselling situation that I have wrapped up in one session involved assessing that the way the couple was dealing with a difficult situation had thoroughly disempowered one of them and suggesting a way for mutual accountability to exist. The couple followed up a month later to say that that one intervention had allowed a destructive dynamic in the relationship to become entirely manageable.

The world desperately needs the feminist critique of power dynamics. It’s essential to our capacity for reworking social structures and relationships.

What we don’t need is a war between genders, and for too many, that is what feminism has come to mean. The actions of people like my wife’s cousin mean that I can’t hold myself out as a feminist. Too many people would be rightly concerned about what sort of bias that would mean I was bringing to my work. And not all of those people would be men. The most scathing critique of feminism I have ever heard was made by a 20-something female in a session in my office.

It angers me that the term feminist is so utterly wounded and broken, because our need to assess, critique and transform power dynamics is as great as it ever has been. When a couple walk into my office I do everything I can to ensure that in the therapeutic space they are equal in power to one another and with me. That is fundamental to the work I do.

It’s also been fundamental to my marriage. I may not be able to be a feminist in the public arena, but thank you, Lisa, that we are both feminists in our own house.

Is there a narcissist in your relationship?

Warren_Beatty_-_1975Our household has been in the process of rediscovering some classic rock and pop tunes, largely as a result of our 14 year-old son exploring his own emerging musical tastes.

One of the songs that has emerged from this is Carly Simon’s You’re So Vain – a song that I’ve come to think of as “Ode to a Narcissist”.

It’s not clear whether the song is about someone who would meet the clinical definition of a narcissist, or whether it’s about someone whose narcissism is perhaps, shall we say,  more situationally generated by fame and wealth.

To be diagnosed in clinical terms as a narcissist, there are a number of specific features that have to be present.  In my time as a clinician, I’ve only worked with one person who I thought could perhaps have benefited from assessment for Narcissistic Personality Disorder.

However, as a couples counsellor I regularly hear the word “narcissist” as one partner in the relationship describes behaviour in the other partner.  Behind these descriptions there’s often pain and fear about the future of the relationship.

Your partner can seem like a narcissist to you because when the most important relationship in our life is not working the way we want and need it to, we do things to protect ourselves.  Sometimes those protective behaviours can seem quite self-centred, and hence, narcissistic.

However, resorting to protective behaviours in these situations is quite rational and understandable.  The basic problem is that when both partners have to focus on protecting themselves, the relationship doesn’t get nurtured and it is difficult to feel close and safe in the relationship.

Your couples counsellor can help you understand the protective pattern that you’ve fallen into in your relationship and can help you develop a new pattern where your needs are met in the relationship and you don’t need to protect yourself when you’re with the person you love the most.

Working with Grief and Loss

Consolation by Andy via Flickr
Consolation by Andy via Flickr

We commonly associate grieving with the loss of a loved one.  The death of someone near to us is very clearly a profound loss that needs grieving.  However, we can experience loss in a wide variety of ways, some of them much more subtle.

Nearly any change in our lives involves loss of some kind.  Even a change that you’re happy about can involve some pretty profound loss.  For example, you might be thrilled to receive a long-awaited promotion.  At the same time you are moving on to new challenges, you might also be losing important working relationships and work experiences that have given you a great deal of fulfilment.

Being aware of these more subtle forms of loss can open the door to dealing with feelings and difficulties that otherwise might not make much sense.  Grieving is something that has been widely studied and worked with.  There are concrete ways of making sense of what is happening to you and working through the pain and other experiences that come with loss.

In the late 1960s, a psychiatrist by the name of Elisabeth Kubler-Ross came up with a well-known five-stage model for understanding grief.  She outlined a progressive process where people experience denial, anger, bargaining, depression and acceptance.  This model has been helpful in normalizing people’s experiences and telling them that it is OK to be experiencing the strong emotions they are feeling.  However, sometimes people get confused if they don’t move through these stages in the order in which they are laid out.  The model can also make it seem like grief is something that happens to you as opposed to being something you can influence and work with.

William Worden, a psychologist, developed another more recent model where grief is seen as involving four basic tasks.  The first is to accept the reality of the loss.  It is normal to want to believe that the loss can be avoided, but one has to work towards acceptance.  The second is to allow yourself to experience the pain of grief.  Again, it makes sense to want to avoid this pain but research and experience show that this is something that must be gone through, not around.  The third is to adjust to the new, post-loss environment.  This is a task that can be actively undertaken, once you have accepted the new reality.  The fourth and final task is to withdraw your emotional energy from the person or situation that has been lost and to invest it in new relationships or new situations.

The ease with which these things can be done varies based on the nature of the loss and your own circumstances.  Sometimes just being aware that you’ve experienced a loss can help you to see and experience it for what it is and work with it.

Terry Noble is a therapist in Peterborough, ON.  You can find information about his counselling practice at www.terrynoble.ca.

Why should a therapist be on social media?

 Vasile Cotovanu on Flickr
Photo by Vasile Cotovanu, Flickr

I’ve been thinking about why I have chosen to have a presence on social media through this blog and Twitter.

Steve Ladurantaye of Twitter Canada came here to Peterborough, ON in July to talk to businesses about using Twitter.  Some of his suggestions were clearly great for many businesses, but simply wouldn’t be appropriate for a therapist.  For example, live tweeting what I do (Look at this picture of a couple in marital distress!) and offering discounts by tweet (Come in before 12 p.m. today and mention this tweet for 25% off an hour of counselling!) are examples of things that you’re not going to find me doing on social media.

However, when he mentioned some of the attributes of a good tweet he allowed me to make a connection about why I want to be on social media.  Steve suggested that authenticity on Twitter is vitally important.  The crowd is pretty adept at sniffing out insincerity and misinformation.

I was motivated to have a larger online presence when I asked one client how he found me and he said that he had asked Siri for a counsellor and was given my name.  In that instant, my mind was blown.  Counsellors have traditionally relied heavily on referrals and word-of-mouth marketing.  Clients have come because someone they trust has referred them.  If potential clients are going to trust digital means of referral, I want them to know who they are being referred to.

I’m going to seek through this blog and other forms of social media to let people know who I am as a therapist.  Informed consent is an important principle in my profession.  It basically means that therapists only work with their clients in ways that have been explained to the client and that the client agrees to.

I have come to believe that informed consent has to start with clients having access to authentic online information about who I am as a professional therapist.

Terry Noble is a therapist in Peterborough, ON. You can find information about his counselling practice at www.terrynoble.ca.