The role/goal model

There are many models of human behavior in the field of psychology, among them the psychoanalytic, behavioral, gestalt, and dialectical models. Most have their utility, but none of them is “the best,” or explains everything. A model is just a description or a map and, as I quoted in a prior post, “the map is not the territory.” I haven’t written about what follows in any formal or comprehensive way yet, but I’ve come up with the bare bones of my own model. I think it’s original, and helpful in explaining certain unconventional or extreme behaviors – as well as many common ones. I call it the role/goal model. It has to do with motivation and it’s rooted in social psychology.

We all play multiple roles in our lives, some of the more conventional being spouse, parent, employee (or boss), host, and caregiver. Other roles have to do with one’s profession or skill set, and yet others are unconventional and highly specialized. Behaviors appropriate to one role in a person’s life – for instance sexual expression within a marriage – are inappropriate in other roles. If a drill sergeant behaved at home like he did at work, it would be domestic abuse.

Many behaviors are motivated by the desire to feel good about ourselves for fulfilling the expectations of a given role, whether that role is father, wife, breadwinner, merchant, healer, or evangelist. You may not feel like getting up when the alarm goes off at six, but in service to your role as family provider, you get up on time and prepare to go to work, day after day. The goal of such persistent behavior is the feeling of satisfaction you get from providing for your family’s material needs. You know that if you don’t get up and go to work most workdays, you won’t get a check on payday. You’ll fail to meet the goal of the breadwinner role, your family will suffer, and you’ll feel terrible about yourself.

Many times in my life I’ve heard people say things like, “He did that for no reason!” In fact, people don’t do things without a reason, and a more accurate statement would be “He did that for reasons I don’t understand.” We might have a hard time grasping what would motivate a person to torture animals, or purposefully start a forest fire, or shoot schoolchildren, or coax cult followers to drink a fatal dose of poison. I think this model helps to make such behaviors comprehensible.

The role/goal model explains conventional or extreme behaviors by identifying the role that a person perceived herself to be in at the time of the behavior, and the goal of that role-appropriate behavior.  For instance, a mother who has never acted-out violently in her life might inflict severe bodily harm on a stranger, if he was threatening her children with violence. Some roles, like mother, are conferred by circumstance; other roles are self-conferred and may be secret, or unrecognized by others. Self-conferred roles include Rescuer/Hero, Tragic Hero, Devil, Martyr, Outlaw/Rebel, Victim, Player, and “Secret Agent.” Identifying the role and the goal explains almost any behavior that isn’t due to psychotic mental processes.

By Secret Agent I don’t mean a literal spy {although “spy” is an example of a rare and highly specialized role), but someone who acts in secret, or has a perceived “secret identity.” I think that role descriptor helps to explain many aberrant behaviors, such as serial arson or serial rape. Examples: “They think I’m a Nobody, but I burn down forests.” “Women trust me because they think I’m a nice guy.” People like this get off on not only the feeling of power they experience when they commit their crimes, but on their daily feelings, when they think “Nobody knows who I really am” or “She doesn’t know that I want to rape her.”

A less extreme example is the role/goal analysis of an obnoxious, Bible-thumping street preacher who thinks he’s preaching on the street because God wants him to. What motivates him to persistently shout at strangers who don’t want to listen to him? The role/goal model posits that he’s in the evangelical role, and what could be more important than saving souls? The behavior is motivated by the attendant feeling, not the sure knowledge that souls will be saved. People in such a self-appointed role believe that their objective (i.e. saving souls from damnation) is what’s driving their behavior, when in fact their role-appropriate, goal-directed behavior is motivated by the feeling that they’re doing the most important work of all, God’s work.

The goal of the Hero is to be admired for his achievement or strength. The goal of the Tragic Hero is to get sympathy and to justify his helplessness in the face of insurmountable odds. The goal of the Victim is to gain something by being pitied. The goal of the Martyr is to be admired for her sacrifice. The goal of the Player is to get over on people. The goal of the Rebel/Outlaw is to get away with breaking the rules. The goal of the Devil is to raise Hell. The goal of the Rescuer is to feel powerful and to take credit for someone else’s survival or success. None of these roles exists objectively, but in subjective perception and the attainment of consequent, predictable emotional states. The feeling state is often the  goal of the behavior, although it will be rationalized as role-appropriate and goal-directed.

Emotional expression is modulated by both role and goal. An emotion is suppressed if it’s seen as inappropriate to the role or unhelpful in reaching the goal, i.e. never let them see you sweat if you’re in the Hero role. The emotion is exaggerated for effect if it’s seen as role-congruent and/or helpful in reaching a goal, i.e. the Boss’s display of anger, or the Victim’s tears.

 

 

 

 

Sexuality and guilt

I was raised a Christian and most of my values are congruent with Judeo-Christian values, but one concept I’ve never bought into was Original Sin. Many Christians believe that we’re born into Sin and therefore require divine Redemption. I tend to distrust organized religions, as most of them seem to me to be rigid patriarchal hierarchies that claim the authority to be the only authentic interpreters of the ancient texts on which they’re based. Most teach that any sexual activity not sanctified (usually in heterosexual marriage) by their religion or sect is innately sinful. I believe that such teachings have fostered widespread sexual repression and shame in many cultures and have damaged a lot of lives. As a psychotherapist I worked with a lot of people who’d been taught that their sexual feelings were somehow innately sinful, and who felt guilty for perfectly normal sexual thoughts, especially if they acted on them.

“Normal” is a statistical concept, not a moral one. Homosexuality is only “abnormal” in the statistical sense. It’s a sexual variation, not a deviation, and occurs in every known culture. Among the people I worked with on sexual issues were people who thought they might be gay and were terrified by the prospect. Because of their education by homophobic role models in a sexually-repressed society, they didn’t want to be gay; but they felt what they felt. Sexual orientation isn’t a matter of choice. I’m happily heterosexual, but it’s not because I chose to be. It’s just  part of who I am. My brother is gay, and his sexual orientation wasn’t a matter of choice for him any more than mine was for me. I don’t think God condemns anyone for who they’re sexually attracted to.

Masturbation is undeniably a normal behavior. In fact, it’s quite popular. I believe that what somebody fantasizes about when he or she masturbates is their own business and nothing to feel guilty about – as long as it doesn’t lead to irresponsible, exploitive, coercive or violent sexual behavior. (For some sex offenders, masturbation can be a mental rehearsal for things they intend to do; and part of sex offender treatment involves their learning not to indulge in fantasies of criminal or exploitive sexual behavior.) And yet many good, decent people feel terribly guilty for sexual thoughts and fantasies that they would never act out, or even want to act out. The only bad thing about masturbation, as one of my cousins told his son after his ex-wife caught the boy in the act, is getting caught doing it.

Despite outward appearances we live in a sexually-repressed culture, where erotica is a guilty pleasure, nudity is inevitably sexualized, and the display of breasts is okay in advertising and commercial TV shows, as long as no nipples are exposed. I’m concerned about the effects of the widespread availability of porn to young people online; but it might be the inevitable backlash of societal sexual repression, enabled by capitalism and modern technology. I consider “reality TV” shows that attract viewers with the lure of nudity, but blur out the breasts and genitalia, to be more obscene than outright porn – because of their hypocrisy.

In my career I had to educate many people about the normality of their sexual thoughts and behaviors because few of them had received any meaningful sex education, either from their parents or at school. Many women told me that when they had their first period, they didn’t know what was happening. Gay, bisexual and transgender people were often in despair because society had labeled them as “deviants.” Sexual fetishes such as cross-dressing may not be normal in the statistical sense, but as long as such activities involve consensual acts, and nobody is coerced or violated, they aren’t blame-worthy.

One of my “standard raps” to clients who were fearful or guilt-ridden about their sexual predispositions went something like this: “I get it. You don’t want to be gay (bi/trans, etc.), but you feel what you feel. For the time being, there’s no pressing need for you to put a prefix on your sexuality. What we know is that you’re a sexual person, just like everyone else, and that’s okay. Maybe someday you’ll be able to identify a prefix that fits; but when you do that is up to you, not other people. Only you can know what’s in your heart of hearts. What’s important now is that you’re a sexually responsible person. That means you don’t take advantage of other people sexually, don’t have sex with children or other people incapable of giving consent, don’t coerce anybody to do things they don’t want to do, and practice safe sex. Nobody can put a label on your sexuality unless you give them that power. As long as you’re sexually responsible, you don’t have to justify your sexual identity to anyone.”

For me, the next stage of therapy with a person who responded, “But I can’t be gay!” was teaching rational thinking: “I know it’s tough being gay in this society, so I can understand your resistance to considering that you might be gay. But I invite you not to catastrophize. Good things still happen to gay people, things that couldn’t have happened without their knowing who they are. Being gay isn’t awful or terrible unless you make it awful or terrible by your thinking. And it’s better than living a lie.”

It’s my belief that people shouldn’t be judged or condemned for what they think and feel, but only for what they do. And yet a lot of sexually responsible people feel guilty about sexual feelings or fantasies they’ve had. My behavioral prescription for this, as with other self-judgments, is “Learn to distinguish your rational thoughts from your irrational thoughts.” As long as nobody was exploited or hurt, such guilty thoughts are almost always irrational.

The therapeutic relationship

The idea of the “talking cure” has only been around for about a century. At its core is the development of a therapeutic relationship. This relationship is a special kind of intimate dialogue, with  specific guidelines and limitations. I think that there’s something to Freud’s notion of transference and counter-transference. Transference is when clients “transfer” feelings about a significant other (parent, lover, close friend) onto their therapist. Counter-transference is when a therapist is unaware of his own feelings about a client, to the extent that it unconsciously influences the relationship.

It’s incumbent on the therapist to be aware of these dynamics when they occur: to be conscious of her own feelings, and to recognize the unrealistic nature of some client expectations about the relationship.  When this occurs it’s not uncommon for a client to mistake a therapist’s accurate understanding and caring attitude for the kind of love and acceptance the client longs for in his personal life. If a therapist develops romantic feelings for a client, or if he can’t successfully address and resolve the client’s misplaced feelings, he needs to refer the client to another therapist or terminate the therapy.

The first thing a client should expect of his therapist is confidentiality. Knowing that what you say to your therapist won’t be disclosed to others (outside of supervision) allows you to admit things you might not otherwise admit to anyone. Speaking generally, the second thing a client (in most therapies) should expect of her therapist is that she won’t be judged for the things she admits to in therapy. Of course, people who’ve done abusive or horrible things can’t expect therapists to ignore or excuse what they’ve done, and confidentiality isn’t an absolute guarantee in all therapeutic relationships. Therapists are required to report sexual or physical abuse, and specific threats of intended harm to another person.

The therapeutic relationship is built on trust. In some cases this can be won quickly, if the therapist is genuinely caring and accurately empathetic. With other clients trust is earned gradually, over time. It may take a while before a client discloses the real reason he entered therapy. In my early days as a therapist I was surprised at how quickly some clients disclosed intimate details of their lives to me, a man they barely knew. I came to realize that, although some clients already had someone in their lives with whom they could be (non-sexually) intimate, others were starving for what they encountered in therapy: a genuinely caring person who listened carefully to what they had to say, and seemed to understand them and their problems.

I’ve known a lot of people who were hungry for emotional intimacy, for someone in their lives with whom they could get “emotionally naked” without fear of being judged or lectured-to. Those who have such a person (or persons) in their lives – whether a friend, sibling, spouse, aunt, spiritual counselor, whomever – recognize emotional intimacy when they encounter it in therapy. Getting closure at the termination of treatment can be easier with such clients, because they have one or more persons in their lives who meet their intimacy needs. With clients who first discovered intimate dialogue with their therapist – to whom it was a revelation – there’s a danger that they’ll want to prolong treatment, to continue the dialogue. With such clients I’ve validated their ongoing need for intimacy after termination, and coached them on developing trusting, emotionally intimate relationships within their circle of family and friends. To paraphrase an old milk ad, “You never outgrow your need for intimacy.”

The therapeutic relationship isn’t a friendship, although it might feel like one to the client. The relationship may be characterized by warmth and genuineness, as in a friendship; but it’s up to the therapist to remain aware that it’s a professional, not a personal, relationship. A good friendship benefits both friends more-or-less equally. As a therapist, you’re there for the client’s benefit, not your own. You can’t necessarily be expected to be completely objective about a friend, while a therapist always strives to maintain her objectivity. Lastly, a therapist is always aware that the relationship is time-limited. At some point, it must end.

An effective therapist plans for termination from the first session, asking questions such as, “How will you know when the goals we’ve discussed have been adequately met?” or “Do you want to agree to ten sessions, then we’ll decide if you need more?” or “How many sessions do you think it might take for you to meet your goal?” In a sense, the therapist is there to facilitate behaviors that will at some point make her further assistance unnecessary.

The time to terminate therapy is usually a mutual decision. Termination issues are worked on in the final sessions, with the goal of “closure” – which may include not having  any “unfinished business” between therapist and client. When I’ve heard clients credit me with the changes they’ve made, I’ve handed the credit right back: “You did the hard work. I just helped out.” One of the most rewarding things a therapist can hear from a client who appears to have reached his treatment goals is, “I want to thank you for your help, but I’ve gotten what I needed from therapy. This will be my last session.” A general goal of every therapy is to increase the client’s autonomy. If a client has become dependent on his therapist and wishes to unnecessarily extend therapy, the therapist’s final goal is to convince him that she’s no longer needed.

Finally, I need to clarify something I said earlier: that the therapist isn’t in a therapeutic relationship for her own benefit. I mean that this is something she needs to keep in mind, not that therapists don’t benefit from their intimate dialogues with clients. My own life has been enriched by the candor and courage of many people who’ve trusted me to help them help themselves. Some I have genuinely admired. I’m very grateful to the people I worked with in therapy, who taught me new things about what it means to be human.

 

Making good decisions

Decisions, decisions! We all have to make them. Some are trivial and some are life-altering. Sometimes we’re pleased with the results, other times we regret them. Here are some thoughts on the kinds of decisions we have to make, and things we can do to help us make decisions we can live with.

But first I’d like to explain the drive-reduction model of behavior, something I learned about when I was studying gestalt psychology. It has to do with motivational priorities. According to this model, we constantly have an emerging drive that needs to be satisfied: thirst, hunger, elimination of body waste, attention, pain reduction/avoidance, sexual gratification, etc. If the emerging need is extreme (i.e. you’re dying of thirst or hunger), your exclusive focus is on meeting that need, and you may  engage in extreme or uncharacteristic behaviors to get what you need. Once a need is met, another drive comes to the fore. As Gilda Radner put it, in her SNL role of Rosanna Rosanadana, “It’s always something!”

Either/or conflicts can be approach/approach or avoidance/avoidance. An example of an approach/approach conflict is when Tom is attracted to both Susan and Joan, who are friends. He can’t court both of them, so he has to decide which one of them he’s most attracted to. He might make a decision and make a move, or might get stuck in ambivalence and not act at all. In an avoidance/avoidance conflict, one has to choose which of two undesirable alternatives is the “lesser of two evils.” If a person’s only available opportunity to make money is a job that is repugnant to her, she has to choose between taking that job or living day-to-day in dire poverty, hoping that another opportunity will eventually become available.

A third kind of conflict involves a single prospect that has both positive and negative aspects. This is called an approach/avoidance conflict. It may be that a prospect seems relatively attractive from a distance, but the closer one approaches it, the less attractive (or more frightening) it becomes. This can be a recipe for protracted ambivalence – going back and forth.

Consider an alcoholic’s conflict regarding sobriety. He may want to stop drinking and may see the benefits of sobriety clearly, but the longer he goes without a drink, the less attractive – or more frightening – the prospect of lifelong sobriety becomes, relative to having a drink right now. Recognizing that sobriety is the best option in the long term, but craving a buzz, he may decide “I’ll quit tomorrow.”  This is an example of a profound, and often persistent, state of ambivalence.

One method I’ve taught as a therapist, to assist clients in resolving ambivalence regarding a major decision, is listing positives and negatives. Let’s say Rhonda is being courted by Jim. She thinks he’s handsome, enjoys his company, and  especially enjoys all the attention he lavishes on her. But when she senses that he’s about to propose, she’s unsure about what to do. So she draws a line down the middle of a sheet of paper, puts a “+” at the top of the left-hand column and a “-” at the top of the right-hand column. Then she “shotguns” her thoughts, jotting down everything (positive or negative) that pops into her mind about her prospects for happiness with Jim as a husband.

On the positive side, Jim (1) has a great job and makes enough that she won’t have to work outside the home if she doesn’t want to, (2)  is sexually attractive and (3) good in bed, (4) is generous, (5) has a great personality and (6) sense of humor, (7) is popular and well-respected, and (8) treats her like a queen, always telling her how much he loves her. Now, in the case of some +/- lists, there may be a nearly-equal number of positives and negatives, giving you a numerical basis for comparison. But in Rhonda’s case, she can only think of two negatives. She doesn’t like Jim’s father – but she could live with that. However, number two outweighs all of the positive qualities she’s listed: she isn’t in love with Jim.

So it’s not always a numerical comparison of positives and negatives. The final step in this method is to assign a weight to each quality listed in each column. One quality in one column might outweigh all of the qualities in the other. Using this method to decide between two attractive job offers, the weighing of qualities might be helpful because a quantitative comparison reveals one job to be slightly more attractive than the other.

The shotgunning of ideas can be very helpful when a group has to arrive at a decision. Any group member in the room can call out a factor or idea relevant to the decision, and someone records it (i.e. on a whiteboard or a large piece of paper taped to the wall) for all to see. Once all relevant factors the group has come up with are on display, the group doesn’t assign weights as with the +/- method, but rather discusses the relative merits of each. In this manner the group can arrive at a well-considered decision that everyone (or almost everyone) can live with, because it was based on group consensus.

 

 

 

Mood, disposition and disorder

In a previous post I referred to suicide as a “mood-specific” behavior, and I feel the need to clarify this statement. I wrote that nobody suicides when they’re in a happy mood, suggesting that if people in a depressed mood can “ride out” the mood without doing something lethal, the urge to end their lives will pass when their mood changes. Moods are transient emotional states that can be prolonged by irrational thinking and by ruminating.

Thoughts such as “My life is my problem; the only way to solve my problem is to end my life” can seem logical to a person in a depressed mood. When the mood passes, the person will likely recognize the thought as irrational – or at least as one that doesn’t have to be acted on immediately. Suicide hotlines have prevented many impulsive (mood specific) suicides by helping people to not act on suicidal impulses and to ride out the depressed mood – or to sober up. This principle doesn’t apply to suicidal people who experience chronic depression.

While moods aren’t enduring emotional states, dispositions are. We each have a unique disposition or set of dispositions. For instance, we’re each disposed to be somewhere on the continuum between optimism and pessimism – glass half full vs. glass half empty. I don’t know whether one’s disposition is a result of nature or nurture, or some combination of the two. Other adjectives I’ve heard used to describe disposition include gloomy, chipper, pushy, cranky, generous, stingy, passive and aggressive. They are a component of our personality. As a psychological construct, disposition has so many variables that it’s hard to precisely define or to measure, so these are just my opinions. Dispositions tend to be enduring traits, but that’s not to say that they can’t change over the course of one’s life. For instance, I think that people who’ve tended to be distrustful of others can learn to be more trusting, given enough positive experiences with trustworthy people.

When anxiety and depression are chronic emotional states that seriously affect our functioning, they’re diagnosable as psychiatric disorders. There’s considerable scientific evidence that there’s a biological basis for such disorders, although irrational thinking patterns can exacerbate them. The key to distinguishing  pathological states of anxiety and depression is impairment. Even during the saddest times in my life, my sleep and appetite weren’t seriously affected, and I was able to function adequately. I cried but didn’t have crying spells, and have never come close to attempting suicide. (I’m  not taking credit for this; I consider myself very fortunate.) During my year-long employment in an extremely stressful job, I suffered sleep loss; but my sleep improved immediately after I quit the job.

People who suffer from chronic anxiety and depression often get blamed for their symptoms, because they’re not understood as the symptoms of a chronic mental disorder. Because of the widespread stigma attached to mental illness, many people don’t feel the empathy they might feel for someone with a debilitating physical disorder. And people who suffer from these mental illnesses often blame themselves, telling themselves they “should be” able to control their symptoms. Others self-medicate with alcohol and other drugs that might give them short-term symptom relief, but only add drug dependency to their list of problems.

It’s hard enough to have a mental illness and to have to deal with societal stigma; but in addition, mentally ill persons are increasingly neglected in this country. The mental health system is shamefully under-funded, which explains why so many people with mental illnesses are homeless, why hospital Emergency Departments all over the country are swamped with people who are experiencing a psychiatric crisis, and why jails and prisons have become major providers of mental health services.

Everybody experiences anxiety and depression, and most of us learn how to cope with these transient conditions, because they’re not overwhelming or disabling. But some people with chronic anxiety and/or depression can’t cope without help from social support systems, whether in the form of professional services or community resources – family and otherwise – that recognize mental illnesses as treatable conditions, and provide needed help.

I’m taking a break for a couple of weeks, but will be back with a new post in early June. In the meantime, you can access other things I’ve written at my website: jeffkoob.com. It features links to my books, samples of my artwork, and a short story, “Demon Radio.”

It’s only Monday if you think it is

This post is one of my occasional philosophical departures from my usual subject matter. Although it isn’t specifically about rational thinking (which I’ve written about in previous posts), it is about mental habits and how they can shape our experience. I even intend to examine what “is” is.

Things that we know and experience through our senses are phenomena: rain, wind, temperature, the day/night cycle, seasons, etc. Mental concepts – noumena – such as justice, authority, honor, nationality and race don’t exist in the same way rain exists. For one thing, they’re not Absolutes; they mean different things to different people. And yet we often act as if certain noumena were as real as rain. Race used to be thought of as a biologically-based reality. Now we know that it’s a social construct based on culture and tradition. All homo sapiens belong to the human race, despite variations in outward appearances.

Days, months and years are all phenomenal, based on planetary rotation, the lunar cycle, and the earth’s orbit around the sun, respectively. The convention of the week, however is noumenal – it isn’t based on any natural phenomenon. The seven-day week has long been the standard way of sub-dividing months throughout the industrialized world, and most of us organize how we spend our time using this noumenal convention.  “Monday” (for instance) is a social construct.  But it’s only Monday if you think it is.

Try this thought experiment: Imagine waking up on the beach, alone, on a desert island. You’ve been delirious with a fever and don’t know how long you were “out of it,” so you’ve lost track of what day it “is.” You have no sensory way of determining it, and it doesn’t even matter in any practical way whether it “is” Monday or Tuesday, because you’re not on anybody’s schedule. Will you arbitrarily choose a day of the week as your baseline and keep track of what day it “is”? Or will you adopt a different mode of thinking and just live each day on the island, without having to give it a name?

Even though it’s just a mental construct that most of us buy into, the day of the week may control our actions and thoughts, and even our moods. You might hear someone who works Monday through Friday complain about having the blues “because it’s Monday.” He’ll predictably perk up five days later because it “is” Friday, the start of the weekend (another noumenal concept). Which brings us to the question of what “is” is.

“Is” can be used to cite a phenomenal reality (it is raining), a noumenal belief (it is Monday), or to state a quality or property of a thing (the apple is red) – the Aristotelean “is of equivalency.” In the first instance, regardless of what I may believe, I’ll get wet if I step outside when it’s raining. As regards the second instance, wars have been fought over where, exactly, the border between two countries “is.” In the third instance, if one person in a room says “It is hot in here” and another person in the room says “No, it’s not,” one of them has to be wrong. What “is” is the basis of many a dispute, whether interpersonal or international. Such disputes can be avoided by dropping the pretense of objective truth implied by an “is of equivalency,” and “subjectivising” the statements: “I’m hot.”/ “I’m not.” No conflict about what “is.” Whether or not Sally “is” pretty can be viewed as a matter of subjective opinion, not of objective fact. Beauty is, after all, in the eye of the beholder.

E-prime – English that omits all forms of “is” – is a tool for learning about the linguistic traps that can be set by its use. Nobody has ever suggested that E-prime should replace English. (It’s often more precise than English, but doesn’t lend itself to poetic word formulations.) But try writing without using is/am/are/were etc. and it will help you to appreciate how much you tend to unconsciously objectivise things you believe to be true or important.

Here are some translations of English sentences into E-prime: English – She is pretty. E-prime – I find her attractive/pretty. English – This is really difficult.  E-prime – I really have a hard time doing this. English – Look, it’s a UFO! E-prime – I can’t identify that flying object. English – Time is money. E-prime – Earning money correlates to a high degree with the way you spend your time. English – This is Monday. E-prime – Because of the social convention of the seven-day week, most people think of today as Monday. English – He is a liar. E-prime – He lies a lot. English – God is love. E-prime – I believe in God as the embodiment of love.

There’s some overlap in the ideas I’ve written about here and my previous posts on rational thinking and cognitive behavior therapy. Linguistic conventions can make us prisoners of language. Wittgenstein wrote, “The limits of my language are the limits of my universe.”

Some irrational self-talk involves the “is of equivalency.” The thought “I am a Loser” presupposes that people are either Winners or Losers and might mean any of several things to different people. It might mean “I think that I lose more often than I should” or it might mean “I’m destined to fail, no matter what I do.” In either case it’s an irrational simplification that can’t help anyone to achieve their goals. “Being a Loser” is a self-limiting noumenal notion.

It’s only Monday (or Tuesday, etc.) if you think it is. Monday isn’t real in the same way that rain is real.

 

On supervision and treatment teams

Throughout most of my career as a public sector psychologist, working in a variety of settings, I was blessed with good supervision. The few times I either didn’t have a clinical supervisor (as in Jamaica) or didn’t get adequate supervision, I felt like I was walking a tightrope without a net. A good supervisor will listen to you as carefully as you listen to your clients, and give you feedback on how you’re doing.  Positive feedback validates your work and increases your confidence that you’re on the right track, and negative feedback teaches you humility and provides valuable instruction.

As in therapy, a good supervisor asks the right questions. (When the person you’re talking to asks spot-on follow-up questions, you know she’s listening and understands you, whether it’s a friend, therapist, or supervisor.) As your supervisor gets to know you, he will validate your competencies and strengths, be part of your continuing education as a clinician, and insure that you know the appropriate scope of your practice. He will offer constructive criticism when necessary, and may suggest resources for your professional development. He will alert you to possible ethical issues.

At  the beginning of individual supervision, the therapist being supervised might have to staff each case in some detail, until the supervisor gets to know her strengths and limitations. Later in supervision, the therapist might provide brief updates on the progress in cases already staffed and spend more time on new, or challenging, cases. In group supervision, participating clinicians may be asked to prepare case presentations, usually on their most challenging cases.

The other group setting where clinicians might be asked to present cases is in treatment team, which is a kind of group supervision. In community mental health centers (CMHCs) and other treatment facilities, each new case has to be staffed,  and the treatment plan has to be approved by a multidisciplinary treatment team. Not only do treatment teams insure that all treatment is reviewed by colleagues on an ongoing basis, they also serve a professional development function. The ideal treatment team consists of one-or-more psychiatrists, psychiatric nurses (or nurse practitioners), psychologists, social workers, counselors, and possibly specialists such as art therapists or activity therapists. Each discipline represented on a treatment team brings a different area of expertise to the table. In the best treatment teams a kind of cross-pollination of ideas occurs, as treatment plans are generated and reviewed.

I’ve been a treatment team member at CMHCs, juvenile and adult prisons, and hospitals. The smallest, at a rural satellite office of a CMHC, consisted of only a psychiatrist, a psychiatric nurse (my supervisor), and me. The largest consisted of something like fifteen members, with people from all or most of the helping professions listed above. Some treatment teams might give assignments to its members, such as  asking a psychologist to do some psychological testing for a client on someone else’s caseload. In facilities run on the medical model, treatment teams are headed by psychiatrists. In a well-run treatment team, everybody has a voice.

I’ve not only appreciated, but enjoyed most of my treatment team experiences. Working with colleagues from a variety of disciplines has broadened my knowledge and increased my appreciation of the unique contributions offered by each profession. The highest goal of both clinical supervision and treatment team staffing is to insure that clients receive effective treatment, tailored to their unique needs. I have fond memories of interactions I’ve had with a number of my clinical supervisors over the years and – full disclosure – I fell in love with one of them. We’ve been married for almost thirty years.

Maria, a psychiatric nurse, was my third clinical supervisor, and I admired her before I fell in love with her. I had the silly notion – grounded in my own insecurities as a young therapist – that group therapy wasn’t effective with chronically mentally ill clients. She set me straight, telling me that I’d be leading  a weekly group with some of my most challenging clients, and offering to co-lead the group with me until I felt competent to lead it on my own. She was my first role model for doing group therapy.

We felt awkward at first when we started dating, but Maria did the right thing and talked to her supervisor about it. He reassured her: These things happen. You know what you’re doing.

The rest is history.