Stress Management

We’ve all heard that prolonged stress negatively impacts our health, but stress isn’t necessarily a bad thing. Dr. Hans Selye, one of the pioneers of stress management, said that stress can be “the spice of life or the kiss of death.” He labeled negative stress distress and positive stress eustress. If we choose to ride a rollercoaster, or to scale a cliff, or watch a horror movie, we’re choosing to experience stress. Stress is an unavoidable fact of life, and a stress-free life would be an uneventful life – boring. Sexual excitement is a form of stress, and we all enjoy an adrenaline rush from time to time, especially if we chose the stimulus that triggered it.

Our autonomic nervous system, which regulates automatic behaviors, has two branches: sympathetic and parasympathetic. Both are involved what Dr. Selye called the “fight or flight” response. Activation of the sympathetic response gears us up, preparing us to fight or flee, whether or not we’re in danger. Heartbeat and breathing instantly become more rapid,  delivering more oxygenated blood to the brain and the extremities. Blood pressure and blood sugar rise, muscles tense in anticipation of action, and you may experience a jolt of adrenaline. After the event or situation that triggered the sympathetic response is past, the parasympathetic branch kicks in, reversing the fight or flight response and allowing us to “rest and digest.” We’re told not to go swimming right after eating a meal, because our blood flow has been re-directed from our extremities to our gut, increasing the possibility of a muscle cramp.

The fight or flight response evolved to help our ancestors to avoid being eaten and to hunt dangerous prey. If you’re a soldier in a combat zone, or a cop, or a firefighter, you may experience it on a regular basis. But although only a few of us in modern society frequently face physical peril – other than heavy traffic – we respond to perceived existential threats, even if we’re not actually in immediate danger. Combinations of financial, social and environmental stressors (How am I going to pay the rent? Is my wife being unfaithful?) can result in a high level of distress, sometimes manifesting as anxiety.

Anxiety is similar to fear, although the causes might be multiple and may not be immediate physical threats. A person having an anxiety  attack may experience their fight or flight response as paralyzing. Once you’ve had one, your fear of having another one becomes yet another stressor in your life. If you only occasionally have fight or flight reactions, stress may not be a significant factor in your health. But if you have them frequently, your health may be affected. But frequent fight or flight reactions aren’t the only stress-related threat. Chronic overstress – having more on your plate than you can handle – can kill.

Stress management doesn’t mean eliminating stress. It means controlling the amount of stress in your everyday life and, where possible, eliminating stressors. There are both physical and mental aspects to stress management. But first you need to identify the sources of stress in your life, your triggers for stress reactions, and how stress affects you.

If you need to practice stress management, start with an inventory of your stress factors: job security and satisfaction, finances, safety, residential issues, and personal relationships. Think of how you might be able to reduce unwanted stress in each area. It may mean some tough choices. Then list the kinds of situations and events that tend to trigger stress reactions. Being aware of your stress triggers may help you to prepare for them or learn ways to avoid them. Become more aware of how you typically respond to stress triggers and overstress. Do you somaticize (physicalize) it into headaches or bellyaches or backaches? Do you stay angry or depressed? Do you worry excessively? Anxiety has many faces , including free-floating (generalized) anxiety, panic attacks, and phobias – including social phobias. After doing this analysis of the role of stress in your life, you’re ready to look at physical and mental stress management techniques.

Physical stress management techniques include breath control, learning to relax your muscles, meditation, self-hypnosis, yoga, exercise, good nutrition, and adequate sleep. Avoid self-medicating with alcohol or other drugs. If you’ve listed rapid breathing as a stress symptom, you can learn to slow your breathing when you’re under stress. This helps to bring the fight or flight response under your control. There are many techniques for relaxing tense muscles, and relaxing the body tends to simultaneously relax the mind. I used to teach clients a method of focusing on the sensations in each of the muscle groups of the body in turn, tensing and relaxing each muscle group until they became aware that they could relax them at will by focusing on the changing sensations. It’s a form of mindfulness.

Learning time management or anger management might be part of your stress management plan. The best single mental stress management I’m aware of – besides meditation, which calms both body and mind – is rational thinking. (I’ve previously published several posts on rational thinking as a learnable skill.) Any stressful situation can be made more stressful by the way we think about it, and the effects of stressors in our lives can be minimized by thinking about them rationally. Failing to achieve something you wanted to achieve doesn’t make you “a Failure.”  Telling yourself that you’ll never get over a loss can be a stress-inducing self-fulfilling prophesy. Thinking that they “can’t stand” something has never helped anyone to cope with distress.

Some stressors can be minimized or overcome, others can be tolerated until circumstances change, by developing coping skills. We can all learn to manage our stress to some degree, if we understand it for what it is and make a conscious effort to control its effect on our lives. Coming up with your own personalized stress management plan and implementing it can help you to become more resilient in times of adversity, and might add years to your life.

 

What I learned in prison

Hey, I only worked in prison, honest! I’ve been inside many jail and prison cells during my years working in community mental health and Corrections, but I’ve always been able to leave them at will. Correctional institutions are as close to Hell as I’ve ever come, or want to come.

My first job at a correctional institution was at South Carolina’s largest juvenile prison, where I did counseling, clinical and psychological assessments, worked on a treatment team, gave testimony at parole board hearings, and co-led treatment groups in the sex offender treatment program. Years later I worked at two maximum security prisons for males, with visits to the women’s prison to co-lead groups. During my three years as a psychologist at the Intermediate Care Unit (ICU) – the “mental health” unit of South Carolina Corrections – I routinely visited the Administrative Segregation Unit (solitary confinement) and the prison psychiatric hospital, and even went on the Supermax Unit, where the worst-of-the-worst criminals in the state are housed. I’ve had career criminals, rapists, murderers, and other violent felons on my caseload. I was once sucker-punched by a legless man on the prison yard, but I’ll save that story for a later post. One thing I learned was that incarcerated people know two distinct worlds, with totally different sets of rules: Inside and Outside.

Another thing I learned was that all too often prisons are dumping grounds for mentally ill people who should be housed and treated in more humane institutions. The ICU housed some of the sickest psychiatric patients I’ve ever encountered. If one of the inmates in the unit needed hospitalization, he was temporarily transferred to Gilliam Psychiatric Hospital (GPH), on the prison grounds. Sometimes when I went there to check on a patient, I was reminded of the origin of the word “bedlam,” which was derived from Bethlehem Asylum, in Old London. The bay in GPH was often filled with a hellish cacophony of shouts, shrieks, and men banging on their metal doors. And this was where inmates were sent to recover from psychotic episodes.

I learned that when people have their freedom of movement restricted to a tiny cell and almost everything is taken from them, as in solitary confinement, they can become very creative with such things as their body fluids. I won’t elaborate here, except to say that self-mutilation is not uncommon in Administrative Segregation (“admin seg”) units, and that a colleague had a “corrections cocktail” of urine and excrement thrown in his face. I’ve known guys who could hide a razor blade in their mouths, or conceal a straightened paper clip beneath their skin. I knew an inmate artist who painted with his blood. Admin seg units are where you get housed if you need protection from other inmates, violate certain prison rules, or present a danger to other inmates or staff. Only inmates in admin seg, the psychiatric hospital, and the Supermax Unit have a cell to themselves. Part of my job was to help formulate behavior management plans for inmates who were engaging in extreme behaviors, or were suicidal.

I learned about “lifers” – inmates with life sentences. They’re only a small percentage of the prison population, but having a life sentence confers a reputation for violence. Many lifers have the attitude that they can do whatever they want, short of murder. “What are they going to do, give me another life sentence?” In prisons, the strong inevitably prey on the weak. I learned that some inmates have genuine regrets or remorse for their crimes, while others only regret having been caught.

I learned at a deeper level something I already knew: that you can’t rehabilitate a person by treating him like an animal. Some people think of prisons as correctional institutions, with the goal of reforming criminals, knowing that most of them will return to free society someday. Others think of prisons as penitentiaries, whose goal is to exact legal revenge, to make the inmates suffer for their crimes. I was glad to resign from my job as a prison psychologist, because I’d come to see the prisons I’d worked in as misery factories. There are evil people in the world, and we need prisons. The temporary deprivation of liberty can be a powerful incentive to reform, for those who have a conscience and good judgment. If we, as a society, deprive a person of his liberty, we are morally responsible for his humane treatment. Jesus taught that we should love our enemies; he never said it would be easy.

One of the things I learned in prison that makes me saddest is that when prison systems aren’t adequately staffed and don’t succeed in habilitating or rehabilitating criminals, they often return brutalized people to the streets, and institutionalize many inmates who could have been prepared to return to society. I’ve known inmates who, upon release, weren’t prepared to make it Outside and committed crimes in order to return to prison, where they understood the rules.

 

 

Peace Corps service in Jamaica

I only met one Jamaican psychologist during my two years living in Kingston, serving as a Peace Corps Volunteer. She told me that there were only a few psychologists on the island. The University of the West Indies, on the outskirts of Kingston, didn’t have a psychology department. When Maria and I applied for Peace Corps service after our marriage in 1990, I never dreamed that I’d be employed as a psychologist in whatever developing country invited us to serve. (The more open an applicant is to serving wherever his/her services are needed, the higher the likelihood of acceptance.) With a bachelors degree in English, I thought I’d end up teaching English somewhere near where Maria worked. Maria was a psychiatric nurse – easy to place – and our Peace Corps recruiter initially referred to me as her “ball and chain” – not so easy to place. Maria was selected by Jamaica to serve as an instructor at the University Hospital of the West Indies (UHWI) School of Nursing. It just so happened that UHWI had just opened Jamaica’s first detox/rehab ward (mainly for alcoholics and crack cocaine addicts) and was in need of a ward psychologist. So from 1991-93 I wound up being one of Jamaica’s few practicing clinical psychologists.

The ward was initially run by a young psychiatrist who had just finished his residency at Johns Hopkins, and the staff consisted mostly of nurses, none of whom had experience working exclusively with substance abusers. When I reported for duty I discovered that the 8-bed ward had no treatment model (other than the medical model) and I had no job description. The only thing resembling treatment was several Twelve Step meetings  a week.

So I told the staff what I was qualified to do and they encouraged me to write my own job description: I would interview each new patient, review his/her medical record, and write a clinical assessment, with recommendations for the treatment plan. I would serve as a member of the treatment team. I would conduct group therapy sessions (psycho-educational and process  groups), and do individual and family therapy as needed.

I knew the program really needed to be based on a valid treatment model if it was to be effective. Other than the ward psychiatrist, I was the only treatment team member to have had training in substance abuse treatment. I knew that my first task as a Peace Corps Volunteer (PCV) was to listen and observe and learn, and to win the trust and confidence of the rest of the treatment team before I started making suggestions. However, I also started to work on a relapse prevention model that I’d introduce once I’d earned my place on the treatment team. I wanted to co-lead my groups with staff nurses, but they repeatedly declined. They were content to monitor the sessions from the nursing station.

I initially felt somewhat anxious at the prospect of leading groups. I was confident that group dynamics would be the same in Jamaica as in the U.S., but I knew that I had things to learn about Jamaican cultural norms, and I hadn’t yet developed an ear for Jamaican patois. English is the official language and all educated Jamaicans speak it clearly, with that unmistakable accent. But all Jamaicans also speak patois, and “deep patois” is initially unintelligible to English speakers. An effective group leader has to stay on top of not only everything that’s said in group, but also the non-verbal communication within the group. My initial test came early-on.

In a group session with all males, after a heated exchange between “Clarence” and “Desmond,” I thought, Did I just hear a death threat? Indeed I had, and I did an immediate intervention: “Threats of violence are not allowed in group, gentlemen. I know it’s almost lunch time, but we’re not leaving this room until Clarence not only takes back his threat, but means  what he says.” Before the end of the session, Clarence had retracted his threat, and shook hands with Desmond. Jamaican men tend to be macho, and it took all of my group leadership skills to stay in control during some contentious sessions.

The nurses were relieved to learn that I could stand up to angry Jamaican addicts. They never had to call Security, no matter how heated things got in group. More than once I had to break up fights. Most of the addicts I worked with came to respect me, and most seemed to like me. Some requested that I work with them individually. My psycho-educational group sessions focused on the relapse prevention skills that I was incorporating into my treatment model.

I soon “earned my spurs” with the ward staff, and began to feel like a valued member of the team. Everyone seemed pleased with the quality of the clinical services I provided, and in my second year of service I introduced my relapse prevention model. I’d written a relapse prevention manual with workbook exercises such as “Identifying your triggers for relapse.” I printed and assembled it at the Peace Corps office, and provided copies to all staff and patients. The model and the manual were approved by the treatment team and adopted into practice. When I left, after Maria and I had completed our two years of service, I felt a sense of accomplishment. A fellow Returned Peace Corps Volunteer (“Once a PCV, always a PCV”) later told me that when he’d served at UHWI, a few years after my service, the manual was still in use.

Peace Corps service can be very challenging, and many PCVs aren’t able to accomplish what they set out to do in their assignments, due to circumstances beyond their control.  The Country Director said to our training group, “If you feel like you’re ‘giving up’ two years of your life to serve in the Peace Corps, Jamaica doesn’t need you. You’re here to live two years of your life among the people of Jamaica.” The Peace Corps Mantra is “I got more than I gave.” Our lives were enriched by our two years in Jamaica. You can read the whole story in my first book, Two Years in Kingston Town: A Peace Corps Memoir, available online at Amazon and Barnes & Noble. For those with an interest in cross-cultural therapy, the book contains vivid descriptions of some of my clinical interventions in therapy groups. But it also describes places on the island that tourists seldom see, daily life in Kingston, and encounters with all sorts of interesting people.

 

 

 

 

 

 

 

 

 

 

Attributions and the blame game

Part of the human condition is that we tell ourselves stories that help us to make sense of our lives. Making sense of things is a subjective process, but in our stories, we objectify. We often make ourselves the Good Guy, and others the Bad Guy(s) in our personal mythologies. I ran into Good Guy versus Bad Guy interpersonal conflicts innumerable times in my career as a psychotherapist. Of course there are bad situations that are entirely attributable to other people or to some external factor, but it’s often easier to blame some person or some external thing than  to examine your own co-responsibility for finding yourself in an undesirable situation. Instead of working on ourselves, we can attribute our problems to external factors.

I’ve written  previously about avoiding the “monofactorial hypothesis” that A caused B. (“He became an alcoholic because he stopped going to church.”) The monofactorial hypotheses is simplistic, whereas human behaviors and relationship dynamics can be very complex and multifactorial. I’ve also written about the way people give away their own power when they blame other people for their emotional state or their behavior. (“I wouldn’t have hit him if he hadn’t dissed me!” or “She ruined my life when she ________.”) In another post I wrote about Dr. Erik Berne’s book The Games People Play, in which he identifies interpersonal “games” such as Wooden Leg. This game involves statements like “But for my ‘wooden leg’ (i.e. family history, shyness, unpopularity, bad luck, etc.) I would/would have _________.” There may be an element of truth in a stated belief such as this, but there are likely other factors at play.

Many people come to therapy because they feel out of control in some area of their lives. Frequently they have pat explanations of how people and circumstances are making their lives difficult or intolerable, without factoring their own contributions to the problem into the equation. But before I go on I want to be very clear that I’m not blaming anxious or depressed people for their symptoms, especially people suffering from clinical anxiety and depression. However, even people with these chronic conditions can worsen their symptoms by the way they think. Some people attribute their anxiety and depression entirely to external factors, but to some degree they’re unconsciously “doing” anxiety and/or depression.

Many people with anxiety disorders and phobias come up with unique behaviors or rituals that subjectively help them to cope with their symptoms. These behaviors can affect relationships in minor or major ways. The only explanation for the symptom-relief is the person’s belief in their efficacy. I worked with one highly anxious woman who’d “discovered” that crunching on shaved ice cubes temporarily relieved her anxiety. That meant that her lifestyle was restricted to situations where she had constant access to ice, every waking hour. Most people in her life found her persistent ice crunching very annoying. In therapy I got her to see how she was, to some degree, “doing anxiety,” by convincing herself that she had to constantly crunch ice, and worked with her to find better ways to cope with her anxiety. Eventually we got past her exclusive focus on symptoms, and examined the root causes of her anxiety.

Some depressed people “do depression,” or exacerbate their clinical depression, by the way they think. The deep sadness we feel when we experience a significant loss is a natural response. But we can block the natural healing/recovery response to a tragic loss by our thinking, i.e. “I’ll never get over this.” or “I deserve this suffering because I ______.” It’s only human to attribute blame or responsibility onto externals, and sometimes there are  external factors – things we can’t control – that are understandably heartbreaking or discouraging or infuriating. But attributing blame and responsibility can be an excuse, or a distraction from choosing to change yourself in positive ways.

We are, by our very nature, subjective in the way we convert our perceptions – our experience – into cognitions. Some people are more objective than others, because they strive to be fair and objective, and to pay attention to the role of their own thought processes in their experiences. Having witnessed and dealt with countless interpersonal conflicts as a psychotherapist, I’m quite aware of the tendency of people to think of things in in Good Guy/Bad Guy terms. I try to practice what I preach when I’m having a relationship conflict. I ask myself, “How much of this is him/her/them, and how much is me?” This has helped me to resolve conflicts, so it’s become a reflex.

Often there’s a third important factor in the equation – the situation or context. Sometimes that situation or context is a major determinant in what’s going on, and has to be taken into account and given due weight as a relevant factor. In such situations the analysis can be two-sided (“How much is me and how much is IT?), or when others are involved, three-sided (“How much is me, how much is him/her/them, and how much is IT?”) Both as a therapist and in personal relationships, I’ve found this way of thinking to be helpful in coming to terms with problems in my life, without creating new ones by the way I think.

If I blame external factors as the only things holding me back, I have to wait for them to change before I take action. If I take my share of the responsibility for being in an undesirable situation, I can start working to change it immediately. In situations that are entirely attributable to externals, all we can do is work on our attitudes and coping skills.

 

 

 

The mystery of consciousness

In this post I’m going to depart from my usual subject matter to explore something related to psychology, but belonging more to the study of philosophy. Somewhere down the road in this blog I intend to explore topics not directly related to psychotherapy, such as the effects of language on consciousness, the traps of language, and even what “is” is.

Psychology is a relatively young science. Some of the earliest psychologists thought that consciousness should be the primary focus of psychology; but it can’t be observed and measured. Behavior can, so psychology is now understood as the study of human behavior. Consciousness clearly exists in the universe, or I wouldn’t have written this and you wouldn’t be reading it.

Although consciousness is self-evident, science can’t account for it, and it’s relegated to the realm of metaphysics. American psychologist and philosopher William James (who had experimented with the effects of nitrous oxide and ether on consciousness) had this observation: “Our normal waking consciousness . . . is but one special type of  consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different . . . . No account of the universe in its totality can be final which leaves these other forms of consciousness quite disregarded. How to regard them is the question . . . . At any rate, they forbid a premature closing of our accounts with reality.”

James clearly believed that the mystery of consciousness is a vital piece of the cosmic puzzle. But I need to comment on his phrase, “Our normal waking consciousness.” The whole notion of the term “altered states of consciousness” rests on the assumption that there’s a standard, or normal, state of waking consciousness – which I don’t think is the case. To my way of thinking there’s a spectrum of  “normal” states of consciousness (SOCs). I’m in one SOC when I’m engaged in a debate, another when I’m solving a math problem, another when I’m absorbed in a story, and yet another when I’m dancing. All of these are normal states of waking consciousness. This range of normal experiences can be altered in profound ways by drugs, meditative practices, symptoms of mental illness, and other life experiences.

I’ve already written about ways to change your experiences by changing the way you think. But before I expand on non-drug consciousness alteration, I need to be candid about my own psychedelic experiences. (I actually met both Dr. Humphrey Osmond, who coined the term “psychedelic,” and Dr. Timothy Leary, the high priest of LSD.) It’s not my intention to promote the use of psychedelic substances to anyone, but I do think more research needs to be done on their therapeutic use. There are many factors to be considered before taking a psychedelic drug, including the possibility of mental illness, dosage and purity of the substance, as well as one’s mental set and the setting in which the drug is taken.

I haven’t taken a psychedelic drug in years, but in my hippie days I “tripped” many times – mostly on LSD, but also on peyote and psilocybin mushrooms. I’ve never had a “bad trip,” and I believe that my philosophy has benefitted from having experienced SOCs so discontinuous with my “normal” experience that I can’t find words to do them justice. In psychedelic consciousness both perception and cognition are altered in a way that’s unimaginable without experiencing it first-hand. Almost all of my trips had a strong spiritual element, unattached to any specific religious tradition. Especially on high dosages, I felt a oneness-with-the-universe that’s beyond description.

I may never get answers to all of my questions about consciousness, but it’s my Grail Quest. Some books have helped me along the way. After reading William James’ Varieties of Religious Experience, I went on to read Daniel Goleman’s Varieties of Meditative Experience and Masters and Houston’s Varieties of Psychedelic Experience. I’ve also read much of Varieties of Anomalous Experience, published by the American Psychological Association, which explores the scientific literature on such purported phenomena as near-death experiences, out-of-body experiences, hallucinations, lucid dreams, mysticism, “psychic abilities,” and reincarnation. All of these books explore aspects of consciousness, and I recommend them all to any readers who share my fascination with the topic. The best book I’ve ever read on the psychedelic experience was Alan Watts’ The Joyous Cosmology.

What consciousness “is” depends on who you ask. Some philosophers have a materialist frame of reference and view consciousness as a byproduct, or epiphenomenon, of biological existence. From an evolutionary perspective, consciousness arose in complex organisms, allowing them to detect and avoid threats in their environments, enhancing their odds of survival. Science favors a materialist viewpoint. Philosophers with an idealist frame of reference view consciousness as a (or the) fundamental underpinning of the cosmos, or as the cosmic glue that holds everything together – much like The Force in the Star Wars movies. Many religions have an idealist frame. For instance, Hinduism holds that the material world is an illusion – the veil of maya that hides the true, non-dual reality of Brahman.

This post will serve as a point of departure for some future posts about the mystery of consciousness. I won’t be blogging next week, as I need to focus on another writing project. I wish you Godspeed and good fortune in the New Year!

 

 

Metaphor and storytelling in therapy, Part 2

Throughout most of my mental health career I was blessed with good supervision. My first clinical supervisor was a PhD licensed psychologist, Dr. Robert Klein. He taught me a lot, including a procedure for helping enuretic children – bedwetters – to “keep a dry bed” when their families were trying to force them to “stop wetting the bed.” Using this procedure I was able to help several enuretic children to overcome their problem quickly. In one instance, it only took one session for a boy to immediately start keeping a dry bed. The procedure uses storytelling in two different ways, to role-model the desired outcome – as well as a family systems intervention.

This is the sequence I’d learned: After establishing some degree of rapport with the anxious and humiliated child, I’d tell him – in front of his parent(s) – a very brief generic story about “a boy your age” with the same problem, who’d gotten over the problem as quickly as it had started, after seeing a counselor. This provided a ray of hope for a child who desperately wanted to stop wetting his bed, but was clueless as to how to do it.

Then I’d do a family systems intervention, to change the family’s response to the problem, and to get the family to start promoting success, rather than punishing failure. I’d explain that the problem was caused by anxiety ( or “nerves”), and when the boy stopped worrying about bedwetting, it would stop. I’d instruct the parent(s) to stop shaming and punishing the child for “wetting the bed,” and encourage them to talk instead about “keeping a dry bed.” Any siblings should be instructed not to tease their brother. Once I felt confident that the parent(s) understood the plan and that the family would stop blaming and punishing their child, I’d speak to him individually.

By this time, the boy saw me as an ally, one who’d asked his family to stop shaming and punishing him, and who’d predicted quick success. I’d tell him, “There’s a part of your brain that never sleeps” (it’s called the reticular formation), and predicted that when his bladder got full when he was asleep, that part of his brain would wake him up, so he could go pee in the toilet. Then I’d ask him to name his favorite hero, so I could craft a story especially for him. If he said Spider-Man, I’d make up a story on the spot about Spider-Man defeating some supervillain, then going home. There Peter Parker would eat supper, pee, and go to bed. When his bladder got full in the middle of the night, he got up and peed in the toilet, and woke up after sunrise in a dry bed.

Somehow this simple story that models the desired behavior, using a role-model chosen by the child, helps him to be less anxious and to wake up when he needs to pee. In the case of my “one-session enuresis cure,” when I saw the boy’s mother weeks later, I asked her how he was doing and she told me he’d kept a dry bed since the day we met. I asked her how she understood what had worked for him, and she replied, “He said you’d told him that there’s a part of his brain that never sleeps.” Using metaphors and stories that predict success, and give the  client reasons to expect it, can be very effective in therapy.

Therapists who are good at storytelling can craft stories on the spot, or collect teaching stories and select the right one for the right client and situation. The following story, slightly modified, comes from therapist and author Bill O’Hanlon. It’s a good story to tell people whose lives are affected by phobias and irrational fears: The abbot of  a monastery had to go to town for the day, but he hesitated because every time he went away, the monks got into some kind of trouble. The monks urged him to go, promising to stay out of trouble, and not leave the monastery until he returned. So the abbot set out the next morning. Not long after he left, the monks heard a loud knock on the heavy oaken door to the great hall. One of them went and opened the door. He found himself facing a hideous, slimy demon, with a mouthful of fangs and claws like razors. The monk screamed and jumped back, and the demon entered. Other monks heard the screams and ran to the great hall, where they saw the demon menacing their brother and growing larger before their eyes.  They started screaming, too, and the demon grew even faster, towering above their heads.

When the abbot returned, he knew right away that the monks were in trouble again, because the door to the great hall was open, and he heard screaming inside. He entered, closing the door behind him. He saw the huge demon growling and menacing the monks, who cowered in a corner, trembling and screaming. Calmly, the abbot walked over to them, saying “Hi, demon” offhandedly as he passed him.  “Look” he said to the monks, “This demon eats your fear and it makes him grow, but he can’t hurt you. Ignore him.” Comforted by their abbot’s calm presence, the monks stopped screaming and stood up; and the demon started to shrink. Then, to their surprise, the abbot started laughing and telling jokes. Soon all the monks were laughing, and the demon continued to shrink until it was the size of a mouse – its actual size. It couldn’t leave because the door was closed, and the monks decided to keep it as a reminder not to let themselves be ruled by their fears. The abbot told them, “Fear cannot grow where there is heart and humor and laughter.”

If you’re a therapist or are studying to be one, I recommend Bill O’Hanlon’s website <billohanlon.com> as a gateway to a treasure trove of resources. He studied under Dr. Milton Erickson, one of the giants of psychotherapy, whom I’ll be writing about in future posts. Bill has written over 30 published books, and has written about how you can write and publish your book. I got the fear demon story from his CD of stories, “Keep Your Feet Moving: Favorite Teaching and Healing Tales.”

Metaphor and storytelling in therapy, Part 1

Partly because I was an undergraduate English major before I got a psychology graduate degree, I was very language-oriented as a therapist. Carefully listening to my clients’ metaphors and linguistic formulations  (as well as noticing non-verbal cues) was my best key to understanding their unique experiences of being-in-the-world. I tried to use their own language and metaphors in my tailored communications with each client, and often crafted strategic metaphors that I hoped would reach them where they lived. Sometimes I presented the metaphor concisely: “It’s like you always wear a suit of armor around people, and you’ve been wearing it for so long you don’t know when it’s okay to take it off, or even how to do it if you wanted to.” When a strategic metaphor hits the nail on the head, it’s immediately validated by the client, and helps to establish trust in the relationship. (“She understands me!”) If it doesn’t, the client will often use the metaphor as a starting point for clarification: “It’s more like a wall I build around me than a suit of armor.” This provides the therapist with a better understanding of the client’s worldview, and a better metaphor to use with him.

Sometimes I extended my metaphor into a story: Once upon a time there was a knight named Val who survived every battle he fought in, and was a renowned warrior. He was known for his bravery and for his impressive suit of armor, crafted by the best armorer in the kingdom. Sir Val took great care to maintain the steel armor and oil the leather straps, and never went into battle without a careful inspection, to make sure everything was in place. In time, he became known as the most formidable knight in the kingdom. But then there came a time of peace. With no battles to be fought, the king declared an outdoor feast on Midsummer’s Day. It was hot, and the knights and ladies wore their light summer finery. But Sir Val showed up wearing his full suit of armor. He was sweating bullets, it was almost impossible to eat or drink wearing gauntlets and a helmet with a visor, and romancing the ladies with a lute and a song was out of the question; so he left shortly after he arrived. It didn’t hurt his reputation as a brave and formidable knight, but nobody could understand why he thought he needed to wear his armor to a picnic.

Sometimes a story is more effective than an explanation or an interpretation or a speech. I still remember what I learned as a boy from the “Story of the Boy Who Called Wolf” : if you develop a reputation as a liar, people won’t believe you even when you tell the truth. It gave me a practical reason to lie, not a lecture on truthfulness. Teaching stories abound in Buddhism, Sufism, and other religious traditions. Jesus used parables to illustrate religious truths.

One of my favorite Buddhist teaching stories, which I told many times in therapy, is about a Western scholar, an expert on Oriental religions, who was visiting Japan. He had the good fortune to be invited to a Buddhist monastery for a formal tea ceremony with the abbot, or roshi. He was escorted to a serene rock garden, where the roshi awaited him, sitting on a mat. The scholar knew something about tea ceremonies, and sat opposite the roshi, who bowed to him and set about preparing the tea in silence. Impatient, uncomfortable with the silence, the scholar began babbling about Confucianism and Taoism and Buddhism, wishing to impress his host with his broad knowledge. The roshi kept silence until the tea was ready, and nodded to indicate that his guest should hold out his teacup to be filled. The scholar did so, still talking. When the cup was filled, the roshi kept on pouring. The tea overflowed the cup, at which point the scholar shut up, watching the tea drip onto the mat. “Your mind is like that teacup,” the roshi observed. “It’s already so full that it can’t hold anything new. If you want to learn new things, first you have to empty your cup.”

Another Buddhist story I told many times in therapy was about a senior monk and a novice who are journeying on foot through the countryside. They belong to an order that generally observes silence and forbids physical contact with women. One rainy morning they come to a rain-swollen stream. An old woman is weeping, unable to cross and return to her family on the other side. The older monk lifts her up and carries her across the torrent. Then the two monks continue on their journey, in silence. When they set up camp that night, the novice asks for permission to speak. “Our order clearly prohibits physical contact with women, and yet you took this woman in your arms this morning.” “Yes,” the older monk replied. “But I put her down on the far bank of the stream. You’ve been carrying her all day.”

Do you know anyone who might benefit from hearing any of these stories? I’ve collected teaching stories for years, and will share more of my favorites in future posts. An extended metaphor is an analogy, and a story is a kind of extended analogy. A good story can lodge itself in your long-term memory, and affect your behavior.