Truth, it comes up a lot.

We're all trying to "give up" some stuff, trying to stop doing some things, but often have difficulty doing it. Aside from a blog I wrote about this a while ago, we might want to think of such things as surrender instead of "quitting", stopping, etc... but I digress. We endeavor to stop drinking, overeating, eating poorly, isolating, perfectionism, controlling things, spending, video games, TV, and a host of other things. Sometimes we're trying to avoid things that are actually good for us- exercise, going to a support group, going on a job interview, self care and the like. Most of the time we point at a lack of insight, "willpower", or related ideas. For dozens of years, people have been going on *wince* Dr. Phil, Oprah, Donahue (I don't watch too much TV- who do we have now?), and others asking why people can't stop __________.

There's an interesting colloquialism in 12-step programs that addresses this. Some say that "what makes people drink is sobriety". Whatever one feels about 12-step programs, this is a pretty elegant, and deep idea when applied to alcohol or drugs or other things we might want to give up. Consider it this way- what if our inability to stop something (or start something) is not the difficulty in stopping or starting, presence or absence of "willpower", but the difficulty of how we will feel if we do?

Try this thought experiment. How would an alcoholic feel if they stopped drinking? Someone that stopped "obsessing" over __________? A person obsessed with control feel if they stopped controlling things? Someone that stopped overeating? It's intuitive to say that these folk might be "relieved", but I'd argue that's a superficial look. I think these persons (and other people with other issues) would feel pain, fear, sadness, even shame and anger.

What I'm getting at (simply) is this: if we have trouble surrendering something, it's more likely that is difficult because of how it would feel to do so. More difficult than the effort or organization or "insight" about what we need to give something up. If that's the case, it points to why much deeper "work" is more often necessary than simply will-ing our way into stopping something.

You can find out more about Petar at: http://www.april30th.org

The famous American standup philosopher George Carlin has a fantastic piece about euphemisms. Paraphrasing and simplifying, he offers that he's against euphemistic language.

May 5th, there was an article in the Washington Post indicating that a group of psychiatrists hoping to change the term "Post Traumatic Stress Disorder" (AKA "PTSD") in the upcoming DSM-V (the "Diagnostic and Statistical Manual, 5th Edition", the industry standard for all things psychiatric diagnosis... to "Post Traumatic Stress Injury". The change, they hope, will make it easier for people, particularly military personnel, to more readily seek help. They cite that the term PTSD has a stigma attached to it.

While it arguably does, "Post Traumatic Stress Injury" might also be an equally unhelpful euphemism. Non-military personnel frequently get the symptoms of PTSD as well. Victims of crimes, violence, sexual abuse and more often have sufficient symptoms to justify being diagnosed with the disorder (Wiki here, for a quick look).

My concern about this is not simply haggling the diagnosis. The DSM is a convention (with some real science too, but arguably still a convention)- a means of shorthand for mental health professionals to communicate. My interest in the book is mostly about how it helps us guide treatment.

Back to Carlin, he specifically addresses PTSD. He takes us through the historical context- that the problem began with our recognition of the symptoms post war. A condition we used to refer to as "shellshock" gave way to "battle fatigue", then "operational exhaustion" (probably the grossest evasion of the depth of the severity of the symptoms of the problem), eventually leading to the current "PTSD"- arguably in light of the awareness that lots of things besides war can cause the aforementioned symptoms above.

We need a shorthand. This will be the 6th shorthand (if we count "combat stress") we've endeavored to come up with. What we need more though, is an honest representation (and advocacy of awareness) of the consequences of these horrific events. I'm less worried as a professional about whether or not someone suffering needs help than I am about whether we can actually get them access to it- and our evasion of these truths, often through our language, prevents us from getting legislation, funding, and other resources necessary that we can serve all victims of trauma in the ways that they need and deserve most. Sadly, my experience of the last 28 years (at this point) has led me to feel that how we communicate about these problems has led largely to desensitization, in part, due to a euphemistic way of communicating such problems.

On a related note, often, a lot of the language in my discipline serves the individuals and the discipline itself, rather than the sufferer. Pharmaceutical companies are served, occasionally a "new" theorist is served in terms of marketing their ideas, insurance companies are served, but rarely is it people that are suffering who are served. It's a source of consternation for me, both personally and professionally.

Some might say I need to come up with a more accurate term. Maybe I should, but it's not really the part of this that I'm invested in. It takes longer to talk about someone suffering flashbacks, avoiding situations and experiences, fears, hypervigilance, poor regulation of their feelings, struggling with being overwhelmed by sadness or shame, having their ability to function in their responsibilities and relationships diminished (and much more), and explain what these things are to people, specifically. But seeing how these folk are so suffering, it's clear that doing so is worth it. Taking the time to live with these words and feelings means much not just in terms of understanding the suffering, but honoring it. If we're truly going to care for people who are suffering, it will take at least that.

You can find out more about Petar at: http://www.april30th.org

In a New York Times Op-Ed piece from today, one of the leads on the DSM-IV (the "Diagnostic and Statistical Manual", the current edition of an industry standard tool for mental health, primer here) task force wrote about the upcoming changes in the DSM-V (likely to be released in early 2013). Summarizing, Allen was suggesting in part, "...after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription.", and that the American Psychiatric Association was arguably no longer in a place to be singularly in charge of the meting out of diagnoses, calling it a "monopoly" (offering that an agency akin to the FDA or National Institute on Mental Health might be examples of ways to provide oversight in the efforts to insure some science around diagnosing emotional and mental problems).

Am with Allen on quite a bit of this. What comes to me often too, is that we have equally large fish to fry with the DSM and the profession than just the pathologizing and monopolizing he suggests. We have been over-diagnosing ADHD (attention deficit hyperactivity disorder) and bipolar disorder, among others. Our differential diagnosis (rationalizing one diagnosis vs another) has also been resulting in much harm to people by way of treating issues unneeded, and/or incorrectly. We are also arguably guilty as a discipline of using interventions that are more "intrusive" than necessary (for instance, medicating a problem before efforts at traditional talk therapy and/or other interventions have yet to be tried).

It seems to me that in reviewing the DSM, we are more currently in need of insuring the accuracy and value of our diagnoses, in terms of insuring that those so suffering are treated more appropriately. We do know ways to treat depression, anxiety, addictions, bipolar disorders and etc. We do have means of helping people through grief/loss, communication problems, abuse, suffering with stress and etc. As the saying goes though, the "cure" (a dubious word to begin with) is only as good as the diagnosis, and with the numbers of the diagnosed only increasing in the US year after year, either our diagnosing or treatment (or maybe a bit of both) are not faring as well as they might.

A quick aside here- not all of the missed treatment opportunities are about the above issues. Some of them are due to the influence of Big Pharma (an intense imposition by the pharmaceutical industry), access and funding of mental health treatment, the insurance industry and more.

Specifically related to the DSM though, my hope is that we'd simply be better at a lot of the material we already have. Adding diagnoses, or simply separating them into finer and finer constellations of symptoms seems both unnecessary and unhelpful, philosophically speaking. Part of what I'm getting at above is that I think we have some good ideas about how to help many ills- I just wish we spent more time treating them, and less time diagnosing new ones.

You can find out more about Petar at: http://www.april30th.org

As I've said before, I try to work in the spirit that it's my job to put me out of a job. There's some things I see pretty often though, that seem to be both counter intuitive and appear to keep me and my type in work. My experience with therapists is that we often see these things, but rarely talk about them in a semi-organized way. As much as loss, abuse, and abandonment cause depression, sadness, shame, low self esteem, anger, pain, addiction and etc, there are things we do that perpetuate our suffering in this way. Some of these are survival or coping skills and thus necessary, but don't really go very far to help someone get, and stay out of places like my office. Here's a list of some of those things off the top of my head:

Absence of critical thinking.
Responding to struggles by simply "staying busy" or just "trying harder". AKA, operating as a "human doing" instead of a human be-ing.
The kind of thinking that "Time heals all wounds...", "It's water under the bridge...", "You're just giving __________ power over you...", "The past is in the past...", "Just stay positive..."...
Using ideas and principles that got us suffering in the first place, to resolve that suffering. Drugs, alcohol, isolation, shopping, food, gambling, etc.
Simply not knowing, and/or avoiding feelings.
Thinking and/or behaving as if the only answer to our suffering is for someone else to change or stop their behavior- even if their behavior was the cause.
Money, property, prestige.
Carrying the torch (or stick, if you will) of someone else shaming or diminishing/devaluing us.
For those that can and should, not being self supporting through one's own contributions mentally, emotionally, physically (food, clothing, shelter...), and "spiritually".
Perfectionism- both imposed on others, and ourselves. Same is true for managing and controlling everything.
Going where the love "should be" in our lives, instead of going where the love is.
On a related note- staying in abusive or emotionally unavailable relationships.
This one is a little backwards from the context in the opening paragraph: took me a while to realize that I don't have to do everything I think.
Blame.
Poor boundaries. More specifically, not knowing where one person "stops" mentally, emotionally, physically, and/or "spiritually", and another "starts".
Operating as if our feelings are facts.
Euphemistic language.
Behaving or thinking as if we have to not be, or stop being afraid, before we can accomplish a task.
Same as the above, but instead of stop/not be afraid, that we have to be "motivated".
Being an "island". Meaning, not having closeness with other folk, using ourselves as a sole resource for support or perspective or interpretation or encouragement, etc.
An inability or unwillingness to be "present".
Can't emphasize this one enough: not knowing who we are, and how we are.

Am guessing I'll be adding to this list as time goes on. The ideas above certainly warrant a deeper look/discussion to both understand and make them practical. It appears to me that there's a lot of fairly simple myths that might be dispelled that could help us all reduce chaos, and "increase the signal to noise ratio" in terms of our perspective and thinking. The ideas above, I think, are a pretty great start at doing that.

You can find out more about Petar at: http://www.april30th.org

My last piece is begging for a follow up. If there's things that put me in a job, there should be some things that will put me out of one. Ideas, principles, behaviors that clients do that get them and keep them out of our offices, clinics, & hospitals. In all fairness, as with all professions, there's arguably some things we don't agree on or see a little differently, but if we're really endeavoring to be socially responsible and progressively-minded about our responsibilities, I think we ought to be transparent about some of these things.

Should mention where these ideas come from. One day at a hospital I was hired to create dual diagnosis programs at, it dawned on me that there were a lot of suggestions that most clinicians of all types gave to clients of all diagnoses/problems to be helpful. I created a beginning list of these as I saw them, and asked different psychiatrists, therapists, social workers, nurses, etc to add/change/delete parts of the list. After compiling 60 or 80 different items or so, we began using this as a resource tool for the clients. The list below is some of those ideas, but am leaving some of them out for brevity's sake.

As with my last blog, would suggest that these might take deeper explanation and guidance, and hence, some of that work is beyond this medium. That said though, I think that some of these ideas are extraordinarily useful (despite their age... ;-p ), and can be applied a lot of places. Not an exhaustive list, but as a start...

Knowing who we are and how we are is one of the most important things- and arguably the basis for dealing with a lot of our problems.
Have a "congruent affect" (affect is "feeling" or "emotion" in this context)... let your outsides match your insides.
Learn how to identify feelings, and share them with supportive/healthy people in ways that are easy to understand.
Don't treat all feelings as facts.
Have "boundaries". Know where we each "start and stop" mentally, emotionally, "spiritually", and physically.
Eat healthy, exercise, regulate sleep.
Remove thoughts/behaviors that put distance between us and us, us and others, or are used as simple distractions.
We have to "have" something to "let go" of it. This arguably applies to how we feel.
Mindfulness.
Using critical thinking. Skepticism, defining terms, consideration of alternate interpretations, considering how an idea might not work/go wrong, resisting oversimplification/generalizing, comparing/contrasting with other people's ideas...
Have a "resource group"... people with whom we exchange ideas, get support, do critical thinking with etc that have experience and/or education with the things we struggle with.
Treat happiness as an inside job.
Avoiding self-medicating with drugs, food, alcohol, shopping, gambling, sex, TV, etc.
Be self-supporting through our own contributions, mentally, emotionally, "spiritually", and physically.
Don't just read literature related to our problems and difficulties- actually try the ideas contained.
Give up comparing our insides with other people's outsides.
Delay gratification.
Know and work on our "issues".
Stop trying to control other people, places, and things.

Again, this is a painfully truncated list, none are a substitute for working with a professional for learning how to do them if they are going to be useful. My experience though, is that my clients who take up these things, with a pro, have a pretty common experience of feeling and behaving better themselves. In some ways, it's hard to imagine doing treatment without these things. Of course, a lot of these are hard to do, but not impossible, and easier if made practical- things we can measure and point at. Would love to hear ideas from other folk about things that they think are fairly indispensable, and might work for a lot of folk in a lot of different circumstances...

Though depression, shame, fear, anger, pain and the things that cause them (abuse, abandonment, loss) keep me in a job (some of you know I think it my job to put me out of a job), another thing that keeps me in work are ideas and terms that are ill-defined. One of these terms is "intimacy".

I was told once of a rumor that someone had asked Confucius what he would suggest doing to help society, and he replied "I would revamp the language." A lot of my work is about what we speak about, how, and how we define things between one another. According to Alexa.com, Facebook is currently the number two most visited site on the internet. For many years before that, MySpace was most frequently visited site. It seems to me that these are about two things- being known and knowing/connection others. Intimacy and community. I think we all want intimacy and community, and the presence of these sites are great evidence to support this idea.

As I started to mention above though, the terms we use are rarely common between us. At the suggestion of my partner, the woman I call "The World's Most Dangerous Librarian", I use Wordnik (www.wordnik.com) as my internet reference source for words. "Intimacy" is most frequently/commonly defined as (using Webster's here): "n. The state of being intimate; close familiarity or association; nearness in friendship."

What's "close" though? Association? Friendship? Am only tackling "close" here though, and think I can offer something that might be a helpful principle. When describing intimacy to my clients, I suggest that intimacy is "me having feelings about your feelings about your life". Frequency, disclosure, and intensity of course mediate the depth of that intimacy, but I think this is a pretty principled way of defining that closeness or "intimacy" we're most often talking about.

As Tom Waits said though, "The large print giveth, and the small print taketh away." This capacity for depth in closeness is largely dependent on both parties being in touch with their own feelings to begin with (see my previous blog "You Can't Heal What You Can't Feel"). How clearly, presently, and transparently we both have our emotional experience affects our ability to be intimate with one another.

These also obviously affect our capacity for community. Without a sense of my place and my purpose on this planet, a sense of purpose and community, we all suffer. Absence of this breeds shame (low self worth/low self esteem), loneliness, sadness and depression. As confusing and difficult and even painful as it might be, us having our own feelings, giving others access to them, a willingness to risk and be intimate with one another, seems to be our best shot at avoiding these things.

When "solving problems" in addition to good "issue identification", "diagnosis" (or whatever), it's really important to examine methods/means to diminish or solve these problems, and have those methods be principled. Huxley opined:

"We are so anxious to achieve some particular end that we never pay attention to the psycho-physical means whereby that end is to be gained. So far as we are concerned, any old means is good enough. But the nature of the universe is such that ends can never justify the means. On the contrary, the means always determine the end."

But even principled means don't go far enough. I have been discussing with a couple of clients and friends in the last week about getting from "point A" to "point B" as relates to The Work. Have also come across a couple of psychology related blogs addressing resolution of specific problems. What these conversations and blogs have in common, is my friends/clients complaining that when they've mentioned a problem to someone (anxiety, impulse control issues, depression, for example), and when given advice by some folk about how to resolve them, we have found essentially that at worst the suggestion amounted to "stop being __________ (anxious, impulsive, depressed)", or simply suggesting that the opposite behavior/idea be employed.

There should be attention to the steps taken in the middle. Those steps should specifically address the issue at hand, not simply be something rationalized as "good" or needed or healthy. As some of my heroes have suggested, these ideas often amount to "activity instead of action".

For instance, exercise arguably helps depression, anxiety and the like, but seems that in many cases does not specifically address the concerns identified that might be causing such in the first place (loss, abuse, etc). Steps taken from anxiety to "groundedness", sadness/depression to happiness (or somesuch) etc should be principled. Meaning, they should be rooted in ideas that are repeatable, work for different kinds of problems, and preferably don't create new ones in their wake.

What keeps coming to me about these ideas is when observing "problem solving" from the outside, it's often difficult to point to the work that is done. Just like we're encouraged in most math classes, we should be able to "show our work". When dealing with issues/problems/concerns, problem identification is really important. So are means of problem solving- but what seems a good test of the effectiveness or value of such is the ability to point at the work done that specifically addresses the problem at hand.

As a simple example... telling someone to "calm down" rarely helps. There's no steps to show, it's difficult to see any principles this idea of "calming down" is based on. While problem-solving emotional or relationship problems and the like it's tempting to simply give advice and/or lean on philosophy, but there's a lot of value in making such practical- something we can "point at".

In our martial arts training group, if one of us has or is taught an idea/principle, we test that idea out in real time with a resisting opponent. We also try to "break the idea"- see what conditions or problems it will not work with. In some circles this is referred to as "pressure-testing the material". The same ideas might apply when solving other real world problems.

Am advocating here for critical thinking when it comes to the utility of tools or ideas for problem-solving. It seems that one of the places this utility is revealed is in whether or not we can show our work- make use of an idea in a way that is repeatable and observable (what we say/don't say, do/don't do). As a therapist, I really endeavor (and hope other professionals) to give ideas that can be used by anyone, ideas that are practical enough to show the work that specifically addresses an identified problem, not something that simply gives us the feeling that we are doing something.

Talking with a client the other day, the subject of platitudes came up. Many of us use them routinely. Whether opining about inferences made, used polemically, or giving feedback to a friend or loved one, they're used fairly often in all different kinds of discourse. These certainly occur in therapy, twelve step programs (Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Co-Da, ACA, Overeaters Anonymous, etc). We hear them at church/synagogue. They're used copiously in political speeches and discussions.

Many years ago, a friend began saying to me when discussing platitudes, "Cliche alert! Cliche alert!" ala the robot from "Lost in Space". It was his way of indicating that the user was often either not really saying anything, and/or wasn't really aware of the content or context of the cliche being used.

One of my favorite quotes is from Gandhi: "It is because we have at this present moment everybody claiming the right of conscience without going through any discipline whatsoever that there is so much untruth being delivered to a bewildered world." What I think he was getting at was pretty fundamental, and horror-producing... we all claim a right to truths and perceptions without really going through any real self or "concept" examination, and impose a subsequent template on the world in its wake.

That's a fantastic way to create and/or perpetuate problems. Am bringing it up because it seems that platitudes are a common ways this occurs. Not that many platitudes or cliches aren't true, just that we often don't seem to examine if we're using them, truly understand them, use them in context and the like. I often see therapists, psychiatrists and other mental health professionals use cliches and platitudes simply because they don't know what else to say.

Going back to twelve step programs, one cliche that is often used is "attitude of gratitude". With equal measure, it seems that an "attitude of platitude" is what is often in use. Ideas like "just do what you're doing", "keep it simple", "I decide for me, you decide for you, we decide for us", and more are arguably great ideas. These ideas even have utility for depression, relationships, self esteem, addiction, grief, loss and more. However, our command of the language doesn't necessarily indicate a real handle on what they mean or how/when/what context to use them and make them practical.

You can find out more about Petar at: http://www.april30th.org

Yes! As of today, I have one less supervisee... Brendan Thyne passed the second section of his licensing exam! He has always been a fantastic therapist, and this is a great thing to happen for everyone, patients and colleagues alike. Brendan Thyne, LMFT. Nicely done Bren... you rock, and can't say enough about who you are and the work you do.

Last Monday (9-26-11), Judy McGehee MFT, Melissa Lamoureux MS, Erika Gayoso MA, Ted Aaselund PsyD, Michael Cardenas, Jeffrey Craig, Jessica Wilson, Elvia Cortes MA and myself were recognized by the board of the Glendora Unified School District at their monthly meeting. Formally, the agency is called "Partners in Recovery", a nonprofit organization of clinicians providing services in Glendora and surrounding communities.

Judy, and I have been providing clinical supervision (a necessary component for grads and soon-to-be grads to get their "hours of experience" to sit for licensure as therapists or social workers) for the above mentioned interns and trainees. Trainees are obtaining hours to graduate with their Masters degrees, interns are working on their hours (3000 hours of service over 104 weeks) to sit for the licensing examination with the Board of Behavioral Sciences. In turn, the supervisees (the ones above and others from previous years) have provided thousands of hours of free services to the Glendora Unified School district, from elementary thru high school. The supervisees from Partners have been assisting with issues of depression, abuse, family discord, eating disorders, suicide, addiction, grief and loss, bullying, self esteem, anxiety problems and more.

The program has been running since 2009 with Judy at the helm, and will continue at least through this year. Judy, Ted, and the interns/trainees are all highly skilled clinicians. It is a fantastic way for people to get services that might not have otherwise. Nicely done everybody.

Was reading the PsychCentral blogs (one in particular called "8 Tips for Making Friends"), and found something that frustrates me a little as a clinician, and a person. The piece presents some fairly solid, simple, and doable encouragements about making new friends.

When it comes to doing therapy or any other related type of recovery, the confusion and difficulty that arises can prevent movement and change, unless a relationship we may be working on and our support group (or "resource group", as my friend/colleague Barbara Waldman PhD refers to them) can support our efforts and suffering. Would argue that this is an essential component to working through all kinds of issues.

The only thing difficult for me about the blog was an idea that I think we often leave out. There was no mention of having our own personhood and "friendship skills" intact to begin with. It seems to me that we engage in many relationships without having gone through some important steps to insure our readiness for such to begin with. In short, as the colloquialism goes, you might have to be a friend to have one. Being a friend is often a "work" as some fighters say, and not necessarily an innate part of who we are. A sense of our own personhood is an even more fundamental responsibility, and too is demonstrably not an innate characteristic. Seems that both of these are requirements for making friends, keeping them, and of equal importance- being one.

You can find out more about Petar at: http://www.april30th.org

Have to start here with some gratitude. As many of you know, The Work is really a mission of sorts for me- trying to put myself out of a job so to speak. So many have been so kind and encouraging about my work. Clients, colleagues, friends. It's really important to me to have a clearsighted and organized way of being a partner with people in eliminating suffering, having principles... preferably both.

Left doing inpatient full time in April, in favor of doing private practice full time. The folk above (and more) have responded by sending a lot of folk my way to do service with/for. As a result, my longtime office space with Brendan Thyne MA, and his dad Rick Thyne MFT (Patrick Thyne and Associates) became too small (time wise) to accommodate my clients.

Noting this because getting a new space wasn't just a task- it is a loss in a lot of ways. Brendan and Rick are relatives (of choice and affiliation)- and fantastic therapists. The space across the street from Pasadena City Hall has been beautiful, and I really enjoy the surroundings. Between losing the familial contact and the space, is a big deal.

That said though, have found a fantastic space to do The Work in. Am hoping that it will bring an energy and space that can be filled with whatever it is that people need. Want to send some appreciation specifically for Yvonne, my dad, Judy McGehee LMFT, Erika Gayoso/Michael Cardenas/Ted Aaselund and Elvia Cortes. Also appreciation to Jeff Boxer Esq, David Wolf, Ed Wilson PhD, Sue Stauffer, Barbara Waldman PhD, Barbara O'Connor MFT, Tricia Hill, of course Lali and Sadie. A special note for my clients though- you all continue to humble me deeply, and have been fantastic supporters of my work.

Here's the new space- near the end of the 110, the 134/210. New address is 547 S. Marengo Ave, Pasadena, 91101:
More information about Petar at http://www.April30th.org.

Quick note from Partners in Recovery about the work we've been doing. They can now be found on Facebook:

"Petar Sardelich, MFT, MAC, LPT, has joined Judy McGehee, MFT in supervising La Verne University Trainees, and Interns, in the Glendora Schools Internship Program. Since September 2009, interns, therapists and trainees have been offering 40 hours per week of probono mental health counseling and education in the community. This includes Whitcomb High School, Glendora High, Sandburg and Goodard Jr. High. Community and Parent nights have educated participants about drug and alcohol abuse, building communication between parents and teens, and in March, 2011, information regarding bullying and helping individuals in combatting this behavior. PIR is a non-profit organization where volunteer therapists and board members provide mental health services and referrals in the community."

Just by virtue of having eyes and ears, we have emotional responses to everything. When we have experiences that create loss, damage, violate our sense of self or ethics (prompt an experience of feeling "less than" or being broken, also known as "shame"), frighten us or etc, we have to do something with how that feels. Just like falling off a bike and skinning our knee, we hurt in part because that's the healing process in action. Many therapists and others refer to these unresolved hurts as "issues".

If we don't have a means of healing/dealing with these, there are lots of unintended consequences. Not healing "hurts" (shame, fear, sadness, etc) causes "neurotic" behavior. "Acting out", drug use, manipulation, self-ful-ness, isolation, "codependent" behavior, "anxiety", avoidant behaviors, etc. Long term and in the wake of continued losses/traumas, these can turn into more serious problems- depression, relationship issues, "mental illnesses", addictions and etc.

Sometimes these other problems and behaviors are simply ways of surviving or "coping" with our feelings about things, sometimes they become problems in and of themselves. Exercise, church (etc), self-help books, "will", diet and nutrition, hobbies etc are all efforts that can be helpful in varying degrees, but for reasons too long for a blog post, they're insufficient and/or incomplete for this task. Some of these things sometimes turn into means of avoiding our feelings as well.

If we don't have a fairly organized (and effective) means of transforming or eradicating our experience in this way, as above, we create or perpetuate problems in our lives. Different therapists have different "tools" suggested to help resolve or diminish the intensity of these issues. My sense of this process though, goes something like this:

List the behaviors we use that put distance between us and how we feel. Some of these are external- but some are internal. Some examples are food, alcohol, work, spending, sex, focus on others, perfectionism (whether imposed on ourselves or others), TV, turning our feelings into anger, etc.

Diminish (or preferably, maybe necessarily) or stop those behaviors. There's many, many ways of making this happen- see my blog "Wanting to Stop" for some suggestions. As has been said in other blogs, "letting go" means little for something we are not fully letting ourselves "have" in the first place.

Give the feelings we're experiencing/left with as simple, and common a name as possible. I encourage mad, sad, glad (happy), afraid, ashamed, and/or hurt. And/or because we can certainly feel more than one at a time. Simple, because we often use euphemistic or complicated language as just another means to dissociate (separate) us from our feelings.

Share those feelings, as much as possible with the person we're having the feelings about, as close to the time we experience them. It's also really important that we're actually allowing ourselves to have the feelings as we're expressing them. Of course this isn't always appropriate because of time or circumstance. Sometimes, it's not appropriate because of the person we're with. Be careful though not to "preach prudence when practicing evasion".

As has been said by many, "you can't heal what you can't feel". This process is assisted by doing it with a professional who has has both education and experience in doing so not just as a therapist, but hopefully as a person as well. We are trained in various means that facilitate some really important parts of this process that are sometimes not intuitive to our friends, families, loved ones. Am getting at a fairly simple list of ideas here- stop doing what we do to not feel, have an organized way of naming and letting go of or diminishing their intensity.
More information about Petar at http://www.April30th.org.

Much of my time is spent here, and in my therapy/counseling practice, attempting to get folk to honor how they feel. That's an oversimplification, but will leave it for brevity's sake. This is a daunting task because of the intensity and availability of our distractions, but I keep trying anyway.

One of the things that oft keeps this from happening is that when someone "hurts" us (shames, takes something away, etc), we find ourselves (understandably) making sense out of why they'd do such a thing. We think more about the person in question "doing their best", "having had a hard time" etc than we ever do simply saying "Ouch, that hurt...", or some variation on that theme. It's safe to say that many of us, often don't honor how it affected us at all. Working on problems of low self esteem, depression, addiction, abuse and more we don't want to "blame" anyone (nor should we), and oft go so far as to think our therapists are prompting us to "blame" that person, our parents, etc.

As for my sense of this, I think we could safely remove the word from our vocabulary entirely. Maybe even replace it with considerations of "responsibility". In terms of a solution, will offer something I hope is very simple: we're only blaming someone else for our feelings or problems, if we do nothingwith our feelings about it.
More information about Petar at http://www.April30th.org.

Been thinking a lot about how most of us, when we were kids, didn't have fears about playing with other kids, meeting new people we liked and such. Maybe when we were very little we might have been "shy", but in this case I think we're talking about caution, fearfulness, as opposed to lack of a sense of self esteem.

When I was a kid, it was easy for me to go down the street and ask about a kid there I thought was my age that I could play with, to try new things... I think because we're actually born with a sense of self esteem, and that sense of worth gets taken away. That sense of our value, how we are connected to others, self worth, gets replaced by shame- feeling "less than", insufficient, unlovable, broken and defective as human beings.

This sense of self esteem is diminished a lot of ways. Verbal abuse- actually being shamed by others, made fun of, called names, diminished for mistakes or lack of knowledge of a thing, literally being told one is somehow bad, not going to amount to anything, being compared against others, being yelled at or threatened.

Physical abuse. The predominant message a person gets when struck by another person out of anger, an effort to discipline, etc. is that they are somehow flawed. Being treated gently shows someone their worth. It takes effort... attention, patience, softness- the opposite of which takes little effort. Of course, this is often coupled with verbal abuse, sometimes sexual abuse.

Sexual abuse. When this happens to someone, they often get the message that this is their only value, their only utility as a person. It's also extremely common for the abuser to be able to continue the act, that they diminish the victim as a person. Taking away their power, their human-ness, their self worth, makes it easier to continue violating them. The act itself literally causes shame- it instills something in the person that they have to hide, something that makes them feel less human, separates them from others.

The media. There's a lot of images in our society, a lot of messages that we get about our worth. Television, magazines, movies, other people, all bombard us with a message about what we "need" to do, have, look like. We are given the sense that unless we're attached to some product, some lifestyle, some particular achievement, we are somehow not successful. This is not simply a message about how far we've gone in life, it's a message about our being-ness, our human-ness.

We do a lot of work to "get" self esteem- take care of ourselves physically, our appearance, do esteemable acts, visualization, affirmations and etc. Those of us that have done these things often haven't been able to maintain our self worth despite such efforts. These ideas help us feel better in the moment, but long term, we often still experience a deep sense of shame.

Some have said that a central idea in Buddhism is that at the center of each human being is the fear we don't exist. This lends itself to the idea that we are constantly reaching outside of ourselves for things, naming and labeling them, attaching ourselves to them, trying to obtain them. In doing so, being attached to a thing (person, etc), we can fear less that we don't exist. So we go about our lives in a way that diminishes our personhood, our being-ness, our selves being "enough" simply as we are.

The answer to this is not simply adding things to our lives, behaviors, personhood. Shame, low self worth and etc is something we have to give away. We have had experiences that diminished our self esteem- abuse, abandonment, exposure or humiliation, being diminished or demeaned verbally- those are the things that make us feel less of ourselves. Until we find a way to "let go" of those feelings, to give them away, to make space for our self esteem, we will be unable to experience it no matter how many "creative visualizations", affirmations and etc. that we do.
More information about Petar at http://www.April30th.org.

We constantly "do" things- behaviors and thinking, that put distance between us and us, us and "others", us and 'god' or the 'universe' as we MISunderstand s/he/them and/or it. Food, sex, TV, gambling, relationships, rationalizing, avoiding, intellectualizing, alcohol, money, property, prestige, drugs, toys/devices (cell phones, computers, etc), fixing other people, "acting out" etc. Overstating, when it comes to distance between us and us, we're talking about putting distance between us and our emotional condition. Simply using a lot of words (Lao Tzu has famously said, paraphrasing, that "many words lead one nowhere") and even certain types of words can put distance between us and our feelings.

To simplify getting in touch with and processing our feelings about things, I encourage using what are sometimes referred to as the "Six Basic Feelings". These are mad, sad, glad, afraid, ashamed, and/or hurt. Certainly, we can have one or more of them at any given time, even about the same issue. I really resist other words if at all possible, for reasons too long to go into here.

If we're engaged in the aforementioned behaviors, we are often mood-altering, and/or simply less or unable to be in touch with our emotional condition (and as a result, others and the rest of the "universe"). If our feelings are indicators of possible realities, if these are altered or stunted, we may not have all the information about a given circumstance. The idea we're going for is to talk about them in a way that transforms them, and or helps us clarify different circumstances.

So, my suggestion to get in touch with and begin transforming these is this: know the things we do that are mood-altering, let go of those behaviors (a whole other note all together), and as our feelings come up, say the facts of the circumstance, and one or more of the six basic feelings. For instance, "When my mom (or whoever) said/did/didn't say/didn't do __________, I felt __________." That's all. Trying to avoid inferences, interpretations, assessments, judgments, manipulation, controlling, etc., certainly avoiding behaviors we do that ignore or diminish our ability to be in touch with how we feel.

It's been said too that we can't heal what we can't feel. So the process I'm encouraging is identifying what we do to not feel, letting go of those so that we can feel all of our feelings ("all" meaning each one, in all circumstances, and with 100% of the intensity we're experiencing them...), naming them simply, communicating them in a way that helps us stay in touch with/get help/transform them, then finding ways to live our lives gracefully through what comes up as we process them. This is a process I encourage with therapists, relationships, as many places as is possible.

It's really important to point out that I'm not advocating for this process to change anyone else's behavior or perspective. This is not an idea about right and wrong, certainly not about comparing the relevance of our feelings to others. It's simply a way of getting in touch with what we feel, so that we can change it. We often say to one another that we should "let go" of things- but you can't let go of feelings you don't totally have.
More information about Petar at http://www.April30th.org.

We do some *ahem* interesting things with sadness.

Often, people ask us how we are. I think the real question is about how we feel, but we will oft answer "good" or "bad" or "not so good". All judgments about how we feel. Most of us would argue that "sad" is a "bad" feeling. If we can get past that, we may use another euphemism: "depressed". Our relationship to this thing is often not great.

When I left my office this morning (my second office at the Life Fitness Center, a group that provides a more holistic set of services), I was sad myself. I'd spent several hours with people who were in horrible circumstances, and had already been suffering. Mightily, and understandably, I might add. When I got to the light, I noticed a gentleman, probably 7ish, walking through the crosswalk with his mom. One of my licensures is in developmental disabilities and other related problems, and I noted his cerebral palsy right away. They were holding hands, and though his body was having a hard time- his soul certainly wasn't. He appeared really happy.

Behind my wheel though, I was pretty sad. For my clients this AM, and for him (though he was probably fine). Most of the time when we get sad, we find some way to resist it. We push it away with our minds, set our attention elsewhere, numb it with all kinds of different behaviors, even shame ourselves for having such feelings in the first place.

Would argue though, that my sadness, has great utility. Not only is it the most effective way to heal my losses, it certainly makes me useful to other people. Exactly how it heals grief and loss is not quite the gist of this missive, and takes time with a therapist/counselor/life coach to know how to do effectively and gracefully. Am certain that my sadness today assisted me in being kind and present for my clients, and likely would keep me "softer" when dealing with folk like the gentleman in the crosswalk.

My hope is that I never lose this. As long as I am sad about the suffering of humans, I have business doing the work that I do. The point of this though is that this is true not just in terms of my relationship to my clients or other folk in the world, but all of us in relationship to ourselves and one another in general. Honoring our sadness does more to "cure" "anxiety" (sorry for the consecutive quotes), relieve "depression", and make us available for intimacy than most any other thing I can think of.

Reconciling ourselves with sadness, and finding some "grace" in how we live with it, if the above is true, surely presents some great reasons we should stop treating our sadness as something repugnant.

On a different note: as a reminder, Judy McGehee and I will be on the radio/live stream/podcasting at the link below tomorrow from 1130AM until noon on the "Project Get Well America" show with Dr. Mark. The link for the show is here.
More information about Petar at http://www.April30th.org.

Because it's been coming up recently, and because it's a fundamental principle of what I do in terms of therapy:

Feelings aren't necessarily facts. They are just indicators of possible realities. Of course this doesn't mean they're not facts- but that's beyond the scope of a blog. They give us information about our environment that might not otherwise be discernable or supported by our other senses. They do much more than this, but that too is too long for a blog.

Unless we have a relationship with our own emotional condition that is healthy, I'd argue that we will have a difficult time "seeing" things clearly (circumstances, other relationships, etc.), and making choices about how to handle things. This is true even in absence of grief and loss, depression, relationship problems, abuse, addiction and etc., and is certainly made worse by the presence of these issues.

Processing feelings (emotions as some call them, or as I often do, e-motions), transforming them, reconciling with them, how to identify them and what to do about our sense of things in light of our feelings is of course what counseling, therapy, and life coaching are all about. At least seeing this idea as a principle, even in absence of those things can help us tell real alarms from false ones, provide some simple relief in some circumstances, give us an opportunity to be kinder to ourselves, and an opportunity to be kinder to others and more..
More information about Petar at http://www.April30th.org.

So many of us are looking for self esteem, happiness, "God" (if one believes in such), good relationships and etc. These ideas come up a lot in my work, from all kinds of people, all different kinds of age groups and backgrounds. They're understandable, and common efforts, much of what make our lives worth living.

We do a lot of... interesting... things to get these. We "socially engineer", we try to bolster our sense of self with our egos, we do all the prescribed things that religions or spiritual traditions or philosophies (or therapists) encourage us to do to get a sense of "spirit" or "God", we buy things, try to get him or her to be interested in us. We use drugs, alcohol, money, property, prestige. We even use a lot of methods we've gotten from other therapists or self-help books (or programs) to get these things as well.

More and more, I think that these things, if we're to have them at all, are far less about "getting" them than they are about making space for them. If we've been told all our lives that we'll never amount to anything or have had things happen to us that have made us feel "less than" or broken or defective, no amount of the above ideas (and more) will be sufficient to bring us self esteem or happiness. The ideas I'm suggesting about "God" or relationships etc are much the same- we have to make space for these things, that are usually occupied by some loss, hurt, anxieties and etc.

The how and why of this is beyond the scope of a blog, but it's certainly an idea worth pondering. Overstating, learning how to let go of hurts, losses, shame, ego- these will go much further in bringing us healthy relationships, a healthy relationship with ourselves, a sense of connectedness to "God" or others or the "universe", than any amount of money or anything else will ever provide.
More information about Petar at http://www.April30th.org.

Thanks for dropping by my blog page. As the introduction notes, I am a Licensed Marriage and Family Therapist, Licensed Psychiatric Technician, and Masters level Addictions Counselor in Pasadena, California. Though I’ve been doing some private practice for many years in addition to the twenty-six I’ve been doing inpatient work, I’ve now gone out on my own, to do just private practice.
Providing treatment is my life’s work. Having not just survived, but also (somewhat) gracefully dealt with some suffering of my own, I have been given not just some answers- but with those answers, also responsibility to others. Holding on to those responsibilities is not only bad for other people, it would be unhealthy for me too. So, very early, I started being of service.
Having worked inpatient for so many years, I’ve been lucky (and saddened) to take care of most every type of human suffering possible. Most of my work has been with adults and adolescents. Depression, loss, grief, addiction, trauma, abuse, stress, mental illness (for lack of a more graceful term), relationships, desires (and need) for personal growth or “life coaching”, chronic pain, medical illnesses, family problems, couples problems and more have all been tragically present and have arguably increased over the years I’ve provided service. There is much work to be done about all of these things and more. It seems now that the most effective way to care for these problems is for me to see individuals, families, and couples privately.
It was suggested by someone I consider wise that I find a way to make myself available to people when they are not able to be around me. Aside from writing a book, providing materials from talks I do in the community, I am starting a blog. There is much work to be done, and many answers are possible that can improve the quality of all our lives, if we’re willing to live by some principles and do some work. My hope is that I can take you along with me as I do so, by way of communicating here.
And so to it.
More information about Petar at http://www.April30th.org.

Next Thursday (May 6th) at 1130 AM, Judy McGehee MA, MFT (www.mcgeheepartners.org), Tom Aaselund MFT, and myself will be discussing... whatever comes up... about psychology, therapy and etc for what I think is half an hour. It will be on the "Project Get Well America" show with Dr. Mark. It's live streamed and podcasted. The link for the show is here. If there's any more details, will let you know.
More information about Petar at http://www.April30th.org.

Got to do a talk with the aforementioned Judy McGehee MA, LMFT (www.mcgeheepartners.org) tonight at the "Parent Summit" organized by the Glendora School District. There were breakout sessions with different professionals and agencies providing talks on different topics. Dr. Mary Suzuki (wife of Dr. Dan Suzuki) began the session with Captain Rob Castro of Glendora PD, who discussed a previous summit focusing on adolescents and use of pharmaceuticals (illicitly).

Judy and I did a talk entitled "How to Talk so Your Kids Will Listen, How to Listen so Your Kids Will Talk". As we discussed in our PowerPoint presentation, it became pretty clear that this was a misnomer- not only because it has more to do with relationships with kids, and further, much of the skills we discussed were relevant for most relationships in general.

During her talk, Judy identified the importance of being interested in your kids, not letting technology like cell phones and iPods get in the way of communication, ideas about developmental stages, roadblocks to communication and more. The parents and professionals who attended asked her a lot of questions about different types of age-appropriate communication, problem-solving specific issues and etc.

My talk endeavored a practical approach that highlighted suggestions to put me out of a job (one of my personal goals), principled ideas for use in communication, and some adolescent/child specific tools. We also discussed problem-solving issues like when/when not to intervene between siblings, children (who were sometimes adults in the examples) "stonewalling", giving short and/or avoidant responses, even what might be described as resentful feelings prompting one or another to not talk all together. The details of these are of course beyond a blog.

That said though, will copy/paste some of the suggestions I had here. Any questions, ideas, encouragements etc are welcome. Again, would offer that many of these are useful in communicating with all types of people, in all different types of relationships. Here's the abbreviated list:

• Don't yell.
• Don’t be critical and/or judgmental.
• Don’t try to change others’ mind or behavior.
• Don’t interrupt.
• Don’t only have feelings of fear or anger, or not have feelings at all.
• Be graceful with the feelings you do have.
• Don’t interrogate. *only be a parent* (meaning, resist the temptation to be a police officer, financial adviser, career counselor, etc)
• Don’t interrupt.
• Don’t say one thing, then do another.
• If someone says something you don’t understand, ask them to explain it.
• If someone starts yelling, speak quietly.
• Avoid power struggles.
(Here is where some of the adolescent specific ideas began)
• It might be a good answer to them.
• Don’t be afraid of technology. Learn to text. Email.
• Ask their opinion.
• Tell them you love them, and what you like about them.
• Learn their language. You don’t have to use it. (www.urbandictionary.com)
• Use the “rule of five”, particularly in crisis. Five words a sentence, five letters a word.
• Find a way to be interested in them- what they think, what they like and care about, and why.

This is certainly not an exhaustive list. It also doesn't address some of the principles that might otherwise be employed, doesn't give some answers in context, and doesn't explain why some of these tools might be important. Those ideas, as a rule, have to be discussed, processed. They also don't address specifics about working through problems or issues. Most of these things are best done with a professional, over time. Hope some of these can be helpful.
More information about Petar at April30th.org.

My friend and colleague Judy McGehee MA, LMFT (www.mcgeheepartners.org) along with Ted Aaselund LMFT have been providing clinical supervision (completing hours for graduation and/or eventual licensure) for a great group of interns and trainees at Judy's office in Glendora, California. They have been providing sometimes up to 40 hours of services to local schools with these Masters level folk to students and families who might not get these services at all otherwise.

I have been truly humbled by the work of these people, and lucky to get to participate in part of the supervision. We have been discussing the obvious concerns about professional standards, law and ethics concerns, types of interventions, philosophy, differential diagnosis, addiction, depression, abuse and etc. What has been so remarkable though is the intensity of the losses and difficulties these students and families have had, but equally, the grace and commitment of the interns and Judy insuring that these folk get taken care of.

It appears now that eventually, on top of the individual services that are being provided to the educational institutions, students, and families, there may be an opportunity for a multi-family group therapy at low cost for these individuals. This is such a great service, but sadly, there is no funding available for this to happen (space may be made available at a school). Of course I can't discuss the details but, there have been some huge losses for these families that they are getting little support for treating from a public standpoint, the responsibility of both the service and the internship being largely on the shoulders of Judy and the interns, a little on Ted and I (as we didn't take this on from the beginning). The families served aren't just getting low-level services- they are getting truly insightful, wise, professional services thanks to the good heartedness of the people involved.

Providing clinical supervision is such an important part of what I'm lucky enough to get to do. It means much to me that I'm in a place where I'm not just empowered to help people, but that I am empowered to help people, who can further be of service to others. What I do, I hope, matters a great deal, and the opportunity to share some of that with other people who might further use some of that to help yet other people is amazing.
More information about Petar at http://www.April30th.org.