Client or patient?

Client or patient? What do you think?

I remember the question coming up in graduate school regarding the most appropriate term to use to describe the relationship with the people who come to us, the community of mental health providers, for service. The word patient was quickly dismissed as it brought to mind someone who is sick and wanting to be healed, as in a physician/patient relationship, where the physician has all the answers and the patient trusts and relies on that. Most mental health providers, myself included, shy away from the notion that we “fix” people. Rather, we like to see ourselves as forming collaborative relationships with people to help guide them toward their own senses of wellness. The term client seemed more appropriate as describing more of a customer-type relationship, someone who is seeking the services of a professional. Attorneys have clients. Hair stylists have clients. Financial advisors have clients.

At a recent professional conference, the topic came up, again. The speaker asked the room of 300 mental health practitioners, “What word do you use to refer to the people who seek your services?” Most yelled out, “Client.” I don’t think I heard anyone say, “Patient.” The speaker asked us to consider the Latin roots of each of the words.

From the National Institutes of Health:

“Whereas patiens simply denotes someone who is suffering, cliens is derived from the alteration of an earlier form, cluens, from cluere (to listen, follow or obey). Hence, a client was always listening out for another’s orders, unable to take independent action. Client denotes a person of lowly status at another’s beck and call and dependent on him[/her].”

Master/slave?

The definition goes on to explain that, in ancient Rome, clients were plebeians who were bound in a subservient relationship to their patrician patrons.

I haven’t encountered a responsible mental health practitioner who would view themselves to be in a superior position to the people who present in their offices, to see people as subservient. I think we would all agree that the people who come to us for help are all suffering in one way or another. Hence, the word “patient” seems to be more appropriate to describe the therapeutic relationship.

Discussions continued in the hall after the presentation. Like myself, others had a difficult time considering the transition to using the word “patient.” Perhaps it is, simply, because we have become accustomed to the idea that “doctors see patients/we see clients” that it will be a slow transition.

In light of how powerful I have always considered language to be, I think it most appropriate that I begin my own transition into staying clear that the people who come to my office are looking for a way out of their suffering. I see my job as helping people to find their power and be able to take independent action to relieve their suffering. Referring to them as “patients” does not put me in the position of having to figure out how to fix them. After all, they were never broken.

Any patients out there who would like assistance in relieving their suffering, give me a call.

We got marriage!

I awoke later than usual yesterday from my second round of sleep. I got up the first time to fill-in to teach a way-too-early yoga class and had gone back to bed when I got home. When I saw the first mention of the Supreme Court’s decision regarding marriage equality, I was confused when I felt happiness and excitement rise and fall as quickly as a spike on a cardiogram. What quickly filled the void was a feeling of hurt, joined by sadness. Anger tried to rush in to empower the other feelings but I knew it was not what I was, primarily, feeling.

My feelings of happiness and excitement were like a blip on a screen.

I felt off balance all day, partially from my disrupted sleep pattern but, also, from feeling out of synch with the joyous celebrations I was seeing, all the exuberantly congratulatory emails I was receiving from the numerous organizations that have been fighting so hard for marriage equality. Even after getting a good night’s sleep last night, I still don’t feel all the excitement that I think I should and wish I were feeling. Why aren’t I feeling it?

Damn that internalized homophobia

I think what might be revisiting me is all those years of feeling invalidated as a gay man in a homophobic, heterosexist world and it is disappointing to me that I lack the sophistication or whatever it takes to completely insulate myself from this internalized homophobia. The remarks, comments and jokes that we, as LGBT people have endured our whole lives, seeming to come from all angles, reminding us that we don’t deserve…, we’re not worthy of…, we’re not entitled to… simply because of to whom we are attracted. It seems wrong to have had to fight so hard, to exert so much energy and money for the modicum of validation that comes with some lawyers saying, “OK, you can get married.” It seems like so much and, yet, not enough to have five out of nine Supreme Court justices declare that I deserve to have the same as regular folk. I didn’t expect, perhaps naively, that there would be people who would call to disband the Supreme Court after the clearly wrong, in their eyes, decision. I didn’t expect there to be such a wide divide between the five justices who voted in favor of equal treatment and the four who believe an egregious decision has been rendered. It is usually enough for one dissenting justice to summarize and pen the dissenting side’s opinion. In this case, four dissenting opinions against the marriage equality ruling have been recorded. They didn’t just disagree with the decision, they REALLY disagreed, four times.

What could be worse than marriage equality?

And now, as expected, the lunatic fringe on the right is going into spasms over the decision. They proclaim that recognizing the equality of LGBT people is the worst thing to ever befall the U.S. Do they think this is worse than landing on the shores of this pristine continent and arrogantly annihilating the earth-loving souls that were here before us? Is this worse than thinking it was OK to enslave a whole race of people and, then, launching an all out, bloody war against the government for their right to continue enslaving? Is it worse than supporting multi-billionaires to become even multier-billionaires while many children in the U.S. go without necessities? Where’s the perspective? Those crazy, religious fanatics should feel utterly relieved that the god they believe in doesn’t, actually, exist. Otherwise, he’d be down here slapping the shit out of Mike Huckabee, Glen Beck, Rush Limbaugh and their ilk. He’d be shooting lightning bolts up the asses of all those who have manipulated the teachings of the Bible and Christ to suit their own twisted and hate-filled agendas.

Rejoice and carry on

We can rejoice in this win and, still, there is no room for complacency. The opposing forces have already begun their assault on the marriage decision. In the name of “religious freedom,” constitutional amendments are being proposed, legislation at all levels of government is being considered to find ways to work around, what is now, the law of the land. It is pathetic? laughable? that some, in some states, are even proposing seceding from the Union or disallowing marriage, altogether, to avoid having to allow our marriages.

Whether we’re aware of it or not, every time these things are reported in the media, it strikes a chord deep in the soul of every LGBT person. It reminds us that we are considered “other,” we are, “less than.” Those of us with some degree of experience and wisdom are better able to fend off, but absolutely are not immune to, the implications of ongoing minority oppression. Although huge strides have been made in our culture, I fear for the more vulnerable, the young and impressionable who fear their lack of acceptance and otherness, the tender hearts who come to believe that hiding in the shadows or, worse, leaving this planet is their only option to find peace.

I think it important that we continue to band together and build on this foundation of equality that has been started. We need to keep pushing the opponents of this decision to question their motives. Celebrate and be aware that, following this important decision, there are many emotions that people will be feeling. I’m reminded of Sarah Conner’s prophetic warning from The Terminator, “There’s a storm brewing.” Before we get to take on the revolt of artificial intelligence, we have to deal with the revolting actions of high profile “religious” and political people who will loudly and righteously launch a vehement and highly publicized battle to keep LGBT people from being recognized as fully equal humans. And that makes me sad.

Sleep

Sleep – one of my favorite topics and one of my favorite things to do. For the vast majority of the time, I sleep well and, for this, I am deeply grateful. I consider it so important that it became the first “S” in my S.T.R.E.S.S.S.S.S. Formula for Wellness. Sleeping is such a mysterious process that looks so passive and unproductive, it’s easy to justify short-changing it. If you live by the adage, “I’ll sleep when I’m dead,” that may happen sooner than you think. Lack of good sleep has been linked to a host of health problems including heart disease, low sex drive, headaches, depression, unwanted weight gain and memory problems among others.

How much do we need?

Sleep Duration Recommendations

This article from the National Sleep Foundation shows us the most current recommendations for sleeping requirements, broken down into age categories. Adults, ages 18 – 64, are still recommended to get 7-9 hours of sleep each night. After that, the recommendations are for a little less, 7-8 hours per night. If you are chronically sleep derived, you may have grown accustomed to feeling fatigued. You may not even realize that you are unrested. The National Sleep Foundation suggests asking yourself the following questions to help assess your current status:

• Are you productive, healthy and happy on seven hours? Or does it take you nine hours of quality ZZZs to get you into high gear?
• Do you have health issues such as being overweight? Are you at risk for any disease?
• Are you experiencing sleep problems ?
• Do you depend on caffeine to get you through the day?
• Do you feel sleepy when driving ?

Sleep Hygeine

If you have trouble sleeping, here are some recommendations for Sleep Hygeine including a technique for inducing a good night’s sleep. If sleeping difficulty is a chronic problem, you might want to consider Emotional Freedom Techniques (EFT) to explore the sources of your sleeping problem. Call or email me to discuss it.

Happy Zzzzzzzzzzzzzzzzzzzzzzzz.

Never too early to start.

I received a request from an Employee Assistance Program (EAP) asking if I would see Jake (not his real name), a 10 year-old boy with anxiety.  I learned from his mother that Jake hadn’t spent a full night in his own bed since he was 2 years old. During the night he would either sneak into his parent’s bed or he would make a bed on the floor in the parent’s bedroom. The parents were concerned, not only for their son’s well-being, but also for his six year old sister who was learning from her brother that there was something frightening about being in their own beds.

Mom brought her son in. He was a polite and engaging kid, did well in school, played soccer and basketball and said that he had a lot of friends. There didn’t appear to be anything weird going on at home and the family seemed pretty healthy with the exception of dad’s family history of anxiety. I decided to start out simply.

I talked to Jake and his mother about how our minds and bodies will work together to maintain an internal state to which they have become accustomed. In his case, his mind and body were accustomed to feeling anxiety. To his mind/body, anxiety is what is now familiar and, thus, feels safe. I talked to him about actual vs. perceived safety. He was intrigued with the idea that we have some control over how we interpret information that comes into the mind/body and that we could either process raw data in a way that would produce anxiety or peace. Of course, I, somehow, found a way to describe these things in a way that his 10 year-old brain could understand.

We started with breath. When I asked him to take a deep breath, practically all the air went into his chest. I had him place one hand on his chest and the other on his belly. I challenged him to make his chest hand remain still until his belly hand had moved away from his body as much as it could. This proved to be challenging and he started to get it. We practiced counting as he inhaled and taking longer to exhale. I suggested to him that, when he woke up in the night, he could lie in his bed and take 5 of these deep breaths while he reminded himself, “I am safe in my house. I am safe in my room . I am safe in my bed.”

The family already had a fairly good bedtime ritual for the kids that included bath and book reading. To it we added the turning off of all screens including TV, phones, computers and tablets one hour before bedtime. Screen viewing at night can fool the brain into thinking that it is daytime, interfering with the release of sleep chemicals in the brain. (See earlier post, below) Since Jake’s major concern was that someone would come into the house at night and take him, we included a ritual door locking ceremony where the whole family would make sure that the house was secure.  I also gave them a variation of the Buddhist Loving Kindness Prayer:

May I be well.
May I be at peace.
May I be safe.

May my mom be well.
May my mom be at peace.
May my mom be safe.

May my dad be well.
May my dad be at peace.
May my dad be safe.

(Repeat for any and all friends, family, pets, etc.)

May all people be well.
May all people be at peace.
May all people be safe.

To be honest, I was shooting from the hip, never having been faced with treating anxiety in someone so young.  What amazed me was how well these simple concepts resonated for this 10 year-old. The concepts seem to make so much sense to him.

The next week, I called Jake’s mother to arrange a second session. She was so excited. Jake had spent the previous five nights in his own bed, something that hadn’t happened in eight years. She said the whole family was invested in the bedtime rituals and that they were all sleeping better. Dad was so impressed with the effects of the breathing exercises that he started his own meditation practice.

While I’m sure the cognitive and behavioral interventions had some impact, I think the most powerful aspect of what Jake had learned was how to use his breath to move from sympathetic (fight or flight) nervous system activation to parasympathetic (rest and receive) nervous system activation. His knowing that there was something that he could do to slow his racing heart and settle himself gave him a feeling of confidence and sense of control. Utilizing our breath to move into a quieter state is something that each of us can access whenever we need it. The trick is to remember that we can.

Check out this infographic from The Huffington Post, Change Your Breathing, Change Your Life, on the effects of focusing on your breath. If you want to experience the effects of managing your breath, go to Learn To Meditate.

Namaste

Dr. Dan Siegel

Dr. Dan Siegel, renowned brain researcher, tells us why it is important to stop looking at our device screens, at least, one hour prior to going to sleep. The glow of the screen signals to our brains that it is not time for sleep. This can cause the chemicals that are necessary for falling asleep to not be released in our bodies, keeping us awake longer than we want. Watch this short video.

Antidepressant properties of microbes found in dirt

Ever wonder why it feels so good to get “Down & Dirty?” This article talks about the mood elevating properties of microbes found in dirt. Gardeners and would-bes, check it out.

http://www.gardeningknowhow.com/…/antidepressant-microbes-s…

What do you believe?

A very simple definition of the mind is the activity of the brain. The activity of the brain manifests as thought. Thought comes in the form of beliefs, attitudes, perceptions and memories, which develop for each of us as a result of our life experiences. They can be so much a part of us that we cease to remain aware of these powerful processes that are running us.

What do you believe?

An important question to ask ourselves when life feels like a struggle: “What do I believe about myself right now?” When we develop the skill to slow our minds down, (see Learn To Meditate), we have a better opportunity to step back, identify our beliefs and question them. When we identify beliefs that no longer, or never did, serve us, we can begin the life-long process of retraining our thinking. If you find that anxiety and/or depression are interfering with your quality of life, chances are you have one or more damaging beliefs operating in the background.

A counselor can help

I approach all my clients from the perspective of Cognitive Behavioral Therapy (CBT) and incorporate Emotional Freedom Techniques (EFT) with those clients for whom it is appropriate. With CBT we look at what is happening in the client’s life, how it is impacting them and what changes we can make in thinking and behavior to bring about positive life changes. EFT helps us to reduce the emotional charge that is connected with the damaging beliefs so that they can be, more easily, released.

Damaging Myths We Should Not Believe

This Huff Post article reveals 15 Damaging Myths About Life We Should All Stop Believing. If you find yourself struggling, seek the help of a qualified mental health counselor, who can help you identify what you believe and how it is impacting your quality of life. From there, you can take on the challenge of managing your mind, cultivating the beliefs that serve you and releasing those that no longer do.

Looking inside the rubber band ball

For years, I’ve used an analogy of a rubber band ball to counseling. As kids, we would take golf balls apart. After you get through the tough, outer layer, you’ll come to a densely packed ball of thin rubber bands. If you start picking at the rubber bands, you can begin to peel them away, one at a time. At some point, when you’ve removed enough layers, the ball will unwind quickly, releasing a small explosion of rubber bands.

My analogy has been that people walk through life, holding their rubber band ball. As long as it remains undisturbed, it can be carried around, as if holding it all together, tentatively. Therapy gives us the opportunity to poke at the rubber band ball, to begin to examine the layers. When the ball starts to unravel in a little explosion, that represents the parts of therapy where things feel unsettled and frightening. If we allow ourselves to go through that part, what follows is a resettling as things fall back into place. As counseling continues, we have the opportunity to lay out the inner contents of our psychic rubber band ball, keep what works and set aside what no longer serves us.

Here is a dissection of an actual rubber band ball. Enjoy.

How Yoga Can Contribute To Our Mental Health

People come to therapy for many different reasons. Regardless of their reasons, there are some fundamental concepts and skills that I discuss with each of my clients. Through both personal and professional experience, I have learned that life unfolds with much less struggle as these concepts become operational in our lives.

Among these are:

• The hazards of comparing ourselves to others
• The problems with expectations
• The benefits of being in the moment
• Being with discomfort
• Living in non-judgment and compassion

MindBodyGreen.com

Megan Bruneau, a mental health therapist from Vancouver, Canada does a nice job of presenting these concepts as they relate to our personal yoga and mental health practices in a post on MindBodyGreen. com.

From the safety of our yoga mats, we have the opportunity to observe how these things play out for us. If our tendency is toward comparing our own yoga practice as it unfolds on our mats with those around us, there’s a pretty good chance that we compare ourselves to others out in the world at-large. If we’re invested in our expectation that our yoga practice is going to look or feel a particular way, maybe we allow ourselves to move into disappointment when other people or situations don’t behave or unfold in ways that we think they should. How we react when facing a challenging pose might tip us off as to how we deal with discomfort, in general.

An opportunity to observe

Yoga gives us the opportunity to develop the important skill of witnessing. Becoming an observer of our own behavior and reactions is the first step in making changes that we consider to be valuable. It gives us the opportunity to replace reaction with mindful response.

I recommend yoga to all of my clients. I have found nothing else that gives us the same opportunities to explore our relationships with ourselves. Inviting yoga into my life has been the single most important action that I have taken toward increasing my own sense of peace and “okayness” in my life. I hope you will give it a chance.