Advice: Dismissed, Unheeded and Pooh-Pooh-ed

There are things that most therapists say, wish they could say, or have given up saying, that no one ever listens to anyway.

You probably won’t listen either:
But what the hell – I’ll give it another shot:

Please get your thyroid checked, your blood sugar, make sure you aren’t anemic. Get a blood test and a physical. If you are an older man, check your testosterone levels. (I see your eyes glazing over already) Let us make sure before we spend hours and hours and you make a significant financial investment in psychotherapy that we aren’t trying to talk your glands or your pancreas into functioning more consistently.

Your symptoms don’t just live in your mind. Your mind is housed in your body. You have to treat your most pernicious anxious/depressive symptoms in your body too.

And, sure, yes, I am also talking about exercise (recent, flawed studies aside) If you’ve had your exam and your physical health permits: Get some air, some sunshine. Or get rained on. Go to a gym. Find some exercise that you find pleasurable, and do it whenever you can find time and push yourself out the door. Work up a sweat. Salsa dance. Rock climb. Or just walk. Especially when you don’t feel like it. Just around the block a few times, or to the corner and back. Spend a little time in the company of your own body – pay attention to it. We just feel and function better when we treat our bodies with self-respect.

If exercise offers no gain at all – or your energy and motivation is too too low to even consider it – then we need to intervene with your body in some other way: Medical intervention and medication may be a possibility for those who feel committed to the medical model. There are other routes as well: Acupuncture, yoga, a nutritional consult. Therapeutic massage, qi-gong, tai chi, Some believe that a ‘cleanse’ can reboot their bodies response. Some consult an herbalist. Eat aruvedically if that is your thing.

Whatever.

Any gesture that will get you respectfully engaged with your body’s needs again.

The futility of directiveness, I suppose, is why I allied with psychoanalytic, existential, and depth psychology models – as I’ve surrendered to the notion that there is no such thing as effective, directive advice, and that our cognition is rarely changed with out understanding our deeper fears, inheritances, habits, survival mechanisms and resistances.

But I’ll admit, sometimes I still try to slip it in, sandwiched in between moments of exploration and mirroring, amplification, and empathy.

Sometimes I am just itching to tell you what to do.

Especially when you are asking me to.

Actually, its when you ask me to that you seem to listen least of all.

Medication:
I would prefer, if you are considering taking, or feel that you will benefit from psychiatric medication that it be prescribed by a board certified psychiatrist, and please please please, if you won’t or can’t use someone that I refer you to, please find someone who will collaborate, or at least return my call. Please ask them at the first consultation.

Say words like these:
“Will you feel comfortable collaborating as part of a treatment team with my psychotherapist? How do you prefer to be contacted? I would like to be sure to sign a consent for the two of you to communicate before I leave today. Are there times when you might want to know what is happening in my therapy, or would want feedback, or have questions for my therapist?”

I would prefer that you see someone who truly believes in the construct of the lowest therapeutic dose as an guiding ethical value. I would prefer that you consider it as a last resort rather than a simple quick fix. No matter what medication you may utilize for whatever emotional symptoms trouble you, please bear in mind that medication will not change anything enough in and of, or all by itself. In the very best case scenario, it is a single, potentially effective tool to apply to a multi-pronged problem. Tools can be necessary and make things easier. And tools can be dangerous and injurious.

And you will still need to talk things through, look at your choices, heed your intuition, change your life-style, confront changes that you would rather avoid.

Continuing on:

If you are single:
That is fine. Single is not pathology. Life as a single person can be an excellent and healthy choice, and far far preferable to life in a toxic destructive relationship. You are not less than because you are not in a relationship. You are not more unhappy than many many people who have partners. You may have different kinds of unhappiness then they do. Committed partnerships do not inherently make people happier. There are miserable people single, and partnered. There are joyful single folk, and joyful married folk.

No one ever listens to this at all.

If you are dating:
You can have no idea if someone is “perfect for you” after three dates, or a couple of hook ups. Truly. You, and everyone who loves you will be spared a great deal of agony if you can tolerate that fact that we human beings can be extremely attracted to someone who we don’t know at all, probably exactly because we don’t really know them at all.

Enjoy the pheromones. Try to guard your attachments until trust is earned.

And the second prescription for dating singles is like unto it:

Just because you have a somewhat icky feeling after the third week of seeing someone doesn’t in and of itself mean that you should dump them. That icky feeling may very well be a signal that this is a relationship that has the capacity for intimacy. Intimacy is scary, and dangerous. It could hurt you. But, it is what most people are seeking when they look for love. When intimacy begins to emerge – it can scare the shit out of you. Wait a few more weeks before bolting. Get more experiential data. Maybe it is a signal that something is wrong or not working between the two of you.

Or maybe its a signal that you could change each others lives.

In someways, being consistently ignored in my more advice-y moments has been relieving from the inflated illusion that I may have substantial power in my clients lives.

Its proven to me that none of of us take in anything that we do not want to, or are not ready to hear.

And none of us can take any action, or change our thinking until we are ready.

But, lets keep going shall we?

For parents of young children:
I know it is expensive, I know its a hassle. I know you are so exhausted you are done for by nine o’clock. But for god-sakes you need to get away from that baby sometimes. If you are in a couple, you need a date night. Single parents also need nights out with other grown ups: Ideally once a week but for many that is a tall order- but at least twice a month – once a month? Your child truly, ultimately doesn’t want to eat you alive, but they will if you let them.

For the chronically overworked:
You need to leave work at a reasonable time at least once a week. If it were up to me it would be more. I know there are deadlines, and this is a big ambitious city. But you need to have some sacrosanct activity – in addition to therapy – that you leave work for and show up to regularly. A book club. A painting class. Any of the activities that I already mentioned that you don’t remember because you were just yes-ing me and not really paying attention. You need to leave work sometimes. Your employer, may, in fact be happy to eat you alive, but if you let them, you will be even more miserable.

My words wash out into a wave of white-noise: just as any adult in Charlie-Brown’s universe: Wah-wah-wahwahwah-wah.

For those who complain about boredom and isolation:
Volunteer somewhere, or get connected to a community organization. We feel better when we are connected to a community of others who share similar goals and values.

A church, a temple a mosque, a political campaign, a charitable organization, and animal shelter. Habitat for Humanity, an urban garden. Its easier to feel connected to people when we are working side by side. Its easier to chat and get to see something about another’s character when you are pulling up weeds, or serving soup, or doing something meaningful together.

There is a vague and anxious guilt that accumulates when we stockpile all of our personal energy for ourselves – and don’t generate something for others. Do something that makes you feel clean and aligned with your own values and proud of yourself.

Certainly by now I have lost you.

But shall I continue to proffer and assemble my beautiful bouquet of all things ignored?

If you are “stuck”:
Keep a pen and pad by your bed and write down whatever you can remember about your dreams. I know, I know, you don’t dream, you never remember your dreams, your dreams are “just weird”, about nothing, are just little bits here and there, mostly about your job. Please. Pretty please? Just indulge me?

When you complain of feeling stuck, and spend hours and hours polling your friends and family and neighbors, and me about “what you should do” to get out of your circumstance – the problem is that you haven’t forged a sufficient, or patient relationship with your own intuition.

You don’t know what you are hungry for and you are asking other people what you want to eat for dinner. The answer will only come from the outside in that your internal hunger will recognize it or reject it.

You can eliminate the middle-men and learn to listen to yourself directly. Your dreams, your unconscious, your psyche is chewing on all of this stuff day and night. When you sleep – you produce little mind-movies about the dilemmas that are most central to you. When you have failed to solve the problem with your consciousness, why not try letting your unconscious have a crack at it? What do you have to lose?

Turn off the morning talk radio ( you only have about 30 seconds to a minute to remember your dream upon waking) set your alarm 7 minutes earlier and hit snooze. Use the 7 minute interim to think about where you just were, and write it down. Even a few key words may help. It might be boring at first. Detritus from the day – nothing exciting – but these are symbols produced by you – and if you keep paying attention – we will certainly find some content to riff on, some grist for the mill, that may lead us right where you need to go.

A drip, drip drip at a time, water built the Grand Canyon, and its part of my work to chip, chip chip away at people’s resistances to the activities of daily living that will at least make our work in the room flow more smoothly, and best put you in more contact with yourself, your core needs and a sense of well being.

But, certainly, you can feel free to ignore me about this too.
Its fine.
I’m resigned. I’m used to it.

For those who “do not know what they want:”
You will likely need some space in your life for some kind of conscious, waking contemplative activity. Learn to mediate, or write in a journal, or draw or create something. You need to spend some time listening to your inner world. Even if its boring or hard. You need to grab your fishing pole, cast the line, and wait for a nibble. Day dream. Paint. Garden. Hike. Buy some charcoals and one of those squishy erasers.

I know its embarrassing. Its not about creating a masterpiece, its about exercising your creative imaginal capacities so that your creative self is more engaged with the process of figuring out how to live a fulfilling live. Something quiet, and a little bit alone. 5 minutes! Thats all I’m asking! Fine, then just 3 minutes doodling and fantasizing and exercising your imagination?

Your imaginal world is going to give you far better advice than I can if you will just spend a couple of minutes listening. How will you be able to surprise yourself if you fill up every moment with email and texting eating and fretting, and TV and live-streaming, and errands, and work?

But I still I sit in my chair, week after week, year after year, trying to restrain myself but, of course, I crack, and indulge in re-re-re-reciting the most basic life prescriptions.

My words blow back to me like spit in the wind…

But random reinforcement is the most enticing: Every once in a while, one pushes through the icky feeling and finds the love of her life. Another, who had become hardened and frozen and cynical discovers his yearning for meaningful engagement with the world by listening to his dreams. Someone treats their thyroid and finds they have more energy for life. Two or three date nights reanimate an unhappy couples dormant sex life. A regular mediation practice slowly relieves life-long anxiety.

Just enough to keep me hooked.

I try not to. I know its dangers.
It almost never leads to anything good.

Except for when someone actually listens.

A quick note about this post: WG at Therapy Tales illustrated a silly, lovely distillation of this essay – Be sure to see the previous post for the charming result!

copyright © 2012
All rights reserved Martha Crawford

28 responses

  1. I love your comments about dating/being alone. So true, and it’s rare to hear “you are not less because you are not in a relationship”. This post is full of wise words! I’ll make that doctor’s appointment soon. :)

  2. Wow, am I some freak of nature because I will try what my therapist suggests even if it doesn’t make sense to me at first? I mean, I figure I am paying her because she knows more than I do about certain things. I even gave her the benefit of the doubt when she told me that sitting on a balance ball would help my anxiety (I still don’t understand how it works, but it does, so I do it.) The only thing I haven’t done yet that she asked was to draw her a genogram, but that’s only because I’m procrastinating asking awkward questions to certain family members.

    So is this just more of me being that weird person who actually reads the directions, or are you somehow attracting all the stubborn clients?

  3. Great blog today! So important that growth is a co created process. We have to all learn to be good parents to ourselves.

  4. My personal favorite as a therapist, is having suggested something a zillion times with no result; and then my client comes in and says, “My friend said I should do [the same thing I've been saying] and, you know what, she’s right!”

    It’s okay. I’m fine with no credit. I still get to enjoy watching the results in my client’s life! Reading the comments above, I probably said it to my therapist!

  5. My therapist has never suggested or advised any of those things to me (and I’ve been seeing him for 3 years), and I often wonder why. Especially since I am a 50 year old woman and I wonder if any of my problems can be due to menopause. But I don’t want to insult him by asking why he is not concerned with this, or to imply that my medical problems might be more important than my emotional problems. As for my therapist and my psychiatrist I would NEVER sign a release form for them to speak to each other. No way. I tell my therapist things I would never tell my psychiatrist, that is why he is my therapist.

    • A release would not in any way impel a therapist to “tell your psychiatrist everything” just the minimum data necessary to make sure your care is coordinated medically and that can be specified. “only with regard to managing psychopharmacological treatment”

      Say, for example, you are working through some specific episode of grief in your verbal therapy that is clearly related to a temporal, or historical external stressor and the MD interprets this as an exacerbation of depressive symptoms and increases your meds?

      Or the MD feels that you are becoming dangerously depressed and the verbal therapist is attached and hopeful, and you enjoy being a “good client” both reluctant to acknowledge that you are suffering more than either of you want to admit?

      Coordinated care doesn’t waive your right to confidentiality unilaterally- only with respect to coordinating medical treatment.

      Or, anti-depressants can sometimes trigger hypo-mania, or mania in people who have been misdiagnosed as depressed when they actually have an underlying cyclothymic/bipolar disorder. Diagnosis in psychiatry is rarely straightforward and often relies on trial and error to find the meds that “fit”. Mis-diagnosis is common, especially early on and the “wrong meds” can have serious consequences.

      Suicidality, agitation, sedation, toxicity, hypo mania are often first detected by the verbal therapists who are seeing clients weekly or more often.

      It is considered “best practice” by all professional associations – but rarely manifests because of busy schedules, the wish for autonomy among private practitioners- and as you’ve described- client resistances.

      It sounds like you have a system that works for you and your care providers…

      And I generally don’t communicate regularly with the doctors of stable clients who are pleased with their medical choices and treatment.

      But there are times when coordinated care is vitally important.

      .

  6. I love this. As a practicing psychotherapist I know people don’t take advice generally. I also know that the healing part of therapy isn’t in the understanding and light bulb moments .
    It’s far more abstract than that . It’s in the expression of emotions in my view. Sometimes to express real emotions the steps you describe so beautifully are catalysts to release that expression . The challenge also as a therapist is in being right. So your client finds your advice accurate , helpful , it “works” ?
    Now what ? They learn they need you to tell them what to do ?
    I love my work in equal measures as I hate it at times and this I suspect parallels the lives of our clients as like us they learn to live with ambivalence rather than seek certainty .
    Great article and so so true .

    • Thank you!

      It’s true that all of this creates a scaffold for the work to take place in, and can allow for for healing to proceed more smoothly- and also to allow for our own natural self-healing function to commence.

      The goal is to “prime the pump” and then retreat from being the initiatory source- allowing intuition and the visceral internal experience of “healthier”and well-being to become the inner guide!

      Thanks for reading and for your comments!

  7. Thank you for reminding this very tired mom to take a bit better care of herself. After I tend to the needs of the baby, the toddler, my spouse, the dog and a full-time job, there is precious little time for me. I savor my weekly 45-minutes of therapy as my “me-time” but come to think of it, I spend much of that time talking about my marriage, my children and my work.

    I can think of a million excuses: maybe I’ll have time for myself when I stop breastfeeding (and am no longer tethered to a baby or a pump) or maybe when the kids start sleeping through the night (I look forward to payback in the teenage years!) or when I land that new job with the shorter commute… But until that far-off day, thanks for the timely suggestions. Now the hard part – taking action.

  8. Pingback: Advice: Dismissed, Unheeded and Pooh-Pooh-ed | what a shrink thinks « andrea patten

  9. as i read this i thought, ” i do all of these things too with my clients and myself”…. and then the next thought was… “of course i do because i learned this from you (martha)!” so i thank you. also loved the bear blog- didnt get a chance to comment but thought that was brillian!

    • And I’ve certainly learned a thing or two from you as well!

      Thanks Perri. Its nice to hear that you are reading, and that it speaks to your own practice as well.

      Best,
      M.

  10. My dear: I thought you were good. Now I know you’re an outstanding writer and communicator! My advice, which you may or may not listen to: one of these days you need to write a book. Include these posts, and any other similar musings you may have that happen to feel right at the moment. This is the real thing and exactly what people need to hear right now. You come from your heart and truth. A rare gift.

    Gratefully,
    Jeanie

  11. Hi,
    I read it and thought for a while. I agree with the suggestions. At times it may come back to the are not able to hear the suggestions for some reason until they are ready. Maybe that comes from currently raising a 17 year old and having to let the rope out, watch him learn the hard way and kindly, gently assist in guiding him to pick up the pieces himself. Oh, how much easier it would be to do it for them and not have to be patient or repeat or wait. Then again they can only learn what they are ready when they are ready. And some of the best lessons come from making mistakes. Which are painful, remembered and valued.

    • I think it’s true – that it takes time to acclimate to new ideas- I wrote earlier about some of the reasons that we have resistances to such basic self care in earlier posts in the archives:
      The Lazy Illusion,
      Practice Practice Practice
      A Tale of Unmatched Socks and Miracle Chili.

      It is is rarely easy to feel entitled to care for ourselves, or to learn new self-regulatory skills or to surrender to change and release old habits.

      Thanks for reading!

      M.

  12. Pingback: June links round-up | Body, Movement, Art, Life.

  13. Oh yes! Sometimes I was I want to be clear and direct, and to have people listen and act! Sometimes I even say, “I know you’re not going to hear this right now, but lemme tell the future you. ..” silly therapist!

  14. As the parent of forty-something children I feel like we have a lot in common…I so want them to hear my advice, and try so hard to give it in the mildest, most non-threatening way, and have finally (perhaps!) learned to sit back and lovingly watch.
    I would say I enjoy your blog, except that sometimes ‘enjoy’ is not the right word. Your blog about the most painful moments hit me like a sledge-hammer. I am good at remembering the most painful circumstances of my own life, but your comments helped me to put them into perspective.
    I sincerely appreciate your blog. You always give me food for thought.

    • Thanks very much.

      I’m glad its helpful – and yes – sitting back and watching, for good and ill, with acceptance is often more productive than the best advice!

      Thanks for reading.

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