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