A Client Question: “Who don’t you counsel?”

Mostly I ask questions to my clients. But I receive lots of questions as well. Here is one: “Are there some people you don’t counsel because you don’t think you will be successful?”

That’s a good question and with some people I am less capable than others.

I think that I work best with couples and families, though I do see lots of individuals. As a therapist I watch 3 factors – I call them 3M: motivation, match and method.

Motivation is what the client(s) bring to the sessions. Some come to change. Others come for support to stay the same (this is by far the minority). My job is to assess motivation and this is the best indicator of therapy success.

Match is the connection between the therapist and the client. This has a lot to do with shared values and hopes. Mostly I experience empathy for my clients and this is a huge factor in success.

Method is about the particular strategy. Marriage counselling skills are not very helpful with someone experiencing a major depression or recovering from rape trauma. Where I don’t know the method, I ask for training or supervision. Or I may well refer.

So there are some people I don’t counsel because I won’t be the best for them. It is based on the 3Ms. And if I say “not now” to the request, I work to find a best referral for the person asking for help.

Two Boxes

Some of you know that I am a professor at Carey Theological College at UBC and that I have a private practice in psychology in West Vancouver. In both places I am aware that I work with my head and my heart, sometimes more of one than the other. When I meet people for the first time, I often make quick judgments of them as primarily heart-people or head-people. I guess I put them into boxes.

Box 1 is the empathy-compassion box. These are the pastoral, giving folk I meet. They emote integrity and doing right is most important to them. They might give you their last dollar, as did the New York policeman who gave a street person his warm socks and winter boots (this was reported in the news last week). Heart people are friendly, trustworthy, sociable and want to be helpful. These folk are the “heart” of churches, families, community centres and everywhere people are considered more important that programs. They have high social and emotional intelligence. They think with their hearts.

Box 2 is the competency box – this is the head box and it includes thinking intelligence, the ability to solve problems quickly, express creative ideas and fluent thoughts. These people are often motivated by success. They are typically problem solvers and talkers more than listeners, though they often do both. (At this point, some of you are liable to say something like, “This is exactly like my husband!” but in my meeting of people, women are as often to be thinkers-solvers as men.) The competency people are my go-to friends when I have a computer problem or when I need to consult on a difficulty in my life or in my work. They don’t hold my hand and emit sympathy – they get to the problem and figure out how to fix it.

I have found that Box 1 people (the warm-hearted ones) admire Box 2 people (the competency folk) and that Box 2 people wish they were more Box 1-ish, especially with intimates. Someone said that the difference between thinking with your head and thinking with your heart is only about a foot! However, the distance between head and heart is immense when one is stressed or in conflict. Then we tend to polarize around the value of thinking (“What you are saying is illogical. Can’t you hear yourself?”) and feeling (“You don’t understand what I am saying! Just listen to me.”).

When we first meet people most of us have intuition about whether he or she is more of a heart-person or more of a head-person. And we may warm to one over the other depending on the context. Recently I went to a social gathering that I was not interested in attending and I found myself cornered by a hyper-competent, business guy who wanted to tell me the evils of religion. I told him, “I know something about that” and he carried on without pause. I hoped for a little understanding from him, but his speech was well-practiced and thorough. Actually, I quite enjoyed the discussion once I figured out he was a Box 2 guy and that he was exercising his competency muscles. I flexed some of my Box 2 stuff as well.

It seems to me that intellectual competency and heart ability make for a healthy and soulful dyad in relationships and within ourselves. It also seems to me that this is the best competency in teaching and counselling, the best in conciliating and problem solving (though not the best in argument-winning), the best in movie-watching and in Christmas-present buying. And in novel reading, and friendship-making, and…

“The Female Brain”

I am reading “The Female Brain” (2007) by Louann Brizendine, a neuropsychiatrist at the University of California, San Francisco and founder of the Women’s and Teen Girls’ Mood and Hormone Clinic. I had read “The Male Brain” (same author) and felt understood – now that is a compliment. But as well, a bit boxed in without the freedoms and capacities I think that men have. However, it is probably timely to understand my wife and so I have launched into her older book on “The Female Brain.”

Here are some of the things I have read, enjoyed and wrestled with:

(1) “Men use about seven thousand words per day. Women use about twenty-thousand words per day.” I know that Carole often asks me, “What are you thinking” when I don’t really have any words for my thoughts. In fact, I am not sure I am thinking at all. More cognitively muttering.

(2) “Girls arrive already wired as girls and boys arrive already wired as boys.” This is certainly the case for my 2.5-year old grandson. Loves trucks, shouting his “outside voice” around the dinner table, playing pirates with a hooked finger and a mean sounding “grrr” (taught to him by his aunt) – if this is part of what it is to be a boy toddler then he seems to have been born this way.

(3) “Men are on average twenty times more aggressive than women.” Makes no sense to me at all. I have talked with lots of female client-friends who are the clear aggressors in their parenting and marriage. And their husbands / partners / kids agree. Seems more personality-driven than gender-caused.

(4) “Girls are motivated — on a molecular and neurological level — to ease and prevent social conflict.” Interesting. I am aware that men are often domesticated by women, especially in marriage and so become less competitive over time. But many men are “rescuers” in relationships equipped with a dominant fear of harming the significant other.

(5) “85% of twenty to thirty-year-old males think about sex every fifty-two seconds and women think about it once a day – up to three or four times on fertile days.” No wonder math scores are plummeting. Actually, I have heard this so often I think it must be a suburban myth. What I do know is that men can control their thoughts and lusts however frequent and that this self-control reduces the obsessional, minute-by-minute interruptions. I don’t think that most men are victims to their sexual impulses.

(6) “Men pick up the subtle signs of sadness in a female face only 40 percent of the time, whereas women can pick up these signs 90 percent of the time.” Maybe for some men but it is not true for me. And I am aware that men can learn to discern faces and the differences between sadness and tiredness, or hurt and anger.

(7) “65 percent of divorces after the age of fifty are initiated by women.” A divorce initiation, by a man or a woman, is a response to something else, usually a hurt or a harm. Subjectively I think that men typically break covenant for another relationship, probably sexualized, while women break covenant for peace and quiet or differentiation (“find out who I am again”).

The thesis of this book is that the female brain sees the world differently and reacts differently than the male brain in every stage of life from newborn to old age. Sweeping in its generalizations, I feel like I know women less by Brizendine’s research or at least I have to think more about what I think about men and women.

(1) I think that men and women are not “opposites” but “equal others.” Opposite-thinking looks for differences, creates misunderstanding and minimizes similarities.

(2) I think that men and women have strengths and abilities based on context, culture, circumstance and that both or either can lead or submit (the latter I see as a great strength), create or appreciate, initiate or complement.

(3) I think that emotional-sexual resourcefulness is distributed to the species in a higgledy-piggledy way with men typically being the sexual initiators (80%?) and women typically being the emotional initators (80%?). This is more of a clinical guess than research. And we can learn and practice and benefit from the other’s strengths.

There is a wonderful King James description in the Bible about men and women in relationship. “Helpmate” is the ancient word. It means help appropriate to another or resourcefulness sufficient for another. I think that man is sufficient for a woman and woman is sufficient for a man and they can be more than sufficient by empowering each other. More than hormonal or biological differences.

Fiddling with the State of Being

I grew up in a home where alcohol ingestion was done compulsively. I discovered as a child that the drinking compulsion is an equal opportunity phenomenon – both my Mom and Dad were serious imbibers. I also learned that my parents and their friends formed an alcohol-conscious community where successful parties were granted the status of “great” by the quantity imbibed and the consequent sexualization of intimacies.

My parents were trained in drinking by the Canadian Forces during WW2 when service men and women had their pleasures subsidized by the government. I am reminded of this each and every November 11th and sometimes I stop to tell the “poppy people” why I am not buying their red and black lapel flowers while I stride righteously into the liquor store.

Over the years I have had lots of addicts of various sorts in my practice. I prefer to call them “obsessive fiddlers with states of being” – it sounds less prejudicial than “addicts” though that is what some of them are. These fine folk and friends have been compulsed by all sorts of obsessions: being happy, being right, being perfect, being taken care of, being in love, being admired, and the list goes on. (Perhaps making lists is a compulsion too?) And then they act these ideas out with predictable behaviours: drinking and drugging are common but so is arguing and defending and mean-spirited criticism. I especially dislike it when addicts pretend the moral high ground (e.g. “You are a bad person and I am busy being good or right,” or “I wouldn’t drink if you didn’t criticize me so much.”).

I often hear of sexual addictions as well. These are usually requests for affirmation and attention where the behaviours involve a moving computer image and a few square inches of genital flesh. What these folk want most often is some ordinary passion and some affection directed in their way. At least that is what heals them (mostly men) more than “Just Say No” mouse pads.

Now… I think that there are factors that may increase risk of some kind of addiction. Here are a few for you to consider and I am thinking especially of online compulsions:

♦  Fear of relationships can lead to online compulsions. I mean real relationships not surface social contacts. And a consequential lack of other interests and social isolation – this can lead to compulsive behaviour.
♦  Pre-existing abuse or addiction can easily transfer: for example, online gambling or gaming, cybersex, or online shopping.
♦  Social anxiety or nervousness can make online interactions a very attractive alternative to face-to-face interaction and thus much more compelling.
♦  Low self-esteem, poor body image, or untreated sexual dysfunction can add to obsessions and compulsions.

What fixes this more than anything else is a little reality and a little thoughtfulness. Person-to-person honesty and care, also called empathy, works well. I have found that Cognitive Behavioural Therapy is really good in breaking the power of addictions and compulsions. I recommend people buy “Mind Over Mood: Change How You Feel by Changing the Way You Think” by Dennis Greenberger and Christine Padesky. It is best to work this through with a therapist and I have a copy in my office so that if you choose we can work through the harder parts together.