Self-Sabotage: Significance and Strategies

“Self-Sabotage is when we say we want something and then we go about making sure it doesn’t happen.” Alyce P. Cornyn-Selby

You may find yourself after the fact, stating you don’t know why you did it.  Why you ended the relationship when nothing was wrong. Why you walked out of the job after only a month. Why you picked a fight and got kicked off the team. These are just a few examples of when someone may have engaged in self-sabotage. And the question is, why?

Under the Iceberg

Identified as the founder of Psychology, Sigmund Freud once described the mind as an iceberg. The tip of the iceberg above water was our conscious or thoughts or feelings we are aware of, and accounts for roughly 20% of our mind. The other 80% under the surface represents unconscious, and represents things we are not yet aware of to better understand our behaviors.

Mark Tyrell, Self Help author of “Self-Sabotage Behaviour can come in many forms,” identifies four common reasons one may engage in self-sabotage.

#1 Anticipatory Grief

For some of us, the familiarity of failure is a painful, somewhat predictable experience. We may go through our world anticipating loss, or anticipating when something good, something we enjoy, is going to switch, fall, end, or fail. Perhaps you can relate to the following thoughts of anticipatory loss or end:

• I’m waiting for the other shoe to drop.

• This is too good to be true.

• What’s the catch?

• Nothing good lasts for me, when will this go south?

Because these thoughts have a lot of power, you may find yourself engaging in a belief that you don’t deserve good things. Or that you are doomed to suffer and that failing is inevitable. Similar to self-fulfilling prophecy, you may find yourself predicting the outcome, and in this case, it’s negative. With these thoughts in mind, you may find yourself also subscribing in the second reason one can engage in self-sabotage.

#2 Control Freak

If we truly believe something good is going to end badly, we may want to be in control of the outcome. Have you ever found yourself thinking:

• I’ll just end this relationship now, it’s less painful in this moment than when it ends months or years from now.

• Better to leave this job before I get fired.

• I already know they are going to say our friendship is over, so I’ll just stop talking to them and get it over with.

We may convince ourselves that feeling in control of the failure in this moment can hurt less than something that comes on suddenly, out of the blue, or later when our guard is down.

#3 Boredom

The experience of our guard being down and everything feeling predictable can lead to discomfort as well. Predictability can lead to boredom, which can also be a reason to self-sabotage. If we go from feelings of chaos and excitement to monotony and boredom, Mark Tyrell states, as one example, we may find ourselves picking a fight with someone for no reason at all. Perhaps just for the alive feeling we get from adrenaline and excitement. Do you find yourself engaging in any of the following:

• Picking a fight when you aren’t upset

• Looking for trouble in new environments

• Engaging in substance use

• Relapsing when no trigger is present

#4 Feeling Unworthy

Relapsing when not triggered can also be due to feelings of low self-worth. Maybe you feel you don’t deserve success or happiness and instead, engage by punishing yourself and setting yourself up to fail. This can represent the cornerstone of self-sabotage in wanting something and doing everything in your power to not achieve it, basically going the other direction from success. When explored further, many truly believe they “aren’t worth it” and engage in behaviors that prevent progress due to those negative beliefs.

#5 I’m Unprepared

One final example of self-sabotage to consider is the feeling of being unprepared. Perhaps you don’t feel ready to end a support program and so you relapse to remain involved with probation or the treatment community. An observation of those in the legal system is that they don’t feel they have resources on the outside, so they find themselves committing a petty crime to be reintroduced into the environment that feels most familiar. You don’t yet feel prepared to do this on your own and so you create a reason to not be on your own.

So where do you go from here? For many, just the awareness of why one engages in self-sabotaging behaviors can be a powerful process in exploring needs and change to more positive behaviors. Being aware that you are not alone in the reasons for self-sabotage and talking about the challenges can be a healing journey towards self-love, acceptance, and success.

For additional ideas of how to manage self-sabotage, you can check out Mark Tyrell’s “Self-Sabotage Behaviour can come in many forms,” at http://www.uncommonhelp.me/articles/stop-self-sabotage-behaviour/  

“In order to succeed, we must first believe that we can.” Nikos Kazantzakis

Engaging Adolescents and Caregivers in Family Therapy

“Do I have to do family therapy?”

Yep, that's such a common question I get from my adolescent clients at the start of therapy. Here are some other common questions and statements a therapist may receive in regards to parents and caregivers being a part of an adolescent's therapy process:

"So how much are you going to tell my parents?"

"I hate these family things; i just feel so awkward."

"Do I have to be in the room when you talk to my mom/dad/guardian?"

“I’ll talk to you, but I will not talk to my parents about this!”

“Why try, nothing is going to change!”

“They/she/he just doesn’t understand me.”

Do any of these sound familiar in your therapeutic work?

When reflecting on these common initial responses and questions about family therapy, it has been my professional experience that I see a clear pattern of fear, lack of trust and shame arise as barriers to adolescents getting their needs met by their caregivers. Additionally, many adolescents seem to have a common misunderstanding (and caregivers too) that family therapy is about pointing fingers and being the “problem” of the family. So with this in mind, I’m excited to share some strategies I use to build rapport, connection and trust with adolescents to empower them in engaging with caregivers in family therapy.

1) Be Transparent! In other words, BE REAL with your client. Adolescents are smart, clever and can read through any BS or tip-toeing going on in the room. I give them the direct and transparent version of confidentiality and expectations of what therapy entails. 

“I know you may or may not be wanting to communicate certain things with parents, but I want you to know what I must report immediately. Any safety concern including suicidal ideation/planning, abuse, neglect, witness to violence, and self-injury must be reported to caregivers or appropriate authorities. With that being said, there may be things that come up that you are not open to sharing but would be beneficial to do so in order to get your needs met from your parents/guardians. When this happens, I want you to know I will challenge but not force you, and together we can figure out the best way to schedule a family session around it when you are ready.”

2) Build trust immediately: I know this one is a given, but I start with every first session letting my adolescent client know that I don’t expect them to trust me right away in an effort to ease any tension or pressure someone might feel.

“I want you to know that I don’t expect you to trust me right away. Trust takes time and is earned so that’s exactly what we are going to do. We will take time to get to know each other. You can ask me any questions you need to about myself or the process. I’ll let you know if I can’t answer it for any reason. And I want you to know if I ever ask or discuss something that you are not ready to answer, you say so, and we will use the time for what you are ready for and need. This is your time and space, and I want you to feel safe.”

3) Share the responsibility and “workload”. It’s essential to dispel any myth or belief with the adolescent and caregivers that a) they are the problem child and b)your job is to “fix” them in some way. Again, this is where I use transparency in the first session or parent consult (as well as throughout ongoing treatment) to set clear expectations for all involved.

To caregivers: “I want you to know that if i’m working with your child, I’m working with you also.  In many ways, this work can be equal or more for the parent.  My job is not to “fix”. Rather, i’m here to provide assessment, education, skill-building and a safe space to process and build awareness so that you and your child can more effectively communicate, understand one another and connect in a meaningful way to address the barriers.” I always let adolescents know that I’ve had this conversation with the caregiver(s) as well so they know it’s a joint effort.

4) Empower the adolescent voice. I like to give my adolescent clients as much choice and opportunity to lead as possible when it comes to parent involvement. Here are a few different ways, I frequently go about this in session:

“Would you like me to check in with mom/dad alone or with you it the room?”

“Is there anything you’d like to share with mom/dad/caregiver from our session today?”

“Is it alright if we bring mom/dad in at the end to share any skills we worked on so they can practice it too?”

“Is it ok if I emailed mom/dad about (a specific one or two things from session) so that they can be more aware and better understand what you are going through or how to support you?”

“Is there anything you want to teach mom/dad today?”

“Would you like me to explain (specific pattern or skill) for you to caregiver with you in the room?”

“Would you want to do a family session with mom/dad on this? If so, when do you think you’d like to do it?”

5) Parent Coaching Sessions are a must! Along with letting parents and adolescents know that this is joint work, I let them know that some sessions will be just with the parent(s). I am transparent with the adolescent and parents about the purpose of these sessions from the start.

“These sessions with your mom/dad are NOT to report all that you’ve said or processed in session. Instead, they are an opportunity for you parent to explore their own barriers getting in the way of supporting or connecting with you. I will always let you know when i will be having a session with you parents in case you have any questions or anything you would like me to share or work on with your mom/dad.”

To caregiver: “These are sessions where you can explore challenging emotions, patterns, behaviors that you are struggling with that might be acting as barriers to your relationship with your child. The main goal is to empower you as a caregiver and strengthen your relationship.”

6) Provide Outside Resources to Caregivers and Adolescents from the start.

At the end of an initial session or consult, I provide at least one book and internet-based resource that will help parents get a head start on some of the topics and ideas we will be addressing in therapy. Throughout the process, I continue to provide both the caregivers and the adolescent ongoing supports based on what is coming up in therapy and what the family barriers may be.

Some of my favorite resources are:

Ted Talks: Especially for the adolescent and caregiver to watch together at times.

Wellcast videos: Here is one of my favorites, but they have them on all topics! I often show to adolescent in session and send to both caregiver and adolescent after session. https://www.youtube.com/watch?v=UMIU-Uo8cZU

Phone apps: mood meter, calm.com, Headspace are just some of my favorites.

Books: there are so many; here are a few favorites

The Gifts of Imperfection, Daring Greatly and Rising Strong by Brene Brown (also has great ted talks to introduce the concept of vulnerability and shame)

Whole-Brain Child, Yes Brain and Brainstorm by Dan Siegel and Tina Payne Bryson

Emotion Focused Family Therapy resources: This includes caregiver webinars and in-person workshops, book recs, links to articles, etc. All greatly support parent coaching and family work. http://www.emotionfocusedfamilytherapy.org and http://www.mentalhealthfoundations.org are two helpful websites.

Review/summary emails: These I send with adolescent permission to specifically review a skill, idea or new strategy that would be helpful for the caregiver or adolescent from session. This way, they can refer back to it as needed.

Engagement with adolescents and parents can be difficult at times, but I have found the more i’m able to focus on empowering families and setting clear expectations of what family work is and isn’t, the more willing adolescents and caregivers are to engage in the process. My goal is never to be the one the adolescents trust or “go to” the most, it’s to help them build that with their parent(s) or caregiver to be able manage their challenges and barriers in life in a sustainable and connected way.

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Guest post written by Meaghan Burns Sablich, LCSW

Meaghan Burns Sablich, LCSW is a Licensed Clinical Social Worker, Licensed Colorado State School Service Provider and clinical supervisor with 10+ years experience in the field. Meaghan received her Masters Degree in Social Work from the University of Denver with a concentration in Families and Children. Meaghan has worked in a variety of therapeutic settings including inpatient hospital, residential treatment center, day treatment center, schools, non-for profit organization and private practice. Areas of clinical focus include: depression, anxiety, ADHD, eating disorders, family therapy and parent coaching, grief and loss, school/learning concerns and self worth work.

Atlas Complex: The Weight of the World

Have you ever felt like the weight of the world was on your shoulders? Like you have to take on all the projects, help everyone around you, just to maintain a sense of order? By modern standards, this experience is identified and defined as the Atlas Complex, thus describing a need to take on all the responsibility and all the stress of the world as you navigate through it. Why would one experience the state of mind that they must take on the world? There are many reasons that encourage the behavior of being responsible for everything around us, including internal and external factors that drive us to action in search of relief.

Need to be Needed

One external motivation for taking on the world can be our relationships. For some, the avoidance of conflict by saying yes to others’ needs is enough of a reason to take on more than we can handle, and to make do for the sake of friendship, approval, or respect. Connecting and helping others isn’t all negative, however when our own needs are sacrificed for others with no opportunity for self-care, resentment, burnout, and poor mental health can follow. So how do you know if you are experiencing symptoms of the Atlas Complex in the scope of relationships and boundaries? Below are some questions you may ask yourself:

• Do you secretly resent the request to help but feel you can’t say no?

• Do you feel like you are the only one who can help, so you say yes?

• Do you feel like you have to say yes out of avoidance of conflict or judgement?

• Do you fear disappointing someone if you don’t take on their request?

• Do you need to be needed? Do you feel most worthwhile when helping others?

It isn’t uncommon to identify with one or more of the questions above when connecting with others. One way to check in with yourself around your boundaries is to explore how you are helping yourself in addition to others. Remember that you can’t take care of others if you don’t take care of yourself first. Similar to the airline directives about oxygen masks, you must first put on your own oxygen mask before helping others, implying you are no good to them or yourself if you aren’t conscious from lack of oxygen in trying to address others’ needs before your own.

Escalating Anxiety

Having solid definition of your boundaries with others can be important in having quality relationships and can also improve expectations of what you are able and willing to do to help. You may feel anxious enforcing new boundaries when they weren’t present before, especially if loved ones’ question or push back against new boundaries out of confusion around the change. Change itself can also be a trigger for anxiety. The Atlas Complex can be present out of a desire to control something because you feel out of control in other areas. For example, if you feel like you can’t control the declining health of your parent, you may find yourself controlling your living environment, cleaning compulsively, and snapping at your partner when small messes are left in the kitchen. This increased irritability and urge to control several things at once manifests in response to internal anxiety that isn’t as easily controlled, making things more difficult in your relationships, work, and home life.

Awareness of your anxiety can be a first step in addressing it in healthy ways. By being aware, you can track patterns and make changes in your thoughts or behaviors, which can then have a positive effect on your emotions. Below are some ideas of what you might say or do to address the anxiety you feel:

• Change the scene. Try getting out or away from an area that aggravates anxiety to gain some relief or perspective on what’s happening in your life.

• Move your body. Movement can help reduce anxiety in the form of exercise. Take a walk to think things through, which helps anxiety by both serving as light exercise and as a processing tool, giving you time to explore what’s happening that stresses you out.

• Think happy thoughts. Studies show that how we interpret a challenge can impact our anxiety.  For example, if we think, “nothing will ever change,” our emotional reaction will feel heavier and more helpless than if we think “this is temporary, I can do this.”

• Try coping skills. Taking a drink of water, breathing, listening to music, or healthy distraction can help address the anxiety you feel to make it more manageable.

Managing the Atlas Complex and all it represents can have positive effects on your mood, relationships, and life. Check in with yourself frequently to determine the motivation behind urges to hold the world on your shoulders and you may just find that the world looks and feels lighter than it once did.

“Optimism is a happiness magnet. If you stay positive, good things and good people will be drawn to you.” Mary Lou Retton

Making Meaning of the Dance: A Journey Through the Couple Cycle

“From the cradle to the grave, humans desire a certain someone who will look out for them, notice and value them, soothe their wounds, reassure them in life’s difficult places, and hold them in the dark.”
The practice of Emotionally focused Couple Therapy: Creating Connection by Sue M. Johnson

The Tango, The Charleston, The Swing, and The Cha-Cha. Yes, I know these are famous dances, but I would like to talk about another kind of dance. Within a relationship we all long to move toward our partner. To sway in the rhythm of passion, and desire. We long to feel the power of true connection that comes with being able to say “I need”, and get a loving and empathetic response in return. The dance I’m speaking of is the common relational exchange called the Emotionally-focused Couples Therapy Cycle. Emotionally-Focused Therapy or EFT as it is commonly referred to was the forward and remarkable thinking of Dr. Sue Johnson. In the 1980’s very little in therapy was being done to explore the scientific concept of adult attachment, which is a stark contrast to this same time period when so much emphasis was being placed on the continued study of childhood attachment theories and models. As Sue begun to delve into the attachment science, she began to see a potentially incredible model that could not only address attachment injuries both from childhood, and adulthood, but could systematically uncover relationship fractures, and invoke new and lasting connections. According to the ICEEFT website using the EFT model leads to couples being to move from distress to recovery 70-75% while 90% of couples showed significant improvements.

So how does this beautiful, and empirically proven model work? Well then, let’s begin!!

EFT is made-up of 3 stages i.e; Assessment and Cycle De-escalation, changing interaction patterns, and creating new bonds, and consolidation, and integration.

STAGE 1: ASSESSMENT AND CYCLE DE-ESCALATION

1. Ascertain primary concerns, and set couples goals. Then, explore relational history.

2. Interactions, and patterns are explored, and delineated. Therapist supports and assists in seeing historical interplays that have negatively impacted the coupling.

3. Partners comprehend attachment-related emotions. Couple first acknowledges covered emotions, and feelings, and discuss those emotions, feelings, and behaviors with their partner.

4. Couple and therapist with analyze cycle, triggers, and behavior output which results in two defined roles which are pursuer, and withdrawer. Therapist will also be mindful to notice, and name triggers present in the cycle.

STAGE 2: CHANGING INTERACTIONAL POSITIONS AND CREATING NEW BONDING EVENTS

1. Space is created for transparency in order to state attachment needs, for which partner had not received in the past, which cause bond fracture.

2. Couple develops the ability to compassionately respond to identified needs, and begin to accept the hurt, longing, and emotions that have been impacted by their partner.

3. As cycle awareness increases, and new cycle, and interactional goals are practiced new conversations and interactions present themselves, which increases likelihood of bonding experiences.

STAGE 3: CONSOLIDATION/ INTEGRATION

1. Couple integrates techniques, communication, and transparency, as they discuss the old cycle, and practice the new one. Practice is done outside the sessions in their own environment that exposes them to their domain that has been a potential trigger. Work with the therapist explores issues that came from those practices, and post conversations.

2. With heightened awareness of skills, and deeper bonds couple and therapist focus on the celebrating efforts, and future methods to enhance new found rituals. To safeguard couples success, and decrease history of emotional breaks safety risks are addressed and prepared for.

Real-life example:

In an EFT therapy session, a wife pursues her avoidant and emotionally absent husband. Her protest becomes a sense of loneliness, abandonment, and sadness that she no longer feels connected to her spouse. In the past she felt that she was assertive, and asking for her needs to be met, by demanding, yelling, screaming, and sometimes becoming violent. Over a period of time, her protests turn to withdrawal, as her pleads go unanswered, and she is tired of getting so big to be seen, but yet still remains invisible. “I want to be wanted, loved, and cherished”, so please stop avoiding me, walking away, and pretending that my yelling doesn’t mean more.

Her husband’s stark hallow shell, becomes empty, but rumbles underneath as a fire, and a quiet storm brews behind a cold and distant face. The separation turns from heartbreak to fury, as he doesn’t understand why his wife hates him so much and just wants to yell at him all the time. “I walk away because it hurts”! “I leave because my space no longer feels safe, and threatens any bit of quiet we have left”. “Why can’t you just see, that you are tearing us a part”.

She has grown, learned, and observed the hurt, and pain that both her and her partner are experiencing. This shared pain has given her a new perspective, and has gotten her closer to a man that she felt was lost. She has discovered that she can still be seen as she quiets the storm of her own pain, and brings her partner closer and shows him that loneliness that brought her right to the edge. He has found the passion, and strength to expose his vulnerability and deep need to be loved, and comforted without fear. His transformation travels from “you don’t care, and your cruelty is just too much”, to “this is really hard, for me, but I want to trust this feeling”. “Please be with me, and make me feel safe within this relationship”.

New cycles of closeness contact interactions appear and dissipate previously established cycles, criticize-defend or pursue-withdraw, withdrawer reengagement, or pursuer softening. As the partners experience the cycles together in safety and empathy these behaviors are reinforces, which leads to a positive and permanent change. Space for healing, and a new sense of having a brand-new safe haven sparks connectedness, and fulfillment previously missing.

“EFT can be thought of as a postmodern therapy in that EFT therapists help clients deconstruct problems and responses by bringing marginalized aspects of reality into focus, probing for the not-yet spoken, and integrating elements of a couple’s reality that have gone un-storied.”
Becoming an Emotionally focused Couple Therapist: The workbook by Susan M. Johnson

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Guest post written by Jamie Benson MFT-C, M.Ed, EFCT

Jamie Benson MAMFT, MFT-C, EFCT, M.Ed has been providing therapeutic services to Denver area children, adults, couples and families since 2015. She holds a Master’s Degree in Marriage, Couples, and Family therapy, as well as a Masters Degree in Education with an emphasis on Applied Behavior Analysis. Jamie currently works at Allhealth Network in Littleton Colorado and her work is centered around at-risk populations, including human trafficking, homelessness, human services, PO/probation, and substance abuse.

Community Confidentiality: Supporting Collaboration with Consent

“I cannot confirm or deny.” How do you maintain confidentiality for your client? It may seem easy enough when there is a clearly written, signed release or when your client refuses a release, thus declining collaboration at this time. However, what does it look like in the following situations?

• Your client is involved in an open Child Abuse and Neglect case.

• An attorney calls you saying they represent your client and would like copies of your client record for a disability claim.

• An insurance company calls to report the client listed you as a provider and they want to know your diagnosis to award the client a life insurance policy.

• You outreach an organization about who they serve. They respond by wanting to obtain additional information from you on the client you want to refer.

• A referral source wants to know if their client called to set up an intake and begin services with you.

• A community resource shares that your client scheduled an appointment with them for next week.

• A foster parent wants to know why the parent isn’t engaging in services to reunify with their child.

• A CASA volunteer wants to know if the family is working on their fighting in your sessions because they believe it would be helpful.

• The spouse of your client calls asking you how sessions are going.

• Your client acknowledges that their friend is also your client.

• Their probation officer includes you in a group text or email to schedule a meeting on behalf of the client with several parties you don’t know.

These are just a few of what could be dozens of examples of sticky situations when it comes to maintaining your client’s right to privacy. Let us look at possible responses to the above scenarios to determine what could be best. And as always, seek consultation, supervision, or legal advice if you have needs or concerns.

Signed Release

When a third party reaches out to you by email, text, or voicemail, it can be helpful to notify your client and obtain a release in the next scheduled session. Notifying your client of the outreach you received can support trust and transparency in the therapeutic relationship. It can also help facilitate a discussion on the importance of getting a client’s written permission to respond to an inquiry on their behalf, whether it’s an insurance company, secondary referral, family member, or community partner.

Legal Requirements

Perhaps your client is involved in an open Abuse and Neglect case, diversion, or probation. These entities have been assigned to your client as part of a larger treatment plan to address a legal concern. Whether your client is mandated to complete therapy or the third party referred directly to you, there is a different level of confidentiality implied due to the collaboration needed from you to provide progress reports and updates as appropriate around your client’s engagement in services. If you client is resistant to signing a release, helping them identify the specific pieces of information to share—and thus restricting some information in the effort of privacy—can be helpful to the client’s anxiety about personal information that is disclosed to others. When submitting a progress report to DHS or probation for example, providing your client with a copy can also demonstrate a sign of transparency and trust in encouraging them to review it and provide feedback on their level of comfort with the material shared.

Sense of Urgency

The desired scenario is one of those mentioned above, where we have the client complete a signed release of information highlighting exactly what is released and for what purpose. However, there are times that a sense of urgency may arise in getting permission quickly to collaborate with a community partner in a timely fashion. Depending on the frequency of client contact including regularly scheduled appointments, you may need to get email or verbal permission over the phone from your client as a temporary measure in obtaining consent prior to a written release. Standard practice is to have permission in writing so email can feel slightly more comfortable than verbal permission to us as providers. Either way, documenting your client’s permission with intention to get a full release in the immediate future can be helpful in allowing collaboration and sharing of information under a time restriction.

Curbing Curiosity

Collaboration is a helpful component of therapy, within reason, to support and validate client efforts. It may become apparent that there are other parties involved who may want updates on your client’s progress. This could include caseworkers, probation, child advocates, other mental health providers, foster parents and more. Where it can feel confusing is when third parties know you are actively working with the client and make assumptions that you can share information in the spirit of collaboration. For example, the foster parent is wanting to know how the parent, your client, is doing in services in order to encourage their child of the parent’s hard work. The inquiry may feel innocent enough, however the foster parent is not your client, and is therefore not privy to this information without your client’s consent. Something as innocent as attendance or participation in services can be reported back to other parties and could result in information being misconstrued or shared without permission.

Encompassing Electronics

In an effort to not have information shared unintentionally with third parties, being mindful of how your electronic correspondence is recorded can be helpful. Being aware of emails with additional recipients or group text messages requesting scheduling of a team meeting can feel nebulous regarding confidentiality. Documenting your effort to send correspondence only to approved parties identified on a signed release supports your client’s wishes as well as ethics compliance. Providing disclaimers in your electronic signature in email composed on your computer or phone can also support limiting liability if information is sent to the wrong recipient or forwarded to a third party outside of your control.

Limiting Liability

Documenting each of your efforts to maintain confidentiality as a standard of your practice can limit liability. Obtaining regular releases yearly from your client can keep their record up to date. Utilizing encrypted email and electronic health records for client progress notes can restrict situations where their information could be compromised. When it comes to confidentiality in direct interaction with third parties, identifying a statement of “I cannot confirm or deny they are my client” can feel unhelpful, restrictive but necessary in not admitting unapproved information to family, friends, referral sources, or legal representatives without permission. This feels most challenging by phone when even acknowledging your need to obtain a release is admission of your client’s connection to you. For many, having to share that a release has been revoked can feel even more challenging. You may say something like “permissions have been revoked and we suggest you contact the person of interest directly” can provide enough information for them to understand you won’t be interacting with them further and prevents direct identification of your client by name or circumstance.

Communication with community partners is an intricate dance that can feel challenging when caught off guard by emails, texts, or phone calls asking for updates on your client’s work. Demonstrating your ethical capacity in delaying disclosure of information until a release is obtained can indicate your professionalism in the community and willingness to collaborate under the appropriate circumstance. Be sure to follow up with the community partner once a release is signed to further demonstrate your willingness to collaborate together. Lastly, thinking about the possibly scenarios that put privacy at risk and obtaining signed releases upon introduction to the client can streamline this process by simply asking who else is involved in their treatment or care. Having a scripted response ahead of time for situations where a release is not yet completed can support you in making the best decision to support client confidentiality and community engagement with consent.

Goal Setting: Measurable Motivation

As the year comes to a close, you may be looking to the new year to create resolution or revisit goals in the hope of change. It’s a time to explore goals that are measurable and attainable; it’s a time to create small steps to build self-confidence to remain motivated and hopeful. Perhaps you say “I want to join a gym to help my depression.” You want to work out every day to help your mood but aren’t currently working out on a consistent basis, and not at a gym. So, you find it important to explore your motivation as well as the perceived strengths and challenges of reaching your goal. You learn that smaller steps can support success and agree to working on short-term goals to build confidence and to move towards your long-term goal of working out daily.

Monitoring Motivation

Why is it important to explore motivation around a goal? Research tells us goals around fitness and gym attendance peak in January and dramatically decline by February and March every year. Additional research tells us that we must do something consistently for a minimum of 30 days for it to become a habit. What this conveys to us as human beings is that we need to see results or progress to continue to work hard at a goal. You may normalize this for yourself in understanding the pattern of motivation. You may also explore research on the Stages of Change from Motivational Interviewing as a visual to support yourself in identifying strengths and barriers to change. By being open and honest with yourself, you will be setting yourself up for success. Ask yourself the following questions to fully discover where your motivation lies (and note the Stages of Change in parentheses):

• What do you want to change? (Precontemplation to Contemplation)

• What makes that a problem for you? (Contemplation)

• Is it a big enough problem to want something different? (Contemplation)

• How would you achieve the desired change? (Preparation)

• What do you need to support change? (Preparation)

• What would help you to begin? (Action)

• How will you know when you are ready for change? (Action)

• What would help you keep going? (Maintenance)

• Who/What would hold you accountable?

• What would happen if you don’t succeed?

By exploring these questions, you can identify any current strengths or barriers to succeeding and further explore what is needed to progress through the Stages of Change.

Make it Measurable

It isn’t uncommon for someone to identify a goal but not know how to attain it, thus remaining in the stage of contemplation. It becomes our responsibility to break down a long-term or larger goal into measurable, smaller pieces for it to feel worthwhile. Here are some examples of how to make it measurable when identifying a larger, more abstract goal:

Smaller, more measurable efforts can support short-term goals blending into long-term goals over time. By identifying and writing down goals that are measurable, can be reviewed regularly, and can be celebrated when attained, the effort it takes to achieve these goals can feel validated and encourage motivation for the long-term work as well.

Accountability Buddy 

Motivation can be internal such as, “I can do this” or external, “she said I can do this.” Identifying a trusted support as an Accountability Buddy can help you achieve your goals. Accountability Buddies are selected as a support person who is aware of your goals and holds you accountable by remaining in regular contact with you on your progress. They may meet with you weekly, monthly or on whatever schedule can help you remain focused and present on the goals you are working towards. Sometimes Accountability Buddies have a similar goal and may participate alongside you, such as going to the gym with you three times per week. Not having to work towards a goal alone can serve as an incentive in absorbing someone else’s positivity when you begin to question your own motivation. You may struggle to recognize the small but important shifts in progress and begin to question why you are working so hard for minimal results. Perhaps they help you recognize the smaller changes that have taken place when you feel the seeds of doubt are planted, thus preventing you from giving up on a goal that is supporting healthy change. By identifying an Accountability Buddy that is supportive throughout the process, you can experience motivation and recognize goal progression, allowing the ongoing growth and change you desire.

“Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.” Barack Obama.

Canine Assisted Substance Abuse Treatment

Imagine that you have a guarded new client with a history of substance use. You try everything to make them feel comfortable and they still show reluctance to engage in treatment.  There may be several valid reasons for being closed off. This can lead to an increase in the stress hormone cortisol, possibly causing cravings for relapse. The next session you bring your certified therapy dog. The dog is welcoming, non judgmental and accepting of your client and is happy when they arrive. What has just happened in the client’s body? Meeting the dog caused their cortisol level to decrease. Their bonding hormone, oxytocin, has increased. They used to get the release of dopamine from their drugs but now they are getting oxytocin from your dog instead. Their heart rate has stabilized, their blood pressure has reduced and their frontal lobe is back online (Odendaal and Meintjes, 2003). Now, they may feel less guarded and more comfortable in therapy.

Often times, clients are more willing to trust a canine therapist versus a human therapist. They are more open to touch and comfort when it comes from a dog. They feel the attunement from the therapy dog and get to experience what a healthy attachment feels like. They finally feel heard and seen. As a certified canine assisted therapist you notice when your client and dog have bonded. The therapeutic relationship has accelerated and you are ready to try many different interventions over the course of their treatment. You come up with a few interventions to try. One might be having the client teach the dog a trick to help them practice healthy communication and relationship skills. Another intervention to try might be discussing what they have in common with the therapy dog. This can be drawn out to increase empathy for the dog and themselves. Now that they have the experience of a healthy attachment with your dog, they can move on to practice attaching to healthy people in their lives. Now they are ready for canine assisted family therapy to start. Eventually the desire to use substances begins to diminish.

Practicing animal assisted therapy comes with many challenges and it’s no easy feat. I have been practicing canine assisted therapy since 2005. I’ve seen 65% of my clients obtain sobriety which is double the national average. I incorporate it in individual, couples and family therapy sessions. It is extremely important that you and your dog have proper training and that your dog enjoys the work. It is necessary that you know your dog’s calming signals and can advocate for them. In order to ethically practice canine assisted therapy you need to follow the recommended animal assisted therapy competencies written by the American Counseling Association. They suggest attending a canine assisted therapy training, having your dog pass the canine good citizen test and obtaining regular consultation among many other things.

If you want to learn more about canine assisted therapy go to my website:
http://www.pawsitivetherapeutic.org/aat-qa/

References
Odendaal, JS and RA Meintjes. “Neurophysiological Correlates of Affiliative Behavior Between Humans and Dogs.” Veterinary Journal, May 2003, pp: 296-301.

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Guest post written by Amanda Ingram, LCSW, CAC III

Amanda Ingram, LCSW, CAC III, graduated from the University of Denver (DU) Graduate School of Social Work with an Animal Assisted Therapy (AAT) Certificate in 2007. She also trained Guide Dogs for the Blind for seven years. Ms. Ingram currently owns Pawsitive Therapeutic Interventions, LLC where she trains mental health providers in animal assisted therapy and also offers individual, couples and family therapy in the Stapleton community.

Oxytocin for All: Uncovering Secrets to Treating Client Isolation

Just for a moment, imagine yourself at a family gathering for the holidays. Look out onto the faces of the people you love.  Feel the stripping away of the stress of daily life and the warmth of realizing that these people that you love also love you back. Nice feeling, right? I would venture to say that oxytocin plays a big part in that feeling.  Many of us know about oxytocin and have probably encouraged our clients to get more social interaction with others to alleviate symptoms of anxiety and depression. After all, it is known as the “love” hormone. But not all of us have someone to love!  Social isolation can be a stressor for many people. We are, after all, social beings. I’ve read that prairie voles have similar social conditions to humans when it comes to isolation. At some point, a few years ago, I became interested in the social and physiological implications of isolation among other mental health issues. Isolation seemed to be common in people transitioning and/or suffering from depression and anxiety. We all probably have those clients that are isolated and disconnected from others. Whether it is because the client has distrust for people, has a mental illness, just moved here, lives in a rural area, is mobility challenged or any number of other issues. In some of the more difficult cases, clients can be resistant to self-care suggestions and/or have lifestyle structures that prove difficult. It can be hard for our clients to know what is healthy alone time verses unhealthy alone time. When I first started out, I panicked when I kept finding my skills were lacking in this area because my suggestions to clients were largely limited to my own experiences. I realized after working full-time and going to grad school full-time, my lifestyle left me with little free time to socialize. I had no family in Denver and I set my life up to be dedicated to my goals but not dedicated to seeking connections with people.   

There is also the issue of technology fostering disconnection even though it appears connection should be easier. One of the ways I have grown into my therapyhood (that’s a word) is to help clients find other ways to be connected even if that meant they were doing it ‘alone’.  It was through my own journey that I researched alternative ways of thinking about this issue.  Denver, for some people, is perceived to be an isolating place. There are many activities around the city, but mostly, I hear complaints from clients that when they put themselves ‘out there’ to try to make friends, they felt shut down or ignored by the object of their efforts. I have to admit when I moved here my experiences had been somewhat similar. I did not share that with clients necessarily, but I am uncertain I was able to confidently respond with effective tools that would help them when I struggled too. At that time, in just wanting to be accepted by others, most connections I found were unhealthy and probably produced negative effects of oxytocin (for another time). To make things worse, some of the clients that I came across were resistant or unable to make changes in their lives and were less likely to find what they were seeking, which was connection. Certain clients can further internalize the voice of society regarding being alone and isolate even more, which can turn to loneliness and shame. Research I have come across contend that loneliness and depression share some characteristics, but are in fact separate from each other, and that loneliness increases the risk for depression.

One of the ways that I approached this gamut of problems with clients that are isolated is to talk about the science of neurotransmitters in the brain and how they can be produced with a little manipulation from them. More specifically, I began discussing ways to stimulate oxytocin and possibly vasopressin in the brain. Oxytocin is known for its ability to make people feel more connected when they are with others, but what about ways to increase oxytocin when you are not around people.

First, a few facts about oxytocin. Oxytocin is produced by the hypothalamus and then released by the posterior pituitary. It can also be synthesized in many peripheral tissues including the heart and sex organs. Oxytocin is released in response to activation of sensory nerves not only during labor and breastfeeding, but also in response to skin-to-skin contact between mothers and infants, during sexual intercourse in both sexes, in connection with positive, warm interactions between humans and interaction between humans and animals (in particular dogs), in response to several kinds of massage and even in response to suckling and food intake. It can also play a role in generosity and helps with trust and depressive feelings. Oxytocin can also amplify both positive and negative social experiences equally depending on the area of the brain where receptors take up the neuropeptide, but that is for another time. Vasopressin is molecule that has a similar structure to oxytocin and can act as an agonist (activator at the receptor). Oxytocin agonists or antagonists (blocking at the receptor) are able, because of their similar structure, to bind to the oxytocin receptor (OTR) and create physiologic responses.

My interest in discussing this topic is that it is very easy to find oxytocin stimulation when one has companionship in the form of a partner, friends and family around. The problem arises when someone has completely isolated themselves or have very little access to support. How do we as therapists help these clients find connection or at least mimic the physiological response to companionship by manipulating certain molecules. Here are some of the ways that I have suggested clients elicit production of oxytocin and vasopressin in an effort to help increase connected emotions.  

1. Oxytocin or vasopressin supplementation. Since I am not a doctor, I cannot recommend particular frequency, dosage or brand. I simply mention to clients that these exist but that I cannot suggest anything in particular and advise they check with their primary care doctor or psychiatrist.

2. Orgasm via masturbation or intercourse increases plasma oxytocin. Of course, psychoeducation about healthy masturbatory habits will help the client normalize this behavioral intervention so that there is not further harm.

3. Hugs provide skin-to-skin contact that releases oxytocin, but I also suggest clients hug themselves in a butterfly hug. I am unsure if this is as effective, but if nothing else, it may be possible to get a placebo effect from doing this.

4. Petting an animal is something I suggest quite often. Suggestions for getting a faux fur blanket at work, in the car, and at home have also been effective when an animal is not accessible.

5. Eating has apparent rewarding and also relaxing effects. It represents an important pathway to achieve wellbeing and stress relief and eating or overeating for self-soothing is very common. If I make this suggestion, I generally provide psychoeducation and determine boundaries as guidance. Mostly, the suggestion is framed in a mindfulness promoting way. Like savoring their favorite piece of chocolate, for example. Additionally, eating foods that contain tryptophan such as eggs, chicken, turkey, bananas, yogurt, whole grain rice and quinoa, sesame seeds, cashews, walnuts, salmon, spirulina, potatoes, beans and legumes. Dark chocolate has also been known to increase dopamine and oxytocin.

6. Exercise is a great way to increase neurotransmitters. Whether it is at the gym or on a sports team, vasopressin and oxytocin are released in the plasma during exercise.

7. Massage is a great way to get oxytocin. Oxytocin can be released by various types of sensory stimulation, for example by touch and warmth. Bloodstream levels of oxytocin have been shown to rise during massage. Clients can also self-massage.

8. Intranasal administration of oxytocin causes a substantial increase oxytocin. It can be purchased online and possibly in health stores but recommendations cannot be made in this forum as to amount and frequency. It is a good idea to recommend the client speak to a doctor.

9. Talking to mom or a loved one is also a way to get oxytocin even if it is just on the phone. Only, however, if the person is a loving and supportive connection.

10. Singing or playing an instrument. The tactile and visceral experience can raise oxytocin levels in addition to other peptides.  Listening to music can create this response as well.

11. Travel, even alone. This can foster passive connection with others who are also traveling and can raise oxytocin. It is also more likely when you travel alone that you are forced to interact with others.

12. People watching is a great way to trick the brain into releasing oxytocin.  I suggest clients try to guess the story of others. If the situation organically arises, I invite clients to practice social skills.  Occasionally, social skills are lacking in clients that are isolated.

13. Reduce misconceptions of society. Your client might isolate because they see the world and other people as dangerous. Reframing distrust of society may help the client to feel less disconnected and alone and feel reconnected with society.

14. Bumble, where best friends meet online. Suggesting this in the context of being alone is to suggest that the act of seeking others to connect with might trick the brain into releasing oxytocin. As an added benefit, it also increases the possibility of connecting with someone online or in person.

15. Crying for long periods of time releases oxytocin and endogenous opioids, otherwise known as endorphins. These can help ease both physical and emotional pain.

16. Looking at pictures of loved ones and recalling memories. When the memory of an oxytocin-producing event is repeatedly brought to mind, oxytocin is produced and fear systems are depressed. This means reduced anxiety for example.

17. Vitamin B supplements take care of your brain’s health. They also support the promotion of dopamine and oxytocin levels. 

So whether your clients are meditating, dancing, sinking in the warm bath water or hot tub, going on a lone quest, watching a comedy, snuggling with a pet, playing an instrument, crying or any number of things mentioned here, the client is letting their body know that it is loved and taken care of. Translation, oxytocin production in one form or another can act as a buffer for isolation.

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Guest post written by Marsha Evans, MA, LPC

Marsha Evans, MA, LPC is a licensed professional counselor in Denver who has a medical and science background that led her into the psychology field. Her Master’s degree in Counseling Psychology was earned in 2012 from the University of Denver. She currently has 2 private practice locations with 4 independent contractors. Marsha works mostly with adults, but has worked with teens in the past.  She uses an eclectic mix of interventions both in-person and online with clients and specialties include mental/medical comorbidity, LGBT, trauma, and anxiety. Please check out her website at www.evanscounselingdenver.com

Tuning into Your Body for Information as a Therapist

When you are sitting with a client, do you ever notice yourself leaning in or tensing up?

I’m sure you have heard the term mirror neurons and how our body (especially our facial expressions) are hard wired to mirror others’ body language to increase our non-verbal sense of connection. But did you know that you are also constantly analyzing and responding to nonverbal expressions of emotion and belief patterns in your clients?

Our bodies hold a wealth of information that we are often in denial of, bypassing emotionally, or defended against. Our bodies are truth tellers. Somatic indicators of repressed emotions and fears can be seen in people’s body language and patterns of tension/holding in their bodies.

I often notice when sitting with a client what my body is doing. Of course, being trained in Sensorimotor Psychotherapy, a somatic psychotherapy, has taught me to do so. I notice when I am leaning in or pulling away, crossing my limbs, lowering my volume, increasing my energy, and when i am holding patterns of tension in my body. These are important indicators of what is happening in the client’s body. Often I will mirror my clients’ nonverbal cues in this way.

And what does it mean, you may ask. Well, if you are holding tension in your heart space, you may feel that the client is struggling with a matter of the heart and soul path. If you notice forward movement in their body, the client may have a pattern of hustling to keep busy in order to avoid difficult emotions. If you notice yourself tangled up in your limbs, your client may feel small and a need to protect their body from others. While there is not manual on what each body cue means, simply checking in with your client can be an incredible intervention.

When you check in with a client about a body cue you are noticing, you bring awareness to information the body holds in the less conscious part of their brain. Often our bodies give away how someone is truly feeling, bypassing their intellectual defenses.

Additionally, you can even hold space for clients to find a reparative experience by slowly shifting your body language to a more relaxed and open state. The client will likely mirror your calm body state and shift to a more calm state in themselves.

So next time you are sitting with a client, check it out! Notice what is happening in your body and check in with your client. You may be able to provide valuable insight through simply noticing and bringing awareness to what their body is trying to tell them.

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Guest post written by Kimberly Massale, MA, LPC, ATR-BC

Kimberly Massale, MA, LPC, ATR-BC is the owner and founder of Brave Embodiment Counseling LLC in Capitol Hill Denver. Brave Embodiment is a team of holistic healers specializing in guiding women to heal from trauma and self-defeating behaviors. Our therapists are specially trained in cutting edge scientifically proven trauma and attachment based methods to get you "unstuck" from old patterns that hold you back from your full potential. We use alternative methods that ease and accelerate the healing process including Trauma Sensitive Yoga Therapy, Art Therapy, EMDR, Psychospirituality, Somatic (Sensorimotor) Psychotherapy, Acupuncture, and energy healing and can guide you in your journey of complete transformation from the inside out.

Setting Boundaries with Parents Who Have None

Working with children in a therapeutic setting can be very rewarding and can prevent further problems with mental health and behavioral issues down the road. Most therapists that choose to work with kids are comfortable sitting on the floor, engage easily with children and are comfortable setting boundaries around safety in the play therapy room. Engaging and setting boundaries with parents can be an entirely different ball game. And unfortunately, establishing a supportive and collaborative relationship where firm boundaries are set in place with the caregivers may be as important as your relationship with the child in order to facilitate positive change. If you are in a private practice setting, there is another layer of importance to engaging parents. Your income depends on you maintaining a caseload of happy parents, as well as children who are improving.

You and the child can do great work in the play therapy room, improving self-regulation, verbalization of feelings, and allowing for an unconditional, child-centered relationship to allow the child to process the most difficult situations and it can be completely unraveled once the child returns home for the week if they are not set up for success at home. Taking two steps forward and then one or two steps back each and every week can be disheartening for the child, caregivers and us as therapists. This is why it is paramount to engage your parents to be a helpful partner in this process. So what do you do if a caregiver to one of your kids is unwilling to make changes or is so stuck in their trauma or emotions regarding a divorce that they are not acting as your partner in the therapeutic process? What if all they are looking for is for you to provide testimony in family court that supports their beliefs about the family situation? How can we as therapists, advocates, and potentially the only objective person in the situation bring about positive change in the lives of these children?

Thorough Preparation is Key

In my twelve years of experience working with children and teens in a therapeutic setting, I have learned that the most important aspect of creating an appropriate and collaborative relationship with caregivers where boundaries are respected and maintained starts before your first interaction. It is important to have a clear understanding of your scope of practice, what you are or are not willing to provide for families, the laws around decision-making and custody in your state, the laws of age to consent to mental health services in your state, and the policies and procedures for your practice or the agency you work for before you call that parent back to set up an initial session. If you are not clear in your own mind of these things, you are more likely to set up a relationship where you have to back track or get stuck in a situation later on.  For example, if a parent calls to get their child in for counseling with you and you do not inquire if there are any issues with custody or if any other parent shares decision making responsibilities in that initial phone call, you do not know if you are able to see that child. You are putting yourself and credentials at risk by not asking the right questions during that initial phone call. If there is shared decision making responsibilities, then you can educate the parent about the laws of your state and request the appropriate court documents to show any current orders in place. Along with having clarification in your own mind about these issues, you also have to have them represented in your initial paperwork so that you have a way to discuss all of these issues with the caregiver. It is important to have fees, policies around communication, policies around providing court summaries or court testimony (including fees), and the rights of the child in your disclosure and consent. This way, the parent has the information upfront and has signed in agreement that this is in fact how you will be running the show. And then, it’s up to you to put it into practice.

Documentation

How do you engage parents and maintain this engagement even when they do not agree with you or have a specific agenda they expect from you? Even if you have started off the relationship with strong boundaries, many parents are still so stuck in their own stuff that they will test your boundaries. Working with these parents is frustrating to say the least.  You see the positive changes that the child is making in session and know that they could improve significantly more if the parent followed your recommendations or if they weren’t so focused on making the other parent look bad. Two things…continue making the recommendations that will benefit your kiddo, continue being their advocate, and document, document, document. Unfortunately in our very litigious culture, you will need to have good documentation of what was recommended and why, as well as if caregivers followed through with the recommendations. If you are ever grieved, you have everything you need documented to show appropriate care.  It can also be helpful for you to keep track of specific recommendations that were attempted, versus the ones that are not. This can inform the recommendations you make in the future.

Communication Strategies

Another area that I have consulted with many child therapists on is how to manage parents going through a conflictual divorce, specifically so that they are not being triangulated into the relationship and can continue to focus on the best interest of the child. Again, the importance of having the discussions around your policies is paramount. I typically have two separate intake sessions if I have the chance, so that I can go through the information thoroughly and so that there is not the perception that I have a better relationship with one parent or the other. I also recommend that most correspondence is done through email (if both parties agree to using email for therapeutic information after understanding the possible issues with confidentiality), and that all correspondence is sent to both parties. This way there is less possibility for he-said-she-said concerns about what your recommendations are. I stick to this policy unless there is a significant safety concern or if there is a no-contact or restraining order in place between parents. I ask that caregivers put the other parent on any emails sent directly to me, however this boundary is always broken. I have already let parents know that anything I send out will go to both parents, so if they need a reply, it will get sent to both parents. If it does not need a reply, I keep the emails as documentation, reply that it is important that all emails go to both parties unless there is a safety issue, and use it as data for my own conceptualization of the case.

There are many other logistical tips that could be provided to working with difficult parents. The tip that I have found the most helpful in maintaining positive relationships with parents that I have to continually challenge or set firmer boundaries is to remember that they are human beings with their own histories. I believe that most parents are doing the best they can with what they’ve got at the time. This may not be very good at all, but there are reasons for their behavior. Remembering this allows me to be personable with them even when extremely frustrated. And remembering that you may be the only safe person in your child’s world at this moment, provides enough incentive to do the hard work of managing their caregivers.

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Guest post written by Sybil Cummin, MA, LPC, ACS

Sybil Cummin, MA, LPC, ACS is the owner and clinical director of Arvada Therapy Solutions, PLLC. Sybil's specialties include working with children, teens and families dealing with family trauma including conflictual divorce, child abuse and neglect, sexual abuse, and domestic violence. As an Approved Clinical Supervisor, she also supervises Master's level interns and clinicians working towards licensure, as well as providing business consultation to therapists embarking on the world of private practice.