Welcome to the middle path

My photo
Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Wednesday, September 29, 2010

finding mercy in the moment

This has been one of the hardest weeks in my circle I can remember.  Tragedies predictible and unimaginable have shaken those I love.  I have felt shattered and heartsick.

This morning I had an appointment to give blood.  I wanted to cancel it.  I felt literally tapped out.  I thought about Ansel, who needed so many transfusions and went through so much so that he could pack a life into 20 years.  I went.

I came home exhausted from a week of little sleep, with an evening full of things that needed done before bed.  Then I took one last walk to the grocery store.  I could have skipped it, but wanted the time with my friend and neighbor, also hit hard by the week's events.  We talked and planned and mourned together.

The night was beautiful.  The stars so bright, the sky so clear, the air smelling of pines.  The crickets sang in the brush.  And then, right in the middle of this small town, two owls called back and forth, back and forth.  The beauty of it lifted my heart, against my will.

It's not that things are ok.  It's that ok and not ok, beautiful and terrible, exist side by side.  That's life.  That's what makes life bearable.  That and a community of people, willing to listen and love each other even when-- especially when-- the terrible seems in charge.

"Christ, this life of mud and miracles-- it's the prettiest little burden, isn't it..."  --Richard Buckner

May we all sleep well tonight, and know we are loved.

Sunday, September 26, 2010

Grief 101: Guidelines for Witnesses

In memory of Mark, Sept 1965-Sept 2010,  Ansel, Sept 1985-March 2006, and Dave, Aug 1952- July 2002

Rule Number One:  There are no rules.
Everyone grieves differently.  It's an American desire to put a time-line or a formula on grief; to tie it up in a neat little package and put it to bed.  There are some relatively predictable phenomena, as Elizabeth Kubler Ross outlined in her stages of grief writings.  But even these are individualized-- people will bounce back and forth between stages, revisit them at different developmental stages, skip some completely.  Grief is as individual as we are.

That leaves us with guidelines, not rules.  Here are some:

How do you support the grieving? 
However they wish.
Some people need space.  Some need you there.  Sometimes they don't even know what they need.  Just show up, and follow their cues.  Best thing, when possible, is anticipate needs and take care of them, within reason.  Bring food, offer rides and rooms to visitors, leave lists of people family can call to take care of last minute necessities such as errand runs and chores.
Listen without judgment.
People react to the shock of grief in many ways, sometimes many ways within minutes-- laughing, being quiet, crying, reminiscing, being angry at being left. All are "appropriate" in the moment.  Don't push them to talk but don't be afraid of acknowledging what is happening and what they are feeling.  Don't push your agenda on what you think they should be feeling or talking about.
Remember that grief lasts a long time.  The grieving person is usually surrounded by others in the first few days.  It's later when they may really need your help. Acknowledge important events such as anniversaries.  Know that the first year is the first anniversary of everything since the loss-- the first particular season, the first holiday, the first birthday alone.  Let them know they are loved and their loved ones remembered.

A few don'ts:  Don't make them talk if they don't want, or try to force them to accept things they aren't yet ready to think about.  They will talk in their time.  Denial is nature's way of protecting our tender hearts while we are taking in realities that are very difficult.  Give denial room to work.
Don't tell them this is God's will or it was just this person's time unless they are already putting forth their belief in that.  If that comforts you, fine.  It may not be a comfort to them, and may feel like an invalidation of their own natural anger or right to sadness.
If you don't know what to say, just let them know you are there and you love them.
Don't berate yourself for being scared of doing it wrong, facing them in their grief, not knowing what to say.  All this is very common.
Similarly, be mindful that what you say to or do for them is for them, not for you.  What comforts you may not be what they need.
If possible, don't avoid them because it discomforts you.  That's your stuff, and this is a time to put it away to help others who really need you.

In short:  let them know you love them and are there.

Quotes of the day:
To live in hearts we leave behind 
Is not to die.
~Thomas Campbell, "Hallowed Ground"

Oh heart, if one should say to you that the soul perishes like the body, answer that the flower withers, but the seed remains.   --Kahlil Gibran

A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist.  --Stewart Alsop

I shall not die of a cold. I shall die of having lived. --Willa Cather

Poems of the day:
If Death is Kind 

Perhaps if death is kind, and there can be returning, 
We will come back to earth some fragrant night, 
And take these lanes to find the sea, and bending
Breathe the same honeysuckle, low and white.

We will come down at night to these resounding beaches
And the long gentle thunder of the sea, 
Here for a single hour in the wide starlight
We shall be happy, for the dead are free.

--Sara Teasdale 
Gone and Dust
When we have done our
and left
what will remain of us?
Certainly a statistic,
 and a number,
or maybe if you're lucky
a memory inside a head
or two.
He used a tool
and dug in deep
to leave a mark
that would last longer than
he would.
   --Anselin Reed

Video of the day:  Dave Carter and Tracy Grammer

Monday, September 20, 2010

How to Do Therapy Part Two: Bang for Your Buck

Therapy is expensive.  Insurance helps, if you have it, but the copays and deductibles can be significant.  I grew up frugal and I haven't changed. I want to get, and give, best value.    Psychotherapy is usually much less expensive than medical therapy (I think I paid $350 for 12 minutes with one doctor this year), but it can quickly add up with multiple visits.  Here's ways to make the most of the investment.

First, a disclaimer.  This is how I do therapy, and how I like to get it.   I use a very interactive solution-focused style.   Lots of therapists have different models and these won't apply to all of them, for example, to the practice of long term psychoanalysis.  This isn't meant to suggest those aren't useful modes of treatment; it's just not what I do.

Know what you want.  It helps a lot if you have some global goals and specific objectives for what you want to gain from your therapy work.  Your therapist should be able to help you articulate these, so don't worry about being confused at first or having vague ideas of "being better". You can work on these together.   An example of a goal:  Be happier.  An example of an objective:  increase social support network by spending quality time with two or more people this month.  Goal:  Improve my marriage.  Objective: learn and use two positive communication skills with spouse.  Goal:  Improve health and lose weight.  Objective: reduce emotional eating and decrease daily calorie count.  Goals usually remain constant for the course of the therapy while objectives change as you meet them and move on to new challenges.

Share what you know of yourself as early as you can to help your therapist know how best to work with you.  Some questions to ask yourself:  what's not working for me now?  What's been a historical pattern for me that hasn't served me?  What strengths do I bring to this work?  What learning style works best for me?

Tell the therapist what you don't want.  If you have dyslexia, for example, lots of reading assignments might prove overwhelming.  Maybe you've had a previous therapist and things didn't feel right.  Tell your therapist what you can about what doesn't work for you and why you think that is true.  Your therapist may ask you to trust them to try new things.  If you have real doubts, tell them. 

Do your homework.  Not every therapist gives it.  I do, for several reasons.  First, we get maybe 50-55 minutes together a week (and often I see people much less than weekly).  The main work really needs to happen outside of the session for you to see much change.  Secondly, I have a reason for assigning the homework.  Usually I want you to practice a new skill or gain some new information.  Even if you practice skills in session, that doesn't mean they translate in the rest of your life.  I want to know what works, what doesn't and this is how I find out.  Finally, insight without change is really not that worthwhile.  It doesn't help to label yourself and excuse behaviors that have never worked.  The idea is to find new ways of being in the world that serve you.  By the way, I don't fire clients for not doing homework, or yell at them.  Sometimes I get that you just got busy or distracted.  But if you consistently aren't doing any work outside of session, it's time to look at what that means.   Am I moving too fast?  Have we failed to appreciate the function of the symptom and find a healthier alternative to meet it?  Do we need to include significant others in your life to support the changes?  If you aren't doing the work, explore that with your therapist. 

Similarly, Prepare for your sessions.  Keep a notebook and jot down things that come up during the week you want to address, reactions to homework assignments, questions about the therapy process. Have your copay ready at the beginning of the session so time can be used for therapy, not paperwork. It really helps me if you come in having thought about your session and with some idea of what you want to get out of it.  Don't worry if you feel confused at times about this-- we're used to that.  But when you don't think about your process and therapy except when you are in the office, and wait for the therapist to do all the leading of the session, you just aren't going to get nearly as much out of it.

Ask questions.  This is a partnership in which both of you are working toward your best health.  You are relying on and paying for specialized expertise.  But if you don't understand what your therapist means by a certain comment, why they are suggesting a particular course of treatment, or their motive in asking to see you more/less often, etc.-- just ask.  Similarly:  make comments.  If something feels uncomfortable, if you don't know WHAT you are thinking or feeling-- it's fine to say so.  It's our job to help you figure it out when possible.

If it's not working, talk about it.  It may be a poor fit-- I know, for example, that I am not everybody's cup of tea.  I move and talk fast and some people need a much gentler, more reflective and less active style.  That's not a slam on them or me-- no one can be everyone's everything.  You can always vote with your feet, as psychiatrist Jim Phelps says-- just go to someone else.  But I prefer it, and it's usually helpful to both of us, if we talk about what doesn't seem to be working and either adjust treatment or talk about who might be a better fit.  Also I have found that sometimes just the conversation is enough to clear up misunderstandings about expectations and barriers to change.  

It's pretty common for people to come to a stuck point.  Sometimes it's simply fear about change, or discomfort (believe it or not) with being comfortable.  If you've been in crisis mode for a long time, you may not trust peace.  Sometimes it's time for a break to practice skills.  Sometimes you are just done-- you've done what you came to do, and it's time to stop.  Again, if things seem to be standing still-- talk about it. 

The gist of this is to encourage you to take agency in your therapy work.  You aren't meant to be a passive recipient in this process.  What you bring to the session makes a huge difference and saves you money, and will help you make the changes you are here to make.

If you have additional thoughts, comments are always appreciated.

Tuesday, September 14, 2010

How to do therapy part one: finding a therapist

Having been on both sides of the therapy couch, I know how anxiety provoking it can be to turn your inner life over to a near/complete stranger.  Here's some tips on finding a good fit.  None of these are guarentees, but it beats throwing a dart at the yellow pages.

1)  Talk to people who've seen them.   You can get some idea of their style-- formal, in-your-face, analytical, practical.  Some therapists are different with different people-- well, most are at least sometimes-- but it's a start. 

2)  Check out their website, if they have one.  It should give you an idea of their therapeutic orientation and demeanor.

3)  Google 'em.  Psychology Today has a "therapy finder" website that has bios and information about rates and insurances accepted.  It's a paid advertising service; not all therapists use it.  There are others as well.  

4)  Ask your MD or another therapist.  They aren't going to know everyone in town, but they aren't going to give you a name of someone they don't trust, either.  Don't be afraid to ask your OB/gyn, pediatrician, dentist-- they've all been asked before.

5)  Call,  or if they have a website/email contact, email. If you are comfortable, give a brief idea of what you're working on and looking for.  It can be discouraging, I know-- you will find most of us are full.  Some of us will still try to offer an idea of someone else you could try.  If we're not full, you'll get a better idea if you're a fit if you can have a brief conversation.  Ask if you can be on a wait list if it's someone you are really hoping to work with.

6)  Ask others who they've heard recommended and why.

7)  Call your insurance company or visit their website.  Some sites will have bios of providers and what they specialize in. They will also only refer you to people they are willing to cover (though copay amounts/limitations will usually apply).

Things to consider:  If you want to use insurance, make sure the therapist you choose accepts your particular plan, and get preauthorization if needed.  It often is. 

If you have limited availability, establish that up front-- most therapists operate like any other professional office, 9-5 M-F.  No sense opening up your entire life story if you can only come in on Saturdays and they can't see you then.

If you've got other tips, please add them in the comment section.

Tuesday, September 7, 2010

A Sermon on Uncertainty

Jana Svoboda/ Unitarian Universalist Fellowship of Corvallis/ Aug 21, 2005

Opening words: Poem
If There is the Seed of Something in You

if there is a seed of something in you, and
all you can think is house on a hill,
house on a hill; built by the river and
thank god for the hill-- maybe you
live too close to both safety and danger
to either enlarge or relax. if the
seed needs water, do you resent your choices,
the well you never bothered drilling,
the bucket you let rust? you
look down at the swollen river;
even the river's pregnant, you think,
bursting its confines-- and you, more
like the seed, dry and hard and contained,
but within you some untapped largesse,
something wanting to be wet, and to break open.
from the hill, the river looks dangerous.
you forget that water is just what you need.
                 JLS, May, 2005

In Plan B: Further Thoughts on Faith, spiritual writer and professional neurotic Anne Lamotte begins: “These are desert days… I feel we began witnessing the end of the world in super-slow-mo...and some days it takes everything I can muster not to lose my hope, my faith, and myself.” I relate closely to her fear, and the paralysis that wants to follow it. She takes her fear to a theologian friend and asks, what can I do? He tells her—“left foot, right foot, breathe”. Because sometimes that is all we can do—sit with our uncertainty, and connect—through our breath—with something deeper and more divine. In the desert, Anne writes, we “know” what we should do. Stay out of the sun. Seek shelter, and safety. The desire to go back, to retreat into nostalgia—the pain for home-- is a natural reaction to dangerous and uncertain times. But courage, as the saying goes, is not being without fear—it is doing what needs to be done despite the fear. 

At a workshop with Jungian psychoanalyst and writer James Hollis, he asked us to rank our values.  What did we see as the most important tasks of our lives? I've done this many times.  But then he asked something else: to estimate how much conscious intent we put towards the items at the top of our list. A middle-aged man remarked: “The top of my list is love and growth. But I realize I spend most of my days just trying to avoid discomfort.”

I believe this is true for many of us. And for some, religion becomes a way of doing that. A hope for easy answers, for formulas: if I do this, that will happen. It is both a hope for the illusion of control and predictability, and a retreat from facing in ourselves and the world that which we cannot know. Rabbi Kushner referred to it as “God as Santa Claus”—we follow the rules, we get the goodies. 

James Hollis talks about these competing agendas living with in us: the drive for growth and actualization, and that for regression-- the wish for “the confident hubris of youth”, and for the familiar and the comfortable. When the desire to go home, to go unconscious prevails, “we will choose not to choose, to rest easy in the saddle, remain amid the familiar and the comfortable, even when it is stultifying and soul-denying… Each morning the twin gremlins of fear and lethargy sit at the foot of our bed and smirk. Fear of the unknown, the challenge of largeness intimidates us back into our convenient rituals.” But he admonishes us: “To be recurrently intimidated by the task of life is a form of spiritual annihilation.”

Hollis continues: “The recovery of personal authority is a daily task imposed upon all of us by the soul. It means to find what is true for oneself and live it in the world. If it is not lived... we abide in what Sartre calls “bad faith, the theologian calls sin the therapist calls neurosis. Respectful of the rights and perspectives of others, personal authority is neither narcissistic nor imperialistic. It is a humble acknowledgment of what wishes to come through us.”  It is also the maturity of realizing we don’t have all the answers. We don’t even have all the questions. “...from this encounter with our limitations the wisdom of humility comes: to know that we do not even know what we do not know.”

And yes—dealing with this will make you anxious. Coming forward always does. Kierkegaard said: move away from what makes you depressed, and toward what makes you anxious. The former is to regress. The latter—scary as it is to leap into unfamiliar territory—is growth.

In Plan B, Lamotte says: “In my experience, there is a lot to be said for desperation. Not exactly a bright side, but something expressed in the word formed by one of the the acronyms for the names of God—gifts of desperation. The main gifts is give up the conviction that you are right, and that God thinks so too, and hates the people who are driving you crazy. And this forces you to listen deeper, with your heart.” This is where we come up with wisdom, instead of information. 

If we are students, and we really want to learn something, it’s best not to steal and memorize the answers-- BBACACC. That’s not knowledge. It’s certainty—but it’s not wisdom. Unitarians have accepted that task as a foundation of our principals: the individual search for truth and meaning. But it’s not unique to us.

Buddhists teach it:
“Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is found in written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. But when after observation and analysis, you find anything that agrees with reason, and is conducive to the good and benefit of one and all, then accept it and live up to it.” (from the Kalama Sutra)

And Daoists:
“A tree that is unbending is easily broken. The hard and strong will fall. The soft and yielding will overcome.” -- Tao te ching, 76.

And Confucians:
“To learn and never think—that’s delusion”. Analects 2.15 

The Koran states:
"Do not accept any information unless you verify it for yourself.  I have given you hearing, the eyesight, and the brain, and you are responsible for using them."  Koran 17.36.

Christians, at least in the early church, agreed:
"Test everything. Hold fast to what is good".  I Thessalonians 5.21

But when times get scary, we regress. Like children, we look for external authority. Benedictine Sister Joan Chissiter writes: “We suckle ourselves on clear or comfortable answers because we fear to ask the questions that make the real difference to the quality and content of our souls. The spiritual life begins when we discover that we can only become spiritual adults when we go beyond the answers, beyond the fear of uncertainty, to that great encompassing mystery of life that is God.” Uncertain times are nearly always accompanied by a rise in fundamentalism, and I see it happening now. We divide into us and them, good and bad. This tendency to split, present since birth, becomes urgent. 

Writer and Buddhist Nun Pema Chodrin quotes one of her spiritual teachers, who said, “"The essence of bravery is being without self-deception.” Pema’s favorite mantra is “"Om, grow up!" It takes great courage to meet life on life's terms and accept responsibility for our actions. "To stay with that shakiness -- to stay with a broken heart, with a rumbling stomach, with the feeling of hopelessness and wanting to get revenge-- that is the path of true awakening. Sticking with that uncertainty, getting the knack of relaxing in the midst of chaos, learning not to panic-- that is the spiritual path." It’s also about the very Adult goal of accepting reality and letting go of attempts to control it. Anne Lamotte puts that into her spiritual practice with her morning prayer of “Whatever”, and her evening prayer of “Oh Well.”

Thomas Moore said: “You cannot do good by thinking of yourself as good. You have to sink into the complexities and go down far enough into life that you realize that it is not even good to be good. To do what others may judge as bad may be the best you can do.” (Here I am thinking Rosa Parks). “Certainly you have to admit to your moral ignorance in many matters. Can any one be certain in every design they are doing the right thing?...
Religion often avoids the dark by hiding behind platitudes and false assurances. Avoidance and defense are not the true purpose of religion. It shouldn’t whisk you away from daily challenges but offer an intelligent way of dealing with all the complexity involved.” 

Another Jungian thinker uses the story Jekyll and Hyde to illustrate. Jack Sanford writes: “Striving for a pure goodness results in a pose or self-deception about goodness, a persona. Dr Jekyll had a very big persona and believed in it completely, but wasn’t really good and became compulsive about expressing Hyde. He went to religion, not to find God, but as protection against his own Hyde. Religion often attracts persons struggling to exorcise the shadow rather than understand and make peace with it but what we cannot see in ourselves, we cannot forgive in others.” When otherness takes over, evil takes root.

Jung said “I would rather be whole than good.” Before we ate the apple, we were a thoughtless people. We were a GOOD people, but not by choice. We were thoughtless.

Christianity has seen evil as something that destroys the soul-- but originally the tradition recognized we carried both, and the Bible said —“For the good that I would, I do not; but the evil which I would not do, that I do.” Knowing we are capable of evil and no different helps us to choose. It also helps us to understand that “Ain’t No Man Righteous”, as Bob Dylan says. And if that’s true, we are all in this together. Being without self-deception, and seeing our own capacity for evil, we then can responsibly manage it rather than act it our or project it into the world. When we don't accept our contradictions, we act them out. When we turn away from our true natures-- even those we are uncomfortable with-- we are asking others to act them out for us.

Part of the work is in learning to sit with our discomfort without reaction. To just be with it. if we are lonely, to be lonely. If we are angry, to see our anger. Not to feel we have to manage it, do something with it, or even change it. When we are sad and someone starts to tell us all we have to be happy about, we feel compelled to defend our sadness, and explain why they are wrong. The shadow must have that same instinct of self-preservation. Perhaps the battle is in befriending it. Not feeding it, but not turning away from it either. Just sitting with it. Like Jesus sitting with the sinners. 

Given the burden and gift of thinking and choice, we may want to regress to certainty. We are pattern-seekers. We want to know. But often knowing, or thinking we know, prevents us from seeing what is truly there. There is a Buddhist sutra that says: Protect me from the disaster of my own thinking. Realizing we don’t have all the answers may prevent us from uninformed decisions, or worse yet, stuckness in our thinking. We need to allow ourselves the bravery of loosening our grip on what we believe to be true to find even deeper questions. Maybe, in sitting with the mystery we’ll find what for us is true. 

Closing Words: Rilke, from letters to a young poet.
Have patience with everything that remains unsolved in your
heart. Try to love the questions themselves, like
locked rooms and like books written in a foreign language.
Do not now look for the answers. They cannot now be given
to you because you could not live them. It is a question
of experiencing everything. At present you need to live the question.
Perhaps you will gradually, without even noticing it,
find yourself experiencing the answer, some distant day.