inspiringchangellc – Page 5 – Inspiring Change LLC

When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD. (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia” (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

13 Reasons Why NOT

13 Reasons Why is a video series available on Netflix. If you’ve been told you NEED to watch this drama in order to understand teens now, I want to argue the opposite. I don’t believe that watching this series is necessary in order to understand teen cultures. Many viewers make this series sound as if it is presented as a documentary; it is not. It is a sensationalized, emotionally wrought fictional presentation of hours and hours of teen suffering and feels voyeuristic in its brutal and graphic portrayal of suicide. I managed to watch about 15 seconds of that scene and was so repulsed I turned it off.

Fictional, video streaming accounts of high school are not the way that our youth their own experience their lives. Parts of it, yes. Intense, highly edited with a powerful sound track? No. What this series does, I’m afraid, is double down on the visual trauma our youth are exposed to regularly. And we wonder why they are anxious, depressed, afraid and suicidal in greater and greater numbers?

If parents or counselors are curious, then watch a half hour or so. You won’t need any more exposure than that. I suggest it is completely unsuited for anyone, never mind teens. Watchers of any age are participating in reinforcing trauma. As a pastoral counselor and family therapist, I see the effects of too much trauma exposure daily. It’s very difficult to heal.

Healing Traumatic Memory

If only life was one long, beautiful, inspirational journey. But it’s not. Some of us know that life can include experiences of such fear, helplessness and pain that we wonder how we survived. Over time, and with support, most of us get back to what we would call our normal. Yet others of us discover no matter what, we just can’t.

We call these experiences psychological trauma, the kind of experiences that steal our mental equilibrium. Many traumas have their origin in childhood; our bodies and minds are dependent, small, developing and vulnerable. The younger we are when they occur, the more impact they may have on the way we learn to relate, think, feel and trust the world around us.

Traumatic memories happen within the brain when we survive a life-threatening event and experience overwhelming shock, loss, fear, horror and helplessness. The words we have for what we experienced are just not enough to explain it to others. Motor vehicle accidents, physical, sexual and emotional abuse, parental neglect and addiction, domestic violence, plane crashes, witnessing homicide, military combat, escaping house fires: these are among the experiences that can overwhelm our emotions and capacity to bear what we have seen and known. The memory of the experience is stored in a kind of jumble in the brain, never blending into what we would call our normal sense of self, our everyday explicit memory.

Neurologists, psychologists and other researchers have made wonderful strides in the last 30 years in understanding how trauma effects the brain. And as the science of trauma becomes clearer, so has the clinical work of seeking effective treatments: treatments for the post-trauma effects that are expressed in our bodies in the form of chronic pain, sudden panic attacks, visual and auditory flashbacks, depression, anxiety, relationship and work problems, addictions and patterns of emotional dissociation.

First generation psychological care for traumatic memory was talk therapy; some relief was attained by patients helped to fully describe their experience in a private, compassionate therapeutic environment. Second generation care added strong prescription medications to calm the nervous system, limit emotional affectivity or target psychotic symptoms. What the most recent research has shown is that both methods are insufficient; talking uses the cognitive portions of the brain without adequately engaging the emotional and survival systems, systems that were in charge during a trauma, and dulling trauma memories or disengaging them temporarily with psychotropic drugs won’t heal the damaged and chronically misfiring memory patterns.

What does work is helping the sufferer to carefully, artfully, and in a controlled and focused way to re-experience the memories, feel the experience again in the body while expressing the energy, body movements, sounds, sights and postures that were suppressed at the moments of helplessness, dissociation and physical restriction. To think the thoughts that seem too terrible to think, and to help the mind link up the original memory to the fuller, day to day explicit or narrative memory that we live and work in every day.

This is what the work of Francine Shapiro’s EMDR (Eye Movement Desensitization and Reprocessing), Peter Levine’s Somatic Experiencing (SE), Albert Pesso’s Psychomotor Therapy and Pat Ogden’s Sensorimotor Approach all seek in their similar models: to have the sufferer become integrated with their physical bodies, those same bodies that have experienced the trauma, to feel, tolerate, express, observe and rewrite their story in the present sense of the self.

All this is to say: there has never been a time in human history where more can be done to help the trauma sufferer than now. If you are besieged by physical and mental echoes of a terrible event in your past, please seek out care from a psychotherapist trained in the newer trauma resolution techniques. Many of us have found peace where there was no peace, and wish the same health and healing for you.

Core Long-Term Marriage Skills

One of my couple clients asked me to create a summary of our work together. I know these skills apply to nearly every long-term marriage, so I share them here.

1. Assume positive intent from your spouse. Trust him/her. Build positive interactions. Look for the good. Notice it, appreciate it. Stop trying to control the outcome of every interaction so that you feel less vulnerable. Protect yourself less, be open to one another more.

2. Self-focus: always pay more attention to how you are managing your own emotions/behaviors/words/tones than you are to your partner’s. Think: what can I do to improve our relationship? Journaling, prayer, ritual, reading about emotions/relationships/family of origin patterns.

3. Make every effort to improve your conflict conversations.
Don’t ignore important pain. If you find you are doing a lot of internalizing, mind reading, and stuffing emotions, it’s time to talk. Bring up pain as complaints (about the issue – “I feel”) not criticism (about the other person – “You are”).

Start a conversation gently, “low and slow.”

Expect your partner to initially defend. Wait until that strong reaction passes before you respond. Ask your partner to lower their defense so they can listen, if necessary.

Listen for one another’s point of view. Appreciate whatever truth you can in your partner’s POV. Repeat it to them so they know they have been heard. Share your POV. Check to see if your partner gets what you are trying to say.

If conflict begins to hurt, STOP. Don’t escalate. Take some time out to calm down and return again to the conversation.

4. Cultivate your marital friendship. Remember, however well you think you know your partner, don’t assume you can no longer be surprised. Make asking questions of your partner’s day, experiences, dreams, hopes, memories, plans and pains a regular habit. Do some new things together. Allow one another the emotional room to do things independently. Too much intensity can be just as hard on a marriage as too much distance.

5. Flexible people are more satisfied in their marriages. Recognize and reflect on the fact that the that details of our lives we take for granted as we become adults – our bodies, minds, work, relationships with children, hobbies, friendships, emotions, goals – are changing all the time. Especially make peace with the ongoing aging of your body.

6. Keep emotion primary in your experience of life and one another since emotion is the way our bodies and minds give us moment by moment information. Continue to grow in your ability to notice, name, manage and understand your emotional life. Remember that your spouse is doing the very same thing. Think emotion before you attempt to use logic in hard conversations.

7. Know that the past never leaves us, but we can find creative ways to manage how it informs our present. Holding resentments or secrets is poison to healthy long-term relationships. When someone injures another, the healthiest couples use their spiritual resources of remorse, repentance, renewal and forgiveness to experience the hurt, commit to the healing of the injury and press on.

8. Build a positive appreciation for touch, smiles, eye contact, and physical proximity as expressions of affection and sexuality. Use your creativity to express sexual energy and desire in ways that work for both of you. Be sure to talk to one another during sexual activity so that you are clearer about what works and what doesn’t. If there is a difference in levels of drive and desire, work to blend masturbation and some kind of mutual sexual activity.

9. Share the leadership of your family/couple. Appreciate one another’s unique skills and allow for growth and change. Make decisions together, and think of your marriage as a team, a unit, even as you are always individuals.

10. Remember that life is short, and grows even shorter as we age. Set a daily intention to do the best you can as a person and a partner. Cultivate your spirituality and your sense of humor. Stop threatening divorce; take the word out of your imagination and vocabulary. Re-commit to your shared future; appreciate and marvel at all that you have already endured and experienced together.

Have some advice you’d like to share with long-married couples? Comment below!

Direct vs. Indirect Communication

Nearly every time I meet with a new couple, one or both of the partners will tell me they think that their main problem is “communication.” When I ask them to tell me more about what they mean, they will often talk about repeated and escalating conflicts, days of avoiding contact, in-house separation, lack of eye contact and physical touch, and constant critical vocal tones. And more. What I hear in that sad list of problems is a relationship that has suffered for awhile from emotional hurt and mental frustration, with communication being just the most obvious, surface-level issue they face.

As we begin to work on the multiple layers of pain they present, I often find that both have developed the mental habit of communicating very indirectly, all the time. Instead of asking their partner for what they need, or answering a question specifically, or commenting on something that is happening in the moment, they weave and dodge with their words. Now, we all know that to get along with other human beings, whether a friend, boss, neighbor or parent, we often side-step direct speech in favor of a softer, side-ways answer meant to smooth the emotional waters. “So, do you like this new (hideous) carpet we just laid down all throughout our house (for thousands of dollars…),” asks your mother-in-law? Oh, it’s terrific, we may say, simply to go along with the obvious drift of the conversation. What do we care if our spouse’s parents have new lime green shag carpeting under their feet? It’s not an important opinion, and we go along to get along.

While an important adult social skill, in the context of marriage, it can be applied too often. If we always avoid conflict, skirt an important issue, never give our critique or opinion, our partner never really knows what we think, and we are left alone with our hidden thoughts. Do this repeatedly, and with both partners, each will inevitably feel chronically misunderstood, unappreciated, hurt and angry. What’s left? Each partner secretly expects the partner to read their (true) mind, figure it out from their vocal tone, body language, hand gesture or facial expression what the truth is. And around and around we go, with no one feeling free or safe to say what they mean, express a real need or ask for help. No wonder the marriage feels lost and hopeless. I ask if it feels like the opposite of the early days of the relationship when partners were just getting to know one another, and their talk was free and personal and detailed. Invariably, both partners say Yes.

Getting a marriage back to a safer emotional position, in which both partners feel more able to express themselves as they truly are, ask for what they need from their partner and stop constantly mind reading and avoiding is long-term work and takes both partners working at it at the same time. This is where good couples therapy comes in. If what I have written here reminds you too much about your daily experience in marriage, I encourage you to call and set up an appointment. Come and see how a skilled counselor can help you untangle the habits of mind that keep you stuck, and get you back to a more direct, collaborative and warmer emotional style of talking with your spouse.

Your Big F***ing Job Can Ruin Your Marriage

As our economy has crawled out of the recession, so many people have experienced the shrinking of the job force at their companies, and the subsequent increase in the demands of their job descriptions.

Many are doing the work that 2 (or even more) people have done in the past. More people are traveling more miles, more leaders are being pressured to increase production, or customers, or digital content, or whatever is on the front line of worry for stake or shareholders.

Add in the natural disaster that a very harsh 2014 Minnesota winter brought to several industries (transportation, energy, retail, just to name three), high level executives are using up all their available energy at work. They come home exhausted, worn out and without any emotional flexibility at all.

They don’t have the energy for the demands of parenting, or if they put in a bit of their work with the kids, they certainly have not one single thing left for their spouse. The Marriage Will Not Survive if this goes on for any length of time.

I tell my clients that if they are working like this, dedicating themselves to the salvation of their company, they must save at least 5% of themselves for their spouse. It isn’t much, but in the scheme of life, it can be enough to greet your partner, listen to them a bit about their day, share some of yours, and connect.

No one will care at the end of the job if you lost your marriage for it. But your spouse and children will.

Stop living for your work, and work for your family and life instead. And if you can’t seem to figure this out alone or together, please call me or a local family therapist for some coaching, understanding, and practical help.

What Goes Wrong in Marriage?

When I was a parish pastor, I counseled dozens of couples who were preparing for marriage and presided at their ceremonies. Every one of them was a hopeful (if too stressful) occasion for both bride and groom.

Virtually no one starts marriage without confidence that their relationship will last. Pledges are made, often “til death us do part.” Are some people marrying too fast, too young, too ill prepared for a joint married life? Yes. Add children into the mix and the normal stresses and strains of life pile on. But what really happens to the emotional closeness that most couples feel when they are preparing to marry? What happens to that experience of feeling “in love” that spurs so many to take on these very serious legal bonds of marriage?

Research into marriage done in the last 20 years by Dr. John Gottman (gottmanblog.com) points to a key phase of marriage that seems to make or break relationships. It is the second phase of the relationship, after the first “falling in love” phase in which couples have real conflict.

The couple argues. Words are said, decisions made, feelings hurt. But are they be able to feel that despite the differences, their partner really has their back? Does their partner still care about their opinion when they fight? Can they recover quickly after disagreements? Does their partner have empathy for their pain? This is the time a marriage either builds trust or does not. One partner may feel completely fine. But the other may feel lost, distrusting, and disconnected. This is precisely the time therapy can be very helpful.

It’s at this point that one person may decide to stop the relationship. But if the marriage continues, and the amount of negativity in the relationship builds, the relationship will deteriorate. And even if it lasts years, will never get to the more secure, lasting phase of marriages that are loyal despite differences, that are able to cast off hurts because there is so much positive connection to outweigh it.

Marriage is not just one long experience of being “in love.” That phase of human bonding is relatively short lived in our brains, and fades by the end of 2 years. But marriage can be about a deeper connection, a lasting kind of love that is full of security, joy in shared experiences, loyalty and commitment when life gets hard, and it will. It takes a lot of work to have conflict, to share the process, and land on the upside of emotional wellness. If you and your partner aren’t having success in this second trust-building and conflict-centered phase, good couples therapy can help you recover.

Please Don’t Lie to Me

I know as a person and therapist that Truth with a capital T is often a very subjective target. Your truth about an experience doesn’t have to be anywhere near my version of the truth of that same thing. You may LOVE Taylor Swift as a musician, and me? Well, I’m more Bruce. We went to the same concert perhaps, but did we have the same experience? No.

But when it comes to arriving at some shared version of what is or has happened in your family or marriage, or where you went on a vacation, or what your child said to both of you when she arrived after curfew last weekend, we should be able to agree on a mutual version of facts. We won’t get the details quite straight, but we should be in the same county. Even the same neighborhood. When we can and do, we can begin to talk about what is painful, or good, or what is not working or what you may want to talk about changing.

What sets us all up for failure, however, is when one person in the conversation is lying. Omitting facts or key feelings, covering up important details, scamming the rest of us in the group. I have to tell you, I’m a pretty good judge of people, most of the time. But I get slammed rather regularly by clients who have been lying to their spouse or to their family and friends for so long they are great deceivers. We will go session after session, even month after month, and I will notice that we aren’t getting much traction for emotional or behavior change. I will hear reports from one side of funny feelings or vague worries they have, and I keep working to be optimistic and focused.

And then the phone call, or the teary confession. “I’ve been having an affair.” “I want out.” “I can’t do this anymore.” Hits me up the side of the head every time.

If you are going to spend the money and time and energy to do therapy, please know that I will begin by trusting you to tell me the truth. Maybe not the Whole Truth, and Nothing But, but some version of truth that helps me know what we are all talking about. If you want some help uncovering that secret in the rest of your life, you will need to start by trusting me to hear it. Please don’t lie to me. I can’t help you when you do.