Author: dabarradmin

I commonly work with the ego states of clients. Ego states are the dissociative states of individuals, usually identifiable by the age at which they became active. I view individuals with complex trauma on a continuum of dissociation. Those who did not want to be in the stressful environment in which they were raised are going to find the need, if they are resilient to dissociate for the purpose of managing the unhealthy environment. With highly traumatized clients who are highly dissociative those ego states create an experience of having a mind that is fractured, with a seemingly constant input of data coming in at the same time from different sources. The work of those ego states in therapy is to recognize they are safe in present time and that it is no longer necessary to maintain the constant responsibility they have been engaged in since their creation. They allow a person with a traumatic past to manage the stability of the self while managing daily activities. Once they recognize the adult self is able to manage daily life in a safe environment the ego state is allowed to be less engaged and be quiet and eventually integrate into the adult self. Most highly dissociative individuals believe that when this occurs they will be finished with therapy and all will be normal. I caution them that there is more work to do. It takes time to adapt to being “normal” and some previous trauma needs to be processed in present time, particularly if it has been placed in a “container” when working with the ego state. Their relationship with everyone around them changes and both the client and those they interact with have to adapt to the change and learn to trust that the change is going to be permanent. Significant people in their life often have difficulty with the change. Life can be challenging to those who have learned one way of coping with stressors, mood swings, emotions, and everyday events when they find they not longer are affected by them in the same way. Communication with others changes when they find themselves reacting to situations differently than thwy would have previously. Relationships are transformed and sometimes a partner does not like the change. Boundaries with others changes. New possibilities are presented and goals are redefined.

I love working with snowflakes. I have been working with teens and young twenty somethings more often. Most of the teens I work with come from middle class families; therefore, their lives have been rather easy, with all their basic needs taken care of. They spend to much of their time in their rooms, particularly during covid, using social media and playing video games. Besides having most of their basic needs taken care of they have created rather bad habits that are not conducive to growth and social support. They go outside much less than before, they isolate from family, and worry about what they are going to do when they leave the home. Anxiety is often high. Occasionally they are asked/told to come to therapy by a parent. Just as with any client, I will not see them unless they choose to be there and participate in therapy. Recently, young clients choose to be there and have been highly engaged. Some stop after a shorter number of sessions than most clients. My work with clients is aggressive and it may be to much for their developmental stage. I often label them as being snowflakes, not a diagnostic identification in the DSM-5 of course, but a description of those who have never been challenged by real life. It is surprising how much they identify with the label and the impact it has. It is characterized by a lack of resilience, since they have rarely been challenged to deal with responsibility for themselves or others. They are highly insecure socially; although, I have often found them to be better communicators verbally than I expected. They are naive to basic developmental changes of teens and sexually naive, with significant false information about their peers. Identifying them as snowflakes has supported them in taking more responsibility and placing less blame on their parents or guardians. The benefit of working with young people is that if they are engaged change can happen quickly. If they get on the right path when they are young they have the ability to thrive much earlier and have a greater impact with those they interact with. They can take on greater challenges where more risk is acceptable and leave the snowflake label behind.

The secret to being successful is being grounded in the present, be passionate about your task, and taking reasonable risks. Life becomes much easier when you are not carrying the past with you. Past trauma, anxiety, need for attachment, addiction, distractions and disregulation require energy to repress them. It takes energy that makes it difficult to focus on present tasks. Being able to focus allows one to process, problem solve, communicate, analyze, or create as needed. If you are successful at these tasks you are much more likely to have the confidence to follow your path towards your goals. Because there is such a large part of our society that is not able to be in the present the opportunity to succeed is there for those willing to focus their attention on tasks presented to them. With all the opportunities that exist today and the extraordinary need for talent, there are opportunities for success in every direction in the fields that are desperate for talent and people willing to work.

One of the most difficult challenges to being grounded in the present is the increasing problem with addiction. Addiction is becoming an acceptable mode of functioning. The use of cell phones is no longer for person to person communication. It has been corrupted by social media, gaming, and the constant notification from news organizations and contacts providing the most recent emotional stimulus. The development and design of digital content is to bring about immediate reward. A necessary part of a psychological assessment today is to identify the amount of time clients spend daily on their “cell phones” or with gaming. Self reporting for cell phone usage is just as unreliable as self reporting for quantity of alcohol consumed. All addictions inhibit the ability to be in the present, to have a balanced life, and consequently the ability to succeed.

The use of marijuana is becoming socially acceptable in our society and is readily available. Here in Alaska it is readily available in your neighborhood cannibas store, through friends and the common local dealers. It has become so acceptable that many professionals are not concerned with the effect it has on their ability to function. It is not unusual to see consumers leave their identifiable business vehicle to enter a cannabis store. The need to meet the needs of an addiction overrides all other needs and drives. Habitual use of marijuana has a significant effect that has not been sufficiently examined, It has been my experience that habitual cannabis users have significant difficulty processing past elements that are necessary for change and I am not interested in having habitual users of marijuana as clients.

Todays workers have many addictions. Addiction to social media, gaming, marijuana, alcohol, pornography ; all, make it much more difficult to carry out the functions necessary for success in the workplace, creative endeavors and in relationships. This provides a multitude of opportunities for those who are grounded in the present to succeed with little competition.

I have a large aluminum sculpture in my office that my mother created. It is a useful tool in describing what happens in successful therapy. An artist has an image of what the final result will be. A metal sculpture begins as a large clay block. To create the sculpture she took away the clay that is not part of the image she had in her mind. When she finished taking away all of the clay that was not the sculpture she had it cast in aluminum. I see effective therapy as pretty much the same process. We begin with the image of what we were created as at birth. As time goes on we are triggered by fear, insecurity, trauma, loss, pain, and other baggage that we attach to our original birth image and as time goes on we lose our original form. The purpose of therapy is to remove that baggage that is not part of us but prevents us from moving, sleeping, breathing, speaking, and relaxing; allowing us to be comfortable in our minds and bodies again. It allows us to be able to interact with the world and others as our true selves.

I also use the image of carrying a backpack of rocks that has been accumulated along the way. Each rock represents unnecessary stuff we have collected in life. Visualizing taking off the backpack allows immediate feedback to the body which usually results in noticeable release of tension and sometimes long held pain, particularly around the neck and shoulders.

Effective therapy is not about fixing someone who is broken; it is about pealing away the layers of trauma, negative beliefs, repressed emotions, and fear that builds up over a lifetime. It is okay to leave that baggage behind and become the person you were created to be.

There are a number of obvious assessment indicators for mental health for an individual or couple. For an individual in my opinion the best indicator is the quality and quantity of sleep. For a couple its about the quality of communication. A common indicator of poor communication in the home is if people are always walking on eggshells. One doesn’t feel safe stating their opinion or the truth, fearing the reaction of the partner will be unreasonable. Anger issues often need to be addressed. An environment where everyone is walking on eggshells creates negative stress. If it is in the home, it becomes an unsafe environment rather than the sanctuary that it should be. If the home is not a sanctuary it becomes a household of anxiety and hypervigilance. If you find you are walking on eggshells action is necessary to support mental and physical health of both adults and children. Stress in the home is felt by everyone, including the young.

To be able to be safe saying the truth in a relationship trusting your partner is necessary. You have to trust that you are not going to be emotionally attacked or that the partner is going to shut down and avoid meaningful discourse. There are a lot of barriers to developing trust such as addictions, trauma, and poor coping mechanisms. It takes a lot of intention and commitment to develop trust.

Clients often identify forgiveness as a goal of therapy. During the first session I do an assessment, in which a diagnosis is considered, goals set and a therapeutic plan is discussed. If a client is having difficulty being able to see there is a future and what the outcome might look like I give them possible ideas to consider, such as feeling comfortable in their mind and body. My clients are often dealing with complex trauma; to include significant childhood abuse and neglect, sometimes by a parent or related family member with whom they still have contact. When discussing goals they sometimes identify forgiveness as a priority. My experience is that forgiveness is nearly always am impossible goal to achieve in therapy. It may be an outcome of therapy; however, I would not recommend it as a goal. A child typically learns to repress the anger and fear they experience when they are abused. It is not safe to express it and that learned behavior carries forward to adulthood. The anger, fear, sadness and other distress is carried in the body and mind and is manifested in all kinds of physical symptoms. To try to forgive their perpetrator usually results in repressing those emotions even more. It is usually normal to process the distressed emotions and allow them to be released for progress in the therapeutic process to take place. Forgiveness may end up being one of the outcomes of therapy, but I resist a client identifying it as a goal of therapy.

Western culture, of course, is influenced by Christian doctrine regarding forgiveness. Matthew 6:14 (NIV): “For if you forgive other people when they sin against you, your heavenly Father will also forgive you.  But if you do not forgive others their sins, your Father will not forgive your sins.” I believe that for those of us who are Christians it is an important aspect of our support. As I indicated above forgiveness is often an outcome of processing anger and fear and forgiveness can be welcomed.

It is also my experience that some rare individuals have no filter for their Shadow (dark side), are without a conscience and are truly evil, and that forgiveness for them is not possible .

Having a support network is an important aspect of being mentally healthy. Living in isolation without relationship with others significantly reduces the resources available when challenges begin to become overwhelming. Having a support system is a primary indicator of success in mental health treatment. Knowing there is someone you can trust allows us to spread the weight of responsibility, loss, and frustration. A close friend or spouse provides support and helps us to recognize we don’t have to do it alone and they can affirm that we are taking the right action or that we are on the correct path to overcoming the challenge. It is one of the main reasons having a significant other is such a natural drive for most healthy individuals. Knowing that support is always there is reaffirming and supports taking on newer and more challenging tasks. When working with couples I have them watch the YouTube video “Its not about the nail”. It’s the best couples training video I have seen. Discovering the support network of my clients is an important assessment tool with a new client. To a lesser degree, it is also one of the reasons I ask about pets during an assessment. Unfortunately, a dog is the only support the client totally trusts.

One of the goals of working with anxiety is to feel comfortable outside the bubble one creates to have a sense of control. Severe anxiety or hypervigilance related to trauma create a sense of fear about what may be around the corner. A typical method of dealing with the triggers of that fear is to try to contain the environment. This severely limits opportunities for getting to know others, exploring the outdoors, moving into new careers, and engaging in needed conversations. Individual growth is stunted. A goal of therapy for anxiety is to process those fears that cause the body and mind to feel stressed, so that the client will be able to feel safe in present time. The body becomes more comfortable and the mind becomes more quiet as the past stops interfering with present day activities and relationships. I enjoy watching clients experience this for the first time. It makes it much easier to expand ones comfort zone. Eventually it’s possible to look at life through a new lens with opportunities that were difficult to imagine in the beginning. Life becomes easier, requiring less effort. A common experience when this occurs is that colors are brighter and objects are sharper when looking outside the office. When we are comfortable in the world opportunities are noticed that were not visible when hypervigilant .

Many people do not like being in conflict. It is necessary that one be comfortable with conflict to grow in relationships, the work environment, and in the world at large. If it was not okay to be in conflict in the home during development it is typically not going to be okay to be in conflict with significant others as adults and with others outside the home. It is an important ingredient in being successful in relationships, in ones career, and in being comfortable exploring the world.

Noticing how clients deal with conflict in initial assessments is an indicator of resilience. Often those who have difficulty with conflict will be self limiting in their career choices and social interactions.

It makes it much easier for couples to communicate effectively if they are comfortable being in conflict. It allows them to openly discuss issues that may be barriers to being themselves. There is always conflict in a relationship, and almost always at least one signifiant conflict that is not reconcilable, as was pointed out by therapists and researchers Drs. John and Julie Gottman. It is necessary for partners to be able to engage with each other to find a comfortable understanding or compromise.

If there was a lot of anger and overbearing aggression in the home while growing up it can become a trigger to feelings of distress; such as fear or anger that does not have a means of expression, resulting in repression. When in a relationship with an assertive partner I find that conflict often appears to trigger fear and anxiety. When asked about their response to the conflict they often report negative responses that are appropriate for processing. Doing so allows for them to reach a place where conflict is not so frightening.

I often use Maslow’s hierarchy of needs in working with clients to assist them in being able to visualize their motivations and barriers to growth. It is very useful in understanding the primary needs and goals. If a client or couple is struggling with finances, they are going to be focused on the second level of Maslow’s hierarchy of needs identified as “safety”. It increases the level of stress and makes it much more difficult to deal with higher level needs. Clients often find it useful to know that sex or reproduction is at the first level of needs identified as “physiological”. It is such a strong instinct that Freud became stuck on its importance and focused his theory of psychology on sexuality. It is always an important aspect of couples work. And since almost all therapy is about relationship with others it is virtually always comes up in individual work. To focus therapy and to be able to function on the higher level needs of “esteem” and “self actualization” it is important that the lower level needs be fulfilled at some level. Over time and even throughout the day we will typically move between the different levels. If a couple is focused on a different level of need or a different objective within a need; such as, one being focused on sleep and the other on sex within the “physiological” level, conflict with arise. Being able to work with couples to identify and visualize their conflicts within Maslow’s hierarchy of needs is often a good starting point.