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I have found that developing the creative process is an important part of bringing about wholeness. Being creative uses the brain in a different way than normal cognitive linear thinking and is helpful in several ways. It can be used to bypass the fixed thinking that causes the constant negative perspective that many with mental health challenges face and finding wholeness. I use it commonly in practice to identify the path one is on towards reaching goals. I often have clients create a tree of life, with various useful therapeutic processes being elicited by the task.

I regularly hear a client say “There is something wrong with me”. Usually I find that it is because they feel they are different than everyone else they know or from someone of influence who reacts with the world differently. Multimedia has compounded this believe.

Being different is what makes us unique, interesting, and of value to our family, friends, peers, and the career we choose. It is wonderful being able to see the uniqueness of clients who are becoming comfortable in their minds and bodies. One of the goals of therapy is to be able to embrace ones uniqueness. It is what makes us interesting to others and allows us to have a voice and be ourselves. When you are given permission to be yourself and have individual thoughts, beliefs and ideals your are more valuable to those around you unless they are threatened by someone who thinks and feels differently. Those who are not comfortable being around someone who is unique are threatened by their own uncertain feelings, negative beliefs and fear of not being included.

It is all too common today for group identity and feelings of acceptance to be influenced by drugs and alcohol. It is sad that people lose themselves through drugs to be part of a collective. It is particularly sad when you have the opportunity to see someone’s uniqueness and find they struggle for self identity at the same time they are on a path towards mediocrity because of the amount of time they spend intentionally separating themselves from reality. It makes it impossible for them to do work in therapy or to be present in the world around them.

Being able to see that the goal of therapy is to peel away the layers that interfere with our being able to be authentic selves is the goal and not to be fixed. That allows us to be content in present time.

Embracing fear is often necessary for change to take place. It is one of the reasons why there are so few who participate in counseling. A very small percentage of the community actually engages in individual psychotherapy. It is commonly felt that therapy is not going to make a significant difference in their lives. Most beginning therapy believe that, at most, it will allow them to cope with their anxiety, mood, conflicts, sleep deprivation, addiction, or other symptom that they struggle with. It is necessary that tools be provided to help cope with them, but the primary purpose of therapy is to have the symptom go away. Yes, in many cases this includes depression and addiction. To deal with the causes of mental health challenges it is usually necessary to process previous unpleasant experiences, whether it is trauma, neglect, or abuse. The biggest challenge with new clients is getting them to a place of hope. Selling the client on a path forward with the hope and expectation of a different relationship with their environment is necessary for change to take place. The goal is always to get to a place where they feel safe in present time. They can then allow themselves to experience being content. Being content in present time is something that a lot of people have never experienced. Many people have a base line level of distress that rarely, and sometimes never, gets below a 3 or 4 on a scale of 10. For some they have never experienced a 1 or 2.

I always connect the physical and emotional response with the cognitive response. Clients often report they have only done cognitive therapy. This is often never under the surface of conscious thought. It can be very difficult to process their emotional or physical experience, because they have spent so much of their lives repressing those experiences. I have worked with a lot of male and female law enforcement and combat military personnel. The males from these disciplines have always been the ones who have the most difficulty processing their physical response to the past. I have had much greater success with female clients from these disciplines because they are less afraid of processing the physical response.

My primary responsibility as a therapist is to not have a client go to such a high level of distress (8, 9, or 10) that they are not able to ground themselves before they leave the session. This requires them to process the less fearful triggers and memories and learn to trust the process before going on to core issues where they learned the coping mechanisms and defenses they use to manage daily stressors. Those who have the most effective coping mechanisms are the most resilient and the most challenging to work with. They are also the ones who are most resistant to letting those copying mechanisms down for therapy to effectively affect change.

My experience working with PTSD is that you can recover from it. I have also found there are some who do not wish to give up their PTSD. There may be several reasons for this, one being they are part of a brotherhood of others who they went through events that gave them meaning. It may be they are afraid they will forget someone from the past. It is also true that most individuals living with the disorder have little hope of recovery. Recovery from PTSD means the criteria for the disorder are no longer met. It does not mean all of the challenges of PTSD have gone away. The work in moving past PTSD is hard. After recovery from PTSD other mental health challenges may exist but not PTSD.

An individual’s response to trauma is highly complex with multiple systems of the body affected. One of the defense mechanisms that allows individuals with PTSD to successfully cope with stimuli in the environment is dissociation. Dissociation supports resilience but it may also leave one fragmented, making it difficult to respond naturally to conversations and decision making. It takes significant effort trying to manage the multiple paths of communication coming into consciousness at the same time when parts are fragmented. Those who become dissociative as a result of severe complex trauma can get past their history and give up defenses that were necessary for coping when they recognize the former threat is not longer present in their lives. This distress caused by childhood trauma is les distressing.

Military personnel may fit into the category of those who are conflicted about giving up their PTSD. They have a bond with others with similar experiences; including the loss of comrades and other life and death experiences. They may want to hold on to their past and the trauma that went with it because it gave them meaning. They typically limit their contacts and support system to others with similar experiences. It is difficult for some to move on. It is common for them to want to return to the combat arena where they left their team.

I am not a fan of group therapy for individuals who have been diagnosed with PTSD where their traumatic event is discussed. It is difficult to manage the heightened subjective units of disturbance (SUD) in a group setting when being reminded of the trauma of others. If the level of distress nears its maximum limit the member will likely be retraumatized, making recovery more challenging. If the purpose of the group therapy is to establish tools for coping and managing they symptoms a support group work may be beneficial.

I have found and studies support that there is a high correlation between PTSD and childhood developmental trauma and experiences of attachment. If a feeling of security and safety was not experienced in childhood someone is going to go through life feeling unsafe unless attachment is experienced with a partner or through a healthy motherhood experience.

A significant stressor affecting mental health is the stress brought about by a job. Stress from a job is unfortunately taken out on those individuals who mean the most, the family. I have witnessed on more than one occasion where a new manager can take a rewarding and fulfilling job and turn it into a job where the employee does not look forward to going to work. Good managers are worth their weight in gold, both to the organization and heath of a community and should be rewarded accordingly.

The management of most companies and governmental agencies is underwhelming. In the organizations I have been part of, investigated, and where clients have struggled, it has been rare that effective management exists. A good manager can create an environment where employees are rewarded for taking on stressful tasks. I have found working with clients with high stress jobs the greatest stressor is often not the work, but their peers or management. An effective manager will see the problems that occur and take corrective action. Their primary objective should be supporting their staff and motivating those working below their potential to find the desire to perform at a higher level.

There needs to be a significant increase in reward to motivate individuals with the rare character assets required for leadership. Leadership takes unique skills in communication, sales, and vision for the future. There are many reasons someone might not want to be in management. The pay increase may not be worth the extra work and time expected of management. There may not be sufficient peer support at that level and job performance will be evaluated differently. If the promotion requires a move to a geographically undesirable location and when a family is making the move other factors must be considered. All too often the management job goes to the individual raising his hand, since no one wants the job and the headaches that go with it. Creating an environment where staff are willing to be supervisors/leaders and take on the additional and unique responsibilities of management requires significant support at all levels. And in the best organizations those skills will be exhibited and developed at all levels.

The goal of trauma work is to feel safe in present time. The same can be applied to anxiety, which I view as a learned experience related to a fear of identifiable adverse life events. If it were possible in the first session to get a client to know they are safe in the present moment the work would be done. This doesn’t happen because events from the past are revisited whenever a trigger of past events causes the physical, emotional, cognitive spiral of a stressor to escalate and cause distress. Trauma work in therapy is about rewiring the brain to avoid going into that spiral and to be able to view the present moment more fluidly; where observations, decision making, and communications are more effective. The rewiring of the brain is described by Francine Shapiro, as the Adaptive Information Processing (AIP) model. She created Eye Movement Desensitization and Reprocessing (EMDR) as a tool to facilitate the process. The amount of work and time necessary to feel safe in present time is typically dependent on whether the trauma is a single incident event or developmental trauma. When developmental trauma is coupled with attachment issues the process for feeling safe in present time can take significant time. What I find most fascinating is the resilience that some children have in their ability to create dissociative states to cope with the severest constant emotional and physical abuse in childhood where they often have a feeling of hopelessness. The ability to do so is the difference in someone being able to thrive and those who suffer mental breakdowns and self destructive behavior. The work of the therapist is to facilitate the client in separating the content of the trauma that has been compartmentalized from the dissociative state and allowing that part stuck in the past to recognize it is in present time and can stand down and be less vigilant. When this occurs it is much easier to cope with daily challenges recognizing that options are available that did not seem possible in the beginning. This is why it is necessary to routinely reassess what the goals of therapy are.

When assessing the potential for growth and compatibility of a couple I consider the level of trust and commitment that exists between them. If one of them is not committed to the relationship it has little chance of success. If there is limited trust between partners it is going to be difficult for the relationship to grow while working through the conflicts that are always present.

Normal relationships begin with levels of trust that is limited and it develops as the relationship evolves. A healthy person has a normal suspicion of others. If one of the partners has never been able to trust others growth is going to be a challenge. Those with attachment issues is going to be particularly cautious about trusting others. Being in conflict with a partner can trigger past memories and emotional upsets presenting vulnerabilities that people respond to in many ways. Being able to trust a partner in conflict provides the opportunity for individuals to know that their inner weaknesses will not be used against them. Being in conflict provides a window for resolution or compromise, which provides for long term growth.

I do marriage counseling, but I find myself doing more divorce counseling than marriage counseling. I was not aware of divorce counseling as a field of practice until I recognized how often I do divorce counseling and began doing research on it. I sometimes find the primary goal of clients is moving on and preparing to move on before, during and after divorce. Sometimes the client is preparing for a divorce and sometimes it is for the partner who does not want a divorce and is shocked when faced with it. While doing a search on divorce counseling I have noticed that most dedicated marriage counselors do divorce counseling. I have not seen training for it like I have marriage counseling, but I find the issues of divorce counseling are the same relationship and trust issues that most clients deal with.

Divorce is a major life event whether you are the one asking for the divorce or the one being forced into divorce. It changes those things that are most important to us. Most areas of a persona life is impacted. Relationships with children usually have the greatest impact and the factor that weighs most when contemplating divorce. Divorce without children is much less complicated.

Clients learn to cope with life and conflict based upon what life was like in the home when they were young. Protecting the children from the negative energy in a home filled with conflict, anger, addiction, or yelling will have a life long impact. Divorce is sometimes preferable for the children over staying in an unhealthy marriage where constant stress and negative energy overwhelms the household. I often have to process with clients their response to people having a loud voice where their typical childhood learned response is to shut down.

Unfortunately, finances are a major factor in the decision to get a divorce and a very significant stressor no matter how much money is involved. It is costly to get a divorce, where an attorney is almost always recommended, and duplicate living expenses are necessary. The unknown is always child custody. Even when a partner has a predisposition and history of maladaptive behavior one never knows what a family court will do in regards to custody.

Much of the work in counseling for someone around divorce issues is creating better boundaries and decision making, while dealing with overwhelming emotions. It is often necessary to address attachment issues. The loss of what what may have been or of what was experienced early in the marriage can be overwhelming. Grieving the loss of that trust and commitment can make it difficult to see a path forward. Grieving the loss of someone who is still living may seem more difficult than the loss of a partner who has died because of the continued hope that the relationship can be renewed. After someone gets past the divorce the fear of committing to a new relationship may be met with trepidation where one questions their ability to trust others.

Divorce is a regular occurrence in our society and brings many clients to therapy that otherwise would not have considered doing so. It gives them the opportunity to find a path forward that they might not have imagined after the shock and stress of change is dealt with.

Normal life requires that we create methods of coping with life’s challenges. When l was nine I had Perthes disease and walked on crutches for over nine months. I fully recovered from the disease but had adapted to having the crutches be part of me. I would not walk without them after I had been told I did not need them. I even crawled into the house after my mother took them away from me in the back yard. At the next visit to the doctor’s office I was told I could not leave with the crutches. I walked down the hallway and never used them again.

I wish I had the authority of that doctor with my clients. When I see clients fully recover from PTSD, DID or other negative belief from the past, they still use the crutches that are no longer useful. Crutches prevent us from being able to live outside the bubble people place themselves in to try to control their environment. We refuse to take off the armor one wears to protect ourselves from threats that no longer exist. It is odd that when one recovers from an identifiable mental health issue, which I see happen with my clients, the significant work is to adapt to being normal. Habits that have been created over a lifetime are not easy to let go of. It is easy to assess when they are able to feel safe being themselves in present time. They are able to sleep more restfully and wake more alert. They have an easy smile and are excited to talk about their life , whether it is about something they did, an experience with others, or something they are passionate about.

I have been recognizing lately how often it is necessary to grieve the loss of a child, parent, or spouse who is still living. The family member may be lost to addiction, mental illness, a cult, a possessive spouse or a spouse who has found someone else. It is complicated by the existence of hope that recovery or common sense will prevail. I’m often told that it would be easier to deal with if the person had actually died. There is always hope that the addicted member will find the ability to find a path back towards a future rather than the chaos they are entangled in. A family member who becomes psychotic and loses touch with reality creates incredible pain for those who love and care for that person. It can become even more distressing if the family member is a threat to them. I find too often that parents lose contact and relationship with a child because of a spouse who is too possessive and threatened by their family. I often hear people say “I never saw it coming” when a spouse or significant other leaves them for someone else. The endearing memories from the past feel like only yesterday and one wonders how could this have happened. A support network of friends or a spiritual faith can be helpful, however, the grief that one feels is real and painful. Accepting the loss can be just as real as if the person died and often my perception is that it is worse.