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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.

If someone has a path forward they have direction in their life. I always insist that clients create their path when beginning their work. This usually includes creating it physically with pencils or paint. The only instructions are to put an “X” where you are currently and to identify your goals in the opposite corner. The object then is to create the path from where you are presently to your goals. If change is going to take place it is necessary to know what that change looks like when your reach it. The goals may change or be refined as you move forward. Using your creative mind to establish your path forward and putting it on paper or canvas is very different than creating it in your mind. After creating your path and finding direction with it you have a compass on what to do when you find yourself lost or challenged by what to do next.

I often use this with clients who are in a dysfunctional relationship with someone who is addicted. The addiction becomes the overriding objective of the addicted and it is impossible for them to get out of it unless they take responsibility for finding a path to new goals. The addicted path is one of chaos that has no future or direction. The spouse or significant other of the individual in chaos has little possibility of finding their partner on their own path.

For those who are goal oriented but have not considered higher level needs other than being successful in a career or basic security needs, their path is often a straight line. This makes it difficult to meet higher level needs such as emotionally fulfilling relationships and balance in life.

The creative process is very useful in bringing about change. I typically have my clients “create their path” after identifying their goals. It sometimes takes minutes and for others it can take weeks. Clients will tell me they have thought about it and created it in their mind. That is very different than drawing it on paper or painting it on canvas. My perception is that actually creating something seems to use a different part of the brain that establishes something more permanent in the individual. It gives them a compass for direction if they find themselves off course. The physical act of creating something sets in place what the cognitive brain has considered. I use their path often during times of difficulty to assist clients in being able to find their way when they are lost and without direction. They soon learn to use it on their own.

Developing the creative process is very helpful in being able to ground oneself and to establish a clear understanding of what one is facing. I have been using the creation of images on paper during sessions to better understand and accept what is true and to motivate clients to take action where they have been resistant to doing so. The use of EMDR helps to create the possibility for change when the need for change has been resisted.

I often hear clients tell me they want to volunteer. Volunteering can be rewarding and an indication of a healthy society; however, it is often the last thing someone needs to be doing if they are challenged by taking care of themselves. If the client is not taking care of himself, but wants to focus their attention on others, volunteering can have a detrimental effect on being able to move forward. They often have difficulty identifying and establishing goals and are not willing to experience the distress that comes with being vulnerable enough to take risks. There is generally a negative belief that they are not worthy of putting themselves first and taking care of their own needs. Instead, they often have a history of spending many hours helping others, but go without themselves. Typically, their defense mechanism is one of shutting down their emotional self, but yet carry the burdens of others. With proper support it is necessary for them to become vulnerable to their own distress and find ways to take care of their personal, emotional, and physical needs and give themselves permission to do so.

Anger is by far the easiest emotion to express. Many couples I have worked with find anger to be the primary barrier to being able to trust each other. It makes it nearly impossible to deal with conflict and gets in the way of being able to feel love and affection. Individuals who have learned to shut off feeling emotion usually do so to protect themselves from environments where the emotional energy of the home or environment they live in is negative and where it can not be safely expressed. It is an appropriate coping mechanism often used by children resulting in the parent saying their child never listens to them. One of the consequences to this is that it is difficult to be able to let down defenses and be connected with those who mean the most to us. One of the challenges of counseling is to overcome the lack of trust individuals have in others and particularly to being vulnerable with emotions. Dependents who have had to repress anger around a parent or caregiver usually have excess anger stored in their body. Often times attachment issues are present and the significant other, being the one who means the most to them, presents the greatest potential for loss. It can easily cause major damage to a relationship or family unless one learns to effectively live with the emotional self.

Sometimes clients seek counseling for anger management, often at the recommendation of a significant other. Anger management is only one of the outcomes of working with clients with anger. We learn how to cope with the stressors of life in various ways, some healthy and some not so healthy. It is invariably from copying the person most influential to them when they were a small child. If the adult caregiver coped with stress be getting angry it is going to be learned that it is an appropriate response. However, it is going to feel uncontrollable if they have to repress their own anger or receive further wrath from the adult. Anger is by far the easiest emotion for an individual to access and usually the one most evident in unhealthy relationships. The first step in working with clients with anger issues is to give them tools to manage it; however, this is only the first step. I typically use ego state therapy (EST) and EMDR to process anger. In doing so the current presentation of anger and memories of anger are identified and allowed to be processed so that the way the mind and body respond to anger and conflict is adaptable. Repressed anger is then no longer repressed in the mind and body and the way the client responds to conflict is no longer with exaggerated anger. We then are able to deal with stress and conflict with appropriate communication and support. Partners are able to then learn to trust each other in being able to manage their emotional response when in conflict.

An assessment for mental health is very easy. Are you living in the present? If you are you are probably mentally healthy. If you are living in the past or for the future you are going to be challenged in being able to enjoy your family, friends and job. Those who have not processed trauma in their lives or never experienced attachment commonly live in the past. If you are living for what you might have in the future it is not possible to be present and you are missing out on life. If you are waiting until you retire, get out of school, or until the right person comes into your life your life is on hold. That is not what positive mental health looks like.

I am sometimes asked if I am a Christian counselor. I am not a Christian counselor, I am a counselor who is a Christian. It makes no more sense to ask if someone is a Christian counselor than it does to ask providers if they are a Christian dentist or a Christian neurosurgeon. If someone provides counseling for Christian spiritual belief challenges, which happens often, it is appropriate. However, as a mental health provider the term Christian counselor leaves one with the belief that all counseling is provided based up on Christian teachings and based primarily from the Bible. The science of psychotherapy is based upon what has been learned from the fields of neuroscience, biology, philosophy, psychoanalysis, pharmacology, religion and other fields. I feel it is important for an individual to identify their spiritual self, whether they are in touch with it or not, to be whole. For many of us that is our Christian beliefs and it is an important aspect of who we are and provides strength in dealing with the challenges of life and death. I have also worked successfully with those of other religions and have found their spiritual identities to be important in being mentally healthy. I regularly see individuals who have been traumatized by others within the environment of the church. For an individual to be whole and mentally healthy my experience has been that there is a strong spiritual belief present. It is sometimes necessary to separate our spiritual self from negative influences of past negative personal experiences within a church setting.

One of the common symptoms experienced by those with mental health problems is sleep deprivation. It is the first go to assessment tool I use with new and long term clients. During initial assessments and regular session status updates I inquire as to the amount and quality of their sleep . If they are getting six or less hours of quality sleep per night for more than a few days mental health challenges are going to exist. If it extends for a significant amount of time it is going to be difficult to make progress in therapy without first being able to make progress in dealing with sleep deprivation. If regular sleep hygiene methods are not effective in producing the needed sleep it may be helpful to refer them for medication management. If work stress prevents someone from getting needed sleep during the week it is unlikely a nights sleep will be much help. One or two nights of restful sleep is not sufficient to get out of sleep deprivation. Self medication with alcohol or other drugs is not helpful and compounds the problem. The sleep is often disturbed by trauma from the past which one confronts when the unconscious accesses it during sleep. A strong indicator of progress in therapy is improved sleep, whether the cause is from trauma, anxiety, pain or other mental or physical stressor.

A magnitude 7.2 earthquake occurred in the Eagle River area on November 30, 2018. The resilience of the community was amazing and the affect it has had on individuals has been surprising.  Working with many clients with complex trauma I thought I would know who those individuals would be that had the most difficult time dealing with the earthquake and its aftermath.  I was very surprised at how inaccurate my expectations were.  There were several common responses to the earthquake and aftershocks that I have noticed, both in my clients and in those I have talked to in the community. The aftershocks seem to have been much more troubling to the general population than the earthquake itself. The most common identifiable characteristic of those who had the most difficult time were with those who were at home alone when the earthquake occurred. If a  group of people got together immediately after the earthquake in support of one another they seemed to have had less difficulty than those who were alone. Those individuals who are first responders and were able to take action following the earthquake thrived during and after it occurred.  They did however sometimes have difficulty recognizing the need for emotional support of significant others while they were taking action. Those first responders who were at home often had just as much difficulty dealing with the earthquake as those who were not first responders.  Most individuals who were in cars that I have worked with had little difficulty with the earthquake. Typically, they believed something was wrong with their vehicles and only realized that was not the case when they notice lights went out with the loss of electricity in the area. Those individuals who had damage in their homes took a lot longer to get on with everyday habits than those who had little damage.  It is incredible how well most houses, buildings and infrastructure did surviving the earthquake. Most had some damage to sheetrock and other observable parts of the house, however must structures and foundations did incredibly well. A 7.2 earthquake is a powerful earthquake and there was no loss of life. Much smaller earthquakes in countries where building standards are minimal or nonexisitent have resulted in significant loss of life. Pets seemed to have had a much harder time than people during and after the earthquake, which may reflect the benefit of understanding what happened. Five months following the earthquake I did not have clients who reported having difficulty with dealing with the earthquake. I do hear from some in the community who say they are leaving Alaska because of the earthquake, however I believe they generally wanted to leave prior to it occurring.

I had a couple of new clients as a result of the earthquake. They had favorable responses to short term treatment with Eye Movement Desensitization and Reprocessing (EMDR).