Friday, February 26, 2010

Letting go

Letting go, moving on, saying goodbye, rarely are these easy to do. Yet, life seems to require that of us, whether we want to or not. The co-workers we're fond of get new jobs, our favorite neighbors relocate, our siblings get married, and our children go away to college. Then there's the unwanted divorce, the unexpected death, and the estrangements with which we have to deal. And, deal we do; sometimes better than other times.

Grieving clients ask me all the time, "How do I let go?" The Book of Ecclesiastes makes the point that there is a season for all things, and that would seem to include relationships, which have to come to an end. Buddhism teaches a philosophy of non-attachment to material things, and that, too, would seem to include people. Yet, Attachment Theory tells us that we are hard-wired for connection to others, which is why it hurts so damned much when we have to let go.

The divorced client can't move on, stuck in an old mindset that says that she's still married. The grieving client can't stop yearning for the deceased loved one. The jilted fiance can't return the engagement ring to the store where he bought it. The drug addict continues to mask the pain of the death of his best friend when they were 9 with a plethora of street drugs. The overweight woman eats to fill a hole that can't be filled with food. The successful survivor of a very destructive dysfunctional family continues to allow the family to pull him back into their underachieving world. If all of them could just let go, by themselves, I'd be in search of a new career.

Well-meaning friends and family are always telling other people (aka my clients) to "let go and move on." And then I'm asked, "What is letting go?" and I have to say that I don't know what it means. I'm not sure that we ever really let go; maybe we just don't hold on as tightly, or as self-destructively. Maybe we just find a place for the lost person ---or we grieve the unmet need, and then, one day, it just seems that we let go.

Let go sounds like an action verb, an activity that we do with zeal and self-discipline. It sounds like something over which we have control. The Cognitive-Behavioral folks would say that's exactly right--we make up our mind, change our behavior, and voila, we let go. Hmmm. I've yet to see it happen quite that way. It's usually a very painful process to accept the goodbye, especially when we didn't want the goodbye in the first place.

And, that's where therapy comes in. Trying to let go (whatever that means), all by yourself, can be an exercise in futility; certainly an exercise in circular thinking. Ever notice that when you're talking to yourself about a highly emotionally charged issue you seem to return to the same starting place, no matter how long you go at it? We call that circular thinking or a closed network. Therapy changes the number of people involved in the thinking, it adds a new thought, an insight, and a helpful hint. Therapy becomes the action verb that is needed when trying to let go.

A broken heart requires mending. How will you begin the process of mending it?

Journal topics re moving on:
I have outgrown...
I miss...
I don't miss...
I am not quite ready for...
I look forward to...

Friday, February 19, 2010

Suggested readings

Readings that have helped yours truly cope with her losses...

When Bad Things Happen to Good People, by Harold S. Kushner.
When Living Hurts, by Sol Gordon.
Man's Search for Meaning, by Viktor E. Frankl.
Necessary Losses, by Judith Viorst.
How to Go On Living When Someone You Love Dies, by Therese Rando.

Perhaps, as you meander through this time without your loved one, trying to find meaning or purpose in your life, you might find comfort and increased joy in living by joining others in a support group, talking with a clergyperson, working with a grief specialist, or reading an inspirational book. Just a thought.

The Keeper of the Flame

We were 37 when my oldest friend died. We'd known each other since we were 11 years old and attending the same dance school. We were very different people: I took classical ballet and tap dance; she studied modern jazz and tap dance. It was our similarities that brought us together and our differences that added spice. We knew each other for 27 years through the first boyfriend, the first pregnancy scare, the first spouse, the first everything. And, then, a few months before our 20-year high school reunion, she died. Suddenly. Literally, she dropped to the floor and was gone. The Coroner said it was an aneurysm.

Sudden death is particularly hard to deal with: there's no time to wrap your mind around the loss. Perspective has to come in time. The emptiness can be crushing. Feeling your heart pulled out of your chest, leaving behind ragged edges, is excruciating. The loss of a friend, especially an old friend, can be very much like the loss of a sibling because they have an essential ingredient in common: a long-time friend, just like a sibling, knows our history. They know where we came from, who we used to be, what mattered to us waaay back then, and they know how we've changed. They are the keepers of our story, and when they die, there is no one who knows what the story means anymore. For example, when the first real love of your life dies thirty years later, who is still alive who knows what that person meant and can recall the tender and joyful moments with you, as part of your healing?

When you lose a sibling, or your oldest friend, you lose your archivist: the Keeper of Your Stories. And, it feels like you've lost the Keeper of Your Flame. It does get better over time, although I'm not a big believer in the old salt that time heals all wounds. No, time does not heal all wounds...hard work heals all wounds. We have choices to make in our grieving---after the grieving seems to be over, there's still the yearning for the person. Will the yearning become a fulltime "occupation" or will it make an appearance only on holidays and birthdays? There is the need to have a place to put them. Will we preserve them under glass, the pain and agony very much alive? Or will we find a spot in the closet, in an old hat box, available to be taken out when we want to enjoy it, and safe and protected when we put the lid back on? The choices of how to deal with loss are ours to make.

When I have lost a loved one, I have been comforted by this meditation. I hope you will, too.

It is hard to sing of oneness when our world is not complete, when those who once brought wholeness to our life have gone, and naught but memory can fill the emptiness their passing leaves behind.

But memory can tell us only what we were, in company of those we loved; it cannot help us find what each of us, alone, must now become. Yet, no one is really alone; those who live no more, echo still within our thoughts and words, and what they did is part of what we have become.

We do best homage to our dead when we live our lives most fully, even in the shadow of our loss. For each of our lives is worth the life of the whole world; in each one is the breath of the Ultimate One. In affirming the One, we affirm the worth of each one whose life, now ended, brought us closer to the Source of life, in whose unity no one is alone and every life finds purpose. (From the New Union Prayerbook)

YOU ARE NOT IN THIS ALONE. I am here to help.

Wednesday, February 17, 2010

Free "therapy"

I'm a psychodynamic therapist, which means I do a whole lotta listening, while the client does a whole lotta talking. (I also do a whole lotta educating, responding, searching for insights, etc.) Carl Rogers, who created humanistic, client-centered therapy, is one of my heroes. I'm a big fan of the work of John Bowlby, who is synonymous with Attachment Theory. I give all praise and hazzuhs to William Worden, who (literally) wrote the textbook on grief therapy and grief counseling. Each of those psych professionals had their roots in psychoanalytic psychotherapy (aka Freudian therapy.) I'm a big fan of Freud's work. (Okay, not all of it. I'm not a fan of his Drive Theory or his ideas regarding women's sexuality. He was a Victorian, after all, and subject to the influences of his time.) And, philosophically, I'm an Existentialist: in short, a major believer in the concept of personal responsibility.

If it isn't clear already, I'm not a cognitive-behavioral kind of gal. I don't buy the idea that changing your behavior is enough. That seems much too much like putting cream on a rash: yeah, it'll get rid of the itch, but it doesn't "cure" the cause of the rash.

Having said all that, I do, happily, use one technique from the Cognitive-Behavioral handbook: journalling. Personally, I journalled like crazy all the days of my own therapy, and even when I wasn't in therapy. I always considered it free "therapy." So, from time to time, or maybe even regularly, I'll include a journal question or topic for readers to explore.

Write from the heart. There is no right or wrong answer. Don't worry about spelling or grammar. This doesn't have to be poetry or worthy of publishing. No one has to see it except you. It's simply you talking with yourself, so enjoy the conversation. And, if you want to share it with me, send it to my email. I'll be delighted to hear from you.

The first 3 journal topics are:
My first memory is...
I have tried to forget...
I wish I could remember...

Paths to God

Therapy clients frequently ask me about faith. It's a reasonable topic to come up in therapy, especially when a client knows that I spent years in hospice as both a therapist and an inter-faith chaplain (and am an ordained inter-faith minister). The assumption is that I must be a religious person in order to have been a chaplain, or at a minimum, I must be a spiritual person. The client is right on both counts, but it wasn't always that way. When I began working in hospice as a volunteer in my 20's, I was spiritual, but not religious. Then, in time, I became more religious, enjoying the practices and culture of my religion, but I did not possess a faith in anything I couldn't see, namely, God. (Or the Higher Power, the Creator, choose a name that suits you.) My path to God was, perhaps, a little unusual.

Hinduism teaches that there are 4 paths to God. The Four Paths are: The Way to God through Knowledge, The Way to God through Love, The Way to God through Work, and the Way to God through Psychophysical Exercises. In a nutshell, the first path, through Knowledge, asserts that thoughts have consequences and our thoughts animate our lives. Thoughts can involve positive thinking, or learning in one fashion or another (e.g., books, classes), and asking questions. The path of Love says that one adores God with every element of his or her being, for no ulterior reasons other than to simply and adoringly love God. Love can involve prayer, service (as in becoming a monk or a minister), meditation, etc. The path of Work says that each task becomes a sacred ritual, lovingly fulfilled as a living sacrifice to God's glory. Again, that could include committing to a life of religious service, or it could be digging ditches, which becomes a holy activity when done for the glory of God. And, finally, the path through Psychophysical Exercises, which asserts that one must drive the psychic energy of the self to its deepest part to activate the true self. This could include a deeper yoga practice, meditation, or my personal favorite, psychotherapy.

Many of my patients arrive with a bushel of excruciating issues and old pains that create walls between them and a satisfying, peaceful life...and between them and God. ("Where was God when I was being beaten/incested/raped/scorned/abandoned by my mother/father/grandparent/stranger?") As therapy progresses, as the issues are worked-through, as the walls come down, they desire more out of life: they want meaning in their work, a purpose for their lives, answers to deeper spiritual questions, and, maybe, a reconciling with the God they believe abandoned them in their tragedies...or, perhaps, they seek their first adult relationship with God. Yes, therapy can lead a person to God. It isn't my intention, I don't proseletize or preach. It just seems that the folks who come to me want something more out of their lives, once they feel more whole. (Is this Divine intervention, perhaps?)

Which was my path? Knowledge. Specifically, questioning. Questioning and more questioning. What's unusual about that? Nothing. The unusual part was the the actual, real, physical path that I walked: the path of hospice. Some of the patients I worked with had tremendous faith in a Higher Power. They had a very real, almost palpable relationship with a living God. A God who inspired them, supported them, encouraged them, and believed in them. I envied their faith and their ability to talk, unselfconsciously, with their God through prayer. How could they believe in something that didn't seem to work, namely, prayer? (May I recommend a great book, Healing Words by Larry Dossey? That book took me to new places of scientific understanding regarding prayer.) How could they believe in a God they couldn't see and who didn't seem to talk to everyone, just to a select few?

Years would go by, decades for that matter, and as I worked with dying people their faith just seemed to rub off on me. That isn't to say that I didn't ask a lot of questions of anyone who would answer me. I certainly did, year after year. But, funny thing about prayer: as a chaplain, I prayed with persons from every faith tradition and in various prayer languages, and as I prayed with them it seems a little bit of something came my way. Maybe it was a little bit of peace, maybe a moment of clarity, or maybe a deeper understanding of a word (e.g., grace), concept or practice.

Then came the day when a questioning patient asked questions of me regarding faith. "How do you get it? How do you get faith?" he wanted to know. I heard myself saying, "Why don't you try faking it until you make it?" "Really?" he asked. "That's not dishonest?" "Seems to me if it is in an honest pursuit of higher knowledge, part of a true search for answers and comfort, then fake it like crazy. Maybe something will come of it." And something did: he found a special relationship with a God he could love....and he died with the peace he'd always envied in others.

My path was to ask questions like crazy. I questioned with the energy of a storm. I have some answers now. I will gladly share one answer that I have received: The Path of Questioning, and a life of service, brought me answers and peace. Okay, I'll share another answer: I have come to believe that my work is the vessel through which God provides blessings in my life. At long last, I have fewer questions than I have answers. Or to put it another way, I have more answers than I have questions. Maybe that is the definition of peace, after all.

The answers I received are not for everyone. They're mine, they work for me. I have peace...the peace I've always envied in others. Now, then, which of the Four Paths works best for you?

Saturday, February 13, 2010

When life sucks

Disappointed in Life, a young friend recently asked why happiness had eluded them. Why couldn't they be happy? Why isn't life being better to them? At the risk of sounding like a self-help book or a pop philosopher, it seems to me....

It seems to me that if we give up on something (e.g., a relationship, a college education, self-discovery) just because it is hard, we will not have a very satisfying life. If we generalize the painful or unpleasant experiences in our life, then it will seem as if Life is against us. If we need perfection in our self and others, then we are doomed to a life of disappointment in our self and others. If all we see are the walls that we hit, then Life will seem like a miserable maze filled with concrete barriers. If we continue to be hard on our self and others, then we will live a lonely life. However, if we open our self up to enjoying the wonder of Life, to exploring the variety of people within our sphere of influence, to pursuing the meaning and purpose of our own time on this planet, then, when our days are over, we will have had a life that we enjoyed.

It seems to me that when we pursue happiness, it eludes us. However, when we pursue meaning and purpose, happiness is a delightful by-product. As examples, when we pursue marriage, we will find someone, regardless of whether or not they are good for us... or bad for us. However, when we pursue an appropriate partner in life, then a good marriage is a by-product. When we pursue the acceptance or love of others, we will probably get it, but it will be fleeting and unsatisfying, because it is theirs to give or to withhold, not ours to demand or command. However, when we pursue our own identity (aka self-knowledge), then we will be in a better position to know who and what we want, to know who and what is good for us, and to have the strength and skills with which to deal with choices, decisions, commitments, responsibilities, success, failure, rejection, adversity, pain, and loss.

It seems to me that most of the things that we pursue in our lives are better left un-pursued.

Now I'm not suggesting that we just passively or indifferently let Life come to us. I'm just saying that most of what we want in life will come to us through routes other than direct pursuit. For example, happiness. In truth, happiness is fleeting. We think that a new car will make us happy, and, then, when the new-car smell is gone, we're not as happy as we were when we bought it. And, frankly, we think that a new spouse will make us happy (in fact, for most people it is part of the job description of a spouse), but when the "new-spouse smell" wears off, when they disappoint us, when our needs are in conflict, then we're unhappy and we want to know where our happiness went.

If the happiness is not already inside of us, then pursuing it won't do us any good.

However, if we pursue self-knowledge, then, quite honestly, an attitude of self-contentment, a joy in our purpose, a satisfaction in the meaning of our endeavors, will allow us to view the world through happy eyes. Have you ever pursued a butterfly? Then you know that pursuit pushes it away---and peace and quiet create the perfect environment to encourage it to visit your garden. And, it helps, A LOT, if you plant the right kind of flowers, the kinds that attract butterflies. Just a thought.

Friday, February 5, 2010

What do you say to a person who is dying?

The other day a patient tearfully asked me, "What do you say to a person who is dying?" It wasn't the right time to answer her question. Mostly because she didn't really want an answer; it was the time for grieving the recent loss of a young friend, not for answering questions of deathbed etiquette. It was the time for expressing the shock and pain of witnessing a progressive and pernicious disease take the life of a young person. It was the time for first attempts at clarifying the meaning of the loss and its still vague implications for life lessons. However, when the time is right, I will answer the question.

As a hospice chaplain, with patients with whom I had shared the long and winding journey from diagnosis to last minutes, I said what I felt: "When you die, you take a piece of me with you; and you leave a piece of yourself with me. You live on, inside of me. Thank you for sharing your journey with me." The look of peace and contentment on their face said it all. To another person, I said, "I will miss you. I will miss your sense of humor, your quick mind, our deep conversations." To a beloved uncle-by-marriage, I spoke the unvarnished truth, "Thank you for being such a great uncle. You were truly one of the finest men in my life." To the cat of my dreams, the cat that my daughter cherished, I remember thinking, "Thank you for all you gave to my daughter...and me."

Truth be told, no one knows the meaning of the loss more than the two of you who share the goodbye---and that includes saying goodbye to a marriage, sending a child off to college, or saying goodbye for the rest of a lifetime. The words that pass between you should come from the heart of your relationship. And, the simpler and the more direct the words are, the better. As we say goodbye for the last time, can you imagine that there is there anything more meaningful to the dying person than to know that she or he will not be forgotten? Is there anything more powerful than knowing that you will live on, at least a little bit, in the memories of those whose lives you touched? What do you think you would want to hear as you say goodbye to this world and the people you love?

As for me, well, I'd like to be remembered.

Tuesday, February 2, 2010

I figured out how to respond to comments!

Did I mention that I'm a techno-idiot? And, despite the fact that this blogging site is pretty near to being idiot-proof, I still did not know how to recognize that folks were commenting. Seems that there is a learning curve here. I have now responded to the comments and I welcome discourse, as they say. And thank you for your comments. Okay, so, here is a true idiot-question: are the comments "viewable" to all readers, or just to me? Seriously, if someone would answer that question for me, I'd be grateful.

First official rant

Officially, this is my first rant: I'm tired of cleaning up behind other professionals.

Some therapists are very good at some issues, and should stay out of other issues. Just because they have a license doesn't mean that they should offer their services in areas in which they have limited experience or no real education. And I don't want to hear that old salt about, "Gee, how else are they supposed to get experience, if they don't practice on whomever comes through their office door?" Oh, please. They can't just read a book and then decide that they're an expert. Or take one class and change their business card to reflect this new expertise.

Okay, so, how do you get experience doing something new? Take several classes AND read several books AND go to a few conferences, and if any of those learning experiences are credible, then the therapist should have the opportunity to participate in roleplays, watch roleplays, talk with actual professionals, and develop some skills. At a minimum, they should inform their new/prospective client that they have limited experience in that issue and not charge their new client(s)---or volunteer at a community clinic and receive supervision while volunteering.

Why do I care? Because I'm tired of cleaning up behind so-called professionals, who may not do harm (unless you consider lost years in one's life harm), but don't do any good either. And, then, there are those who actually do harm by establishing expectations of what therapy is and will be. Case in point, the woman who came to me after three previous therapy experiences: the first therapist used to pour a drink for the both of them while they had session (did I mention that she was an alcoholic?); the second one spent their time talking about his personal issues in the guise of teaching by example; and the third one slept with her. At least one of those therapists committed a criminal act (sex with a patient is NEVER okay!); one should have been reported and punished (drinking? during a session? with an alcoholic client? seriously!); and the over-talker needed to take a couple of good therapy classes and remember that therapy isn't about showing how brilliant you are, or how well you manage your own life, it's about helping the patient discover him or herself (and to discover how well s/he can manage his or her own life).

And, then, there are those therapists who think that grief counseling and grief therapy are no different than whatever kind of therapy they ordinarily do. For example, if she is a cognitive behaviorist, she simply addresses grief with the same techniques that she uses for cog-b therapy. Agh! Talk about compounding the problem! Grieving people need sensitivity, warmth, inclusion, and psychoeducation, not techniques, and certainly not emotional distance. They need someone who will explore the deeper meaning of the loss, uncover the ancient or multiple losses glomming onto the current loss, and who will (figuratively) hold their hand throughout the grieving process. Instead, they get no real help, and I see them years later when their lives are approaching the sunset years and the former years cannot be recaptured.

There are no do-overs for decades lost to grief. And, certainly, no do-overs for dreams, ideals, hopes, and love lost. So, please, therapists, stay in your areas of true expertise and leave grief to the true grief experts. And, consumers, BEWARE. Ask about specialized training, years of experience, where they earned their experience, what special certifications they may have, their philosophy of grief therapy, and their usual style of therapy (humanistic, cog-b, Jungian, etc.), and then go to and look up the style of therapy so that you understand it. You wouldn't do less if you were looking for a heart surgeon, would you? You owe your psychological future at least as much. Just a thought.