Access to Mental Health Care or the Jackson Pollock of It All

by Monica A. Ross, LPC

Problem-solving. Why would the ability to problem solve be a core component of resilience? My first thought on that one is that people who are struggling just to survive, for those who face steep obstacles in life, the ability to problem solve is critical in order to figure a way out of the crisis(es). 

Take a look at this clip, for instance, from the Center on the Developing Child at Harvard University called “How Resilience is Built.” It talks about the importance of relationships and the importance for the developing child of the ability to both monitor and problem solve. 

At the time of this posting, what comes up in a Google search on “How to problem solve” is this method:

1.     Identify the issues.
2.     Understand everyone's interests.
3.     List the possible solutions (options).
4.     Evaluate the options.
5.     Select an option or options.
6.     Document the agreement(s).
7.     Agree on contingencies, monitoring, and evaluation.

This is, of course, geared towards problem-solving in the workplace. That sounds about right, but we also know that people who find themselves in crisis at work or at home can’t even begin to complete number 1, let alone move smoothly along to 2, 3, 4, etc. The reason for this perhaps is because those living in crisis are living life from a scarcity mind-set. 

Mullainathan and Shafir in their book Scarcity: Why Having Too Little Means So Much explain that the focus on what we lack, or approaching life from a scarcity mind-set forces a type of preoccupation in life. When we are preoccupied we do not have the cognitive bandwidth to begin to address other problems. Or at the very least, addressing other problems becomes a daunting task.

The scarcity mind-set, as the authors point out, is not about lacking the capacity to process, but it is about lacking the mental resources. With the scarcity mind-set we tend to do things like incorporate tunnel vision, which is good when something deserves our sole focus and concentration, but towards how many singular things in life do we have the luxury of dedicating all of our attention? 

Scarcity also affects our executive control, making it hard to have self-control.

A lack of self-control can then interfere with problem-solving. Lack of self-control more often than not can exacerbate a problem. It is these types of psychological biases affecting those living with a scarcity mind-set that fuel sometimes poor choices despite the fact that the consequences of those choices can be extreme.

This lends itself to doing impulsive things despite the fact that the stakes are higher. Not only do those who are operating at the survival level (e.g., the poor) have less room to fail because they have fewer resources, but they also have a compromised ability to make good decisions. This, in turn, increases the likelihood of failure.

As clinicians, one of the modules we are typically called upon to utilize in working with clients and in conducting psychoeducation is the module on problem-solving. Why? Because people with severe mental health issues sometimes forget to take their medication, and when that happens they may stop taking medication altogether. They may act on impulse and find themselves running up gambling debts or maxing out credit cards in an impulsive spree, or making hasty, major life decisions like moving cross-country.

It’s important, then, both to gain some level of stability as a consumer or client either on or off medication and from there to work towards maintaining that stability. Stabilizing itself takes a certain amount of problem-solving ability and that problem-solving ability may never be reached if a person finds themselves in a constant state of making both impulsive and poor decisions.

Now let’s compound the issue for the person struggling with mental health issues by making access to help in and of itself confusing. If I were to describe the process of finding a psychotherapist from the consumer or client’s side, well it’s a bit like this:

Some Issues for Consumers

To me the current marketplace is like…..my own artistic interpretation:

scribble

 

Or

Like a Pollock Painting:

Pollock Painting

Or

Like my friend Yoon Lee’s paintings

Yoon Lee

It’s like a kindergartener took a piece of paper and did this:

kindergarten

To put it metaphorically. . .

It’s like a city wanted to build a new roadway system and they let everyone decide where they wanted to put the pavement, stoplights, lane markers, and highway signs.

Book Reference

Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. London: Allen Lane.

Negative Core Beliefs and Underlying Insecurities: Chaos versus Rigidity

by Monica A. Ross, LPC

The time that I spent working at a community health clinic in East Texas was good training.  I got used to seeing a high volume of clients with a wide range of issues, much like I do today.  I value the time that I spent out there.

Here I am now back in Austin. Typically I schedule 7 to 8 sessions per day. There are several reasons for that.  For one, you never know when someone will have to cancel last minute.  Also, my rates are pretty competitive.  I offer sliding-scale. I see clients with insurance. 

At the moment, I am subleasing space.  I limit myself to just 4 days out of the week for sessions.  Those days are Friday, Saturday, Sunday, and Monday.  Working over the weekend is good for the 9-5 crowd and it’s good for families with adolescents that have extracurricular things going on during the week.

My style of counseling is psychoeducational.   I spend a lot of time listening, but I also spend quite a bit of time explaining the concepts behind the modalities that I incorporate. I’m very active and participatory and collaborative during sessions. I listen but I also challenge.

And my clients, well it always surprises me who finds me.  Such great people!  They keep me on my toes and thinking. I had several sessions this past week that really got me thinking in terms of Cognitive Behavioral Therapy (CBT) and the search for negative core beliefs underlying what show up for people as insecurities.

Negative core beliefs lead to behaviors that either correct or overcorrect for our thoughts, in other words, they lead to adaptive behaviors. They may show up as the need for control, or behaviors related to shame and guilt, behaviors that may even perpetuate a feeling of being unsafe.

For example, being born into a turbulent family can lead to a kind of inflexibility in life that perpetuates the thoughts of being unsafe. By the same token being born into a strict family can lead to risk-seeking behaviors which perpetuate the thoughts of being not good enough.

I had one professor who put it this way—you can take all of the disorders found in the DSM and categorize them as one of two things.  They are often either disorders that come from a way of being that is chaotic or a way of being that is overly rigid. Think of mania.  Think of obsessive-compulsive disorder. That suggests then the value of balance in our lives. 

It's the playing off of opposites rigidity/chaos that’s got me thinking today.  And how even in relationships one partner may overcorrect for the other partner’s behaviors--a kind of counterbalance and adaptation. For example, a partner who thrives on structure may find themselves partnered with someone who is more laid back. A partner who lacks creativity might find themselves with someone highly creative.

The problem with identifying too closely with one role or another in relationships is that we can become stuck in our roles. One of the ways out of falling into a role whether it’s one that we place on ourselves or one that we inherit is to lay claim to that part of us which is forgotten or underused kind of like a muscle that atrophies. 

In other words, we have all of our parts. Though some of our parts may be experiencing neglect. The person who is structured does, in fact, have an unstructured and maybe more playful side.  The person who lays claim to no creativity does, in fact, have a creative side.

For all of us, I believe there is that part that prefers structure.  There is also that part that prefers fun.  There is that part that is laid back.  There is that part that is concerned. There is that part that is fill in the blank ________. 

And it’s important to feel as though we have access to all of our parts when we need them.  We don’t have to be estranged from the feelings of being playful or from the feelings of being in charge and responsible.  Though at one point in time, it may have served us better to adapt this way. No one part of us need to feel abandoned or trapped.

 

The Balancing Act of Empathy and Distance and Maintaining a Lifeline of Hope

By Monica A. Ross, LPC

When a person comes into therapy sometimes it’s all they can do to utter the words that bring them in.  Oftentimes those words are linked to tragedy or emotional distress. “I was raped,” “I had an affair,” “My mother passed away,” "I hate my job," “I’m so deeply sad or anxious I can barely get out of bed.” 

We as therapists hear these words every day.  We hear tales of abuse, tales of shortcomings, and tales of disconnect.  It takes a combination of things to balance out the low energy that these thoughts and feelings come with. 

While it’s important to have a measure of empathy, it’s also important to have a measure of distance. We each individual need I think to have a measure of distance from our own inner pain and we as clinicians I would argue need to have a measure of distance from our client’s emotional pain.

It is possible to have both empathy and distance.  It’s a balancing act.

The empathy helps with connection and the distance to a certain extent keeps us sane and practicing. I’ll never forget walking into the lobby of the community health clinic that I was working at and seeing one client who had the obvious appearance of having just had major surgery. My first thought as I saw the client and the nature of the injury and where it was located was that they had been the victim of violence by their own hands. 

That instinct was right. That particular individual had attempted suicide. That was not the first individual that I saw that came into the clinic having attempted to commit suicide in a violent manner. To pull back a client like that and enter into a conversation about mental health with someone who had stared down death at one point takes a measure of distance.

Because to lean too far into someone else’s pain risks losing professionalism and composure and the counterbalance that it takes to be a lifeline of hope. This is no different really than any other of the roles that a physician, a nurse, or any other type of healthcare provider might provide. People come seeking better health often because they are in some sort of pain, discomfort, or distress.

But that pain, discomfort, and distress is unique and separate although it's our shared connection to pain and suffering in general that helps with empathy. Want I guess I’m addressing today is the delicate nature of this job.  On the one hand, we as therapists are called daily to practice empathy and understanding.  I do my best to do that.  I get asked all the time, “How do you what you do?  I could never do that.” 

Well, actually I absolutely love what I do.  I love going into work every day and keeping this space for people to share their stories and hopefully find some kind of relief and buffer from the world.  And it’s not all tears and boxes of Kleenex.  It’s often also laughter and joy and celebration.

Quite often I get clients who come in having complained about something that a previous therapist did or said that was off-putting and I have no doubt that I at a moment of weakness may have rubbed someone the wrong way inadvertently. This does not make any of us bad practitioners.

There’s so much that goes into a delivery of a service especially when that service is intangible in some sense and the process is that of collaboration and co-creation. Perhaps there are times I think when I have tried to rush the process or introduce another perspective at a time it wasn’t in sync with a clients’ emotional needs.  That is an example of how an issue of timing can come across perhaps as a lack of empathy.

It’s hard for anyone to be good at what they do 100% of the time.  I’m not sure what my error rate is, but hopefully fairly low.  Lol.  So, when I get a client who comes in having had a bad experience with therapy I have both empathy for the client and the client’s former therapist who had they known would have likely tried to rectify their mistake. 

Clients have a right to terminate their therapy at any time and for any reason.  Though we suggest that if possible it’s good to try to work out whatever issues arise through the process of therapy within the therapy process itself.  It’s okay to be pissed off by something your therapist says and then walk in the next week and bring it up or gain clarification or what have you. It’s just part of the process.  But then there are other times when maybe it truly is time to move on and find a therapist who is a better fit.