I LOVE MY PATIENTS

I love my patients. When I say this it oftentimes makes others uncomfortable.On one occasion I was being interviewed by a psychiatrist on radio and she said,"I read your book and I really liked what you had to say. However, your using the word love made me uncomfortable. I think that I would have preferred the word nurture - I nurture my patients." I responded,"I am aware that it makes people uncomfortable- sometimes it makes me a little uncomfortable too. We need to ask ourselves why does saying'I love my patients' make us feel that way?" One of the reasons is that in our culture the first associations to the word love are usually to sexual or romantic love. Of course,those expressions of love would probably be harmful to our patients. Yet, in other areas there is a wide spectrum of acceptable expressions of that feeling. We can easily say "I love...my children, my wife,boyfriend,friends,animals,home, community etc. Why not include patients?
Another explanation for the internal struggles is that it feels unprofessional to say,"I love my patients." We tend to define professional as objective and not emotionally attached. Yet, in some other cultures that is not true. Several years ago a dear friend,who is a psychotherapist, was on a trip in Cuba sponsored by a social justice organization. On this two week trip she was among a group of health care professionals who were in Cuba to witness how their health care system worked and to interact with Cuban health care professionals. She was very surprised to witness how often and easily the Cubans said,"I love you" and were openly expressive of their love toward their patients. And how openly they expressed that love of their patients at professional meetings. When she returned we had several interesting conversations. We discussed how our training emphasizes this other notion of "professional" as objective and non-attached - more scientific. It led us to recall how important it was for the early leaders of the fledgling fields of psychotherapy to be accepted by members of the medical and scientific community. They felt that in order to establish the legitimacy of this field among the other sciences that it was essential for them to be viewed as objective and emotionally distant. It seemed to both of us that we were still unnecessarily holding on to that earlier model.
When I am asked during interviews how I express my love I reply that, first of all,it is important to state that I am not talking about sexual or romantic or sentimental love. Those expressions of love towards our patients would be unprofessional and harmful. I am talking about open-hearted expressions of praise,encouragement,compassion,acts of loving kindness,warmth,celebrations of growth,consoling touch,non-judgment,caring challenges etc. A common response from other psychotherapists and counselors is,"I do those things too although probably not as often as I feel them and I don't really talk about it with my colleagues. Also, I don't usually think of those things as an important part of the treatment." Yet,according to the research literature about effective psychotherapy, when clients are asked what was most helpful to you in your therapy most frequently people reply that,"My therapist cared about me as a person." Moreover,there is increasing research on brain patterns indicating that compassionate caring over a period of time changes brain patterns in positive directions.
For most of us psychotherapists, counselors, life coaches, pastoral counselors a significant part of our original intentions in doing this work was our heartfelt desire to help people with their problems - to alleviate human suffering. For many of us our training with its emphasis on theories, techniques and professionalism has caused us to suppress those original heartfelt feelings.
A primary motive for me in writing the book,"Working From the Heart:A Therapist's Guide to Heart-Centered Psychotherapy", doing this monthly blog and Twitter, and making my youtube videos is to advocate that we return to our original heartfelt intention by being more openly expressive of our caring. Then our patients benefit not only from our theories and techniques, but also from our open-hearted expressions of love.

WHAT IS IN MY BEST INTERESTS?

Whenever patients are faced with conflicts I encourage them to ask themselves the question, "What is in my best interests at this time of my life?" Sometimes the conflict is a major life dilemma the resolution of which will probably change their life in significant ways. In these instances I tell them that, "This conflict cannot be resolved at the level of consciousness at which it currently exists. A good resolution that is in the best interests of your total personality can only come from a higher level of consciousness by engaging your Higher Self and your compassionate heart". Then I describe to them the technique of The Council. This process of convening a Council to resolve major life dilemmas is described in detail elsewhere in an earlier blog entry, in my youtube videos and in a chapter in my book, "Working From the Heart:A Therapist's Guide to Heart-Centered Psychotherapy?
The question,"What is in my best interests?" is also helpful in resolving the small conflicts of everyday life. Usually my client experiences the conflict as being between two different ideas, feelings or courses of action. I ask them to consider the possibility that each idea or feeling is emanating from a different part of their personality. Each part needs to be heard with compassion and honored. Most commonly my patients will describe one feeling or idea and then say "but" and describe the opposite/different feeling or idea. I then encourage them to substitute the word "and" for "but". I explain that that when "but" is used in these circumstances it tends to negate,diminish or devalue what preceded it. By substituting "and" I am valuing both and helping my patient to find a pathway of allowing the two to coexist in their consciousness with compassion. By using the word "and" my patient learns to respect both parts of their personality and begins to have a tool for containing the tension between them. The longer they contain with compassion the tension between the parts the more they create the possibility of a middle path resolution emerging. It may be a creative synthesis of the two ideas or courses of action. Or it may be a totally different third resolution that serves the needs of both parts of the personality. Or it may be that one part of the personality - after having its voice respected and treated with compassion - will realize that the other viewpoint is better for it too.
By encouraging my patients to more frequently ask themselves,"What is in my best interests at this time?" I am helping them to access their higher consciousness with ever increasing frequency. From my perspective the source of this question is their Higher Self. Someone else might say their personal Higher Power or their Inner Wise Elder. Whenever I use this perspective I hold up my right hand - symbolically indicating higher consciousness - as holding the big question, "What is in my best interests?" In my forty years of doing this therapeutic work it has been quite rare that any of my clients were taught about their higher self or shown any ways of accessing it in their everyday lives.
It is a very rewarding feeling for me to hear how my patients gradually internalize this notion and more frequently ask themselves, "What is in my best interests?"


This entry is based on material discussed in more detail in The Council chapter of "Working From the Heart:A Therapist's Guide to Heart-Centered Psychotherapy"

AN ISLAND OF SANITY

For some of our clients we are an island of sanity amidst the madness of their lives. Sometimes there are so many things happening in their lives that they are completely overwhelmed and on the edge of panic much of the time. Sometimes what is happening is mostly internal. They are feeling so much conflict among different parts of themselves or some unwanted long-repressed feelings are emerging from underneath or there is some deep sense of dread about what is going to happen next. Our clients in these situations are feeling very anxious - near terror - that they are going to "crack up" or totally collapse.
During these very difficult times they look to us to be a reliable source of stability - an island of sanity - when everything around them and within them feels like an unending turbulent storm. Our peaceful and compassionate presence provides a sense of refuge that they do not feel with other people in their lives. Our office space,by how we have furnished it and the objects we've place within it, also helps to create this sense of tranquility. This aspect of psychotherapy is rarely ever talked about in our training with its emphasis on theories, techniques and professional objectivity. Yet, I have experienced the importance of this way of being for our clients especially when their outer world or inner world is coming apart.
Jennifer,an old patient of mine, recently called me. The company where she had worked for twenty years decided to close, her husband was diagnosed with cancer and her daughter - the mother of her beloved granddaughter - had inexplicably become closed off. She was having frequent nightmares, daytime panic attacks and felt like "I'm falling apart and I'm going to crack up." Jennifer felt quite embarrassed that she was in this state after having done so well since we ended her psychotherapy ten years earlier. I let her know that I was not disappointed in her and felt honored that she was seeking me out during this very difficult time. I also said it was not unusual for patients to reconnect with me during these kind of crises.
Jennifer felt so relieved to be in the sanctuary of my office where she could feel the reliable safety and peaceful security of my presence. I helped her to understand that part of the reason for her being so overwhelmed and terrified was that these current events were triggering the chaos and profound neglect of her childhood home. This perspective helped her to feel somewhat more stable. However, increasingly she felt flooded by these memories. Combined with the powerlessness created by the unfolding events of her life she continued to feel very anxious about having a breakdown.
I did with Jennifer what I have done with other patients under these circumstances. I gave her something personal from my office that she could take home. I handed her a carving of a tree that I had brought back from a vacation in the redwood forests of Northern California. Redwoods, of course, are trees that heave survived many storms, fires and attacks from insects. They are an iconic image of strength and stability. I held the carving for a while, rubbing my hands on it and said, "Bring this home with you as a reminder of what it feels like to be with me in this office. When you're feeling overwhelmed pick it up and hold it. Keep it until this storm is over and then bring it back to me." My perspective in doing this is that she will be borrowing my strength for a while until she can reclaim her own.
I also asked Jennifer if she felt like there were any other places where she felt safe and sane. She remembered that throughout her childhood she had always gone into the woods near her home. She felt safe there and not alone - like the big trees were protecting her from the emotional insanity of her home. I encouraged her to spend a lot of time in the woods now to recapture that childhood sense of sanctuary and tranquility. I also asked whether she had any photos of those woods or some similar woodland setting. She recalled that she did have a photo of a wooded place that reminded her of that childhood refuge. I told her "Put that photo up in your home. Whenever you're feeling very anxious look at it, remember what it was like to be there . Then do some meditational breathing. Amidst the powerlessness and panic of what's happening in your life now you can reconnect to that old familiar sense of sanity and peacefulness that at some level of consciousness you still carry inside of you." Jennifer smiled warmly, "I like that idea, I can do that."

These ideas are based on the Sanctuary chapter of my book, "Working From the Heart: A Therapist's Guide to Heart-Centered Psychotherapy

THE TOOLBOX

Most of the Patients in my current psychotherapy practice are men. At this stage of the evolution of my professional life, 71 years old with four decades of experience as a psychologist,I have a strong desire to help men navigate the complexity of their emotional relationships with their partners and their children. I view it as a mentoring role within the therapeutic relationship. Most of my patients had fathers and other men in their lives who had limited skills for dealing with emotionally-laden situations.

In talking with my patients about this I find the iconic male image of "the toolbox" a very useful metaphor.For example, during a recent session with Hal, who at 38 is floundering in his efforts to connect emotionally with his wife and two daughters,I said "When your father reached into his emotional toolbox he found only two tools - advice-giving and the hammer of anger. Part of what I will try to do is to give you some additional tools." He smiled and nodded his head. This is a fairly typical exchange. We live in an era in which men are encouraged to connect more with their inner emotional landscape and to enter more into the realm of the heart in their relationships with their partners and their children. However, they have been raised by fathers, grandfathers and uncles from another era. So, while there is a cultural permission to define masculinity in a different way, they still have few models of what that actually means.

When discussing expanding their emotional skills I put my left hand over the edge of my chair, reach down to the floor and say, "Imagine yourself reaching into your toolbox and selecting the right tool that is needed for this situation." Oftentimes men will say that they feel helpless because they don't know what to do. My respond usually is "Often she doesn't need you to do anything. She needs you to be....Sometimes that means being an attentive listener who doesn't interrupt or give advice. Sometimes that means she needs you to be in your heart and not your problem-solving head - to be an open-hearted compassionate presence. Sometimes the tool you need is patience - to give your partner or child the gift of your time while something unfolds." We also talk about being a provider, which is certainly an archetypal male role. The use of that term resonates with my patients at very deep levels of consciousness. However, I'm talking about being a provider not only of their external needs, but also of their inner needs. That means asking the question, "What does my partner or child need from me at this moment to nurture their inner life. Do they need a warm soothing voice, encouragement, some affectionate touch, praise, celebration of an accomplishment ....?

As a way of reminding my patients to respond from their hearts to these emotional situations I recommend to them that they gently touch the breastplate at the center of their chests and do some meditational breathing. I suggest that they tap that spot for several minutes before they enter their home or apartment as a reminder to shift from the problem-solving mode that their work usually requires to the more open-hearted presence that their home life needs. I also encourage them to do that gentle tapping of their heart area during emotional situations at home so that they can respond from the realm of their emotional hearts.

This blog entry is based on the MEN chapter of my book "Working From the Heart:A Therapist's Guide to Heart-Centered Psychotherapy"

CARRIERS OF HOPE

Not all of our patients reach levels of despair or profound discouragement wherein they feel a sense of hopelessness or some significant diminished of their capacity to be hopeful. More than a few clients,however, do experience that dark place at some point in their therapy or counseling.

Sometimes it's because nothing in any area of their life is going well and everyday life feels so overwhelming that they cannot see a away out. Sometimes they feel a sense of powerlessness to change any of the externals of their lives. Sometimes they feel that whatever changes need to occur are so daunting that they are beyond their own inner resources. Sometimes it's because they feel consciously or unconsciously that they are unworthy of a better life. Sometimes it's because they are over attached to certain desired outcomes or over identified with some self-concept or certain ways of being-in-the-world. Usually it is a toxic mixture of several of the above factors.

It is in these moments that our patients need us to be "carriers of hope". It is not necessary for us to offer them reasons to be hopeful,nor is it essential for our client to think of things to feel hopeful about. During these times of profound darkness any imperative to find reasons to be hopeful place too much pressure on our client or us. What we can offer though is companionship in the darkness - to be alone in the dark is more scary - and a persistent willingness to keep working with them on these issues until some light appears. What I usually say to my patients during these difficult times is,"I have experienced my own version of this place a couple of times in my life and I've been with other patients in this dark place. For now I will carry the hope until it reawakens in you."

Whenever I've said that most patients have voiced that they feel relieved and grateful. Occasionally there is some client for whom that message is no conscious source of solace. I simply accept that they are unable to take in my offer at this time and I continue the work placing no extra pressure on them to acknowledge that message.

Twice in my life I have experienced periods of sustained suicidal ideation. I have never acted on those thoughts. Because of my own toxic mixture of the feeling states that I described earlier I know what it feels like to feel that the only way out of the overwhelming darkness is death. Obviously I am grateful that I never acted on those feelings. I am also grateful that I have experienced those states. It is both an additional source of deep compassion for my patients who are suicidal and also helps me to be less fearful about being in that place with them. With most patients who are feeling suicidal I share that aspect of my personal story. It enables them to know that there is an additional source of my genuine empathy - as a human being who has suffered similar states in addition to being a professional who cares. I am also offering myself as a beacon of hope.They are usually grateful for that moment of sharing our humanity. Periodically I do not share my story because I sense for reasons that are idiosyncratic to that patient, that it would not be helpful.

Never in my training was it ever mentioned that one of our important roles was to be "carriers of hope". Increasingly I feel that it is an essential aspect of our work. I'm not sure why. Perhaps in these complicated times wherein the political, economic and environmental issues are placing so much conscious/unconscious pressure on our clients that the need for us to be a source of hope in their individual lives is greater.

Accessing Our Big Hearts

    Once our work day begins we are in the psychological field of whatever each patient brings to us that day. Sometimes what they bring feels enormous and overwhelming: profound sadness or despair, terror or unrelenting anxiety, tremendous rage, or, a huge void. When our patients experience these big feeling states, there is a palpable shift in the energy in the room. In the presence of these states it is understandable that our first response, often unconscious, is to constrict our emotional hearts as a way of protecting ourselves from being overwhelmed.

   On some days there is something occurring in our own lives that makes it very difficult for us to be compassionately present. We are feeling miserable because we have a heavy chest cold or did not sleep well. We're worried about how we are going to pay that huge doctor's bill or this month's rent. We had a big argument with our spouse or partner or adolescent daughter this morning.

   Under these circumstances we may wonder how are we going to get through this evening's work and be present to our patients. In these moments it is important to remember that we all have Big Hearts that are able to transcend the limitations of the small hearts of our ordinary consciousness. How we understand the source of this Big Heart will depend on our cosmology. Yet we all know about the existence of these aspects of our consciousness from personal experience. We all have these periodic moments when we transcend our ordinary love and feel a much larger love for our spouse/partner, for our child, for a dear friend, for a particular place, for a beloved animal, for ..... These are Big Heart moments.  From my perspective my Big Heart is an aspect of my Higher Self. Someone else might postulate that this larger love emanates from their personal Higher Power or Buddha Nature or Christ Consciousness or .....  

The important pragmatic question is how do we access his Big Heart during psychotherapy or counseling sessions? I think that it is very helpful to have some image of this larger heart that uniquely fits for us. Many years ago my wife, Jeanne, gave me a piece of California redwood that had been carved into the wizened face of a bearded old man. I keep this carving in my office in a corner behind my patient's chair as an iconic image of my old friend Wiseheart, my name for my personal Higher Self. I think of Wiseheart as the Big Heart aspect of my consciousness. he is also the container of the enlarged compassion that has developed through my life experiences and the conduit for other sources of deep compassion and wisdom that are available to me through the collective unconscious. I encourage my patients and supervisees to develop their own personal image of their Big Heart. Until that emerges I suggest that they imagine a larger emotional heart that is located near their physical heart.  

   About five or ten minutes before the beginning of my first session, I use a small wooden hammer to tap an antique Chinese bell that sits on the floor inside my office door. This tapping ritual is a symbolic reminder that my intention is to enter a psychological space that is different from the concerns of my everyday life. Then I look at the carving of Wiseheart, imagining that I am connecting to my Big Heart and then I do some meditational breathing. Then I open the door to welcome my first patient.

   During sessions whenever I begin to feel overwhelmed by the bigness of the feeling states that my patient is experiencing or I start to feel myself becoming emotionally distant I again look at the carving of Wiseheart and do the meditational breathing. At these moments I feel that with the in breath I am connecting to my Big Heart and with the out breath I am releasing the energetic vibrations of my patient's large feelings. Then they do not penetrate the field of my consciousness. I can continue to be a compassionate presence for that person and the next and the next. At the end of a morning/evening of work I do not feel depleted.

   I encourage you to adapt these notions about our Big Hearts to your individual cosmology and ways of working.

   These ideas are described more fully in the Small Heart, Big Heart chapter of my book Working From the Heart, A Therapist's Guide to Heart-Centered Psychotherapy    

      

RECHARGING

   Each day as therapists and counselors we are in the psychological energy field of so much suffering and struggle. In one morning or evening of work some patients will be depressed,anxious,grieving, angst-ridden,doubtful,despairing or enraged. Or a combination of those feelings. Our office reverberates  with the energy of those feeling states,day after day,week after week, month after month for years.

   Each of our patients needs us to be a compassionate listener, a source of loving kindness, and a carrier of hope. How do we sustain that level of presence and not become exhausted, emotionally distant or numb? How can we be in the psychological energy field of that amount of suffering and then go home and be emotionally available to our spouses, partners and children? This is one of the greatest personal  challenges of doing this lifework.

   I call the process of replenishing the energy supplies of our emotional,physical and psychospiritual batteries recharging. I have developed ways of recharging myself both outside of and during sessions that I would like to pass on. Before I discuss these it is important that I ask you to consider this question: why are psychotherapists and counselors so good at taking care of others and not good at taking care of themselves? 

   It is important that each of us explore that question in depth in our individual psychotherapy. From my own personal experience, and of working with psychotherapists whom I've had as patients, the answers were found in exploring how the role that I played in my family contributed to my choosing this lifework. As a child being the emotional caretaker of my mother was a reliable source of love and special status with her. That led me to unconsciously take on the role of emotional caretaker of others as a primary source of approval and love from others and self-esteem from myself. In my own psychotherapy I discovered that my struggles in taking care of myself were connected to an unconscious fear that others would no longer love me if I took time away from them to take care of me. That fear made me anxious about and resistant to doing things for myself. I would encourage you to learn what are the psychological roots of your difficulty in taking care of yourself.

   I have found two primary pathways of taking care of ourselves outside of sessions. the first is to take regular solitary time- at least a few hours each week - away from everyone, to do something that is nourishing for you. For me that involves taking a contemplative walk in some local nature setting at least once a week. For other therapists and counselors that I know that solitary time is by riding a motorcycle, horseback riding,spending time in the garden or in an art studio. The essential aspects are that the captivity feels replenishing and that it occurs in some place where no one can access you. Because the nature of our personalities tends to be that when we are with other people we think of their needs before our own it is critical to have regular time when we take care of only ourselves. the second pathway is to regularly spend playful time with playmates. Playmates are people with whom we share a passion and who have no psychological need for us to take care of them. I have friends with whom I share my passions for jazz and college basketball. other therapists that I know are in community theatre. have a weekly poker game, play music or sing with others.

   It is also possible to recharge ourselves during sessions. Within the limitations of this brief blog I will describe effective ways of doing this that I have evolved. Whenever I am with a very fearful patient I spend a few moments looking at a Taoist painting behind the patient's chair. It depicts a man sitting in a small boat in a tranquil lake and to me it symbolizes serenity. It reminds me of solitary time that I've spent by a local pond. As I glance at the painting I take a few meditational breaths - imagining with the out breath that I am releasing any fearful energy from my patient that might have entered my field of consciousness. When I am with a patient who is deeply grieving I look at a wood carving behind the patients chair again with some meditational breathing imagine myself releasing any sadness from my patient that may have entered my field of consciousness. This redwood carving is of the head of a bearded old man - it is my image of Wiseheart, my Higher Self whose Big Heart is capable of much more compassion than my ordinary small heart. When I am feeling depleted or overwhelmed by what a patient is describing I look at a large poster in a corner of my office. It is of a giant redwood - to me a symbol of great strength and stamina. I recall what it felt like to walk underneath those giants and to walk among the big trees near my home. With the in breath I take in that feeling of strength and with the out breath I let go of feelings of depletion.

   Having done this kind of recharging for years I am pleased to report how effective it has been in helping me to sustain a sense of open-hearted compassionate presence for hour after hour and not feel the need to become distant in order to protect myself from the cumulative effect of the enormity of feelings that we are present to in this work. Hopefully this will help you to find something similar that will work for you.

   This entry is based on the Recharging chapter in Working From the Heart: A Therapist's Guide to Heart-Centered Psychotherapy