Category: Authenticity

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The Buddy Bench

“Play makes us nimble — neurobiologically, mentally, behaviorally — capable of adapting to a rapidly evolving world.”
~Hara Estroff Marano: A Nation of Wimps
     I’ve heard discussions about something called the Buddy Bench. These are benches for children to sit on when they don’t have any friends to play with. Sitting on this bench is a cue for other children to invite this child to play. There are probably some nuances to the Buddy Bench I’m missing, but this is the basic principle. For more information, please check out the Buddy Bench website. The vision around the Buddy Bench is fantastic. Growing up, I experienced severe bullying and exclusion. Inclusion and friendship are great goals and we should be intentionally providing ways to encourage these behaviors in children. We should also be teaching them to adults! However, I believe the Buddy Bench potentially does more harm than good. Existentially, there are a few reasons this is a bad idea, and I’d like to recommend some alternatives.
     In A Nation of Wimps, Marano claims that parental over-involvement serves to undermine children’s confidence by weakening their psychological resiliency. Maranos’ research based book illustrates the risk of removing reciprocity from relationship (Buber). I will suggest why the Buddy Bench may inadvertently subvert the very ideals it seeks to encourage. Then, I will suggest a more difficult and authentic response to encourage children, and adults, to engage in healthy social relationship.

The Problem

    The primary issue I have with this idea is that it puts the onus of relationship almost entirely on the “other”. It does so through passive, rather than active/assertive communication. Sitting on the bench is making a statement without making a request. This is passive-aggressive communication 101. For example: if someone comes to your house, is sitting down to dinner with everyone, and made the statement, “It sure is hot in here…”, it may be a natural response to turn on a fan, open a window, turn down the AC, apologize for the unseasonably warm weather, or simply agree with them! However, the person making that statement has avoided vulnerability by making a request. Instead of asking if they could turn the AC cooler and risk being told, “No” (a rejection), they can use manipulative statements in an attempt to elicit a behavioral response from someone else.
     The more adept someone is at reading body language, subtle context clues, and implications, the better they will be at accidentally enabling others to continue using passive-aggressive speech. This prevents people from creating actual trust in others, because there’s no vulnerability. Without risking rejection, there can be no trust because no one has had the opportunity to let you down or hurt you!
     You may be saying, “Hey, Nathan! You don’t think sitting on a Buddy Bench is an act of vulnerability? You’re crazy!” Well, you may not be wrong about that last part, but here’s the issue: Sitting on a Buddy Bench automatically shifts the responsibility of connection from self, to others. It is a clear signal of needing support or relationship, but it is a request without risk. Even when the bench works, it doesn’t work, because the child will not know if they have a relationship with another child out of social obligation or due to their own personality, choices, and skills.

The Alternative

     Bullying is not acceptable. Bullying is meaningless, destructive, hurtful, and unhelpful. Anything I suggest from here on out should, in no way, be construed to imply that bullying is useful or healthy. And, just because a child is struggling with friendships/relationship, does not necessarily mean they are being bullied. It’s important to look at the context within which the isolation is occurring. If it’s primarily one or two children, then it’s likely bullying. If the child has almost no friends and is conflict with most other children, then it’s likely the child themselves is the issue.
     The response should not be to request the rest of the world to change to accommodate a lack of social skills/social understanding in one child. If this was the expectation, then it would stand to reason that we should all change in order to acquiesce to the requests of bullies! There are societal expectations and norms. They are not always fair, but they exist. Children are particularly skilled at punishing undesirable social behaviors. There are healthy ways for children (and adults) to learn to adjust their behavior to be more acceptable.
     I am not suggesting we should “go with the crowd”. There should be a sense of self that modulates all interpersonal and intrapersonal behavioral choices. But it is difficult to establish a sense of self by externalizing the locus of control in relationship creation. The better alternative would be to teach social skills in schools. Provide training to educators and administrators about how they can foster resilience in children. Resilience does not come without a certain amount of stress and discomfort. Having faith that our children are capable of learning new and better ways to interact and express themselves is a more difficult and time consuming route, but it is far healthier than a buddy bench.


Buddy Bench
Buddy Bench
(C) Nathan D. Croy, 2016
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Subtypes of BPD, Part II

“Your perspective on life comes from the cage you were held captive in.”
― Shannon L. Alder
Introduction
        The first post provided a brief overview of BPD by way of metaphor. Now, I would like to suggest an original way of viewing BPD from an existential viewpoint. This is not based on any research, but professional experience and observation over time.
Subtypes of BPD
    
      From professional experience and observation, there tend to be three types of BPD. BPD shares a similar pathology with diabetes: Type I, Type II, and Gestational. Not only does the pathology tend to match, the treatments are similar as well: Maintenance/Life changes, Life changes, and Monitoring; respectively.

Type I
     The first, and most severe, type of BPD is Type I. Many adults with BPD have a history of trauma and abuse. Often times, a history of trauma is evidenced as a previous or current diagnosis of PTSD, RAD, or Disinhibited Social Engagement Disorder (DSED). Nearly 75 percent of clients with BPD report sexual abuse or trauma (Aguirre, 2007, p. 104). This statistic can be somewhat misleading, as many BPD symptoms involve antisocial, impulsive, and risky behaviors. These behaviors can expose people to situations where sexual abuse/trauma is more likely to occur. In addition, research has shown that people with BPD are more susceptible to developing PTSD (Golier, 2003). Etiology research has identified multiple factors involved in the development of BPD, but early trauma is one of the most common factors for people with BPD (Bandelow, 2003). However, meta-analytic study suggests that anywhere from 20-40 percent of people diagnosed with BPD do not report a history of childhood sexual abuse (CSA) (Fossati, 1999).
     Similar to Type I Diabetes, Type I BPD manifests early in life, will impact multiple systems, and requires medical treatment in addition to lifestyle changes. Type I BPD would be present in the 80-60 percent of cases where CSA, trauma, or neglect are reported. These instances will most likely have multiple diagnoses of PTSD, RAD, or DSED along with BPD (Binks, 2006). The proclivity of comorbidity of Type I BPD can muddy treatment goals and overwhelm resources, providers, and family/social supports.
     It is estimated that 90 percent of people with BPD attempt suicide at a 10 percent completion rate (Aguirre, 2007, p. 201). The rate of death due to diabetes is also 10 percent (National Diabetes Statistics Report, 2014). An additional commonality between Type I BPD and Diabetes is neuropathy. With diabetes, weakness, numbness, and pain from nerve damage, usually in extremities occurs. The resulting numbness can prevent people from noticing when they have a wound or injury. These injuries can then fester, become infected, and result in amputations. An emotional and relational equivalent also occurs in people with Type I BPD. They have experienced an emotional numbness that, when not addressed, can exacerbate relational wounds or injuries which fester to the extent the relationship requires amputation. This does not mean relationship repair is impossible. However, there are times when damage sustained from someone with BPD is so severe, the other person in the relationship is unwilling or unable to risk additional harm.

Initial Treatment
     To summarize, Type I BPD is evident in people who have a history of trauma, complex/compound trauma, unhealthy attachments, self-harm, likely multiple acute psychiatric hospitalizations, and symptoms have been pervasive since adolescents. Type I BPD will require long term treatment due to inherent distrust, emotional lability, and difficulty with attachment/joining. Emotional neuropathy may require multiple specialists to address specific symptoms while an overarching therapy is maintained. This could include EMDR, DBT, CBT, or IOP.

Type II
     In a minority of BPD cases, clients will present with no identifiable history of trauma, CSA, or familial trauma. Parents and family will state the client was a happy child with little to no mood lability, relational stability, and no history of hospitalizations, suicide attempts, or self-harm. Like Type II Diabetes, Type II BPD occurs when natural attempts to identify meaning and meet existential needs are frustrated. This exacerbation of the natural existential vacuum results in what Frankl identified as noogenic neurosis (Crumbaugh, 1964).
     An existential vacuum, a term created by Viktor Frankl, is defined as an emptiness and lack of meaning in our lives. “Frankl suggests that one of the most conspicuous signs of existential vacuum in our society is boredom” (Boeree, 2006). If this is not filled in a meaningful way, people will tend to settle for anything. People with Type II BPD often want for very few things. They tend to be wealthy with access to various supports and seemingly unlimited resources. This strength becomes the weakness which predisposes individuals to this existential form of BPD.
     When people reach out for meaning, belonging, and purpose, but are provided with resources, directions, and expectations, they end up meeting their “wants” without meeting their “needs”. This results in an existential version of “rabbit starvation“. This phenomenon occurs when rabbit meat, which is very lean, is the primary food. There are too few fats to make the meat truly beneficial in these circumstances and, though the hunter may be full from consuming massive amounts of rabbit meat, they starve to death.
     In clients with Type II BPD, they may have been “fed” a steady diet of resources, medications, and treatment, but they have been devoid of genuine relationships and meaning. Suddenly, out of relational desperation, these clients begin to panic. They become hypersensitive to abandonment, react strongly to any form of critique, and symptoms escalate rapidly. The crucial component then, is lack of authenticity and genuineness in relationships accompanied with an awareness of what is lacking. Van Deurzen (2007, p. 45) identifies inauthentic living as “a sense of imposed duty or the experience of discontentment with one’s fate”. The symptoms are exacerbated by a lack of sense of self (Buber, 1996, p. 126).
 
Initial Treatment
     This form of BPD, in my experience, responds remarkably well to existential psychotherapy, EFT, and the humanistic/experiential aspects of DBT. Like Type II Diabetes, Type II BPD can go into remission with lifestyle changes. Clinicians working with this population must be very intentional to avoid exacerbating symptoms. Preparing the client for successfully handling the necessary anxiety this treatment will produce is critical. Basic coping skills, psychoeducation, and planned gradual exposure, built on a solid foundation of the therapeutic relationship, can provide the necessary safety for someone to overtly and intentionally experience authentic relationship. Prognosis in these cases is very positive and could be completed within 12-20 family and individual sessions. Any hospitalizations should be normalized as part of treatment seeking stabilization. This will help clients avoid feeling shameful about their attempts at growth.
 
Summary

     This information is important to help understand and delineate types of BPD in order to specifically target forms of treatment in order to increase positive prognosis. As with any other diagnosis, knowing severity is important to assist in setting expectations and arranging necessary supports. If providers view every BPD case the same way, they may provide too many, or too few, resources. More research needs to be done to help clinically identify forms of BPD. Gestational BPD, a suggestion on how new research can be done, and how it may impact treatment will be covered in part III.

Phi
(C) 2016, Nathan D. Croy

Sources
 


     Aguirre, B. A., M.D. (2007). Borderline Personality Disorder in Adolescents: A complete guide to understanding and coping when your adolescent has BPD (1st ed.). Beverly, MA: Fair Winds Press.

 
     Bandelow, B., Krause, J., Wedekind, D., Broocks, A., Hajak, G., & Rüther, E. (2005). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Research, 134(2), 169-179. Retrieved from http://www.fafich.ufmg.br/cogvila/criancaadolescente/bandelow2005.pdf
 
     Binks, C., Fenton, M., Mccarthy, L., Lee, T., Adams, C. E., & Duggan, C. (2006). Psychological therapies for people with borderline personality disorder. Protocols Cochrane Database of Systematic Reviews. Retrieved from LINK.

     Boeree, C. G. (2006). Viktor Frankl. Retrieved February 10, 2016, from http://webspace.ship.edu/cgboer/frankl.html

     Buber, M., & Kaufmann, W. A. (1996). I and Thou: Martin Buber; a new translation with a prologue “I and You” and notes. New York, NY: Simon & Schuster.

     Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20(2), 200-207. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.505.6866&rep=rep1&type=pdf

    van Deurzen, E. (2012). Existential counselling & psychotherapy in practice. London: SAGE.
 

     Fossati, A., Madeddu, F., & Maffei, C. (1999). Borderline personality disorder and childhood sexual abuse: a meta-analytic study. Journal of personality disorders, 13(3), 268.
 
     Golier, J. A., Yehuda, R., Bierer, L. M., Mitropoulou, V., New, A. S., Schmeidler, J., . . . Siever, L. J. (2003). The Relationship of Borderline Personality Disorder to Posttraumatic Stress Disorder and Traumatic Events. American Journal of Psychiatry AJP, 160(11), 2018-2024. Retrieved from http://ils.unc.edu/bmh/neoref/nrschizophrenia/jsp/review/tmp/482.pdf

     National Diabetes Statistics Report. (2014). Retrieved from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

 

 

 

 
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Subtypes of Borderline Personality Disorder, Part I

“People with [Borderline Personality Disorder] are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” 
― Marsha M. Linehan
     Let me begin by saying I am not an expert on Borderline Personality Disorder (BPD). The information discussed throughout this post, like all my posts, should not be used to diagnose or treat patients. Instead, I would like to share how I’ve come to view BPD throughout my career and how my treatment changes based on that understanding. This, the first post of three, will describe a metaphor I use to help explain BPD to clients and families. The last two posts will describe the specific subtypes (I, II, and gestational) and explore existential treatment options.
     The DSM 5 outlines specific symptoms and diagnostic criteria for BPD. Information can be found here. A few theories on subtypes of BPD already exist. Millon has theorized 4 subtypes, and Lawson identified 4 types of borderline subtypes for mothers. All of these suggestions are useful in long-term treatment. However, I would like to suggest a new alternative to identifying subtypes of BPD from an existential and systemic standpoint.
     Lastly, I may not consistently use person first language throughout this post. This is not to say people with BPD are defined by their diagnoses. Rather; it is important to see this post as my clinical view on BPD rather than the people who suffer with it. 
Borderline Personality Disorder
     Often times, clients with BPD are unaware of their diagnosis or they aren’t sure what their diagnosis means. The DSM 5 describes symptoms in clinical terms which, to the one receiving the diagnosis, may mean very little. When providing treatment for clients with BPD, a primary goal is to help them understand the diagnosis. Therapists would do the same with depression, addiction, or any other diagnosis. As a way of clarifying some of the clinical jargon, a metaphor has often helped to illustrate the critical aspects of the disorder in an approachable way.
The Window Painter

     Imagine we are all born into a room. The architecture of the room has unique and distinct features setting itself apart from other rooms, and is mostly bare without any furniture, paint, window dressings, or decorations. As we mature, we begin to decorate our room as a reflection of who we believe we are. As others look out their perspective window into ours, and as long as the blinds are open, they will see aspects of how we’ve decorated our room. We move past other people’s windows, and sometimes other people, from within their rooms, move past our windows. Regardless of the external changes, we remain in our rooms.
     People with BPD, tend to spend an inordinate amount of time looking out their window without looking into their room. Eventually, they begin to see other rooms are decorated or designed, and they want to appear the same way. Then, instead of working on interior design, they begin to draw on the windows. The window drawing becomes so effortless that, over time, they can change the entire look of a room, nearly on demand. If, when looking into the surrounding rooms, a person with BPD sees primarily pinks, pastels, bows, and trophies, they will paint their windows to match! Then, if there are a new set of rooms appearing out their windows, the paint quickly disappears and a new set of illusions are constructed and painted to match.
     All the while, the inside of the room, the actual room, is nearly devoid of real substance. There are no chairs to relax on, no beds to provide rest, and few lights to illuminate the recesses of the room. After a time, the energy required to maintain a nearly constant vigilance, begins to consume the window painter. When this happens, they start making errors in dressing the window. Someone notices the mistake and asks a harmless question. The Window Painter panics! They turn to see their room and find it empty, save for dust and cobwebs. Consumed with dread and shame, they enable one of the few design pieces in the room: the blinds.
     With the blinds fully closed, the window painting is still very visible, but the Window Painter is hidden. These are not healthy moments of introspection and solitude. These times are when the Window Painter, looking at the back of the blinds, sees no one, no thing, with which to connect. They are utterly alone. Within that instant, thoughts of self-harm and suicide begin to spiral into perseverating patterns of self-destruction.
     This is often when those on the outside, in their own rooms, feel so disconnected and confused. Loving parents cannot understand the source of the destructive behaviors. Friends and social resources begin to be consumed with drama and crises. People begin to distance themselves from the Window Painter. Then, when they peek through the blinds, their worst fears are confirmed: everyone really was leaving!
    Enraged and unable to engage, the Window Painter scratches and claws at the illusion on the window. They throw the blinds open and show the world the cultivated emptiness of their room. This only happens for a few brief moments before the Window Painter sees into the room of another. The connection becomes a juncture, an opportunity, for the Window Painter to bare their emptiness to another. The alternative is to resume painting, pretending, pantomiming, and hoping others interpret their real needs without risking exposing the bare walls.

Diagnosis

     The primary criteria for diagnosing BPD is “frantic efforts to avoid real or imagined abandonment” (Sperry, 2003. p.93). In the metaphor of the Window Painter, there is a dim awareness of the emptiness of the room. The compulsion to look outward, to the exclusion of personal insight, is fed by the overwhelming fear and dread which awaits those who look inward. This places the Window Painter in an existential dilemma: They want nothing more than to connect with others, to see and be seen. However, their greatest fear is abandonment. If the connections they experience are superficial and communication is primarily passive-aggressive manipulation, then very little rejection is risked. After all, how can someone truly reject someone they don’t really know?
     The sacrifice for this perceived safety is true intimacy. They are not fully known by anyone and therefore unable to truly connect. Behaviors emerging from fearful attachment (Agrawal, 2004) ultimately serve to confirm the greatest fear: Everyone leaves. This cycle repeats over and over again until the person struggling with BPD is truly alone. The mechanisms by which we come to know our selves (insight), our reactions (awareness), and others (empathy), all interact to help form relationships.

About the Doodle

      The Greek letter Phi is used to symbolize many things, including the “strength (or resistance) reduction factor in structural engineering, used to account for statistical [variability] in materials and construction methods” (Bulleit, 2008). While it should not be inferred that people with BPD have reduced strength, Phi is ideal to indicate a certain statistical variability in how BPD reacts to attachment and threats to attachment. In regards to the reactivity of those with BPD, there is a level of uncertainty which is almost always certain. Reactivity, self-harm, manipulation, low insight, and various other factors should be taken into consideration when entering into a personal or professional relationship with someone diagnosed with BPD.
     This is not to imply that people with BPD are too unstable to participate meaningfully in relationships. Rather, there is a greater degree of variability in mood, affect, and reactivity, all of which can add stress to any relationship. Therefore, to have successful, healthy, supportive, and strong relationships, we must take into account this variability and anticipate the need for additional supports. These may include therapy, hospitalizations, group therapy, medications, and education.



Phi
(c) Nathan D. Croy, 2016

   

Sources

     Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment Studies with Borderline Patients: A Review. Harvard Review of Psychiatry, 12(2), 94–104. http://doi.org/10.1080/10673220490447218

     Bulleit, W. M. (2008). Uncertainty in Structural Engineering. Pract. Period. Struct. Des. Constr. Practice Periodical on Structural Design and Construction, 13(1), 24-30. Retrieved from http://www.ce.berkeley.edu/~mahin/CE227web/UncertaintyInStructuralEngineering-Bulleit_Feb08_ASCEJofEP.pdf

     Kreger, R. (n.d.). The World of the Borderline Mother–And Her Children. Retrieved February 06, 2016, from https://www.psychologytoday.com/blog/stop-walking-eggshells/201109/the-world-the-borderline-mother-and-her-children

     Lavender, N. J. (n.d.). Do You Know the 4 Types of Borderline Personality Disorder? Retrieved February 06, 2016, from https://www.psychologytoday.com/blog/impossible-please/201310/do-you-know-the-4-types-borderline-personality-disorder

     Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. New York, NY: Brunner-Routledge.

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Truth or Care.

“I took a test in Existentialism. I left all the answers blank and got 100.”
― Woody Allen
     Nearly every morning when I come to work, Mr. Ben is working diligently to make the office look pristine. As he was cleaning a window he paused, took a step back, inspected his work from several angles, and then touched up a few missed spots. I couldn’t help but be reminded of how therapists need to do this in their work, and also teach this skill to families. How often do we need to step back from the process to gain perspective. To reassess our goals and focus on what is meaningful? If we never step back from the process, we can become hyperfocused on minor smudges and miss large spots all together.
     Often times, the therapeutic process can be distracted by seeking for specific truths. This post will share a few types of “truth seeking” which can derail treatment, how these can be clinically addressed, and an alternative way to provide authentic treatment which is true without being burdened by seeking “truth”.

Validation Seeking

     The first, and most common, form of seeking of truth which can distract from therapy occurs when affirmation of convictions become more important than the truths themselves. Nietzsche is attributed as saying “Convictions are more dangerous foes of truth than lies.” This plays out many times in group and family therapy. People will become hyperfocused on being “right”, or verbally bludgeoning another person into admitting they were wrong, lied, cheated, or failed them in some fashion. This is completely normal. This reaction happens when people assume their perception must be valid in order for their emotions to be valid.
     To an extent, this is not wrong. If we see a car being driven dangerously fast down the highway, it would make sense for us to be startled, afraid, and angry. However, throw a set of spinning lights on top and add a siren, and suddenly, we pull the car over, allow them space, and are relieved to discover we weren’t their target. In this example, the setting is nearly identical (fast car on highway). Technically, we were just as unsafe with the police car speeding as we were with the civilian car. Sure, the police should have more training, but accidents happen! So, why were we less afraid? Because our perception and expectations were different, so our emotions were different.
     We expect our loved ones, friends, and family to be safe. When they drive down our emotional freeway, dangerously fast or out of control, we feel it is important for them to understand they scared, hurt, and frustrated us. The reaction often looks like anger (punishment) and control (prevention). The “truth” we’re seeking is the validation of our own rightness. If it existed, the best word may be “rightittude”. We’re so concerned about being right in regards to being right, we fail to see why we want to be right: Validation.
     Ultimately, in these situations, people want to be validated. Their existence, their perception, and their emotions regarding a situation. If we fall victim to the false belief that our rightness and validation are synonymous, it will no longer matter if we even are right. The victory will feel hollow. A symptom of this is when people consistently bring up previous examples of times they were right, I-told-you-so’s, and other people’s failures. This assuages the internal fear of an existential incorrectness. What we want is to be right and be validated. What we forget is the harmful assumption which accompanies this belief: If I am wrong, I’m no longer worthwhile. This type of belief slowly dissolves confidence and personhood. The irony being that, the very process of seeking external validation fosters deeper fears and anxiety of rejection.

Concrete Seeking

     Therapists often hear families say something along these lines: “If we just knew how this happened, or how we got here…” The ellipses can be filled in with just about anything. If they only knew why, when, where, how, what, or who was the source of their stressor resulting in treatment, they could specifically address that thing and be better! While identifying community supports and/or providing case management services is often a necessary part of therapy, these should be future based supports rather than salves to address past wounds. 
     Concrete truth seeking reminds me of the old southern adage because it’s like nailing jell-o to the wall. It really doesn’t matter how many nails you use or how hard you hammer, it’s just not going to stick. As people seek power and control, they look for facts and concrete evidence that will allow them to argue specific points.
     How often has therapy degenerated into a pale reflection of itself: The argument. It’s exhausting. Trying to figure out who’s right and wrong, who to support and who to refute. It’s easy to get caught up in and certain clients are better at this than others. Clients with Cluster B traits regularly use this line of thinking and rhetoric to avoid talking about themselves, their emotions, or their therapeutic needs. It turns the therapist into a referee and forces them to “pick sides”. Once in this position, it becomes very difficult to be a non-reactive presence and, more often than not, we accidentally feed into the systemic distress rather than address it.

Ethereal Seeking

     As an existential therapist, I enjoy philosophical discussions about the afterlife, personal meaning, and the validity of social norms; to mention a few. There are times when clients will state their primary concerns are broad existential concerns just like these. When it happens to me, I never fail to get excited. This is my milieu, my passion, and someone is going to pay me to have a conversation with them about the very thing I love! However, I have to be cautious about secondary gains.
     The questions may be exceedingly important. What we must never fail to address is why these questions are important to the person. If they only want to discuss these issues to discuss these issues, we are doing them a disservice. It’s like teaching someone to drive in a golf cart and then expecting them to perform at the Grand Prix. Without real world application, these questions can be little more than a diversion! Failure to address this results in decreasing relational knowledge which relegates any answers divined by processing these questions to nothing more than esoteric knowledge.
     Initially, it may be refreshing to work with these clients. They seem motivated, intelligent, and capable. Some short-term treatment, identification of coping skills, and they’ll be on their way. Yet, the short-term goal comes, goes, and we find ourselves sitting in our chair after the 20th session unsure what just happened. If this is the case, a therapist may have made the assumption they know why the client is seeking treatment. If it’s solely for conversation or self expression, that may be just fine; as long as this is overtly stated and understood. Otherwise, the secondary gains of philosophizing may actually encourage problem behavior and reduce therapeutic efficacy.

What To Do Theoretically

     All of these truth seeking actions share one commonality: the truth being sought is external to self. There is a lure to this behavior. The safety and assurance of an external truth. However, the safety an external truth provides is inherently unstable due to its locus. It necessarily deprives people of will, freedom, or power. It prevents people from being confident because their truth is really faith in other people’s beliefs. For these people, there is no confidence or experiential knowledge to which they can refer. Rather, their truth, peace, and safety reside in the hands of others. That is a scary world.
    Internalized truths based on perceptions and healthy experiences foster opportunities to accept responsibility, establish intentional boundaries, and maintain healthy relationships. Many religious people raise objections about existentialism and relativity stating these ideals deny the existence of God. Yet, the Christian Bible clearly states that external laws and truths are meaningless if they are not internalized (Proverbs 3:3, 6:21, 7:3, Deuteronomy 11:18, Jeremiah 31:33, John 1:17). If we fail to look at the intent of the laws and truths, we will quickly bend them to our own will and make them expressions of self rather than expressions of healthy relationships and love (Matthew 23:3, 7:12, 2 Timothy 4:3).
     Instead of spending our valuable therapeutic time on trying to discover “truth”, it can often be more productive to seek “reason”. Why is it so important for the client, for the therapist, to discover truth? Do we think it will make life, therapy, or relationships easier? Are we seeking reconciliation and healing? Authenticity and genuineness? In that case, let’s not spend so much time trying to figure out who’s right and focus more on how to reconnect. Finding ways to acknowledge our relationship is more important than our knowledge. Failure to do this will encourage division rather than unity.

What To Do Practically

     In each of these cases, it is prudent to acknowledge the desire to know, then move directly to the expected outcome. If we had validation, concrete, or ethereal knowledge, what would that do for us or how would that make us feel? Asking these two questions (an oversimplification of Socratic Dialogue) can help clients and therapists establish robust treatment goals. These are crucial if therapy is to weather uncertainty and avoidance.
     Family Sculpting, an intervention created by Satir, is a dynamic way to allow every family member the opportunity to communicate their desires in a non-concrete way. It removes many of the barriers to verbal communication between family members. It leaves room for experiential interpretation rather than static answers.
    Identifying the very need to be “right” or find “truth” should overtly be addressed by the therapist if the client or family is resistant to change. Finding out if this behavior is a primary contributor to the reason they are in treatment can be very valuable. If this is the case, we can simply practice being wrong through gradual exposure. Once clients can control their anxiety enough to process being wrong, address 1, 2, or all 3 reasons a client may be seeking truth.
     Lastly, normalizing a clients inability to have or control truth, along with their desire to do so, may allow the client to feel at peace about struggling. This can help the client be less anxious about their process and, paradoxically, become more calm about being able to acknowledge their compulsive need to identify truth. In this case, treating the desire using OCD interventions (like the 4R’s).
     If you have experiences with “truth seeking”, please share them in the comments! Remember to maintain confidentiality!

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A Story for Everyone

“Recall how often in human history the saint and the rebel have been the same person.”
                                                      ~ Rollo May, 1975, The Courage to Create, p. 35

     Sitting in the circle, each of us took turns looking at the other wondering who would begin. The six of us knew each other, some more deeply than others, but there was still an unease. The prompt for the group was this: Tell your story. No one knew where to start. There were several revelations as we began talking about how we should talk about our stories.
     We realized that crises are relative. That just because the trauma doesn’t bother you now doesn’t mean it isn’t still important. There had always been people along the way, but we often failed to see them in the moment. And suddenly, I was thinking of Woody Allen.
      Allen brought a “quirky” and “neurotic” perspective to his films which people had not seen before. He told uncomfortable stories in a way that was just fantastic enough to allow people a safe mental distance. As I sat, thinking about how I would tell my own story, a seemingly insurmountable problem occurred: A story requires a beginning, a middle, and an end. Identifying those aspects required an outside perspective. The characters in the story never know how close they are to their own end. The cessation of one struggle could merely be the prelude to the next act. I do not know if I can ever tell “My Story” until it is over. And by then, I would not be able to speak.
     The distance Allen brought to his movies, the perspective, does not exist for us amidst our own existence as it occurs in the here-and-now. While others, through reflection and feedback, can offer glimpses into these perspectives, they are never complete. Which means the designation of “saint” or “rebel” must be put off until our story is over. In the meantime, we can reflect on our past, the history of others, the stories already told, and the parts of our story we have already seen unfold. But let us not be so bold as to imagine we can tell our complete story. Let us also not be so timid as to believe we cannot tell the parts of our story as they happen.
     I would leave you with this thought: Perspective is a requirement for wisdom and time is a requirement for perspective. As we allow our story to fulfill itself, do not miss the foreshadowing, the past struggles, and the joys which have already occurred. We do not know how close we are to the end of our own story, let us make haste in writing and sharing what we can.

Allen
(C) Nathan D. Croy, 2014