Monday, May 16, 2016

Just Keep On, Keepin' On

It has been a long time since I have written a post here. Life, both professional and personal, has been very busy. Clearly! ;)

And I'm not thrilled about the content of today's post; it's kind of heart-breaking, actually. I was made aware by a client today that there are some really awful reviews of me online. One just posted last week. And it is hard to know how to respond to these. Well, in reality, there is no way to respond, and I guess that is simply what is difficult about the digital world; providers cannot respond to reviews like business owners can. The sites don't even make a space for doing so. So, I'm going to try to respond to some of the reviews. I'm not sure all the reviews are written by actual clients; only one can I actually identify who wrote it. And, sadly, there is an individual in my life, not directly connected to me, who has motivation to cause harm, so I can never know for sure if what is written is by actual clients, or by a non-client.

That said, I'll start by simply saying that if you are a past or current client with a complaint, I am more than willing to try to respond to your complaint as effectively as I can. I cannot resolve any complaints written on the internet, as they are anonymous. And even in the case where I know who wrote it, I really cannot contact the author without potentially then being accused of harassment. It's a tricky position, ethically. I WANT to be able to address concerns, but I don't know the avenue to do so.

So, to address some of the complaints:

When working with teenagers, I require family therapy. I will not work with a teenager without family therapy as part of the treatment process, and this has always been the case. Parents always see how I work with their kids, as they are in the session at least every other week. In therapy, I am equally confrontational of parents as I am kids; my goal is to address the problem and facilitate change, and never is a problem one-sided. As a parent, I imagine (and have experienced!) it is hard to be challenged, but it is equally challenging for the child to be challenged week after week to change dangerous behaviors. I also will not continue to treat a client that is not getting better under my care. Because I treat eating disorders, a higher level of care is always available, and if a client is not improving within 2-3 weeks, I refer to a higher level of care to ensure progress.

Another review boldly states I identify myself as atheist and have no tolerance for any other views. I am not atheist, and never have been, and I feel that alone adequately addresses that review (yes, I'm a little frustrated by bald-face lies). Quite honestly, it has never mattered enough to me to identify a religious stance (it's possible my Facebook page actually says, "H*&% if I know") My goal in addressing religious issues is to allow the client to process his/her own beliefs. My beliefs are not remotely relevant to a client's work, though I will answer when asked my if I believe in a particular religion or thing.

A couple reviews refer to me being immature. I guess I don't know how to best respond to that. I hope that is not the case, but it doesn't really make sense for me to claim I'm not. So, I guess all I can say is that, I'm confident I'm immature at times, but I welcome contact with anyone, and if I am then determined to be immature, I can respect that.

I would agree with those who say I am reactive and rigid. These things are true. I am reactive to my clients doing harmful things. I am reactive to clients lashing out at me, in the rare instances...less than 5...where that has occurred. I am reactive to people treating other people poorly. I am not a therapist who believes in sitting back and just listening; if I see something that i think is interfering with my client enjoying his/her life, I respectfully (or at least that is my intention!) challenge him/her. I fully understand my job would be "easier" if I just wouldn't challenge as much as I do, but I honestly cannot stomach taking people's money to mostly just listen. People hire me to help. And at times, my help is listening. But it is more than that also, especially with the population I treat.

Now for rigidity...I am rigid as a person. I tell clients this often, in fact! It works for me in this career as it is beneficial to be rigid with eating disorder behaviors. The other place I am rigid is in expecting clients to pay for services and for missed appointments. I understand that other providers let things like this go, and I am fully aware that my adherence to a strict payment policy opens me up for criticism. After all therapists are supposed to be always understanding and compassionate, right?! But, we also run businesses. It is surprising to me how therapists are often not seen as the professionals we are. And we are running a business. If a client late cancels or no shows, it effects our business. I go over my policies repeatedly so clients are fully aware of charges for late cancellations and no shows, but still, some are offended when I adhere to those policies. But, I believe that if we, as therapists, continue to allow people to cancel on us without consequence, we are only reinforcing that our time is not important. Now, this is not to say there are not valid reasons for late cancellations, and there is some flexibility in applying charges, but overall, I'm quite rigid with the financial policies. I do not want to be accused of favoritism, so all clients get the same penalty, which has frustrated a few clients. Overall, my time, a therapist's time, is important; not MORE important than anyone else, but equally important. I have managed to flub my schedule a couple times in my career (being rigid helps avoid this problem also). And, each time, I have given myself the same penalty I give clients, meaning I work for free when I next see the client. I am rigid, but equally rigid; I expect the same of myself that I do of others.

All therapists make mistakes (I hope!). At times, I have put myself in the position of apologizing for a reaction or an action, whether that was in group or in an individual session. I see those situations as (difficult and) an opportunity to demonstrate that repair is possible in relationships. I care deeply about the work I do, and the clients with whom I work. At times, the best action is to end a professional relationship due to incompatibility with a client, but the majority of the time, there is much to be learned from working through conflict/disagreement/hurt feelings, etc. Nobody is all good, or all bad. The vast majority of, if not all, humans are good with some kinda bad, and some really bad moments. I have had some really bad moments in my career, and for each one, I have tried to initiate repair. If that is what I am teaching clients to do, it is what I must do myself, even though it's hard.

To have my work, identity, and personality attacked is painful, but part of the job, I guess. I treat eating disorders. I do my best to not anger my clients, but to instead make it clear I will stand strong and fight their disorder tooth and nail. Sometimes, maybe that comes across in an unintended manner. As far as I know, I have not made as many clients angry as there are negative reviews, so that is part of what leaves me unsure of the reviews themselves. Regardless, I hope that this really long post (!) is in some way beneficial. Earlier today, of course I was tempted to just hang it up, take myself out of the public eye, but then, as I went on a walk to try to ground myself, I realized that what I would advise a client would be "keep doing what you are doing, with whoever wants you to do it with them, and let the rest of it go." If I do good work, I'll help people. If I don't, my career will die a natural death. If it dies a natural death, it is likely for the best. All this "being grounded" stuff is hard, but it's what I advise clients to do, to practice, so here goes....


Monday, October 20, 2014

Detachment, without disconnection

I recently completed a training that addressed attachment, detachment, connection and disconnection, and it led me to think of these concepts in a deeper way. Detachment sounds like such a negative thing. But, in reality, we all need to detach sometimes. So, how does connection/disconnection fit in? And how do all four go together?

Well, it's easy to think of being attached and connected. In that type of relationship, you are both physically and emotionally attached to the other person (or animal), and you are tuned in to that person/animal. You are aware of what he/she is doing.

But, can you be attached and disconnected? Sure. How that might look is that there is physical contact in the relationship, but no deeper awareness of the other, or awareness of o
ne's impact on the other. It may look like you are connected, but if your mind is elsewhere, really you are not. You can imagine kids like this, perhaps. They might allow others to hold them, or hold their hand, but when you are with that kid, you know they are not really present with you. Maybe they look away, or they are playing a game with themselves, fairly oblivious to those around them. Sadly, adult partners can also be this way, and it can be confusing because it looks good on the surface, but doesn't feel good. And, lastly, I would argue an eating disorder can create this. It appears the one with the ED is present in relationships....they make the right moves....but, really, sometimes they are connected to their ED more than those in their lives.

So, now, detached and disconnected seems to go pretty much without description, much as attached and connected does. I think this is the person who is isolated, not letting the relationship in at all.

Okay, so that brings being detached, but connected. In the training, the task was to physically detach from the horse... meaning, we were to no longer touch the horse or communicate in any significant way....but, we were to remain connected. So, our task was to keep the horse tuned in to us, while we backed away. For another example, in dog terms, perhaps this is telling your dog to stay, while you back away. You want to maintain the dogs attention, without having to be attached.

So, how do we apply this concept to human relationships? In what situations might we need to detach, but remain connected. Well, a big part would be linked to our ability to bring our connections with us even when we need to be separate. So, can we hold onto the love from another, even when physically separated? Can we allow that love to comfort us, without the person being there? Perhaps there are times where we need to disconnect from the actions of another, but remain connected to them, rather than simply throwing the relationship away. I can see this definitely being present in some of the more extreme stages of an eating disorder. It feels terrible, but the family might need to detach from the person with the eating disorder, so they are no longer hooked into care taking or unintentionally reinforcing the disorder, while remaining attached to the person inside, their loved one. These family members would not walk away, but instead respond as soon as their loved one showed a commitment to change.

Now, all this is pretty much me musing "out loud." I'd be interested in what some of you think about this concept!

Wednesday, September 10, 2014

But, What Do YOU Want?

I'm guessing this won't come as a surprise to anyone, but sometimes there are a number of power struggles involved in our lives. A good number of us really don't like to be told what to do. And, sometimes, this can become a challenge in therapy, as sometimes, the best intended suggestions can end up feeling like we are telling our clients what to do.

As you might guess, this is a not uncommon phenomenon with teenagers. Teenagers do not want to be told what to do! At least most of the time... So, being the therapist to a teenager carries the risk of just being the next adult in line to have authority worthy of bucking. And the last thing a therapist wants to create is
a power struggle.

So, I often find myself asking clients what they want for themselves, who do they want to be? What are their values, morals, and beliefs? And, in going down this path, I find that it's not uncommon that the client actually wants the same thing that the person they are defying wants. The client actually wants to be a good student, a good worker, reliable, trustworthy, and to have good relationships. So, for example, rather than continuing to battle the parent over grades, the focus can change to the reality that the client wants to be a good student, or wants to be respected by teachers, or wants a particular job some day.

Of course, this can also be applied directly to eating disorders. What does the eating disorder client want more? To be thin? To feel in control? To be numb? To have good relationships? To enjoy life? To have integrity? To be honest?

If you will identify what you truly want, you can then measure your behaviors against that. Is what you are doing in any given moment consistent with your long-term desires? If yes, fantastic! If no, you have to decide whether this means your desire has changed, or something is overriding it. And, you have to distinguish between what you want in that moment, versus in the big picture.

This way, it no longer matters what anyone else wants, and whether you want to follow their direction; it only matters that you are pursuing what you want.

Update, a long time coming

Today, I was asked to write a blog post. Now, I asked the requestor to give me a topic, and her ever-helpful response was, "I dunno; you are the one with a PhD." Well, thanks for that help! ;) So, I will write two blog posts, in a flurry of posting!

First, an update:

Equine therapy session formally began on June 1, and it has been a wonderful thing to be a part of. Violet was added to the herd mid-June, and has been a wonderful addition. It is amazing what can happen with horses present. Often, my clients miss the grin I get on my face when they turn to see what one of the horses has just done that is perfectly timed. It is phenomenal to watch the horses work their magic, and I feel very honored to be a part of these sessions. Sometimes, it's a client learning a new skill with the help of an equine partner; other times, it is the horse and client standing forehead to forehead in silence. Throwing rocks has also become a favorite pastime, and fortunately, my corral has no shortage of rocks. There's just something to standing in nature, next to these beautiful animals, that is amazing; I love it.

In the downtown office, Angela Hicks is hard at work building up her practice, taking on a number of eating disorder clients. I am so thankful to have her on board to help decrease wait times for clients seeking treatment. It is so hard to tell someone with an eating disorder that they have to wait on a wait list, so it feels very good to be able to get people in quickly. And, it's fun to have a partner in crime!

So, that's the update. Now on to a post about a specific topic, in spite of receiving NO HELP from the person requesting a post!!! ;)

Friday, May 30, 2014

What Does the Body Hold?

One of the reasons I have become committed to equine psychotherapy is the fact that it requires the use of the body, rather than simply talking. But, why is this so important? Well, most clients with eating disorders are very intelligent; they don't suffer from an inability to use their brains, even if their actions are not the most rational. The average eating disorder client can easily talk for an entire hour about all of their thoughts and beliefs, but can make it through that hour almost completely avoiding emotion. It's a challenge for us therapists, as our job is, you know, to talk. So, it's easy to get caught up in talking brain to brain, leaving out emotions, and the body.


And maybe this sounds kind of "woo-woo," but I think it is true that our bodies hold onto emotions. Think of how many physical ailments can be linked to emotions. Headaches and stomachaches are easily seen as sometimes being the result of emotions. I have become very interested in Peter Levine's work with trauma, and he is probably the foremost person to convince me that our bodies hold suppressed emotion.

In short, Levine argues that we can use animal models to understand human trauma. (Disclaimer: this is my interpretation of his writings.) Levine specifically uses whiplash injuries as one of his examples. He indicates that many people who experience low speed car accidents that result in whiplash report physical symptoms that surpass what one would expect from the low speed rear-ending. This is where he brings in animal models. He argues that animals, who can be under pretty constant threat from predators, don't demonstrate trauma. Now, I don't know if this was his example, or just what I ended up using as an example, but think of a deer in the headlights. It is frozen, but then bounds off into the woods. Well, apparently, if we were to follow that deer, we would eventually find it shaking in the woods. And, Levine indicates that this shaking is the release of the emotion from the body.

Now, back to the car accident. Humans get into a low speed car accident, and then get out, get their insurance, call the cops, call loved ones, etc., and the emotion they might be feeling gets blocked by this flurry of acting. His argument is that if we were to stand on the side of the road, and allow our bodies to release the emotion, we would be less likely to have the effects of trauma. I am confident this is dramatically oversimplifying his stance, but this is the basics. He has written a number of books on trauma, any of which would provide more in-depth information on this concept.

So, now, back to the clients with eating disorders. Not everyone with an eating disorder has a clearly definable trauma history; that is not my stance. But, eating disorders do serve to block emotion. Rather than feel about something, you focus on food in some way or another. That effectively blocks the emotion inside your body. Often emotions are numbed completely and clients will report really not feeling anything anymore. But it's still there. The extent of blocking varies from person to person, but I'm arguing that, in order to achieve recovery, and general psychological health, the emotion(s) must be released. There are many avenues for achieving this, sometimes even including simple talk therapy. But, if the emotions are NOT being released through talk therapy, it might be time to look for something to add to you therapy work. Dance therapy, yoga, art therapy, physical movement, and equine psychotherapy are all possibilities; and I'm sure there are many more I've not listed. But the bottom line is this: Release the emotion from your body. Trust it will not consume you. And, in fact, understand it is consuming you more when you block it than when you release it.

Tuesday, May 27, 2014

Why Equine Therapy...and What is it Anyway??



Hmm, I have run into an unexpected difficulty in marketing Shadow Mountain Equine Psychotherapy (from this point forward, known as SMEP). As it turns out, the vast majority of people think equine psychotherapy means I am therapizing the horse. Hmm, quite a problem! So, to be clear, no, I am not a horse whisperer; whereas I am known to talk to horses, (and all animals...and myself...) they do not, in fact, talk back to me!

So, how to get out there that equine psychotherapy (aka, horse therapy, equine therapy, equine assisted psychotherapy, equine facilitated psychotherapy) is this very powerful form of talk therapy that simply uses horses as a co-therapist? This is proving to be tricky here in Utah. In Colorado, where I am primarily training, you can't hardly take a footstep without tripping over an equine psychotherapist, and the field is pretty well understood, I believe. In Utah (and on airplanes, it appears!), it is assumed I think I'm a horse whisperer. Umm, no.

Therefore, I guess I am left trying to describe some of the work. Work that oftentimes seems pretty indescribable, or at least difficult to represent how powerful it can be. In my office, I work hard to make sure I am not just talking to clients using their brains. While there is some benefit to cognitive therapy, the risk is that the highly intelligent people I work with will simply "overthink" themselves or their lives, but not necessarily make the changes they are wanting. So, I work to help clients experience, feel, and understand what is actually happening in their bodies. If you think about it, each emotion we have has at least one physical sensation that goes with it. Over time, you might have become really good at blocking the physical sensations (much as you maybe have become good at blocking the sensations of hunger and/or fullness), but I promise they are still there. The risk is that, in the office, clients will just think really hard about what they are feeling, which, in the end, often is not really feeling at all.

Now, let's translate that out to the pasture/stall/wherever the horse is. So much emotion can be elicited simply by being around horses, and my task is to help you "feel into" your experience, rather than think about it. There's more to experience in a pasture than in an office. Every sense can be triggered, and in different ways each time; in comparison, my office looks, smells, and feels basically the same each time. Getting into emotion, sensation and feeling is simply "easier" in the pasture.

The part that's indescribable is the work the horses do. Mind you, horses are not really trained to be therapy horses. I cannot, as far as I know anyway, teach them what to do. They do what they do, and it's kind of amazing. Things I have seen:

  • A donkey come up and repeatedly head-butt a woman who was talking about being pushed   around in her relationship.
  • A yearling come and rest her chin on the head of someone squatted down, crying.
  • A horse come through and repeatedly violate the boundaries of someone talking about.....having a hard time setting boundaries. 
  • An active, fidgety horse stand stock still, not moving a muscle, while a woman leaned on him and cried.
  • Many, many horse hugs....provided by the horse, not the human.
These are things that cannot really be described, and can only be understood when witnessed. These are the unsolicited actions of horses. I won't pretend to know why the horses act in these ways. I don't know what they do and don't understand. I just know I have seen it over and over, and thus believe in what they do, and the power it has with people. 

I worry that people see equine therapy as "woo-woo" or as not having sufficient backing. Honestly, the second is likely true, as there is little data to back it up right now. Many of us are working on that problem. But, I have no doubt that if we could hook biofeedback machines to clients working horses, we would see significant changes in heart rate, blood pressure, etc, as clients learn to use their relationship with horses to create calm, happiness, and connection. Someday the research will get there. 


In the meantime, all I can say is that I am one science-minded woman...and I believe in equine psychotherapy. 

Monday, May 12, 2014

Shadow Mountain Equine Psychotherapy and the return of Angela Hicks, PhD!

Hi everyone! It has certainly been a long time since I have posted. A lot has been going on! Some major changes have happened around here, all for the good! The major news is that the week of June 1, I will begin to offer equine psychotherapy to clients with, and without, eating disorders. I have previously posted on how I see equine psychotherapy being relevant in the treatment of eating disorders, so I will not rehash that.

What is interesting is that there are virtually no equine psychotherapy options in the Salt Lake valley. I'm aware of a couple programs that offer hippotherapy, which is more designed to treat physical disabilities, though I understand some small amount of psychotherapy might be done at these facilities.

I feel strongly about the approach I am using in providing equine facilitated psychotherapy. What is emphasized is the clients' relationship with the horse, and using that connection to help facilitate change. Some other approaches use horses to complete certain tasks, such that the client can learn something. Unfortunately, this can take the client out of relationship with the horse. Therefore, in the approach I am using, the horse will not be forced to do anything other than be a horse. It is very hard to explain the power of equine psychotherapy; it really is something that must be seen.

So, I hope you will all check out my new website: shadowmountainequine.com. I am excited to get this phase of my work started, though my availability will be limited. I am very thankful to Keystone Equestrian Horsepark for their support of this venture. Check them out at keystoneteam.com

The other major change is that Dr. Angela Hicks is returning to part-time work with me! I am very excited about this, and welcome her back with open arms. She is completing her final stage of training to receive her PhD in Counseling Psychology; this will be her second PhD! So, she will have limited availability until the fall, but then will be back full force! Welcome back, Angela!