Showing posts with label crisis. Show all posts
Showing posts with label crisis. Show all posts

5/8/22

The Lonely Bachelor: A Story About Vulnerability

I've noticed an interesting trend among my clients; particularly those who come to therapy because of a maladaptive behavior that's getting in their way. Often even if they've identified the problem and are motivated to change, they feel powerless. After experiencing disappointment over and over, they mostly believe that change is impossible. Clients with this mindset usually come to their first session looking defeated, skeptical, and often having already predicted that I won’t be able to help them. One of the first interventions I use with these clients is the Empathy Equation. Here's an example.

A client, let's call him Andrew, was a 40-year-old bachelor who was fed up with his long history of failed relationships. At our first session, Andrew said his goal was to learn how to be "less picky" about the women he chose to date. According to his assessment, the problem with his love life was that his standards were too high. He thought if he could learn how to settle for less attractive, successful, and confident women, he might finally find a long term partner. 

Naturally, I was struck by his automatic l assumption that the only thing he had the power to change were his expectations. While I agreed that he had unrealistic expectations, his pickiness didn’t seem to be the heart of the matter. After building trust, I gently encouraged him to tell me his story. Together, we discovered several traumatic events and abandonments early in his life that he had never validated or processed. He was forced to be the "man of the house" and the breadwinner in a rough city at a very young age. It had trained him to project confidence, hyper-masculinity, and perfection at all times to keep from getting stabbed in the back. The business he got involved in just to keep food on the table had required constant bravado and intimidation. Unfortunately, this habit had continued in his dating life. 

Andrew was baffled by the rejections that kept happening despite his best efforts. It would go like this: He'd meet a woman, hoping she'd finally be "the one". He'd spend their first couple dates trying desperately to impress her. He'd show off his spotless, chic apartment and wear clothes carefully chosen to flatter his body. He would brag about his career success, portray himself as fun and carefree, and tell his date about how many people relied on his wisdom and support.

His strategy of projecting absolute perfection inevitably backfired, though. Shocking, I know. If he didn't alienate the woman he was wooing with false arrogance, he would spiral as soon as any vulnerability was required. If she asked him about something he perceived to be a weakness, he would instantly feel humiliated and inadequate. To make the pain more bearable, he'd quickly pivot and identify a flaw in his date. He'd then fixate on it until he'd convinced himself that SHE wasn't good enough for HIM. Thus emerged his theory that his standards were simply too high. 

Andrew's denial about his shame had completely blinded him to the true cause of his relationship troubles. Even after identifying the true issue, several more weeks went by, the cycle playing out again and again. I suspect that deep down, Andrew was still holding out hope that his perfection gambit might work if he just tried hard enough. Finally, however, he was ready to accept the truth: His outdated defense mechanisms were pushing him to withhold empathy from others, and more importantly, from himself.

As the insight grew, he quietly told me a deeper version of his story. He said he'd only survived his traumatic childhood by using bravado to bluff his way out of danger. He had to pretend that he wasn’t wounded. There was no room for mistakes or weakness. As an adult, he’d just continued bragging, competing, and posturing to prove himself. Considering how much professional success it had brought him, the idea of intentionally letting down his guard felt completely counterintuitive. His inner caveman was driving the train. Cognitively, Andrew understood the problem, but when he had opportunities to show vulnerability, he would revert to his old habit and put up a front. 

The first few times he tried to go against his instincts, he had panic attacks, but he kept trying. Slowly but surely, the facade came down, revealing a much more relatable human underneath. By the end of our time working together he was in the longest relationship he’d ever been in. Not only had his love life improved, but the symptoms of depression and anxiety he'd felt for most of his life were significantly reduced.

So what exactly happened? Andrew had started out by noticing the feelings, beliefs and behaviors that were getting in his way. He'd been listening to the inner caveman for so long, he'd confused his behaviors with his identity. But as he started to investigate how his origin story had impacted him, the puzzle pieces fell together. Suddenly his frustrating feelings and habits made sense. Once he understood himself (aka learned self-empathy), he realized he wasn't trapped reacting the old way.

As he learned to have compassion on himself, he gained confidence that the true version of him could be known and loved. By detaching his unhelpful behaviors from his identity, he had the power to choose a different strategy than the one that had been sabotaging him for so long. Much like in my experience with the Bieber Incident, the Empathy Equation helped Andrew reach a deeper understanding of what he was feeling (shame, judgment), believing (survival requires perfection), and behaving (sabotage of intimacy). Once he had accessed self empathy, he gained control of himself.

3/19/22

Othering The Enemy

When beginning my internship hours to become a counselor, I took a job as a crisis interventionist in Dallas. I wasn't sure how I wanted to use my counseling license, and since regular therapy sounded boring, I made the most of my adrenaline-fueled skill of being “good in a crisis”. I had no idea how much vicarious trauma I was about to incorporate into my nightmares and future therapy sessions. You live, you learn, I guess.

adjusted to a stressful but rewarding routine of driving to crisis situations each day, often working late into the night. My partner and I would be dispatched to meet people all over the Dallas-Fort Worth area who were struggling with things like suicidal ideation, acute trauma, psychosis, self-harm, substance use, domestic violence, and pretty much any other mental health crisis you can imagine. We worked closely with the police on many of these cases.

After two years of community crisis work, I transferred to the Dallas County Jail where I met with recently arrested inmates who had been flagged for suicide risk or other mental health concerns. My job was to assess their risk, connect them with resources, and most importantly, offer them empathy and emotional support. In many cases, I was meeting these clients on the worst day of their life and they were not always happy to see me.

My typical approach to therapy is to offer every client what Carl Rogers calls “unconditional positive regard”, no matter who they are or what they’ve done. This approach proved insufficient, however, the day I was assigned to counsel an inmate who had been arrested for raping a child. Having personally been the victim of sexual assault in my childhood, he was in the one category of humans that I had absolutely no positive regard for. I knew immediately that I needed a strategy that didn’t rely on my instincts.

The inmate (let’s call him “Joe”) was a registered sex offender who had already been convicted of sexual assault of a minor twice before but had been released on parole. The evidence indicated he was likely guilty of the new charges and would spend the rest of his life in prison. As I reviewed the jail records I had on him, I numbly noticed myself shutting down emotionally. I felt a familiar detachment from my body, a trauma response designed to help me ignore my racing heart and shortness of breath.

Taking some deep breaths, I thought about the challenge ahead of me. I could have referred this client to a colleague, but I knew this wouldn’t be the last time I encountered a trauma trigger at work. For better or worse, I wanted to confront it. The first step was to stop ignoring my intense reactions. I chose to consciously confront my obvious bias toward Joe.

Immediately, I realized that I saw all child molesters as monsters who were categorically undeserving of compassion. Recognizing this hatred in me made me more uncomfortable than I’d anticipated. If I genuinely wanted to help Joe rather than harm him, I couldn’t continue hating him. I needed to find a way to push past my instinctual disgust and stop seeing him as a monster. To do that, I needed to get to know his origin story.

As I sat at my desk in the courthouse preparing to meet Joe, I organized my thoughts. Crisis training had taught me empathy is essential for helping someone de-escalate from a crisis. This rapid-form of empathy requires the clinician to think about the person in crisis in the context of their identity and life experiences. Only with that perspective can the clinical can offer meaningful understanding.

I jotted down a list of questions to ask Joe that I hoped would help me understand him better. Who was he? What parts of his identity needed consideration? What had he been through? How did he see the world? What circumstances were contributing to his distress right now?

Feeling determined but sick to my stomach, I sat down outside his solitary confinement cell. Internally, I was repeating a mantra of “don’t judge, just listen” over and over. I bent over awkwardly to speak to him through the small feeding door to his cell. With as much gentleness as I could muster, I started asking him questions, taking notes as we went.

Joe was a Black man in his mid-thirties who had been raised in Texas by a drug-addicted single mother. He had been born into extreme poverty with a family history of mental illness and minimal education. All of this was saturated in the racial inequity that Black Americans face in the south. With these basic facts about his identity, I knew that Joe had been born into a life of adversity.

Next, I asked about his life experiences. He told me he had been the victim of multiple forms of abuse, including sexual assault, starting when he was still a toddler. Survivors of early childhood sexual assault often have a skewed understanding of consent and body autonomy if they don’t get the chance to really address it in therapy. Additionally, studies have found that perpetrators of sexual assault are extremely likely to have first experienced sexual trauma in their own childhood. 

Jail records informed me that in addition to his trauma history, Joe had untreated mental illness and had sustained multiple brain injuries that impaired his cognitive reasoning and impulse control. Sadly, he had never gotten the treatment he needed for these issues or even been educated on healthy sexuality and consent. Like most sex offenders, Joe didn’t spontaneously decide to abuse others without a catalyst; he was a victim first. He had already continued the cycle of abuse before anyone had told him that the violations that were done to him were tragic and wrong.

Lastly, I asked Joe what he was feeling that day, crouched in his cold, solitary cell. Due to his suicide risk, he was wearing nothing but a thin paper gown. He was humiliated and terrified of the inevitable violence that awaited him in the general population. He said it was like living a nightmare that was never going to be over. I imagined Joe as a small vulnerable child, afraid and desperate for understanding.

As we spoke, I was surprised at how quickly my empathy bloomed. I found myself genuinely moved by his story. He wept as he told me that I was the first person who had ever cried about the things he had been through. He hadn’t expected anyone in the world to show him kindness. I no longer saw a sociopath or a monster in him, I simply saw a human who was hurting.

When I left work that day, I felt like I’d been through a battle but I knew something life-changing had happened. Setting aside my anger and disgust to find out who Joe really was had been a healing experience I wasn't expecting. Since then, I’ve seen this kind of intentional empathy play out in astonishing ways over and over, affirming that my interaction with Joe was not a fluke.