Levels of analysis – Victims of perpetrators.
 
I was visiting with dear friends last evening and one of them reminded me that it is important to distinguish between the victim of a hurtful action (intentional or otherwise) and the person or event which causes the injury.  For example, currently a hurricane has visited Puerto Rico, the Virgin Islands and is moving towards Florida where it may or may not do significant damage. In this care it is clear the perpetrator is the hurricane and the victims are those whose person, possessions or community Is damaged by the hurricane.   It is obvious that no one caused the behavior although there may be some human actions which affects aspects of the weather or the extent of the damage.  In this example the perpetrator will not be locked up or made to suffer other punishment .  Although the hurricane is, in some senses, a living phenomenon, it is not a being capable of  malevolent intent. It is doing what the various forces determined it would do.   On the other hand, if a person steals from another  although at level I there is a victim and a perpetrator, at another level we have to examine why the person did something which ultimately is not in his or her best interest.   Treating anyone as less then ultimately hurts the entire community.    Stealing might temporarily alleviate the financial distress of the person who stole, but in the long run he or she has contributed to an atmosphere of distrust and, thus, violated the community contract.  All suffer.   On level I we clearly have a victim and a perpetrator of a wrongful act.  On level 2 we need to examine why the person stole. The possibilities are:
 

• Through no fault of his or her own they lost their job and have not been able to find assistance to help feed their children.
• Through no fault of their own the person has a brain tumor or other medical condition  which blocks the ability to consider the rights and needs of others.
• Though no fault of their own the person has an addictive disorder which affects their ability to consider the needs and rights  of others.
• Through no fault of their own the person has some other mental illness which blocks the ability to consider the rights and needs of others.
• Through no fault of their own the person was raised by parents who themselves were unable to teach moral or rational behavior.
• The person lacks the mental capacity to consider the effects of his/her behavior.

 
Obviously there a number of reasons why a person is unable to consider the rights and needs of others. The person can be a victim of any of those conditions or circumstances.  Often the perpetrator needs assistance in changing how their brain functions.  Perhaps, however, there is no treatment available or there is no way to determine why his or her brain is unable to consider the needs of others.  That person may need to be placed in a secure setting  - not as a punishment and, thus, not jail – so that they are not able to harm themselves or others.  Perhaps in the future a treatment will be found.   
 
At level I the goal is clearly to stop the harmful behavior.  If someone is physically abusing another one must realize that one person is at that level the abused victim and the other person is the abuser.   The abuser must be restrained. Once that is accomplished it is time to move to level II and attempt to discern what it will take to prevent the abuser from future abusive behavior;  Merely labeling him or her the abuser or the perpetrator is not helpful in stopping or attempting to stop future abuse.  We know that punishment does not change how the brain functions; in fact it may ensue it functions worse. Merely labeling this person as a victim is of no help. We need to, if possible, identify, the reason he or he is unable to consider the needs of others.
 
It is important to identify the victim as a victim to ensure the person does not blame themselves for being abused and, thus can heal.    The perpetrator must be identified as such so that they can, when appropriate, be held accountable (not shamed), be taught the steps for reconnecting with the larger community and how to choose different behavior in the future. The ultimate goal is to heal the one who is hurt and to restore the perpetrator as a connected member of the community.  It is not helpful to merely use the labels victim and perpetrator.
 
Written August 31, 2019
Jimmy F Pickett
coachpickdett.org

​Diagnosis:  DAA
 
I was formerly an approved provider for the Department of Transportation. If a driver tested positive for a recreational drug including alcohol I would assess the individual to determine whether, in my professional opinion, he or she had an addiction or abuse issue.   There were times when, in fact, I determined that he or she did have a diagnosable addiction or abuse issue and needed treatment before they resumed driving.  I would then submit a  recommended treatment plan for this individual to the Department of Transportation.   Occasionally, I would evaluate someone who overdrank or smoked a joint at a wedding or some other event where they connected with an old friend and shortly thereafter were called in for a random drug test. If I determined that this was a one-time occurrence or a rare occurrence which just happened to precede the random drug test I would diagnose them with “DAA”.  The Department of Transportation representation would question the diagnosis since they could not locate it in the latest edition of the official Diagnostic Manual of the American Psychiatric Association.  I would inform them that they would not find DAA in the diagnosis manual. DAA was short for “dumb ass attack”.  The next question from the representative was, “What is your recommended treatment plan?”   I would reply: “None.”  This was not acceptable. The representative would insist that everyone had to have a treatment plan.  Naturally the extent of the treatment plan was to avoid DDAs in the future.  Not surprisingly the bureaucrat could not find that option listed and would insist that I draw up and submit a comprehensive treatment plan.  I would simply tell them I was not doing so even if they refused to authorize a payment for my assessment.   My guess is that they then found another provider who would obey the rules, assign an approved diagnosis and submit a detailed treatment plan recommendation.  My relationship with the Department of Transportation soon ended.
 
I was remembering that history this morning as I was reading of the arrest of some local men and one woman.  Some of the men are publicly known. The woman is accused of operating a house of prostitution and the men are accused of using her professional services.  Sadly, we do not live in a state where prostitution is legal, monitored by the health department and which  allows the local government to collects taxes as it does for my business.  I have no idea if the business was causing a traffic issue for the local neighborhood or if there were any other adverse effects.  The possibility of some car service was mentioned which the neighbors might not appreciate.   Otherwise, I fail to see why anyone, other than possible spouses/partners, would care what this woman or the men using her services were doing.  I highly object to using tax money to investigate, make arrests, prosecute and force other law enforcement individuals to waste their time on such a case.   As a counselor if this behavior causes marital or partnership issues I certainly would be happy to help the couple or the family deal with the ensuing stress.   Unless there was a case which fit the diagnostic criteria for a sexual addiction or some other co-occurring disorder insurance would not be billed. Of the woman who operated the business and the men who used the services, I would ask, “What were you thinking?  Did you have a DAA?”  if one is going to illegally operate a house of prostitution one should attempt to select a better location than a suburban neighborhood where it is noticed if Alexis makes an extra delivery! Of course, one can live in such a neighborhood and not have the funds to rent another location.   Still….  Surely the men using the services know that there is always an insomniac in such a neighborhood who is going to monitor the traffic and other activity. Every  neighborhood has such a self-appointment watch department!
 
Sadly we  often arrest many people just because we are mad at them or because we do not like their behavior. We also arrest the mentally ill including those with addictive disorders and send them to jail or prison when they deserve and need  quality mental health services.  We arrest many who have had DAAs when, in fact, we need to extend a helping hand or with humility admit that tomorrow it may be us having a DAA.      
 
We give an impossible task to the law enforcement individuals at every level of our society.  We make them responsible for potentially dangerous situations, the mentally ill, for behavior with may displease us or which feels wrong in our value system.  We tie the hands of judges who may want to be more empathetic and to consider extenuating circumstances. Still we complain that the very expensive judicial systems of local, state and national communities are not working.    Perhaps it is time that we  allow for some humility and perhaps even a dash of common sense in formulating and enforcing laws. I promise if you have a DAA not to judge you or insist that you be convicted of a crime. 
 
Written August 29, 2019
Jimmy F Pickett
coachpickett.org

​Life coaching or psychotherapy
 
Communities have always respected the fact that at times we all need an objective  person to help us through tough situations. That might have been a wise woman or man, the local shaman, a clergy person,  another community healer, or some other person in one’s community.  In many communities today we are limited to licensed therapists or counselors who  diagnose and treat mental illness or coach one through a tough time in one’s life.
 
When  living with a mental illness  one hires a trained professional  - psychiatrist, psychologist, counselor, therapist, psychiatric social worker, addiction counselor – who diagnoses and explains what is happening with one’s brain and the options for treating the symptoms and the illness itself.   If the professional is not a psychiatrist who can prescribe medication, one may then be referred to see a psychiatrist to determine/make an educated guess as to how and when medication might be helpful.    One will also need to see their family doctor to determine if the symptoms are the result of a treatable malfunction such as a thyroid disorder, a tumor, or an infection which affects how one’s brain works.   If one has a chronic mental illness medication can only do so much.  Other health related habits such as exercise, good nutrition, spiritual support, and emotional support can also help one’s body cope with any illness.     Mental illness often distorts how one experiences and perceives oneself and the world.    Talk therapy or counseling can help one identify and correct the distortions or outright lies.  Clinical depression, for example, chemically blocks out the automatic experience of color and movement.  One is unable to experience the positives or the fact that there is movement in time. Thus one may have a day during which the world seems negative but if  not suffering from a mental illness one knows  that yesterday was positive and there will be many positive tomorrows. Clinical depression make it seems as if all days have been and will be negative.   Cognitive behavioral therapy can help one identify and correct the lies thus allowing one to move forward with life.    Traumas including combat, domestic violence, sexual abuse and other  life experiences can also lead to a distorted thinking process.   While mediation may help the brain function better it may take a lot of guidance and practice to change the habits of thinking one stores prior to the illness being treated. A trained therapist or counselor can also often recommended alternative treatments which might be beneficial.
 
In order for an insurance company to pay for counseling there has to be a mental illness diagnosis which is listed in the official Diagnostic Manual (DSM).   Sometimes a therapist or a counselor will use a diagnosis which seems consistent with the symptoms but the symptoms are the result of a life event which the individual is struggling to incorporate into their llfe journey. This may be a death, a divorce, a discovery about oneself or a family member or some other difficult life event.  One does not have a mental illness but one may need guidance and support. For lack of a better term many are calling this life coaching.   I sometimes tell people that they do indeed need some support or guidance but they do not need therapy or counseling for a mental illness.   The good news is that if one does not have a mental illness diagnosis one does not have to report life coaching to life insurance companies, potential employers or others. One can honestly report that one has not received treatment for a mental illness.   The only negative is that, of course. health insurance does not pay for life coaching.   When I am seeing someone for coaching I see them for a fee that they can afford.    One can refer to the section of this web page under fees which describes my fee policy in more detail.  Some religious organizations  will provide life coaching free of charge.
 
A trained professional will do their best to help one determine whether one needs life coaching or treatment for a mental illness.  The more history one can provide the professional about the history of one’s symptoms the more likely the professional can give one an educated guess about the help one needs.
 
Written August 28, 2019
Jimmy F Pickett
Coachpickett.org

​I do not feel safer
 
In many places in the world we continue to arrest individuals who are selling recreational drugs including ecstasy, marijuana, as well as others.   Just this morning I read in the local newspaper of the arrest of a  26-year-old young man for possessing with intent to deliver.  I suspect the charges are accurate as they also found nearly $23,000.00 in a suitcase with his name on it.  He is now in jail on $75,000.00 bond.  There is a good chance he will be convicted and sent to prison.  This is also a chance that a good attorney will convince a judge that his primary issue is addiction and he will go to be sentenced in drug court although I fear this is a slim chance.  It he is sent to prison there is little chance that he will  have access to treatment and whatever help he need to claim the good life he deserves.   Recently in Oklahoma a pharmaceutical company was found guilty of using misleading marketing of their drugs including opioids to contribute to the opioid crisis.  The judgement was relatively small in dollars but it sets a precedent which could mean monetary awards in all 50 states.  The company, Johnson and Johnson, will, of course, appeal the case.   Even if they lose the appeal and have to pay the court decreed amount there is no talk of anyone going to jail.   I am not suggesting that anyone should go to jail but am confused about the difference in these two cases.  In the case of the young man it is true that it is impossible for him to know if the drugs he was selling were safe. In the case of the drug manufacture they clearly knew the drugs were not safe long term. The drugs would and did kill a great many people.  There is ample evidence that many drug companies aggressively marketed drugs with the primary objective of making money.  In fact here in WV a major pharmaceutical company has raised the price of epi pens to a prohibitive rate even though this is not a new products and cost very little to make.  
 
I have had clients who were  employees of drug companies nearly suffer mental breakdowns because of their guilt of pushing certain drugs for the sole purpose of making money even when there was no scientific evidence that a particular drug was necessary or preferable.  Many of my medical colleagues find that prescribing drugs are the most efficient way to treating patients even if, at some level, they know that  this is not the best course of treatment. Many physicians are expected to spend a maximum of 15 minutes or even less with patients who they see all day on a back to back basis. There is no time for evaluation, education or just human interactions.   Physicians spend many years in school for which they have to pay huge sums and which postpones the start of their careers.   Because of this they often feel entitled to large salaries and the perks those salaries will buy; big houses and expensive cars which they have little time to enjoy.   The divorce rate and even the suicide rate among physician in the United States is high. In fact I read the results of one study that as late as 2018 the suicide and addiction rate of physicians in the United States was the highest of any profession.
 
The goal of the street drug dealer is also to make money. Sometimes the goal is just to support his or her drug addiction.   We jail the drug dealer, at most slap hands of drug company executives and largely ignore the death by suicide and drug addiction of physicians.  We can always crank out more physicians although there is a shortage of those entering the field of psychiatry in the United States.
 
What is the difference between the street drug dealer and possible addict, the owners and other decisions makers in the pharmaceutical companies, and the physicians who are focused on making money only to find that they are depressed and miserable?  What is the payoff for the larger community in pretending as if there is a difference? What responsibility do we as a larger community have for creating a culture in which money, position, “success”, and things are the gods?   What is the payoff of pretending as if  the quality of life will be improved for the larger community by jailing the scapegoats – the street dealer?  Sure we occasionally sacrifice a physician who has not yet killed himself or herself, but on the whole we ignore one and jail the other?
 
What sort of courage and humility does it take for all of us in the community to ask and wrestle with these and related issues?   Who is safer or better off for ignoring these   questions?
 
Written August 27, 2019
Jimmy F Pickett
coachpickett.org
 
 
 

​The sins of the flesh
 
As soon as one decides to use the word sin many will call up the history of their religious teachings.  Of course, not all religions use the term sin, but most strive to control the behavior of others by suggesting that their particular god or gods is going to be  displeased if one does not reign in sexual behavior, gluttony, jealously, anger and other behavior.
 
Obviously gluttony is available as a sin to the very wealthy or those who only have access to unhealthy food which results in the appearance of gluttony or those who need to use food to suppress their anger at those who refuse to share their excess of goods with one’s family.    Jealously  is available as a sin to those who  want what others have, but here again most who express jealously are not wanting the spiritual peace of others.  Many are more likely to want “the more” which has failed to bring spiritual peace to those who have more.
 
One might assume that most of the sins of the flesh are related to  physical or spiritual behavior and not the underlying pain.  Ironically, many religions have focused on the symptoms of the pain rather than the pain itself.  Surely no one could comfortably posit a god or gods who responded to pain with anger and punishment.    Yet, by pretending as if they are not human and, thus, have no experience with pain, religious leaders attempt to control others by  focusing on the symptoms of pain.     Daily, of course, we hear more revelations about those very same religious leaders who have the very same symptoms of “dis ease”. Then some religious leaders point fingers at other leaders as if they themselves are exempt from the same symptoms and the same underlying pain.
 
Interesting that the sins of gluttony – mega churches, huge salaries, gold chalices, expensive cars, planes, clothes, etc., acute overweight- do not usually bring the same reaction from religious leaders as do the sins of sex.     Although science has long debunked the myth of the shortage of sperm, the sexism which mutilates females as an attempt to take away the sin of sexual desire and, thus, the temptation to behave sexually as do males, worldwide religions continue to act as if the need for sexual intimacy can be restrained or controlled with angry, punishing gods and even legal systems which carry out the will of these very same gods.
 
We move in every evolving circles. We do away with the extended family system for raising children and then justify the restriction of sexual pleasure by suggesting that poor people will have more children than they can take care. Of course, the nuclear family does, for the most part a poor job of raising children. It takes a large extended family to do this well.   There are,  in some communities some wonderful examples of extended families raising children.  This may be a biological family or an intentional family.  Those with more assets often do not raise their children. They use nannies, boarding schools and a host of other paid resources. Love may or may not be an ingredient in child rearing which is considered necessary for such important community members who are using money and position to get their temporary fix.
 
We know to prevent pregnancies. We know how to prevent many sexually transmitted diseases. We know how to create clean, safe brothels (only for those who can afford them).   We know how to celebrate the sexuality of children while still teaching them safe sex and about not confusing control with intimacy. We know how to support  billions of dollars of porn, including child porn, but not how to massage the pain which leads some to use sex to control small children or to get some human connection without having to be intimate.   We do not teach the safe use of porn.
 
The sins of the flesh are:
 

• No access to healthy food, shelter, health care and other necessities.
• No community sharing of child care.
• Teaching shame of bodies and sexual intimacy instead of how to celebrate our bodies while being responsive and responsible to each other.
• Using weapons which kill as a means of controlling others and as a means of profit, profit, profit.
• Pretending as if some of us are exempt from the need for intimacy and sexual pleasure.
• Pretending as if sex is just for procreation and every time a sperm and egg decided to hang out with each other god or the gods has ordained that a child be born.
• Pretending as if philanthropy  is possible without some having an unequal share of the wealth.

 
Written August 26, 2019
Jimmy F Pickett
coachpickett.org



 
 
 

 
Sunday Musings – August 25, 2019
Where are the voices of compassion?
 
Every Friday the magic of the internet brings the newsletter from Trinity Church Wall Street.   If I scroll down to near the bottom I can access a video of the previous Sunday’s sermon as well of some of the other sermons delivered by various clergy who serve with the community of Trinity.  All of the sermons are thought provoking although given our individual histories we all hear each sermon differently.  I love the passion of some of the clergy, the  poignant challenge of others, and the soothing reminder by still others.  The Reverend Winnie Varghese is one of those whose articulate passion grabs my heart and my mind challenging me to reclaim the simple truth that we must make our voices heard in the desert of these times.  We must speak out for justice and not against those whose understanding of the world is held together by grids in which each person is assigned their small space.   We must speak to the fear of those who sense of worth is tied to the illusionary safely of their grid.  We must speak to the heart of those whose  wall of anger is borne of fear which would keep children separated from parents, farm and factory workers with or without green cards denied simple gratitude, and women (and men) regulated to sexual body parts, We must speak to the fear from which the  bully behavior of individuals, companies and nations originates.  
 
It is tempting to speak out against those use hate, greed, exclusivity and false prophecy which is attributed to a god who is posited as a self-centered, angry, revengeful teenager whose feeling are so fragile that he/she/it must strike out with vengeance.
 
As individuals gather several times a day to face Mecca; as others gather on various sabbath days, the challenge is to risk positing a God which speaks to the pain which keeps many locked in their place on the grid and viewing those outside their grid as “the other”.  The challenge is to truly proclaim the good news that indeed we can visit the sick, welcome the hungry and those fleeing all forms of violence, take the hand of the prisoner who needs a mentor and not a guard, and beat the sword or guns into implements which will help cultivate food.
 
On this Sunday morning I am reminded of the words of Bigger Thomas  in Richard Wright’s Native Son, “You can’t do nothin except kill me and that ain’t nothin.”; of those in the  Holocaust camps who created beautiful music, of those in countries such as Estonia who made amazing sculptures out of munition part  when they were controlled by the Soviet Union, of those who refuse to give up their dance of life.  
 
When I first came to Wheeling there was a man who dressed in the costume of a woman and proudly strolled the streets.   It is true that his or her makeup skills sometimes extended the lips or the accented the cheeks a tad too red, but he had the courage to proudly share his dance. This was long, long before the first Pride event would touch even the edges of this community.   
 
I often find myself reacting to the action of the fearful; to the actions of those who costumes may be greed, exclusivity, and isolation with self-righteous distain which is not helpful or healing for anyone.  I am better at catching myself these days; at just non-judgmentally noticing and stopping myself from speaking judgmental or even hateful words. Yet, it is often a challenge to keep my dance positive; to look past the superficial  costumes and embrace those whose lives seems to be guided by fear.   We need to weep over the pain of others while demonstrating the simple joy of loving the outcast.   In my Christian tradition when the disciples questioned Jesus chatting with the prostitute and he replies “Let those who are without sin throw the first stone.” we are given the only lesson we need – to show up with joy and unconditional love.
 
This then is the challenge as we move through  a time of great change; a time when the mirrors of fear are very bright.
 
Written. August 25, 2019
Jimmy F Pickett
coachpickett.org

​What if?
 
What if
 
every day was a new opportunity?
 
What if we
 
 did not drag the garbage bag full of
 
                        self-hate
                        anger
                        resentments
                        attachments to what was
                        blame
to the new day?
           
What if we
 
            did not repeat the same experiments expecting different results?
 
What if we
 
            suspended judgments
            dropped the dualities?
 
We if we
 
            faced head on the mirror of the destructive filth of
                        racism
                        sexism
                        homophobia
                        creation of the other?
 
What if we
 
            celebrated the gifts of each other.
            embraced our wildlife cousins
            bowed down to the forest
            listened to the songs of the whales, the birds and the elephants
            held tight to the whole of the universes?
 
What if we
 
            laughed often
            pushed the air with feet until the swing soared over the trees.
            forgave ourselves and each other as quickly as little children?
 
We if we
 
            were okay with being perfect in our imperfectness?
 
What if we
 
            answered hate (fear)  with love?
 
What if we
 
tied a bow in the ribbon which connects our head and heart?
 
What if?
                       
Written August 23, 2019
Jimmy F Pickett
coachpickett.org                    
           
 

When hope leaves
 
The relationship between hope and faith is one which has been explored by many wise teachers.   Hope or the lack of hope is sometimes described as an emotion but can also be thoughts based on experience and statistical odds. As a social scientist I have long had a strong desire to identify what factors affect whether a person grabs holds of hope or sinks into a paralyzing living grave.  When a person sinks into that space they may appear to the observer to be perfectly capable of functioning in all areas of their life.  Yet, they may be incapable of leaving home or even doing the simplest task at home.  They may or may not be able to perform some tasks for loved ones, especially children, but the least bit of activity will exhaust them. The observer will often label them as lazy, undeserving of assistance and, if they receive any public housing, food or cash assistance they may be accused of fraud.  True they may have all their limbs and all medical tests will confirm that there is nothing medically keeping them from being self-supporting and self-sufficient in all areas of their lives.   Yet they will tell themselves and anyone who asks that they are incapable of moving forward.  Some will  say that there is no basis to believe that anything they do will make a difference.
 
Many conditions and experiences can steal hope from an individual, a family or a community.  These include:
 

• Being denied access to the tools which allow one to earn a decent income and provide for oneself and one’s family – education, degrees, drivers license, promotions, health care, etc.
• Repeatedly being told that one is less than, less valuable then, less deserving of care, less deserving of access to a decent grocery store, transportation, health care and other basic necessities.
• Being subject to questioning and arrest just because one is a particular color, religion, gender or “different” in some other socially constructed manner.
•  Living in a combat zone as a civilian or solder for a significant period of time.
• Living under a repressive regime for a significant period of time.  The regime may be a ghetto, a  country or a facility such as a prison.
• Death or multiple deaths of loves ones, especially children..
• Mental illness including addiction, clinical depression, bipolar depression, schizophrenia, acute anxiety, PTSD

 
The metaphysical question concerns the exceptions of those whose similar experience  leads to a tenacious faith or even understanding that one can find a way to claim one’s space in the world.  Sometimes one can identify the perception of light or a rainbow in the midst of the darkness of the lies which tell one there is no  light or rainbow.   In many respects, Rosa Parks, Sonia Sotomayor, Bigger Thomas the lead character in Native Son, Harriett Tubman, Maya Angelou, Darnell Moore and a host of others have proven that one can take in millions of lies and still grab hold of hope. The question always, for me, is how did they do that. Some will tell us that one teacher, one relative, one poet, one writer, one scientists or some other unseen force removed the blinders; revealed the lies as lies; provided that sliver of hope which found its way through the cracked prison walls – real or metaphorical.  Sometimes that sliver of light combined with the right medication to treat one’s mental illness, a new approach to the treatment of addiction, or the voice of a child which says “Come back mommy.” or “I miss you dad.”
 
Sometimes someone will see beyond our carefully constructed professionalism to the cracked human who reclaimed hope and decide that if we could make that leap of faith they can to. Sometimes, as my 9-year-old friend L says “You got to standup to the person who is bullying another and tell the truth.” take the hand of the person being bullied and skip to the front of the line.  
 
Blaming the oppressed person for the symptoms of the oppression is an all too easy and common explanation of why one does not create virtual boots and pull oneself up by those virtual bootstraps. Taking a hand and walking the long, rocky road in bare feet to the freedom of hope is not only more compassionate but stands the tests of science.  Science tells us when we have lost the thread of or it has become as fine as a single silk thread we need x-ray vision provided by the eyes of those who have proven the lies wrong.   
 
Written August 22, 2019
Jimmy F Pickett
Coachpickett.org
 
 
 

​A sacred relationship
 
The relationship between health care providers and patients/clients has always been a sacred on.   Shamans, priests, other clergy, midwives and other village designated care takers have always been a neighbor, friend and honored as physical, emotional and spiritual healers.  In more modern times there is often not a common history and thus, the relationship between provider and client/patient can become impersonal.  It can still be a sacred partnership, but only if the providers and the clients/patients are intentional about  remembering:
 

• Health care providers are the employee not the employer. We cannot hire and fire patients/clients.   
• Patients/clients and health care providers are committing to a very intimate relationship.  The nature of the relationship is primary.
• Decisions needs to be shared and agreed upon by both the health care provider and the patient/client.  Decisions are not to be dictated by either the employer or the employee.
• A health care provider may not have the expertise needed  by a patient/client but can share responsibility for helping a person find that expertise.
• A health care provider cannot  be a competent employee if they do not take care of themselves.
• A passive or silent employer is not fulfilling their part of the relationship agreement. If an employer (client/patient) has a difficult time speaking up then they need to take an advocate with them.
• Anger may be understandable emotion at times but dumping anger on another is not helpful or kind.
• First and foremost in any interaction between one or more humans it is a relationship between two humans.   Always  begin the relationship by respectfully and genuinely greeting the other person by name. If the employer (patient, client) or the employee (health care provider) refuses to do this it cannot be a healthy or helpful relationship. 
• If one is mistreated by a health care provider and the health care provider refuses to apologize or take responsibility then one may need to terminate the relationship. If the health care provider apologizes and says they are having a tough day the employer needs to accept that apology. If, however, this is a regular occurrence then one may need to report the provider to their local supervisory or licensing board.
• If the employer is simply exhibiting symptoms of their presenting illness or distress than the employee needs to be trained to work with those symptoms.  Safety does, however, need to be maintained for all involved.
• The employee needs to insist that the provider take the time needed to listen to the concerns of the employer while also being respectful of the fact that other patients/clients may be waiting.  It can be very helpful if the patient/client has two copies of a short list of concerns which need to be addressed during the time together.  One copy is given to the provider at the beginning of the appointment.  If the health care provider consistently overbooks then, if possible, hire another health care provider.  In rural communities this may present a difficulty although with the increase in telemedicine more options are becoming available.
• Before instigating a lawsuit or filing an ethics complain options  such as addressing the issues with the provider need to be explored.  Mediation may at times be an option.  If necessary one can take a responsible, respectful, assertive advocate with them to a meeting with a health care provider.
• Before quitting one’s job as employee one needs to attempt to resolve relationship issues with the patient/client/employer.
• Health care providers and clients/patients need active listening skills with each other just as they do in all relationships.   Thinking about one’s response rather than listening is not helpful.
• Symptoms may lead one toward a diagnosis but are not the diagnosis.  For example an angry client/patient may be addicted, recovering from a trauma, have a brain tumor or some other physical malfunction which adversely affects the ability to process incoming stimuli without becoming overwhelmed.   An angry patient/client very often may be frightened.  The goal of the health care provider needs to be empathy without accepting an invitation to balance the system by also becoming angry.

 
It is my experience that the more we are able to focus on treating all relationships as sacred/worthy of our time and attention the more effective two or more people will be in accomplishing a task without creating or leaving behind emotional garbage.  This is a journey and not a destination.  We are never going to be perfect but we can get more comfortable  with and accepting of each other’s humanness.
 
Written August 20, 2019
Jimmy F Pickett
Coachpickett.org

​Empathy or a lifetime of being a victim
 
In my role as a professional counselor I need to be very mindful of the often-thin line between empathizing with someone who has been abused or is living with a miscarriage of justice and supporting their view of themselves as a professional victim.  For example, a friend of mine was abused by her daughter who was drunk.  My friend was hurt but mostly she is worried about her daughter who refuses to get help for her addiction.   She will do what she needs to do to let her daughter know that she is very worried about her even if it means filing charges with the police.  My friend will be fine. She knows that the behavior of the daughter is not about her but is about the addiction.  Recently . I talked with another person who was sexually abused as a teenager.   He has allowed this “secret” to have an enormous negative impact on his life for 18 years.  I suggested that the abuse, while sad, did not have anything to do with him. It has to do with the illness of the abuser.  While it affected this young man, it was not about him. Knowing he was sexually abused did not tell me anything about this young man other than he had been abused. While that is sad, it  does not define him, tell me anything about his sexual orientation or demand that he continues to let this abuse direct his life dance.  In many ways he had adopted the role of professional victim.  He has also adopted the role of “shameful, worthless person”.  He is being treated for acute clinical depression by a psychiatrist.   He is also in treatment for many years of active addiction to drugs.    I have no idea if he truly has a clinical depression or if his many years of a shameful, victim dance have resulted in the symptoms of depression.  Certainly, his treatment of himself is depressing.   It is not unusual for a person to have more than one illness. Many addicts also have a co-occurring mental illness diagnosis.  Before that diagnosis is made, however, it will be important to see what happens as he begins to let go of the shameful, victim self-identification.  It is entirely possible to grieve sad instances of injustice and to have a very joyful and positive life dance.
 
Some of the music identified as Holocaust Music – music written while living in the cruel situation of the death camps during WWII – is very moving and adds to the richness of the lives of those who wrote the music and those who now experience it.  People I have known who lived through the painful, frightening years of Hitler, Mussolini, and Stalin often did so by practicing the serenity prayer – focusing on what they could control.  Many of those who survive combat experience reasonably healthy, albeit with deep scars, did so by focusing on the positives in the midst of war.  They did this without the use of recreational drugs which would limit their ability to respond to danger.   Positives might be communication from home, a goody box from home, a sunrise, a moment with a loving friend, or some other treat.  They did not deny the negatives but they also did not define the moment by just the negatives.
 
In our roles as helping professionals – counselors, physicians, judges, probation and parole officers, social workers, and teachers as well as others – we need to help individuals and families access their identification as whole humans’ beings; human beings who may have greatly suffered as victims of abuse but who are much more than that experience.  They are people capable of expressing pain, experiencing joy, and dancing with safe loved ones.  I have often heard counselors, social workers, physicians and judges say that an abusive or other sad experience has damaged someone for life; that they will never have the life they deserve. Certainly, the abusive experience or other sad trauma has changed them for life.  It does not need to define them. We are all more than our sad and painful experiences. If we know hurt we can use that knowledge to be our best, kindest selves.  Knowing pain frees one from the illusion that we can postpone dreams forever.
 
In short, we helping professionals must nor unwittingly steal a positive life experiences from those we serve by defining them as victims.  In our rush for what passes for justice, although the intention might be positive, we create new levels of impotence.  In other words, our behavior creates iatrogenic  symptoms – the negative side effects of treatment. 
 
Written August 19, 2019
Jimmy F Pickett
Coachpickett.org