Earlier today, I noticed myself suggesting to someone that he might want to be a little more proactive than just waiting for God to thrust him in front of a mentor or  sponsor to guide him in his spiritual journey.   As is  frequently the case,  it did not take me long to acknowledge that I could greatly benefit from listening to myself.   Sometimes, I “patiently” wait for the muse to visit before attempting to write a new blog, to help me create the perfect marketing tools for my business, or to enlighten me about how to do something with some program on the computer or ….    At other times,  I notice myself waiting until I “feel” like doing some chore; waiting until it “feels” more manageable.  

I suspect that many of us have some of these same habits.  While we are awaiting for the “right time” our partner or boss might irreverently suggest that we are procrastinating; that we are telling ourselves lies or finding excuses for putting off doing something which might be uncomfortably tedious, boring, or difficult,  When I am accused of such behavior, I might get defensive.  I have noticed that there is a high correlation between the intensity of my defensiveness and the truth of what the other person is suggesting.   None of us – certainly not me – likes to have their faults or character defects pointed out to them. Rather than just admit that we have been “caught,” we may attempt to change the subject by blaming the other person of nagging or of not knowing what they are talking about.   It does not usually matter that we know that they know.

There are, of course, times when it is judicial to temporarily set aside some project and then view it later with a fresh eye.   I have to be careful, however,  to not wait for weeks or months (or even longer) for that fresh “eye.”    If I am honest, there have been items I have placed  in the pending pile which have now lain dormant for years.  Now I am faced with the decision to work on those items or just admit that I have no intention of  doing them.

It occurs to me that my habit of having an enormous pending file or folder or list is akin to the practice of hoarding.  Instead of or in addition to  hoarding things, I hoard projects or ideas.  Pretty soon the list or the folder is so overwhelming that it is a major project to just review them and  make  an honest decision about what I am going to do – work on them or discard them.   Of course,  this new task of reviewing and making decisions about tasks has become a new task and one that is more than worthy of going into the pending folder. One could be forced to lie down exhausted from just thinking about the weight of this folder. It really is too much for this life journey!                                                                           

If I am even more honest,  I will admit that I allow this same habit to dominate other parts of my life.   Several years ago, I knew that eventually I would make the move of downsizing from a three-story Victorian house to a two-bedroom condo.  I knew that it was not practical to take thousands of books with me. Most of these books I had actually read at one time. Some I “intended” to read or study again. In fact some of these very same books have been on my list to reread or study since graduating from college in 1968.  Some may have been on the shelf even longer.    Among those were books written in other languages and dictionaries in other languages   I was determined to live with my delusional thought that I was one day  going to be able to read and write in Greek, Hebrew, German and Italian.  Now, the fact that I was never proficient (I did get passing grades) in any of these languages and the fact that I have not picked up most of these for well over 40 years did not deter me from telling myself and others that, “Trust me. One of these days I will get around to doing what I need to do to be proficient in these languages.”  That was the same part of me which told myself that I would one day be as focused as my deceased friend, Jim Nichols.   For years, Jim Nichols and I exchanged weekly, multi-page letters for.    Jim often shared his latest project such as “I have decided to reread all of Shakespeare’s works. If you also do so we could discuss what our current experience is in reading these works.”  I would tell Jim that I thought that was a splendid idea.  That idea went into my pending or “someday” folder.   Jim actually set up a schedule and reread all of Shakespeare’s works.    I am sure Jim knew that I would never get around to do this but, just in case, I should keep all of Shakespeare’s works in my home library.   Of course, I also knew by this time that I could cheaply or for free download audio versions of most books to my iPad.  I did not need them in my library “just in case”.  

When I downsized over a period of several years before moving to my current two-bedroom condo, I did get rid of many of my books. I even got rid of some of my artwork.  There are many other things I did not get rid of including all the writing projects which I have started and put into the pending files. These are all collecting dust in my now very small home office. I am sure that for each one the muse is going to visit tomorrow or  at least by the weekend.

As I have been writing I have been acutely aware that, once again, the subject is honesty with myself. I have previously written about honesty.  I am reminded that the first step in letting  go of my “waiting for Godot” habit is to be honest with myself about a whole host of things and projects.    Either I am going to make a schedule and work on these projects or I am not.   If I am honest, many of them I am not going to ever work on. 

As I age, I am also acutely aware that anything that I do not attend to now, my son is going to have to sort through when I die or when I get too disabled to do them for myself.   He will either tediously go through all my “things and folders” or he will just toss them  Leaving all this for him to do does not seem fair or kind.

It may be true that suddenly a “window of opportunity” will open and I will get excited about some writing project I started years ago or a new blog will appear in my head already written or I will suddenly feel capable of sorting through and getting rid of everything I have not used in the past year    Alternatively, I might decide to practice being honest and be realistic with myself and set aside time to make decisions and take action on areas of my home including my office and those remaining bookshelves. 

Perhaps Godot will suddenly visit or perhaps ……

Judging the Judgmental

 I have long known that I am somewhat anxious when I hear someone judging another person or group.  Some years ago, I figured out what now seems to be obvious.  I am fearful that others will know that I am far from perfect and will find some reason to judge me.  Yet,   I have long placed myself in the position of publicly stating opinions on controversial topics and, thus, opening myself to the criticism of others.  There is very little that folks do not know about me or cannot find out about me.  My mistakes are often very public and well within the knowledge of the average person.  

 I suppose that I could “brag” that I have never killed anyone by driving drunk or losing my temper. In fact, I have never hit anyone. Yet, I have often done things which were directly or indirectly hurtful to others.  I recall in the midst of my divorce losing contact with some people who had been very important to me and then feeling too ashamed to try to reconnect with them later.   Although I was still very young, I knew better. Another time I raised a tiny bit of money for a worthwhile cause, held on to it until it was a larger amount and eventually spent it. I think it was all of $16.00.   I could go on and on about these lapses in judgments or getting so self-centered that I ignored the needs of others. I could also create a long list of the times that I have been distracted while driving and nearly caused an accident or the time when I felt like hitting someone but managed – just barely – to avoid doing so.

 One of my most “frequent sins” is noticing myself judging the person who I perceive to be judgmental.   How is this possible one might reasonably ask?  If I am aware of how hurtful judging others can be and how close to home this often feels, why would I judge another?  Just yesterday, I got an email which had been sent to several people.  In this email the person was being very critical of a group of people.  I know the person who sent the email, and I often experience him as being negative and critical of others. He does this in a way which I often hear or experience as unkind.  In fact, I have been the recipient of his sharp and judgmental tongue on more than one occasion.   I “know’ that we humans  basically believe that it is not enough to just be our human selves and are always looking for some way to boost our worth. We may do this by trying to convince others that we are stronger (the bully), better than, more spiritual than, smarter than, better looking than, more able to achieve material success than, able to dress better than, or any of the myriad of ways we can try to be enough by being more than something or someone else.   Being right and thus asserting that someone else is wrong is another way that we try to puff out our chest to be enough.    So, I know that this brilliant attorney  has a need to feel good about himself and it comes naturally to him to use his sharp intellect to put others down or to best them in an argument.  The most logical response to his man’s basic need to be loved and respected is to love him.  His style of trying to be enough may be different than mine, but the fact that he tries to prove himself  is not something which is foreign to me.  I know  well what it feels like to feel ignored, not appreciated, ashamed of being poor as a child, not feeling as intellectually smart as, not as tall as, not as smooth talking, or not as adept as sports, small talk or any number of other talents. I have no musical talent and no way of standing out in a crowd.  Yet, I know, at some level, my feelings of not being enough are shared by this other man and by all humans.   Just as I need reassurance that I am enough,  this man I perceive to be judgmental needs to be loved.  If I respond to his style of trying to be enough, it is no different than responding to some other exterior difference or some other costume!   I am being as shallow and narrow minded as the person who I am criticizing.

 A Catholic priest friend of mine recently wrote to me of Pope Francis’ actions, “if we are all in love with Christ and lovers in Christ, what is the harm of a little conversation about the real situations in which we live?  Jesus himself never seemed to mind?” 

 It seems to me that no matter whether I am studying Plato or Jesus or the Buddha or another teacher I admire,  one of the things they all seem to agree on is that spiritual growth takes enormous courage; the courage to face ourselves as we are; the courage to see ourselves in others and others in ourselves.  

 Thus, perhaps I have made a tiny step in my spiritual goal of honesty. I am a long way from going an hour or a day without labeling or judging another. I will, however, continue to lovingly notice when “the pot is calling the kettle black”.   I will open my heart to both myself and the person I was initially seeing as different/less than myself.

 I suspect that, as I know my friend, Dr. Johnen, would recommend,  it would be helpful to laugh a little and not take my own illogical  or contradictory behavior so seriously.  The ability to laugh at ourselves  or with each other might be a good starting point towards a more peaceful world. It certainly would be a good starting point to accepting my own humanness.

As a patient, a psychotherapist and as a clinical supervisor of other health care professionals I have often noted that the language many of us in the health care professions use could  be experienced as critical by patients/clients and, thus, not  conducive to healing.   How we use language and what language we use can result in symptoms which are iatrogenic in origin.  Iatrogenic refers, as many of my readers know, to the illness caused by the treatment. Most frequently it may be used to describes the side affects of medication or other treatment.  

Psychologist, therapists, physicians, nurses and others who  practice the health care profession have, in recent years, often been reminded to be more culturally sensitive.   There is often mention of the fact that a word, phase, or action may not mean the same thing in all cultures. We need to know who the patient/client is culturally which then affects how we approach and treat them.  Yet, often the same material which is attempting to educate the health care professional about cultural sensitivity, uses language which continues to blame the patient/client for their illness or for a treatment plan not working. 

Recently I moved to a different state and, in the process of getting licensed as a mental health professional and certified as a professional addiction counselor have been reviewing material which is designed to help those of us who may have to retake professional exams.

Sadly I have found much of the language to be critical and very disrespectful of clients/patients.

My belief is that despite what motivates a client/patient to walk into the office of a health care professional he/she deserves to have the best possible treatment  we are able to provide or the best possible referral when we, ourselves, are not able to provide that help either because of the lack of a particular skill or because we do not believe that what the client/patient is asking for is  a treatment we can ethically or legally provide. For example, if a person with a drug addiction wants a physician to prescribe a medication which is going to merely temporarily feed their addiction or which the addict can  sell on the street to get the drugs he or she needs to starve off withdrawal, it is not ethical or legal to prescribe that drug. On the other hand, we can all have empathy for the person who believes that his/her only hope of feeling decent is having  a particular drug. Despite what we may tell ourselves, we have all, if we are honest, wanted or believed that we needed something that may not have been healthy for us long term.  Addictions comes in many forms – power, drugs (including alcohol) the corner office,  a new car, larger muscles, food, cigarettes, a date with a certain person, sex, parenthood, or whatever.    Not all addictions are, as we know, as immediately dangerous or illegal.

Yet, in order to avoid being honest with ourselves or in order to convince ourselves that we are not like “those people” we will distance ourselves from some of our patients/clients. 

Language is a big help in distancing us from the pain that we often see and which often mirrors some pain in our internal file drawer.  I was just looking over some counseling exam preparation material this morning.  Some of the words  used to describe patients/clients or their behavior included:

         Non-compliant

         Resistant

         Hostile,

         Oppositional defiant

         Sullen

         Oppositional

         Belligerent

         Irritable

         Inappropriate

What, one might ask, is wrong with these words.  On one level they may be very accurate.   For example, if a physician prescribes a medication and the patient does not take it or if a therapist recommends an addict attend a 12 step meeting and he or she does not attend, one might accurately say that the patient/client was non-compliant. Asking whether or not they were compliant is  not helpful. We want to know why they did not take the medication or attend the meeting.  A prime example of this was in the eighties when the AIDS epidemic was at its height.   Initially the only treatment which was available was AZT which had to be taken every two hours.   A study was done which involved giving AZT to homeless people in a major city.  The patients were non-compliant.  This was accurate.  They did not take the AZR as prescribed. They also did not have watches, a timer, water always available or any the supports which makes it easy to follow such a regimen.  The problem was that the treatment plan was unrealistic.    It was around that time that some health care professionals begin to suggest  that words such as compliant or non-compliant no longer be used.  The terms has been used in such a negative, punishing manner that it was easier to adopt the use of the term adherence. Adherence came to be defined as  whether or not a treatment plan was working. The presupposition was that health care provider and patient/client would together formulate a treatment plan which was considered an educated guess of what might work. If it worked that was great. If it did not work then the health care provider and the patient/client  simply put their heads together and  formulated another plan.  There was no blaming of the patient/client or the health care provider.  

Let us consider another term:  resistant.  The client/patient is resistant to treatment. Surely the patient/client should recognize that we have their best interest in mind, that we are  the expert and if they truly want to get well  they will agree and follow our plan.  If they do not they clearly are not motivated to get well and we may tell them to come back when they are ready.  This is one version of the truth. Another version may be that we have not found a way to instill a sense of trust or hope in the patient/client; a belief that doing what we suggest is going to make any difference.  A good example of this is that I just recommended to a client  who is a recovering addict and who recently relapsed, that he should get a sponsor. He may not be convinced that he needs the help of another person or he may believe that no matter what he does he is going to continue to relapse or he may believe that he can occasionally use and not do anything destructive to himself or anyone else or…… The bottom line is that I think it could help him and I want to see him successful in his recovery. I think it is dangerous, given his addictive history, to try for the 50th or 60th time to  try to do recovery on his own, but the client is not convinced and it is his decision.  It is also true that, for some reason, he continues to communicate with me and to ask for advice.  I will certainly give him my best advice and will work with him to formulate a plan which works for him. I will not tell him or put in the chart that he is resistant; that he is a bad or unmotivated client who does not want to get well.

Although there may be some drawbacks to my approach, except in rare instances when the patient/client is so out of touch with reality that they are not able to view their illness from a distance yet, I share my initial several page assessment and my clinical notes with clients.  If working with a treatment team, I also share them with the treatment team members. Thus, I am very aware that whatever language I use will be read by the client or other treatment team members.  My goal is to be as accurate as possible, but also to write in a way which shares the responsibility for the success or non-success of a treatment approach.  I am not going to use language which is non-complimentary to a client. At the same time I am going to be as honest as possible.

A good example was a high school teacher I was seeing. She was teaching in a very small community where she frequently saw her students outside of the school setting.   When she came to my office she was usually dressed for school in a very short skirt, a very form fitting top and high heels.   Ironically one of the reasons she was coming to see me was because she felt that men treated her as a sexual object.  Her dress was, I thought, very provocatively sexual.   I  talked to my female colleagues about  how to address the issues with her. I finally said to her that she was so traditionally attractive that, unless she dressed down a bit , high school  boys and men she might associate with would only see  her as a sexual object. I further explained to her that we men could be very sexist and shallow when it came to our relationships with women; that many of us learned to view women first as sexual objects.   What I told her was honest and not critical. Now, my initial thought might have been: “Goodness, look at the way you dress.” But saying that would have been heard as critical and would made her feel worse about herself.  

In recent years a lot of  health care professionals have been exposed to an approach which is being called motivational interviewing. In my mind this is another way of stressing that we need to treat the client with love and respect.  One way of doing that is to keep putting ourselves in the shoes of the client/patient and to remind ourselves that  we will also  be a client/patient and we want to treated with love and respect.

No matter how careful we are we may use a term or a word which is particularly hurtful to a client/patient.   We need, I think, to be appreciative of that fact and to be quick to apologize.    I once used the word big to refer to a client’s big heart. This was intended as a compliment. She was a significantly sized woman who was very shameful about her size/weight.  All she heard was the word “big” which was very insulting.    She was very hurt and never returned to therapy despite my apology and my attempt to explain that I had used the word big to refer to her heart.

In the end it does not matter what we intend. It matters what the other person hears.    The client/patient may already be thinking of themselves as the sick person and the health care person as the well person.  When we begin to label them, they are in danger of hearing that they are the labels rather than a sacred person who is presenting with certain symptoms or issues for which they are seeking help. Even words such as depressed can have a very negative connotation.  If a person “hears” that they are a depressed person, they are not necessarily going to feel like this strong, good person  who, through no fault of their own, is having symptoms which we label as depression.

I do not think that any health care professional enters the field because they think that they want to just make money. I do think that we have designed a health care system in which there is a lot of pressure for the health care professional to perform: to “cure” people quickly, and always be concerned about lawsuits. This is an enormous amount of pressure. Many doctors and therapists I know who entered the field because they genuinely care about people end up feeling as it they are expected to perform like a machine and do not have time to connect with their patient/clients as individuals.  I think we need to be very intentional about treating each other with as much respect and love as we want to treat patient/clients.    I have often been in the position of teaching or clinically supervising other health care professionals. I have to remind myself to be as patient with my colleagues as I am recommending that we are with our patients/clients.   The same applies to myself. I may find it easy to be patient with a client, but very difficult to be patient with myself.

Perhaps it is important to remind ourselves that life is very short and, if not careful, we get so focused on a goal that we forget to be present to ourselves and others; we forget that healing is not about living forever, but about living  with as much quality as we can.  We may need to remind ourselves that in the original Greek the term physician meant healer.  If we were lucky enough to have a parent who kissed our new hurt  and held us in their lap, we know what healing feels like. They did not make the injury go away but we felt much better.  Perhaps that is a laudable goal for we health care professionals; to do not harm and to do all we can to enhance the quality of life for the client/patient and for ourselves when we are seeing them.  They may not always satisfy our employer or the health insurance company but we and our patients will feel much better.