Machiavellian Therapy

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I bet you never expected to hear someone say that one of their role models is Machiavelli, a man who has come to represent deceit and lack of scruples, but here you are. I admire him because he was the first proponent of Reality Therapy.

If you look it up, William Glasser gets all the credit for inventing Reality Therapy. He was a psychiatrist who lived five hundred years after Machiavelli. Glasser didn’t believe in reaching into a person’s psychological insides to root around for what was wrong like the Freudians do. He thought problems arise when the person is not getting her needs met. He preferred helping people discover what they really want and showing them how to behave in a way that leads to success.

Nowadays, you don’t hear much about William Glasser or Reality Therapy. You heard it from me because, being a reflective eclectic, I possess a vast storehouse of unfashionable therapeutic methods. Glasser’s ideas have become mainstream, after having mated with others and evolved into present day forms of CBT, ACT, and DBT, which you may heard of, if you traffic in therapeutic methods.

Glasser probably did not realize how Machiavellian his ideas were. Niccolò Machiavelli is not often associated with therapy. We don’t study him in shrink school. His very name conjures up images of bare-knuckled political realism, duplicitous bad faith, and self-centered expediency. There’s even a theory that the Devil is called Old Nick in reference to him. But Machiavelli was a counselor, a counselor to princes.

As a counselor to princes, Machiavelli did what I like to do with my clients. He got them grounded. I don’t mean grounded in the sense of meditate-on-your-breath-till-your-thoughts-stop-racing type grounding; I mean grounded in reality: the basic knowledge of what is. You see, if we don’t pay attention to reality, we’re not going to know how to thrive within it. Continue reading

Telehealth Psychotherapy

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A man I talked to the other day seldom looked me in the eye. His gestures were not in rhythm with the things he was saying. At times, he skipped half the words in a sentence. Once, he disappeared entirely and went on talking as if we were still together. He seemed oblivious to many things I said to him. His face froze. Reactions were delayed. Was this a bizarre psychotic I was talking to? An individual with autism? Someone with something to hide? No, it was just an ordinary day in an extraordinary time of social distancing. It was what’s called a psychotherapy session thanks to the wonders of telehealth technology.

I’ve got to assume I was just as peculiar to him as he was to me. Continue reading →

 

Cook the Negativity

Old Posts

You learn a lot quicker from negative experiences than you do from positive ones. The stick is more damaging than the carrot is enticing. There’s a good reason for that. If you get whacked hard enough by the stick, it won’t matter how many carrots you have. But the result is that you will continuously look for bad news, zero in on the negativity, and lose sight of the big picture. You take for granted all the blessings you have, are ignorant of your resources, and blind to grace.

When people come in for counseling, they can often see all their problems very clearly. They can talk for hours about the terrible things that happened to them, the effect the problems have on them, and why they can’t change. They make the same mistakes over and over again and believe that, if only they could feel badly enough about themselves, they would do differently. They don’t. Heaping guilt upon themselves and reproaching others does nothing other than burden them with guilt and anger, it does nothing to free them. Continue reading

The Therapeutic Milieu

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Some milieux (the plural form of a fancy French word for social settings) are therapeutic, meaning they bring out the best in people; others bring out the worst. If you need an example of those that consistently bring out the worst, think of a maximum-security prison, a busy highway, the cafeteria of a middle school, or the parents’ bleachers at a basketball game. I wish I could give you a list of settings that consistently bring out the best in people, but I can’t. A home, a marriage, a gathering of friends, a workplace, or a church are all places that could be therapeutic, but often aren’t.

If you want to enjoy the therapeutic properties of a well-functioning milieu, you either have to be very lucky to find yourself in one, or you must create it, yourself. Fortunately, I’ve had a hand in creating a therapeutic milieu or two in my day, so I can tell you how it’s done. For many years, I worked in a program where almost two hundred people with serious mental illnesses and intense addictions came to spend the day together, every day. If we could make that kind of gathering therapeutic, then you should have no problem with yours. Pay attention to the following factors. Continue reading

Eleanor Oliphant Might Be Completely Fine But Using Therapists to Resolve Your Plot Isn’t

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Ordinarily, I avoid reading books and watching movies that portray head shrinking because I’m careful to maintain a work/life balance. But I couldn’t ignore Eleanor Oliphant. Too many people recommended the novel as a delightful portrayal of someone with serious troubles.

I soon saw they were right, and so was I. Eleanor is truly delightful, but the book did remind me of work. Over my years as a therapist, I’ve sat with dozens of Eleanors and many of them were delightful, too. By Eleanors, I mean disturbed and painfully lonely young women, awkward around people, scarred by horrifying secrets. The world is full of Eleanors. Continue reading

Evidence-Based Therapy

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In the peculiar land of shrinks, evidence-based therapy is a phrase we use a lot. It’s supposed to refer to therapy that’s backed by scientific evidence. But what they call evidence-based therapy is not evidence-based therapy. It’s a term for a standardized, manualized, commoditized therapy protocol. It’s not necessarily the best therapy for you. Continue reading

A Bad Mood

Photo by Ryan Magsino on Unsplash

A bad mood is when your feelings get stuck in a terrible place and you can’t change them, no matter what. You’ve been in the doldrums for weeks, sad and depressed, even though you have nothing to be sad and depressed about, except for being sad and depressed. How do you shake that feeling and experience the joy you have every right to claim?

Imagine a radio dial with many frequencies along a continuous range. When you tune into one station, you get one genre of music, Country-Western, say. When you tune into another, you get a different kind, the Classical station where they play Bach, Beethoven, and Brahms.

Your moods are like that. When you’re depressed, you’re thinking depressing thoughts, talking about depressing things, watching depressing movies, and counting your losses. The food you eat is plain and filling. The curtains are drawn. You stay in bed and never do anything. You are tuning in to a particular feeling, so that’s all you feel. No wonder you’re depressed. If you weren’t depressed already, everything you’re tuning into would make you depressed.

It looks like it would be easy to change your mood. People tell you to stop thinking depressing thoughts, talking about depressing things, watching depressing movies, and counting your losses. Eat food with flavor, they say. Pull open the drapes. Get out and take a walk. Doing those things is almost impossible because you’re depressed. If you try doing them, or someone makes you do them, it feels forced or you feel nothing at all. Even joy is jarring and uncomfortable. How can you ever get out of this pit? Continue reading

Free Therapy During the COVID-19 Emergency

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Thanks to COVID-19, people with insurance in New York State do not have to pay copays, co-insurance, or deductibles for telehealth sessions for as long as the state of emergency lasts.

That’s one thing to be grateful for.

This is a state mandate. Insurance companies haven’t advertised it, and I haven’t seen it in the news. So, spread the word. Even among us shrinks, there’s been a lot of confusion in the past two weeks. Many of us have been collecting these copays, co-insurance payments, and deductibles because we didn’t know, couldn’t believe it, or were puzzled by the impenetrable prose of bureaucratic pronouncements. But I have it from the horse’s mouth. Free therapy. Read it yourself.

The catch is that it must be a video or phone session with an in-network provider. If you insist on meeting your therapist in person, or if she is still expecting clients to do so, then you still must pay those fees. I guess they’re trying to encourage people to stay home so they don’t spread the virus. That, and to get the help they need before they go stir-crazy in their homes, ready to kill someone over a roll of toilet paper.

You’re out of luck if you have insurance that originates outside New York State because your company’s headquarters is in Chicago, Kansas City, or some other place, unless that state has ordered it, too.

Video counseling is preferred by therapists over the phone variety. But you need a good cellular signal or Wi-Fi connection to see a therapist by video, as well as a private place to talk. That can be hard when you’re all cooped up with other people. I’ve had clients talk to me in their cars or from the bathroom. You can read more about video counseling here.

If you have been particularly anxious these days, or depressed, or if the bonds between you and your loved ones are beginning to fray, don’t let this opportunity pass you by. This is also a perfect time to change bad habits. We therapists can’t do much to change the state of the world, but we can help you with your response to it.

Is it safe to go to counseling during this pandemic?

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I’m sending this letter out to all my clients prior to their appointment.

 

In this age of the coronavirus, you may be wondering if it is safe to keep your counseling appointment. I’ve thought about that, too; and here is what I came up with.

My office does not get a lot of traffic. Compared to a grocery store, a school, a church, a doctor’s office, or a coffee shop, few people go in and out and there’s little physical contact. Moreover, they are generally in good health.

I’m also in good health. I’m experiencing my environmental allergies, but I have no fever, cough, or shortness of breath, the symptoms of coronavirus. I have not knowingly been exposed to anyone with the virus. Nor have I recently been to China, Iran, Italy, Japan, or South Korea. I’ll let you know if any of that changes.

If you don’t have a fever, cough, or shortness of breath; have not been exposed to anyone with the virus; or have not recently been to China, Iran, Italy, Japan, or South Korea; then you are welcome to come. I have no reason to be afraid of you.

In between sessions, I can easily clean the places in my office people touch. If you want, you can see me do it. We don’t have to shake hands.

If your kids are home from school and you have no one to watch them, you can bring them with you, provided they are old enough to stay in the waiting room or young enough not to understand anything if they are with us.

So, come to my office, if you can. But, if you can’t; then keep your appointment anyway by phone. It’s not optimal to have a psychotherapy session by phone, but doing so, permits us to maintain progress you’ve made and address any problems you’ve encountered.

I just got clarification from the insurances I take that phone sessions are fully covered. That didn’t used to be the case. So, contact me if you would like a phone session, beforehand preferably.

I’ve done video sessions in the past; but stopped because there were too many problems and not enough demand. I can begin doing video sessions again and try to solve the problems if there proves to be a need. Let me know if that would be important to you.

So, please, keep your appointments if you can, either by phone or in person, but preferably in person.

If you have any questions about the coronavirus, here’s where I’m getting my information. From the World Health Organization: https://www.who.int/health-topics/coronavirus

Keith

Note: Within one day of posting this announcement, it was already out of date. On Tuesday, March 17, 2020, I stopped seeing clients face-to-face in compliance with the Governor’s recommendation that non-essential businesses close. Counseling is often essential, but it is not essential that I see people in person.

Today, March 18th, I’m just having phone sessions. I’ve signed up with a video provider, but they haven’t set me up, yet. They’re probably swamped. Tomorrow will probably be different.