The last few months have tested the patience, stamina and beliefs of this nation. Stress and uncertainty has evolved through the pandemic and the recent, yet repeated systemic racism that was sparked by the death of a black man at the knee of a white police officer, and a bat in Wuhan China. The closest I can relate this too is the Vietnam War and the civil unrest that happened in the sixties and early seventies. An invisible and virtually unknown disease has changed how we interact and run our day to day lives. But I have learned from others.
And the result:
We have changed how we look at interacting with others. You can no longer hug a friend of shake their hand. You are encouraged to keep the distance and talk through a mask.
Face timing, texting, and other technology has helped, but it does not have the comfort and closeness of touch.
Even though many have holed up with family, many feel alone.
Parents had to reassess how they parent. New rules and new social challenges.
Ideas and preconceived beliefs on what is the way things are, and the reality of the way people are treated have been challenged to a degree that many find uncomfortable.
Anxiety over the unknown. Stress over being confined. Sadness over the losses that many have experienced. Division over how to act or follow expectations of society, and family.
Feeling guilty or unprepared.
Fear of reopening our society is real.
I am considered an essential mental health worker. I don’t feel essential. But this label has allowed me to keep my business going, even though it has been on a virtual platform. I have not had to suffer lost wages. I have not had to worry about paying bills or juggling childcare. However I had to adapt my therapy to help others with the unique circumstances that have come from the lockdown, and the visual of a man dying.
There have been other times in our society where the challenges would overwhelm us. There are and still will be disenfranchised cultures and groups that endure overwhelming fear and anxiety. People will still be affected by this disease for many months to come, especially if there is no vaccine on the horizon. Most will overcome, adapt and survive. But scars on the soul and the psyche do not disappear, only fade.
I have a border collie named Lucky. He insists on getting my full attention. He will whine, push his head under my hand as I lay on the couch, smile at me or use is puppy dog eyes to elicit sympathy. Oh, he gets a lot of attention. But I guess if you were to ask him he would surely say “it’s not enough.” To be honest, he really does not ask for much. Good dog food and occasional human food. A soft bed or couch to lay on. Lots of hugs and petting. And he loves to go out on adventures. How does he pay for this? Well, He does let us know when someone is at the front door. He listens. He gives unconditional love. He models how to be calm and be in harmony with his world. It is so easy for him. As long as a family member is with him, he is happy.
A friend of mine had a health scare about a year ago. He has taken up hiking in the woods with an almost obsessive passion. He had to retire from his business due to his health condition. At first, this was very difficult for him as he felt a loss of purpose in life. Hiking the trails around his home has brought back a sense of accomplishment and vitality to his life. Not to mention it helped him to drop 70 plus pounds. About two months ago he was down in South Carolina. He just took off by himself to try a section to the Appalachian Trail. He texted me a picture when he reached the top of a small mountain. I called him when I received the picture. I heard in his voice something that I had lost. Pure joy and reverence for the beauty that surrounds us if we just go looking for it. Later on, he talked me into training to hike a five-day section of the Appalachian Trail in late summer or early fall. So we meet about once per week to hike together (he kicks my butt right now). On other days I go out alone on the trails that surround my home or are close by. I am blessed in living near two state recreation areas that have a good trail system. Some days, when I can have Lucky off his leash, I take him with me. As with any exercise regimen, the first fifteen to twenty minutes are the most difficult. My mind goes through this ritual of identifying every ache and pain, questioning why I am doing this at my age. And how comfortable cozy my couch is. Once I finish this mind ritual I get into the rhythm of the trail and the harmony of the forest. I have noticed that Lucky does not suffer from the agonies of the mind. He goes right into harmony mode. He will smell every smell, see every tree, hear every bird or squirrel, and of course let all the other animals know he has been there by marking his passing. How does one bladder hold so much pee is beyond me?
I am blessed in living near two state recreation areas that have a good trail system.
Many years ago I saw a book titled Chop Wood, Carry Water. I never read the book but I always remember that title. For me, it tells how to find joy in simple activities. I found this to be true when I scrape paint off of wood. Most find this work tedious. I found it calming. I loved to be outside up on a ladder leaning against the side of my century-old house, scraping the multiple layers of paint off of the old wood. With music playing or just the rustle of leaves dancing to the rhythm of the breeze, the sun peeking through the shadows onto the surface of the wood. I found peace. I found simple joy.
Making an effort to do the simple things in life can bring a sense of harmony and peace when you are feeling overwhelmed or just plain stressed out. It is easy to make excuses to not go outside, meet up with close friends, scrape and paint wood, or go for a walk with your dog. But then you miss out on simple joy, harmony, and the balance of a life well-lived.
When I did my graduate work to become a psychotherapist I was introduced and trained in three theories of treatment.
1. Psychodynamic.
2. Family systems.
3. Cognitive Behavioral.
However, my undergrad major was social work. The basic tenets of social work do not rely on the above psychological beliefs. The beginnings of social work can be traced back to Jane Adams (September 6, 1860 – May 28, 1935) and her work in Chicago with immigrants and families who were impoverished. The basic necessities such as food, clothing, shelter, hygiene were paramount to survival. In 1943, Abraham Maslow wrote the paper, “A Theory of Human Motivation.” In this paper, he proposed that humans have a “Hierarchy of Needs” starting with the basic needs mentioned above. This was further defined in his book, “Motivation and Personality.” Once these needs are met, individuals can go to the next level, which according to Maslow is Safety, then Social, Self Esteem, and Self Actualization. At any point in a person’s life, they may have to descend the hierarchy to reclaim the original needs. For example, the loss of a job puts in jeopardy the ability to obtain basic necessities. This doesn’t mean that an individual regresses in their personal growth, but their priorities change. Another example is when
you lose a close friendship or have to move and lose the community you had developed for your social needs.
William Glasser, MD defines Reality Therapy as, “…A therapeutic approach that focuses on problem-solving and making better choices in order to achieve specific goals. …Reality therapy is focused on the here and now rather than the past.” (https://www.crchealth.com/types-of-therapy/reality-therapy/). Reality Therapy-borrowing from Maslow’s hierarchy-uses problem solving to help the client address the specific blocks that are hindering their ability to resolve the current dilemma they are facing.
In my practice, I blend the different psychological approaches to address the difficulties my clients are facing. Reality therapy techniques are used when an obvious solution is visible or a client is stuck in faulty or fantasy beliefs. An example of the use of reality therapy is in the couple’s work I do. On rare occasions, I will have a partner who is emotionally abusive or controlling their partner. Many times, the may not recognize how they are abusive. Directly addressing the abusive behavior is essential in these cases in order to save the relationship.
There are two basic tenets of Psychotherapy. The first one is the Hippocratic Oath which is summed up in the phrase, “Do no harm.” The second tent is, “Meet the client where they are at.” When a client seeks counseling they are at various stages in their life. From developmental to psychological, to specific circumstances. Understanding and having empathy for a client is paramount to developing a therapeutic “healing” relationship. In the initial stages of therapy, it is usually not effective to be using reality therapy until trust has formed. For some, their ego or sense of self is not stable sufficiently to use problem-solving skills as it may overwhelm them. An example is when someone has recently lost a loved one. Problem-solving is not effective during the initial stages of grief. Developing a safe, nurturing environment during the sessions allows a client to gradually address concreate problems. However, in an urgent or crisis period, the client must change, avoid, or remedy specific dilemmas or their emotional or physical health may be threatened if not injured.
Reality therapy can be as simple as gently pointing out how a person communicates to others may be considered inappropriate. Or, it may be as complex that it needs to be addressed in specific concrete steps laid out in a logical order to achieve the desired outcome.
The most effective way to use the techniques of reality therapy is with compassion, empathy, and timing so that it can be heard and utilized by the client. Unfortunately, there are times when I have had to be blunt with a client because their actions are hurting the physical or emotional wellbeing of others around them. Or their actions are seriously hurting themselves. This is the most difficult time for a client. And once the intervention is completed, a return to empathy and compassion can negate the sharp edge of reality.
Throughout my training, I was told that I must not induce my opinions or emotions into the session. This is sound advice for 95% of all therapeutic issues. However, when I see a client drinking themselves to death, or their hostile actions are hurting those around them, it is my belief that it would be unethical to not confront it with the force directly needed to alter the actions of the client. This is the hardest part of the job. I have seen many a therapist avoid and thus collude with the negative behaviors. An example of this is when a husband berates or belittles their spouse in the session and the therapist sits back without intervening.
In short, reality therapy is a technique that is used when appropriate for the clinical situation. It needs to be delivered if at all possible with caring compassion. Timing is critical. It does not replace the use of other therapeutic modalities but rather blends in with them to enhance the effectiveness of the client’s work.
