Saturday, July 1, 2017

What's wrong with America's drug enforcement policies?

 From the Pacific Standard, , March/April, 2015 

 And for the past century, our policymakers have responded to the challenge of managing public drug use in a manner that is, alas, riddled with contradictions: We have enforced strict bans on some intoxicants (cocaine, ecstasy, marijuana) and allowed the legal sale of other addictive substances (nicotine, alcohol, caffeine). Some legal substances are quite dangerous to public health; some illegal ones appear safe by comparison. Along the way, the United States has spent more than a trillion dollars enforcing anti-drug laws, and has imprisoned millions of people.

For more click here.

Editor's note: 
While health care providers are increasingly held to "evidence based practices" and/or "scientific based practices" unfortunately, politicians, policy makers, and the public are not held to the same standards. Is it time that they were?

Autism myths - "I saw it on the internets."

Mindfulness meditation practices help with insomnia

From Science Daily on 02/16/15:

Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance in a clinical trial comparing meditation to a more structured program focusing on changing poor sleep habits and establishing a bedtime routine, according to an article published online by JAMA Internal Medicine.

In a related commentary, Adam P. Spira, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, writes: "As the authors explain, effective nonpharmacological interventions that are both 'scalable' and 'community accessible' are needed to improve disturbed sleep and prevent clinical levels of insomnia. This is imperative given links between insomnia and poor health outcomes, risks of sleep medication use and the limited availability of health care professionals trained in effective nondrug treatments such as behavior therapy and cognitive behavioral therapy for insomnia. This context makes the positive results of this RCT [randomized clinical trial] compelling."

For more information click here.

A Psychological Model of Forgiveness

The Psychology of Forgiveness


As mentioned in the previous introduction to the essay on spiritual forgiveness I work with two models of forgiveness: the spiritual model and the psychological. This psychological is based on a systems conceptualization of restoration of equity, fairness, in a relationship. Restoration of fairness does not necessarily mean reconciliation but it does mean the reparation of the harm that was done and a restoration of “right relationship.”

These two models can, of course be used together as there is much overlap although spiritual forgiveness can be done I believe without psychological forgiveness although psychological forgiveness may make spiritual forgiveness easier.

In psychology there is the idea that forgiveness should be done for the benefit of the forgiver not necessarily for the benefit of the forgiven. Research shows that harboring grudges, resentments, bitterness is bad for one’s physical and emotional health. To forgive, to let go, frees one physically, mentally, and emotionally from the servitude of nursing past injustices, and liberates one to move ahead freely into the future.

At a spiritual level also, masters such as Jesus taught us that to forgive is divine. To rise above injustices on the earth plane allows one to focus on the big picture, the transcendent, and to realize that injustices are petty and insignificant in the long run. “It all comes out in the wash” as they say. As Richard Carlson says, “Don’t sweat the small stuff, and it’s all small stuff.” To rise above injustices is to see them in context. To understand the context, the circumstances and false thinking that lead to the transgression in the first place contributes to an awareness that helps us make sense of the injustice so that we can take it less personally. So often it’s not that people are unwilling of doing the right thing, of treating us better, they are incapable; they are just incompetent. There is a difference between being unwilling and being incapable given who the person is, how he/she is wired, where they are coming from. Most injustice, requiring forgiveness, is born out of a lack of awareness, and being stuck in the person’s egotistic thoughts, desires, and motives, they do stupid things. Stupidity does not require punishment as much as education, enlightenment. And so forgiveness, as an interpersonal skill and strategy for spiritual growth, requires four steps.

The first step of forgiveness requires that the forgiver has the right and opportunity to have his/her say about what he/she believes the injustice is. Everybody deserves his/her day in court, for the record if not in person. Even after the offender has died, the forgiver still deserves the opportunity to have his/her say about what the injustice is. If the offender is sincere about reconciling, the offender needs to give the forgiver a hearing, to allow the forgiver to name the injustice and how it has affected him/her. So often the offender doesn’t want to hear how the forgiver thinks and feels about the situation, of what the forgiver perceives as unfair and unjust. The offender might say, “Get out of here! I’m not listening to your nonsense!” Having a hearing, getting your day in court, for the record if not in person, is the first step in the forgiveness process.

The second step is getting an explanation. The forgiver has a right to hear what the circumstances were that contributed to the injustice occurring. This takes time. It takes digging which may take some time to understand, in any comprehensiveness, what the myriad of factors were that contributed to the injustice occurring. The explanation is not a justification, or a rationalization, an excuse, or cop-out. The explanation is an honest, and sincere attempt to examine the unfair situation, to understand how it occurred so that it never happens again, and that something of value can be learned from a hurtful situation. Hopefully, we “live and learn” as they say. If we don’t learn from mistakes and injustices we are doomed to repeat them.

The third step is a genuine apology. There is a difference between a band-aid apology and a sincere apology. A band-aid apology is placating to get the offender off the hook, but a sincere apology follows from the first two steps: having heard what the injustice is and what how the victim thinks and feels about it, and to have examined the circumstances that contributed to the offense, the offender can say, genuinely, “I’m sorry. I had no idea the extent of the harm of my actions.” Most victims want an apology. An apology sometimes, but not always, brings about a healing, a restoration of a sense of equity which leads to a sense of peace.

The fourth step is the making of amends. If the offender is genuinely sorry and has apologized, there is a natural desire to want to make amends, to repair the harm. This making of amends, in many situations has to be very creative, because the injustice is water under the bridge, nothing can be done to put things back to where they were before the offense, and yet there is a need to redeem oneself by repairing the harm. How the harm is repaired needs to be negotiated by both the forgiver and the forgiven. In the instance where the offender is dead or unwilling, Life has a way of making amends to the victim. If he/she can acknowledge that blessings have repaired the harm, the victim can move forward feeling whole.

These steps can take minutes, hours, days, weeks, years, and even decades. We cannot live in our imperfect world and not be victimized, not to feel the sting of injustice and unfairness. Injustice is natural. It is an everyday human experience. Injustice will continue as long as humans are unenlightened and unaware, and yet injustice is not the problem; how we handle the injustice can  be the problem as we either benefit or further compound the problem. Having our say, our day in court, understanding the circumstances that contributed to the injustice, obtaining a genuine apology, and the making of amends is a four step model for bringing about a greater sense of equity, justice, and compassion in our human relations and in the whole world.

The mature soul knows what really matters in life and how to act accordingly. This knowing and  positive acting comes from experience reflected upon and learned from. Forgiveness is one of the most important spiritual activities which we can engage in. It is very good for our soul.

Questions for consideration and discussion
1.      What do you think of the four steps outlined? Can you give an example of a situation where you might have worked through the four steps or got stuck?
2.      What is the difference between a “genuine” apology and a “band-aid” apology?
3.      Have you ever had to get creative in making amends because the harm is long gone, or water under the bridge, and what had been done couldn’t be undone so some other way of compensating the victim and/or repairing the harm had to be creatively implemented?

Spiritual forgiveness

Spiritual forgiveness

    It is very common in couple counseling to hear the complaint “She doesn’t love me anymore. I know that she could if only she would, but she won’t because she is holding out on me. I’ve tried to get her to change and I have grown more frustrated and discouraged. I’ve talked to this one and that one. Their advice hasn’t helped. People are growing tired of me complaining and have told me to go for counseling.  I’m not crazy, but I don’t know what else to do. What should I do? Can you help me?”

            When the other person gets a turn, the other person says the same thing. They both have the misguided notion that the other has the power to make them happy. An objective outsider, observing this dance of mutual recrimination, recognizes that neither one of them can make the other happy. They can’t make themselves happy, let alone take the responsibility for someone else’s happiness.

            If one were aware, they would understand that they don’t have the power to make other people happy nor do other people have the power to make them happy. We, each, have the responsibility for our own happiness. To project this responsibility on anyone else is to give our power away and to deceive ourselves, barking up the wrong tree as they say, preventing us from  coming to an accurate understanding of how to achieve true happiness.

            It says in the introduction to A Course In Miracles “The Course does not aim at teaching the meaning of Love, for that is beyond what can be taught. It does aim, however, at removing the blocks to the awareness of Love’s presence, which is our natural inheritance. The opposite of love is fear, but what is all-encompassing can have no opposite. The course can therefore be summed up very simply in this way: Nothing real can be threatened. Nothing unreal exists. Herein lies the peace of God.”

            The course is not talking about romantic love, or brotherly love, or altruistic love, or parental love, or aesthetic love, it is referring to something much larger, more fundamental, some might say transcendental. The course is referring to Divine Love, Grace, being one with everything. What did the monk say to the hot dog vendor? Make me one with everything. The monk handed the hot dog vendor $5.00 for the $2.00 hot dog and when the hot dog vendor failed to give him his change, the monk complained, “Where is my change?” The hot dog vendor said, “You, monk, should know more than anyone that change comes from within.”

            On the earth plane we suffer under the illusion that “special relationships” will make us happy. “Special relationships” are romantic relationships, parent/child relationships, best friends. As we develop these relationships we expect them to be permanent and we project all kinds of expectations and requirements onto them, that if met and fulfilled, we believe, will make us happy. When our expectations and requirements are not met we complain of betrayal, disappointment, frustration, discouragement that leads to resentments, recriminations, grievances, that can becomes so severe that they culminate, in the extreme,  in homicide and suicide. The suffering experienced because of unfilled expectations at a spiritual level is totally unnecessary and can be absolved if we can forgive ourselves and our loved ones for sins and dysfunction which, at a spiritual level, never existed anywhere but in our own insane minds.

            As the Rolling Stones sang several decades ago, “I don’t get no satisfaction” and “You don’t always get what you want.” Rarely would we admit that our pain and suffering is self generated by our own conditions which we put on our efforts to love another. We don’t say it, but we think it. “I’ll love you if…….” This, of course, is conditional love. We pay lip service to unconditional love but it is rare in our own behavioral repertoire, and few people are mature enough to actually practice it, if we are honest enough to admit it.

            When our conditions, meaning our expectations and requirements, are not met we first become afraid that we won’t get what we want, and then we become angry and frustrated, and then we become discouraged and depressed. In psychotherapy we say “You can either be mad or be sad.” It usually hurts a little less if we are angry, and when we deal with our fear of loss with anger we look for someone or something to attack with blame, accusations, and sometimes mental, emotional, and physical abuse. When we act out our feelings of anger and sadness we often think of ourselves as a victim while we also are being a perpetrator.

            Often times in counseling when our conversation turns to the observation that the client is powerless to get their partner to love them the way they want to be loved I will ask, “Do you think your partner is unwilling or incapable of loving you the way you want to be loved?” Often times, the question is met with confusion and puzzlement, and rarely can the client clearly and immediately answer. This view of the relationship and situation has never been raised before, and the client may ask, “What do you mean?”

            I will say, “Well considering the person’s personality traits, the way they are neurologically wired, the way they were raised with certain values, beliefs, opinions, and practices, do you think the person is capable of loving you the way you want to be loved? Maybe they are just incompetent. It’s not that they are unwilling, and holding out on you, but they can’t.” It is frustrating to expect and require things from people that they are incapable of. While somewhat degrading I will ask them if they ever heard the joke about the farmer who tried to teach his pig to sing? When they say “no”, I say, “Frustrated the hell out of the farmer and annoyed the hell out of the pig.” I quickly will say, “I am not saying that your partner is a pig, but you are acting like a farmer who is trying to teach a person to do something that they are incapable of doing.”

            It is at this moment of awareness that the person is incapable, not unwilling, that we come to the realization that we need to forgive ourselves for having inappropriate expectations for gratification from a “special relationship” that are not going to be met through no fault of the person we are expecting the gratification from. We come to understand that “special relationships” based on expectations and requirements for our satisfaction will eventually make us unhappy.

            One of my best professors in my graduate Master’s In Social Work program used to tell us that we have to “take the client where they’re at, not where we want them to be, or think they should be, or ought to be, we have to take the client where they’re at.” When we can take people where they’re at we can begin to love them unconditionally and we experience peace and love ourselves.

            So often what we call love is really egotistical attempts to decrease our fears of loneliness, isolation, and death. Unconditional love, on the other hand, begins with first loving our self and then extending our sense of well being and gratitude to others for our awareness of Love’s presence in our lives. If we want Love in our life we have to be more loving, loving unconditionally without expecting or requiring anything in return. When we do this we should have fun doing it which adds abundant grace to our lives and great peace.

            Unconditional Love is not of this world. It does not reside on the ego plane. It is something that seems strange and unattainable and yet it is present constantly often outside our awareness blocked by the nonsense and illusions which we create and project onto our lives and relationships. Our egotistical desires, intentions, and thoughts often get in the way and block our awareness of Love’s presence like clouds blocking our sight of the sun. When we see glimmers of the sunlight of Love we become aware of being a part of ever widening and more encompassing systems of being, an interconnectedness with life we hadn’t been aware of so much previously. This growing awareness leads us to enlightenment.

            So often my clients who are frustrated and discouraged say to me, “I just don’t understand!” And I quietly say, “Yes, you do. I think you understand it very well. You just don’t want to accept it. As the Buddhists say, ‘It is what it is’. You need to forgive yourself for your expectations and requirements, and your partner for their failure to meet them. You need to recognize the torture you put yourself and your partner through because of the conditions you project that are not getting met. Forgiveness, in this case, means recognition, acceptance, and rising above the situation.

            Spiritual forgiveness is “rising above” the ego plane and letting the projected illusions go. Drop the conditions projected by your expectations and requirements. As the spiritual masters have counseled in all faith traditions for centuries, let go of your attachments. As they say in Alcoholic Anonymous, “My life is unmanageable. I need to turn my life over to my Higher Power. Let go and let God. You do your best and the universe will do the best.”

            Wayne Dyer, the psychologist, perhaps said it best when he said, “Forgiveness is really just correcting our own misperceptions.” The purpose of other people is not for them to meet our expectations. The purpose of other people is for us to learn how to forgive ourselves our juvenile resentments and to love unconditionally. Humanity will have arrived when everyone loves everyone all the time. The path to this kind of love is forgiveness and the recognition that what I do unto another I do unto myself.

Discussion guide:

 Describe a time when have you been afraid, angry, frustrated, disappointed, sad when someone let you down? How were you able to take care of yourself in spite of the distress?

 Describe a time when you were so upset about a relationship that you thought of killing yourself or someone else. Perhaps, simply, you thought that life was not worth living. How did you manage these feelings and get yourself out of this situation?

What role, if any, has your faith played in your managing the above situations?

 What else has helped you manage these situations?

What has been your experience with forgiveness? What did you learn as a child about forgiveness from your family, church, friends?

If you are a parent what have your taught your children about how to do forgiveness?

Have you ever been in a relationship where the other person has to be right about everything and will never or rarely say they are sorry? What do you think about these kinds of relationships in terms of what causes this dynamic and how it should be handled?

Do you believe in a God that loves you unconditionally or do you believe in a God of judgment who will punish you for what you think are your sins? Where does this belief in a punishing God comes from?

 Do you hope that God or fate punishes some people in your life or in the world for the bad things you think they have done? If yes, who are the people and what have they done that deserves punishment? Do you think they could ever be forgiven?

Who do you need to forgive for what? What will it take for you to do it?

What do you need to forgive yourself for? What will it take for you to do it?

Friday, June 30, 2017

What Kind Of Therapy Is Best For Me?

What kind of therapy is best for me?
By David G. Markham, L.C.S.W.

I have been depressed and unhappy for many years, and have finally wondered whether psychotherapy can help me. I have done some reading and talked to friends and I know that there are psychoanalytically trained therapists and cognitive behavioral therapists, and people who do all kinds of therapy. I found a web site which said there are over 500 different kinds of psychotherapy. I even wonder if hypnosis would help me?  How can I choose what kind of therapy would be best for me?

You have asked an excellent question and one which many people find perplexing. There are many ways I could answer your question. Let's start with the practical approach first.

I think the best way to find a therapist is to ask friends, relatives, your doctor or pastor if they know of a good therapist.  I think the best way to find a therapist is the same way to find any professional, by asking other satisfied clients.

A more conceptual way of answering your question would be to share a little bit about the therapy field. There are many schools of therapy which have their own training programs and credentialing standards. These programs  "certify" the competence of the practitioners in their method. The fact is that competence does not equal effectiveness. In other words, a practitioner can be very competent and heavily credentialed but still not help the client achieve any better outcomes than someone less well trained. This seems to be a puzzle in the field. Often psychotherapy training programs and institutes claim that their credentialing standards exist to protect clients. Interestingly, there is no evidence that any particular model or technique gets better results than others when scientifically evaluated.

When researchers examine the outcome in psychotherapy they find that the variables which contribute to good outcome are as follows: extra-therapeutic factors 40%, relationship factors 30%, hope and expectancy 15%, model and technique of the therapist 15%

Extra-therapeutic factors include things like persistence, openness, faith, optimism, supportive family, membership in a religious community, satisfying work, good friends, enjoyable hobbies, and all the other positive things in a client's life before they enter therapy.

Relationship factors include feeling understood by the therapist, having trust and confidence in the therapeutic relationship, feeling cared about, etc.

Hope and expectancy sometimes has been referred to as the placebo effect, that is, does the client believe that therapy can help? The more the client believes that therapy can help, the more likely it is that it will.

The model and technique of the therapist only accounts for 15% of the outcome, while the other three factors account for 85% of the likelihood of a positive outcome.

So, to answer your question about how to choose a therapist, I think it is important to find a therapist whom you feel understood by, whom you come to feel you can trust and put your confidence in. A couple of visits should be enough to make this determination. If you have met with a therapist two or three times and still don't feel understood by that person, or feel you can trust and put your confidence in that person, it is not that psychotherapy can't help, it is just that you have a bad match and you should save your time and money and try again with someone else.

The outcome research is very clear that psychotherapy does help and that the majority of people who use psychotherapy report improvement in as few as 4 sessions.

The overall length of therapy depends on the client’s goals and purposes. In a crisis, most clients find things improving in 4 to 8 sessions. For other problems and concerns, clients may want to continue in therapy for several months. It usually isn’t necessary to meet with the therapist weekly after the initial phase of therapy (the first 3 or 4 visits) and clients may want to meet with the therapist every other week or every three weeks, or once per month. Sometimes people want to see how things go for a period of time and return on an as needed basis.
Usually within a month or two, most clients find that they are managing things more effectively in their lives, and they are feeling better.

Reference ; The Heroic Client, Barry Duncan and Scott Miller, San Francisco: Jossey-Bass, 2000, pp.56-61

Thursday, June 29, 2017

Approval can be like a drug

Approval can be like a drug.
By David G. Markham, L. C.S.W. _ R.

I went to church yesterday and the priest said in his homily that approval is like a drug.

I started thinking that he's right. Approval makes people high. Some people will do anything for it. I have known people who have cheated, lied, stole, killed, screwed, taken drugs just to make others happy so they can get their approval.

What is it that makes some people crave approval?

Low self esteem? Insecurity? Low self confidence?

Some people need to be loved by others because they don't love themselves, and because they don't love themselves they don't believe that anyone else could really love them either, and because nobody else seems to love them, they don't love themselves. Dog chasing its tail. Vicious circle.

Advertisers know how to play on this lack of love and craving for approval. That's how they sell their products. They tell us that if we wear these clothes, and use this perfume, and drive their car, then other people will approve of us and we will be happy.

My son worked with some guys who robbed the Olive Garden at 2:00 AM when they were closing. Got away with $258.00 to be split three ways for hip hop clothes for the rapper's concert coming up on Saturday night. Got caught. Got three to five in State prison.

I knew these kids' mother. She claims they didn't do it. My son says the guys were bragging about it looking for approval.

Preacher's right. Approval is just like a drug.

Some people will do anything for it. Even ruin their lives.

How to kick the habit?

When you quit, you go through withdrawal. You get depressed. You get anxious. You get paranoid thinking people are saying nasty things about you.

When you start being yourself and saying "No" to people, they start to wonder what's gotten into you. They will say that you are being bad, or that you are crazy, or that you are being disloyal and not wanting to fit in with the group any more.

You start finding new friends and new things to do. You start to realize that you are looking for satisfaction and fulfillment from using your talents and abilities in ways that you enjoy, and that you find following your interests rewarding. If people approve, that's great. If they don't, you still had a good time.

Having a mind of your own feels good. Standing on your own two feet feels solid. Counting for something which is important to you, gives you confidence.

Kick the habit, and be yourself. Take yourself out to dinner and see how you enjoy the company. Wherever you go, that's where you'll be, and you won't need the approval drug.

Remember the bumper sticker that says "If you don't stand for something, you'll fall for anything."