Damage-Proof Your Relationship From A St. Patrick’s Day Drinking Fiasco

happy-st-patrick-s-day-elf-background_23-2147599152.jpg

Another potentially disastrous drinking holiday is upon us. This year, St. Patrick’s Day falls on Saturday, March 17 Oh no. Not a weekend! Doubly scary time to have a knock-down, drag out fight under the influence with your date.

So how do you avoid a drunken shouting match with your guy over green-dyed beer? Keep reading:

  1. Don’t get incredibly drunk. Your brain on booze is dumb. Very dumb.
  2. Do not do shots. Ever. You get dumb even faster.
  3. Do not drink on an empty stomach.
  4. Have a non-alcohol drink in between.
  5. Do not monitor how much he’s drinking and make the big mistake of not monitoring your own.
  6. Do not start discussing a serious infraction you saw (or think you saw). Zip it until both of you are stone-cold sober.
  7. Do not yell at your guy for getting blitzed. He won’t remember. And you’ll be humiliated, screaming at him in public.
  8. Do not initiate any conversations about his behavior, your feelings, other women, etc. until at least the next morning, when everyone is sober and having a nice cuppa joe and a muffin.
  9. Enjoy the festivities and don’t focus on the drinking. You have a chance at remembering the night if you do!  : )

Here are some additional resources to help you have a memorable, fun St. Paddy’s Day.

Awesome website for tools to help moderate drinking:

harmreductiontherapy.org

moderation.org

Book recommendations if you’re ready to dive into this subject:

Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. Patt Denning, PhD and Jeannie Little, LCSW, 2017

Responsible Drinking. Frederick Rotgers, PhD, Marc F. Kern, PhD & Rudy Hoeltzel, 2002

Is Snapchat Dysmorphia Ruining Your Day?

Snapshat Dysphoria.pngSocial media has found another way to make us feel bad about ourselves. It even has a name:Snapchat Dysmorphia.

With Snapchat Dysmorphia, we’re devastated when we look in the mirror and don’t see the face staring back at us that the Instagram and Snapchat filters gave us. What happened to my Angelina Jolie lips and flawless skin? And what about those cellulite free legs and Kate Hudson abs?

What to do? Some are flocking to plastic surgeons, selfie in hand, to go under the knife in hopes of getting that perfection. Ouch! Of course, that’s the worst-case scenario.

Neuropsych research shows that the more time you spend with any given thought, the more you’re building neural pathways that will make that your permanent way of thinking. Basically, you’re building a rut for yourself that you can easily get stuck in.

TAKE IMMEDIATE ACTION TO STOP THIS NEGATIVE THOUGHT LOOP

Here are some easy ways to do it:

  • Move your attention somewhere, anywhere else. AKA “change lanes, brain”
  • Get your mind engaged in what you’re really supposed to be doing right now, probably work — and off Instagram and Snapchat
  • Take 3 really good long breaths. Feel that dopamine, our feel-good neurotransmitter, wash over you with each exhale. Ahhhhh.

Read Huffington Post article

Oxytocin: The Secret Ingredient For Teamwork

Oxytocin - Secret Ingredient For Teamwork - gaylepaul.com.jpg

Oxytocin is a powerful brain chemical that is an important part of many dimensions of our lives. And, surprisingly, it plays a very large role at work, since most work depends on relationships.

With my practice in San Francisco, I have many clients who work in the tech industry, so I hear from the front lines of the drive to re-invent the workplace, on top of everything else.

Some experiments turn out well, others not so much. For example, the flattened hierarchies that startups are famous for can be very invigorating work environments, with a lot fluidity and opportunities to try new things. On the other hand, a lack of clarity about goals and reporting structure can create a very frustrating work environment where everyone is going a hundred miles an hour but somehow going nowhere.

Dr. Paul Zak, who did the research this graphic is based on, uses the Morning Star Company as an example of a company that creates an oxytocin-positive work environment. They are set up so that team members self-organize into groups and coordinate their own communications and activities with fellow colleagues, customers, and suppliers. And they don’t even have job titles. This is discussed in some detail in his recent book: Trust Factor: The Science of Creating High-Performance Companies.

You can find out more about the research by Dr. Zak at the Center for Neuroeconomics Studies by visiting http://www.neuroeconomicstudies.org.

Please share this graphic with your friends and colleagues!

Rewire Your Brain To Reduce Negativity Bias

I was first introduced to Dr. Hanson’s work on neuroplasticity at the 2016 Symposium on Neuroscience in Berkeley, CA. I immediately thought this could be very useful for some of my clients. One of my most stressed-out people actually calmed themselves down by repeating this right before first dates and big work presentations. He’s happily coupled up now–and working for a booming start-up!

Since this technique is so successful, I put this hand-out together to share with other clients. Please take it and share freely.  : )

Rewire Your Brain to Reduce Negativity Bias - gaylepaul.com.jpg

Neuroscience Shows That Couples Fight More When Sitting Side By side

Neuroscience Shows That Couples Fight More When They're Sitting SIde by Side - gaylepaul.comThis striking piece of insight comes from the work of Stan Tatkin, MFT, PsyD, and founder of the Psychobiological Approach to Couples Therapy Institute. Most people are surprised to hear it. It’s the kind of counter-intuitive thing that science does a good job of discovering. You’d never guess your way there, but research protocols can reveal it.

In session, I have my couples face each other in and look into each other’s eyes. Even better, I’ll ask them touch knees or hold hands. Touching floods the body with oxytocin, also known as the “cuddle hormone”. It’s hard to keep fighting, or even start fighting in the first place, when you’re feeling cuddly with your sweetheart.

Touching also anchors you in the present. So instead of your brain not-very-helpfully digging up past experiences and applying them to your present moment, you’re able to actually hear what your partner is saying now. And a conversation experienced in the “now time” is your opportunity to do something different.

So if you’re driving somewhere, riding on public transit, or even just watching TV at home, and you start to feel a conversation go south, remember this discussion could be very different with eye contact or touching involved. You don’t have to go down the rabbit hole and maybe end up saying things you’ll regret later—or hear your partner saying things that are hurtful. This is especially true for subjects that you’re all-too-familiar with.

Take a deep breath and re-route. Come back to the topic later. You might be surprised at how different the outcome can be.

Please share this graphic with your friends!

 

How to Confront Your Mom About an Obsession

Discovery - How Stuff Works - Health.pngThis article originally appeared on Discovery Fit & Health and How Stuff Works: Health in March 2012.

You think your mom is obsessive. Your best friend thinks your mom is obsessive. And even your little brother thinks so. But what’s the best way to talk to her about it?

Let’s start with some facts. The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders defines “obsessiveness” as actions, behaviors or thinking that circle around the same thing repeatedly, even to the point of getting in the way of conducting the regular activities of daily life.

So, if your mom’s daily three-trips-to-the-gym routine means she’s forgetting to pick you up after school, skipping out of work early, missing parent-teacher meetings and never showing up for dinner, you’ve got yourself a mom with a workout obsession.

SET THE STAGE

People usually feel extremely defensive about their obsessive behavior. It can feel like the thing that keeps them together. And moms often feel like it’s the one thing they’ve got for themselves after giving all their time and energy to their families. So, it’s good to proceed thoughtfully. Here’s how:

  • Choose the right time. Don’t blurt out what’s on your mind because you feel frustrated and can’t hold it in anymore. And don’t pounce on your mom at a moment when she’s exhausted or under pressure. Pick a low-stress time to bring it up.
  • Pick the right place. Where you do it can make a lot of difference. You want a calm, restful setting where you both feel comfortable. Try to avoid places with distractions so you won’t be interrupted – and also so you won’t be giving your mom an easy way to avoid having the conversation with you.
  • Start in a low-key way. How you begin the conversation sets the stage for how it will probably go. So start gently and ease in. Don’t ambush her with a string of accusations about how messed up she is with her “stupid” obsession.

WHAT TO SAY SO MOM WILL LISTEN

  • Tell your mom about how her obsession affects you. Explain the impact it has on you and your relationship. If she’s away a lot because of her obsession, you might say, “I miss having you here when I get home from school. I miss telling you about my day.” If she’s diet-obsessed you could tell her, “I miss our family dinners when we would all get together. It’s not as fun as it used to be when we ate as a family.”
  • Ask for what you’d like to have happen instead. Make a clear request. It might be, “Could you meet me at home on Mondays because that’s when I have lots to talk about?”, or, “How would you feel about some ‘you and me’ time when we make dinner after work?”
  • Really listen to her answer to your request. Hear what she’s willing to do. If she veers off onto other topics or gets defensive, gently ask her again about your request. Don’t take on an attacking tone: that will lead to defensiveness.
  • If she’s on board with your request, great. But these talks don’t always turn out perfectly. Focus on what she’s willing to do and start there. Maybe there’s a compromise you can agree on. If she does offer to make some change, don’t forget to tell her that you’re happy she’s willing to try to work with you to make things better.

WHAT NOT TO SAY

  • Don’t tell her she’s wrong, bad or ”blowing it”. That will just make her defensive and effectively end your conversation.
  • The tone you use and the words you choose are very important. The idea is to keep your mom open to what you have to say. It may be a big effort not to get angry or sarcastic, but it’s definitely worth it. Your goal is to get your mom to listen and really hear how her actions are hurting your relationship.
  • Remember that you can take a “time out” if things start to go badly. All you have to do is suggest it. Don’t yell and leave: just state that things are getting off track, “so I’d like to stop now and talk about it another time.”

Remember, you’re not responsible for your mom. You can love her and be concerned about her, but you can’t make her do anything. What you can do is take care of your health and well-being as best you can. Once you’ve let her know what you’re seeing and how it’s affecting you, you’ve done the right thing as a daughter. It can be useful to talk about it. Some conversations with a friend could be very helpful.

©2007 Gayle Paul, M.A.

Gayle wrote this article to accompany her appearance on the “My Mom is Obsessed” series on the Oprah Winfrey Network. Her hometown newspaper was very proud. Here’s their article.  : )

Harm Reduction for Joe Six Pack

Over The Influence

A review of Over the Influence: The Harm Reduction Guide For Managing Drugs and Alcohol

This article originally appeared in The Bridge, Fall 2007.

Harm reduction, one of the alternatives to the disease model of addiction, has slowly been gaining acceptance in the psychological community. Over the last ten years, a number of books have been published that explore the various facets of harm reduction and extend it in new directions. These books have by and large been aimed at addiction professionals.

Now there’s a new book that brings the principles of harm reduction to the general reader. This book, Over the Influence, reflects the coming of age of harm reduction as a therapeutic alternative. It’s focused on what works and how to do it.

Harm reduction is sometimes described by its practitioners as holistic and humane. In Over the Influence, it comes across as realistic and doable. The book coolly walks away from the moralistic overtones that have dominated this field for the last hundred years, providing instead a practical course of action with the conciseness and clarity of a workbook.

Power to the People

Over the Influence is aimed at reaching people who often opt out of therapy. By giving them the tools to explore their relationships with psychoactive substances including evaluating both the benefits and the harm they may have suffered, this book opens a door to those who would normally stay far away from anyone labeled “counselor” or “addict.” The authors accomplish this through the use of conversational language, humor, worksheets that readers can fill in, real-life stories, and information presented in dialogs. For example, the book opens with, “Do you know anyone with diabetes who has ever been refused insulin by his doctor because he wont stop eating ice cream or drinking alcohol?” In another section, the authors make it clear that readers have at least two choices regarding their drug use: “1. Change. 2. Don’t change.” And later, readers are offered such practical advice as an entire chapter on “How To Take Care of Yourself While Still Using.”

The underlying assumptions are clear: People have the power to choose and make large-scale decisions that will affect their lives. With this kind of empathetic approach, Denning, Little, and Glickman are clearly striving to make information available to as wide an audience as possible.

Tested in the Real World

Two of the authors of this book are directors at the Harm Reduction Therapy Center in San Francisco. Patt Denning, PhD and licensed clinical psychologist, has served on the faculty of two schools of psychology and is widely recognized as an expert in drug treatment. Over the Influence is a popularized version of the ideas she first set out in her 2000 academic work, Practicing Harm Reduction Psychotherapy. Jeannie Little, LCSW, is the Executive Director of HRTC and trains other mental health professionals on chemical dependency, dual diagnosis, harm reduction, and group treatment of substance abuse. And Adina Glickman, LCSW, has been guided by the principals of harm reduction since the beginning of her work as a therapist.

This wide array of clinical experience has given these well-established professionals ample opportunity to try out their theories with real people and thus refine their approach.

If you’re considering trying the harm reduction approach with your clients, you may find this book to be a useful information resource to recommend to them. While not something that can be scanned in an afternoon — it’s no comic book — Over The Influence has the information and the street-smarts to reach those who may need it most.

Other Resources on Harm Reduction

Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. G. Alan Marlatt, Ed. Guilford Press, 1998.

Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. Andrew Tatarsky, Ed. Jason Aaronson, 2002.

Motivational Interviewing: Preparing People for Change (2nd ed). William R. Miller and Stephen Rollnick. Guilford Publications, 2000.

Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. Patt Denning, Jeannie Little, Adina Glickman. Guilford Publications, 2000.

Responsible Drinking. A Moderation Management Approach for Problem Drinkers. Fred Rotgers, Marc Kern, Rudy Hoeltzel. New Harbinger. 2002

©2007 Gayle Paul, M.A.

 

He Said, S/he Said: Untangling a Complex Couple Dynamic

Therapist - May 2006.jpgThis article originally appeared in The Therapist, May-June 2006

My new client sat across from me with her hands folded in her lap. Irene, (not her real name) was in her early forties. She fidgeted, her generous body in constant motion as she tugged at her cropped brown hair.

Irene’s Story

Irene had a problem, she said, and the problem was her husband of five years. When they first married, he had been zany and fun-loving, a joyful addition to her life. A few months ago he had lost his job, and instead of looking for more work, he sat passively in their apartment. Irene sent out resumes on his behalf, and called to set job interview appointments for him. Robert (also a pseudonym) didn’t go to any interviews. He didn’t refuse to go; he simply sat and could not be prevailed upon to leave the house, or even move. As I talked to Irene more over several visits, more details came out. Robert would not go out and get coffee with her or meet friends for lunch. Robert would not pay bills, wash dishes, or put gas in the car. And finally: Robert was feeling suicidal.

Robert’s Story

I met with Robert. He was a slightly-built man with delicate features and bright blue eyes. It was clear he was depressed, but I had a hunch there was more to the story. He hinted at secrets. Over the course of several sessions, I tried to draw him out. He started talking about gender bending. At first, he refused to be specific about what this meant. Then, one day, the whole story spilled out.

He told me that since his early twenties, he had occasionally dressed in female clothing and gone out to clubs in San Francisco’s (predominantly gay) Castro District. With his slender figure and small features, he would have been able to pass as female, but passing wasn’t his goal. In fact, he usually made a point of mixing aspects of masculine and feminine attire and presentation, e.g. painted nails, lipstick, and five o’ clock shadow.

He took on symbols of womanhood (women’s jeans always fit me best) to get in touch with and express his own feminine side. He wasn’t sexually attracted to men. In fact, in his younger days, when he had considered getting a sex-change operation, he had always imagined himself as a lesbian-to-be. The primary reason for going to the Castro District was that this was a safe place to experiment.

Robert had been doing this regularly for about fifteen years when he met Irene. Early on in their dating phase, she insisted that he stop all aspects of his gender bending. He was reluctant, but finally agreed because he valued their relationship. However, this loss of a vital part of himself had gradually undermined his joy of life.

Digging Deeper

I saw Irene and Robert both separately and together for several months. Over time, a clearer picture gradually emerged. Among other things, Irene experienced Roberts gender bending as a form of competition with her own femininity. She had often felt uncomfortable and awkward with her identity as a woman, and she felt that Robert was a competitor in this area. Indeed, she sometimes felt that he was a better woman than she was. A large portion of her ultimatum to Robert early in their relationship had to do with this perceived competition.

Irene also felt unappreciated for all the work she had done to maintain their household and their relationship. With his depression taking him out of the picture as a partner, she had to pick up the slack. Robert felt nagged and thus found it hard to appreciate her efforts. Since stress increased his desire for transgender behavior, the nagging led to a greater drive for gender bending which he was unable to act on. He was caught in a bind. This made him more passive, and made her more angry, and then more cut off emotionally.

Robert said that he wanted to save save his marriage to Irene. He maintained that he was very attracted to her and also very emotionally attached. Irene, wanted to continue the relationship as well, but not with the wan and lethargic man her husband had become. She wanted the old Robert back.

As I continued to work with this couple, it became clear that Roberts gender-bending was really a non-negotiable issue for him. His identity was primarily built around his feminine side. When he had given this up to get married, he had given up his vitality along with it.

In sum, both partners said they wanted to save the relationship. Was it possible?

Plotting a Course

I set a number of therapeutic goals for Robert and Irene and worked with them in both individual and conjoint therapy over a period of months.

In Irene’s therapy, I worked on helping her:

  • Establish exactly what was hard for her about Roberts transgender behavior
  • Understand what she would need in order for the gender bending to be integrated into the relationship
  • Find a benefit in Roberts transgender activities, including understanding the link between the gender bending and his vitality
  • Become more emotionally available
  • Move away from seeing her femininity as being in competition with Robert’s

In Robert’s therapy, I strove to:

  • Bring into consciousness the benefits he was seeking through gender-bending and find out what it was that he needed
  • Increase his empathy for Irene
  • Encourage him to acknowledge Irene’s feminine side and her efforts to be more emotionally available

Initially, simply providing Robert with a forum to talk about the fact that he felt crippled without his transgender activities. Ultimately, Irene was faced with a clear choice: if she was willing to accept Roberts overt expression of his feminine side, she could regain the energetic and fun-loving husband she once enjoyed so much. After some consideration, Irene said she was willing to give it a try.

Almost Home

As Irene moved away from seeing Roberts gender-bending as a threat to her own womanhood, she was able to become more emotionally available. And that meant she was able to be with him as he really was rather than holding out and waiting for an idealized version of her husband to show up. As the pressure came off him to be normal, Robert bounced back from his depression and again became the person Irene had originally fallen in love with. As he became less passive and more capable of effective action in the world, her anxiety decreased and so did her nagging.

Their satisfaction with their relationship, themselves, and each other continued to build over time as each person relaxed more and more fully into their unique and accepted roles. It was a good outcome. Maybe one day they’ll even paint their toenails together.

©2006 Gayle Paul, M.A.

Doing an End Run Around Resistance: Working with the Adolescent Substance Abuser

Therapist - Dec 2004.gif

This article originally appeared in The Therapist, Nov-Dec 2004.

Many therapists get frustrated when working with teens, especially in the context of substance abuse. Adolescent clients are often forced into therapy by their parents or other authority figures, and often resist buying in. Resistance to treatment, missing appointments, arriving late, and spending therapy sessions talking about peripheral issues are all assumed to be an indicator of poor motivation (Denning, 2000). Attempting to meet the resistance head-on may only make it worse. As a consequence, the therapy can get bogged down, and therapists may experience countertransference. Feelings of I’m failing, I’m being rejected, and Im frustrated are not uncommon. Sometimes, especially with teens, it can be helpful to take another tack.

Miller and Rollnick (1991) define motivation as a flexible state, and suggest a two-phased strategy they call motivational interviewing. The first stage is building the clients motivation to change, followed by strengthening the clients commitment to change. A number of techniques, as outlined by Patt Denning in Practicing Harm Reduction Psychotherapy, can be very effective with teen clients.

  • Express empathy. Let the client you know that you understand his or her wish to deal with the problem, and that you appreciate both the amount of effort required and the difficulty of the situation.
  • Develop discrepancy. Emphasize the client’s expressed awareness of any drawbacks to his or her use of alcohol or drugs.
  • Avoid argumentation. There is no right answer about a person’s drug or alcohol use. You are trying to understand the client’s perspective, not impose some external authority.
  • Roll with resistance. Ambivalence is normal and healthy, and resistance can be a sign of ego strength. Do not put yourself in the position of “boss.” Reflect back the client’s own ambivalence and confusions about his or her drug use.
  • Support self-efficacy. Research consistently shows that a person who feels confident about his or her ability to make a change is much more likely to do so.

Here’s an example of how motivational interviewing can be implemented in a clinical setting.

Meet Ashley

Ashley (not her real name) is an adolescent I worked with recently in an adolescent substance abuse program. I was her individual therapist and she also in family therapy with another staff therapist. When I met her, she was fifteen years old and living with her mother and one older sister. She had been expelled from her high school for possession of marijuana, shoplifting alcohol and attending classes while intoxicated. She had been placed on juvenile probation, and court-ordered into a school-based day treatment program for substance abuse with both group and individual therapy components. Regular urinalysis showed her to be a daily marijuana user.

History

Ashley is the younger of two daughters born to married parents who immigrated to the United States from Beijing while in their early twenties. Her parents were successful entrepreneurs who owned an import/export company. Talented in graphic composition and expression, Ashley excelled in art classes from early on. Painting and stained glass were two of her favorite media. And she maintained an A and B average up though the eighth grade.

In general, Ashley’s father was domineering, while her mother tended to be passive. Her parents fought often and Ashley was exposed to frequent instances of domestic violence. She began escaping via marijuana and other psychoactive substances at age eleven, and her drug and alcohol use escalated as her parent’s marital discord increased. I hypothesized that she chose marijuana for its dissociative effect. That would be particularly useful for a child in a home with strife, arguing and domestic violence.

When Ashley was thirteen, her parents divorced. She continued living with her mother. Her father left the family home and began spending long periods of time overseas on business. Although her mother did not withdraw via alcohol or drugs, she considered the post-divorce era to be my time, and paid minimal attention to her daughter. When she did interact with her, she tended to be very invasive. Ashley’s father moved overseas, and she saw him infrequently. She also had an older sister, not living at home, who was a weekend marijuana and alcohol user. As Ashley’s drug use increased, her school attendance became more and more inconsistent, her grades dropped, and her interest in art diminished.

Cultural aspects: As an Asian-American, Ashley is part of a culture where passivity for girls is commonly valued.

Program Overview

When I began working with Ashley, she was in a 12-step, abstinence-based, day treatment program for teens with substance abuse problems. Participants had to earn points via academic achievement, completing12-step assignments, and therapy participation. Accumulating points enabled them to gradually move up through four levels in order to graduate from the program. Urinalysis tests were performed weekly.

About 50 adolescents entered the program each year. Most stayed on Level 1 for three to four months. The majority didnt get past Level 2, and about a third reached Level 3. On average, two participants reached Level 4 and graduated in any given year.

Therapy: Beginning Phase

For our first few sessions, Ashley had difficulty making eye contact. Instead, she would look through her purse or school notebooks. When setting up therapy appointments, she would come up with many excuses why she couldn’t leave class. I conceptualized her as someone who is frightened of sitting in a room with a stranger. Given her family history, I thought she might be having transference reaction worried that I might invade her, as her mother sometimes did. Instead of scolding her about canceling appointments, I would occasionally make remarks like, “Yes, it’s kind of weird to meet with a stranger and talk about yourself, isn’t it?” She would nod and look relieved. (Expressing empathy.)

In response, I thought of slow ways to move towards her. I saw her behavior as an outgrowth of her need to set boundaries with me, so I respected her implied rules. For example, I didn’t tell her to put her purse away or insist that she interact with me during the first few sessions. I also noticed that Ashley seemed threatened if I sat across from her and looked at her. She would be more fidgety, distracted, and anxious, and would be even more reluctant to meet again. I rearranged the furniture so we could sit side-by-side, not looking at each other. Her level of anxiety appeared to diminish significantly. (Rolling with resistance.)

After two months of non-invasive therapy, Ashley looked at me closely one day in a session and remarked on the fact that I wore contact lenses. I concluded that she was able to tolerate being present with another person, and felt comfortable enough to engage and observe.

Therapy: Middle Phase

For the next few months, Ashley talked about her experience in the program. She was not a behavioral problem, not relapsing or acting out in classroom, but she made C’s on her school work, participated minimally in groups, and was not moving up the levels. A typical comment: “I could do more school work but I don’t feel like it. I don’t feel comfortable talking in groups because I don’t know what to say. I’d like to be able to go off-campus for lunch and but they won’t let me.” I would respond by reflecting her awareness of the drawbacks of her behavior: “In order to have more privileges, you would need to complete more school assignments and participate more in groups.” (Developing discrepancy.)

Some members of the program staff identified her as “resistant to the program.” After almost six months of low participation, they wanted to expel her. “She’s not buying in. Why is she here?” I defended her by bringing up cultural and psychodynamic issues. For example, in her family of origin, her mother was passive and her father was domineering. A common consequence of assertiveness on her mothers part would be violence from her father. Also, her family was part of a culture in which passivity in females was considered desired and appropriate behavior. Both these factors inclined her to avoid action.

I consciously refrained from presenting her with the possible consequences of the lack of motivation. This enabled her to engage with herself and make her own assessment of her position. I made a point of not invading, but instead listening and presenting names for what was happening. I refrained from judgement and allowed her to embrace the names if they fit. (Avoiding argumentation.) Over time, she began to name her own feelings without feeling confused or guilty about them.

I became a person she could be herself with. Motivated or unmotivated: however she came in, I accepted her. In the therapeutic environment, she learned that she could assert herself without being penalized. As a result, she slowly built her self-confidence and powers of introspection.

Therapy: End Phase

One day, Ashley asked “What do I have to do to graduate from this program?” I reacted with surprise and described what she would need to do to move up the levels. She said: “I could do that.” I agreed. (Supporting self-efficacy.)

Suddenly, it was as though she woke up. Once she decided it was valuable to her to move up and get points, she did not have trouble paying attention and excelling. She became the top point scorer in the school for the next fifteen weeks. And she grew more and more into the identity of a person who set goals and reached them.

Fifteen weeks later, Ashley graduated from the program. She was released from probation, and returned to her mainstream high school. Shell complete her high school degree next year. And she’s planing to go to college to “possibly study art.”

Conclusion

Pushing Ashley did not work. Anything which could be even remotely construed as domineering caused her to withdraw further into her protective immobility. Instead of presenting myself as an authority figure, I acted as a witness and a consultant. Following the techniques outlined above, I showed empathy, mirrored her awareness of the drawbacks of substance abuse, did not present arguments, reflected her ambivalent feelings, and supported her sense of her own efficacy. By letting her take control, and move at her own pace, I was able to coax her out of her static stance and show her that it was safe to act in the world and be a part of it.

©2004 Gayle Paul, M.A.

%d bloggers like this: