Then, it happened again. Another client says to me after several weeks of appointments and lots of emotional work, that the most powerful part of counseling was the decision to come and keep coming back.  Then a few weeks later, again, I hear the sentiment in an initial session with a new client. "Just by coming here today, I feel a relief." In these statements, I hear that to have sought out help, made the call or sent the email, set up the appointment, and stepped foot in the door...these actions alone make a difference. 

I like metaphors. They are helpful in giving us new perspectives on old material. So for instance, we may have an idea of what counseling is about. We may have an idea that it's for people who are broken. Or that it's for people in crisis. Or that it's for people who are severely mentally ill. Or that it's an absolute last resort when nothing else works. These associations are powerful. That's our old material at work.

But what if we create new material here? What if we think about counseling as a sunrise, a dawning of a new day? Let's imagine the last time we couldn't sleep at night...how frustrating it is not getting the sleep we want, worrying about what will happen the next day if we don't sleep. Then we imagine ourselves putting our insomnia to work for us. Maybe we walk to the kitchen and make a cup of tea and sit with ourselves and reflect. Maybe we take a hot bath to calm our nerves. Maybe we massage our hands or temples to create ease. All of these steps are actions that make a difference in our insomnia. We greet a new morning, perhaps not with a great night's sleep, but with a sense that we cared for ourselves through the process.

Likewise, the steps toward seeking out counseling are actions of self-care. They are messages to ourselves that we are worth it, that a new day can dawn, and that we can connect to another human being even in the midst of pain. Pain has a purpose in this way. It can bring us closer to others, to what we seek, and to our true nature. 

Carl Rogers believed, and research has shown, that the power of the therapeutic relationship is what creates change through counseling. The connection to another human being is the substance of change and hope. The permission one grants themselves in arranging the words of their story and sharing them with another person with the intent to make change...this is the mechanism by which counseling works. This is the way that new perspectives, new beginnings, and new sunrises are born.

So my responsibility as a counselor is to continually invite these moments to occur in the lives of others. And to meet each person and each story with unconditional positive regard, empathy, and honesty. The dawning of a new day is a brilliant display to witness.

There are so many experiences of work that are negative, and many that are positive. Sometimes we are so caught up in the tasks at hand, we don't notice how we feel about them at all. Here's a chance to step back away from the work you do and see it more clearly.

First, consider what is work? (As a quick aside, did you know the counseling field developed from the work of career counselors in the early 20th century? Because of this, all of us who get an advanced degree in counseling must take an entire course on Career Counseling. In this course, we are asked to define work. It turns out to be a worthwhile question!) So work is... the hours of the day in which you are at your place of employment. Right? Or when you work at home? Like reading emails after hours? Or working in a home office? Or worrying about your day at the office tomorrow while you're trying to relax at home? Is that work? What about stay at home moms or caregivers for older family members? They aren't paid but they are working, aren't they? They do all their work at home, but it's still work right? What about doing chores on the weekends when you're "off" work. Don't chores still feel like work? What about volunteering? You're not getting paid, but it's still work, yes? Wow, ok, maybe it's not that easy to define work. 

After much reflection in Career Counseling 101, I came up with this conclusion...Work is any way in which we use our energy to accomplish a goal that will benefit both ourselves and others. Work is getting out of bed, making a meal, taking care of your children or your pets, doing your chores, going to your job, doing the tasks of your job, paying your bills, working out (notice how we use the word "work" here but for most of us, it isn't a job!) What do you think? The point is that sometimes our thinking about work is misleading, like it's a certain set of places or activities that are discretely different than the rest of life, when actually, it is in many ways inseparable. 

It may help to identify some of the elements of satisfaction or dissatisfaction at work. 

Then mark them on a scale like pictured here. Make a bunch of these lines and put a tally mark there on the line for each of the different elements we identified. You may be highly satisfied with some aspects of work and dissatisfied with others. Some of these elements may be more important than others, so take that into consideration, then you can rate your overall satisfaction with your work based on the elements that are most important to you. 

In order from most restrictive to least:

1.      Medically Managed Inpatient

• Supervised detoxification and stabilization under the care of 24/7 medical staff
  
• Provides safety when detoxing from substances like alcohol, benzodiazepines, opioids
• Helpful when clients have complicated medical conditions and co-occurring substance abuse and mental health conditions

2.       Inpatient or Residential (IP)

• May or may not include 24/7 medical care
• Involves a stay at the facility or hospital while receiving treatment.
• Can last from overnight, a few days, weeks, or in rare cases a month or more.
• Usually receive medical care, individual counseling, group counseling, family counseling, recreation, all meals
  

3.       Partial Hospitalization (PHP)

• Involves spending most all of the day at the facility or hospital, but evenings and nights are spent at home
• Usually receive medical care, individual counseling, group counseling, family counseling, some meals
• Removes you from your everyday environment without the added cost and time of spending nights
• Must have a stable and healthy home environment
  

4.       Intensive Outpatient (IOP)

• Involves 3-6 hours per day at the facility or hospital
• Involves group, family, and individual counseling, might share a meal
• Appropriate for those who need a high level of care to support a change in everyday living but need to maintain their work or school schedule
• Must have a stable and healthy home environment
  

5.       Outpatient (this is what Flourish provides)

• Weekly counseling sessions for family, individual, or group
• May or may not involve collaboration with physicians for medication management
• Focus may be on abstaining from substance use or problematic behaviors, and preventing relapse 
• Focus may be on “harm reduction”, or decreasing the amount or frequency of substance used
  

6.       Prevention and Early Intervention

• Information is provided to the general public about mental health and substance abuse
• May be used with  individuals experiencing life stress that may lead to substance abuse or mental health diagnosis

Health care professionals can help you make the best decision for what level of care is most appropriate. The first step is reaching out and letting us know what you're going through. We are here to help.

I've recently been thinking a lot about how positive change occurs and what it takes to reach goals. How is it we shape the life we want to live? I watched the movie Brave last night with my kids and Merida teaches about the importance of knowing ourselves well enough to choose our own paths in life, while still respecting tradition and societal norms around us. It's easy to fall into patterns based on others' expectations or behaviors. For instance... to choose a college because that's where your parents or friends want you to go, or to choose a profession because of the financial reward rather than a true passion. Similarly, we fall into habitual coping patterns based on what we see around us, including the way our parents or significant others cope with things. If our parents screamed and fought, we may find ourselves doing the same thing as adults, even if we don't want to. If our friends use alcohol and drugs to numb life's challenges, we may fall into the same behavior, even though we know the danger. 


So once these negative coping mechanisms are in place, and lead to more suffering, how does change occur? First, we learn to practice self-compassion.

Recognizing when change needs to occur, in order to live our very best life, is a multi-stage process. This awareness itself can be hard to come by. We often adamantly defend our negative ways of coping, or our lack of movement toward long-term goals, with statements like:

"This is the only way I know how to do things..." 
Or
"Even though I'm dissatisfied with my job, I'm comfortable there..."
Or
"Using drugs is the only way to deal with this stress, nothing else works..."
Or
"Everyone else is wrong, they just don't understand me..."

Then, once we get to the awareness that something about us needs to change, we may experience a wave of negative self-talk. There may be guilt and shame about how we've behaved in the past. We may believe our own deficit in character is responsible for our problems, therefore we will always be sub-par, inadequate, and hopelessly flawed.

I encourage every client I see to maintain self-compassion and self-acceptance through the counseling process. Even though change may be ideal, the practice of being kind to ourselves in our current state and as we are today will lead to a more fulfilling and pleasant life.  

Second, it's often tempting to push ourselves too hard. Some pushing is necessary, otherwise we are stuck. But too much pushing is not helpful either. I call this the three P's of the growth process.

We can Push ourselves gently to take sometimes difficult but advantageous steps forward. This is the beneficial nudging that moves us to a new and better place in life. But we sometimes will become more insistent on change and become Pushy  with ourselves. (We all know the feeling of being on the receiving end of "pushy" behavior from someone else. Is it possible to recognize this behavior in ourselves toward ourselves?) Finally, striving toward change in its most brutal form becomes Punishing, actually causing more harm than good. We may demand change at any cost, and be unable to accept the time it takes to create new habits or thought patterns. Negative self-talk increases. We may starve ourselves or binge eat. We may increase use of drugs or alcohol. We may exercise compulsively.

The goal is to maintain balance between desire for change and acceptance of our present state. Do you think that's possible? I'd love to hear comments! As always, go and be, and Flourish.