mental health – Jason Hobbs LCSW, M.Div

“Insight does not equal change”

Part of an occasional series about phrases that this therapist finds himself repeating, often.

This image has an empty alt attribute; its file name is 0_CgS_HZ0uNKxU-877-1-1024x682.jpeg — Photo by Johannes Plenio on Unsplash

As a clinician in private practice, one of the phrases that I frequently hear myself saying is this: “Insight does not equal change.” In therapy, this most often emerges at the beginning of treatment or sometimes when we have reached a plateau. This phrase itself is a sort of “light bulb moment” where we realize that just because we understand something does not mean it will change.

Since much of my time is spent working with children and adolescents this necessarily means working with the parents of children and adolescents. And when working with parents, there is often a pull toward explaining a simple behavior in a complicated way.

And yes, the beginning of the behavior may have its roots in some deep object-relations, Freudian soil, but this insight does not equal change. And change is what is usually desired by the patient and their family.

This image has an empty alt attribute; its file name is 0_7-uX3kLCUe_HUGUv.jpeg — Photo by Janko Ferlič on Unsplash

Let’s try an example: “anger issues”. This is sort of a catch-all label for when a child reacts with anger to some event. Now, a good assessment is important so that we can see whether there is some depression or anxiety present. We should look for dietary changes, assess whether there is the possibility of mood changes related to undiagnosed diabetes, thyroid difficulties, or some other medical issue.

Another common root cause for an “angry” child may be the anger or depression displayed by a parent. And one should certainly assess for some sort of abuse or neglect. Any of these (in addition to some root in the Freudian soil) could be part of what we are seeing when we see “anger”.

But then what do we do? This is where getting stuck on the cause may keep us away from the intervention.

So taking our example again, let’s imagine that once we think through this display of “anger” we see that the child is actually anxious and fearful. Remember that at the bottom of anxiety is the “fight or flight” mechanism. So some of us run from trouble; some of us get angry when we get scared. Just think of all those videos you might have watched of people punching their “friends” who jump out and scare them.

So some of the best interventions for anxiety have to do with either expending or soothing that anxious energy. This may mean getting regular exercise or it may mean reacting calmly and with understanding to your child instead of yelling at them to “STOP BEING ANGRY!!!”

Often intervention means stopping, removing yourself from the situation and taking a good, deep breath.

This image has an empty alt attribute; its file name is 0_sMPj66P6X_dnXoHx.jpeg — Photo by Tim Goedhart on Unsplash

Remember that our bodies and brains are tied together. You are not just teaching your brain some neat, new trick. We have to communicate with our bodies, sometimes as the first step.

But the reason that I point out that “insight does not equal change” in this situation is that these interventions will take small efforts over time. The interventions themselves will build and build; just because you recognize that your child is feeling anxiety underneath that anger does not mean that everything will suddenly be different.

The clouds are not going to part. The light is not shining down. The “Hallelujah Chorus” is not playing. Insight does not equal change. Change happens slowly, over time.

And while yes, a good assessment for the source of a behavior is helpful, there are also times that we simply won’t know where some behavior started. Children (and adults for that matter) do strange things sometimes. It may be worth spending more time on what reinforces a behavior than where the behavior started.

For those of us that call ourselves “adult” now, we think about how some behaviors are reinforced simply because they make us feel better, even for a short period of time. Some of our habits around eating or drinking can fall into this category; even when we may deal with our underlying frustration, sadness, or worry, there is still a habit left to change and steps to take.

This image has an empty alt attribute; its file name is 0_Z4aeTEjJV3gfX_bp.jpeg — Photo by Jeffrey Wegrzyn on Unsplash

Even as the adults, we may have some wonderful insight into the “why” or “source” of a behavior, but changing that behavior is where the work is.

Changing behavior is often slow and a sometimes tedious effort.

Behavior change is step-by-step. And while there may be some big steps along the way, the path is made by many of those short, repetitive efforts.

So yes, spend some time looking at the situation, the context, the behavior itself. Assessment guides intervention. But place your effort on finding ways to facilitate change. Insight is good, but “insight does not equal change”.

Originally published on Medium.com on February 21, 2019

Robins Resilient!

for the town in which I live and work

What we are experiencing is a slow-moving trauma. There is a way in which you see something coming, not exactly knowing what “it” is. But you feel the challenge already. It reminds me of the way that we have weathered hurricanes and tropical storms in the past … glued to our screens, watching the bands of wind and rain move closer and closer.

There are feelings of helplessness and fear … and the advice that we hear is often to prepare, then hold on.

At least for me, I want more than that.

Part of the reason that I think of this through the lens of trauma is my own occupational bent. I work with a lot of people, young and old, who have had upending experiences in their lives. We live in a “base town”. Often these experiences are related to deployment and war, but just as often they could be family trauma, abuse and neglect, or a present difficult reality.

This present reality we are facing involves some of the hallmarks of trauma: the threat of death to you or someone close to you, indirect exposure to violence or death (our healthcare workers), and those feelings of horror and helplessness as the event unfolds.

Most scholars will point to resiliency as the way through trauma, with “resiliency” being a trait that we can nurture in ourselves and those around us.

A resilient person as “a twig with a fresh, green living core. When twisted out of shape, such a twig bends, but it does not break; instead, it springs back and continues growing.”
from Aging Well by George Vaillant

This ability to “spring back”, to have some flexibility in the midst of life’s challenges, this is what we mean by resiliency.

But how do we foster resiliency in ourselves and in our community?

We start with the story that we tell ourselves. In therapy, I often use the analogy of eyeglasses, that the words we tell ourselves, about ourselves, will either bring clarity or distort how we see the world. If the story we tell ourselves over and over is one where we failed, where we were “not enough”, or a story that predicts future failure, then we begin to live out that story.

Now this is not to say that we can tell ourselves that we can fly without being inside an airplane! But it does mean that we should practice taking off those lenses, looking around at what is really in front of us, at all the possible ways of looking at our situation, and make a decision from that place.

As a community, this small farming village of Wellston grew into a thriving base town during World War II and then later during the Korean War. Our story is one of meeting adversity and finding a way to help.

Another aspect of resiliency is having a strong moral compass and the grounding of religious/spiritual support. This makes sense in that when one is being thrown around by the challenges of life, having some center onto which you hold aids you in making sense out of the senseless. Our faith communities help us hold on during the crisis. They also are the types of places where we rethink what happened and find ways in which meaning and purpose emerge.

Not that the number of places of worship is the only measure, but Warner Robins Georgia and the surrounding communities have a large number of faith communities. Finding our way through often means holding on, with others, to what we know to be true.

Standing together with others is also an important aspect of resiliency. It is a myth that any of us do anything on our own. Our military members will remind you over and over again that even the one who stands at the front has been supported by so many others behind them. Without a supportive community of parents, our teachers could not do their jobs. Without a community who cares about our first responders, they would lose their ability to keep us safe.

One aspect of a pandemic is a tendency to “draw in”, to become suspicious of others, perhaps even angry with others. And although “social distancing” requires physical distance, it does not mean that we cannot reach out to each other, support each other, in ways that don’t require us to be physically together.

Practicing flexibility is a key aspect of resilience. The shadow side of having that “strong moral compass” can also be an unwillingness to change or see another way; this is often a reaction based more in fear than faith.

Resilience is about looking honestly at your situation and then considering ways to adapt and change. We work to maintain a flexibility in our thinking and emotions. This often means taking a deep breath and asking yourself the question, “I wonder if there’s another way here?” You give yourself a moment to look around so that you can see all the possible directions.

Fear tends to cause us to think in either/or terms, not both/and.

With parents and children, I often find myself coaching both of them by simply saying, “I wonder if there’s some other way you might have thought of … even if it feels silly at first.” When we share these in a space of curiosity instead of judgment, then we may be surprised at the possibilities that emerge.

Physical and emotional fitness are vital to resiliency.

It has been heartening for me, a runner, to see so many people running, biking, walking, and finding those ways to take care of their physical selves. As a mental health clinician, I know how much research there is about how exercise is important not only for our physical health, but our mental health as well.

And as a clinician, I know that we often neglect our emotional/mental health because it seems to be harder to consider our brain as an organ that we need to protect in the same way that we see a cardiologist for our heart and an endocrinologist for our diabetes! Mental health is about our overall health. And when we aren’t caring for our mental health, our physical health usually follows.

We should also not forget how all of this works together, for ourselves as individuals, but also for our families and our community. Part of the story of this community is coming together to help an effort as a country. There was purpose and meaning in what we were doing. Oftentimes the best actions we can take are small ones that we see as connected to a larger whole.

Our lives are tied together. Our diverse community has a history of uniting in a shared purpose.

That is Robins Resilience and Robins Strong!

“Handle the emotion first, then talk…”

Part of an occasional series about phrases that this therapist finds himself repeating, often.

*Photo by Torsten Dederichs on Unsplash*

As a clinician in private practice, one of the phrases that I hear myself saying sometimes is this: “Handle the emotion first, then talk.” This is another of those multi-purpose phrases, having applications with couples and other relationships, but maybe most clearly with children and adolescents.

For example, your child has hit one of those “HALT” moments. If you are not familiar with this acronym, it refers to

Hungry
Angry
Lonely
Tired.

At that moment, your lovely child is throwing an even lovelier tantrum, the full-on screaming, snorting, throwing, hitting, crying type of tantrum. There is a lot of emotion coming forward, a lot of expression happening … although most of it could look like anger and threat.

Remember that the sympathetic nervous system and their fight/flight system is engaged! They may be feeling scared, but it looks like “fight”. And better than that, at that moment if you ask them “why” they are upset, they will come up with a reason, but that explanation is being filtered through the storm of the emotion.

While either/or explanations are often unhelpful, it can be helpful to think about whether you are dealing with a non-rational emotion or a rational thought.

If you were dealing with a rational thought, then you talk to it. That would be the perfect situation to sit back and think about the natural consequences of a behavior. You could explore other options that you could have taken and how those other options might have worked out.

If you are dealing with a non-rational emotion, talking to it is the absolute wrong way to handle the situation. Emotion most often comes out of fear. If you are hungry, then that primitive body fear is one of starvation. If you are angry, then you may be perceiving a bodily threat and feel the need to retaliate in kind. If you are lonely, then there is the deep fear of isolation, of abandonment. And if you are tired, then that fear may be one of exhaustion, of the thought that you will never be able to rest or stop.

Those non-rational emotions do have a rationality to them, but it is a rationale that places survival first, that often trades in either/or, all/nothing decisions.

So let’s consider the wrong way first.

Your child (or substitute loved one or boss or client as you need to) is full of emotion, anger, threatening, frustrated, upset. Perhaps you try to tell them that they are being “unreasonable” or “silly” or (gasp) “emotional”. They feel entirely justified in their emotion in that moment; for now, you will be the one who is wrong. And through the fog of that emotion, they will think of every possible reason (justified or not) to prove the emotion right.

Remember, this is not rational, but there is a rationale.

Your loved one is experiencing fear. To get into the brain of it, their amygdala and sympathetic nervous system are prioritizing survival over their prefrontal cortex and slow, rational, deliberative thinking. It is a heuristic, a thinking shortcut, that is good for survival but can be tough on relationships.

So what can we do?

“Handle the emotion first, then talk.”

Get yourself as centered and calm as you can. This can be tough in the face of a toddler or adult in the midst of a tantrum, but take your own deep breath then think in terms of what would be soothing and calming.
Your next step could be moving closer to the person (especially if it is a loved one) and giving them a hug.
Your next step may be reducing the stressor/trigger by calmly saying, “You know, I know I’m feeling a bit upset right now. I’m going to take a walk for a few minutes, then come back.” In other words, leave for a little while because you might be the stressor/trigger. But do come back! And reassure them that you are coming back.
Then once the storm is past or the fog has lifted, then you can talk about it.

In my practice I find myself saying a lot of things over and over, but many of them come down to how we are body and brain together. They are not separate. And this particular phrase, “Handle the emotion first, then talk,” has a lot to do with approaching our selves and the selves of those we love as whole beings, not disembodied brains.

Then we can get back to enjoying being with our children, our loved ones, and maybe even our co-workers!

Originally published on Medium.com on February 11, 2019.

Writing Your Story Again

My wife and I have been DEEP into the editing process with our publisher. Much of this entire process of publishing has been new to us. We received a book contract, signed it, and sent our manuscript to the publisher. Then we received a “developmental edit”, which was more about style and larger issues. For example, our editor wanted us to better connect some of the scripture we had cited to our proposed exercises or to clarify some of our thoughts or stories.

There is a sort of pause that many of us take when receiving criticism. It can dig down into some old beliefs about “what if we can’t do this” or “are we good enough”.

And although we did have a sort of pride in our work, we did need the editing.

As we worked through what our editor had proposed, again and again we could see the places where our wording was vague … or that ideas that seemed clear to us needed to be fleshed out for the reader.

We had started writing this work five years ago. Yet this process of working through the manuscript alerted me to the ways in which my own thinking and feelings about anxiety had changed. We had grown and changed through these years, with experience and with knowledge.

Yet to learn and grow through this process, we had to stop ourselves from wincing at some errors and problems in wording; instead, we needed to look for the lessons along the way.

We all can use some “revision” and “rethinking”.

Any of us can get very stuck in our thinking. Try talking to someone about their opinions on any sort of political or religious issue and you will quickly find where people are very reluctant to revise or rethink a deeply held opinion. The same is true for feelings about ourselves, about our worth or value or competence in the world.

The challenge is to allow just enough flexibility in our “vision” and our “thinking” for change to be possible. It only takes a bit of space, a breath, to imagine a world where our fear or sadness is relieved, even just for the space of that breath.

For me, as a therapist, I know that part of the work of therapy is talking about some of the events that have led us to have fearful and negative narratives about ourselves. Then, with the help of a guide, we can rethink, revise, and rewrite what those events mean to us.

Remember to approach any work on yourself with grace and understanding.

As my wife and I continued through the edits, we found ourselves, again and again, erring on the side of grace. There were multiple places where we remembered that whoever may be reading this book would often be blaming themselves for the times when they felt panicky and fearful. The best approach is one of grace and understanding, not criticism or judgment. The same is true for any of us that are doing some new work with ourselves.

Be gentle as you look at yourself; treat yourself with the sort of kindness with which this God of love sees you.

Once you are able to see that vision of God’s love for everyone, even you, then consider what “revisions” that you need to make in your own life and relationships.

We all have to let go of some control.

As my wife and I have moved through this process of writing, submitting, editing, and submitting again, of choosing a title, and all these next steps with a cover and marketing … we are learning to let go of control … of the book.

Yes, of course, there was a bit of a sigh for both of us as we hit the [send] button that submitted our initial manuscript to the publisher. As we have edited and revised, there was another [send] moment as we sent our editor our revisions and comments and concerns.

We practice letting go … of our control.

This practice of letting go is as easy as taking a deep breath, then having a long, slow exhale. The more challenging parts of letting go are about our work or our parenting. Or perhaps the difficult piece to let go has to do with past hurts and wrongs. Whatever it is we use to define ourselves, there is a gift to receive in our giving it away, of opening our hands instead of holding a closed fist.

Reach out to others. Work with them.

Working with others and trusting their expertise can feel scary, but it is worth it. All along this path, from working with an agent to our interactions with our publisher, this journey has been one of reaching out and trusting.

For some of us, reaching out and opening our hands to others for help and support can be frightening. We have been hurt before. It is hard to trust that someone else will be there for us. Sometimes our own thoughts about what is “right” will conflict with others.

This work is not just about you; it is for all of us.

We are all in some sense a “work in progress”. One point we return to again and again in the book is how much the “journey of faith” is just that … a journey. Yes, there is a beginning, but there are many points of struggle and resolution, of “revision” and “rewriting” along the way.

My hope is that as we move along this way, and as many of you journey with us, that we do so with openness to God and each other.

If you are interested in following along on this journey, go to my “books” page, enter your email, and receive updates as we make our way toward publishing.

“Anxiety is a body event.”

Part of an occasional series about phrases that this therapist finds himself repeating, often.

As a clinician in private practice, one of the phrases that I hear myself saying over and over, often in this way is this: “Remember, anxiety is a body event.”

So what does this mean?

First, this statement, “anxiety is a body event”, reminds us that when we feel anxiety, it is made up of physical sensations. While you may not have all of the symptoms, people often describe an increased heart rate, sweating, tingling fingers, chest tightening, chest pain, nausea or pain in their stomach, feeling hot, and changes in breathing that usually show up like quick, short breaths.

These symptoms are often followed along by a deep sense of fear, of feeling closed in and needing to get out. You may feel as if you are about to die. This can also show up like an overwhelming irritability that may lead you to lash out at people around you. Anxiety is about “fight or flight”, so some of us are likely to want to run . . . and some of us get ready for a fight.

And all of this is NORMAL and NATURAL; we need this system! The problem is that this system has been triggered by some internal or external event that has bypassed your “thinking” brain and is talking directly to your body first. This reaction is about survival, and correct or not, your lower brain has decided to pull the switch to help you live through whatever is happening.

Emphasizing the body is important because that is where we need to first target our interventions.

Depending on who the client is, sometimes we will take crayons or a pen and draw our nervous system together, linking our anxious brain with our lungs, our heart, our muscles, making a stop by the adrenal glands sitting on top of the kidneys, all the way down to our feet, since running is something that anxiety will often lead us to want to do.

So with that understanding of how anxiety, something that starts in our brain, affects our body, that leads me to the perhaps more important place.

Second, this statement, “anxiety is a body event”, reminds us that we need to talk to our body first before we talk to our “thinking” brain.

It is a common mistake. I see lots of parents who try to reason with their child that “No, there is a not a monster under the bed.” The child remains scared, so the parent thinks that saying this LOUDER and THREATENING some punishment will surely make this situation go away. At that point, the child has probably gone into “freeze” mode due to the anxiety getting worse, not better.

The quiet of “freeze” mode may look like calm, but actually this child is more scared, more worried about what you as the “big scary adult” are going to do next.

And even though I have used the example of child and adult, you can easily see where this happens between two adults, especially adults in a relationship. I will often have the spouse come in with a patient to learn about what anxiety is so that they can respond in a way that helps the situation be better, not worse.

This is why interventions with anxiety are often activities like focusing on the breath in your belly, taking a warm bath or shower, taking a walk, petting the dog, getting or receiving a hug.

In order to calm a “body” event, you have to talk to the body.

The body only understands soothing and calming, not communication filled with words like “But that isn’t real!” or “For the last time, you are not about to die!” Even though anxiety sometimes starts in the thoughts, most often the future-oriented, “what if” variety, it proceeds to the physical very quickly. The physical body is where the intervention must first be targeted.

So with all that “in mind”, remember that anxiety is a body event. We feel it physically, but that also means that the key to working through it in therapy and at home is physical too.

Originally published on Medium.com, Jason B. Hobbs LCSW, M.Div on May 17, 2018.

If you are interested in the subject of anxiety, my wife and I have a book forthcoming from Kregel Publications. Go here to follow the progress. Release date is expected to be Fall 2020.

“Our hurts return at different ages and stages.”

Part of an occasional series about phrases that this therapist finds himself repeating, often.

As a clinician in private practice, a phrase that I hear myself repeating often is “Our hurts return at different ages and stages”. This phrase generally arises in working with the parents of a child or maybe even a young adult when some early difficult event in their life seems to have returned.

We feel like we have circled all the way around to the exact same spot again.

You may feel defeated or may say, “But I thought we had beat this” or “I thought I was done with talking about this.”

But here we are … sometimes dealing with the same problematic behavior. Sometimes we are treading through the trauma again, although there is something different this time around.

We feel like we are in the same place, yet it is different, all at the same time.

Our hurts do change us. Much in the same way that a physical injury means that we have to adjust; we find a new way of moving through the world and often a change in how we view the world. The world won’t be the same again. And there is a way that this change unfolds again and again, over the lifespan.

Children go through developmental stages, with discrete tasks to work through.

Depending on when the trauma happened, there may be a great deal of self-blame associated with it. Children often see themselves as the center of the universe, therefore they often see themselves as having a major role in an event, even if the trauma was certainly not caused by them.

For instance, if the trauma is the loss of a parent, a child may have worked through the difficulty at the earlier age. But when moving into adolescence, the absence of that parent means something different to them. Even in their physical self, that child may look for their missing parent in their facial features or in the way that their body is maturing. “You look just like your mother when you …” is common for children to hear.

In addition, there is the realization that this missing parent will never watch them play soccer. The missing parent will not have a chance to criticize who they are dating. The child will not hear, “I’m proud of you” from the parent who is no longer present.

The original absence of the parent was a trauma, but the absence continues as the child moves into a new stage of their lives.

Young adults hit milestones in their lives that remind them of the original trauma.

As the child turns into an adult, there are new questions about identity and finding one’s place in the world.

For the young adult who has experienced difficult events in their life, identity questions lead them to look to how their identity has changed with respect to what has happened to them, and specifically the trauma.

Who am I now? How do I tell my story?

Another aspect of identity is about relationships. Relationship questions arise because learning to be intimate with someone (whether emotionally or sexually) may bring up some of the violations that occurred with the original trauma.

So even though they may have worked through an aspect of the trauma at the age it occurred, we should be aware that it may come around again … in a different way perhaps … in a different guise.

But … we didn’t circle around to the exact same place; it is more like a spiral.

Yes, we may finish with the trauma at that stage, but it does not mean that we don’t find it waiting for us at the next stage.

This is not necessarily a pessimistic stance. Because the spiral shape of change represents growth and development, not stasis.

Circling around and around again would be frustrating for you as a person, but also for parents who are raising children affected by trauma.

Being realistic about the nature of trauma means moving into a recurrence of symptoms with curiosity, seeing this as an opportunity for growth.

In a way, it should not be a surprise that you (or your child) encounter a different aspect of the trauma as you move into different developmental stages. But if it does feel like a shock or surprise, then simply step back, take a deep breath, and think about what you might need in that moment.

What worked before to help you through may work again.
The lessons you learned then may need to be adapted to a new age and stage.
And this new older you has the opportunity to see the hurt in a different and potentially healing way.

So when you find that you are working through the hurt again, recognize that this may be another “age or stage”. There may be new meaning and potential for healing here too … if we are willing to walk through it.

Originally published on Medium.com.

Not on the journey alone

on walking and writing and walking and writing

This is one of those lessons that I learn over and over again: you are not alone, nor should you be. I am aware that it speaks to something foundational for me, and perhaps for you. As for me, I’ve been walking and hiking more of late, mostly due to a running injury that has kept me from logging my usual mile after mile. In its place, my time has been consumed with writing and editing ahead of signing a book contract, revamping websites, adjusting online profiles so that it all fits some marketing niche (yes, you can tell I don’t exactly love this part).

But there it is. One step. Another step. Watch where you step. Listen to where others encourage you to step. Walk with them.

You see, I’m used to running on my own, at my own pace (which is not so slow I must say). Running solo typically means getting up early, lacing up my shoes, and going for a run when I want to … for as long as I want to. But at this point, I am a middle-aged runner with an injury.

When you are injured, your first best step is to deny, deny, deny, right?!?

But the pain reminds you. And when you decide that you can try to go out for a longer run this time the injury will remind you that you are in a season of “one step at a time”. It may also be helpful to reach out for some help along the way … which brings me to the writing piece.

My lovely wife and I have signed a book contract. Now this has come after many hours (especially for her) of blogging and writing, self-publishing her own book, eventually, me catching up and self-publishing my own work, a lot of work to secure a literary agent and agency, and finally getting to the point of having an actual contract with a publisher! Whew. This process has been a journey, a journey that has been step by step by step, word by word by word. And in the end, we haven’t been alone.

Each part of the way it feels that we have gathered additional support for the journey. Initially, it was my wife and I deciding to try to have an eight-week class on anxiety by combining sound clinical information with Christian spiritual practices. To our delight, we had a classful who wanted to walk that journey with us! We wrote and led and learned from the class participants.

We wrote and revised, rewrote and changed based on what seemed to work and what didn’t work in that class setting (and the other two classes after). We imagined what it would be like for someone to read the book as an individual, not in a class at a church, or not with a clinician or pastoral counselor alongside them.

And along the way, we picked up supporters, people saying “you can do this”, a supportive agent and agency, and now a publisher and editor that are excited about these next steps. For me, it connects to a quote from Anne Lamott:

Writing and reading decrease our sense of isolation. They deepen and widen and expand our sense of life: they feed the soul. … It’s like singing on a boat during a terrible storm at sea. You can’t stop the raging storm, but singing can change the hearts and spirits of the people who are together on that ship.
Anne Lamott, Bird by Bird: Some Instructions on Writing and Life

So on Wednesday, the day before Thanksgiving, we were grateful for a supportive conversation with our editor. He gave us helpful and supportive feedback, and we feel we have another person to help us know where to step and to accompany us on this journey.

There are still steps to go and sites to see along the way. We’ve got some revising to do. We will be part of a team that chooses a cover for the book, that makes decisions about audience and marketing, but also gets to launch a book out into the world that is full of God’s grace for people who are struggling with anxiety.

And for those of you who have taken a lot of these steps with us: thank you.

We’re all still on the path, taking it step by step, and we are grateful for your presence with us.

Raising up our Hurt

Numbers 21:4-9, “So Moses made a serpent of bronze, and put it upon a pole; and whenever a serpent bit someone, that person would look at the serpent of bronze and live.”
John 3:14-21, “And just as Moses lifted up the serpent in the wilderness, so must the Son of Man be lifted up, that whoever believes in him may have eternal life.”

[Sermon for First Presbyterian Church, Thomaston, Georgia, Sunday, March 11, 2018]
Good morning! I am glad to be here this morning, but I have to tell you something. When I looked at the lectionary readings, and this story of grumbling and snakes was there, I could see why Glenn might want someone else to handle this reading about the snakes. And as we are in a Presbyterian church, that does mean that the only handling of snakes that will be done this morning, and frankly, the only kind of snake-handling that I am interested in, is to attempt to handle them with words.
But even handling this passage with words, it is not easy to grasp, to hold. This is not a passage with which we feel safe.
This is a passage about suffering, even more, suffering sent by God. I suspect many of you feel as I do, that we would rather move on, quickly, to the gospel reading. This predicament reminds me of times when I have been walking around the pond on the land where I grew up, over in Dublin, Georgia. As a boy, I would be walking through that wooded area beside the pond that felt for all the world like a wilderness to me at the time. But you had to watch your step, because right around the spillway, where there was a collection of rocks to hold the soil, there sitting on a rock was often a snake, sunning itself. And when you saw that serpent . . . you stop . . . pause . . . and you gently stepped around it. At the time I could not have told you exactly what sort of snake that it was, although my father had told me a story, more than once, about being bitten on his fingernail by a baby rattlesnake that had somehow made its way into his toolbox. Luckily, thankfully, its fangs did not pierce the nail of my father’s thumb.

There are sometimes dangers around a farm, around the woods, and in the wilderness. As a boy, I had been warned.
So yes, this is the sort of story when we encounter it in scripture, that we too feel that we would like to gently step around, to avoid it, to leave well enough alone. So we move on to the gospel reading, of Nicodemus coming to Jesus by night. This Nicodemus was a Pharisee, a religious leader, who came by night because he might have lost his position had he been seen with Jesus during the day. Jesus was the sort of person with whom “respectable” people did not want to be seen. There was danger there too.
But then when we try to avoid the first reading by slithering over to the gospel reading, the danger shows up there too: “And just as Moses lifted up the serpent in the wilderness, so must the Son of Man be lifted up…”. There is that staff with the snake, being held up, and being held up as an image of who Jesus would be.
And this reminds me of a truth about our faith, about our lives: we cannot always hide from what we are afraid of. We cannot perpetually avoid our hurts, those hurts we have done and the hurts that have been done to us. Sometimes we have to look at them.
And the children of Israel, this group of people wandering about in the wilderness in this passage from Numbers, they had plenty of hurt to look at. Yes, they were now free from slavery, having been liberated by God through Moses from oppression under Egypt. But still, this freedom was not so easy either. And as with many who have left difficult situations, there is sometimes a way of looking back, even at a situation that hurt us deeply, and saying, “Well, it wasn’t that bad.” And we grumble. We grumble about the food. We grumble about how far we have to walk. We grumble like kids in the backseat on a long trip asking “are we there yet?!?!”
So in this passage, God gets tired of the grumbling. But instead of being the angry, frustrated parent in the front seat yelling, “NO! We are not there yet!”, in this passage, for reasons that I’m not sure there is an adequate explanation for, this God sends venomous snakes to bite the people, causing them pain, causing some of them death. And it is at that point that the people go to Moses to “please, please, please” take these snakes away from us.
But then that is not what happens.
Instead, God has Moses create a snake made of bronze. Moses attaches it to a pole and then raises this snake high above the people so that those who have been bitten can look on this bronze snake and then be healed. This was what God told Moses to do. It is a strange cure to be certain.

1_SbWM7YvRTFUhYiHelmZuWg — Rod of Asclepius

The cure is that we must look at what hurt us in order to live.
Now, I am a therapist, a clinical social worker by training. And there are many with whom I have sat that know that when they come to me, we will look at what hurt. Most of these wounds are emotional and mental, although those wounds often come with injury that is physical as well. These wounds that we carry are painful; they burn as the venom continues to work its way through our system, infecting our thoughts about ourselves and our thoughts about others. Over time this venom infects our biology in ways that affect us physically, not just mentally, although the mental pain is enough.
And so we raise up what hurt us. We look at it long and hard, seeing it clearly so that it cannot hurt us anymore.
So as you can see, on this particular Sunday in the season of Lent, this passage about the snakes is paired with this story of Nicodemus going to Jesus, by night. He wanted to talk to Jesus about being “born again” or depending on your translation, “born from above”. And Nicodemus struggles with these teachings that he has heard from Jesus. He struggles with who Jesus says that he is. And then in the context of this conversation, Jesus says that Jesus too will be lifted up just as Moses lifted up the serpent in the wilderness.
We will have to look at our hurt, the hurt we have caused and the hurt that has been done to us. We will have to have it raised over our heads and fully see it.
This is the path to rebirth. This is the path of healing. This is the way for us as Christians.
And Jesus goes on to one of the most loved, most memorized, most often seen at football games on a piece of paperboard passages: John 3:16. “For God so loved the world that he gave his only Son, so that everyone who believes in him may not perish but may have eternal life. Indeed, God did not send the Son into the world to condemn the world, but in order that the world might be saved through him.”
You see, God did not send snakes this time . . . and the purpose is not condemnation, but reconciliation. But that reconciliation may mean looking at the hurt that we have caused . . . and the hurt that has been done to us. Reconciliation is not just forgiveness of sin by God, but also forgiveness of each other, of the extension of light and grace and love from God to us, but also to everyone.
So, as we continue this Lenten journey, may we be a people who are willing to look at our hurt, at the hurt done to us and the hurt that we have done, and may we be willing to be people of light and grace and healing out in the world.

What is a first visit with a therapist like anyway?

So, yes, people often do not know what to expect when you visit a therapist’s office.

It can be an awkward, vulnerable, and just a very different sort of conversation than you usually have. If you were going to a general practitioner, then you may get asked questions about your injury, your cough, the possible infection. There are blood tests and urinalysis. And the subject of the visit generally stays there.

Therapy can feel like a conversation, but a conversation with a purpose.

On a initial visit, you will typically be asked to fill out a questionnaire that asks you about your symptoms (e.g. sadness, anxiety, fears, sleep, appetite, substance use, other behaviors). There will be questions about how you grew up (or stressors in your current growing up). There may be questions about any sort of family history of substance abuse, mental illness, or trauma, as we know that we are a complex combination of genetics and environment.

Then the conversation begins.

And while some of the questions may be difficult, remember that this person is trying to help in the end. Oftentimes you may not say everything in the first session; and that is OK. In fact, there is a phenomenon called “flooding” where sometimes people tell everything in the first session, feel that they have then shared too much, feel embarrassed, and then do not return.

Therapists are trained professionals and will typically guide the conversation in such a way as to get the information they need to make a diagnosis, but also begin to guide you toward a plan for how to tackle the difficulty at hand.

As you get to the end of the session, there is usually a summing up and a plan.

Most therapists in the state of Georgia can diagnosis mental illness. These are illnesses such as depression, anxiety, schizophrenia, bipolar disorder, and ADHD. While therapists are able to diagnose, there are some entities such as school boards and government agencies that may require further testing to meet their requirements. So by the end of your session, you may have a preliminary diagnosis. And I use the word preliminary, because diagnosis of mental illness does change over time as new symptoms present themselves and some initial symptoms become less important.

Mental illness is more challenging to diagnosis because most of the information is based on history and questions, not blood tests and brain scans.

And while there are very good folks working on using blood tests and brain scans, it is not technology that is widely available or financially accessible for most folks at this point.

So at the end of your first session, you may have a referral to a psychiatrist or back to your general practitioner so that you can discuss medication for an illness or other tests to rule out other possible causes of your symptoms like thyroid disease or diabetes. We may have a discussion about certain lifestyle changes that we know can help us physically as well as mentally, such as changes in diet and exercise. And your therapist will likely give you some homework that involves noticing certain thought patterns that may be contributing to your symptoms or a writing assignment like “the miracle question.”

It is OK to ask your therapist about these next steps, how long they expect treatment to last, and what you can expect as a patient/client.

And somewhere in this process, you should be given in verbal and/or written format some idea of privacy practices, about what to do in case of an emergency, and when you can schedule another appointment, if you wish. Because this last part, is potentially the most important. There is good evidence that the “type” of therapy is less important than that you feel comfortable with and trust your therapist. While their skills and knowledge base are what got them there, if you do not feel that you have a good, trusting relationship with that person, the most knowledgeable and skilled provider will not help near as much, if at all.

The ABCs of Mental Health Treatment

[Note: This is the last in a three-part series of articles written several years ago for a local publication. The purpose was to do some education about mental health, especially for a church audience. I thought it might be good to revisit.]

LMFT. LPC. LCSW. PsyD. MD. M.Div. Ph.D. CAC. RN. CSB. Medicaid. Medicare. MHP. When you dive into the bowl of alphabet soup that is our mental health system, it is confusing mix of letters, providers, payment types, and places to go for services.

How do I access the mental health system?

The first item to know is how to access the system in situations of dire need. In other words if you or a loved one are unable to leave the house because of debilitating depression or anxiety or if you or a loved one is suicidal or homicidal, then you need to call emergency services at 911.

If the need is not an emergency, but is urgent, then it is a good idea to call your regular doctor or pediatrician and discuss the symptoms you are noticing and ask for a referral. Many times the doctor may ask for a blood test to evaluate for other conditions that may look like depression or anxiety. Thyroid problems or diabetes are common conditions that have symptoms that may look like mental health concerns.

Another important consideration in our health care system is how you are going to pay for services. If you are insured, it is best to look at your insurance card for words such as “behavioral health” or “mental health” or “substance abuse” and to call the number on the card to discuss a referral. Many insurances have separate plans for mental health coverage; it is important to understand these rules so that you do not go to a provider that is not “in-network” and then face a large bill.

If you are not insured, or are insured by Medicaid, another avenue for mental health services is your local community service board. These are the state-funded mental health providers such as Oconee Center, Phoenix Center or River Edge Behavioral Health Center. They typically have a variety of services ranging from all-day services for adults, treatment for addiction, counselors and psychiatrists.

Lastly, there is inpatient treatment. While there was a time when inpatient treatment last for weeks and perhaps months, being hospitalized in a psychiatric unit typically lasts for three days to one week. Treatment in this setting is to manage a temporary crisis until a patient can be stabilized and released to outpatient treatment.

What happens at a psychiatric hospital?

Inpatient units are typically in a large hospital or in a separate psychiatric facility. Inpatient treatment is NOT what many of us saw in the film One Flew Over the Cuckoo’s Nest. Typically, there are counselors, nurses, and psychiatrists on staff there who will monitor whether medications are working. There are also groups and classes that patients attend to work on the life circumstances that may have created or may be maintaining some of the problems in their life.

There are also in-between sorts of options for people who need the intensity of everyday treatment, but are not needing to stay in a locked unit. These programs are usually called “intensive outpatient” or “partial hospitalization” programs. These can be wonderful options!

But who are the people who provide these services?

The type of provider you need to see is largely based on what type of need you have. Just as doctors are regulated by a medical board, there are also boards that license and regulate counseling. These boards ensure that providers who hold that license have fulfilled the requirements, both in terms of education and experience, which enable them to competently provide mental health counseling and psychology.

If you are looking for psychological testing, then a psychologist is who you need to call. These tests (which are both paper/pencil and computer-based) can test for everything from mental illnesses, learning disabilities, intelligence, and can also be helpful in assessing career paths and in helping groups of people learn more about each other to help them work better together.

Some psychologists also provide therapy to help with behavioral health issues. These are generally folks with a Psy.D., but may also be people who have a Ph.D.

Other providers typically have a Master’s degree in professional counseling, marriage and family therapy, or social work. Master’s level providers are the bulk of people providing therapy to address behavioral health. The type of license is either a LPC, LMFT or LCSW. Sometimes you will see someone with a LAPC, LAMFT, or LMSW; this means that this person does not yet have their full license, but is working towards the ability to practice independently.

What happens in therapy?

Typical sessions with a therapist or counselor are 50 minutes and cover some of the patterns of behavior, family structures, and ways of thinking that may exacerbate the problem or have led to the problem. The MOST important item in finding this type of provider is that you feel you have a good “fit” with this person. Research has shown that beyond the style/type of counselor, whether you have a good fit with them is one of the strongest predictors that you will get better.

Meds?

Master’s level providers and psychologists do NOT prescribe medications. Psychiatrists are the providers who do treat mental illness with medication and other interventions that require a license to practice medicine.

Another group of providers are certified addiction counselors. These are people that have been through training and supervision in order to specialize in providing services for people struggling with addictions. While this is not regulated by the state of Georgia, there is a state organization that certifies them.

In finding a provider, insurance is definitely a factor, but you should also ask your clergy, your friends, and your family about their experiences with a provider. The “fit” is important, so make sure that you trust and are comfortable with the person.