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.