Psychful

I (re)learned a valuable lesson yesterday involving the importance of good communication between therapist and patient. It’s humbling to have to relearn things that you know intuitively as well as learned through long professional experience. The humility should serve me well. Humility has a way of doing that. 

After training a seven year old boy with severe ADHD for about 12 sessions with neurofeedback, I was discouraged by the lack of progress that was reported by his mother. My solution was to change the reward frequency I had been using in his training. Instead of remaining in the infralow frequency range (.0001 Hz), the current iteration of the Othmer Method of neurofeedback, I raised his reward to 7 Hz based on the recommendation of a colleague who reported success in many cases of treating ADHD with this intervention. The youngster was unaware of the frequency change and continued to sit comfortably watching “Barnyard” on the computer monitor with the EEG leads on his scalp.

This particular boy had been on Concerta for the last 2 1/2 years, and as is often the case, the effectiveness of the prescription medication had waned to the point where he had regressed to engaging in dangerously impulsive behavior. That is what triggered the call for my neurofeedback services from his mother.

I knew I should share my intervention with his mother so that she could be attentive to any symptom changes or possible side effects from the change in reward frequency.  I told mother about the change and explained my reasoning was based on the lukewarm treatment progress she had reported to date. Mother replied with an apology. She had not intended me to interpret her reports of progress as being limited in scope. This was her first experience with neurofeedback and she had no basis for comparison.  She had only my initial presentation of the possible treatment outcomes for training away symptoms of ADHD using neurofeedback.

I decided to inquire a little deeper to better assess her report of her son’s treatment progress.

(Me) I understand that when your son began using Concerta he quickly showed a tremendous positive response to the medication.  What percentage of that initially great medication response was lost by the time you called me for neurofeedback?

(Mom) About a 75% loss. It was so much that he was engaging in dangerously impulsive behavior, like riding his bicycle out into traffic at major intersections of busy streets without my knowledge. This was happening even when he was taking the medication.

(Me) Since we have been training him with neurofeedback, what percentage gain would you estimate he has made towards that originally good response he got from the medication?

(Mom) 60-75%.

(Me) Your saying that in these 12 sessions of neurofeedback your son’s symptoms of ADHD have remitted to nearly the point he was at when he first started the Concerta?

(Mom) Yes.

Glad I asked! I had been interpreting her someone stoic appearance and cautious reports of treatment progress as being lukewarm and needing an intervention to increase the effectiveness of the the neurofeedback.  But making a 60-75% improvement in symptom reduction with a few weeks of neurofeedback training was hardly lukewarm!

Mom had tried withholding the Concerta on a weekend day and her son, quite naturally at this point, responded by becoming wholly undisciplined. His treatment progress while on medication reveals the fact that significant measurable changes are possible in treating children with ADHD using neurofeedback even while they are on prescription medication.

Now I will need to evaluate the merit of changing that reward frequency. We weren’t doing so bad after all!

Central to each person’s psychological health is the concept of respect. Respect is one of those common concepts that nearly everyone can describe.  If I ask a big-city gang member or a Baptist minister, both will agree that respect is important to human beings and critical for social relations.  Their definitions of what constitutes respect may differ, but they both understand the concept, and they know it when they see it.  It is worth understanding respect in more detail.

For our purposes, there are basically three types of respect; self-respect, respect for others, and respect from others. People who manifest good psychological health appear to practice all three types of respect.  Those with poorer mental and emotional health may suffer in the healthy application of the three types.

Self-Respect

Basic self-respect is critical for a person’s psychological well-being.  Sometimes called self-worth, self-concept, self-regard, or simple pride, self-respect is the basic sense of being a good and decent person.  This means that out of self-respect I live my life in a healthy manner.  I practice good physical health, good emotional health, and good social health.  I avoid excesses, and I live with dignity. I look out for me in a healthy way because I respect myself.

Self-respect can be considered along a continuum from very low levels of self-respect on one end to excessively high levels of self-respect on the other end.  On the low end of self-respect we may find people who lack confidence, who neglect themselves, and who are dependent on others for their feelings of worth or basic respect.  Lacking self-respect can be so painful that these individuals may numb their painful feelings with alcohol, drugs, sexual activity, or risk-taking.

On the other end of the self-respect continuum are those people who appear to have enormous self-respect but may be compensating as well.  These individuals may appear overly confident, boastful, and arrogant.  They may act as though laws and rules do not apply to them or that they deserve greater attention and admiration in social or business settings.  They may feel they are worth more than others and somehow entitled to be treated as superior individuals. This excessive self-respect may reflect narcissism at its finest.

Somewhere in the middle of the self-respect continuum are those psychologically healthy individuals who believe they are basically good and decent people, no more and no less.

Respect For Others

If it is good for each of us to have a healthy sense of personal self-respect, then it logically follows that other people are entitled to a similar benefit.  If I have good self-respect, then I must respect others as well. This is the basic healthy position popularized in 1969 by the book, “I’m OK, You’re OK”. To believe differently is hypocritical, or a sign of prejudice or psychological impairment.

By showing respect for others, I affirm my own self-respect.  It’s following the Golden Rule.  If it’s good for me, it’s good for you.  Anything less suggests there is a problem.

If I fail to respect others, perhaps I am acting hypocritically, not practicing what I preach. Perhaps I am not good at managing my emotions and tend to snap back at others when I perceive the slightest of insults.  If I am too sensitive to criticism from others, perhaps my self-respect is wanting.  If I feel superior to others and demonstrate less respect for them, perhaps I am compensating by maintaining an excessively high sense of self-respect.

It is not unusual for individuals who lack self-respect to have excessive respect for others, feeling unworthy of respect in return but able to demonstrate respect for others.  This is not a sign of psychological health.  If others repeatedly behave in a manner that we cannot respect, we may lose respect for them, “fall out of love with them”, and begin to emotionally or physically withdraw from them.  They may then need to ‘earn’ back the respect we once had for them.

Respect From Others

If we have basic self-respect, and we show basic respect to others, then it follows that we will not tolerate disrespect from others.  If I allow another to be disrespectful to me, then I am not acting with self-respect.  The problem, of course, is that I cannot force others to treat me with respect.  Attempting to do that would be disrespectful to others.  Yelling at another, “Stop being disrespectful to me!” is hardly being respectful and violates the Golden Rule. The challenge is to insist on being treated with respect from others, and if that respect is not forthcoming, to withdraw from the abusive treatment.

If I am in a restaurant and the waiter appears to be providing poor service by being inattentive to my needs as a customer, I can attempt to get his attention and repeat my request for service.  If the waiter ignores my request, then I may need to speak with the manager, or simply leave the restaurant and not soon return.  I cannot make the waiter treat me with respect, but I can practice assertiveness in a respectful manner in an attempt to achieve respect from the waiter.

If I am in an intimate or family relationship with someone who is disrespectful to me, I am obligated, out of self-respect, to try to correct the disrespectful behavior.  If my acquaintance is yelling at me I may indicate we need to take a time-out from our unproductive conflict and allow reason to return.  If the other will not stop yelling or being otherwise disrespectful, I may need to leave the scene until reason can return.  Allowing someone to treat me with disrespect reflects a lack of self-respect.

If I allow myself to become angry and yell back, I have fallen into a trap: two wrongs don’t make a right.  By yelling back I have failed to manage my own emotions, failed to consider the other person’s point of view, and failed to show the respect I am insisting on from the other.  Little good will come from such an unproductive conflict.

By becoming aware of the three types of respect in everyday life and practicing all three types, we have an actionable way to improve our own psychological health as well as contribute to the health of others.

Nothing can be simpler, or more difficult than apology.  For minor slights, a quick and clear, “I’m sorry” may be all it takes to begin healing the hurt you caused.  When the hurt is more severe, then we move into a different realm of apology.

Most of us men and women (mostly men) could stand to do a much better job with apology.  It’s not complicated, but it is something we don’t often see well done.  We may not have seen our parents make heartfelt apologies to one another in times of need.  There are not many good examples to follow in the media, especially on television.  Occasionally a good romantic movie will demonstrate a dramatic and loving apology by the main (male) character.  But these “chick-flicks” are rarely watched by guys, with interest.

Apology, the “A” part in the LEAP formula for Healing Hurts can be learned by anyone who is motivated to develop this skill.  Even guys.  As a male marriage and family therapist for over thirty years, I have had plenty of occasions to intervene with couples who are stuck in hurt from poor attempts at healing.  I’ve learned it is possible to teach someone how to apologize effectively.

Before we cover the steps involved in making a good apology we must first consider your motivation in making the apology.  If you have really hurt your loved one, intentionally or unintentionally, and you want to do the right thing to help heal this wound, you’re off to a good start.  If you have screwed up again and just want her to get over it, then there’s a motivation problem, and the following steps will not work for you.  Think it over, big guy.  What’s more important, remaining cool, detached, in control and losing the love of your partner, or letting go of your emotional armor and letting your empathy shine through to the one you love?  I know what the female readers are thinking.

Fueled by sincere motivation to do the right thing, a full and complete apology for major hurts consists of five steps: Admission, Sorrow, Change, Request, Thanks.  Sorry, I can think of no good acronym for these steps; you’re on your own.

Admission

Letting down your emotional shield means making a sincere admission of what you did wrong.  You may have learned this by following the Listen and Empathize steps listed previously.  Keep it short and sweet and to the point.  Don’t wander; you’ll be more likely to get into explaining or justifying what you did, which is not a good plan.  This is where you say, “I was wrong when I….” Insert your understanding of what it was you did that hurt your loved one.  If you did a good job listening to her pain, you will know the correct answer for this statement.  If you didn’t listen well, then you will have trouble successfully completing this statement, and she will confirm that by her reaction to your lousy admission.  Non-admissions include, “What’s the big deal?”, “I don’t see what you’re so upset about”, and “Baby, can’t you just get over it?.”  These are not statements of admission for having done wrong, and these statements will not help healing; they will be just another emotional wound.

Sorrow

After having expressed accurate understanding of the hurt you have caused, you may now express your sorrow.  Here is where you say, “I am sorry” with no add-ons.  “I am sorry, but…” is a trap; don’t go there.  Adding a “but” to the end of an apology destroys the apology, just as adding “but” to the end of a compliment destroys the compliment (“You look real pretty today, but…”). Non-sorrow statements include, “OK, OK, I’m sorry”, and “Sorry. There, I said it, OK?”  Again, these are just more hurts piled on top of the original offense, and may explain why your loved one has handed you this article to read.

Change

First time offenses may not need a statement of change following the sorrow message.  But if you have hurt your loved one badly, or if this is not the first time you have hurt her in this way, just making another nice apology may not create the trust that things will be different in the future.  What is said here depends on the circumstances of the situation.  A decent general statement of change might be “I don’t ever want to hurt you this way again.  I will do better.” Non-change statements include “I couldn’t help it”, “That’s just the way I am”, and “It will never happen again.”  Never say never.

Request

If you have really harmed your loved one, and followed the previous steps properly, it may then be necessary to request forgiveness.  After all, your motive for making this artful apology is really two-fold; you want your loved one to heal (not scar) and you want to be forgiven.  Examples of good requests for forgiveness include, “Will you forgive me?”, or, if you need to hedge your bets a little, “I hope you will be able to forgive me.” Non-requests include, “I’ll be glad when you get over this”, and “Cheer up, will you?”

Thanks

If you have hurt your loved one so deeply to need to request forgiveness, and as a result of your artful apology she does forgive you, be big enough to thank her for her forgiveness.  Her forgiveness is her gift to you.  Your expression of thanks is a gift back to her.  A simple “Thanks for being honest with me” because she explained her pain and gave you the keys to a successful apology may be helpful and bring a little closure to this apology process.  Ending it with a sarcastic “Thanks a lot!” is not indicated.

So what do you think?  Does this help?

In apology, timing is crucial.  Offered too early, you appear anxious for her to “get over it” and move beyond her present hurt. You may have overlooked the source of the problem in an effort to quickly gain relief from your misdeed.  Apology offered too late may appear to be reluctant resignation.  Having found no other way to resolve the hurt you “throw in the towel” as a final step designed to end the ongoing grievance.  Either way, your apology appears insincere and fails to achieve any healing, or forgiveness.  Her likely reply, “You’re not sorry.”

You’ve hurt your loved one and stayed to listen based on the blog post Heal Hurts 1. As a result of your listening, you’ve gathered the information listed in Heal Hurts 2. Now you are ready to say something helpful after all your sensitive listening to your loved one’s emotional pain. It’s time for empathy and to show your empathic understanding of your loved one’s feelings.

First some definitions. Empathy is feeling with someone, sympathy is feeling for them. Empathy is a bit more intimate than sympathy. Empathy is feeling some of the same feelings your loved one is feeling, demonstrating that you’ve “been there” and felt similar feelings in a similar situation. When you have never felt the way your loved one feels, never having “been there”, the best you can do is sympathize or feel sorry for her. Your goal in healing wounds is to practice empathy, to feel some of what your loved one feels, and then communicate that reality to her.

Secondly, it is important at this stage of the healing process to show a complete understanding of your loved one’s situation. It is not the time to defend yourself or your actions. You do not have to agree with everything your loved has said up to this point, but you must begin to respond to her with empathy and understanding.  Anything less will not do.

To simplify this emotional process, and to give you a starting point from which to practice a new sensitivity to painful situations, try completing the blanks in the following empathy script with the information you gleaned while listening to your loved one.

“I want to be sure I understand. You felt _(insert feelings she reported)_ when I _(state how you hurt her based on her description)_.” And what you need me to do (in the future) is _(clarify what your partner is asking for)_.”

The short version of this which you may tattoo on the back of your hand:

“You felt___when I___, and in the future you need me to ___.”

That’s it, for now. Don’t add anything at this point. It will just water down the effectiveness of making these statements.

Using this formula sounds very contrived, elementary and insincere. Don’t worry about that.  If you have read this far, you have probably messed up many opportunities in the past to help heal your loved one’s hurts. If you sincerely but awkwardly spit out the statements suggested in this script, she will know that you are trying to do better. She’ll know this isn’t the real you, and, for now, that may be a good thing. Don’t analyze this to death, or toss it aside as too simplistic. You may not be able to afford that.

Let me share a case example from my clinical practice to explain how this worked. A couple visited with me some years ago and in their first appointment announced “We have a hundred issues we need to resolve!”  They sat down and I presented them with some printed cheat sheets that covered the points I have been making in these recent blog posts. We mechanically went through the scripts addressing their issues following the scripted formulas given here and some others I use when people are hurting. At the end of about three weeks of meetings, they came in and declared, “We don’t need to work on the list of issues anymore.” When I asked why, they said, “We have developed the skills to address our concerns now and in the future, so we can drop the other 94 issues.” This simple script had enabled them to begin to find their own language to use in future efforts at healing their wounds, and to release their grip on past grievances.

After you have completed the empathy script, stop and wait for a response from your loved one. If she thinks you “get it”, that you understand and can feel some of what she is feeling, she will likely express some appreciation for your efforts. If you have skipped any of the items on the script, or been incorrect in understanding how you hurt her or how she feels or what she wants in the future, she will likely go back to explaining again and it is time for you to listen again. Repeat this process until you “get it”.

When you have convinced your loved one you “get” the three elements of the empathy script, then, and only then, you can move to the next step, apology. This will be covered in detail in the upcoming post, The Art of Apology.

Listening to your loved one after you have hurt her is a courageous skill. It does not come naturally to most people. To do this well, to do it out of love, requires an active process of mental focus and emotional courage. Simply allowing her to “vent” until the storm blows over is a passive, ignorant, often cowardly process. Any fool can do that and most do. Learning how to help heal her emotional wound is similar to learning first responder skills for a medical crisis. Knowing what to do enables you to stay mentally focused and emotionally self-controlled so that you can do your part in the healing process.

Your reason for listening is to clean the dirt from the emotional wound. By your active listening you create the emotional safety for her to talk about her hurt, the potential source of future infection. The wound must remain open long enough to get the dirt out, and only she can tell you how long it takes to cleanse the wound. Trying to patch things up too quickly, because of your own discomfort, will likely lead to infection and scarring.

Actively listening to your wounded loved one requires you to focus on learning three things: 1) How have I hurt you?, 2) What are you feeling?, and 3) How can I help? The answers to these questions are needed in future steps you take to heal this wound. Listening for these answers enables you to stay actively focused on your loved one and not get caught up in your own reactions to the situation. Remember, this is a crisis, and you are trying to be responsible and do the next right thing.

How Have I Hurt You?

Never assume you know exactly how you hurt someone you love. It may be a fair attempt at empathy to say “I know I hurt you when I said…”, but it can be presumptuous, inaccurate, and it can interfere with great listening. Listen to learn. As long as she is still talking to you, there is hope for healing. If she shuts down, you cannot get the answers you need to clean up this mess.

While you are listening, look at her and give evidence that you are listening. Maintaining eye contact, nodding your head, saying “uh-huh” or “OK” when you think you better understand her pain can be good signs of your active listening. Remember, active listening cleanses the wound. Passive listening can be interpreted as not caring and shut down the whole healing process.

While listening to understand how you have hurt your loved one, do not argue, defend or correct any misperceptions on her part. You are listening to understand the hurt from her perspective, not to share your perspective. She is the one who is wounded, and you are trying to help heal the emotional wound. There may be a time later in the process for you to share your thoughts, even your wounds, but not now. Wounded people don’t want to hear the problems of their first responders.

What Are You Feeling?

Listening for feelings is an art form in itself. Therapists spend much time in graduate training programs to develop this skill. For now, stick with the basics. If she says she feels hurt, unappreciated, taken for granted, insulted, or unloved, remember that. If she doesn’t tell you specifically how she feels you will need to imagine how she feels, begin to empathize with how she feels. If you cannot discern any of her feelings at this stage of your skill development, it’s probably safe to stick with “hurt”.

It may be most obvious that she is feeling angry. Remember that all that noisy anger is a shield protecting hurt feelings underneath. The louder the anger, the thicker the shield, the more feelings there are to protect. The absence of anger can be a sign that there are no longer sensitive feelings that need protecting, a potentially bad sign for the relationship. Begin to see anger as a sign of hope; she still has feelings that need protection. But anger is secondary to the hurt, and you need to remain focused on the hurt.

How Can I Help?

Embedded in every human complaint is a request. Most people complain rather than ask for what they want. In listening to your loved one, you want to discover what she wants from you in the future. In the simplest form, she may just want you to stop saying or doing whatever it was that caused this wound. As in understanding feelings above, you may need to imagine what she is asking for if she is not explicit. The better you do at this, the better the resolution at the end of this healing process. If you can discover or interpret a constructive step you can take in the future to prevent these hurts, you can come out of this healing process more of a hero than a schmuck.

After actively listening to your loved one, after uncovering the answers to these questions, and after allowing her to decide when she has said what she needs to have heard, you may cautiously move on to the next step. If you move on prematurely, you will likely hear your loved one begin talking more about her hurt. Somehow you have given her the impression you didn’t hear it all. There’s still dirt left in the wound. Continue to listen until the wound is clean.

In Healing Hurts 3 we will take the information you gathered in these steps and move on to the next step in the healing process: Empathize. Stay tuned.

You’ve just hurt the one you love. She has put up her emotional shield of anger to protect from being hurt again. This is not the way you thought this discussion would end. But here it is, painful, perhaps ugly, and in desperate need of repair.

It is at these times that we are most naturally inclined to withdraw. After all, who wants to approach a fire-breathing dragon, even if it is one of our own creation. Most of us run from the prospect of getting scorched by the flames of this now emotional beast. We may part somewhat gently: “I’m sorry. Let’s talk later.” We may part more neutrally, not wanting to expose ourselves emotionally: “Whatever!” Or we may make the grievous mistake of parting with reciprocal anger: “I can’t talk to you when you’re angry!”

The problem with withdrawal at times of hurt is that it does nothing to heal and usually aggravates the situation. It feels natural to withdraw in order to cool things down, and from the standpoint of our own emotional safety, it makes sense to run from the dragon. But it doesn’t help.

Worse than withdrawal is defending our hurtful statements, trying to explain what we meant to say, or worse still, countering our loved one with hurts of our own. All of these actions serve to aggravate the hurt and distract from the essential need at this moment, to begin the healing of the hurt we inflicted.

Paradoxically, what love requires of us, what emotional healing requires of us is the courage to stay to listen. If you want to help your loved one begin to heal from the pain you inflicted, even unintentionally, you must stay to listen. Put on your emotional armor if you must, or get ready to emotionally dodge the coming feedback so you don’t take a retort right between the eyes, but stay, to listen, out of love.

The primary purpose of this listening, the start of cleansing emotional wounds, is to hear and understand the feelings of your loved one. You may, out of accurate empathy, have a good idea of how she feels at this moment. You may understand that the anger is a shield, a reflexive protective covering, and that underneath is the hurt, the vulnerable emotional belly so carefully guarded by anger. But this is not the time for you to talk, or worse, offer insights such as those presented here. Now is the time to listen.

Listening is the first step of the LEAP process for healing emotional wounds in relationships. LEAP is an acronym for four vital steps in this healing process: Listen, Empathize, Apologize, and Plan. To do this effectively, we must understand the steps involved and practice them to perfection. Stay tuned for Healing Hurts 2.