Next Level Practitioner

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1 Next Level Practitioner - Best Advice Week 89, Day 1 - Ron Siegel, PsyD - Transcript - pg. 1 Next Level Practitioner Week 89: The Advice We Gain Through Practice and Supervision Day 1: Why It s Useful to Help Clients Learn to Map Their Experiences with Ruth Buczynski, PhD and Ron Siegel, PsyD

2 Next Level Practitioner - Best Advice Week 89, Day 1 - Ron Siegel, PsyD - Transcript - pg. 2 Week 89, Day 1: Ron Siegel, PsyD Why It s Useful to Help Clients Learn to Map Their Experiences Dr. Buczynski: How do you know where you're going if you don't have directions to get there? Well, that's a realization that Dr. Ron Siegel came to after discussing a tricky case with his own therapist. You see, Ron's therapist helped him see a blind spot that many practitioners have. And it changed the way Ron guides his clients from suffering to healing. Dr. Siegel: I got this from my own therapist who used to cross the line into supervision a lot, because sometimes I d be distressed about a clinical case and he d help me out with it. This was many years ago, and Most people don t have very useful maps for how thoughts, feelings, and relationships work. he said most people don t have very useful maps for how thoughts, feelings, and relationships work. It s such a simple insight. But after decades of clinical work, it seems so true to me kids, at least in high schools that are a little bit more advanced, may graduate with a decent understanding of things like differential calculus, quantum physics, linear algebra; and they ve never had even a few minutes of a course saying, What is a thought? What are feelings? How might one work with thoughts when they come up? What does one do when a feeling arises? It occurs to me that it s quite true. A liability that we can have as mental health professionals, those of us who are trained in this, is we are so used to talking about models of thoughts and feelings and how to work with them and the like, that we simply assume that other people have sort of sophisticated maps for this and often they don t; they have maps that haven't been thought through very much. Often, I would feel that to be helpful as a therapist, I need to do therapeutic magic; I need to help the person get in touch with some deep, dark feeling; I need to help the person rework the whole sense of their childhood. We assume that other people have sort of sophisticated maps for this and often they don t.

3 Next Level Practitioner - Best Advice Week 89, Day 1 - Ron Siegel, PsyD - Transcript - pg. 3 It s not that I don t do that kind of thing sometimes; sometimes that is what the work involves. But sometimes simply helping the person to develop a map of where they are perhaps how they got there, and perhaps where might they go from here can be enormously useful. One way that I do that now is by asking the client or the patient about his or her map: What do you do with feelings? I ask these very simple questions: What is a thought exactly? And how do you think we should work with thoughts that are disturbing? What have you been seeing? What have you seen? And what have you been told? it all becomes part of the inquiry. This itself is very, very helpful for getting people to examine their own maps and then to become curious about, are there other maps? Are there other ways to doing this? Of course, there s a danger in this you don t want to have the therapy only be cognitive and not to also help them do the work of dealing with challenging images and feelings alike though, as it turns out, learning how to be with difficult feelings is often part of the map, so that s often part of where we re going to go anyway. So, as long as we don t just do it as a cognitive exercise, I ve found his advice very, very helpful. There are so many different times that I ll try to help evolve maps with folks, but one map that I find comes up again and again is a map of how trauma works. For example, it s so common for people to be confused by trauma symptoms by hyperarousal states, in which they are flooded with adrenaline, can t work cognitively, and are having intrusive memories; or by the hypoarousal states, where they re feeling numbed or dissociated, or just falling asleep, or fainting and the like. I can think of one patient I had with a bad trauma history who couldn t sleep and was very overwhelmed with relationships. She would often panic when she was in the presence of men because she had had particularly bad experiences with males when she was young. And in fact she had a seizure disorder which, after a lot of investigation, turned out to be pseudo seizures; she didn t actually have epilepsy but she had fainting spells and she also had a lot of incidence of spaciness where she would just wander off, or find herself having missed several exits on the highway, and other forms of

4 Next Level Practitioner - Best Advice Week 89, Day 1 - Ron Siegel, PsyD - Transcript - pg. 4 spacing out. This was one of these cases where just beginning to talk about hyper and hypoarousal and it didn t even have to be very sort of detailed. Pretty much everybody agrees that we either relate to threat with fight or flight or with shutting down, as the mouse does that s caught in the jaws of the category. And just beginning to talk to her about this was so, so helpful to her because it made her feel first that she wasn t broken, that she didn t have some mystery disease, but that she was just experiencing a very basic mammalian response to threat and indeed, she had been deadly threatened, so it made sense. It also helped her to not feel like she had to control the reactions. Prior to having the map, she felt like, I ve got to get rid of these arousal states whether it s the hyper or the hypoarousal state, she felt, I ve got to calm down if hyperaroused, and I ve got to snap out of the spaciness if hypoaroused. And then she started realizing, No I can just ride this out. This is an expectable nervous system response and it will settle out if I give it time. It really worked quite well for her. Now, of course it doesn t always work well; there are situations in which the map-making tends to backfire and I ve had these as well. This has happened when I get too heady; I think what happens is my own joy in map-making and coming up with the cognitive framework for what s going on, dovetails with my own resistance to sitting with the client or the patient s pain. Then I make maps rather than empathically connect. And that s happened to me many times, I m sorry to say. I think of once with a woman who I worked with who was quite depressed because she had always felt quite unloved and in fact, in her family of origin you could see where she got that message from. In retrospect and partly because we found our way here I think what she needed most was many, many sessions of me just being there, doing a little bit of reflection while she cried, while she just stayed with the deep and wide pool of tears that she had from this experience. What was helpful was me just sitting there and being with the pain. I would try to bring us out of it you know, make a map to find a pathway through, and most of the time that wasn t very helpful to her;

5 Next Level Practitioner - Best Advice Week 89, Day 1 - Ron Siegel, PsyD - Transcript - pg. 5 what was helpful was me just sitting there and being with the pain. So, even though map-making can be enormously helpful, it sometimes doesn t hit the spot. Dr. Buczynski: It s kind of like when to do something and when to just witness. Dr. Siegel: Yes, exactly. Dr. Buczynski: As Ron pointed out, many people don't have a framework for understanding feelings and thoughts. But with a balance of empathy and mapping, we can help them understand where they are, and how to move forward. Now tomorrow, we'll discuss when we should trust our instincts, and when we shouldn't. But now, I'd like to hear what you think: How will you use these ideas with your clients? Please leave a comment below. I'll see you tomorrow.