therapist – Pamela Helberg

B is for Behind (Already!) or Boundaries

Published on April 5, 2017April 5, 2017 by Pam2 Comments

I decided a few days ago that B was going to be for Boundaries—a relevant topic now that I am a counselor and caregiver (see A is for Alzheimer’s). But then life intervened in unexpected ways and while I should be cranking out my C is for . . . blog, I’ve still not gotten around to B. Also, there’s the little matter of a poem to go along with. Every time I sit down to write a poem, I get interrupted. Poetry is challenging enough without constant interference. I wrote one the other night, but I’m not sure it is suitable for public consumption—in fact, I know it isn’t. So, back to the drawing board.

A few words about Boundaries. Boundaries are those imaginary lines that we draw in the sand between us and the rest of the world. The word “no” is a boundary, as in “No, I cannot help you move this weekend (or ever).” Boundaries are personal bubbles, as in “if there are 90 empty seats in the movie theater, don’t sit right next to me if you don’t know me.” I am continually amazed at how often this boundary gets violated (especially in Bellingham). Boundaries can be fences, hedges, the edge of the lawn, a strategically placed flowerbed, or (if you are Cheeto Satan) a $65 billion wall between countries. What all of these borders, imaginary or actual, have in common, is they separate me from the rest of you in some way, or us from them, or my yard from your yard, or my body from your body, or my time from your time. Stepping across the line means I am choosing to merge some part of myself with you.

As a counselor, having boundaries means that I must keep our relationship confined to the counseling setting. It’s a bit odd, this particular boundary because while you (the counselee) may chose to tell me (the counselor) many intimate details about your life, I will not reciprocate with intimate details of my own. Normal relationships (friendships, intimate partners) rely on the mutual sharing of such information across boundaries to create a sense of closeness. You tell me an intimate detail, a secret, something you’ve not shared before, and I reward you with a secret/intimate detail of my own, our friendship grows, intimacy flourishes, the exchange is reciprocal.

Not so in counseling or therapy, which works differently. You tell me (the counselor) a secret, and I reflect it back to you, usually with a question. Something like “what meaning might you assign to the anger you have for your father?” or “what would it mean to you if she asked you out on a date?” or “how has being abused as a child affected your parenting of your own children?” Or maybe even (if I’m feeling stuck) “how do you feel about that?”

As a counselor, I have to have Boundaries because how helpful would it be if you disclosed your traumatic childhood to me, expecting insight and healing, and I said to you “Wow! My childhood was traumatic too”? Or, even if I did determine that some level of self-disclosure might be warranted (a quick rule of thumb re: self-disclosure: it can be ok if it helps the client, but not if it’s only for my own sake, i.e. to make me feel better), how helpful would it be if I confused you by having loose boundaries in the therapy room but then ignored you when I ran into you at the supermarket? If I took your money (or insurance payment) under the auspices of helping you but came to rely on your feedback and your insights? If you leave a counseling session knowing more about your therapist or counselor than he/she knows about you, somebody’s Boundaries are too loose.

Therapy is a very specific sort of exchange, one that depends on firm Boundaries. Less than firm Boundaries create all sorts of havoc and may result in the counselor or therapist losing their license. Lapses in ethics often result from lapses in Boundaries and can be a very slippery slope. Loose Boundaries can lead to inappropriate friendships and perhaps even sexual liaisons between therapists and clients. Sleeping with a client is never a good way to help them heal. It might make the client feel special initially, but will eventually destroy them (and probably the counselor as well).

Even something as seemingly benign as a friendship can become problematic between a therapist and client. As your friend, I have a vested interest in telling you things you want to hear, things that will keep you as a friend. As your therapist, I have a duty to tell you things that you might not want to hear but need to, things that will help you heal and move forward, things that a friend wouldn’t tell you. Boundaries make it possible for me to be your counselor.

Confused yet? It’s tricky, I know. But trust me, this is one lesson you’re better off NOT learning directly.

Related Haiku (this is an old one, but relevant)

Please do not invite
me in and then abandon
me at the threshold

The Pinocchio Paradox, or How to be a Real Counselor

Published on June 7, 2016June 8, 2016 by Pam11 Comments

“The doctor is effective only when he himself is affected. Only the wounded physician heals.” —Carl Jung

methow morning — My writing table in the Methow Valley

A year ago I sat at this very table faced with the onerous task of writing a final class paper. Again, I have the same chore in front of me, albeit for a different class. Back then, I had to write a proposal for a group therapy group. Now I must reflect upon my time as a practicum student, as a fledgling counselor seeing clients for the very first time. What are my strengths? What are my weaknesses? (No, it doesn’t say weaknesses, the assignment says “areas of growth” but we all know what that really means). What did I learn about my clients? How did I experience myself in supervision, and how do I want to grow in this area?

Let me just say this at the outset: seeing clients for the first time, the first two, three, four, five times is flat out terrifying. I’ve had two years of classes and coursework preparing me for sitting in a room with someone who wants help. I’ve participated in numerous role-plays and fish bowls and practice sessions with my student colleagues. I’ve had more personal therapy than the average bear over the last twenty-five years, and still. What can I possibly do for the anxious or the depressed, the overtaxed, the under functioning, the overcompensating, the abandoned, the unloved, the overachieving, the lonely, and the traumatized who sit in the chair across from me?

How can I possibly help?

For years I wanted nothing more than to be a therapist. The women I most admired were the ones who had listened from that chair as I unburdened myself of my anxieties, depressions, anguish, loneliness, and traumas. I thought about how amazing it would be if I could bring the same sort of listening ear, the same sort of compassion, the same sort of hope to others that these women had given to me. But I didn’t think I was healthy enough to be a counselor. I didn’t believe that I had the capacity to help myself, let alone anyone else.

But then in the spring of 2013 I had a chance encounter with the author Claire Messud who wrote The Woman Upstairs and The Emperor’s Children. We chatted about her character Nora and what happens to us as we age and begin to realize that perhaps our previously unlimited horizons are shrinking. At some point, Ms. Messud said to me, you wake up and realize that you simply don’t have enough time left on this earth to fulfill all of your dreams. Where once so much was possible, you begin to grasp the reality that you’ve reached a point where that is no longer the case.

That is when I understood that regardless of what I thought about my own mental health or lack thereof, if I didn’t do something about pursuing my dream my horizon would shrink even further. If I didn’t enroll in school soon, my dream might slip away. I signed up for the necessary prerequisites and enrolled at Antioch a few months later.

And what I’ve learned in the time since then, and particularly this quarter as I’ve worked directly with clients, is that my experience on the other side of the couch, my years as a client, what I previously saw as my greatest weakness, is actually my greatest strength and most valuable asset.

What I have learned in practicum and in supervision is that I am enough. Who I am is precisely what I need to be to be effective with clients. I haven’t learned this from my clients. I’ve learned this from my peers primarily, and from my instructors, and from my own therapists. And slowly I’m beginning to see it for myself, from within myself. And that’s the thing—we usually can’t see in ourselves our own strengths. As I move forward into my second quarter of practicum and then into a full year of internship, my greatest opportunities for growth will be in recognizing my own strengths and trusting my own wisdom, sourcing my confidence from within rather than looking to others to reflect my strengths back to me.

I’ve learned from my clients that they too have all they need within them and simply need to be heard, to be given a chance to lay their vulnerabilities and fears out there in order to sort through them, evaluate and ponder, decide what’s working and what’s not, learn how to hang on to the useful and discard the useless. While self love and self compassion are the ultimate goals, sometimes we need external validation from someone we trust, someone whose values align with our own, someone who can see what we’re seeing and tell us we aren’t crazy or imagining things. Sometimes we just need to be seen and heard in a world that seems to be ignoring us.

I learned basically the same thing in supervision that I learned from my clients—I learned to trust myself, that I didn’t need to put on a persona or be an all knowing font of wisdom or channel the great mystics of the ages. I learned to be real, to be myself,

to trust my instincts, and to be present. I learned that I am enough and to bring my self to the sessions. I think my greatest learning this quarter came when I was seeing my own counselor and parsing through my anxieties about practicum and seeing clients. She stood up and walked over to a cabinet near me, opened the glass door and took out a porcelain Pinocchio statue. She set Pinocchio on the small table between us and asked me what Pinocchio wanted more than anything.

“To be real,” I answered. “He wanted to be a real boy.”

“Exactly,” she said. “Don’t be afraid to be real, Pam. When you are real, you are enough.”

C is for Counseling, or How I Got into this New Gig

Published on April 5, 2016April 5, 2016 by Pam12 Comments

Turns out that April is Counseling Awareness Month. Isn’t this just a serendipitous turn of events? I’m writing a blog a day, A to Z about my adventures as a graduate student in Mental Health Counseling and the American Counseling Association is making it a special month. Pretty sure I can’t take credit, but still . . . (maybe tomorrow I’ll tackle Delusional and Diagnosis).

I have a long history with counseling. I started seeing a psychologist in 1992 and have been in therapy of some sort consistently since then. For a long time, I thought of myself as having a serious character defect. I was young. I didn’t really understand how counseling worked, or could work. I had only a vague notion of Freud and his couch and Woody Allen’s neuroses.

Prozac and SSRIs hit the market about the time I began therapy* and not long after my psychologist diagnosed me with depression, she and my general practitioner agreed I would do well to try the new wonder-drug, Prozac. And, honestly, I looked forward to some relief. At 29, in 1992, I was a fairly new mom of an adopted bi-racial daughter, in a relationship with a woman 13 years my senior. I had just sold the bookstore I started, owned, and operated for three years, and I had moved back home full-time after living 90 miles away for most of each week. To complicate things, my fundamentalist Christian parents were only just beginning to adjust to my, er, lifestyle (as we called it then) and its unconventionality.

There’s more, but that’s enough. You get the idea. I was a stress monster. The crinkling of a tissue set my teeth on edge. The noise of someone actually blowing their nose sent me over the edge. The first time I swallowed one of those little green and white pills, I felt like I was taking communion. I crossed myself and sent up a prayer.

After four weeks of taking that precious little capsule every morning, I no longer cared who sneezed or how loud. Irritation rolled off my back. The grey veil that separated me from the rest of the world lifted, and I started seeing in color again. Cliché, I know, but accurate. Everything sparkled. I got a good job as the bookstore manager at the local technical college with a great boss as well as health and retirement benefits. Did the little pill have anything to do with my new job? I believe happier, less-stressed, less-depressed people tend to have more self-confidence and do better in job interviews, so yes. But I digress.

I felt good, and I loved talking to my therapist. I loved paying someone to listen to me. I loved the 50 minutes of uninterrupted attention. I could do this for a living, I thought. I’d love to listen to people’s stories, to help them make sense of their feelings, to help them gain the confidence to reach for their high dreams. I had no idea that someone who went to counseling could actually ever become a counselor. I thought my diagnosis and being on meds precluded me ever being in the field.

I had never heard of Jung’s Wounded Healer. I was an English major who, stupidly and stubbornly, avoided all social science classes. The books cost too much. The classes met on Fridays. What can I say?

I wanted to get off the meds, though, yet every time I quit taking them, things in my life would head south, and the psychologist would exhort me to stay on the meds. I got stuck in a loop and never really got to the issues that were causing me to become depressed. I’d just start popping the pills again, and things would improve. Etc.

I spent about twenty years with the psychologist before I found a new therapist, and the woman I chose to see was an LMHC (Licensed Mental Health Counselor). I didn’t know what the difference was when I made the switch, I was just seeking someone a little more flexible and spiritual, a little less dogmatic and not so pharmacologically oriented. Turns out the switch worked very well for me then. I made several changes in my life at the same time: I got a new job, I relocated, I started taking writing classes and running, and found new community with both activities.

The psychologist got me up and out of the depression and quite literally saved my life on many occasions. And the LMHC has helped me move forward from there, developing self-confidence, practicing mindfulness, introducing me to non-Western philosophies. I have learned so much about myself, about why I am the way I am, and how I can move forward.

I’ll never be done working on myself, but it turns out, I can become a counselor anyway, not in spite of my past, but because of it. Jung believed that disease of the soul could be the best possible form of training for a healer. And as Victor Frankl wrote, “What is to give light must endure burning.” By these measures, I am perfect for this job.

*for a more in-depth—but still inadequate—explanation of the differences among therapy, counseling, psychotherapy, and psychology see this previous blog

N is for Names or What Am I?

Published on April 20, 2015 by Pam7 Comments

Last week in my counseling and professional identity class, a class I should have taken four quarters ago, we spent a good hour and a half debating what we should call ourselves: counselors or therapists? I like therapist, personally, and was more than a bit frustrated that we’d spent so much time splitting hairs, focused on semantics rather than content. At my current tuition rate, this inane conversation cost me approximately $150. Yes, we are studying in the Clinical Mental Health Counseling program. And yes, as a group, we are referred to as counselors. But on a daily basis, in my practice, I will call myself a therapist.

Evidently, in the fine state of California, the marriage and family therapist lobby has legally taken the name of therapist for themselves. No one can call themselves a therapist if they are not, in fact, a licensed MFT. But I do not live and practice in California. Nor do I plan to.

Some of my classmates (well, one in particular) thought that therapist reeked of white, upper class privilege. She actually looked across the classroom at me and said something to the effect of “therapy implies rich housewives going to whine about their lives once a week.” Others in the class thought therapist has a negative, destructive connotation, as in electroshock therapy and reparative therapy.

I tried not to take these opinions personally, but I do use the term therapy when I go to see my Licensed Mental Health Counselor once a week. I do not go to whine about my life, however. I go seeking healing and strategies for making my life richer and more meaningful. I go to get help making sense of my history, to learn how it impacts me now. I go to figure out how I can be happier, more fulfilled, less stressed. In short, I seek therapy in order to heal and live better.

In fact, the root of the word, thera, traced back to its origins means “forward” “progress” and “healing,” all of which make me want to be a therapist, to call myself a therapist, even more. To be someone who helps others move forward, to progress, and to heal? Sign me up.

Counselor, on the other hand, to my ear sounds like someone who gives advice, and, in particular, legal advice. Or, like a school counselor–someone who talks to children who have misbehaved. If there’s one thing I don’t want to do it’s work with children. And, if there’s one thing I’ve learned in my five quarters of school, it’s that we counselors/therapists are not to dispense advice. We are to listen, to guide, to inquire, to reflect, to mirror, to ask questions, but we are not to give advice or tell our clients what they should or should not do.

The American Counselors Association (ACA) Code of Ethics tells us that we are to avoid imposing our values on clients (Section A.4.b.) What is advice if not an imposition of values?

The bottom line is that it doesn’t matter what I call myself if I practice in Washington State. I can get my degree in mental health counseling and call myself a therapist or I can call myself a counselor. I can see upper middle class white housewives or I can see lower socioeconomic white people. I can see whoever wants to come and sit across from me and tell me their struggles. I can offer them a chance to heal, a way forward, a path of progress. I can give them therapy.