Compass For Counselors

Calendar for San Diego therapists and counselors

2012-02-02T21:54:14Z

Hi all,
I know it’s been a while since I’ve written. Work, school, wedding planning, and basic living – it’s been difficult, to say the least, to do it all at once! I have so much respect and wonderment for the students who simultaneously work full-time and have children to care for.

So to compensate for my writing hiatus, I thought it would be helpful to create a calendar that lists all MFT-related events in San Diego county. I hope that this resource will be helpful for the local MFT and counseling community. If you have an event you want to add, please email me at ky[at]compassforcounselors.com!

The calendar can always be found on the right hand column of this blog…or you can just click on the image below:

Art Therapy

2011-11-07T00:16:31Z

Portrait #1

Even though I have had a long history with art, I have always been hesitant to do what I call “expressive art” – that is, art that reflects one’s perception of people, places, experiences, and emotions. This is in contrast to art that aims to capture physical reality. For much of my life, I have strived to master the latter – only to be madly discouraged at the complexity of such a feat!

It’s been some time since I’ve done any art, but the topic has been reeling in my mind recently. A few of my classmates have been experimenting with drawing in their sessions – and we also recently watched a video on doing art therapy with children.

I had a lot going on yesterday, so I thought, “What the heck? Why not some art therapy?”

I dug up my old art supplies – oil pastels, paper, markers, paper.

I quieted my inner art critic, the one that taunts me: “If it’s not perfect, it’s not good enough.”

I gave my hands absolute freedom.

Portrait #2

In the process, I asked myself many questions: Why am I using so much orange and reds? In the head space of “letting go”, why is there still so much structure and symmetry? What is the meaning behind the chaos partnered with orderliness?

In the end, the pieces that I drew were clear reflections of my emotional state, the way I think, and the way I work. Putting everything on paper forced me to acknowledge emotions that I kept quiet. It also helped me to accept the ways in which I choose to operate vs. always striving to be different.

I did not originally intend to blog about this, but this was such a wonderful experience for me, I wanted to share it with you all. I hope this gets you thinking about using art therapy in your practice!

On the righthand side are two of the four pieces that I completed yesterday.

Theorizing About Counseling Theory

2011-11-05T05:12:23Z

Theory is a huge part of our counseling training. Theory informs how we position ourselves with our clients, how we conceptualize our clients’ problems, how we determine what interventions to use in our treatment. Theory is the invisible hand that guides what we say and what we pay attention to in our sessions.

In our first year of school, we spent a semester learning about some of the primary schools of theory in MFT: Bowenian, Structural, Cognitive-Behavioral, Narrative, Collaborative Language Systems, and Solution-Focused. In the last two months, I have really struggled in figuring out if any of these theories truly resonate with me as a therapist. However recently, one of my professors said something that made complete sense to me: “Choose a theory that matches your worldview. If you don’t really believe it in, you’re just going to come off as not being genuine.”

It made me realize that perhaps I don’t entirely believe in the tenets of some of the post-modern theories that I have been experimenting with. And neither do I truly connect with the ways that the traditional theories conceptualize families and individuals.

I am learning that I do love some of the major ideas behind post-modern theories – the client being the expert and the therapist being the collaborator, the problem being separate from the client, mining the client’s strengths and support system, etc. However, I am still craving for a theory that provides a more concrete map on how to conceptualize the problem and the solution, and a map on how to structure the treatment. I am becoming more accepting of how I thrive on structure and direction; without it, I feel like I’m just floating on air.

This self-understanding explains my almost-immediate love for Motivational Interviewing, Dialectical Behavioral Therapy (DBT) and Emotion-Focused Therapy (EFT) – and I am gravitating towards specializing in one of these theories. In this blog, I have only written about Motivational Interviewing, but plan to write about DBT and EFT in the coming weeks.

I wanted to use this post to introduce my ongoing process in thinking about counseling theory – I would love to hear how your journey has been similar or different from mine. If you feel like sharing, please comment in the section below!

- Ky Ngo

Silence is not dead space

2011-11-05T05:14:12Z

photo credit: Casper Moller (Flickr CC)

I’ve recently started a daily meditation routine in the mornings. A few weeks ago, I was meditating lying flat on my back when I sensed my heart beating. My body’s heartbeat is usually so faint that I cannot detect it even in my quietest state; but on this particular morning, I could hear and feel it pounding in a steady yet urgent pace. I tuned into the rhythm and found myself sinking in the spaces in between the beats…the millisecond moments when absolutely nothing was happening: no heartbeat, no flow of air, no blinking, no thinking, no doing. Those moments were pure stillness and quiet. I let myself linger there and savor it – all without my usual anticipation of what was going to happen next. Ironically, being present in these in-between moments made it easier for me to be present in the moments that followed – the next heartbeat, the next breathe, the next movement.

The in-between moments in my meditation is akin to the in-between moments in my therapeutic conversations – the moments between words. I am very aware of my compulsive tendency to avoid silence in my sessions. I fill potential gaps of silence with half-constructed questions, reflections, my ideas on what the client just shared, and, frankly, whatever I can get out of my mouth! I associate silence with awkwardness – and I become fearful what my clients think about me when I give silence a seat in the room. What I’ve observed as a result of this tendency is that the conversation feels rushed, and the client may even feel that they are not being heard. Nervously anticipating what I am going to say next translates into my not taking enough time to make meaning from what they shared. The fear of the in-between spaces of a session has only led to sloppy, unguided and hasty conversations. The fear keeps me from being present with myself and my clients because I was always anticipating what was coming ahead.

Imagine the difference when I applied my meditation insight to my counseling sessions…

After my client shares something or after I ask a question, I practiced letting the room go silent for several moments. Usually one of two things would happen: the silence gave space for the client to say more OR their silence signaled that they wanted me to carry on the conversation or to otherwise re-ask my question. When the former happened. the client often brought conversation that is rich, and our connection felt strengthened. When the latter happened, I simply acknowledged the cue and proceeded to formulate a better-formed question or response.

Giving silence space in the conversation was a little uncomfortable at first, particularly with clients who are not talkative or have yet to open up to me. However, this has helped me feel so much more present as a therapist that the potential for mild awkwardness doesn’t keep me from practicing it. I’m finally beginning to learn what it means to practice with SLOWNESS (thanks for always reminding us of that, R.E.).

After reading this, I hope you take away the idea that silence is not dead space; a lot can happen in silence or as a result of silence…but you can only know it if you try it…

- Ky

How do counselors NOT bring their clients’ stories home with them?

2011-09-20T05:48:46Z

This is my first time making real references to my client work in my blog posts – and I will attempt to do so without actually revealing any details whatsoever about where I am working and who I am working with. If you see any discrepancies in my efforts to do so or know of a better way to protect client confidentiality while still producing meaningful writing, please let me know.

I should preface this by expressing that I feel incredibly privileged when my clients feel safe enough to share intimate and heart-felt stories with me especially in our first few sessions. Therapy/counseling can be an unfamiliar setting for many people. I mean, imagine meeting someone for the very first time and, in the first 30 minutes, revealing details that you may not have ever shared with your loved ones. The therapy setting can be very uncomfortable and people may choose not to disclose too much in the initial stages of therapy.

Last week, I had two very enriching client sessions, both in the beginning stages of counseling. Both clients on this particular day talked in depth about the multi-layered hardships that are currently taking over their lives. I sunk myself into their stories – and didn’t realize until much later that I was still swimming in their words throughout the day. My clients deeply humbled me and put my own life “problems” in perspective – problems that do not begin to compare to their life difficulties as marginalized, minority members of society. It made me feel hugely grateful for the privileges in my life – the privilege of knowing that I can make ends meet, the privilege of a healthy family, the privilege of having people in my life who I can always rely on for emotional or financial support if I find myself in a difficult spot.

I headed home and found myself trying to disconnect from the heaviness in my heart. I tried to distract myself – watching some TV, snacking, checking email – but nothing really helped until I could acknowledge what was going on with me. Later that evening I realized why I wanted to drift away so badly: I haven’t figured out how to break away from my clients once I left the therapy room. I carried them home with me – a tendency that is natural of my empathetic self but is ultimately negative to my own mental health.

As you may have already guessed, this blog is not meant to give cookie-cutter answers to the very complex issues that come up for counselors. I’m much more interested in hearing what your experiences have been like and what has worked for you. So, with that said, here’s a question for all counselors reading this RIGHT NOW: What do you do to unwind after an emotionally intense session with a client?

The meaning of marriage

2011-09-12T00:59:42Z

Photo Credit: Fireman58 (Flickr Creative Commons)

As counselors, it is essential to sort out and assess our pre-conceived notions on “big” topics early in our careers. This week, in my couples therapy course, we were asked to think about one of several questions on relationships and marriage. So, for the last few days, my feeble mind has been trying to tackle the question, why does marriage exist?

First, I have to admit: a year ago when I first started my counseling program, I was very cynical about the idea of long-term relationships. My stance on relationships at that time could have easily translated into a number of scenarios in the counseling room: not having faith in my clients’ relationships, easily attributing my clients’ relationships problems to incompatibility or “a bad match”, or encouraging my clients to find a better fitting partner. Even though my thoughts on relationships have completely shifted since then, it is nevertheless essential to be cognizant of how my worldview affects my client work.

When I think about these “big” questions, I am constantly asking myself: where do my ideas come from? My post-modern training has taught me how dangerous it is for counselors (or anyone for that matter) to believe that their ideas are objective or innate; our school of thought believes all ideas are socially constructed. Although it may be difficult to map out exactly where each of my ideas originated (and I don’t attempt to within this post), I am nonetheless aware that my upbringing, my culture, my exposure to media and politics, and knowledge I’ve gained from school have all contributed to my meaning-making of marriage.

Now back to the main question at hand: why do I believe that marriage exists? From a macro perspective, I see marriage as a social tool to achieve social means. Some of these means make sense to me, such as the social striving for “stable” families (children with two consistent caretakers/providers) and adherence to the idea that paired living is more resourceful than single living. Marriage as a social tool also has its share of oppressive consequences. In my eyes, society stresses the importance of marriage to curb women from engaging in “inappropriate” behavior, such as having pre-marital sex, pre-marital cohabitation, and raising children out of wedlock. Growing up in a Chinese-Vietnamese culture, one of the most important tenets that my family demanded that we follow was “wait until marriage”. However, I’m fully aware that when men do not wait until marriage to engage in these same behaviors, the family unit and society is generally complacent.

From a micro (and more romantic) viewpoint, marriage exists to formalize the commitment between two people to love, support and be with one another for life. Being one of the few things in life that is “forever”, marriage binds two people together so that even through the most difficult times, they have promised not to abandon one another. I have this idea that without a sense of family or community, people easily act out of selfish and individualistic intentions. The partnership of marriage serves to teach individuals to love and give to one another unconditionally. Within the Western world, I find marriage particularly important as a way to escape our individualistic mindset and develop a stronger sense of relational value.

As you can tell, I have some incongruent feelings about marriage. However, I want to point out that even though I am critical of marriage as a legal/political institution and social tool, I’m able to reconcile my skeptical views with my personal faith that marriage is positive for the growth of couples and communities.

I wish I could end this thought with a clean conclusion – but, honestly, my search for answers has only brought up more questions. I’m really interested in what others think about the original question “why does marriage exist?” and the questions below – they are too bewildering for me to think about all at once!

How has your perception of the “sanctity” of marriage changed knowing that one out of two marriages in America end in divorce?
How is the relationship quality of a committed, unmarried couple different from that of a married couple, if at all?
How does the politics of gay marriage affect how you view the institution of marriage?

Motivational Interviewing: Stages of Change

2011-08-28T06:15:16Z

Before I start my second post on Motivational Interviewing, I just want to send my well wishes to everyone on the East Coast affected by the hurricane. This one is a big one, so I won’t expect it to pass through without significant damage – but I hope everyone is looking out for each other’s safety.

credit: SAMHSA

I wanted to briefly write about the Six Stages of Change, which is a core concept in Motivational Interviewing. As you may remember from my last article, Motivational Interviewing is a technique used when the treatment goal is change in behavior. As my MI professor, Diego Rogers, said, “We often think of change as an off and on switch. One day, you’re ‘not going to the gym’. The next day, you say ‘I’m gonna start going to the gym every day’.” In reality, there are several stages that precede change and several stages after one initiates the change:

1) Pre-Contemplation: the person denies that they have a problem and rejects the idea of change.
2) Contemplation: the person begins to play with the idea of change but still not fully bought in.
3) Preparation/Determination: the person begins to make near-future plans for change and action steps.
4) Action: the person is actively implementing the action steps but may experience setbacks.
5) Maintenance: the behavior change is sustained for six months or longer.
6) Relapse: the person returns to the previous behavior after 6 months of more of sustained change.

My professor talked about having seen many counselors burn out because they are working so hard to help their clients, but, many times, the client reverts back to their problem behavior. This situation can arise when the clients are not even ready for change yet the counselor expects them to be once they start treatment. After all, isn’t that what therapy is for…when you’re ready to make a change? This definitely is not the case. Apparently, 80% of clients coming into therapy are still in the first three stages of change – meaning that are not ready jump straight into implementing action steps.

Having said that, it also does not mean that if a client comes not fully ready for “action”, you should throw your hands up and say “there’s nothing I can do if you’re not ready!” After all, your job as a counselor (according to MI, anyway) is to guide the client towards positive change. And you can do this by practicing the four principles of MI mentioned in my previous post.

In MI, the counselor should start treatment by assessing the client’s stage of change (and to periodically re-assess). If the client is in the pre-contemplation stage, the counselor can dedicate the initial sessions to exploring possible internal and external sources of motivation so that the client can move towards the next stage, “contemplation”. Often, external motivators (“I want the courts to get off my back” or “I’m afraid one day my spouse might leave me because of this”) are sufficient starting points to move forward and then to more deeply explore internal motivators (“I want to be there for my wife” or “I want to become a better mother for her”). In the initial sessions, the counselor must especially focus on the first principle of MI “Express Empathy”; unless the client feels heard and understood, it is difficult to move forward.

After several sessions, even if the counselor has skillfully used the MI principles, the client may may not budge from the pre-contemplation stage. The counselor must then use her/his best judgement to decide how to proceed. In a county mental health clinic where resources are limited and demand is high, termination with an “open door policy” if the client chooses treatment further down the road may be the best option.

When I first learned about the Stages of Change, I automatically thought of a client who I had seen for several sessions. I struggled with this client because her emotional outbursts were obvious to me as needing change. As a naive beginning counselor, I wished that she would just acknowledge her problem so we could start working on action steps – that would make my work so much easier! Now I’m aware of where I went wrong. In reality, she was in the pre-contemplation stage – and it didn’t help that I was not spending enough time empathizing and learning to understand her situation. I tried to rush ahead without even having rooted myself in her story and her perspective. Now, I see how truly essential it is to assess (and re-assess) a client’s stage of change when beginning my work with a new client.

Now you have a sense of what the 6 Stages of Change are, what impact do you imagine it can have on your client work? How is this change model different from how you’ve previously understood change?

Reference: Rogers, D. (August 12, 2011). Motivational Interviewing [Powerpoint]

The Basics: What is Motivational Interviewing?

2011-08-30T04:15:29Z

Official Book on MI

Last week, I had the opportunity to take a two-day intensive workshop on Motivational Interviewing (MI) as part of my MFT coursework. The course was taught by Diego Rogers, currently a director at the Community Research Foundation in San Diego. Prior to the class, I was aware of the popularity of this technique but had no idea what it was all about. I knew that many county mental health workers had been trained in it. Additionally, an acquaintance of mine recently learned the technique as part of his psychiatry rotation in medical school. Knowing that MI is a widely used, post-modern technique, I was pretty stoked to start the class – little did I expect that this workshop was going to dramatically reshape my understanding of my role as a therapist and my confidence working with clients.

MI was developed in 1983 by William Miller and Stephen Rollnick – and initially designed to treat alcohol and substance abuse. However, the technique can be applied in all cases pertaining to any change in behavior.

I find that this technique is particularly useful for beginning therapists whose natural inclination is diving straight into problem-solving mode. I know that when I started working with my clients last year, I had almost immediately forgotten all of the basic counseling skills I had just learned (basic listening skills, reflecting, summarizing, etc.) and, because of the seriousness of my clients’ issues, usually defaulted to trying to “fix” them. With my problem-solving cap on, I felt blinded and ran into many dead-ends during my sessions. What was so reassuring In MI, it is not the therapist’s role to resolve a clients’ life problems. Instead their role is to help the client sort out their ambivalence towards change.

Let’s imagine a scenario where a male client, Shane, is sent to therapy to work on his “marijuana problem” by the courts. On one hand, Shane believes that his marijuana use is not a problem and that the real problem is getting in trouble with the authorities. On the other hand, he knows that if he gets caught using again, he will face larger penalties and possibly jail time. He is also aware that his live-in girlfriend is not happy with his pot usage and it has been a source of many arguments. As illustrated, there is ambivalence towards change/acknowledgment of the problem – but just below the surface, there are lurking discrepancies (i.e. girlfriend’s disapproval) that might act as motivators for him to reduce or stop his marijuana use altogether. It is important to note that throughout the sessions, the counselor does not actively persuade the client to change nor push him when he is not ready; that would be contrary to the “MI spirit”, which believes that active persuasion can hurt the client-counselor connection. Additionally the “you have a problem and this is what you need to do” counselor approach can often make the client go the opposite direction.

Having said that, it also does not mean that MI advises merely waiting until the client says “OK, That’s it. I’m ready to change!” MI is strongly influenced by Carl Rogers’ client-centered therapy where one of the main premises is that the client leads and the therapist follows. However because MI is geared towards creating change and commonly used for behaviors that are high-risk or potentially life threatening, the exclusive use of the Rogerian approach is not sufficient. Although the therapist is not in the position of persuading, they are, however, in a position of guidingthe client toward positive change.

photo credit: SAMHSA/Homelessness Resource Center

I find MI’s four guiding principles valuable in understanding how this technique can be both client-centered and directive. And, even more importantly, I find that these principles can act as a directional compass in my sessions with clients:

1) Express Empathy – maintaining a non-judgmental, empathic attitude towards the client and developing connection through the use of the OARS (open-ended questions, affirmations, reflections, summarizing).

2) Roll With Resistance – when the client resists the treatment or treatment goals, the therapist should empathize with him/her rather than confront it or persuade the client to stop resisting.

3) Develop Discrepancies – the therapist empathizes with the client’s ambivalence towards changing their behavior but also helps to amplify it (e.g. “On one hand, I hear you saying that you’re not ready to stop using. On the other hand, you seem to be concerned about not getting into trouble with the law again. You’ve also acknowledged that this is causing a rift in your personal relationships. How do see all that fitting together?”)

4) Support Self-Efficacy (Elicit Change Talk) – the therapist helps the client to talk about the pros/cons of change. The therapist also looks out for and elaborates on any “change talk” in the client conversation (elaborated by the “DARN-C”; more on that in a later post).

My biggest lesson in taking this workshop is the basic counseling skills (active listening, empathy, reflecting, open-ended questions, etc.) must act as the foundation to any technique or theory. Not having seen any clients in the last few months (due to summer break), the MI workshop was a great opportunity for me to see how simply practicing the OARS can make such a huge difference in building connection with a client, particularly with “difficult” clients. I also see it making a big difference in easing my “beginning counselor anxiety” because it demands that I let go of my problem-solving tendencies, which has not proved to be useful, thus far, in my client work.

In my next blog post, I will go over the 6 Stages of Change, a core concept within MI. If you’re interested in reading more online, I recommend glancing at these two references: PDF from the official MI website and http://motivationalinterview.net/clinical/whatismi.html. If you see anything in my explanation of this technique that needs clarification or correction, please feel free to give your feedback in the “comments” section.

Thanks for reading…until next time!:)

Reference: Rogers, D. (August 12, 2011). Motivational Interviewing [Powerpoint].

Welcome to my counseling blog!

2011-08-21T18:10:23Z

So, what’s the deal with this blog? Who are you?! What the heck is a “compass for counselors” and how do I get my hands on one?

So many questions unraveling (and many of which I don’t have the answers to), and I haven’t even published this yet! Let’s see if I can get through my first post before my brain and ego combusts…

Yes indeed, this is my first post and I want to welcome you all to my new blog, Compass for Counselors! A year ago, I started my new life as graduate student at SDSU’s Marriage and Family Therapy program – and, little did I know, that my life was going to be completely transformed. My post-modern schooling has deeply shifted my worldview, my personal relationships, my understanding of systems vs. individuals, and my own personal struggles.

As a writer, I wanted to build a space to share some of the knowledge and experiences that have touched me as a counselor and as a human being – but still bearing confidentiality of the people whom I write about and respecting my own boundaries of personal disclosure. And as a new blogger, I want to find ways to connect with YOU – members of the counselor community – and open opportunities for my readers to lend their voices.

And for you to know: I’m a perfectionist by habit and, to my detriment, always feel like I have to know all the answers before I make my work public. But, for this blogging project, I’ll let time and readership shape the course of whatever this is meant to become.

If there are certain topics that have your interest and curiosity, please share it as a “comment” below. And if you like what you read, please subscribe via email or RSS!