Becoming Better At Failing

Many young colleagues approach me for guidance as they venture out into their careers as a therapist. I thought I would share my experience in avoiding your patient's improvement and - which is most feared of all - your patient's recovery. 


Here is a Twelve Step Program that will almost certainly guarantee dynamic failure as a therapist: 

1. There is a central pathway to failure based upon combining the following foundational ideas. Combine them from the start to guarantee inevitable failure. 
1. Insist with authority that the problem which brings the patient to therapy is not important. 
2. Consistently refuse to directly treat the presenting problem.
3. Assert that if the presenting problem is relieved, something worse will develop.
2. Diagnose more, treat less. That's the beauty of labeling your patients with the scientific lingo of the medical community that will make you sound like an expert. Even better, you will never risk success in treatment is you stick to diagnoses!
3. Use one method of treatment. Doesn't matter what problem. Schools - not tools. If your patients don't behave according to the method, you can always declare them as "treatment-resistant" or even better "untreatable".
4. Cling to an ambiguous, ill-defined theory of what you should do as a therapist to bring about therapeutic change. It would also be un-therapeutic to give directives for change because there is a substantial risk that your patients might follow them and change.
5. Only years of therapy will every really change a patient. Make that clear from the start.
6. Offer repeated warnings about spontaneous, patient-driven improvements. Point out the possibility of psychotic breaks, mood dysregulation and relapse on substances if they improve without your guidance.
7. Definitely focus on the past. It can't be changed and it will reliably decrease your patient's mood.
8. Center your work about your patient perceives as his faults and past failures. Subtly increase guilt to resolve guilt by ongoing "treatment"- can you think of a more sustainable business model?
9. This technique is underutilized since the advent of Cognitive Behavioral Therapy: Ignore your patients' reality and dive into their infancy, their relationship with their mother and their fantasy life. And don't forget to interpret their dreams.
10. Avoid the poor, avoid  patients who ask too many questions. Both inquisitive minds and people with limited financial resources are much more difficult to distract from progress with insightful conversations.
11. Your continuing refusal to define the goals of therapy is essential. Can you imagine what would happen? One could actually raise the question whether goals have been achieved. That's a no-go for failure. In the same line - avoid evaluating the results of therapy at all costs. 
12. Always deal with your patient alone, being at the interface of family and society dramatically increases your patients' risk for recovery. 

To sum this up into a more memorable slogan, here are the Five B's to abide to as a successful failure-oriented therapist: 

• Be Passive 
• Be Inactive 
• Be Reflective 
• Be Silent 
• Beware 

> Irony/sarcasm off. 

This is based on "The Art of Being a Failure as a Therapist" by Jay Haley
Read more of him. Try to stand on the shoulder of giants.

Going Full Kondo

Time for spring cleaning. 

This year, I will go full Kondo. 

If you don’t know who (Marie) Kondo is, read here and there about her.

This is where I’m going:

Why not going full Kondo and move beyond just decluttering my house from belongings that don’t spark joy? How about decluttering my life from activities, content and people that don’t spark joy?

So, the next time you’re doing something, like right now, ask yourself: Does this bring joy?

You will probably point out now that snorting a line of cocaine would do that. 

Even cheating on your partner, when you’re giving into the temptation. 

Point taken. So sparking joy alone is not precise enough. Let’s add time to and subtract your ego from the equation. Ask yourself: Does this bring consistent joy to you and people you care about? Because snorting cocaine and cheating usually turn out to be destructive over time to you and the people you care about.

Going full Kondo means therefore to be rather selective about what you make your own by buying, picking up, taking in, and associating with.

Material objects can clutter your space. Can human beings do the same?

I think they can clutter your mind by taking up a lot of your time, especially when leveraging emotions like shame, guilt and complaining to get your attention. 

If you haven't so far, understand soon that your undivided attention is the most precious gift you have to offer. Everyone (family, friends, neighbors, Facebook, Netflix, Google, TV, and the list goes on) wants yours because that’s the most valuable commodity of the Information Age. One of the tried and tested ways to get your attention is to appeal to emotion. How is that done? 

By those little dopamine bursts you get from all those "likes" online. 

By using a drug like cocaine. 

By activating your fear response, claiming something is so, so urgent, you have to listen, watch, do, now, now, now! 

If you can activate the evolutionary older emotional pathways of your brain, they will take over and draw your (cortical) attention to whatever is triggering this emotion. 

That’s a sustainable business model:

Netflix is here to make money. 

Netflix is NOT here to make the world a better place. 

Netflix needs your attention to make money. 

Netflix will vie for your attention and use whatever they can to get it. 13 Reasons Why anyone?

CNN is here to make money. 

CNN is NOT here to make the world a better place.

CNN needs your attention to make money. 

That’s why there is a new urgent, fear activating story coming down that pipeline of new urgent, fear-activating stories. Every. Single. Day. 

Remember that urgent and important are NOT the same. 

Eisenhower is often cited with saying: "I have two kinds of problems: the urgent and the important. The urgent are not important, and the important are never urgent." This was in 1954 he was quoting J. Roscoe Miller, president of Northwestern University.

Have you ever noticed that the urgent stuff demanding immediate attention is usually brought to you by someone else and associated with achieving someone else’s goal? And that few, very few of the urgent demands for your attention are actually also important at the same time?

What is important? That’s what helps you to be the person you want to be, your behavior in line with your principles. Principles (call them values if you like) determine preferences and preferences would make a good place to determine importance. A rather individual affair but something that is very likely to spark joy. Consistently. For you and for the people you care about. 

The bottom line: Consider what you are feeding your mind, your body, what you let into your personal space with scrutiny. It won’t be perfect, you’ll have to make compromises and accommodate negative emotions temporarily. Life is not all joy all the time. Strive to make is joyful more often than not.

PS: The picture above works on the principle of eliciting an emotional response and catching your attention. How did that work for you?