Assessment: Understanding What's Wrong is the First Step to Making it Better

What can you expect if you come to Grace and Truth for Counseling? Assessment is the first endeavor; we need to discover what's wrong, when it went wrong and how bad things are in order to begin the process of helping you to make things better. We also ask what's right, but that's a topic for another blog.

• What's wrong? 

• How did you decide to seek counseling?

• What would you like to get better? 

• What will we talk about in our last session if you get everything you want from this process? 

• What results from counseling will help be worth the time, effort and finances you invest in it?

• If a miracle happens tonight that solves all of your problems, what will be better tomorrow?

• On a scale of 1-10, how would you rate your life right now?  Explain your answer.

• If you answer is a (2, 4, 6, etc.) share what is happening that you are glad about and what isn't happening that you would like to begin happening or happen more?

• Symptoms are things you experience. and signs are what others see.  What are the most difficult symptoms you are experiencing?  What signs of problems are others concerned about?

• When did the problem(s) begin? What was happening in your life at that time? 

• What have you done to try to solve your problems? What has worked? What hasn't? 

• Who has been most helpful to you? How did they help? 

• If you could solve only one problem through counseling, what would it be? 

• The main contributors to the beginning and continuation of mental and emotional difficulties are the body, the mind and relationships. 
• We refer to this as the bio-psycho-social model
• Bio is of the body and includes how your body works, physical predisposition to mood disorders, anxiety, addictions, etc. In other words, your family history.  How do others bodies work in your family.  If there is proneness to mental and/or emotional disorders, what shows up in your family tree?
• Psycho is of the mind; what you think about and how you think about it and how those thoughts affect your emotions.
• Social is your relationships. What is happening and what has happened in your closest and most influential relationships?  What is happening now? Are your relationships overall a source of stress or a blessing? 
• Which area seems to be most responsible for the difficulties you are having? 
• What is happening in each area that could contribute to your difficulties? 

This was pretty quick and pretty simple, but hopefully you will find it helpful to reflect on these questions before you come for your first appointment.  Our experience is that together we will solve the mystery of why problems are problems and how to make them better.

More next time on treatment collaborative treatment planning; how together we can efficiently resolve problems and some of the activities outside of session that are helpful in this process.

Blessings,

Jeff Williams

Why Leadership Coaching Might Frustrate You (and ulitimately benefit you)

Recently,  a coaching client asked my opinion about some decisions they are facing.  While part of me wanted to give my opinion, I knew I couldn't because I was wearing my Leadership Coaching hat which requires honoring the fact that this gentleman is responsible to steward his own life and that giving advise would cheat him of the opportunity to build his own decision-making muscles.  Thus, I launched into the following reminder about the uniqueness of coaching, and why it might sometimes be frustrating.  The re-orientation I wrote to him is below.

Coaching might frustrate you because I might often answer questions with questions.  The reason for this is the uniqueness of Leadership Coaching which is “The discipline of believing in people that engages where they are motivated to grow, change or to accomplish goals, that keeps them responsible for the process.” 

Not only do I not have a right to tell you what I think you should do, I also don’t know.  Seriously.  I believe more in your ability to hear God than my ability to hear for you.  Plus, a core value in Christian Leadership Coaching is “Own Life Responsibility”.  If I tell you what I think you should do then I usurp your right to steward your life.  Does this make sense? 

The furthest I should ever go as a coach is to share what I have done or would do in a set of circumstances, but that only after you have exhausted your own analysis of options for a decision, and only if you ask for it or give me permission to share. After all, part of the reason you’ve chosen me as a coach is because I do have a background of unique life and professional experiences.  I won’t cheat you of perspective or learning from those experiences, but I won’t lead with it.  Focus on your life, your perspective and your goals and action-strategies will ultimately build you as a better leader of your own life rather than cloning you after me. 

Sometimes business executives (and ministry leaders/executives) become frustrated with the coach approach because they are used to hierarchical command and control from bosses/supervisors, or receiving advice from consultants.  Coaching takes more time because the leader is the one doing the hard work of critical thinking and reflection.  I’ve had more than one coaching client become exasperated and say, “Just tell me what to do!”  If I did it would be akin to taking the wheel out of the hand of a student driver, or taking the hammer away from an apprentice carpenter.  The leader who is learning to lead more effectively (in all domains of their life) needs to be the one to rack their brain for phrasing of goals, to generate action-steps and to trouble-shoot challenges.  It’s like weight-lifting; the athlete doesn’t become stronger if the coach lifts the weight. 

I’ve also heard from more than one leadership team that I’ve trained in coaching that they don’t have time to coach their employees or volunteers because it would do one or both of the following:

1. Change the culture from hierarchical command and control which could reduce their value as a decision-maker and supervisor.
2. Take too much time which could hinder the bottom line of the company or ministry in the short-run, (e.g., “It’s quicker and safer to tell people what to do, especially when quotas are at stake.”)

 Both of these are true!  Integration of a coach approach into one's life or organization CHANGES EVERYTHING!  People listen with heart and skill, share more transparently, envision ideal future outcomes, collaborate in problem-solving and much much more.  What could be bad about all of that?  Well, that's a topic for another blog, but let's leave it at this.  Change is challenging.  New ways of thinking and relating might ultimately be good, but making changes comes with a price; namely, time, energy, and grief about a way of being that is no longer.

Now, this isn’t all there is to be said about the uniqueness of coaching, but it’s a fair introduction to what you can expect if you hire a Christian Leadership Coach.  Oh, and by the way.  Give it a fair shot.  A minimum trial of seven sixty minute sessions over a period of three months is a reasonable span of life to sample the unique potency of this approach to building you as a better leader of your life.

God bless, Jeff

A Recipe for Wellness

Clients come for counseling to talk about what's wrong.  It really throws them when I ask, "What's right?  What's going well in your life that you wouldn't want the counseling process to change?"

It's one thing to assess and diagnose problems.  Understanding of what the problems are and how they became problems is a necessary first step in the treatment process.  But things only get better when solutions to the problems are discovered and applied.  It's what I call "A Recipe for Wellness" 

Think about the essential ingredients for your favorite recipe.  Perhaps it's pizza, or lasagna, apple pie or homemade ice cream (am I having some cravings?).  There are very specific ingredients in very specific quantities, combined in order through a process that will render a tasty product...if you follow the recipe.  The counseling process can work in a similar way, though it might take a bit longer than preparing your favorite meal.

Research has demonstrated that there are three basic categories of variables that can cause, sustain and potentially cure mental and emotional disorders: 1. Biological (the physical component), 2. Psychological (what you think about and how you think about things), and 3. Social (relationships).

Biological includes genetic heritage, illness or enduring conditions.  Predisposition to mood disorders, anxiety, addictions are real.  But one's genetics isn't destiny.  Our biological blueprint isn't always what will be seen in reality because other variables are powerful enough to produce different results.

Psychological includes our characteristic way of thinking about ourselves, others and the world in general.  It is shaped by a variety of factors including formative relationships (with parents, siblings and other influential family members), life experiences (losses, traumas and successes).  Cognitive Behavioral treatment approaches target this area by altering what we think about and HOW we think about things.  Such changes result in changes in emotions and perspective.

Social is our relationships.  Are they life-giving or stressful: a source of pain or pleasure; helpful or harmful?  How do the most important people in our lives view us? 

This is a quick over-simplification of the basic categories of life that contribute to overall mental health (or can erode it). Why have I written about this?  Grace and Truth values a collaborative relationship with our clients.  The more you understand about how we think, the more you will be prepared to participate in the process, and the quicker you will get the results that you want.  And whether you get counseling at Grace and Truth or elsewhere, you can begin now to identify the factors that contribute to or detract from your mental and emotional health.

Let me give a quick illustration about how this works in diagnosis and treatment planning:

A 40 year old woman* comes complaining of episodes of tightness in her chest, shortness of breath, perspiration, racing heartbeat.  These began after a particularly stressful season at work where she is responsible to produce a quota of time-sensitive reviews of client applications.  She grew up with parents who didn't have a very happy marriage, and who talked out loud about their unhappiness with each other and their children.  Admittedly, she has never felt very good about herself.  To top it all off, her best friend recently began acting squirrely, like something is wrong between them, but won't tell her what it is.  Her husband might be having an affair, and her once obedient children have hit the teen years and their personalities have changed.  They are not as pleasant as they used to be. And she feels like her relationship with God is strained.

What's wrong?

• Panic disorder (anxiety symptoms) or heart problems?
• Negative self-worth and self-image based on how she thinks about herself?
• Grief and loss in significant relationships? 

Again, this is over-simplification, to make a point.  It is clear that there are plenty of factors in the bio-psycho-social model to produce a painful experience.  After a thorough assessment of all of the contributing variables (ingredients) is completed, it is possible to begin working cooperatively with this client to make adjustments.  A medical physical would be in order to rule out other physical factors producing or mimicking the anxiety symptoms.  If panic disorder, medication might be indicated.  A clear understanding about how she thinks about herself and others (self-talk) would be needed before adjustments could be recommended.  And boundaries and other decisions about how to handle relationships would be part of the therapy.

I'm sure you get this breakdown of factors intuitively.  When things go awry in life most of us "assess" what it wrong and why it is wrong.  I just wanted to give you and model to break down your understanding of the key areas that counselors are looking at in assessment.

We see good outcomes at Grace and Truth when clients fully engage the assessment and treatment process.  We help this along by providing education about variables that contribute to and erode mental and emotional health, and then ask our clients to examine their lives and share with us about the balance of these factors in their life.  The overall goal is to reduce or eliminate the ingredients of pain and displeasure, and to increase the ones that contribute to a sense of physical, emotional and relational well-being.  It's a process of identifying and combining ingredients, just like a recipe.

We hope this helps.  If you or someone you love could use some help to sort this out, please call. We'd love to try to be helpful.

Blessings,

Jeff Williams
Professional Clinical Counselor - Supervising Counselor
State of Ohio, #E-3098
937-717-5591
*This is a fictional scenario.  Any resemblance to any person living or dead is entirely coincidental.

How to Handle the Holidays (before they handle you!)

If the holidays go as well as possible, what will you be able to celebrate after they’re over?  In other words, what are you hoping for, and what (or who) do you hope to avoid?

Holidays seasons are usually mixed experiences for most of us.  We have wishes, hopes and dreams about how they will go, and what we will do.  Some desires end up being fulfilled but some aren’t.  Proactive planning can increase the probability of getting what we want. 

Our suggestion for Happy and fulfilling holidays is to specify desires.  You can do this individually and as a family.  Ask yourself, “What do I want?”  This is a relatively simple, yet powerful exercise. Try it now.  See how many bullet points you can come up with.

For example:

Jeff: What do you want for the Christmas Season, Jill?

Jill: I’d like to have an open house for friends and family before schedules get too crazy.

Jeff: What else would you like?

Jill: I’d like to plan an evening we could take Gabby (granddaughter) to the Clifton Mill to see the lights, and have hot chocolate by the waterfalls

Jeff: What else would you like?

You get the idea.  You keep asking your spouse and other family members what they would like.  Pretty soon, you have a great list of everyone’s desires.  Now you can begin to discuss and negotiate how to make these a reality.

This same exercise can be done to identify what you don’t want or what you would like less of.

Jeff: What do you not want for the Christmas Season?

Jill: I don’t want to be so busy that we don’t have time to enjoy it.

Jeff: What else do you not want?

Jill: I don’t want to get exhausted shopping.  I want to be strategic about the times and places I go, and get shopping done early in the season.

Sometimes emotional topics surface, such as strained or difficult relationships with people you’ll see at holiday celebrations.  A great question to ask yourself or each other is “If your interactions with _____ go as well as possible, what would you like to be able to say afterwards about how you did your part to be pleasant.”

Once desires have been shared and discussed, the next step is to brainstorm action-steps to accomplish them.  This can be done efficiently by coming up with and evaluating options.

Could's (could do's) What could you do? What ideas have you thought of? What have you considered? Try to list 5 options for each desire that you would like to become reality.

The task in step #1 is to generate as many ideas as possible. This is green-light brainstorming. Everything is on the table. No idea is too ridiculous to mention. Often an idea that isn't realistic gives birth to an idea that will work.

Wants (want to's) - The second step is to evaluate the list of options from step #1.  . Which ones do you like, and why? What do you like about them? Which do you not like? What are the advantages or disadvantages to each one? What are obstacles or barriers? Which would you like to try? Which do you think have the best chance of being helpful?

The idea with #2 is to check in with your heart and mind. Which ones are you motivated to try, and which ones do you think will work? Scratch the options from #1 that don't make the cut.

Will's (will do's)- Now that the list of possible solutions has been shortened, it's time to make a decision about what you will do. Which of the possible action-steps/solutions do you want to do?

The best way to handle the holidays is to get out in front of them by thinking about what would like and what you would like to avoid; forethought in other words.  The simple questions suggested above surface desires and the brainstorming process leads to potential strategies, solutions and action-steps.  This is the essence of the coaching process for any life circumstance.  Begin with the end in mind by thinking about the ideal outcome, then explore your thoughts, feelings and desires around that outcome.  Finally, brainstorm possible action-steps to make your desires a reality.

We hope this helps!

Happy Holidays, Jeff and Jill Williams

How to Make the Most of Counseling

It's a big decision to get some counseling. Usually, by the time a client makes the first call, they've thought a lot about how to solve problems and conflicts, and find themselves at a loss for ideas about how to make things better. It's not uncommon to hear strong emotion and tears on the phone. The first step toward relief is to schedule an appointment, but lasting relief comes through an ongoing commitment to the process.

It's one thing to get relief by making a call, taking a step to "get some help", and something quite different to commit to a series of appointments that will help to secure lasting relief and solutions.

Here are some tips to make the most of counseling:

1. Come to your first appointment prepared

• Review information and consent documents sent by email
• Bring notes/journal about what you want from counseling
• What would you like to be different by the time counseling ends?

2. Expect to invest time and finances in 4-6 sessions for the first 6 weeks

• It takes time for a counselor to "get on board" with you.  We need a lot of information to accurately conceptualize what is happening and why.  Then we can diagnose and recommend a treatment plan.
• The issues that led you to seek counseling probably didn't develop overnight.  Give yourself (and your counselor) time to begin unraveling the complexities of your circumstances.

3. Do homework between sessions to extend the value of therapy

• Growth and change from counseling doesn't just happen in the counselor's office; it happens any time a client(s) intentionally think, write and talk about their issues between sessions.
• Some counselors welcome correspondence between sessions
• Send journal entries, copies of therapeutic letters, etc.
• Grace and Truth policy is to read everything a client send, and to respond as possible to questions and concerns that arise between sessions.  Generally this is value-added service, and not billable time (note: privacy of electronic correspondence isn't guaranteed; clients send such communications with this understanding; it is an option, not a requirement.)

4. Be direct with your counselor about what is helpful and what isn't.

• Remember that a counselor is your servant.  You are compensating them for their time and expertise.  Don't be afraid to give feedback about the effectiveness of the process
• Good counselors ask for feedback on a regular basis.  It is part of our ethic to measure progress, and it is unethical to continue a counseling relationship if progress isn't being made.
• Here are some of the questions I regularly ask, "Has this been helpful? Are you getting what you hoped for? What would you like more or less from me?"

5. Expect to take a break from counseling at some point

• The duration of counseling varies from weeks to months (rarely does it take place weekly for years on end).
• Growth and change takes place in cycles.  Expect to take a break after resolving your presenting problems, and/or reaching a plateau en route to your end goal(s)
• Most counselors welcome breaks, and return to counseling at some point of felt need in the future.

6. Don't be afraid to ask to transition to a coach approach to goals once pain and problems are resolved.

• The relationship you have with a dually trained provider and the history you have together can provide a comfortable foundation for continuing work together on life goals (personal and professional).
• At Grace and Truth, we sometimes begin with counseling, and end up with coaching.
• Remember, counseling is generally about problems and pain, and coaching about goals, growth and change

Summary
Ultimately, counseling works if you work it.  To get the most from it requires significant investment of time and energy beyond scheduled counseling appointments.  It also requires commitment on the part of counselor and client to learn to work together in the most helpful way.  This happens best through honest exchanges about what is working and what isn't, with willingness to adjust on the part of the counselor and client.

Hopefully this will help you to make the most of counseling when you make the big decision to ask for some help.

Blessings,

Jeff Williams 
Professional Clinical Counselor
State of Ohio License E-#3098

Could's, Want's and Will's: Three Steps to Creative Solutions for Complex Problems

"If I knew how to solve these problems, I wouldn't be here!" My client was aggravated, but they'd misunderstood my question, which was, "What have you thought about doing to solve this?" I understood their frustration, and was sorry that I'd contributed to it, but still, I always want to work collaboratively with counseling clients. As I see it, I'm their servant with expertise to diagnose and suggest a treatment plan according to proven best practices that research has demonstrated to be effective. Still, a collaborative approach empowers them to actively participate in the process instead of passively awaiting direction.

True, counselors have expert knowledge and experience in mental and emotional disorders, complex marital and family situations, addictions, etc., but still the client has to live with the results of their choices. Thus, the ethic under informed consent is always that they have the right to refuse any recommendation from the counselor, and/or to terminate services at any point. The way I make this arrangement with clients is to generate solutions together. Sure, I offer ideas based on research and experience, but ultimately what they choose to do is up to them.

Here is an efficient brain-storming and evaluation process to develop and select solutions:

1. Could's (could do's) What could you do to work toward a solution? What ideas have you thought of? What have you considered? If I have some ideas would you like to hear them?

The task in step #1 is to generate as many ideas as possible. This is green-light brainstorming. Everything is on the table. No idea is too ridiculous to mention. Often an idea that isn't realistic gives birth to an idea that will work.

2. Wants (want to's) - The second step is to evaluate the list of could's. Which ones do you like, and why? What do you like about them? Which one's do you not like? What are the advantages or disadvantages to each one? What are obstacles or barriers? Which would you like to try? Which do you think have the best chance of being helpful?

The idea with #2 is to check in with your heart and mind. Which ones are you motivated to try, and which ones do you think will work? Scratch the options from #1 that don't make the cut.

3. Will's (will do's)- Now that the list of possible solutions has been shortened, it's time to make a decision about what you will do. Which of the want to's do you want to do?

The premise of this last step is that people are more likely to do what they want to do than what you tell them to do. However, different than coaching, in counseling there are some choices that a client makes that are a deal-breaker for the counseling relationship; such as repeated no-show's, delinquency with fees, AND the Big One, not coming for appointments per the frequency recommended per the assessment of the acuity of their problems. Just as in medicine, if a client doesn't comply with a minimum treatment format (prescribed frequency of sessions), the counselor can't be responsible for their welfare.

Okay, back to the commitment phase for solutions. What will you do? What will you commit to doing? An action-step toward solution of problems isn't legitimate until a client specifies the date and time they are going to do the step. In counseling these can include talking with a spouse about the truth in a situation, making an appointment with their doctor to be evaluated for medication, setting a limit or boundary with a child or extended family member, journaling about a traumatic experience, etc.

In summary, effective solutions to problems can be efficiently generated through three steps. Consider what you could do, evaluate this list according to your desire, "Which of these do you want to do?", and finally, which one's will you commit to doing?

FYI, this post was a result of such a process. "I could write a blog to educate current and potential clients about an effective problem-solving process. I want to do that because I want it to be in writing so that I can reference it and make it a hand-out. I'm going to do it this morning while the idea is fresh." Voila, done in 30 minutes!

Continuing the journey in His Grace and by His Truth,

Jeff Williams
Professional Clinical Counselor
State of Ohio, License #E-3098

Change Takes Time (and requires investment)

Pain motivates people, but only for a short time. When in distress, people will do about anything you ask if they think you can help them to alleviate their discomfort.

"Could you come for an appointment at ________?" Client, "Sure, whenever you say. Nothing is more important than this right now." But, get a few weeks down the road, and scheduling becomes a challenge. "Things are just so busy right now. I'll have to wait a few weeks before scheduling my next appointment."

Social Psychology has proven that we humans are creatures of habit, and that the inertia of our psyche is to keep doing the same things and thinking the same ways, even if they are unhealthy. We need look no further than to those who live in codependent relationships or repeatedly subject themselves to spousal abuse (domestic violence) to illustrate this sad truth.

At Grace and Truth we proclaim the truth that with God all things are possible, but they might not come easily. We say this to our clients like this, "The good news is that (your marriage can be saved/you can learn healthier ways to relate to your spouse/children, you can learn to live sober and clean, your depression/anxiety can be alleviated...BUT the bad news is that it is going to take time and require significant effort on your part."

After a few years of taking calls from potential clients in crisis, I usually have a pretty good idea which ones will follow through with time, effort and financial investment in a counseling or coaching process designed to help them live more pleasurably and productively. They are the ones that lead with statements like this, "We know that things didn't get this way overnight, and we don't expect them to get better overnight. We're prepared to invest in this process as long as it takes, because we can't go on living like this any longer." They lead with a description of their difficulties, ask if I'm experienced in helping with such issues, and treat the opportunity to be helped as a privilege.

Those that aren't apt to follow through lead with statements about how difficult it will be to say no to their current schedule of activities (the kids have this and that, I'm a volunteer here or there), and disclosure that they are shopping for the most cost effective option.

I'll close with an observation by Hugh Hewitt,from his book, "In But Not Of: A Guide to Christian Ambition". (paraphrase) "I know of a retired officer (a Colonel) in the French Army. He wanted to be a General, and could have been, but I guarantee you that if you take a look at his career, there was a time when he was faced with the choice to pay the price to become a General, and he said no. It's not enough to say that you want to accomplish something, you must also be willing to pay the price."

Sustainable motivation is a function of clear vision about what can be, sober understanding that realizing our goals and dreams will be costly, and sustained effort in the process.

What do you want? And, are you willing to pay the price?