When you have a problem, don't you love it when there's an easy, ready-made, complete solution just waiting for you?

A few years ago I turned some magic age at which it suddenly became important to check my cholesterol, which of course was too high. I faced two choices: 1) stop eating every food I like, and start a relentless and excruciating exercise program, or 2) take this pill.

Well, my physician didn't word it exactly that way, but that's basically how I heard it.

If you're old enough to have reached the magic cholesterol-checking age, you've
also witnessed incredible changes in the world of pills. We have so many more now, and they promise to do all sorts of amazing things, and they're marketed so relentlessly. Five years ago, for instance, who knew that so many attractive, middle-aged couples liked to sit outdoors, holding hands, in side-by-side antique bathtubs?

We notice the changing role of pills especially in the area of mental health, of course. Feeling blue? Take this pill. Feeling anxious? Take this pill. Can't concentrate? Take this pill. Mood swings? Take this pill.

Actually, when you have the right problem, and when the pill and your brain chemistry fit just so, the results can be dramatic. We've seen pills lead to remarkable transformations, and we're grateful for the healing power they sometimes have. When your problems or brain chemistry don't exactly fit, though, pills offer a mixed bag.

Albert LaChance, the psychologist who writes about the "Greenspirit" approach to spirituality and recovery, notes that mental health medicines do great things, but get into trouble when they claim to be curative . Pills don't cure depression; their effect is more like aspirin on fever: they suppress the symptoms, which, if you've ever been depressed, is wonderful - but temporary.

And, as LaChance points out, there are some problems for which there just isn't a pill, like "not being able to grow up." Or suspiciousness, or an unfaithful spouse, or a child who won't listen, or a parent who doesn't care.

The research is clear: with most mental health problems where pills are available, the best results come with the combination of medication and psychotherapy - just like the best results with cholesterol combine medication with diet and exercise, rather than the pills-and-French-fries approach I initially favored. This combined approach fits the Samaritan Center philosophy perfectly, since from our beginnings we've worked to address the whole person: body, mind, and spirit.

Over the course of the past two decades there has been an exponential explosion of new psychotropic medications which has allowed for new and improved medical intervention to assist people struggling with all types of psychological distress. One such diagnosis, with which I have done the bulk of my therapy, is Post-traumatic Stress Disorder, commonly called PTSD.

The special needs for these people lie with the combination of symptoms needing attention: chronic moderate-to-severe anxiety, chronic moderate-to-severe depression, severe sleep disturbance, nightmares, flashbacks, poor impulse control, social isolation, relationship instability, and chronic moderate-to-severe physical pain.

Initially, the medical community could offer a few anti-depressants, a few anxiolytics, pain medication, and powerful anti-psychotics. The impact on the people was typically severe sedation and multiple and unpleasant side effects often requiring additional medication to control the side effects. The "talk therapy" I provided was widely perceived as ineffectual or of minor help at best. Clients often felt frustrated that the relief needed took too long.


Clients I see now, with a few exceptions, of course, are finding quicker, long-lasting and more profound help via better medications and renewed support for the value of "talk therapy." The strength of the new medicines lies in reducing symptoms more thoroughly, which in turn allows the "talk therapy" to do its part more thoroughly. The medications provide clients with more "psychological energy", allowing for new and deeper insights into their thinking and behavior. Depression, anxiety, sleep, flashbacks, and other symptoms become more manageable and, therefore, relief and growth increase in quantity and quality. The combination of better medications and effective "talk therapy" quiets the fear and trauma.

The diagnosis of Bipolar Disorder in children appears to be it on the increase. It is a disorder wherein children exhibit unusually high irritability, explosive outbursts and rapid cycling of moods. It is believed that many children suffering from Bipolar Disorder are being misdiagnosed as suffering from other disorders: Attention Deficit-Hyperactivity Disorder (ADHD), Depression, Generalized Anxiety Disorder or even Oppositional Defiant Disorder. One study indicated that one third of all children diagnosed with ADHD are actually suffering from early onset Bipolar Disorder, and another study indicated that up to half of the children diagnosed with depression will later be diagnosed with Bipolar Disorder.

More studies are being conducted and there is still much to be learned about the disorder. We do know that a correct diagnosis is extremely important so the proper medication (mood stabilizers or a combination of mood stabilizer and antidepressant) and proper treatment can be prescribed. Medication given for other disorders can exacerbate the symptoms of a child with Bipolar Disorder. Demitri Papolos, M.D., in his book, The Bipolar Child , writes, "antidepressants and in many cases stimulants given without the benefit of a mood stabilizer (possibly even with the protection of a mood stabilizer) can cause havoc in a child suffering from a bipolar condition, increasing anxiety states, potentially inducing mania, more frequent cycling, and increases in aggressive outbursts and temper tantrums."

Medication is a primary form of treatment, although significant improvement has been observed with other methods. For example, addition of Omega-3 fatty acids to a child's diet and/or undergoing light therapy have reportedly been successful in treating children with Bipolar Disorder. It is important to note that there are some drugs as well as some herbal treatments that should be avoided in children with Bipolar Disorder.

Every child responds differently to medications and it sometimes takes several different tries before the best combination of medications can be achieved. The effort is worth it, however: an unmedicated child often experiences a great deal of suffering. Early detection can improve quality of life for them and for their parents.

Studies about the life cycle of people with Bipolar Disorder are grim: a disturbing number end up committing suicide, and 60- 80% abuse substances. We hope early diagnosis and proper of treatment of this disorder will reduce these numbers.

Children with Bipolar Disorder can benefit from counseling by learning social skills and ways of tolerating their emotional swings. Parents can also benefit from counseling through gaining an understanding of the disorder as well as learning ways of dealing with the behaviors. Counseling, along with the right medication, can make a world of difference in the behavior and happiness of both child and parent.

When a person decides to seek counseling, he or she can anticipate similarities to the initial session with a medical doctor. The first session will likely focus on gathering information about the nature and history of the problem(s), a diagnosis, and the presentation of a recommended treatment (intervention) plan.

With counseling, however, two factors often block progress. The first factor relates to the reaction of people around the help-seeker: family, friends, and coworkers. These people tend to support a medical diagnosis and treatment plan, but are more likely to discount a psychological diagnosis and treatment plan. "You're not depressed. I know people who are really depressed." "You don't want to take Prozac - people commit suicide on that." Sometimes the roles are reversed: family, friends, and coworkers support the diagnosis and treatment plan, but the help-seeker discounts them.

Counseling works best when the counselor, the client and client's social milieu (family/friends/coworkers) are "on the same page." This is especially a problem when a child is seeing a counselor and one parent supports this while the other openly disagrees.

A second major factor is the historical presentation in the media - movie, television, etc. - of mental disorders. When the media deal with mental health issues, they almost always focus on conditions that are serious, disruptive of life, and -fortunately- rare . There have been at least five movies about a person with a "Multiple Personality Disorder." This diagnosis is no longer used and many professionals dispute the reality of MPD as a diagnosis. Also, many movies and TV programs present psychotic killers. "A Beautiful Mind" was a powerful movie about a person with Schizophrenia or "Bi-Polar Disorder with psychosis." This emphasis on the extremes of mental illness can give help-seekers a fear of being labeled, as though going to counseling will mean they have a severe illness.

The reality is much different. A recent study indicated that 60% of the population will experience problems with depression during their lifetime. The presence of anxiety problems is demonstrated by the many anti-anxiety medications on the market along with the heavy use of non-prescription "downers", such as alcohol and some street drugs. If one included depression, anxiety, relationship issues, and substance abuse problems on a list, the list would likely cover over 90% of the problems presented to therapists.

If someone you know is seeking help from a mental health professional, it is important to be supportive and encouraging of their participation in treatment. Changing one's attitude, behavior or feelings is difficult. While a person needs to know the credentials of the helper and needs to be free to ask questions or challenge the treatment program, working conscientiously with a qualified therapist in the context of supportive family and friends is the best predictor of a successful outcome. Ignoring the stereotypes of metal illness allows people to discuss serious problems in a rational and productive manner.
 

An old adage states, "The more things change, the more they stay the same." While this may be true, nevertheless for many of us, change is difficult emotionally and spiritually. We like our routines, to know how to find the bank, post office, doctor's office, and physical fitness center. Many of us also like our stable group of friends on whom we can rely when we face difficult life issues.

Some of us face a myriad of changes over our lifetimes that cannot be avoided, such as our physical health declining, or the aging of our parents or grandparents. These changes can cause us much concern and require extra effort from us to help out in those changes. In my own life, just over the past year I have watched my mother-in-law and father-in-law move from living together independently, to one in assisted living and the other in long-term nursing care. My husband and I grieve as we watch their decline, even though these are normal changes, and to be expected for individuals in their 90's.

In addition to adapting to these changes of my in-laws, I have made my own major change, moving to northern Indiana from northwestern Ohio. While Goshen is only 100 miles west of Archbold, Ohio, and we have been able to drive back to work on the Ohio house, it is a significant change with regard to daily stability. I grew up in eastern Pennsylvania, where roads do not run straight for much distance before making a sharp right or left. In fact, we gave directions by landmarks and right and left turns. I managed to cope in NW Ohio because the roads were logically labeled with numbers and letters.

My brain is now adjusting to learning a new system of road signage and labeling; my heart is adjusting to a new circle of friends; in my professional life I am adjusting to new co-workers, new office space, new clientele, and new ways of doing things. I am still trying to remember where the light switches are in my new house, and I'm still searching for items in boxes. Some days I long to wake up in my old house, with that old routine, and know that everything will be the same tomorrow and the next day after that.

Grief is a normal part of this change and adjustment. My old friends are still in Ohio, and we are still friends, but we don't have the same common connections now that we once had. Anxiety is also a normal part of change and adjustment, as we hope the house will sell, or wonder if we should have settled for a lower bid rather than hold out for more money. Sadness and loneliness are also normal feelings as I adjust to a new community, search for new friends, and wonder if anyone will want to be my friend.

In a former job, one of our doctors would say in response to various clinical issues we would describe, "I have a little pill for that." Perhaps there is a little pill for grief, anxiety, sadness and loneliness, but the best pills are patience, time, energy, determination, commitment, and courage.

Life will not always be like this. This is not the first time I have moved. I well remember my adjustment 11 1/2 years ago when we moved from Kansas to Ohio. I experienced many of the same symptoms, and perhaps did not manage them very well. From my memory of the past, I am learning that I can take responsibility for my thoughts, feelings, and choices. I can choose to be lonely, or I can choose to call a new friend and suggest we get together for coffee. I can get stuck in grieving about the past, or I can choose to look for the good in the new, and celebrate the good memories and experiences of the past home and community. Goshen/Elkhart is where I am supposed to be for now, and that gives me confidence and hope that all will be well.
 

For the last five years, I've been a case manager working with people who have developmental disabilities. These experiences have given me insight into the great difficulties people with disabilities and their families face in our society. It is not that there isn't great joy, there is. It was a privilege to work with people who have disabilities. They have many wonderful characteristics, not the least of which are a sense of humor, creativity and fortitude.

It's unanimous: being a parent is hard work, filled with sacrifice. Parenting a child who has a disability requires more hard work and many more sacrifices. Hundreds of everyday tasks are difficult and time-consuming, tasks that parents of children who are unaffected take for granted.

Parents of non-disabled children assume a progression from day-care to elementary school, high school, perhaps college, and off the nestlings fly into the wild blue yonder. Parents of children with these disabilities know that their children face a vastly different future, far more dependent on factors over which they have no control, with no "flying off" in the end. Navigating the necessary service systems makes many parents of children with disabilities feel they are in a foreign land and don't know the language.

One of the most devastating elements of having a child with a disability is the way some people react to them. People with disabilities, especially obvious ones, continue to face stigma and prejudice. In school they are ridiculed. In the community, people stare, make negative comments and act afraid. How are parents supposed to respond to such a reaction when they are filled with anger and frustration?

Parents of children with disabilities are secondary victims. While the child may receive a variety of habilitative services (case management, behavior management, counseling, physical therapy), many parents have virtually no supports in place for themselves. They often feel isolated and don't know where to turn for help. Many marriages suffer because there is nothing left to give after the caregiving is done. The romantic weekend getaway is but a dream. Families suffer because activities must be structured around the person with a disability. There is more than enough guilt and fear to go around.

These parents often find it very difficult to ask outside family members or friends for help. If I could give advice: if you know a family which includes a child with a disability, don't wait for them to ask you for help, they probably won't. Tell them you will do their errands, cleaning, or caregiving for whenever you are available. Your support is priceless.

In line with the theme of this Pilgrimage issue, there's no pill for secondary victims. No medicine cures the emotions I've listed: anger, frustration, guilt, and fear; no drug heals the deadly fatigue and isolation. The "treatment" secondary victims need comes through individual offers of help, group support, and perhaps counseling.

If you said "It makes you feel alive," to someone, what would you be talking about? What makes you feel alive? Not just here, not just existing, but somehow living in full color, drenched with intensity?

I realize that's a lot of boldface for a short paragraph, but passion (oops) is like that. Not merely the romantic or lustful kind, but also the kind of passion that leads us into action, that turns a hobby into a calling, that turns a job into a vocation.

A guy joined the Rotary club in another city some
time ago. He knew the people, figured it would help with business connections. Then one day he got the call he'd been dreading: another Rotarian asked him to take a turn on the club's current project, which was providing transportation for children who needed medical care. He racked his brain for plausible excuses, but - darn the luck - he was free when they needed him. So he drove his Lexus (or whatever) into a very poor neighborhood, eyes vigilant for trouble, and picked up a small child to take him to the local hospital for some ongoing treatment. The little boy sat wide- eyed in the plush seat. "Mister?" he asked softly, "Are you an angel?" The man turned to the boy, not sure what to say. The boy continued: "My mama says when we're in terrible trouble, the angels will come and help us."

Something happened to that reluctant Rotarian. He was late getting the boy home, because he stopped to buy him things he needed and things he didn't need. Then he was on the phone with the Rotarian who called him, telling him the transportation project was fine and all, but needed to be so much more. He wanted to take over organizing this "more", and he asked when he could transport the next child.

Something happened to that reluctant Rotarian. We could speculate, but it's probably a safe bet that he found passion, that he was moved, that he felt alive.

Scratch just below the surface of most psychotherapists, and you'll find passion. Somewhere along the line we got to be someone's angel, or someone was an angel to us. Like the Rotarian, we get hooked, we want to do more, we want that feeling again. In this Pilgrimage our clinicians talk a bit about their respective professional passions: working with children, with parents, with couples; working with anxiety and depression. Doesn't sound inviting does it? Neither does driving into tough neighborhoods to pick up sick kids.

Until passion strikes.

I had only been in Viet Nam for 3 weeks when I witnessed my first fatal combat victim. It was an emotionally overwhelming moment - one that still is clearly pictured in my memory. Over the course of the next 7 months it was an experience I repeated too many times to recount even today. During those months I often wondered what would become of those terrifying memories, especially those involving my team of 6 Marines. What would be the eventual impact of them on my heart, soul and spirit?

As the next 10 years passed I began consciously processing them in my own therapeutic journey which I repeated several more times over the next many years.

What I discovered was "my passion" to be, hopefully and with trepidation, a "healing agent" in the lives of other combat veterans.

Each time I met and worked with another vet I would have my passion re-ignited. And it would see me and my client through the murky and awful memories he had, and often times another visit to mine. Oddly, pain, hopelessness, paranoia, fear and isolation would be transformed into healing and each time it happened it would rekindle my passion and yes, desire, to go through it all again with yet another brother.

Thirty years later as my healing went deeper and I found that my passion was waning I stopped this facet of my work. But to this day the passion continues and I wonder how many others will, in the face of the new veterans of the Middle East, find their passion, similar to mine, and use it to help in healing of new wounded warriors.

When I think of the stories of people achieving beyond all odds, the words that come to mind are courage, persistence, passion, and discipline. I often ask my clients to share more than their dreams... what are they passionate about?

I ask this because their answer provides insight into their ability to follow their dreams and to be courageous, persistent, and disciplined. These are characteristics one needs in order to overcome obstacles toward a desired outcome. All of which are needed to run a half marathon, kayak the coast of Lake Superior, or hike the Appalachian Trail. These characteristics are equally needed even if the desired outcome is losing weight, alleviation of depression or anxiety, or improving communication and relationships.

It is curious - what separates one person who never quite seems to achieve his/her dreams from one who is successful? Is the successful person just lucky? I think not. If one looks carefully, the person successful faces obstacles, has pitfalls, and at times, defeated. However, the successful person perseveres in the face of all of this. That person gets up in the morning and starts over, as many times as it takes.

I cannot help but think of several clients who when first asked the question 'What are you passionate about?" had no answer. Then over the months, I began to hear that their depression or anxiety was "not that bad this week". Then I began to hear more about their life than the depression or anxiety. I began to hear stories of courage in standing up for oneself persistence in changing negative behaviors, and discipline in following through with healthy activities.

But, the most rewarding is to hear words telling of a rekindled passion for living, to hear a client telling his/her story of achieving against the odds.
 

I really like raspberry pie. In fact, it is one of my favorites.  Fortunately for me, raspberries grow wild and in abundance on our property. Unfortunately, they are difficult to pick. Wild berries are very thorny, and there are a lot of suckers that have thorns but no berries. They always seem to be surrounded by poison ivy, and mosquitoes seem to flock to them. Because of those things I usually wear a heavy flannel shirt, knee boots, bandana and bib overalls (isn't that a picture?) which means I can add hot to the list of discomforts. My scratched and stained hands are evidence to what I have endured. There is also something spiritual about being out in the early morning, just me and nature, that I cherish and which overrides the discomforts.

I think of therapy as being similar for the client The end result is well worth the effort, but there are a lot of obstacles and discomforts we must endure in order to get there. Just as with picking berries, which ripen at different times, we can't get to all of the issues at once. It takes coming back over and over. Sometimes I see berries coming out of the thicket that were covered up going in, just as new issues seem to get uncovered as we explore new areas.

John Donohue, a former Irish priest, quoted Plato in saying that "one of the greatest privileges of the human being is to become a midwife to the birth of the soul in another person." He went on to add that therapy is "helping people retrieve what has been lost to them; wakening and bringing home their fundamental wholesomeness." I am awed by the experience of being a part of that transformation.

I love what I do as a therapist As a therapist I certainly encounter resistance and obstacles to making the progress we are all hoping to make. Therapy is hard work. The relationship between client and therapist is valuable, and the process worthwhile, but the end result, a healthier, happier client, is priceless.

The last time I was that tense for that long was probably in sixth grade, when I was assigned to crossing-guard duty with a girl with whom I was so smitten and of whom I was so terrified that I could barely remain conscious any time she was close enough to notice my existence.

On this occasion, though, there were no redeeming romantic qualities. I was 29 years old, sitting in an overstuffed chair on the third floor of the Danielsen Institute in Boston, clutching a pad of paper with such intensity that my fingerprints were registering four or five sheets down. The occasion: my first session as a professional psychotherapist.  

Across from me was a frustrated fellow about my age — the client — who had come seeking help with something or other. It was hard for me to focus on his actual words because my heart was pounding so loud and because I kept noticing the dubious looks he was sending my way. Possibly he was noticing my tension: in spite of my heart's triple timing, the blood had drained entirely from my face and hands.

What words I did catch, I transcribed furiously. I wasn't particularly trying to understand them, I was too busy writing them down. I felt I needed to catch every single comment, complete with punctuation marks and any stray italics, so that later I could hand the complete transcript to my supervisor. He actually knew what he was doing, and I had faith that he could figure out what I should have been saying, which certainly wasn't the confused mumbling I was actually producing just then.

Those fifty minutes took approximately six years to complete. As they mercifully wound down, my brand-new client said something kindly like, "I don't think I'll be coming back for another session. This just feels too much like another classroom role-play."

I felt a little sad (I'd failed in my first attempt), a little busted (it felt like a role-play to me, too), fairly ashamed (this guy realized what a loser I was) and tremendously relieved: with luck, I'd never have to endure the embarrassment of seeing this fellow again in my life! So I congratulated him on his perceptiveness, wished him well, and said good-bye.

I should note that things are better now, psychotherapy-wise.

I remembered this incident recently (and winced) while reading material by D.W. Winnicott, a prominent psychoanalyst in the middle of the last century. He wrote: "Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play." Play was the farthest thing from my mind that awful day. But since then I've learned.

Of course, many would disagree with Winnicott: psychotherapy isn't about play, it's about work, it's science, or medicine, or something else equally serious and somber. They'd be at least partially right. The work of healing the mind is quite serious, and requires specialized training, and needs to be informed by scientific and medical insight

But if that's all psychotherapy is, then psychotherapy is as depressing as whatever depression it might be attempting to treat There is truly an element of play that is as central to healing as whatever work is involved. As Winnicott notes, play isn't always present at the beginning of treatment, but when things go well, it has emerged by the end.

Before we can play, we have to feel safe and accepted. We have to believe that there is room for us and for our happiness in the world. We have to have been shown how to play, been encouraged to play, been praised for playing. A sad and surprising number of children (and adults) have been deprived of play, have never learned to play, or possibly haven't been able to play for so long that they've forgotten how.

Play is crucial to fulfilling intimate relationships. Imagine being a spouse or a parent without being able to laugh, to be spontaneous and unselfconscious with the ones you love: it can be done, but it's not pretty.

I think just now of a woman who came for counseling. She'd raised her children, found fulfillment in a profession she enjoyed, lived in a beautiful home. She was devastated when her husband suddenly left, announced his love for another, and declared his intention to divorce her. The shock left her emotionally damaged in many ways.

She showed no capacity for playfulness. At the time, that was the least of her worries. (And mine.) But as she went through the slow process of healing, playfulness didn't emerge when it usually does. I asked about this, and she talked about being an oldest child in a humorless family that placed a premium on work and duty. She couldn't remember playing, having fun, laughing freely. Later, as a parent, she went about the serious business of making sure her children played, but she couldn't join them in it. With her husband she was dutiful, but sad — early in the marriage, he seemed to bring fun and playfulness, but somewhere that got lost, and she retreated into work.

It was so sad talking about all these losses, about all the play that never happened, all the happiness she didn't have. Yet as she grieved this, it freed her to give play a try now: wordplay at first, laughing about a pun or double meaning; then she'd tell of trying something new or spontaneous with a friend between sessions. Bit by bit, she learned to play. When we finally ended the work, she was still sad to be alone, but now the sadness had a companion: the joy of this new playfulness, this happy spontaneity, this creative ability to find laughter.  

Learning to play wasn't what she came to the Samaritan Center for. She came for healing, and found that. Healing brings play; play helps healing happen.

When I was a child, playing meant I left the house right after breakfast to go outside with my friends only to return home for lunch and dinner. We played the usual childhood games, played in the creek, and rode bikes. Neither I nor my parents thought about what "play" was. My parents just sent us out "to play" and we willingly "played."

As an infant, play is how the child learns about his/her physical environment and how an interactive, empathic, bonded relationship with the parents is established. Play introduces joy and excitement which is essential for the child to develop a zest for life and engagement with other children and later in all relationships. Through playing with their baby and later their older child, parents come to see themselves as loving, giving, resourceful, confident and competent. Play is developmentally necessary for both child and parent.

Wow, this almost sounds like "work!" In reality, play is the child's "work" or task.

So, what happens to our "play" as adults? Sadly, it sometimes falls by the wayside thought of as "child's play." As adults, some falsely believe play is "too childish" or as an adult, "I do not have time."

As therapy begins, no matter the age of the client, I always ask, "What do you do for fun?" Too often the answer is, "Nothing anymore." As life becomes increasingly stressful or depression sets in, play is the first to go. For adults, "play" can increase energy, foster new perspectives, and rekindle a zest and enjoyment of life. Even in adulthood, play is vital for a balanced life. So, on this sunny spring day, I encourage you all to "Go outside and play." For me, I'm going camping.

There are many dynamics that make marital therapy different and often entertaining. As couples begin they get into a process of "hedging their bets." That is to say, they try to maneuver themselves into positions whereby they cannot be left holding the bag. They offer each other what seems to be revelations of their negative contributions to the martial demise and then quickly take it back suggesting the opposite. In thinking about this I recalled a poignant illustration from Robert Fulghum in his book Everything I Needed to Know I Learned in Kindergarten. On page 76 he shares a credo of his neighbor the insurance salesperson which illustrates this humorous dynamic:
 

• Always trust your fellow man. And always cut the cards.
   
• Always trust God. And always build your house on high ground.
  
  
•  Always love thy neighbor. And always pick a good neighborhood to live in.
  
  
•  The race is not always to the swift, nor the battle to the strong, but you better bet that way.
  
  
•  Place your bet somewhere between turning-the-other-cheek and enough-is-enough-already.
  
  
•  Place your bet somewhere between haste-makes-waste and he-who-hesitates is lost.
  
  
• About winning: It isn't important. What really matters is how you play the game.
  
  
• About losing: It isn't important. What really matters is how you play the game.
  
  
• About playing the game: Play to win!
  

At times this process is played out to a level equal to any Olympic contest, with all the possible twists and turns and surprise endings. Fortunately it usually dies a somewhat quick death and couples are able to see their folly, enjoy a good laugh about themselves and move into more productive exchanges. But I must confess, that even after 30 years of watching this comedy it still makes me laugh which in turn helps me (and the clients) keep my sanity.

I went to the dictionary to find a definition for play - there were 35 listed, none providing me what I wanted, but all rein- forcing the fact that there are so many different ways to play. Work and play overlap. It is sometimes hard to distinguish one from the other and it can be healthy if we can incorporate both.

With young children, their play is their work. It is how they develop into who they are. At the age of 4, my nephew knew the name of and use for every piece of farm equipment . He believed that the dirtier you got the harder you had worked so he worked hard at getting dirty in his play. He now owns his own construction company where he gets to "play" with big earth moving equipment. His play later formed his work. 

I remember as a young mother struggling to get my sons to pick up their toys. One day we watched Mary Poppins where toys magically fly back into place. I suggested pretending Mary Poppins was at our house. Picking up the toys became "fun" as they made them magically "fly" to their rightful spots. Play can improve parent child relationships. I am trying to help a father rebuild a relation- ship with his son by encouraging play and a sense of humor rather than being the critical, demanding parent he has become. Play is crucial in this situation. 

In adolescence, play is important to social relationships. Teens try on identities and relationships and begin to prepare to choose life partners and careers. Sports allow kids to have fun and learn life lessons: following rules, accepting consequences, cooperation, self-discipline, loyalty. As adults, sports can become one's career - from playing professionally, to coaching, to selling equipment, etc.

Play is necessary in our lives. I sometimes see adults who seem to have forgotten how to play. They get wrapped up in their work, working very long hours, then come home and only see work to be done there as well. There is no time to play. They might enjoy their work but it isn't the same as playing or being playful Play can be within the work situation as well. A sense of humor can go a long ways in making our work more tolerable.

Is a task work or is it play? It may be all in our attitude.

I'm the grief specialist at the Samaritan Center. Precious little humor in that. I did my doctoral research on a death-related topic. Some people thought that was morbid. One wouldn't expect there to be much laughter in such a line of work.

All of us at the Samaritan Center work with people going through dark times. We hear stories every day of sadness, trauma, brokenness, fear and emptiness. It can be somber work. Every one of us has been asked by a friend or client,  "How can you do this all day long? Isn't it depressing?"

Yet when identifying a theme for this issue of the newsletter someone suggested the role of play in therapy and everyone around the room was immediately on board. One might think the topic of play more related to the experiences of kindergarten teachers or coaches. Why would a group of therapists so readily agree to write about play? Because we've all had the experience of sitting with someone as they discover laughter amid the tears.

I've laughed with a group of widows as they shared funny stories about the life partners whose deaths they deeply mourn. I smiled as they found humor in teaching one woman in their group the nuances of pumping gas at a self-serve station—a task she'd never performed. I've watched a couple struggling to heal after an infidelity still able to tease one another playfully. I've enjoyed the "Freudian slips" we all occasionally make.

Humor is never the main event in a counseling setting and it's rarely present in the first meetings. It evolves only when an element of trust is present. It speaks of a connection made and a reminder that one is not alone. Play provides hope that healing is possible.

Play is so important to therapists because it's a lifting of the veil-a glimpse into a part of the self formerly hidden. It's the beginning of awareness that life can be balanced. In times of darkness, the ability to play, to laugh and to smile is affirmation of the truth the Psalmist speaks when he writes, "Weeping may endure for a night, but joy comes in the morning." (Psalm 30)

Loving the Unimaginable

 Researchers conducted an experiment. They'd take an ordinary ball in which one half was painted, say, red, and the other half was painted green. The researcher — a woman, let's say, would show a child – a boy, let's say – both sides of the ball. Then she'd place the ball between them, and turn the ball so that the boy could see only the red side. She'd ask, "What color do you see?"

"Red," says the boy.

Then she'd ask, "What color do I see?" Up to a certain age, the boy always says, "Red." The boy's mind isn't developed enough yet to be able to do what adults do naturally: to imagine looking at the ball from the researcher's point of view, and imagine seeing what the researcher would see from where the researcher is sitting. The boy's mind can only imagine things from his own perspective. If he sees red, he can only imagine the researcher seeing red too.

That inability to imagine other perspectives (points of view other than one's own) is called egocentrism .

Another example: a little girl gets a phone call from her father, who asks if Mommy is home. The girl nods. Father, hearing no response, asks again, and again she nods. She isn't aware that he is unable to see her nodding. She can only take her own perspective – "I am nodding. Why do you keep asking?"

While egocentrism is obvious and appropriate in little children, it is present in older children, teenagers, and adults in less obvious and more inappropriate ways. Much of the trouble in human relationships involves some element of egocentrism – and therefore much of the work of the Samaritan Center involves untangling the egocentrism in relationships.

We face an enormous challenge: helping people move beyond egocentric love. This love says: "I love you, but on my terms and from my perspective. It's not that I disagree with your terms and your perspective, it's that they are unimaginable to me. When you talk to. I'm not really listening – not out of rudeness, but because the ball is red, and that's all there is to it."

"In fact, in my egocentric love, your efforts to tell me about your side of the ball are threatening, because for me there can be only one perspective. So I'd be terrified to actually listen to you, because if I let myself believe the ball could be green, that would mean my red 'reality' would cease to exist." (In sharp contrast, some people – abuse victims, for instance – may get so locked into the other person's viewpoint they can't see their own anymore. But that's another article.)

I think of couple therapy. Almost always couples starting therapy complain of communication problems. Often one spouse is egocentrically stuck: "You have to see it my way!" The other spouse may be desperately trying to communicate a different perspective, but for the egocentric spouse that perspective is unimaginable. No matter what the other spouse says about the green side of the ball, for the egocentric spouse, the ball is red end-of-story-period.

In fact, just about any time you come to an impasse in a relationship, there's a red-ball-green ball element. Husband-wife, parent-child, boss employee, whatever. I hesitate to think how much time and energy goes into pointless arguments where one partner can only see one side.

Of course, for a truly pointless argument, get two egocentric people together.

So what's to be done?

Recognition is a good place to start. Is your partner (or parent, or employee) understanding but disagreeing with your point of view, or is your partner simply unable to get past his/her own point of view? This question is trickier than it sounds, because many egocentric people believe something like this: "If you really understood my point of view, you'd have no choice but to agree with it!" For them, if you disagree, it's because you don't understand!

A related question – and closer to home – is: can I really get outside my own point of view to understand my partner's? Can I understand what my partner feels, why it's so important to my partner, why my point of view just doesn't work for my partner?

It's a great sign when partners get curious about each other's point of view. "No kidding? You think that's what's going on? Help me see what you're talking about." There's often a lot of work to do, but at least it is now about loving a partner with an imaginable point of view.

Love in the Interlude

I write this in January, which seems to provide an interlude between two celebrations of love. In December, Christmas brings the hope of love, a giving love that reaches out to us. By now, though, the Christmas boxes are put away in the attic. The stores already are advertising Valentine's Day, another kind of love celebration: romantic, will you- be-mine love. What a good time to reflect on the place of love in our lives!

Many couples go through the customary Valentine motions, yet with an emptiness, a sadness in their eyes. Sometimes one or both partners will talk of a restlessness: "Something is not right." "We are no longer connected." "Were we ever?"

Sometimes both or one will begin therapy, like a couple I'll call Tim and Mary. Tim and Mary began with questions: "How can we make this work?" "What is missing?" "Is he/she having an affair?" "Why don't we ever talk?" They try to express their unhappiness with each other, but like many couples, they fall into the blame game: "He's a workaholic." "She's too busy w/the children and her activities." "He/she doesn't know me anymore." Each partner often begins the therapy process with an agenda: "S/he needs to understand me!" or "S/he needs to change!" Over months and years of frustration, the giving love gets lost, and the romantic love feels empty.

Often the real underlying questions are: Am I loved? Can I love? What happened to the dream of love? Tim and Mary are going through the motions. They argue about trivial things which separate them all the more, increasing their fear of being alone and unloved. So how do Tim and Mary move from separateness to connectedness?

Just as often vulnerability is key. It takes courage to risk vulnerability. Most difficult of all is to start with this question: "Am I able to love myself or am I looking for my partner to somehow make up for that missing love?" In order to fully connect with one's partner, one needs first to know oneself, accept oneself, love oneself.

There are no quick cures. Being a couple together is a journey of mutual growth. When one partner stops growing in the relationship, the other is forced to stop as well. And so Tim and Mary begin the counseling process by turning their questions about their partner inward toward themselves. Instead of "Why can't he/she…?" they ask themselves, "What is it about me that he/she responds that way? How can I change?"

As Tim and Mary discover more about themselves and about each other, they begin to see each other through new eyes. As their focus changes from bitterness to compassion, they become gentler with each other, and the giving love returns. As they practice better communication, they each begin to feel the return of romantic love. There are setbacks. One week Mary says in tears, "Just when I thought we had made progress, one step forward, this week we took three steps backward!"

This journey of loving is not without obstacles, but Tim and Mary made a commitment to finding their answers. They still admit they do not know the final outcome of their journey, but each agrees they have already become "better people," more able to combine Christmas love and Valentine's love in their relationship.

Yielding Slowly: How to Love Your Adolescent

People sometimes remark that teenagers are difficult to love. I disagree. I enjoy working with adolescents. They are trying to figure out who they are, where they fit, and how to become independent of their parents. Those efforts sometimes create conflict, and sometimes the role an adolescent "tries on" isn't what we might hope for. But adolescents aren't unlovable. In fact, they need love, especially unconditional love. This does not mean you approve of everything they do. It means that you still love and accept them even when you don't like or approve of their behaviors. It's a paradox: the more a parent tries to mold the teenager to be who the parent wants them to be, the harder the teen has to work at going in the opposite direction. That kind of parental response – conditional, approval- based love – may send unfortunate messages to the adolescent: "I don't love you, I love the person you'll become if you do what I say." Worse: "You are unlovable."

The complaint I hear the most from teenagers is: "My parents don't listen to me." Sometimes they confuse not getting their way with not listening, but usually they can tell the difference. As parents we think we know what is best and sometimes we don't take the time to listen to their reasoning. It is important to listen, to give the message that we care about what the adolescent thinks, that we want to know what is going on in the teen's life. Adolescents don't have much life experience yet, so it is by talking through ideas that they process and develop their own beliefs. I would rather they be talking about their ideas with me than with some of their peers.

A butterfly emerging from its cocoon can teach us something about parenting teens if we look at it carefully. Our parental love is like the cocoon which once protected our growing children totally. When the butterfly begins to struggle with the cocoon, the cocoon needs to yield, but yield slowly. If the cocoon completely refuses to yield, the butterfly will die a prisoner inside it. If the cocoon yields quickly, the butterfly will also die: the struggle against the cocoon is how the butterfly gains essential strength and stamina. If the cocoon just lets go, the butterfly will be too weak to fly, and too vulnerable to survive.

Loving your adolescent means fighting the temptation to keep the teen "in the cocoon" too long, thereby stifling growth. It also means fighting off the temptation to yield too quickly, to push the teen out before the teen is "ready to fly," that is, ready to be self-reliant. Another temptation combines the first two: expecting a teen to become a "substitute parent" or "adult

Down with the Self

It is a rare day in my professional work that I do not encounter one or more sentiments from a client laying out some way or ways in which that person or couple expresses self-negativity. It has many sizes and shapes; negative self-esteem, selfworth, self-loathing, self-hatred, self-rejection... it is a long list. And rarely are there descriptions offered frivolously or just to shock. They come from deep within a person's core being and they are the fuel that runs the personality.

One of the most devastating negatives, from where I sit, is the belief that "I am useless!" We live in a society and culture that highly prizes "usefulness." "Don't just stand there, do something!" As I travel with people on their way to discovering and then putting to use their talent, skill, and gifts, it is always a singularly rewarding. moment when they look at themselves and say to me some version of "I am worth a lot and I am now going to put what I have to use." This is not simply a matter of going from seeing the glass half empty to seeing it half full. It is rather, as Dr. Mike Magee in his Book Of Choices, says:

"Everyone's work matters. Everyone's job is worth doing well. Each person's effort is as unique as each vision of the world, each touch, each thought, each deed. Each individual matters - from the first day of life to the last." ( Book of Choices , M. Magee, pg. 40).

I am fortunate that almost daily I am reminded of the value of feeling and being useful and energized. I would encourage you to take some time every week to re-examine your self and when needed push through the negative self and give yourself a chance at life.

Hunger Moon

The Cherokee Indians called the month of February "hunger moon." They believed that if you could survive the cold, barren days of February, the rest of the year was a piece of cake. But February was a lean time—a time of just hanging on.

Who of us hasn't had those times when we're just hanging on, hoping to make it to a more nurturing time or place? Sometimes those lean periods come as a result of illness, the loss of a relationship, or some other major life change. Other times they seem to come out of nowhere and we feel like we're just going through the motions of life. Each day is just like the one before and we have trouble feeling inspired or interested or engaged. Even if we can find our way to God at such times, we seldom find a magical turnaround. For like February, periods of "hunger moon" are part of the cycle of life. Inevitably, they come to us all.

Many people come to the Samaritan Center during the Februarys of their lives. Sometimes we can teach them survival skills, offer hope that better days will come, or just help them hang on. Ideally, we can help them discover places of transformation.

The Cherokees also believed that a Great Spirit brooded over the lives of humans. And in the Judeo-Christian tradition, we too speak of a God who hovers and broods over us. The opening words of Genesis tell us that "The earth was a vast waste, darkness covered the deep, and the spirit of God hovered over the surface of the water." And then—out of the darkness and the void—God creates.

In my work with clients, I may, or may not use religious language, depending on the individual's lead. But what I hope to convey to people who come to me in times of "hunger moon" is my conviction that in our own experiences of darkness and void, God is creating—using the lean, fallow times for some purpose. When they feel most despairing and empty, I hope to help people discover that in the difficult times of "hunger moon creative possibilities are waiting to unfold.

I need to, but I'm afraid

When I first meet with clients, I ask what they want from their experience with psychotherapy. Frequently they say, "Advice." I then make sure they understand that I don't give advice; instead I help them work with their problems or concerns in order to reach the conclusion best suited to their needs.

I've noticed that the longer I work with a client, the greater the likelihood that they'll ask a question like, "What is the difference between counseling and therapy?" I believe the difference has to do with the depth of exploration an individual is able to do within. Counseling is more superficial, and I believe often involves the resolution of a particular problem or concern. Counseling can often be the acquisition of skills or the learning of coping strategies in order to deal with life challenges more productively.

Psychotherapy, on the other hand, is looking inward to the deep parts of our psyche to learn more about ourselves. It is the in-depth examination of those patterns of thought, feeling, and behavior that can keep us stuck in unhealthy patterns. Psychotherapy is learning to understand our own psychological structure and beginning to change it so that we can be healthy.

This answer often helps clients better understand what they want from our work. Sometimes after I've given this explanation, a client chooses to stop coming, deciding that the "counseling" they've already received is really all they're after. But many clients decide to continue the work, seeking the benefits of in-depth "therapy."

I'm thinking of one client in particular who initially came with her boyfriend. They realized they had some issues between them, and they wanted to work these through prior to getting married. They were able to successfully address their issues, and they were married. I expected that we would then bring our sessions to a close, as they had done their work and met their goals.

As we talked about wrapping up, the woman seemed a bit anxious, and I asked if there was anything else she wanted to discuss. Her comment was something along the lines of, "Well, I need to, but I'm afraid."

The painful topics that she realized she needed to heal from had to do with childhood sexual abuse and feeling unwanted, unloved, and unprotected by her mother. She knew she had a deep sense that she was an unlovable human being; she had great difficulty believing that anyone would want to be in a relationship with her let alone believing them when they said they loved her. She also realized that her extreme anxiety led to eating to try to "stuff" her feelings. Although she knew these issues were keeping her from leading her life to the fullest, her fears made addressing them seem almost impossible.

We decided to end the couple work, but I continued to work with the woman individually. Her healing from the childhood sexual abuse was long and painful. I believe that in that healing, she was able to understand that so many difficulties in her relationships with people, particularly men, came from not being able to trust, from believing she was worthless, and from feeling that she was unable to protect herself. Through our work together, she began to trust and to believe she had worth. She learned how to protect herself by setting boundaries, asserting her needs and wants, and accepting the nonjudgmental regard I had for her as a human being. This was a long and difficult journey for her, but she was able to see the effect her painful childhood had had on her, and learn that she didn't have to continue to live the rest of her life as she had as a child. She learned to feel feelings, to manage anxiety, and to face her fear and walk through it, not be controlled by it.

This was in-depth, painful, and healing work for her. By the time she finished her therapy, she was married and happy. She had become stronger and healthier, physically and emotionally, than she had ever been in her life. She laughed with gusto and felt joy. She set boundaries, learned to be assertive, and realized that she could feel her feelings instead of stuffing them. She began to exercise and lose weight. She spoke of having a sense of hopefulness she had never known she could experience. It was a transformation. By the time she finished, she had begun to spread her wings and soar. She was proud of the work she had done, and the person she had become. I was proud of her and felt honored to have been a part of that process.

When I first saw her in the waiting room I was struck by her despondent expression, her eyes appeared not to move. I felt a chill. It was as if I could see through her eyes into her dark ominous interior. At only 28, her life was replete with loss, burden, sorrow and psychological pain that seared her heart and soul. It was one of those moments when my clinical instinct told me this would be a long term relationship which would need psychiatric support for medication and perhaps even hospitalization. The question remaining was, "did this woman have the psychological and affective strength necessary for the journey?"

Psychiatric support in the form of hospitalization and long term medication came quickly. In only the third session, she revealed her fear of "outside forces" impinging on her mind. She could not go down aisles in the local grocery store because "…the cleaning agents like Clorox would somehow enter (her) body and devour (her) from the inside."

Some six months after discharge from the hospital, she began to piece together the puzzle. Through many hours of quiet and careful exploration, she came to see that she was not a "defective person." She also came to realize, however, that she had been damaged by the abandonment of her birth mother, and the ineffectual parenting of cold and indifferent adoptive parents who treated her with disdain. Other adults and peers over the years compounded her feelings of self-loathing and uselessness as she was the object of verbal derision.

"Mary" had somehow made her way through life in the face of these burdens. By the time her second child was two, "Mary" felt used up. It was then that she sought help at the Samaritan Center, with her eyes a transparent window into bottomless sorrow. Things did not change for her overnight, or even over a season. Healing occurred gradually, in the context of ongoing depth work. Four years after the initial crisis that brought her to us, she had come to see herself as whole for the first time in her life; she slowly matured into a healthy marriage with her husband, into becoming a "good enough" mother for her children and a friend and confidant to some new friends.

Her transformation was remarkable and comprehensive. It could not have been achieved through shortcuts or fad "cures." Had all the resources necessary for her depth therapy not been available - or if she received only crisis intervention and short-term counseling - she surely would have never healed. But like the mythical Phoenix she was consumed ...and then, in time, she rose again from the ashes.

My family and I recently undertook the daunting task of restoring a cabin built in 1810. This is something I have long wanted to do - I get excited just thinking about it. My family, on the other hand, was wary of undertaking a huge time- and labor-consuming task. Restoring it requires us first to strip all surfaces, label the logs, then dismantle, move, and reassemble them - and many other tasks that follow those! Fortunately, as we have worked on it, others have become intrigued and have pitched in.

This log home had one-inch-thick vertical boards over the exterior, clapboard siding on top of that and shingles placed over the siding. Virginia Creeper vines covered much of the siding. The interior showed several layers of paint and wallpaper. We really couldn't tell initially what shape the logs underneath would be in. We saved what we could of all that was stripped to reuse in some way in the finished product. Some logs have had to be repaired and parts replaced. We even uncovered some "treasures" from the past that we have marveled at along the way. I imagine the previous occupants must have liked the changes they made, even though many are no longer useful. As the layers were painstakingly removed (it helps to have three strong sons), the beauty of the logs and craftsmanship came through. Each area we uncovered encouraged us to continue.

It has been hard work. I cannot remember ever being so physically tired in all my life. I also am incredibly pleased and satisfied with what we have accomplished. For me, the beauty lies in the core structure. It has remained solid, although hidden, for almost two hundred years.

Restoring this log cabin offers an interesting metaphor for the process of depth therapy. The "layers" of the mind might consist of guilt, shame, grief, denial, abuse, addictions, past hurts - the list is endless. These layers often reflect ways a person coped with past difficulties, and the layers very well might've been useful at one time. As I work with clients, I marvel at how past events and feelings, long ago buried or forgotten, continue to influence their present reality. It is difficult to make healthy changes in our lives when the underlying influences and history remain hidden.

Depth therapy can strip away various layers and defenses to find one's healthier self or core within. Some areas of the mind may need repair or replacement, like faulty thinking that leads to self-destructive choices. We salvage and build upon what can be used and get rid of the rest. When we begin, we don't often know what will be uncovered. Each step encourages us.

Just as restoring the cabin is hard work physically, therapy is hard work emotionally. There are times when all the client wants is a surface change, to feel better for now - adding another "defensive layer" much like the various layers of siding, plaster and paint were added to the log home. But depth therapy involves going beyond the superficial in order to uncover the beauty that lies beneath the surface and to lovingly care for that core self.

Our log cabin is a long way from completion. More hard days of work lie ahead, but we are making progress. The process is worthwhile. It is similar with depth therapy: the end results in both endeavors - as well as all that is gained along the way - are very much worth the effort.

The above title is but half a phrase of Helen Keller. The second half of the phrase is: "…it is also full of the overcoming of it." My version of this sentiment, one which I have shared with many clients, is "I am not against people suffering, including myself. But I am against people suffering needlessly." These thoughts have much to do with the theme of depth psychotherapy. Once presenting issues/problems/concerns are resolved in the therapeutic journey, each person is then at a decision point: "Am I content to be where I am or do I want to dig deeper? Do I want to find the source of my affliction so that when I engage my next battle with despair I shall be better equipped to sustain myself and have more and better tools in my box to fight my way through the enveloping cloud?"

Dr. Mike Magee states it this way: "If we look around inside and out, at small problems and large, isn't life a mixture of suffering and overcoming it?" He goes on to say that ours is not a certain world. We all cycle through bouts of pain and suffering but out of them grows insight, hope "…and redemption." The journeys through the pain are best if undertaken with another. None of us is ever and always self-sufficient. Because of this, we as professional therapists are invited along on many scary but wondrous walks, trips of despair and hope. These trips by definition are long sometimes turbulent but always intriguing and they only happen when the two people involved have enough time, trust, empathy, faith and strength. It cannot happen in weeks or even months, it takes years. That is the downside. The upside is, if we can take 20, 30 or even 40 years of suffering and re-work them so as bring about healing and hope in 2, 3, or even 4 years that is quite an accomplishment!

There are few places/agencies/practices around our community that can and do offer such "tips" to people in need. Our Center is one of them. We openly offer people the resources to take as long a trip as is necessary for them heal completely. So that like Helen Keller we can say: "Although the world is full of suffering, it is also full of the overcoming of it."

I suppose Mrs. A* convinced me, if I had any doubts. She had sought counseling initially because of trouble in her marriage: her alcoholic husband was getting meaner in his retirement, and she didn't know how to handle him. So she and I worked at skills and strategies for coping with him, confronting him, moving toward what AlAnon calls "loving detachment" from his addiction. She did well, and after a few months I figured we were about to wrap things up.

But then, as one of these wrapping-up sessions came to a close, she spoke. Almost as an aside, almost in spite of herself: "There's something else..."

"Something else" turned out to be the grief and pain of an awful decision she'd had to make twenty years before, the kind of major life decision where what she had always believed was right collided with what she knew was realistic. She made the "wrong but realistic" choice. In secret, and for two decades, she mourned a terrible loss, suffered a terrible guilt.

In the months that followed this session, she broke the silence, shared the grief, and wrestled with the guilt. In the process we also delved into the structure of her personality, working toward healing and growth. It was incredibly difficult work, but she did it well also. In wrapping up our work - this time for real - she said that she never intended to tell her secret to anyone, and was still surprised that she had disclosed it. Surprised, and greatly relieved: through that disclosure a huge burden was lifted, lifelong conflicts resolved, her capacity for joy recovered.

So Mrs. A convinced me: the great value of the psychotherapy process comes in the fullness of time, to use the traditional phrase. A person seeks help for an obvious and understandable reason; so often behind that "presenting problem" lie other, deeper, more significant issues. It takes time to get to them: time to build trust, time to develop a working relationship, time to sort through the initial issues, time for the client to build courage. In time, what matters emerges.

Of course, time alone is insufficient. A psychotherapist with training and skill in depth work is essential. Mid-term and long-term therapy isn't just stretched-out short-term counseling. Great damage can be done when those trained in short-term counseling step beyond the limits of their abilities.

It is one of the Samaritan Center's uniquenesses that we are committed to providing, where appropriate, depth psychotherapy - allowing for the fullness of time, allowing for the "something else" that takes us beyond the presenting problem and into deeper healing and growth.

It is our recent tradition to have articles in these newsletters reflecting a theme. Our current theme is depth in psychotherapy: how clients move with us into greater depth, and what healing and growth result.

*A, Not necessarily her real initial.

I write this in a time of mudslides and tsunami, when whole communities suddenly vanish, when traumatized survivors tell of watching loved ones swept into the void. After the shock wears off, and the pain of loss hits full force, we ask perhaps the most basic human question: why? The Judeo-Christian version of this ancient question has a name: theodicy. Why does evil co-exist with a loving and all-powerful God? Why would such a God permit suffering and injustice?

Answers abound, with varying degrees of sophistication and plausibility. In the early stages of one's recovery from tragedy, however, these answers hold no meaning. Philosophy doesn't do much for a broken heart. Theology doesn't fill an empty crib. In recovering from tragedy, the most important question is usually how? How can I face this day, this hour, this minute, under the burden of unbearable grief and pain?

Though the murderous mud and killing waves did their damage far from Elkhart County, these questions are immediately present in the lives of some of our friends, families, and neighbors. Whether their tragedies came through nature's violence or human cruelty or implacable illness or simple accident, they sink under the burden of their distress and their questions.

Some find their way to the Samaritan Center. Each day we work with "how," and sometimes eventually we reach "why." I've asked my colleagues here at the Center to consider this "how and why" as a theme for the articles in this newsletter/annual report. As the slash demonstrates, this issue serves dual functions of reporting on the past year as well as offering brief essays we hope will be helpful.

Within, Creatively, and In Its Own Time How does a person find meaning in tragedy? I want to suggest three elements: The meaning comes from within - Achieving a sense of meaning is a creative act - Achievement of meaning has its own timetable

Often as people begin to pull their lives together after a tragedy, they energetically seek meaning from any number of external sources: friends, family, clergy, religious books, etc. This is an important process to undertake, often providing rich resources for meaning. And yet, time after time, people give up such pursuits unfulfilled. It is only when a sense of meaning emerges from within - from meditation, prayer, or even a simple quiet walk - that this meaning takes root. This meaning is almost never a straight-off-the-shelf copy of something they've read or heard. They have made this meaning their own, personalizing it to fit their lives and faith. And in accepting the not-quite-perfect meaning, with lingering pain and emptiness that may accompany it, people find that relief is realistically available.

A grieving parent says, "Nothing will take away the pain of my child's death. But this fund we've established, which helps those with the illness that killed her, gives me a measure of satisfaction. It provides enough purpose to continue living, to resume caring about life."

There is no timetable for finding meaning in the wake of tragedy. It takes as long as it takes. That certainly can enhance the sense of unfairness in tragedy, as people wander spiritually lost for days, weeks, months, years afterward. And yet that day comes when the tiniest ray of meaning breaks through gray despair and lifts up a new possibility. Though it is not the hoped-for miracle that wipes away all pain, it is the actual miracle we get: a new anchor in the storm, a new ladder to take us partway out of the deepest hole. For that gift, limited though it is, we might feel grateful.

A person recovering from an unwanted divorce might say: "I will always want my marriage back, and wish for my ex-spouse's love. But to my surprise I have rediscovered myself as a person, and I have grown stronger than I would have believed possible. It's not the outcome I wanted, but I'm grateful for it."

A key in the counseling process, when we work with persons in tragedy, is to look for ways to make the pain count. That is, times of great pain can also be times of great growth: the pain splays us open, and we can make changes that we wouldn't otherwise consider. Thus the professionals at the Samaritan Center operate in the space between the how and the why, working not only toward healing, and also toward growth, in the hope that our clients can find meaning and even miracle in the transformations they undergo.

Human tragedy and human suffering are equal opportunity experiences. Agony and loss spare no one, not even small children. And at any given moment somewhere, someone is experiencing one or all of the above. Given all this sadness, grief and despair it is no wonder that individuals find themselves on the brink of giving up, abandoning hope altogether.

There are countless opinions, explanations, articles, books, film material and stories about how to recover from these experiences in healthy and meaningful ways. And yet every week people come into my office still asking, "Is there any reason for me to even think that I can dissolve the pain I feel?" My answer is, "Yes, but the journey will be difficult." From the first day of my professional career, I hung a poster on the wall of my office, and I have kept it in all offices since. It is a 2' x 3' color poster showing a Raggedy Ann doll being put through an old hand wringer like the one my mother used to take the water out of freshly washed clothing. Written above the pathetic and pained expression on "Annie": "The truth shall set you free…but first it will make you miserable!"

I point this out to clients, and tell them that before the quest for the "truth" that will set them free from the pain they are already feeling, they must experience yet even more pain. My 30+ years as a therapist have taught me that we can only survive pain by confronting it head on. We must take it apart piece by piece, experience by experience, trying to figure out how each awful feeling joins with others to form what seems to be an unbreakable rock of pain. As we separate off each piece, each little stone, the rock is no longer so formidable. Eventually the rock is transformed into a pile of dust. We can manage the dust pile. We can sweep it up into a much smaller space than the rock occupied. We cannot be rid of it completely but we can now feel healed, hopeful, and "bigger" than the rock.

I believe we all find ways to move toward the hope. For some of us, other people are the primary catalyst, by being with us. They do this physically, emotionally, or in simple caring acts. Others move toward hope through the "understanding" of the pain-causing experiences. For others it is a spiritual/religious series of beliefs and inspirations that quiet the internal storm. For others it is listening to others reveal their similar tragedy and their journey toward hope. For some it is a medical intervention, be it hospitalization, medication, or some other form of "therapy." What I believe is common to all is the willingness to fight for our lives. I believe God gives each of us an indomitable "spirit." This spirit can be shrouded in pain, fear and uncertainty, but it cannot be broken.

Many of my clients are children. They find their way to my office because they have exhibited behaviors that are problematic for their teachers or parents. Rarely does a child ask for therapy. Most are viewed as "problems" needing to be fixed. So children aren't often enthusiastic about meeting me for the first time. Yet once started, most want to continue therapy because they are unhappy and want their lives to be different

Children usually can't identify what caused their unhappiness. They simply know that the world feels unsafe, and they feel insecure. I begin with them by exploring what their lives are like. I often hear common themes: "I don't have any friends; mom and dad fight all the time; I'm so stupid, I never do anything right; I just feel bad."

Finding meaning in tragedy for these children begins with this exploration. Often these children don't feel loved or secure in their families. Their parents may argue that the children are loved and secure, and I take those comments seriously. But it's equally important to note that these children still may not feel loved and secure. There are valid experiences behind those feelings. Making things better involves taking those feelings seriously and healing the hurts behind them.

Sometimes parents are not happily married and fight openly, or fight behind closed doors where they believe the children can't hear. But the children do hear. And some parents simply do not have the resources or ability to be adequate parents. I also work with children whose parents are addicted and unable to give the children the proper love, because the parents' addiction has become the most important thing in their lives.

In such situations (and many others as well), children can feel unloved, insecure, and unworthy of care and concern. As we piece together the events and experiences in their lives, we both come to understand better the "why" of each child's particular tragedy.

The "how" for children is often more difficult. The "how" (how to cope, how to heal) starts with safety. It involves establishing an environment in the therapy office where the children feel safe to explore and act out feelings necessary to healing and coping. There are several ways to make the environment safe. Having fun but age-appropriate toys and games around, for instance, tells the children I'm sensitive to their needs and interests. I validate them and respect their feelings, thoughts, and ideas. Sensitivity, validation, and respect all help a child feel safe.

Safety also means physical safety for the children. When I work with children, I set the rules of my office the first day: You may not hurt yourself - You may not hurt me - You may not hurt anything else in the room.

Children test these rules frequently. In one initial session with a little girl, I stated these rules, as I usually do. She immediately threw herself on the floor. I couldn't get to her before she landed, but I repeated the rule and said that I would try to prevent that from happening again. Within two minutes, she threw herself on the floor again. This time I was more ready: I got to the floor just as she did. Although I couldn't stop her, I was right there with her. The next time she tried it, within another two minutes, I got to the floor first and blocked her fall. She smiled, got up, and didn't throw herself on the floor the rest of the session. This particular child completed counseling recently, and a number of times during the last few months, she would look at me with a huge smile and say, "I can't hurt myself in here. Oh, yeah, I can't hurt myself in here." I acknowledged and affirmed her words.

Initially in counseling some children say particularly mean and hurtful things. I believe they expect me to condemn them, discipline them, or say something hurtful back to them. When I do not, they often seem confused or even uncomfortable. My response is so different from what they expect! In time, however, most of the children come to understand that I am there to help them with their feelings, their behavior, and their ability to cope. As they come to trust this, they can experience an altogether new sense of safety.

Children don't always need to put things into words, so sometimes the "meaning" we find in tragedy is more like new hope, a shared smile, or a happiness that replaces despair. For me, the meaning comes in seeing so many children get better, grow stronger and more healthy, and feel so much better about themselves.