I recently watched a show in which the question "What do you stand for?" was asked. I paused to consider my answer and felt pleased that it came to me pretty quickly. In my clinical work, I find that the answer to this question is often the answer to many of the questions brought into the therapy room.

We don't always give our personal values as much thought as they deserve. Elections give us a chance to consider the issues and leadership qualities that are important to us, but only a small percentage of people vote, and even then our judgments can be clouded by affiliations and other influences. Identifying the rights, privileges, and human experiences that we believe to be undeniable helps us know ourselves more deeply and gives us a solid foundation up which to base our most important decisions.

My clients often come to a point of exploring their next moves in life. Their decisions may include work opportunities, relationships, education, parenting, homesteading, or vacation planning. Sometimes when I inquire about the deep personal beliefs involved in making the decision, I get a blank look in response. So we begin by exploring what really matters to the individual, and distinguishing a value from an activity or a simple preference. The question "What do you stand for?" refers to something we are willing to take action to protect, to show reverence for by leaving our seat and proclaiming our devotion.
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Having values and the confidence to claim and protect them is an important avenue toward creating a meaningful and fulfilling life. Loads of worksheets can be found online to help with values clarification and personal exploration. Your TikTok "For You page" and Amazon ads can you reflect on the values you have aligned yourself with. Look around at your friends and chosen family and remember the saying "Show me who your friends are and I'll show you who you are". In essence, we are our values. So know your values and claim who you are! It will ease your passage through this life.

As much as we humans love to create and label mental boxes in which to organize the nouns we encounter throughout our days, the Russian doll effect applies in that every labeled box actually encompasses endlessly smaller labeled boxes, for our sorting enjoyment. Any member of the LGBTQ+ community can attest that every variation of romantic, gender, and sexual disposition has a name, a flag, and a thriving community of enthusiasts.

Same goes for the Introvert-Extrovert spectrum. Rather than settling for the classic binary, we now understand that gradations are typical and many people strive to find just the right term to describe their particular approach to engaging in the interpersonal realm. Extroverted Introverts are also referred to as Social/Sociable Introverts, Ambiverts, or Omniverts. I'm sure there are other synonyms I haven't come across yet. Feel free to deep-dive into this more if terminology interests you.

My insight of the day around this is a question that occurred to me: I wonder if it is common for Extroverted Introverts to be misunderstood and possibly rejected by others? Lots of people walk this earth feeling different, excluded, and "othered". The people who enjoy and need time alone, who can be quiet and solitary in certain moments, but who can also assertively lead a group and hold their own at a cocktail party, perhaps these people are confounding to others who try to pin them inside a decorative display box and attach a neat label underneath? Maybe these people come across as inconsistent and unreliable due to their seemingly unpredictable nature? These qualities can signal danger and put others on the defensive.
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The catch is, the EI's behavior isn't actually unpredictable if you understand the nuances of the situations, their personal needs and energy sources, and the predisposition that allows them to shift between two different styles of engagement with the world. If you are an EI, it may be enlightening to consider whether this dynamic affects your personal or work relationships. It's fascinating to explore the gradations of human experience and work toward releasing our reliance on clean lines and strong demarcations between us.

I have a hypothesis that there is a place on the neurological spectrum between ADHD and Autism which explains the inner life and functioning of a great many people. My experience has been primarily with women, which is the reason for this piece's title. In my experience with Autistic and ADHD boys and men, their symptoms tend to align nicely with the criteria detailed in the DSM, which makes sense since the bulk of the defining research has been conducted on them. However, it is possible that men will relate to these neurodiverse traits as well. And my use of gendered terminology in no way excludes genderfluid or diverse people from engaging with this work.

This is my answer to my field's practice of diagnosing human conditions via their observable facets. An individual's neurological functioning is often intentionally concealed in order to survive our society's institutional expectations. I have used this chart to honor internal experience above observable behavior in order to help people recognize these traits in themselves or to exclude neurodivergence as the source of their challenges.

docs.google.com/document/d/e/2PACX-1vRirYqW0klpvlXnmBElMMF6-TL6lIkgwicrswvuh2WCMxkW-5a21MbQlsHWTh2uHJETnUn3BQ0TPwl3/pub

Labels have the power to enlighten and enslave us. Hopefully more of the former. An individual officially labeled with a physical, mental, or developmental disorder may be entitled to certain supports and protections. In optimal circumstances, a diagnosis helps people understand themselves better and find direction toward living their best life possible.

The process of diagnosis tends to be veiled in mystery and deemed the territory of very expensive specialists. Capitalism loves a pedestal. However, diagnosis of disorders (I prefer "conditions") actually entails one basic element: matching up an individual's behavior with criteria identified through ostensibly scientific procedures and listed in the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD). The DSM is generally used by mental health practitioners and the ICD is used by medical professionals. The numbers after their name refer to the current revision of the work. Most of the conditions which are listed in both volumes entail the same or mostly similar criteria for diagnosis.

Let me diverge from the main topic for a second. At this point in time, diagnosis tends to be based on observable behavior rather than internal experience. Which means that diagnostic pronouncements are made by an outside authority often based on commentary given by others known to the patient, especially in the case of children. There has been a recent shift in the healthcare field toward replacing the term "mental health" with "behavioral health", as if a person is what they do. This mindset has the power to create more barriers to truly understanding and serving people who are looking for help. I place value on the internal experience of the individual and I like to imagine a world where people's own experience of themselves is honored more than an outsider's judgment of their visible symptoms.

Many paths can lead toward determining whether a person meets criteria for diagnosis, and specifying exactly which diagnosis fits best. I imagine everyone reading this article has had an experience of seeking understanding of a physical or personal concern, only to be told several different things by several different professionals while receiving little useful help. This is because diagnosis, at its core, is not technically scientific. It is based on the clinician's knowledge base, clinical experience, personal and professional biases, competence with measurement tools, energy level and brain power at the time of diagnosis, insurance company influence, and sometimes convenience.

People qualified to deliver diagnoses are those licensed (not certified, credentialed, or trained) by the medical and behavioral health boards of each state. LCSW (licensed clinical social worker), LMFT (licensed marriage and family therapist), and LPCC (licensed professional clinical counselor) licensees are all governed by the Board of Behavioral Sciences (https://www.bbs.ca.gov/) in California and are all technically qualified to make diagnoses of conditions listed in the DSM. However, each field's initial training has a slightly different psycho-social-emotional focus so it's up to the clinician to enhance their knowledge base with further learning and clinical experience throughout their career in order to be competent  in their delivery of services. We have an ethical commitment to work within our scope of competence and to define our field of practice based on our specialty focus and expertise. Just because my license qualifies me to diagnose Hebephrenic Schizophrenia doesn't mean it's the right thing for me to do.

Many clinicians are unclear on the capabilities and limitations afforded them by their professional license. Lacking confidence, information, and scruples leads many clinicians to fall back on common, trendy, or generic diagnoses. Rather than truly understanding the person through a variety of perspectives, they grab at a couple obvious straws and slap a quick label on it. Every decade sees a handful of over-utilized diagnoses which often tend to be the ones most highly reimbursed by insurance companies. Mental healthcare is absolutely part of the capitalist game.

I sound cynical, don't I? I like to think I hold a healthy amount of skepticism toward the whole system. Enough to stay grounded and keep my focus on the welfare of the individual over the corporate bottom line.

So when seeking answers as to why you feel, act, or react a certain way, it's important to have some guesses as to what might be your concern. Trust me, your guess is as good as your healthcare professional's. It will give them a place to start as they consider your symptoms, explore your experience, and weigh that information against their knowledge base of various conditions which may share characteristics or overlap in certain dimensions. The best diagnostician is one who can skillfully discern between varying presentations of conditions and individualize their conceptualization of your particular case. A good practitioner will also be able to explain their thinking and conclusions in a way that makes sense to you, the patient.

I value self-recognition as a useful step toward appropriate diagnosis. Although WebMD has caused many unwarranted panic attacks and sleepless nights, it has also helped millions learn about conditions to which they previously had no exposure. Approaching your healthcare provider with questions and suspicions is extremely valuable in helping them attend to the important details of your concerns. In the best scenarios, they will consider your suggestions and use them as jumping-off points to explore your concerns and arrive at a determination as to the source of your trouble.

I've somehow saved some of the most important points for the end of the article. Most mental health conditions in the DSM do not require expensive testing and long procedures to diagnose! Of course the general public typically has no idea of the correct way to arrive at a diagnosis, so they trust the professionals they hire. And as we all know as seasoned capitalists, the more expensive something is, the better it is. So a $5,000 diagnosis must be more correct than a $500 one, right? I am here to say that is entirely false. Most conditions can be identified through careful interviewing and observation, and perhaps the completion of a written survey or two. If your clinician has expertise in their field, they will know what fits and doesn't fit with all the conditions similar to and affiliated with the predominant symptoms reported and observed.

Clinicians do their best to gather copious information from multiple sources to make the most accurate assessment possible.  Some patients are better able to perceive and articulate their experiences. Some concerns are actually more internal than external and may be difficult to convey. Sometimes observation and psychometric testing is inconclusive. Truly, diagnosis is not typically a linear, objective process. Mistakes are made and details are overlooked, even by the most expensive of diagnosticians.

This is not to say that extensive psychological testing is all hooey. There are many conditions such as developmental and learning disorders which truly reside in the deepest parts of the brain and defy clear outward expression that need expert attention and review through complex processes. The processes are usually not the first step in a diagnostic process, though. Practicing therapists in clinics and private practices ought to be adept in their offered services and worthy of the trust their clients put in them.

Many of us have been taught the Golden Rule: Treat others the way you wish to be treated. It's quaint and useful as a general tool and, oh, wouldn't it be wonderful if the world actually operated according to this philosophy? When deciding where to leave your grocery cart in the parking lot, this is helpful guidance for making a pro-social choice. Interpersonally, it doesn't hold up as well.

I've heard versions of Golden Rule-thinking come up in all of my counseling experiences. At school, students would often try to resolve peer problems by doing the thing they didn't like right back to the person who did it first. "How do you like it?" is thought to be a really powerful lesson. However, no recipient of this treatment ever looked at the ground sheepishly and replied, "You're right, that was a rotten thing to do. I'm sorry, I'll never do it again." That's the desired reaction, but it NEVER actually happens! Except maybe on the "Brady Bunch", sigh.

Intimate partners often say to each other, "I would never do that to you" in an effort to get the other to admit they did a jerky thing and that they themselves wouldn't appreciate if the tables were turned. But that strategy often falls flat. The human ego and survival instinct seem to prevent us from reflecting on ourselves in this way, especially during a moment of tension. Another downfall of this technique is that it rests on the assumption that our preferences are the same and that we respond similarly to stimuli.

I call relationships between partners with different neurological types "neurodiverse relationships". One partner may function neurotypically and the other may fall on the autistic spectrum or have ADHD or another condition affecting their neurological processing, or both partners may function at different places on the neurological spectrum. These styles heavily influence the way people communicate, how they experience and show emotion, and how they respond to touch and sensation, among other traits.

In this field, we acknowledge that people absorb and process information differently. The "telephone game" gives us a concrete example of how messages can change according to the way they are heard and shared. We use the term "filter" to describe the unique way a person interprets information they receive from others. We all have filters based on our personal life experiences and emotional and psychological functioning. When we add a layer of neurodivergence on top of standard communication dynamics, things get even more complicated.

Due to our filters and interpersonal dynamics, it is wise to recognize that the way one person prefers to be treated may not be the same for another, thus rendering the Golden Rule inappropriate. For example, one person might really like a hug when they feel sad, but another might prefer quiet companionship with no physical contact. If the first person follows the Golden Rule to the letter and approaches their sad friend with arms wide open, they will get a response they weren't expecting. Then that misunderstanding and surprising response will lead to new thoughts and perhaps confusion and hurt feelings.

                Treating others according to our own personal beliefs and preferences  fails to                                        acknowledge each individual's unique needs and personality.

This knowledge can help couples understand one another better and more consistently create satisfying experiences. It is actually not reasonable to assume that others want to be treated the way I want to be treated, at least without more information and open communication. As a society, we've come to embrace the Love Languages and know that different people have different ways of giving and receiving love. People are also unique  in their preferences around communication, personal space, home maintenance, gift-giving, and all other aspects of shared living.

Partners can help themselves by asking about and attending to their partners' personal preferences and needs. Assuming they want the same things is a fallacy that does not create the harmonious existence most couples crave. Viewing all preferences as valid and finding ways to compromise so that both partners get some of what they want is the most functional path toward fulfilling interdependence.

I was originally taught, and through experience now believe, that dreams come to us in the service of health and wholeness. They come from the deepest and most mysterious places of our own minds to help us sort through all the material and experiences we absorb each day. I believe dreams are colorful or dramatic reflections of where we are mentally and emotionally at the time of the dream, helping us clarify and process our thoughts and emotions. 

I do not think prophetic dreams are very common, although I do not discount them outright. I think humans are very curious about the future and crave the security of knowing what lies ahead, so the tendency to think that our dreams may predict future events can be very strong. I also don't think the people who appear in our dreams always represent themselves. Some people think if they have a dream about kissing someone, they have some sort of moral obligation to obtain their consent. Let that go, your dream is your own private world. 

Dreams tend to speak in a symbolic language that involves the different realms of our mind that we don’t typically acknowledge or give voice to: our subconscious, the perceptions we tend to discount or ignore; and our unconscious, that which we don’t even realize lurks beneath. Given this context, please know that NO ONE can tell you what your dream means. Only your own intuition and "gut sense" can identify the metaphors and analogies that rightfully describe the content of your dream experience.

Countless books have been written on the meaning of dreams, dream analysis and interpretation, and methods for generating and recording dreams. I won’t go into those details here. This article is intended to provide you with a simple and effective method for understanding a dream you remember upon waking. I believe that if a dream fades away, it doesn’t have an important message to be worked out. Dreams with strong emotional content or startling and memorable images that stick with you into the daytime tend to have information that could benefit your growth and development. Scary dreams are intended to frighten you into paying attention to something important!

As you remember your dream, identify the strong images, thoughts, emotions, physical sensations, colors, or numbers that you experienced in your dream. Focus on those elements that really stand out in your memory. The smaller details are probably less important. Write them down as soon as possible before they begin to naturally fade with the daylight.

Download this page for the form you will use to reveal the meaning of your dream!
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In the first column of the dream sheet (Dream Element), list the elements you remember in any order. Leave some room between each element for the writing you will do in the other columns.

In the second column, you will reflect on what the element means to you personally. For example, if you dream of chocolate chip cookies, write down any significant thoughts or experiences with chocolate chip cookies. Keep it short and simple. You might put "delicious, Grandma made them" or “not my favorite“. Do this for each of the elements listed in the first column.

The time is right to look within and explore the terrain of our hearts and minds, while inspecting the bridges that link us to others. Spending more time with certain people and less with others is causing many of us to reconsider the topography of our lives before Covid and to make decisions as to how the map will look when we eventually re-emerge.

Although many  of our vacation plans are temporarily on hold, discovery and excitement are still available. Being homebound can inspire us to dive to the depths of our lifelong patterns, challenges, and mysteries. Journaling, interpreting dreams, and talking with a deep and active listener can open doors that lead to previously undiscovered rooms, passageways, and foreign lands.

Many people find themselves with a multitude of opportunities to heighten their communication skills through dealing with intimates much more directly than was previously possible or necessary.  Learning about ourselves and each other, as well as developing skills to speak and listen with an open heart, can bring our relationships to places we didn't realize were on the map.

Some difficult journeys feel safer with an experienced guide. Even when we strike out into unfamiliar territory alone, it can be nice to encounter another adventurer along the path to share stories, ask questions, and gain insight or advice to make the trip more successful and pleasant. However approached, the journey itself is worth the effort and something will be learned, regardless of the destination.

I love Lady Gaga for her crusade to educate the masses about the variety of normal sexual and gender orientations and expressions, as well as any personality quirk that might seem to make one person stand apart from the next. Everything in her personal presentation and body of work, including her latest release “Born this Way”, not only preaches but demonstrates the virtue of individuality, acceptance of self and others, and the beauty of expressing one’s true inner self, in whatever form it may take. I see the way she affects the “tweens” with whom I work and I praise her for it. And although the premise of her new song is inspirational and certainly in keeping with the idea of homosexuality as a natural state, I want more.

Research on all aspects of humanity has historically been performed on male subjects with the results generalized to both genders. We now know this is often not helpful to women and can be quite misleading and actually dangerous in some cases.  Although information on homosexuality has historically been gleaned from the lives of men, it is now known that sexual orientation in women often develops quite differently. In a nutshell, gay theory espouses that people’s sexual orientation is hardwired from the start and there is, at some point, a grand “coming out” which reveals what was there all along. Fascinating research by Dr. Lisa Diamond and others shows that the process is actually much different for a high percentage of women. Rather than present a literature review on the academic findings on this topic, I prefer to present examples of normal realization and expression of female sexuality, based on composites of real women I have known. These three styles are modeled after women who are interpersonally successful, productive, and content with their lives.

Style #1: “The Classic”

Jeanette’s first crush was on her first grade teacher. She knew her tingly feelings were more than just appreciation for the way Mrs. Summers recounted the tale of Sleeping Beauty. Jeanette went on to develop intense feelings for her girlfriends, and by the time she was 7 or 8 it was clear that something about her was different from the stories she read in class and saw on TV. She struggled with her feelings throughout school, even having some suicidal thinking in her teens as her experience of isolation and inadequacy became overwhelming. She had her first girlfriend in high school and finally put a name to her experience, as she realized the love she felt was overwhelmingly real. She then began to identify as a lesbian and has never looked back.

Style #2: “Late bloomer”

Helen always had boyfriends in her growing-up years.  The truth is, her family and culture did not actually present her with alternate versions of “normal”, so she just followed the norm for girls and didn’t think to consider other options. She married relatively young and had a couple of kids. Life had its challenges and her relationship with her husband was often strained. Her husband’s mood and addiction problems further complicated the marriage and preceded their eventual divorce. As Helen entered her 50s with a hefty dose of life experience, greater self-confidence, and a desire to finally live for herself, she approached the next phase of her life with a different mentality. Perhaps related to her new perspective, Helen began noticing different types of people crossing her path. Some were women for whom she inexplicably (but somehow not surprisingly) noticed feelings of attraction. She eventually found herself in a relationship with a woman, and it felt very natural and right. Some people thought she had been fooling herself all those previous years, but she feels that this stage came about naturally when the time was right. She now fully accepts herself and feels at home in her current life situation.

Style #3: “Don’t call me bisexual”

Maria was always a free thinker. She didn’t typically fit in with the mainstream crowd and she often felt misunderstood and overlooked. As a young person she had crushes on boys, but certain qualities in girls also caught her eye. Her appearance was pretty standardly feminine and she was not perceived by others or herself as “gay”, but she certainly didn’t identify with the typical dreams and expectations of the straight world. Over time, she developed greater interest in and comfort with the idea of being sexually and romantically involved with women, but she continued to have attractions to men, as well. Maria has had relationships with both men and women, but is always committed and monogamous within the context of any relationship. She may be drawn more intensely to one or the other at any given time, but she believes that when she meets “the one”, that person may be of either gender and she will gladly commit herself to that relationship for the long run.

These three styles are common among non-heterosexual women, but they are not the only “normal” ways for women to experience and share their sexuality. Truly, one important piece of learning to be taken from this new perspective is that our definition of “normal” needs to expand to include a wider range of options for women. Research is showing that although some men follow similar alternative routes to blossoming in their sexuality, it is still most common for males to follow the “classic style” upon which the common understanding of homosexuality has been built. Dr. Lisa Diamond has coined the phrase “sexual fluidity” to describe a woman’s normal tendency to shift in sexual identity throughout the life span. This leads to the conclusion that just because someone wasn’t “born this way” doesn’t mean she isn’t exactly who she is meant to be, right now.

This article can also be seen on: http://www.goodtherapy.org/blog/female-sexual-development-lesbian-bisexual/

I’ve got two clients right now. Granted, the most I can fit into my part-time private practice is six per week, but right now I’m averaging less than 1 per week. Very low.  According to colleagues who work in private practice and mental health agencies, it seems that the early months of the year tend to be slow for new referrals across many branches of the field. I had the double-whammy of terminating with several clients before the holiday season, which brought my client count crashing down. For those who rely on a steady stream of clients in order to pay the bills, times like these can be very stressful and concerning. And they don’t just happen according to set calendar dates. Things can be moving along swimmingly and then suddenly the client load shifts inexplicably and you find yourself with more free time than you might prefer. The following are some reframes and positive thinking about this trying, but common, situation.

1. This may be a sign that it’s time for a vacation. Therapists tend to be “other-focused” and often forget to give themselves the rest and relaxation they need to be available and attentive to those who seek their help. A low time can signify a great opportunity to relax and recharge. Rather than going toward guilt and fear, you may choose to see this time as a gift for all the hard work you’ve been doing. Shift active clients to the same days and get out of town for the rest of the week to a place that inspires, invigorates, or replenishes your soul. If leaving town is not possible, give yourself permission to loaf, rest, and be completely unproductive for a few days.  For those unfamiliar to loafing, here are some ideas: sit on the couch and dive into a reality TV marathon; read one of those novels that’s been sitting on the shelf too long; cook up a double batch of your family’s secret lasagna recipe. It’s even okay to gain a couple pounds in the process! You know what you need to refresh yourself—we all have different ways of stoking our own inner fire. Giving yourself a few days of wild abandon from “shoulds” and routines is a constructive and healthy way to take advantage of the low season and allow it to uplift you.

2. Sleep! Don’t be afraid to catch up on your sleep. There is nothing lazy, time-wasting or irresponsible about it. It is a documented fact that adequate sleep is healing, creativity-boosting, and necessary for peak functioning. The low season is a good time to re-establish a healthy sleep schedule and make it a habit. Sometimes this requires a detoxification from pharmaceuticals, an adjustment of late-night TV or social habits, or a shift in diet. Reconnecting with high-quality sleep will boost your energy, slow the aging process and center your faculties to put you on solid ground for the next chapter of your life.

3. When we rest and revive, we often find our brains tuning in more strongly to our natural creativity. You might notice new ideas hatching for your work, business, or personal life. Perhaps there is an area of your life that has been unintentionally neglected. You may find new inspiration for some of your other interests and life roles, such as spouse, friend, parent, entrepreneur, chef, horticulturalist… you get the picture. Your work as a clinician is important, but your life as a whole is your purpose on earth. When time, energy, and mental/emotional resources are freed up, new ventures often naturally emerge to fill the space. I use a concept called “the fourth option”, which came about in my work with a particular client. We use our minds very productively to brainstorm solutions to life’s challenges, but the list of options we create is naturally limited by our human capacity to perceive and to know. For some reason, it seems that we tend to think in threes and come up with a list of three answers to our own questions. I like to suggest that people acknowledge and hold space open for a mysterious “fourth option” to arise, as if from nowhere. When we open our minds and remind ourselves that we don’t know the “whys and wherefores” of every circumstance, we open the door to unique opportunities and previously unanticipated possibilities. And, believe it or not, they do appear!

4. Sometimes a low season leads to putting pressure on ourselves to expand our marketing and find ways to conjure new clients out of thin air. If your amount of referrals has always been less than you would prefer, perhaps it’s a good time to refresh your advertising strategy. However, if you are typically satisfied with your number of new clients, then the low season is not a result of a poor marketing plan and you might choose to relieve yourself of that pressure during a downturn. Instead, you might open yourself to other opportunities that allow you to share your skills in different ways. There are countless endeavors requiring people with expertise, a few of which are speaking engagements, writing gigs, expert witness services, legal mediation, and certainly a slew of volunteer opportunities in various fields. It might be a great time to step outside the office (either physically or mentally) and shower the world with your gifts in other ways.

We’ve heard the axiom, in many different ways, that when one door closes, a window of opportunity opens. Look back on your life and make note of all the times this philosophy has come to pass. I anticipate that you will identify many. A low season in therapeutic practice is a chance to loosen up and allow new adventures to come your way. Resist the impulse to tighten up and fret about all the “what ifs” that spring instantly to mind. It can be hard to trust that the bills will somehow be paid, but as you live your life as a whole being and expand your energy into the other areas of your human experience, you are cooperating with Life and aligning yourself with true prosperity. 

In closing, I will ask you to remember the standard wisdom that resonates with so many therapists: we get exactly what we need and we need what we get. Think of the client who walks in the door with the same question you’ve been bandying about all week. Or the problem at work that so closely parallels the struggle you are grappling with in your own family. The low season is merely an indicator that there is currently something else calling for your time and attention.  Do what you can to greet it joyfully and open-heartedly and watch with delightful anticipation what transpires.

This article can also be seen on: http://www.goodtherapy.org/blog/therapist-few-clients-self-care/