Bio Breaks


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21st Century (Psycho)education

Whether you’re a psychotherapist, an educator or a parent, sooner or later you will be involved in the facilitation of growth through learning.  The bad news is that most of us were educated in the 20th century, when education was largely modeled on the 19th century.  The view of literacy then was narrower, standardized and often monolithic.  The good news is that technology today can help us invigorate learning as never before, often by using the mechanics or design of video games and social media.

Before we press on, it is time to choose your own adventure!  I encourage you to ask yourself and answer this question: Is education inevitably like a daily spoonful of cod liver oil?  That is, do I believe that it is something that is routine, unavoidably unpleasant the people need to just suck it up and deal with?

If you answered yes, click here to stop reading this post and go to Mordor, where you can play a free MUD with other denizens of gloom and doom.

If you answered no, read on to find some examples of how simple game mechanics can revolutionize a curriculum.

1. Game Patches

Game patches are supplementary, downloadable game content that patches into existing games to either fix bugs or introduce new content into existing games.  One example was the famous Burning Crusade from World of Warcraft, which added another world of play, new races to create characters as, flying, and many new quests to challenge players.  More recently, Minecraft added patches to include jungles (1.2,) fixed multiple crashes (1.2.4,) and made cats more impatient and eager to sit on things (1.2.5.)  Much of the patch content comes from user experience comments, and players often know and eagerly await for patches for weeks in advance of their arrival.

Introducing content into classroom settings can benefit from this approach.  First off, polling students during subject matter about what aspects of what they are learning would they like to know more about?  What ways can learning or behavioral problems be debugged?  For example, elementary school teachers can hype up the class before rolling out Grade 3.5, at the halfway mark of the year, and include in this patch a total restructure of seating plans, allowing new class configurations and addressing problems in a way that starts to be both expected and exciting.

In terms of curriculum, from kindergarten to college, most educators have some lesson plan, and previewing content of upcoming lessons can generate interest and engagement.  This can range from creating a funny trailer on YouTube with teasers for the next lesson, to releasing hints about upcoming problems and subject matter.  This can include contests to name upcoming characters, for example the characters involved in mathematical word problems, or residents of new areas about to be unlocked and explored in geography.

In school-based and outpatient therapy groups, where is often a psychoeducation component, group leaders can initiate a countdown before patching new content or welcoming new group members into the group.  For process-oriented groups, members can be invited to debug and modify the design of the group to deal with challenges or conflicts in the group.  I remember a really interesting version of this that a colleague of mine went through in her internship.  We were at an outpatient mental health clinic, and although it was not languaged as a patch, her co-leader had her join the group for the first several weeks as a participant-observer.  She attended the first 4 groups without speaking, and as week five approached there was much discussion and projection from other members about what she would say when she finally spoke.  She was in essence the new content “patched” into the existing group, which introduced change, and new transference while maintaining some group stability and continuity.

2. Talent Trees

If we can just get beyond the tendency towards and linear thinking in curriculum, I am convinced that this intervention could be extremely effective.  First, for those of you who are unfamiliar with the idea of a talent tree, here’s an example:


In many games, players have some choices about how to specialize in the area of talents.  As they progress through levels, they acquire talent points to spend on unlocking different talents.  So if an educator can be flexible in the order of learning certain topics, students can choose to specialize in learning something first or second.  Let’s take Literature, would you like to be an Arcane Satirist, Epic Voyager, or specialize in Bloodmagic Murder.  If you want to progress through the first talent tree, you will need to read and complete assignments involving Gulliver’s Travels, the second, The Odyssey, and the third MacBeth.

If you are doing psychotherapy we already have a version of this, it’s called DBT.  In it people focus on unlocking talent points in the trees of mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.  Which does the patient feel that they would benefit from working on first?  Which do you recommend?  For adolescents especially, this can make the difference between engaging in treatment and just another boring worksheet.

Other ways to use talent trees effectively can include:  Helping gamer couples unlock skills to better communicate or improve their sex lives; helping parents focus on and prioritize specific behaviors to work on with their children; a template for an emergent adult’s first career search; and systematic desensitization of a phobia.

These are just two ways that we can use both the technology and concepts behind it effect change therapeutically and educationally.  Can you think of others?


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This week I had the opportunity to meet with a group of college students who are on academic probation.  There were supposed to be over 20 in the class, and 10 showed up, 5 late.  One of the the things I was struck by initially was how subdued they were, and I suppose I can’t blame them.  The class they are in, on how to succeed in school, meets twice a week in different locations at the college, half the time in a basement computer lab even though they won’t be using the computers.  If they don’t pass this class they are out of the school altogether.  There was something discouraging about the whole setup.

When I asked them how many of them played video games, they all did.  Most of them had played their favorite game as recently as this past week.  And when I went through the room and asked each what they liked playing, I was taken by how for a moment their face would brighten and they’d smile, even make eye contact.  Probably the most memorable moment for me came after I shared with them the statistic that 80% of the time we play a video game we are failing at it, and asked them to think with me about why we can tolerate failure so much in video games yet have so little tolerance of failure in other parts of our lives such as school.  What was different with a video game?

One student, I’ll call him John, raised his hand and said, “I might win.”

What a sad commentary on what education can do to students who don’t fit a certain mold.  Somewhere along the line, John and thousands like him have lost a sense of optimism, a sense that they even have a chance to win at life.  And yet, throughout the one and a half hours I was with these students, every one of them participated, had really interesting comments, argued and engaged with me.  The last holdout was a guy in the back row.  I asked him what he had learned so far today about video games and our discussion.

He sunk a little into his seat, and said, “I’m drawing a blank.”

“Let’s take a minute,” I said, “and let’s assume optimism.  Because you can add something to this discussion.  I know you can.  What have you learned in here today?”

Long pause.

And then he said, “self confidence.”

I should add, and did say to the class then, that we hadn’t even brought up that key concept to academic success yet.  If he hadn’t have added it, we might not have ever gotten it into our discussion.  Each of them had unique ideas, worthwhile ideas, not all of which we agreed with, but ideas nonetheless.

It takes optimism to risk answering a question in class, start a business, go to therapy, or play a video game.  Without optimism we won’t risk trying and failing, and without trying and failing there can be no innovation.

Take a second and think about the world around us.  Is it perfect in every way, or would you like some things to change?  If you think it is perfect we’re done here.

But if you think that the world can be a better place, for people and all sentient beings, then you’re thinking something needs to change.  Maybe you think racism needs to change.  Maybe you think poverty and starvation needs to change.  Maybe you need to be a better parent or partner, or learn more about something in school.  Maybe you want a better job, or want to create a work of art.  Maybe you want to better understand what it all means and how to fit in?  Maybe you want your daughter to have a better life with more respect, maybe you want your son to have a better future.  Maybe you want a war, all war, to stop.

Nothing gets better without change, and risk of failure.  But to risk failure we need to think we can win.  To fail and try again we need to think we could win this time.  Optimism improves resilience and changes our body, according to dozens of studies done by Seligman and other positive psychologists.  And optimism can create a more conducive learning environment.

Optimism, in my opinion is not simple delusion, or a brain defect, as some would say.  Yes, we might fail, but let’s not let that get in the way of making an effort.  Yes there is a lot of suffering and injustice in the world.  We’d better get busy.

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But Not Your Thoughts: Social Media & Children


Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.


Occam’s Oyster

The oyster has an amazing evolutionary trick.  When a microscopic particle of something or other gets into its soft tissue, it creates over time layer upon layer of nacre, a substance which creates a pearl.  What began as an irritant can go on to become a very valuable object.

You are not an oyster.

If something irritates you, you don’t always need to be stuck with it.  And although I am a big fan of the cognitive reframe, to use it all the time overlooks that you can often resolve whatever is irritating you by removing it.


Case in point, for the past several years I have used a billing service.  They’re great, but there has been something about the process of my patient intakes that irritates me.  I have patients fill out an intake form, which they bring in to me.  At the same time the billing office has a face sheet they use as well, but they need some information that is not on the face sheet but is on my intake form.

So for the past several years the patient will download my form off the site, fill it out and bring it in to me.  I then have to scan the form and fax it to my billing office.  To make things more complicated I have several computers and a scanner at home as well as an iPad.  You’d think this would make things easy, but I can not seem to get them all to talk to each other the right way to scan something and email it in under 30 minutes.  One laptop doesn’t get recognized by the wireless network.  The iPad can scan the form but not email it.  This has been going on for years, and I had grown accustomed  to the irritation as I tried putting on layer after layer of “solutions.”  I’d put off scanning the forms until my office asked me for them, which made their work harder, and payments from insurance choppy.

Then it hit me that I am not an oyster.  Whenever this irritation came up I had been so focused on trying to make things go more easily, that I had never really taken a few minutes to think about how to make this problem go away.  The answer in this case was simple.  Instead of having my patients email the form to me, my introductory email to them can instruct them to email or fax it to the office directly.  They need regular access to it, and I don’t.  They have all of my other administrative paperwork which they keep all safe and secure, so it is actually far easier to have them keep it since they are doing all the billing.  I rarely use that initial paperwork, and I’ll always know where it is.

I offer this as a nuts and bolts example of how your therapy practice needs to be evaluated periodically.  The whole craziness above is a vestige of when I was doing all of my billing, and something I now realize I was not ready to let go of.  And so I just got used to the irritant, ignored it, and hoped it would go away or become less irritating.

We therapists take more irritation for granted than is necessary in our business.  We each have a different version of layering on the nacre.  One of mine is constantly adding new gadgets and trying to find ways to make work easier, rather than making it go away entirely.  I used to spend hours learning the intricacies of a billing software and calling insurance companies, and then I realized I wanted to get rid of the irritation.  I researched different services, and finally decided on one which cost a little more, but did a lot more for me.  Now I give them 9% of my fee, and in return they keep me credentialed with the insurances I take, send out statements, answer questions from patients and submit all my claims electronically to insurances.  Not only do they trap more of my revenue because they can focus on it with more expertise than I, they save me valuable time.

I didn’t value my time as much when I started out, and I am glad I changed that, because I know I wouldn’t have had the time or energy to write a regular blog, do speaking engagements, or write my book this year if I had been chewing on all that paperwork.

So why does it often take us so long to fix systemic problems like this in our practices, or our lives for that matter?  I would suggest that the answer is that we don’t value thinking.

I know, sounds crazy on the surface, therapists don’t value thinking?  Thinking and thinking about thinking is a big part of our profession.  But when was the last time you allotted yourself time specifically to think on something.  By that I mean dedicated time where you think through something single-mindedly, not answering emails, talking on the phone, watching television, etc.  Most people I coach can’t remember the last time they did that, in fact our coaching appointments are often the closest they come to it.

You don’t have to schedule a specific “thinking time” in your day, although you can certainly do that if it works for you.  But in the case above I didn’t do that.  Instead I noticed I was getting irritated for the umpteenth time and said to myself, “Ok, stop EVERYTHING, how can I make this irritation go away?”  Within a relatively short time of dedicated thinking I identified what the system was, what the problem was, and what the new system would need to be to make the form nightmare go away.  Not get less irritating, not more tolerable, but gone.

Look, I’m not saying that everything in life that irritates you can be removed, or even that that would be a good thing.  I’m just saying don’t settle for mitigating damage before you’ve tried making the problem disappear.  Ask yourself, “am I layering nacre over and over?  Is that the best I can strive for?”

Then ask yourself, “am I making time to think, and am I thinking about the things I want to think about when I do?”  Sure there are lots of times when you run a business that you’ll need to think about stuff you’d rather not think about; but if that’s how you’re spending the majority of your time then maybe you’re running the wrong business.

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What Google+ Could Mean For Therapy

Every technology reveals the hand that shaped it.  The technology of the 21st Century is no exception:  Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms.  And the explosion of access to information was detonated by our own curiosity.

For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it.  Listservs are a great example:  They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level.  Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.

And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board.  The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them.  The online world expanded exponentially, and in fact that interactivity and information became overwhleming.

Which brings us to Google+.

For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media.  Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds.  If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it.  But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.

So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.


The Google+ system of circles is as powerful as it is flexible.  Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”



The interface let’s you drag the name and image of different people located on the top to one or more of the circles below.  When you mouse over the circle it expands to give you an idea of who you have put in it.  And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself.  For example, I have a circle for “Minions.”  I’ve always wanted minions.

This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life.  This can be especially useful with patients on the autistic spectrum.  We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of.  Who goes where?  Is everyone a friend?  Can we put people in more than one circle?  Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”?  What sort of circles might we want to create that Google+ didn’t give us?

People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful.  Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be.  Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further.  Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention.  We could help them explore and decide how to set up their own personal boundaries and affectional investment.

Or imagine for a second you are working on emotional regulation issues with a patient.  You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle.  Do some people go in more than one circle of affect?  Do they notice that they are taking people in and out of circles frequently, or never?

Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to.  They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those.  And all of a sudden they also have a visual list of who they can call when they are trying to socialize.

Last example, working with trauma and/or substance abuse.  Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc.  Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis.  It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one?  What do you think you could do about that?”

So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.


In Google+ circles go hand in hand with your Stream or Streams.  A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles.  It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back.  And you can set each circle to have different levels of access to your posts.  In other words, circles and streams together allow you to learn and set boundaries.  Here’s what a Stream can look like:

This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes.  Much like Twitter, or like life.  If we had to pay attention to everyone all the time in the same way, we would become very fatigued.  Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times.  Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them.  But it gets even more interesting.

If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc.  Now if you click on any of those circles, the Stream changes.  Specifically, it changes to list only the posts from the people in any given circle clicked.  This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.

Imagine working with an adolescent and reviewing their streams together.  What sorts of media, comments, and concerns are streaming through their lives at any given moment?  And what is the consequence of having 500 “friends” in their friend circle?  Do they feel intimate or able to attend to all of these friends?  Or are there some times that they may be more interested in attending to some friends than others?  If so, why?  Might it be time to start to rethink what it means to be a friend?  Is it ok to select who they attend to at certain times?  Do they really find the content they get from A interesting?  And if it is consistently uninteresting, does that say anything about their relationship?  Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.

For a second example, let’s return to the patient with ADHD.  Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way.  That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor.  If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done.  Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do.  But these types of decisions and focussing techniques may be crucial to staying on task.  (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment.  It’s not always just “playing on the computer” now.)

Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles.  Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?”  Maybe they’d rather tune into a steady Stream from their “Supports” circle instead?  And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways?  Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?

We make these decisions all the time, we just aren’t always conscious or overt about it.  And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves.  We need to have boundaries and filters.  We need to be able to focus and set limits and values.  These needs have begun to be more clearly revealed by the technology of Google+.  Knowing about that technology may improve our ability to treat our patients.

Epic Mickey and Frittering

The last week I have had a blast playing Epic Mickey; two blasts actually.  In the game you’re Mickey Mouse, and your primary tool is an enchanted paintbrush, which sprays two different substances with very different effects.  The first is a magical blue paint, which can make invisible things real, and make an enemy in the game turn blue and become a friend.  The second is a magical green paint thinner, which can make real things invisible, and thin an enemy into nothing.

There are good reasons to do both of these things, but the unnecessary obstacle in the game is that there is a limited amount of paint and thinner, and so if you use too much too quickly, you have to wait until a cooldown replenishes it, or until you find a power-up.  Power-ups, in case you aren’t familiar, are items in the game you can come across that replenish your health, and in the case of Epic Mickey, your paint supply.

The game is a Wii game, and so the motion controller is how you aim the paintbrush to paint or thin.  And when I started playing it quickly became apparent that I was going to have to get better at aiming if I wanted to accomplish anything before running out of paint/thinner.

Epic Mickey teaches therapists, gamers, and anyone else who wants to learn through video games some important lessons about living life and frittering away your resources.  The game has very simple mechanics, but life often has more complicated ones.  Fortunately, this video game can help serve as a meditation on mindfulness and achieving goals.

Lesson 1:  Paint Vs. Thinner

When approaching a problem, relationship, or business, it isn’t always immediately apparent whether to add paint or thinner.  Do we need to add more stuff or clear some off our plate?  Will additional effort reveal opportunities that were invisible moments ago?  Do we need to process more with our partner, or less?  Perhaps we need to simplify, reduce or focus our practice niche? Maybe we need to remove an obstacle, rather than spray creativity all over the place.  One of my favorite paint thinners in real life is Occam’s Razor, which has been often interpreted as “the simplest explanation is most likely the correct one.”  Or to put it more like it was originally intended, we should try to avoid any unnecessary pluralities, and tend towards the simpler theories or applications.  Sounds like thinner to me, who would have thought Mickey Mouse to be a Scholastic thinker?

And to make things more complicated, Epic Mickey shows us how if we can’t make up our minds we will go back and forth between paint and thinner, undoing anything we may have started and wasting time and effort. So whether we decide we need to add something or take something away, we need to commit to a course of action, or we’ll be confusing dithering with effort.  In Epic Mickey so far, I have found that many problems can be solved in a variety of ways, some using paint, some using thinner.  I suspect life is like that too.

Lesson 2:  Keep an Eye on Your Power Reserves

In the game, you always have to keep an eye on your paint and thinner meters to make sure you pace yourself and don’t run out. They will replenish automatically over time, but slowly.  In my business I can attest that this is also true.  I usually have a couple of irons in the fire, but I have learned to pace myself.  I remember a few years back I was seeing 25 patients a week, supervising three interns and therapists, teaching two classes, taking another, sitting on 2 commissions and trying to write.  I had to learn the painful lesson that I was doing a subpar job of every one of these because I wasn’t prioritizing, and perhaps more importantly, I wasn’t allowing time for replenishing myself.  Nowadays, I try to pace myself and make time to do fun stuff, like running at least once a week, playing some games, spending time with my family chilling or getting a massage, eat regularly and get enough sleep.  Not only are these things rejuvenating, but if I can resist multitasking they block off time so I don’t get exhausted and put out subpar work.

Are you keeping an eye on your reserves?  And more importantly, are you willing to give up a few things so that you can devote more time to living life and having fun so you have the energy to do others?  I certainly didn’t want to give up any of the activities I was doing, I liked doing them all, just not all at once.  Often I hear colleagues say “I just don’t have enough time to simplify and relax,” as if it is a luxury rather than a choice.  Sure giving up a couple of things is going to discombobulate you, especially if you’ve learned to pride yourself on being busy.  But you won’t run out of paint as often.

Lesson 3:  Keep an Eye Out for Power-Ups

In Epic Mickey, time isn’t the only way to replenish, there are treasure chests with power-ups.  When I recently defeated the Clock Tower Boss, the way I did it was to keep an eye out for power ups, and sometimes pass up what seemed a perfect shot to get a power-up.  In the long run, keeping an eye out for the things that power you, your relationship or your work up will be worth foregoing the perfect shot.  This is especially true in relationships:  It can be very hard for us to resist zinging that perfect shot, but backing away and taking time to do something replenishing will usually make things turn out more harmoniously!

What are your Power-Ups?  Is it a massage, a walk in a botanical garden, meditation, playing Super Mario or spending time with your kids?  It’s your responsibility to figure out what these are, make a little time for them regularly, and do them even when you aren’t feeling totally depleted.  Pay attention to what happens when you do certain things, eat a certain way, or take something else into your being.  Do you double in size and power?  Become able to hurl fireballs?  Defeat previously impossible monsters?  If so, chances are whatever you just took in is a power-up.

Lesson 4:  Focus stops Frittering

Last, the more targeted you are in what you’re trying to do, the less wasted energy and resources you’ll have.  In life, like in Epic Mickey, you often need to aim for something. Sure, sometimes random efforts yield surprising results.  When it does, huzzah, but that’s no excuse for not trying to be focused.  Mindfulness is in a large part about focusing your mind and body on something, letting distractions drift by.  Use the Force Luke–if you don’t you will probably find yourself feeling depleted, frustrated, and confused as to why.

Yes, focusing means giving up on something else.  Frittering means giving up on everything while deluding yourself you haven’t.  Parents who become obsessed with quality time rather than choosing a game night are frittering.  Saying you want a committed marriage while you’re out every night drinking beer with the buddies is frittering.  Complaining about managed care and lower fees rather than marketing your business or helping a forward-thinking candidate is frittering.  And there are a thousand other ways that all of us confuse dithering with effort.  So pick something and try to focus on it single-mindedly.  At least that’s what works for Epic Mickey, and can an 83 year-old mouse who can still defeat monsters and jump over chasms be all wrong?  I think not.

Is your Practice Busy or Hectic?

This time of year the reply I often get from colleagues when I ask how their business is going is “Busy!”  This is often said with shortness of breath, decreased blinking, and other physiological signs of anxiety.  At the college I teach at, I often see my fellow faculty members commiserating with each other about how busy they are there.  I think lots of us are busy, but I think it is time to re-evaluate if we are really busy, or hectic.

The way I differentiate between busy and hectic is simple: ROI and organization.  When I am busy, I have most of my clinical hours filled, am up to date on my billing, know which week I am teaching on the syllabus, and returning phone calls or emails within 24 hours.  I am also eating and sleeping well.  That’s “busy.”  When I am “hectic” I am thinking “oh my god I have too many patients to see;” forget to do my billing (or avoid it;) unfocussed when I get ready to teach; and start “saving” (read sitting on/avoiding) voicemails and emails.  I also feel more of a pull to commiserate, to tell people how “busy” I am.  For me, talking about how busy I am when I could be doing something more productive is usually a sign that I am hectic, not busy.

Once you have started to feel more stress in your practice, pause immediately and ask yourself if this is a prod from your psyche to take care of yourself.  Have you done that?  Good, if the answer is you haven’t, and that you don’t have time to because you are too busy, you’re being hectic.

Now knock it off.

Really, I am suggesting it is that simple.  Other than an opportunity to review for self-care there is NO ROI on being hectic.  You won’t get more patients, you’ll get less. You won’t have more time by worrying or commiserating, you’ll have less.  You may derive a sense of self-importance from how crazy things are, but you aren’t really impressing anyone, including if you are honest, yourself.  So put down the cross, we need the wood.

Here’s a suggested checklist if you are still unsure whether you are being “busy” or “hectic:”

  • I miss appointments or double-book
  • I haven’t eaten today
  • I am avoiding the phone and email
  • I have complained to 2 or more people that I am busy
  • I feel like I am working too much, and making less than I usually do
  • I am behind on billing patients
  • I have open times for patients but can’t find the time to schedule intakes
  • I hate my office
  • I’m feeling cranky and dissatisfied with my clinical work
  • I can’t remember the last time I had a non-therapy conversation with a friend, or if I can it was over 24 hours ago
  • I feel a sense of dread when I think about work

You may notice that some of these can also be signs of burnout:  This is not a coincidence.  I firmly believe that if you don’t learn to distinguish between being hectic and busy, your business will fail.  It will fail because you burn out, and or because you sabotage your income streams to the point where you have to close up shop and go work for someone else.  And if you do that, you can guarantee they’ll help you learn the difference between busy and hectic the hard way.

So this weekend, take 15 minutes to sit and reflect, is my practice busy or just hectic?  And if you don’t think you have 15 minutes to do that this weekend, you already have your answer.  🙂


Autumn has rolled around, and yet, I have had to modify my practice of the old New England tradition of complaining about the weather.  The warm and sunny days have been great for apple picking and walks, but at last my inner cranky Yankee managed to put my finger on my discontent with the climate.  It happened when I heard yet another meteorologist cheerfully remarking on our “record-breaking highs,” our “unseasonably warm weather.”  I try not to get political in these blogs, but I have to point out that these changes fit Shakespeare’s quote, “Ill blows the wind that profits nobody.”  We are benefitting from a global warming trend that is no longer surprising or joyful, so let’s encourage the media to stop spinning it that way, shall we?  I have begun meta-complaining about the weather—how’s that for Yankee ingenuity?

The Postman Always Rings Twice

Although I like to encourage colleagues to take advantage of modern technology in our practice, I did want to pass on this article as a word of caution.   If you use email through Yahoo or Google (gmail) your email content is searchable and may be “trawled” for content.  It is an important reminder that your email is not just in your client’s and your computer, but also in the servers that each of you uses.  Keep emails brief and nondescript.  Having your client sign an informed consent around the internet is important, and will make sure you both understand what the limits and challenges of emails are.  Many clients will want to continue to use email for scheduling, but spelling out the risks never hurts.

Racial Stress and Prenatal Care

A recent study from Joint Center for Political and Economic Studies’ Health Policy Institute took a look at 600 African-American women and the impact of racism on their health.  The results indicate that reasons for their higher stress levels ranged from hearing white teachers’ comment on “those kids” to working longer hours to win acceptance from white co-workers.  Looking at the stress disparities across racial lines is nothing new, but this study looks at what causes the stressor with an eye to race, and finds that “rich or poor, well-educated or barely literate, African-American women were still more likely than white women, first-generation, poor Hispanic immigrant women and foreign-born black women to have premature and low birth-weight babies… and that when foreign-born black women had been in the United States for a generation they showed the same infant mortality rates as American-born black women.” (Lu, 2007)  This would indicate that addressing the psychosocial impacts of racism is an important part of prenatal care, and culturally competent practice.

Research and Job Dissatisfaction

20 Years in GLBT Youth Research

The NASW website “Help Starts Here” recently published an article I wrote that you or your clients may find of interest.  The article reviews selected literature from 2 decades of research on risk factors for gay, lesbian, bisexual and transgendered youth.  It compares those earlier findings to the two most recent Youth Risk Behavior Surveys done in Massachusetts.  Although the review of the literature is not exhaustive, it may be useful to clinicians and families.

Take This Job…

Some interesting news came out of the outplacement consulting firm Challenger, Gray & Christmas.  They estimate that 25% of workers regret having taken a new job within their first year.  For those of us who work with clients dealing with work dissatisfaction, this statistic may de-stigmatize it.  It may also free them up to leave a job that providing them with the satisfaction and quality that work can and should bring.