I ate the marshmallow: Lessons in impulsivity.

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I ate the marshmallow: Lessons in impulsivity.

It was a simple experiment that changed the way psychologists understands self-control and the ability to delay gratification. Preschoolers were asked to sit at a table, with a plate of marshmallows. The experimenter left the room and gave the child an important choice: eat the marshmallow right away or wait until the experimenter returned and have two marshmallows instead.

Have one marshmallow now, or wait and have two marshmallows.

Some children ate the marshmallow. Other children stared at the sweets intensively and reminded themselves that it’s better to have two later than one now. They covered their eyes, looked away from the marshmallow, or even pretended to eat it, licking their lips from its imagined deliciousness. Yet they resisted temptation and delayed gratification for a better outcome in the future.

eat me.

eat me.

I would have eaten the marshmallow – no doubt. As soon as the door clicked closed, and the experimenter was out of sight, I would have told myself something along the lines of “Just wait. You can do this…. just – ohhh…that was delicious!”

End of experiment.

To clinical psychologists (or to-be-ones like me), self-control is essential. We have to inhibit our judgment, advices, and responses, and allow the client to lead the session. Delaying such reactions can be challenging for someone like me (i.e., impulsive and extroverted).

Inhibiting social responses is difficult. I want to jump with excitement when a client has done their homework and gasp when I hear sad news. Although these reactions may be appropriate between friends (although I don’t know why I would congratulate my friends for doing their assignments), positive feedback in a therapeutic setting be should attuned to the client’s mood and personality.

I notice improvement, I jump on it.

I hear change, I highlight it.

I see a marshmallow, I eat it.

Withholding advice is also challenging. Lawyers and doctors have it easy. Lawyers are (over?)paid to tell you what to do in order to get the best outcome and doctors write it out on a prescription pad. Whether or not you choose to follow their advice is your business. Psychologists on the other hand are taught to guide clients through their own recovery. Success is defined by the client, not the therapist. This is a challenging and time consuming process that requires – you guessed it – self-control. It would be too easy (and ineffective) to tell my client how to think, behave, and feel. In my work with offenders I have found myself sitting on my hands, biting my lips, while containing the urge to stand up and yell “THEN JUST STOP BREAKING THE LAW!” Thankfully I have managed to curb that urge so far.

I like to think of my impulsive nature as a reflection of my genuine interest in the client’s experience. Once in a while, my spontaneity fits the situation and engages the client. Particularly with children – they light up when you show excitement and interest. Perhaps there is such a thing as planned impulsivity: an oxymoron describing a therapist’s ability to assess whether it is best to be restrained and matter-a-fact or be more spontaneous and direct.

Averagely yours,

the candidate
Impulsive

Burst my Bubble

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Losing an illusion makes you wiser than finding a truth – Ludwig Borne

For about a month now I have been volunteering as an assistant at a local yoga studio. In a class for 40 yogis, it’s helpful for the teacher to have someone walking around, making manual adjustments.

The first day I stepped in the crowded yoga studio, the feeling was strangely similar to the first time I walked into a therapy session alone. Four years ago, I sat across a girl who hadn’t attended school in three months because of delibetating anxiety. With trepidation and excitement, I was prepared to follow the procedure for treatment of separation anxiety, expecting that the little girl would jump right on board and together we could conquer her anxiety! I imagined a shrink-client relationship from the movies: she would open up to me, I would make her laugh, we would hit a bump in the road, she would cry, followed by an “ah ha” moment, and bam! – she would return to school.  We would prance down a scenic road with a single bump (necessary for drama).

The illusion I had when watching the yoga students on their mats, chatting, meditating, or stretching in preparation for the class was similar to my experience before that first therapy session. In my imagination’s movie, the slender lululemon mannequins would breathe and move in unison to the teacher’s voice, they would all touch their toes without bending their knees in a standing forward bend, and I would simply have to brush their necks with my fingertips to release tension.

In both situations, I lived in a shiny bubble that would inevitably burst. Most novice researchers, clinicians, writers, and yogis have flawless illusions and expectations of simplicity.

Illusion is the first of all pleasures” – Voltaire

My therapy illusion bubble burst when the anxious six-year old refused to speak during the first session.  She dropped her forehead on her forearms and gazed at her feet. I offered her crayons and paper to colour, juices and crackers – anything that would make her look at me. I stared at her curly hair wondering what to do.

In the first yoga class, the first “inhale” was enough to snap me out of the yoga clothing commercial. My expectation of coordinated movements was met with jerky contortions and wobbly stances. My imaginary models had forgot to shave and were wearing pajama pants. The room quickly became sweaty and smelly. Despite the presence of a single teacher, there seemed to be 40 individual yoga classes happening at the same time.

I had to think on my feet, leaving the therapy room was not an option – I wanted to connect with the anxious little girl. I looked around the therapy room, picked up a book about emotions from a shelf, and started reading. I first read without asking any questions (including asking for her permission!). Next, I handed the little girl one green crayon and one red crayon. She snapped the red crayon in half while keeping her forehead on her arm. Refusing to be defeated, I read the book a second time, and after every page (i.e., every emotion) I asked “I wonder if you’re feeling like that….show me the green crayon if you are feeling like that and show me the red crayon if you’re not feeling like that”.  Are you feeling sad? Half a red crayon came up. Are you feeling angry? [green], happy? [half a red], scared? [green], lonely? [half a red]…and so on. Without exchanging any words, I learned how this anxious little girl experienced our first therapy session. After the third reading, we were colouring together in silence.

Leaving the yoga class was also not an option. Taken aback, confused, and a little scared, I started walking around the room. I zig-zaged between wobbly arms and legs, watched breath enter and exit the students’ lungs. I did not touch anyone for a first ten minutes, until I noticed the calm and serenity on the yogis faces. Something switched as I reached to touch the first student. I gently drew their hips back, assisted in harm extensions, and applied gentle pressure on necks. While the yogis rested in the final relaxation pose, I glanced around the room, and I saw beauty in the silence.

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We tend to have a whimsical image of what our lives as researchers, clinicians, writers, or yogis will be like. More often than not, these illusions mimic what media has presented to us. However, when reality bursts our bubble, one natural response is to look for an escape.  When our bubble of hope and expectations bursts, it leaves us with wet socks and shivering shoulders in an unknown environment. It’s surprising what a deep breath, patience, and a little imagination can do. There is a world, far more beautiful beyond our bubbles; it’s up to us to discover it.

Did your bubble burst? What did that look like?

How did you cope with it?

Averagely yours,

the candidate.

Is this your first time?

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Is This your First Time?

Look at situations from all angles, and you will become more open

– my man DL (aka, Dalai Lama)

As I escorted my client and her mother to the door, it was obvious that she was taking longer than necessary to put on her jacket. Her child was jumping about, inspecting toys in the psychology clinic waiting room. I pretended to be busy: filling papers, closing books, doodling smiley faces on my clipboard.

“So is this your first time?”

Her voice broke through the thick atmosphere.

I looked up and shook my head “no” too fast for it to be natural: It was more as if I was trying to shake something off my head while over-blinking.

“I’ve sat in on assessments before”

“Right, but you’ve never actually done one have you?”

“We practice the tests before administering them, and all graduate students in clinical psychology are supervised by our clinic director.”

I felt like a novice tennis player playing against a tennis-ball machine on overdrive. She fired shots at me; I hit the ball back but it barely made it to the other side of the net.

“Well my child is a special case. You know that. It won’t be easy.”

She was now on expert mode. Our exchange went on for another minute-that-felt-like-an-hour or so, until I finally told the mother that her daughter was in good hands and I will see her next week.

The machine stopped, turned around, and rolled out of the office.

This happened three years ago, and the thought of that exchange makes my hands shake.

My initial reaction was anger. I “knew” that she wanted me to admit my novice status or acknowledge the difficulty of the case. Why wasn’t I able to admit that to her? To myself? Anger is a normal reaction when we feel that we have been treated unfairly…but she wasn’t unfair…was she?

Anger turned into confusion: why would she ask me these questions? Did I do something to exhume incompetence? Would she ask another student? Again, I looked at my behaviours, my thoughts, and myself as a clinical psychology student and assumed that she saw weakness and incapacity. I assumed that she was poking at my weak spots, scratching on my insecurity scabs, and waiting for blood.

lucy as psychologist

I finally applied one of the simplest but most effective cognitive behavioural therapy methods to myself. I asked myself what evidence I had that the mother was targeting me, or attempting to expose my weaknesses. As I tell my young clients, I played detective for my thoughts! My investigation looked a little something like this:

Evidence for the possibility that she is targeting me and attempting to expose my weaknesses

Evidence against the possibility that she is targeting me and attempting to expose my weaknesses

She asked questions about my experience. She talked about her child being a “special case”, not me being a poor clinician.

She asked about the services offered at the clinic.

She asked about the consequences of the findings.

She asked about timeline.

She did not ask to speak to my supervisor after each assessment (she could have).

She came back and her daughter completed the assessment.

Chances are this awkward tennis match was not about me at all.

It was maybe the mother’s insecurities regarding the assessment and its findings. What could we find out and what would that mean for her daughter?

Once I looked at the situation from a different perspective, I felt compassion for her. It can be difficult to have a loved one poked and probed to figure out “what’s wrong” with him or her.

On the other hand, I was biased in the way I heard the mother’s questions – I assumed they were about me, and that my abilities were being questioned (on some level, maybe my abilities were being questioned). That is a classic symptom of the imposter syndrome but also a very selfish way to think.

As a clinical psychologist in training, and hopefully a “full” psychologist someday, I have to accept that there will always be people who doubt my profession and my abilities.

What I learned from this experience is this:

  1. Not everything is about me (unacceptable!)
  2. Not everyone is out to get me (shocking!)
  3. The tools I use with my clients can work for me (imagine that, I am average!)
  4. Looking at a situation objectively can help me shift perspectives
  5. Taking a compassionate approach is soothing (My man DL says it best)

Averagely yours,

the candidate.

The Therapist becomes the Client


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Having been a swimmer most of my life, it was no surprise that I injured myself while transitioning from a low-impact sport to a high-impact one. Within weeks of taking up running, I began to feel a sharp pain in my right heel. The sensible thing to do at that point was to stop, rest, and seek medical advice.

I kept running.

Standing at the top of the normal curve, I tend to look to my right (your left?) at the people above the Average. I doubt that the above Average person would have stopped running because of pain. In fact, the above Average person would probably not be injured in the first place because he has good running technique and luxurious barefoot shoes. In any case, not running because of pain is not consistent with my “pain is weakness leaving the body” motto. It would also not serve to burn the calories from the daily butter tarts I devour. I kept running until I was limping my way around campus.

It took months before the “call physio” item made it to the top of my to-do list. Before the appointment, I did what any graduate student would do: I collected data. I charted the location, intensity, and quality of the pain on a daily basis in an excel spreadsheet. I Googled “heel pain” and diagnosed myself with plantar fasciitis. I also took four Advil’s a day and kept running.

The physiotherapist asked me if I was comfortable with having a second year student do the examination.

What do you mean a student? Does she know what she’s doing?

That was a hypocritical reaction. I am student therapist myself! I report to a registered psychologist, and a supervisor approves all of my decisions.

“So the pain is your right heel”, she asked with a shaky voice, gripping her pen and clipboard to her chest.

I was compelled to be the best patient this young physiotherapist to would ever have. I immediately told the student physiotherapist (SP) that I had plantar fasciitis. I regurgitated the symptoms off the websites, and asked for shockwave therapy.

At that moment, I heard the physiotherapist’s eyes roll in their sockets.

In a clinical setting, there are few things more frustrating than a client who tells you what to do. There is a clear difference between “This is distressing, what can we do about it?” and “This hurts and I need you to do this for it to stop”. The first expresses the desire to work collaboratively, the second is an order.

From my perspective, I was trying to be efficient and helpful. Instead, I was ruining an opportunity for the SP to learn and coming forward as a bossy hypochondriac.

The SP began the examination by evaluating my foot’s range of motion. Her fingertips barely touched my foot, as if she was afraid to break it. She looked back at her supervisor for reassurance between every exercise and question.

I couldn’t help but sympathize. Assessment and questioning is challenging: you have to formulate an open-ended non-threatening question, evaluate the response, interpret it, note it down, and think of the follow up question simultaneously. All the while, you have to look like you know what you are doing.

Meanwhile, I asked questions about every instrument and exercise. From my perspective, I was being curious, from hers, I was annoying.

Eventually, I was dismissed with a plantar fasciitis diagnosis (Should I say I told you so?), a prescription for a therapeutic sock, and stretching exercises. As I walked out of the office, I realized how uncomfortable the role-reversal was for me.

Therapists and health care professional make difficult clients: we don’t seek help when needed, we don’t follow instructions because we think we know better, we over-research, and tend to be skeptical . I think we compensate for our paranoia and fear of looking weak by trying to show off how ‘knowledgeable’ we are about our ‘condition’. We simultaneously try to save the health professional work and appear confident, but in the end we make the assessment and treatment more complicated.

What if I had walked into the office and expressed more vulnerability? Maybe for once, I should have indulged in someone’s curiosity. I wonder what I was running from.

What type of patient are you?

Averagely yours,
The Candidate