Why both today and tomorrow are so important to your clients.
Subject: Psychotherapy (Management)
Psychiatrists (Vocational guidance)
Time (Social aspects)
Author: Reidenberg, Daniel J.
Pub Date: 03/22/2012
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2012 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Spring, 2012 Source Volume: 15 Source Issue: 1
Topic: Event Code: 290 Public affairs; 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 282741110
Full Text: [ILLUSTRATION OMITTED]

We have all heard the saying, "Time heals all wounds," and for some this is true, while for others it is not. For some events in life this seems to hold more truth than others. Whether you are talking with someone about grief, fear, or excitement, in the end, "time passes." It never stops, not even for a second. The word time itself implies movement and change. Plain, simple, and thankfully; time goes by.

Think of your client who comes in and is filled with anxiety about a conversation they are planning to have with their spouse. Their attention is distracted, and you can not keep them focused. They might be so filled with anxiety that they are behaviorally agitated and restless in your office. Regardless of how brilliant your insights and suggestions are, they are thwarted by their thoughts of "that won't work!" or "you don't know him like I do."

Next, think of another client who is plagued with hallucinations or delusions. They cannot get through the torment of the voices in their heads. These voices seem to speak louder and louder as the day goes by, but nothing helps; not music or art, not walking or talking; nothing dampens the messages they are hearing. Paranoia fills their minds with unanswerable, illogical fears that you can not resolve for them. Something bad is going to happen, although they don't know when, where, or how. Time spent with you seems to be time spent fighting demons that only medications can fight.

Finally, think of the client that cannot see through the darkness of the moment right in front of them. Nothing really matters to this client. They have no energy, no interest in anything, no desires. They don't want to eat, as nothing tastes good. They want to sleep, but they really don't care about that anymore than they do about what is on television. Life is filled with only doom and gloom, negativity, hopelessness, and helplessness. Your words of hope, encouragement, and positive reinforcement for even the smallest of miracles, go unnoticed.

In each of these cases both today and tomorrow are very important. Today, they must deal with the reality that is in front of them. Regardless of the reasons for what is happening to them, today holds something that they have to accept and address, even if that means they do it tomorrow. As their therapist, health care professional, nutritionist, etc., if you are fortunate enough to see them on this day, you will need to address what is impacting them the most. If you fail to do that, the rest of your work together, at least for that day, quite possibly could be of no benefit to your patient. So always try to start your time with a client by checking in with them to find out how they are doing that day. Think back to how many times you have heard a colleague talk about spending 50 minutes with a client, and then the client finally discloses something significant that is not only on their mind, but is requiring all of their attention. When inquiring, make sure to ask about thoughts, feelings, and behaviors (as appropriate) to have a full picture of where they are when they are with you. Once you have established a basis for your session/time together, you can move on to other things they want to talk about, and/or parts of their treatment with you, or keep going with the current concerns that they have; but also don't miss this opportunity you have with them to work on the things about today that can be meaningful and helpful to them. For example, you may choose to try and work with clients that are anxious by working on relaxation techniques. You could engage them in a conversation about stress management, help them build coping skills, teach resiliency, or help them learn how to track and monitor their anxiety.

Today also offers your client a chance that is only here right now. While this moment might be uncomfortable, or worse, it is important for them to realize that it won't always be this way. Nothing stays the same forever, and you can remind them of this while also helping them find ways to appreciate the fact that it has been worse for them in the past, and yet they have made it through. Conversely, if they have never felt like they do at this moment in your office, how would they know what it might be like tomorrow?

And that brings us to: if today is so important, then why is tomorrow so important too? Simply put: because tomorrow is. Since there is no escaping that there will be a tomorrow, it provides each of us with a golden opportunity. The opportunity is, and can be, whatever we make it to be. It might be just the same as today, or it might be 100% opposite of today. Tomorrow might be nothing like we expected it to be, or it could be exactly as we thought it would be. The point is that it will be something, and I often find people are either so afraid of what it could be, or they are so determined to make sure it isn't what they don't want it to be, that they struggle to accept it for what it is.

Think of how many things you can do with "tomorrow." You can talk with your clients about how different from today it might be, and what feelings they have that may or may not be the same as today. You can engage them in a plan that might move them from where they are right now, to someplace else. In the three examples offered earlier, your anxious client might be able to rate themselves two points lower in anxiety following the conversation with their spouse because it wasn't as bad as they feared it would be; the client suffering with hallucinations and delusions might have had another day for their neuroleptics to work, and they can watch television today when they couldn't the day before; and your client living in the depths of despair might see the sunrise outside and feel like they can go on, even if just for one more day. Help them to see what they can't, don't want to, or are afraid to. Give them reasons to get through today so they can reach tomorrow. In doing this, you will have helped them keep living.

I think the most important thing about tomorrow is the fact that there is no avoiding it; there is only a chance to be a part of it. If tomorrow turns out to be just like today, your clients should be reminded that no two days are ever exactly the same. You can help them live through the moments of life, and even when they are not in your office with you, they will be better able to cope with all that life has to offer. In the end ...

"Yesterday is history. Tomorrow is a mystery. Today is a gift. That is why it is called the present." Alice Morse Earle

By Daniel J. Reidenberg, PsyD, FAPA, CRS, BCPC, MTAPA

DANIEL J. REIDENBERG, PsyD, FAPA, CFLS, BCPC, MTAPA, is the chair of the American Psychotherapy Association's Executive Advisory Board and has been a member since 1997. He is a Fellow and Master Therapist of the American Psychotherapy Association and executive director of Suicide Awareness Voices of Education (SAVE) in Minneapolis, Minnesota. Contact him with your thoughts at dreidenberg@save.org.
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