Whole Brain On The Couch


A number of years back Nan was listening to a consulting psychiatrist who was advisor to her counseling center at the time. She told me that one phrase really stuck out to her:

“You can only do therapy with a whole brain on the couch.”

What he meant was that trying to counsel someone under the influence of alcohol or drugs was of minimal value. He also said that counseling someone who needed corrective medications to stabilize and achieve balance was also of limited value. It takes clear thinking to process concepts, make connections, and have accurate empathy or feelings.

I remember having a difficult time with a client many years back. It just didn’t seem like I was getting through to him. I asked him if he felt the same way and what might be getting in the way. He said maybe it’s because I always have a “tall one” before coming into counseling. I asked “why?” His response: “It helps me to feel less anxious.” The truth was it helped him to feel less of anything – at 10 A.M.

I know it is the same with marijuana and other drugs. Some clients have come in loaded on significant doses of pain killers or even over-the-counter medications. I’m not saying that these aren’t sometimes necessary – but they get in the way of good therapy. And I’m not discounting being hung over either. The ability to concentrate is greatly diminished the day after “partying”.

Now translate this concept to having a relationship “discussion”. Do you think you will get much accomplished if you undertake to work on your relationship under the same conditions? We always tell couples not to talk about anything important if they are “HALT” – Hungry, Angry, Lonely, or Tired. I think I am going to change the “L” in that  acronym to “Loaded”. Communicating accurate feelings is pretty difficult when you your brain is not functioning properly.

About needing the right medications: little progress may be made with a significantly depressed or anxious client. Their ability to process accurately is impaired. When a client is suffering from any type of diagnosable disorder they may have a very difficult time understanding and managing the intensity of their feelings and relating correctly with others, including the therapist. However, when appropriately treated, counseling has a good chance of moving them forward.

Does this mean that you should not seek counseling if you are depressed, anxious or addicted? Not at all. Making a call to a counselor or pastor is usually the first step in the healing process. Hopefully they can assess what is needed and recommend a next step.

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