By Mike McMahan, LPC
 
Kudos to Demi Lovato for speaking out at the Democratic National Convention about the stigma of having a mental illness. The 23-year-old singer, who gave us the far superior take on Frozen’s “Let It Go” by unveiling a version with a much more dramatic arrangement than the one in the film (no offense to Adele Dazeem, uh, I mean Idina Menzel), stood alone at a podium on national TV and faced down the cameras and the bright lights.
 
“Untreated mental illness can lead to devastating consequences, including suicide, substance abuse, and long-term medical issues” she intoned. “We can do better. Every one of us can make a difference. By getting educated on this epidemic and its frightening statistics and by breaking the stigma, I urge every politician to support laws that will provide access to better healthcare and support for everyone.”
 
This is not the first time that Demi has advocated for awareness on this important issue (nor will it be the last, I’m sure). Having struggled with an eating disorder and bipolar disorder, sought treatment and being willing to speak out by the age of 24 is not a feat just anyone could achieve.
 
If you are struggling with a mental illness or think you might be, please talk to your doctor or a mental health professional. As Demi points out, while there may be a stigma, your health and safety is paramount. We all matter, and we all have something to do to make the world a better place.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC
 
The mobile game Pokémon GO has joined the fabled ranks of Beanie Babies, Cabbage Patch Kids, Tickle Me Elmo and other legendary fads in the pantheon of “must have” items. It has dominated everyone’s social media news feeds for better or worse—prompting screen shots of people enjoying the game as well as others posting memes and satire mocking them for liking the game. Unlike, say, Tickle Me Elmo, this game has broken outside of the children’s market and is being embraced by adults as well. Nintendo’s stock value has soared and pokémon are literally everywhere. I’m as fascinated as a person can be and want to learn everything about this phenomenon—as long as it doesn’t involve playing the actual game. The last thing I need is another time waster, so I’ll rely on everyone else to have these experiences for me and live vicariously through them. I wholeheartedly endorse something that gets people moving and has them interacting with unfamiliar people. Though there are certainly risks in getting out in the world (we’ve all seen the stories of robberies, people getting lost in caves and so forth). There are some fun aspects to the pokémon phenomenon, some psychological aspects and some lessons about how people perceive and approach the process of psychotherapy.
 
One of the weirdest and most fun pieces that I’ve encountered is this one, which puts a conspiracy spin on the game and it’s allegedly sinister origins. I’m a bit skeptical about this, and it reminds me of details of assessments that I might review for inpatient commitments. That said, there are some who say if you’re not paranoid these days, you’re not paying attention (please note: I’m not one of them).
 
Moving out of the area of abnormal psychology, this article from the BBC takes a look at the psychology-based thought processes that may underlie the game’s success. The article points out that it relies on technology that people have already mastered: as I’ve noted before, playing to pre-existing, recognized strengths can help a person be successful in life as well. The article also points to nostalgia, something I’m sure '90s kids will understand—though I’m too old and missed this the first time around. The most interesting aspect of this article, to me, is the author’s assertion that social media is basically a video game, something I’ve noticed as well. In addition to having a score-driven system (How many friends do you have? How many likes did that post get?), the graphics of sites like Facebook bolster this argument. As we approach the era of augmented reality, it may be that Pokémon GO will give us a preview of how things will look as tech marches on, influencing our lives in unexpected ways.
 
The last piece I want to highlight is from Psychology Today, which highlights some benefits and some drawbacks to the game. I’ve covered this topic before as well. The Psychology Today article suggests benefits such as alleviating social anxiety, helping players set clearly defined goals and being simply enjoyable. I think the idea that it’s fun is a huge benefit—many of us are so busy that we don’t have time for simply mindless fun.
 
Something that I’ve always noticed about people who “collect” things may be summed about by the game’s catchphrase: “Gotta catch ‘em all!” This “I have to do everything” attitude is a key challenge that many of us face, and is one of the top things I hear from new clients and parents who bring their children in for psychotherapy for the first time. The client (or their parent) will list a litany of problems that they hope to solve by coming to therapy: “I’m depressed”; “I feel anxious when I’m around people”; “I can never get a date”; “I’m not getting along with my spouse/family”; “I’m self-conscious about my appearance”; “I can never do anything right”; “I can never make a romantic relationship work”; and so forth. All of these are valid concerns, of course. But, as a therapist, do I need to address them all at the same time, right away?
 
The answer is an emphatic “no.” When people come to psychotherapy, they are likely facing more than one challenge. Perhaps they are facing many of the above as well as a number not listed. But it’s virtually impossible to address all these problems at once—it’s simply too confusing. On top of that, if the therapist and client try to make multiple changes to address multiple problems, it creates the possibility that the client won’t know what’s working or what’s not working. This isn’t good because I, as a therapist, need to know what new strategies are working so I can reinforce the successes as well as help the client bring more focus on that strategy in an effort to bring them continued success. In addition, sometimes solving one problem will solve another one as well, almost inadvertently. Consider the examples I listed above. It’s not hard to imagine that a person who overcomes issues with self-esteem might suddenly find themselves doing better with finding potential romantic partner. After all, confidence can potentially be a very attractive quality.
 
So keep catching all the pokémon if that’s your thing. But if you’re solving problems, slow it down and observe what’s working. Because therapy may be about “gotta catch most of ‘em.”
 
 
 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC
 
It’s been said that there are only seven basic plots in the world. While this is intended to apply to novels, given that we build narratives in our own lives, there is no reason that it should not apply to narrative therapy. I previously discussed the idea that we can change our own story with a few carefully considered “edits”. If our life has a plot, there needs to be a villain; in this case, that villain will be a monster. For that reason, the plot that will be considered in this post is “Overcoming the Monster.”

A few weeks ago, I had the real pleasure of attending a signing and talk from author Justin Cronin, whose recently completed Passage trilogy is one of the best horror/fantasy reads in years. He hosted a Q&A session prior to signing, and talked about the origins of the book, noting that there are “only four kinds of monsters: zombies, werewolves, vampires and frankensteins.” I’m sure someone can dispute the veracity of this claim (hello? Elmo, duh) but I agree that this group of four makes up the vast majority of monsters. Please note I don’t consider witches to be monsters—so strike that one off the list. For The Passage, Cronin chose vampires, but if you observed that his vampires act a lot like zombies, you wouldn’t be wrong. So, in a way, Cronin had his cake and ate it too. While there may be four archetypal monsters, they can be mashed up in new and creative ways. I mean, mummies are basically zombies wrapped in toilet paper, right?

Language usage can play a very important part in the therapeutic process. Even subtle shifts in self-description can play a role in how a client perceives themselves. For example consider the very common statement: “I’m bipolar.” This suggests a person who sees a psychiatric diagnosis as a core part of their being. On the other hand, I always describe clients facing these types of challenges as “a person with a bipolar diagnosis.” This captures a client’s essential humanity as well as giving them room to think about their qualities outside of their diagnosis. Consider also the difference between “my child is autistic” versus “my child has an autism diagnosis.” Yes, there is no “cure” for autism, but with skill building and patient parenting, children with autism can certainly lead rewarding and fulfilling lives.

There is a technique used in psychotherapy called externalization. It is basically what it sounds like—a way to help clients stop thinking of their problems as an intrinsic part of who they are. This builds on the idea that a person is not defined by their problems but, instead that their problems are something that can be overcome and not necessarily a set-in-stone, permanent thing. Going back to the example of monsters that opened this piece provides an opening that can be especially effective with child or adolescent clients. Though I love fantasy type shows, books and movies as much as anyone, there is an undeniable appeal to adolescents. The idea of monsters as metaphors for teenage challenges was used to tremendous success on the long-running TV show Buffy the Vampire Slayer.

Once we accept this idea, the possibilities for narrative therapeutic techniques are virtually endless. Imagine a teenager with a mood disorder such as depression or bipolar disorder. Externalization can be used to help this young person get outside of the idea that they “can’t” overcome the challenges faced by the symptoms of this diagnosis. Questions such as “what is your depression stopping you from doing?” or “what will your life be like when you kick depression out?” are helpful in getting started.

Externalization may, as well, be useful to this process. The diagnosis can be renamed as a monster. It’s not depression—it’s a werewolf that takes control of you every so often and causes you to feel and act different than you might if you weren’t under the influence of depression. This allows the possibility that the illness/monster may be defeated. For example, a silver bullet is known to kill werewolves. So a therapist might ask “what is the silver bullet that will help you defeat the werewolf?” Having used this technique extensively myself answers can range from “being more involved in activities,” “exercising,” “not listening to what the other kids say” and more.

So keep in mind, you are NOT your problems, even though they may cause you distress and create obstacles in your life. What kind of monsters are you facing down?

 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC

Recently two articles caught my eye and caused me to reflect on how we view stereotypical gender roles and how we impart those roles to our children.
 
The first is a recent study that showed interesting results about how boys react to Disney princess movies. It has been well-documented that there are significant concerns about how young girls react to these films. Disney has made strides to address these, most notably with the more female-empowerment themed story line of their most recent princess film, Frozen. Spoiler alert! It turns out that “love at first sight” may not always work out well, as Princess Anna learns the hard way from the dastardly Prince Hans, an aspect I discussed previously.
 
Surprisingly, boys who view these films seem to come away with something less potentially problematic and quite positive: a sense of empathy. The study suggests that the more boys are exposed to the Disney princess films, the more they have “balanced interests,” including a lessened preference for traditionally male toys, such as toy guns. In addition, they were more likely to be helpful with school tasks and have an easier time sharing toys.
 
According to the researchers who conducted the study, "Princess media and engagement may provide important models of femininity to young boys, who are typically exposed to hypermasculine media. It may be that boys who engage more with Disney princesses, while simultaneously being exposed to more androgynous Disney princes, demonstrate more androgyny in early childhood, a trait that has benefits for development throughout the life span."
 
The phrase “rape culture” has gained traction recently, as highlighted by concerning statements and rulings from judges in sexual assault cases. Whether exposure to Disney films will help mitigate this is something that could potentially be explored in future research.
 
Less surprisingly, the study showed that Disney princess films may reinforce negative gender stereotypes in girls, including placing a higher emphasis on physical appearance, possibly to the exclusion of developing more positive skills, such as doing well in math class. These types of concerns about girls and negative gender roles are not new, and hopefully Disney will find a way to provide more and more positive role models—something they are clearly working to do.
 
Disney has worked to move away from having all white princesses, as exhibited by the non-white heroines of films like Mulan, Pocahontas, The Frog Prince and the upcoming Moana, for which they are to be commended. However, Marvel Comics recently took an even bolder step, announcing that Iron Man’s “real life” identity will be that of a 15-year-old African-American girl. This strikes me as a real departure, considering Iron Man literally has the word “man” in his name.
 
The new character is named Riri Williams and, in a contrast to the concerns I expressed earlier about girls not engaging in a math class, is a 15-year-old MIT student. This, obviously, busts a number of stereotypes about both women and minorities.
 
One thing I’ve noticed in working with children and adolescents is that while boys may object to stereotypically “female” media such as Disney princess films (“I don’t want to watch that, that’s for girls!”), young women don’t seem to react in the same way. I have worked with several girls who seem as aware of super heroes and Star Wars as do their male counterparts, especially now that the awesome Rey is on the scene. And while Marvel has had several female leads, they may not be as relatable to adolescents. For example, Jessica Jones; her story lines are more adult in nature, as they reflect her struggles with both literal and metaphorical sexual violence. The idea of a 15-year-old genius building an Iron Man suit herself in a dorm is very positive, and I can see teen girls identifying with this character in a positive way.
 
Something that has been a challenge to the mental health field for a while is engaging African-American clients in mental health services. I’ve written extensively about how I develop narratives with clients and I love the idea that this new Iron Man (or will she be Iron Girl or Iron Woman now?) might be a way to engage female African-American clients. Obviously I’m not saying that this character is going to dramatically improve black clients engaging into mental health services—that would be ridiculous. But I’m fond of the saying “when a door opens, I walk through it.” I see this as a possible door and, if it opens, I am walking through it. After all, reaching people is one of the key components of being a successful psychotherapist and I’ve had success with adolescents using these narrative-building approaches. Viva Riri Williams!
 
 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.