Thinking Disease

Cognitive Behavioural Therapy dictates that what we feel is a product of your thinking.  Depression and anxiety are therefore a consequence of negative thinking.
Free Association was a therapy technique of psychoanalysis.  It encouraged people to express whatever came to mind without the usual mental censorship.  Eventually the analysis could see the patterns of thinking, obsessions, and resistances that the analysand struggled with.  When they were explored together the analysand could root out what were usually once useful thoughts but had outlived their value.
I have shared my own thoughts as a ‘writer’s journal’.  This was the teaching of Julia Cameron in Artist’s Way.  She recommended writer’s daily do ‘morning pages’ to free up their creativity.
“Journalling’ is a recognized therapy technique to help people in my words ’squeeze the pus out of their brains’.  When I journal in the morning I record those things that are uppermost in my mind.  In this way I tell my mind that I have acknowledged its concerns and recorded those matters most important to it.  And just as when I make a list I don’t have to keep returning to remember it but can get on with other things till I need to review the list again, so with journalling I can quiet my mind.  My mind no longer has to repeat the same concerns.
Fear and resentment are the major negative emotions and daily these primal emotions are triggered by recurrent negative thoughts.
Mostly fear and resentment resolve around security or money.  Next they’re a response to interference with ambition or expectation. Something blocks our mental plan or interferes with our intention. Finally fear and resentment revolve around status, how we see ourselves in relationship to other, all the issues that are involved with shame.
Cognitive distortions are recurrent negative patterns of thinking like ‘catastrophizing’,  jumping to conclusions and believing the worst.  Black and white thinking is the ignoring of the possibilities of grey.  Such binary thinking leads to paranoia and persecution delusions.  Grandiose thinking is believing it’s all about you when it fact the play might not even have you as a lead.  Not every theatre has you as the lead.
Logic is the study of thinking and the basis of philosophy.  Rhetoric is the study of ‘sales’ thinking and politicking. Logic endeavours to reach the ‘truth’ whereas rhetoric endeavours to manipulate and ‘win arguments’.  The fallacies are well recognized false arguments.
The one I notice most these days is the ‘ad hominem.  When I say Justin Trudeau needs to be randomly drug tested others respond attempt to ‘kill the messenger’ and attack the arguer rather than address the thesis.  Hence the standard ‘Facebook’ argument, “you’re an asshole to question Justin Trudeau’.  This may be true but it’s quite irrelevant and ‘begging the question’.
Sadly most advertising a series of ‘fallacies’.  Laboissiere teaches fallacy and sadly given the marketing and political nature of the world today it’s a topic that should be the basis of grade school just as scientific method should be taught that early.  However the profound ignorance in the Canadian population reflects the propagandistic nature of the school system which fails to teach children ‘how to think’ by instead teaching them ‘what to think’.
Cognitive behavioural therapy with it’s tools of psychoeducation and logic includes journalling especially free association journalling as a means to allow us to review alone or with another what exactly is going on in our minds.  If we can see and understand that then we can root out negative memes that are no longer useful or simply correct the fallacies and cognitive distortions that make life less joyful.
St. Paul taught us to ‘pray unceasingly’.  My psychiatrist minister friend Dr. Willi Gutowski used to described the brain as a ‘radio’ which picked up all manner of stray frequencies from the world around us.  He recommended taking two hands and turning the dial to the ‘god channel’ and holding it there.
Practicing the ‘presence of the Lord’ requires one to focus on being in the now.  God is Omniscient, Omnipotent, Omnipotential so to know God and all Joy is to be in the present.  As my army friend used to tell me when I talked to him, “Bill you have one foot in the future and one foot in the past and you’re pissing and shitting on the day. Get your head in the same room as your ass is.”
Mostly our mind is ranging out into the past where we have resentments or ranging out into the future where we have fears.  Meditation is a means of focusing on the present.  Mindfulness meditation as taught by Buddha is the means where by we see the thoughts as ‘creatures’.  One identifies with the Self of Kohut’s “Self Psychology’.  This has also been called the ‘Observer’.  C.S. Lewis, the great Christian philosopher encouranged us to join with God and see that God was permanent and infinite and all else was finite and transient.  This expression ‘this too shall pass’ refers to all but the essence of the flow, i.e. God.
Emmett Fox, author of Sermon on the Mount teaches that as we address the thinking disease we will find the underlying ‘spiritual laws’ of creation and be better able to live by them.
Selfishness and self centeredness is closed minded and fear based.  It’s all the response to hurt.  A child is like a fool all trusting until it learns from trial and error the dangers of the world around it.  These leads to ruts of thinking, behaviour and attitudes. These had a value at the time and may be held onto for that very survival aspect but later may indeed impede further learning.

Continental Coffee, Commercial Drive, Vancouver

I'm sitting outside the Continental Coffee Shop on Commercial Drive.  The ham and cheese I ordered is delicious.  The regular coffee is even better, distinctive and robust. The atmosphere of the place is decidedly commercial drive, intellectuals conversings at tables beside beautiful people probably hooking up through on line services with the occasional computer geek working on something, or blogging like me.  The young and pretty blond is journalling. I wonder if she's in recovery or just a budding writer.  There's all manner of middle class on Commercial Drive.  Three decidedly gay men walked by with affected speech. An angry lesbian looked at me and smiled blowing all stereotypes. The ethnic Mediterraneans look like retired crime bosses but probably are just grandfathers.  Across the street the Italian Bakery is doing brisk business.  There's Wonderbucks trading company too. I've shopped there when I was furnishing apartments.
Right now I'm thinking of God.  Gilbert is lying on the sidewalk beside me hoping to smell ass.  A particularly attractive young woman just walked down the street with 30's style clothing and bright red lipstick.  I don't suppose she's horrny.  That's a pornography Hollywood myth in my experience.  Old guys sitting with MacBook Air computers at coffeeshops aren't at high risk of being molested even in Vancouver.
In the 60's and 70's the drug scene was more about awakening while today it's more about numbing.  The slogan then was 'Turn On'. Now it could be 'Turn Off".
There is a preponderance of tattoos on the street.  Even Gilbert has one for identification.
God either is or isn't.  The very question implies existence. You don't deny the Holocaust if it didn't exist. There's not a whole lot of folk invested politically in excluding Santa Claus from schools and court rooms.
It's called 'secular religion'.  A polytheism for sure.  Not a monotheism by any means. Rather 'man as the measure of all things' or to be politically correct and decidedly hip, 'woman as a measure of all things'.  All the promises of feminism seem not to have benefitted me and yet like so many causes I supported them.  Now I'm looking for the old dying white guy movement. I feel and think about death a lot these days.  Sickness does that to one.  Mysterious pains and aches and chronic stress combine to make for cracks where fear will enter.  Prayer and meditation stay hysteria.  A problem shared is a problem halved.
My friend George reassured me recently I was still insane.  I was concerned.  If I was sane I'd believe what the media was telling me.  The planet is dying. The world is overpopulated. The government is all thieves. The banks are criminal and lawyers are all nazis.  Communists and atheists are taking over the country and China is spying on bowel movements with nano cameras built into see through bum lulu lemon yoga pants.  The possibilities for fear are endless.
A beautiful long haired summer dressed woman is walking her leash pulling hound.  Gilbert is watching the dog.
God is an idea.  God is also an experience.  I've known spiritual awakenings and experienced the interconnectedness of all creation. I have seen the whole of the periodic table dancing in a whirling matrix about me with all the hidden names of chemistry labelling existence. The greatest of visions and beatific realities predated hallucinogens. Closed materialist psychiatrists attribute all this to early childhood sexual abuse, misfiring of synapses, or any number of explanations suitable for themselves. They're pseudoscientists at best, never appreciating the limits of our knowledge of even gravity. They're more afraid than I am.  That's what 'uptight' is all about. I prefer my friends praying to raise the dead. Why not.  Beats blowing up people with bombs.
An oriental man with red shoes and diamond earrings is talking on his cellular.  The mundane is so deprived of the sacred as to make science anything but holy.  I , like millions before me, have known telepathy. I know twins who knew each others thinking and anticipated calls half a world away. All such phenomena is disregarded by the main stream monetarists.  To even imagine a connection without an 'airway plan for profit' is a threat to the status quo.
God is the central exchange.
God is that hub in which all souls are connected, time is one, and all things impossible are possible.
To me it's called home and I've been too far away learning the things of this world and proving my competence with the heavy manipulations of this lower zone made lighter by the love of man and woman, man and man, woman and woman, children and dogs.  I feel as if I'm in a reality invented by a cat. It's serious that way.  Mario de Beauregaard's "Spiritual Brain', was only necessitated by the lies foisted on us all.  These days they deny the mind and say everything is the brain.  Why not deny God, in time we can deny man and return to pure aggression.
I envied the woman who passed with the long and healthy body moving in a single form fitting fabric like a futuristic dancer having landed in this world for a day of sight seeing. I'd love to John Malkowitch her body and mind and experience reality from a different locus.
God is in all the eyes of the world. We are his and her hands and feet.  God is one and many and , the one many and the many one. There are no words for the paradox.
Talking of God gets one locked up or crucified.  There are too many Christians these days without scars.  All one has to do is tell the truth and all manner of authorities will descend upon you.  The story of Paul is today.
The sun is out and  still I descend into the gloom of yesterdays.  Resentments and fears make up so much of the thoughts that circle the amygdalla like warriors about a wagon train.
She is passing with red hair and dark glasses, a slim but busty body and no need to wear black on this day.
Men used to wear cod pieces that brought one's attention to their genitals.  It is only when their penis is exposed that they become objects of sexuality. Women have done well to clothe men everywhere so that at least they can think in late spring without hormones distracting them any more than they already are.
Men's clothing conceals, mostly sloppy and loose fitting.  At least gay men celebrate their bodies.  The male suit jacket was developed from the design of British war uniforms.  As a man I've felt at war most of my life, competing with others daily, defending rights that are only rights if defended, begging resources promised but not given, refusing to accept the status quo which would have those I care for marginalized and why.  I was little once and fear that when I am old there will be no one there to help me.
But God.
I was in a hospital with a dangerous sadistic nurse.  She is memorable and yet all the others I have known so much more positively cannot erase the experience of her abuse of power.  But abuse of power is ubiquitous.  It's a subjective state in a greater whole and what Job was written about in the Bible.
My relationship with God is sadomaschistic.  The story of Jesus is one of faith and denial.  I have more faith in God than I do in myself.  I'm a regular Jonah refusing to go to Ninevah.  I'd rather be in Yaffa.  How many whales have I been swallowed by and how many times have companions felt threatened in my presence.
IA young girl walked by wearing a pink shirt "Love who you are."
My seat is bouncing for Gilbert is meeting another dog behind me and his leash is attached to the chair.  Now passing I see this was a pug.
There is a book of biblical Hebrew I need to study for this evening. I've a lesson to prepare and yet would rather look at  two pretty women scantily dressed walking proudly down the street.  "People watching" in Arabian countries must be boring in the extreme. Feminists loved to flaunt themselves in the day and then blame men for looking, before the lipstick feminist set made mockery of the their older dirty silly sisters.
I'd like to be at a nudist colony. I could go to wreck beach and see the phallus as privileged as the breasts of the city are.  The breast prominence is accentuated by all manner of wire and engineering. Stanfields offer me no such assistance.  No wonder men ride Harleys, yet women seem only interested in the cost of such machines and sociobiology prevails.  The egg is more dominant in behaviour.  I am reduced to the behaviour of my sperm.  Sociobiology is so much richer than the mythology of Marx.
A Harley has just driven by and I am aware I could be driving mine on a country road right now.
Instead I am here talking to God, thinking about God, conjuring God, praying for God, meditating on God.
Sexual orgasm is a sensation.  In my material world scale it's more exciting than a bowel movement or a pee but to one who has suffered limitation of either sex holds no comparison.  Sex can't compare with making money for the financially insecure or for someone who has been poor and equated poverty with powerlessness.
I've had ample opportunities and been blessed again and again by Grace. Luck is said to be God acting anonymously.
The sins represent excesseses.  Amorality revolves around sins.  Our laws speak most to sins.
There is the sin of gluttony.  All over the rich are obese and yet so are the poor.  Not perhaps in times of famine.  Historically some meat, like the physique of Marilyn Munroe has been preferred to anorexic Twiggy as defines against disease and famine.  Now our western world dies of excess. The narcissism about food acts out in all manner of variations, cook books, epicurean delights, restaurants, vegetarianism.  There's a regular pornography of culinary indulgence.
Yet, Jesus said, "man does not live by bread alone".  And so few fast when fasting was as sure a route to knowing God as prayer and meditation.  "Could I have a latte and a cucumber sandwich on whole wheat and flax bread, if I fast?"
Sex is dirty to the glutonnously filthy who have lost the feeling below their mouth and insist their daily involvement to all else in their 'taste' and 'gut sensation' is 'necessary'.
Crap.
But yes, the experience of a good bowel movement is increasingly appealing to the aging population whose daily ritual is to look forward to meals. Not so much for social conviviality as the respite from thoughts and memories.
Sloth is another favourite sin these days with unemployment, welfare, rest, vacation, leisure, and sleep and all manner of industry related to the bed and couch and lazy boy.  Disability is another industry which revolves around late night preoccupation and late day rising.  Inefficiency is disregarded and whole government agencies are devoted to promoting a lethargy of sloth that all insist is necessary. And may even induced or coerced. As some who really would do other are obligated to join this 'state' of affairs for political gain ultimately of others, not themselves.  They have their reward in sloth.
And there my mind slips into criticism and negativity.
I turn to God to lift me from the malaise of thought which begs for something to gnaw on as many seek 'no mind'.
Gilbert has been petted quite a bit by passers by. He's enjoyed his time. I just realized my meter must have run out
But my meter calls to me.  It measures time.
God may I know you better today and be more with you.

Blogging

There are many "purposes" for blogging. Some blogs are veritable works of art while others are ad hock family journals.
My blog began as a result of a Canadian Author's Association meeting where the president of the BC Federation of Writers recommended blogging as a means to literally show one's 'productivity'. Publishers are apparently interested in 'productive' artists.
The Artist's Way by Cameron described 'creativity' as a process. She encouraged artists to write daily 'morning pages' as a means to overcome the 'censor' and stimulate the flow of creativity long stymied by all the negativity that individuals encounter in the school and work place.
Drama of a Gifted Child, by Miller, another classic in the creative process described a similiar need for freedom of expression.
Vaillant, the brilliant psychiatrist from Harvard wrote a book on Creativity which I did a review on for a Canadian medical journal years back.
I started my blog then as a kind of 'writer journal'. I rarely 'edit' or 'rework' my blog but have it as the original 'download' of material from which I thought one day I might be able to find something of value. It's the 'first draft'.
I had another blogger tell me that I really ought to have '5 or 6' blogs because of the different themes that run through mine.
I thought this a great suggestion and definitely true but that would defeat my original purpose, which simply was to encourage writing. I have note books full of unfinished novels and boxes of published stories. I found I really enjoyed the 'creative writing' but because I had so much 'editting' and 'careful detailed scientific writing and research' as my 'work' I didn't simply write for the joy of writing as much. Further, while I loved the publishers and editors I've had I found the process of sending things off a barrier of sorts. With blogging I could just write and press the publish button. Sometimes I read what I wrote over for punctuation mainly but mostly not.
The themes are there though, the main things I write on.
So my blog could well be divided into the following:
1) Travels with Gilbert - I always loved Steinbecks 'Travels With Charlie' and while I don't believe I'll ever be the writer Steinbeck was I do believe Gilbert is a much more exceptional and noteworthy dog than Charlie, though I suspect Steinbeck might disagree.
2) Notes on Psychiatry, Psychotherapy, Psychopharmacology from a front lines practitioner of the science and art over 30 years
3) It's hard to separate this from the previous one but Notes on Medicine - being a physician and healer over 30 years.
4) Spirituality - this is what really turns my crank - love of God, desire to be closer to God, theology, Christianity, ecumenicalism, world religions, heaven, all of this is so very important to me and what I like most to write about
5) Addiction and Recovery - I'm an addiction psychiatrist and a recovered alcoholic so it's a joy to write about this in a scientific and objective way, making it part of the earlier two headings but also in a personal way, as part of my spiritual journey and travels with Gilbert.
6) Adventure and the Wilderness - I've been out behind the lines in physical, spiritual and psychiatric territories and being a 'front line' worker , always working where the 'greatest need' is, and being a wilderness doctor , often beyond where doctors like to go, is a theme that runs through my blog and blogging.
7) Sexuality - I taught sexuality and sexuality is a large part of life, subjectively, and medical and psychiatric practice, objectively

Finally I was the high school photographer. My father was an avid photographer and my brother is now a professional photographer. My nephew, Graeme, not only does still photography but has branched out into making movies which is so reminiscent of my father who graduated to a movie camera and would 'splice' little 2 minutes segments of film together to make a movie we'd watch as a family in the living room .
So I usually have a camera along and now my iPhone so enjoy sharing pictures with my blog and love getting feedback from friends and family on my blog.
It reminds me of when I published orthodox scientific papers in prestigious journals. No one got back to me. I was 'cited' occasionally but much preferred publishing stories and writing in the Medical Post because so many of my colleagues read that national weekly medical magazine.
Blogging for me keeps me in touch. I write book reviews, poetry, movie reviews and just about anything that catches my attention. Frankly blogging has been the most fun I've had writing since I began writing poetry as a teenager and performed in local Winnipeg Coffeehouses age 16 to 20, around the time Carrie and I put out the Vincent Massey High School, poetry journal, Poison. Later I'd love editting the Meditoban and talking with friends about the writing we'd share in that.
Then there came a time when I was always writing but the boxes just went into storage. Many might say 'as they should'. Indeed there are those who favour censorship and 'refinement'. I do admire my friends who rewrite dozens of times before they share. I've certainly done this but while we all know that's the 'work' of writing, I think of that indeed as the 'work of writing', whereas my blog has been for me the 'play" of writing.

- Posted using BlogPress from my iPad

Eclectic Therapy - 1) Counselling

I am an "Eclectic Therapist".  I have been formally trained in a variety of therapies so now use them all either when indicated specifically or as an amalgamated therapy drawing on the parts I've found most effective over the years.
My first therapy was 'counselling'.  Counselling is fundamental to training in general medicine.  Even surgeons, not noted for their interest in verbal communication are trained in counselling.  Counselling is a process of one person listening to another and then providing feedback.  The family physician commonly hears a person's complaints which can be physical but as commonly are biopsychosocial.  Counselling in family medicine involves listening carefully and discriminately and asking questions specifically to elucidate the nature of the problem in it's entirety.  Friends often 'counsel' one another but rarely explore the situation with the experience and training of a medical doctor.  Common questions are 'how do you feel?, how do you feel about this?  When did this begin.? What started it?  What makes it worse? What makes it better?
Indeed when I worked as a country family physician I was the town de factor secular  psychiatrist. My good friend the Lutheran Minister and I would discuss how similar our roles were in this regard. He did 'pastoral counselling' and I did medical or secular 'counselling'.  Later I'd study pastoral counselling in my ministerial training at St. Mark's, Vancouver Theological School, Regent College and Almeda.  Frankly, as physicians we often had more to offer than the ministers who often had better 'bedside manners'. The art of medicine is really to a large degree 'counselling'.
My research interest in psychiatry was 'non adherenece to medical regimen' and 'non compliance'. I was fascinated that 80% of schizophrenics in many studies didn't take their medications yet there was this almost cult like following of the 'neurochemistry' effect of medicine without consideration of the 'relational' aspects of the process of prescribing.  Psychologists given the right to prescribe as well as pharmacists or even family physicians rarely had the success with prescribing to the mentally ill as psychiatrists.  In my early practices my personal results with medication or any therapy in fact were commonly lightyears ahead of those reported in general because of a wide variety of research bias factors.  My patients in those halcyon days were 'selected' and highly motivated as compared to some of the post licensing multi centre trials where the rubber hits the road and commonly patients don't respond despite the 'halo' effect of the research.
Not surprisingly an anciety physician said that medicines must be novel and changed frequently to maintain sucessess. He was referring to the 'placebo response'.  Placebo is the tendency of the person to be self healing. Neuts will re grow tails and our evolutionary heritage is this self healing propensity. Much of therapy is removing whatever obstructs a person from healing especially in what are often self limitting illnesses.  As a country gp I remember putting three casts in three weeks on a teen age hockey player with a minor fracture who refused to stop playing hockey. Were it not for me, his minor fracture would have ended up a gross disability not because of his lack of healing capacity but because he was a teen age boy and stupid as a mule.
It may be that all medicine works to enhance this 'placebo effect'.  Nocebo is the opposite.  I had a doctor (see quack - despite the letters after his name) tell me I'd never heal from a condition.  If I had kept him as a physician that would have been a 'self fulfilling prophecy.'.  Lucky for me I saw his shifty eyes and smelt the sulfur in the room. My second opinion was decidedly more favourable and that doctor indeed 'cured' me of the aliment I'd sought treatment for.  His bedside manner was decidedly superior. Unlike his predecessor ,  he didn't slither like a snake.
Counselling was first studied in depth using scientific rigour by Rogers. Rogerian Counselling was easily reproducible and easily taught and proved decidedly effective for mild and moderate conditions. It's still a mainstay of treatment in student mental health.  Here the therapist listens agreeably and validates the person's emotional response and generally is very 'supportive'.
The word 'supportive' is key in Counselling.  Indeed counselling is often called "Supportive Psychotherapy".  This refers to the tendency to 'take the side of the patient."  The patient for instance says, "My boss treated me like shit today."  A supportive therapist or counsellor would say, "that's awful".  As the person went on ad infinitum about the terrible boss the therapist would 'validate' their emotions and sympathize and empathize with their feelings of being abused.
Today more often than not a 'legal advocate' will be a 'supportive therapist'.  Neither will go to any great lengths to ask 'why do you think the boss said you were a danger to society'.  Tyrants love counsellors, supportive therapists and advocates. Mad Magazines wrote a very funny piece on the therapists of Hitler and Stalin.  Very sympathetic indeed.
In contrast those trained in insight therapies or other forms of psychotherapy might dwell on helping the patient see a connection between their behaviour and the boss firing them.  In 12 step facilitation therapy the person is asked to 'clean up their side of the street' for instance.  In this case, the patient might for instance have been a gas station attendant who insisted on smoking while filling school buses.  A counsellor or supportive therapist and certainly a Rogerian might never learn this important detail.
Supportive therapy indeed and counselling go beyond the 'empathic listening'.  They involve exploring the whole context.  The early feminist therapists were notoriously inept at this and only last year  I had a patient who mistakenly went to a so called 'professional' and was told to leave her marriage of 30 years in the first half hour of therapy. The husband was never physically violent and his so called verbal abuse was a product of a head injury which had resulted in a tourette's like phenomena. A dozen of the cities finest specialists were involved but this stupid and arrogant self serving feminist counsellor in 30 minutes destructively advised this beautiful, vulnerable  and intelligent woman to give up on her marriage, her kids, her future all because of the counsellor's grotesque political agenda own political agenda.  Indeed in one community I worked,  the mental health counsellor "marriage therapist'  was a man hating radical feminist divorcee who had a formal complaint lodged against them and it was found that of the hundred couples who had gone to her for marriage therapy all had divorced.  Unfortunately counselling is not scutinized like Obstetrices were a hundred baby deaths would be noticed, the marriage itself being called the couples first 'baby' in formal marriage therapy training. Indeed often counsellors just assume that individual training in counselling makes them capable of working with couples or with groups when in fact I've had to take formal training in both modalities and know well that my individual therapy training used out of that context could be seriously damaging, something I see counsellors doing not uncommonly.
I confess I've seen the best of counselling and worst of counselling and must work to forget the radical feminists or the religious nutcase who had my patient flailing himself naked alongside the minister counsellor.  Despite years of training and experience and heavy punishment  I know psychiatrists who have had sex with students and patients.  Now that psychiatrists, priests, and teachers have been vetted we're slowly moving through society and putting an end to these extreme abuses.  Right now the Boy Scouts are addressing their cover up of homosexual pedophiles in their midst.   The Girl Guides have yet to explore the lesbian sexual abuse that went on in their community.  A northern BC equivalent of the attourney general's 30 year sexual abuse of countless teen age girls has finally been halted. The Divorce Lawyers association has finally accepted only because of public outrage that they can no longer accept sex in lieu of payment for their extortionist bills.  Residential school hearings netted the highest levels of administrators, principals and politicians as well as the janitors and orderlies.  We can be truly thankful for Chief Justice of Canada Beverly McLachlan's demands for increased transparency in the courts because historically abuse was never so bad in the initial round as it was when society subsequently abused the victims as was the norm  in courts in days gone by.  Indeed the concern today is that as only the truly rich can afford 'justice' we're going back to those medieval era times when money and power meant everything.
Back to counselling, advice giving is acceptable.  Often psychaitrists are said to 'lend their ego'.  We can spell out for patients what their options seem to be and even suggest what we might do. Supportive psycotherapy and counselling can be that directive.  When I worked with brain damaged patients I had no difficulty telling them to brush their teeth for instance or get a lawyer or take the medication.  I didn't ask them the meaning of tooth paste and I didn't discuss their cognitive attitudes and distortions. Some of them didn't remember what I told them the week before so my work was literally finding the most important issues and focusing on that.
This indeed was counselling but ironically I learned the 'techniques' from 'Focal" Psychoanalytic Therapy which I'd learned from Sifneos and Malan. Only I actually applied it to developping strategies for team approaches to working with brain damaged individuals. Rather than having them being told a dozen things we would reduce our counselling efforts to gaining success in a few areas because success begets success.
I consider my work in Addiction Psychiatry to have been highly benefited by my learning in "Focal" therapy.  If a person can do such a simply discrete task as stopping taking a needle with heroin in it and instead take their opiate by mouth as methadone maintenance therapy it's not surprising to see these same individuals learning all manner of complex self care matters and societal normals later.  Too often the 'focus' of therapy is really off and horrendous effort and resources are squandered.  I'm cynical enough to think that the people getting paid for the problem aren't obligated to find a solution so are very happy to continue appearing to do good while 'enabling'.   These' do gooders are painful to say the least.  Freud followed by Kernberg and Kohut said that alcoholics were untreatable with insight psychotherapy.  Motivationa therapy and 12 step facilitation therapy both cornerstones of addiction psychiatry, unlike general psychiatry, take a very clear position on whether the addiction is good or bad.
Like Forensic Psychiatry Adddiction Psychiatry in contrast to traditional Psychoanalysis takes a position on abuse of heroin and cocaine. They are not good to the Addiction Psychiatrist as murder and theft are not good to a Forensic Psychiatrist. In contrast I remember in residency training discussing with a psychoanalyst  in group analytic training  a patient seeing a colleague, the patient being a cocaine abuser, thief and enforcer,  and the trainee continuing to ask them the 'meaning' of their theft and violence all the while the community the patient lived in was ripped off and violently assaulted. I was not terribly impressed by the popular psychiatrist playing psychiatrist to the Sopranos.
As an aside I have been the psychiatrist to many people who had committed  criminal acts such as murders who weren't caught or even in war did horrible things which they later saw me about. I was trained that I could not continue to see these people and thereby implicitly 'validate' their behaviour if it were to be ongoing.  In the classic Tarasoff case the psychiatrists confidential responsibility to the patient and the responsibility to the patient alone is overriden by obligation to the community and need to protect specifc targets. Further I always discussed such cases with senior colleagues so that i was not manipulated by psychopaths and sociopaths as the Soprano psychiatrist was. In fairness to this actress , she too sought colleagues for advise and in many ways her performance deserved the award she was given by the American Psychiatry Association as it exemplified the true complexity of modern psychotherapy.
Every day there are advances in our understanding of mental illness and how best to apply therapies and which therapies are most likely to work. For example Cocaine and sex addiction commonly go hand in hand. All efforts to treat the sex addiction without treating the cocaine addiction are likely to fail. This has been demonstrated ad infinitum. Interesting 75% of the those who had sex addiction and cocaine addiction, if only they stop their cocaine addiction will hot have evidence of sex addiction a year later.
Counselling and supportive psychotherapy and indeed 12 step facilitation involved 'self disclosure'.  I enjoyed working with obstetricians who'd tell their patients 'when I had my baby I found breast feeding helped stop the colic."  Pediatricians commonly tell parents what they used with their kids and counsellors often recommend products they've found beneficial.  Self disclosure is not used in psychoanalysis.  It's foundational though in 12 step facilitation therapy. Indeed a psychoanalytic psychotherapist who moved into addiction psychotherapy was only able to get success when he learned to "share' with  his addicts and alcoholics that he himself had been an addict to cigarettes and had had great difficulty overcoming his own addiction.  Something about the field of addiction with it's underlying anti authoritarianism and long history of hearing 'advice' from 'do gooders' and those who are 'superior humans' causes patients to shut off anything from anyone who doesn't meet them half way.
Indeed Christian psychotherapy as well and pastoral counselling are distinctly different from the 'Psycho educational" counselling model used as a mainstay of psychopharmacological therapy.  In traditional psychoanalytic psychotherapy of the Freudian model the therapist was actually fairly paternalistic but having to go through therapy themselves was 'non judgemental' and usually humbler.  One of my favourite Jewish Psychoanalysts was famous for saying 'we all must find the 'eichman' within because he was trained in the non paranoid model of humanity in which we're half good and half bad and there but for the grace of god go I.  The Christian and Pastoral Counselling models see patients as 'sinners" ie those who have 'fallen from the Way' but we are all 'sinners' and we all 'fall' at different times .This is the nature of humanity.  In the psycho educational model and the pharmacological model, I am okay and you are not okay. I am the doctor and your brain, mind, being are broken and I will 'fix' you wilth a "pill' with "shock" therapy or even 'neurosurgery'.
The Transactional Analysis folk summarized these various therapies as I'm Okay, You're Not or I'm Not Okay, You're Not Okay but together We Can Be Okay.  In the Jungian psychoanayltic model we are all on a journey and the therapist is just a little further ahead and acts like a guide.  This notion of a guide is common in the counselling models that stem from First Nations roots.
Lawyers are decidely counsellors and commonly called such.  Advocates too.
Family physicians have long been trained in these more conscious therapies as well as the standard psycho educational model which every surgeon must learn if only to explain to patient's why he plans to cut off their legs.
As a family physician in the country, the city and the far north, working within my own culture and cross culturally and with individuals, families and communities I had extensive experience and formal and informal training in counselling and Supportive Psychotherapy.  Indeed supportive psychotherapy seemed to be the mainstay of hospital care in psychiatry whenever I worked in hospital settings.  One must establish rapport, build therapeutic alliance, learn a common language and common symbols and share information and help change behaviour or thinking and facilitate progress or at very least acceptance.
I trained for a week workshop with Elizabeth Kubla Ross, author of Death and Dying. Her whole work as a psychiatrist was a very elegant and refined form of supportive psychotherapy.  To see her working with a dying patient was to watch a ballerina doing swan lake.  She was a truly  brilliant and loving psychotherapist but she didn't tolerate foolish colleagues well. Probably that had to do with her efficient Swiss background.  I am very thankful that I have had the teachers I've had.
I still do Grief Counselling occasionally, last year having at least a dozen such cases, and this is not a place or time for Psychoanalytic Therapy perse or Cognitive Behavioural Therapy, Supportive therapy is, to my mind, the best form of therapy for grief work.  It's also well documented in assisting people with straightforward psychosomatic difficulties that cause time off work. Commonly 'stress therapists' and 'personal coaches' etc use alot of the techniques of Supportive Therapy.
They include things like journalling, and tracking an illness, monitoring, using score sheets, and all manner of pen and paper techniques.  I've even used gold stars on calendars which I learned in child psychotherapy with great success working with adults.  All manner of Reinforrcement scheduling is part of the repetoire of counselling.
And generally where there is a 'positive transference" , ie very good rapport and the patient is highly motivated, young, educated, attractive and affluent these techniques work well. They are severely limitted where there are 'negative transferences' and where there are unconscious resistances to getting well. Where there is incongurence, ie patient says they want one thing but do the other the problem is usually beyond the level at which counselling is by itself sufficient.  In the more major psychiatric illnesses other and more specific psychotherapies have been developped to deal with the more resistant conditions.  That said, 'supportive therapy and counselling is usually a part of even the greatest 'purists' repetoire.