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Mar 08, 2018

When Push Comes to Nudge: Rising to Challenges

Until recently, I never would have conceived of labeling myself a risk taker. Those around me would likely laugh at the suggestion. But I recently heard a well-timed podcast[1] that triggered some introspection and a few label changes in my head.

Part of the podcast discusses the work of behavioral economist Richard Thaler, the author of the book Nudge. He defines a “nudge” as a small event or stimulus that prompts a behavior change; like cutting up an apple increases the likelihood that a child will eat it. There are also larger events or stimuli that are “pushes”; a more abrupt and violent impetus for change.

Immediately my mind started labeling “nudges” and “pushes” in my life and my behavior changes related to them. That is when I saw it. When life “pushed” me, I tended to jump with both feet instead of just dipping my toe into the water. Some would perhaps have called this impulsive (a label I would never assign to myself) but I reframed these to be the moments in my life where I was at my bravest. They were the times that life challenged me and I rose to that challenge. The result seems to, in most cases, have been a net positive.

In looking at the trajectory that my life and career has taken over the years, I was able to spot two specific “pushes” life gave me that landed me in the profession of counseling. These “pushes” helped to define who I am today. Some would qualify these as adverse life events. I view them as opportunities for growth.  That reframe has changed the world for me.

I remember vividly the night my mother had her first manic episode. I was 13 and we were visiting family out of state. The overspending had already started but my 13-year-old self was not aware that was a problem. The night all hell broke loose was the night she and a family member had an argument and it ended with my mother non-verbal, in the fetal position on the floor, rocking back and forth. It ended with her hospitalized. Until I was able to reframe this experience in the light of a “push”, my most prominent memory from the night was listening to Metallica’s “Black Album” over and over again while hiding behind a couch. But when I look at it through the lens of a “push” I find that this moment is the impetus for me to find my calling as a counselor.

Soon after we returned home from the family trip, I started scouring book stores, libraries, and Goodwill looking for resources on psychology. I wanted to learn about how the mind worked. I was most interested in abnormal psychology, or the times when the mind was not working as it “should.” It is through these books that I learned to love the field of counseling and mental health. Sadly, it would take the disillusion of an engagement (another “push”) for me to get the hint and make counseling my career.


The second major “push” came in my first job outside of graduate school. I found myself squarely planted so far outside my comfort zone that I was not sure I would survive in the field. My graduate program had focused on providing therapy as a counselor in private practice. Little or no mention of public mental health, case management, or psychosocial rehabilitation was made. I was also from a fairly rural area. Lo-and-behold I found myself working in metropolitan Washington, D.C. with homeless women with severe trauma histories. My role was to provide psychosocial rehabilitation and case management services. I was, needless to say, wide-eyed. Looking back on it, perhaps I should have guessed that this was going to be a life and career altering experience when the chief clinical officer threw my resume and letters of recommendation in the trash during the interview. Or when the CEO simulated physically assaulting me during the interview (including grabbing onto my purse and shaking me) to determine if I could defend myself.

The “push” came in an all-staff meeting in my first few weeks at the agency. I hadn’t even gotten paid yet! One of my clients had been selected for an annual district audit. I had never met her before. So when asked in this meeting of all of my peers and supervisors what I planned to do to ensure the audit went well, I used all the terms I had learned from graduate school. I would establish rapport, and attempt to engage her in a meaningful partnership, etc. This was apparently the wrong answer. Immediately I was dressed down and told I did not know how to do the job by the CEO in front of everyone. In all fairness, she did not just single me out. There were a few of us who go her ire that day. It was everything I could do to not cry right then and there.

Afterwards the CEO and clinical director met with the three of us who had been summarily dressed down in front of our peers and attempted to un-do the damage by being supportive. It was in that moment that my frustration became tears. That day, I almost quit my job.

But in the end, the CEO was right. I didn’t know how to do my job. I’d never been taught. But, later that evening my frustration turned to resolve. In the past I would have said I became spiteful. Looking back on it now, I see that I was resolved to excel after being “pushed”: I rose to the challenge. “Fine,” I thought, “If she thinks I’m going to fail at this. I’ll show her. I’ll succeed beyond measure.” I strove to be the best at my job and I succeeded. In the two years I was with that agency, I not only got an award for my work, but got some of the highest scores in the annual district audit for both years with two different clients. While those were great achievements, the real change I saw was in my clinical identity.

I grew to love my work in public mental health. The population clicked for me. I loved the daily challenge of helping people with severe and persistent mental illness and co-occurring substance use disorders. I adored the moments when we found housing, got a negative HIV test, or got a new set of dentures together. These moments, those people, and the atmosphere of the agency in a major metropolitan area helped define what I wanted in a career. Private practice was no longer my goal. Public mental health was my heart and where I would always strive to remain.

Since then, I have taken small forays out of public mental health, but I always find myself returning; all because of a very violent “push” in that direction. Instead of quitting that job or folding under the pressure, I chose to jump in with both feet and meet the challenge head on.


I still have vivid memories of both life events. To this day, if a supervisor calls on me in a meeting I notice my fear response trigger in my body despite the fact that I have never had something like that happen since. When I hear a neighbor arguing I put on headphones and hide away from the sound. But these most vivid memories also yield in me an endless drive. A drive to meet life’s challenges; no matter how big or small, no matter how potentially life altering; head on. To take the risk and reap the reward or the consequence. Through these two events, I became a risk taker, calculated perhaps. But a risk taker.

To this day, I use the idea of “nudges” and “pushes” (albeit, not in those terms until very recently) to help my clients understand their lives, especially how adverse life events impact them. The goal is to show post-traumatic growth. Nine times out of ten they are able to find that, despite their traumas, they have grown. They weren’t buried by their past, they were planted….and they grew.

[1] Ted Radio Hour (June 24, 2016) Nudge (
Brittany Lash is a counselor in Texas and is the director for the Professional Recovery Network ( with the Texas Pharmacy Association. She has experience working in public mental health, mental health public policy, and in training first responders to work with individuals with mental illness.

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