11/14/12 Filed in: Therapy
Emotions can be under-controlled, over-controlled, or balanced.
Take, for example, three different people, who are each angry at their boss.
Bob decides to go out the parking lot after work and throw a brick through his boss’s car windshield. Bob’s anger is under-controlled.
Martha is angry, too. But instead of saying anything to the boss, she goes back to her office, closes the door, cries, says nothing. Martha’s anger is over-controlled.
Dorothy’s response differs from both Bob and Martha. She goes back to her office, thinks about why she is angry, and then channels her anger into a plan that will allow her to assert her grievances to her boss in a constructive way. Dorothy’s anger strikes a balance. She experiences the anger, is guided by it, and expresses it.
Anger gets a bad rap. But anger is a necessary emotion. It is our response to violations, injustices, and the perception that we are being tread upon. Anger is the emotion that prompts self-assertion.
By the way, the so-called “nice-guy syndrome” is a self-assertion problem. There is such a thing as being “too nice.” The nice guy’s anger is habitually warded off, pushed aside, minimized. This may explain why we like these folks so much –– they’re easy to be around, they don’t make waves. But they’re also easy to take advantage of. If you go through life always trying to avoid conflict, anger, or confrontation, eventually you will miss out. You will not get what you want out of relationships, work, or life. Sometimes we have push back, assert our needs, wants, and wishes, and go for what we really want.
Your feelings are important. Tuning into them is a powerful form of intelligence.
Here’s a great quote from Ryan Howes, PhD, who writes a blog for Psychology Today called In Therapy:
“Therapy is kind of like going to a personal trainer. The two of you develop goals and a plan of action, the professional guides and supports, and you do the heavy lifting to reap the benefits. The work might be in the form of journaling, reading books, bringing up uncomfortable material, or taking a risk to trust. Unfortunately, some clients approach therapy more like surgery. They plan to sit passively while the therapist does therapy to them. This leaves both parties frustrated.”
11/02/12 Filed in: Therapy | Change
“Is there a reason why he/she can’t come to phone?” I ask.
If there is a legitimate reason, I’ll move forward with the conversation. If not, I’ll ask either to speak with the person in question or I’ll suggest that he or she call me directly.
Sometimes parents are put off by this. But the first step in receiving help is taking ownership of the problem. Initiating the process of therapy oneself –- through that first call –- sets something in motion. It is a declaration: “I want my life to different, and I am willing to do something to make that happen.”
The client we don’t like to see is the (adult) son or daughter or the spouse who has been coaxed, prodded, or pushed into therapy, and is simply agreeing to attend to appease mom, dad, or a significant other. This is a very different thing than making the choice to start therapy.
If you adult son or daughter is struggling, I do think it is wise to share your concerns with him or her in a compassionate fashion. If you think they could profit from professional help, I also think it is fine to provide them with a number to call, a web address to check out, or some other resource. But let them start the process. Let them choose.
In terms of therapy outcome, choosing makes all the difference in the world.
09/26/12 Filed in: Therapy | Change
In my job, I sit with people every day and talk about the aspects of their lives that are not working. In this way, you could say I catch people at their worse. But that’s only half of the story.
People are always more than their problems. You are more than your moods, your distress, your weaknesses, or your history. You are also your values, commitments, identity, relationships, and potentials. You are capable of goodness and change. You are your strengths (even if you do not know precisely what they are), and you are capable of joy, laughter, connection, and deep engagement with the world.
Therapy is not just about solving problems or alleviating distress. It’s also about finding ways for you to be at your very best.
08/27/12 Filed in: Therapy | Change
But not just any kind of talk.
If you’re going to get to your core pain, you’ll have to speak honestly about your self. You’ll have to tell the truth about what you really feel, what you really think, who you really are, what you really want.
If you’re going to make progress, sooner or later you’ll have to drop your emotional armor. You’ll have to let somebody see behind the mask.
Ordinary social discourse usually requires you to put on a good face, cover up, pretend things are fine. This kind of talk might get you through the day, but it will not help you heal, discover new things about yourself, or resolve problems.
Your words can be used to convey information. But they can also convey emotion, experience, memory, conflict, contradictions, complexities, dilemmas, secrets, insecurities, hopes, dreams, and above all, possibilities.
Talking helps, especially when you have the right listener.
A good listener asks good questions. A good listener keeps the focus on you. A good listener will challenge you, especially if you fall into the trap of trying to put on a good front.
A good listener will offer input, interpretations, and counterpoints, but not at the expense of being heard, understood, or supported.
A good listener talks, but not too much.
Talking helps. Especially if it’s the right kind of talk, with the right person, about the right things. You in?
08/18/12 Filed in: Therapy | Change
This is one of the oldest debates among therapists. Do we call the people we serve clients or patients? And does it matter?
The word “patient” has medical connotations. But strictly speaking, therapy isn’t a medical procedure, no matter what the insurance companies say (it’s a relationship). By contrast, the word “client” emphasizes the business aspects of the arrangement. To be sure, a therapy relationship is a business relationship because it’s something you pay for. But it is so much more than that. There are few other professional relationships that are so personal. Perhaps neither label is satisfactory.
Regardless of the label we use, the person in therapy has to admit he or she has a problem if the therapy is to work. And she must also agree, by virtue of seeking help, to be open to the therapist’s judgement, influence, recommendations, and care. Whether we call you a client or a patient, you are still assuming a role –- one who needs help, guidance, insight, change, support, or encouragement. Accepting this role is really the first step of the therapy process.
Which is why I am reluctant to let adults call on behalf of other adults in making appointments.
“I’m calling for my husband,” a caller might say. To which I reply, “Is there a reason why he is not able to use the phone himself?”
“If he wants therapy, please have him call me.”
This may sound harsh to some. But what’s really at stake here is whether the intended client or patient is ready to assume the role of being in therapy. If he is, he must declare the role for himself by owning his problem and owning his need for help. It is not enough to merely agree, at his wife’s coaxing, to come to the office for a consultation. He must decide if this is what he wants for himself.
Think of it this way. If you go to a medical doctor, he or she can do things to you –- an injection, a surgery, a check of vitals. You can consent to let these things happen. But a therapist does things with you. Without your full participation in the process, nothing much happens.
You are a “patient” in the sense that you are under the care of a therapist, but you are a “client” in the sense that you have purchased the services of a guide who knows the psychological terrain. But perhaps the real question isn’t which label we pick, it’s whether you are ready to do something about your problem.
08/04/12 Filed in: Therapy | Emotions
Expressing anger in therapy is easy enough. Anger is an easy emotion to label and, it seems, discharge.
Usually we know when we feel sad, but deep grief, sobbing grief, is something we often fear. Some will try to avoid it altogether. Others will express it, just not in front of a therapist.
Guilt nags at us. It’s uncomfortable but not unbearable, and often it is accompanied by a nagging sense that we need to make things right.
Anguish is psychological pain. When it’s bad, it’s gut-wrenching. When it’s mild, we are upset, distressed, unsettled. We want it to stop.
Shame is a powerful emotion. When we fee ashamed, we feel don’t just feel that we have done bad (guilt), but that we are bad. Shame prompts us to withdraw, pull back, or even hide if the emotion is intense enough. To be “exposed” would be having our badness revealed. Better to cover.
Sometimes the emergence of emotions are preceded by anxiety. Anxiety is easy to understand when it is directed at something external–-a social situation, a snake, a spotlight on performance. But we can feel anxious in responses to our own emotions, too. Indeed, sometimes the anxiety is so pressing that we believe it is the only thing we feel, and it takes some reflection to identify the deeper emotions that are behind it. Negative emotions, especially powerful emotions like deep grief or shame, are necessary, just not always welcome.
Broadly speaking, emotions are true guides. Without them, we would not be able to make good decisions, have preferences, values, responses to danger, know when we have been violated, or recover from loss. Emotions are a very important part of therapy, especially when someone is trying to recover from emotional injury.
When a toddler is happy, she hugs. When she is distressed or sad, she cries. When she is frightened, she runs. Toddlers are not conflicted about their emotions. They do not worry about the time or place when expressing them. Adults, however, must learn to control their emotions, express them at appropriate times, in some cases conceal them, and understand how they relate to perceptions, thoughts, and actions. But sometimes this process gets off track. Sometimes we have to stop and relearn how to identify, experience, express, or regulate emotions before we can move on with life.
Human beings do not operate strictly according to logic and reason. We are emotional creatures, for better or worse. Therapy is simply one way of helping you sort things out.
07/31/12 Filed in: Therapy | Anxiety
Most people worry to some extent, but some people worry excessively, whether they need to or not. It’s as if their brain is a worry machine and they can’t find the “OFF” switch.
The excessive worrier jumps to worse case scenarios. If he has a headache for several days in a row, he doesn’t assume he’s having tension headaches. He’s more likely to think, “Oh my God, I must have a brain tumor.” Other explanations, if they are considered at all, are bypassed on the way to the worst possible outcome.
Worry is typically concerned with ordinary realms of life: health, finances, relationships, job, children. Worry is a form of anxiety.
Excessive worry can disrupt sleeping patterns because it increases bodily arousal. Worries can distract us, making concentration difficult, which is why it is sometimes mistaken for ADHD. Worry can also be a burden to the worrier’s spouse or significant other because the worrier may need constant reassurance that worry isn’t likely. All in all, excessive worry is exhausting.
When I work with someone who worries too much, the first thing I do is ask them to externalize their worries, i.e., talk about them in the session, in considerable detail. We unpack them one-by-one. Invariably, we’ll discover what cognitive therapists call “thinking errors.” Some these might be:
- Confusing the possible with the probable. (Very common thinking error)
- Failing to consider the simplest explanations first.
- Assuming that if a worry comes true one won’t be able to cope.
- Over-estimating the relevance of someone else’s health problems to one’s own life.
- Confusing prevalence with salience. (e.g., plane crashes are salient but not prevalent)
What we do in therapy is try to put the worrisome thoughts back into perspective. Just because something is theoretically possible it doesn’t make it likely. And if x should happen, well, what would you do then? You might as well answer the question. It takes courage to face your fears –– even when they are hypothetical. But this is one way you have of not letting them control you. So I might ask, “Have you ever coped with anything like this before? Has anyone else? If so, what have they done?” Or: “Objectively speaking, how bad is this fear?”
Anxious thoughts are future-oriented. It’s as if we’re scanning the road ahead of us, watching out for the threat of danger. In therapy, I ask people to identify the threat. Frequently the threat can be reduced. For example, driving defensively, sober, without looking at your smart phone, will drastically reduce the odds of getting in a car accident. Note, however, that the risk is not eliminated, just reduced to manageable proportions.
People who struggle with worry often wish that therapy will banish their anxiety and fears completely. But of course life seldom works that way. There are some things we control and many things we do not. But some threats, perhaps most, can be reduced enough so that we don’t need to stay vigilant about them.
And yet, it takes time to turn off the worry machine. It takes focused attention to practice new thinking skills and regain perspective. Which isn’t to say we should never anticipate dangers or scan the road ahead for threats. Indeed, it is probably adaptive to devote a certain amount of attention to these things. It’s just that it seldom helps us to stay stuck in this mode.
05/16/12 Filed in: Therapy | Change
A silver bullet has come to be a metaphor for the idea of having single solution that creates maximum results. But when it comes to stress, personal problems, symptom relief, or maladaptive patterns, there are no silver bullets.
In therapy, we pay attention to the particulars of your unique psychology. Perceptions, thoughts, feelings, motivations, beliefs, fears, wishes, dreams, personal history, relationships –- these are just some of the elements that may be contributing to your distress. Because your psyche is so complex, solutions to your problems, whatever they are, are unlikely to be simple.
The PAST is useful for...
- Identifying patterns of behavior, emotion, or thought.
- Understanding your working model of human relationships (via relations w/ caregivers)
- Grasping the origins of a concern or problem
- Gaining perspective on your life (i.e., the big picture; the past is a rich source of data)
The FUTURE is useful for...
- Sorting out goals, projects, plans
- Building motivation (“What do you really want?”)
- Making life-course corrections
The PRESENT is useful for...
- Understanding the factors that are maintaining a concern or problem (“What’s holding you back?”
- Understanding what you are feeling –– right now, in session, this moment
- Taking stock of where you are (psychologically speaking)
In therapy, we usually attend to all three orientations. Depending on the issue or concern, one orientation might get more attention than the others, but that doesn’t mean you, as client, can’t choose to shift orientations from time-to-time to keep the sessions fresh and productive.
Moreover, never under-estimate the power of the present moment, especially in a session. Talking about problems will often generate strong emotions. It can be extraordinarily helpful to focus on these emotions as they occur.
I will be out of the office April 2 through 6 and returning on April 9.
03/10/12 Filed in: Therapy | Change
A psychologist will not solve your problems for you. What a psychologist can do, however, is join forces with you as you struggle to overcome emotional concerns. The difference is crucial.
Here are just some of the ways I can be of assistance:
I help people identify their blind-spots.
I help people translate the messages they’re getting from their psyche.
I help people understand other people.
I help people develop insight into their own motivations, patterns, and personality.
I help people create a workable plan for change.
I help people regain perspective, especially during times of distress, conflict, or fear.
I help people keep their goals in sight, especially when resistance kicks in.
I help people sort themselves out, or make sense of what has happened.
Never underestimate the power of join forces with someone as you seek to make progress in your life. I am all for independence, autonomy, and strength of character. But human beings accomplish some of their best work when they recruit others to help them achieve their goals.
If you need help, get it.
Don’t try to build your life boat alone. You might miss something.
02/10/12 Filed in: Therapy
Examples of complex problems are:
- Post-traumatic stress disorder
- Recovery from sexual abuse
- Emotional injuries from childhood (e.g., neglect, emotional deprivation)
- Self-injury (e.g., cutting)
- Eating disorders
- Personal dysfunction
1. Complex problems require special sensitivity and care. By its very nature, therapy –– i.e., talking about the difficult and problematic aspects of one’s life –- can stir up negative feelings, especially anxiety. If you struggle with a complex problem, negative feelings may be especially difficult for you to manage, and it’s the therapist’s job to be mindful of this and to make sure we don’t try to go too fast.
2. Complex problems requires a strong therapeutic bond. If you have a complex problem, you want to feel as though you and your therapist are a good team. You both agree upon the goals for therapy; you feel comfortable enough to say those things that others might not have wanted to hear; you trust your therapist enough to talk about your struggles with trust. A good bond is especially important if you’re going to risk revealing aspects of yourself that are complicated by intense guilt, shame, or pain.
3. Complex problems require a therapist who knows what he or she is doing. If you have a complex problem, look for an experienced therapist, especially one who has experience with your type of concern, and one who has received good training. Be wary of the therapist who promises too much or claims to treat all types of problems. When looking for a therapist, don’t be afraid to shop around. (Tip: if the therapist has a website, don’t skip the “About” or “Bio” page.)
One final thing. Complex problems can be overwhelming, but it is possible to get better and to improve the quality of your life. Don’t give up.
01/31/12 Filed in: Change | Therapy
Every now and then, people will ask questions. Here are some of the more common ones along with my answers.
Q: Why did you become a psychologist?
A: I became a psychologist because I’ve always been interested in people. I became a psychologist who practices therapy because I wanted to make a difference in other people’s lives.
Q: Does therapy really work?
A: Actually, the therapy process has been subjected to been hundreds of well-controlled studies. And what they show is that people who receive therapy are roughly 75 to 80 percent better off than those who don’t (with comparable issues). Having said that, I hasten to add that results vary and many factors contribute to the success of any given therapy experience, not the least of which is the client’s motivation.
Q: Aren’t most shrinks a little crazy themselves??
A: Stereotypes abound in our culture. Unfortunately, therapists are often poorly portrayed in movies and television. Most mental health professionals are hard-working, well-trained individuals who spend years learning their craft. They vary in terms of personality, style, gender, and personal issues. Fortunately, one does not need to be perfect to be helpful to another human being. One does need, however, to be well-trained, compassionate, and endowed with an ample amount of what we might call “emotional intelligence.”
Q: How can you understand me if you’ve not been through what I’ve been through?
A: This presumes that I use my own personal experience as the basis for understanding and helping my clients. Frankly, there is a lot more to it than that. The human psyche is (delightfully) complex. When I listen to people discuss their concerns, I rely considerably more on my training, professional experience, and knowledge than I do on my own personal experience.
Q: How can you stand to listen to people talk about their problems all day long?
A: To a large extent, I think therapy is a vocational calling. Not everybody is suited to do it, and certainly not everybody wants to do it. But for me, working with people is a privilege. I enjoy my work. I like the idea of helping people understand themselves (and others) better so they might lessen pain and improve their lives. My job isn’t for everybody, but it is for me.
Q: Who does therapy cost so much?
A: Actually, I think is a bargain when you consider the potential payoffs. You are your best asset. If you’re unhappy, depressed, anxious, stuck, struggling, lost, or whatever –– what would it be worth to you to move past this place and get on with life? For most people, it’s worth a lot. And the cost of not getting past this place is generally quite high.
Having said that, there are many expenses involved in being a therapist that are not immediately apparent. Therapists charges the fees they do because they need to account for their training, experience, inherent limitations on their time, continuing education, self-care, malpractice insurance, overhead, and more.
When you find a therapist who offers an unusually low fee, buyer beware. This may indicate someone who has no or little experience in the field, or someone who under-estimates the practical realities of running a therapy business for the long run. With therapy, you really do get what you pay for.
Q: What do you tell people who––
A: Let me stop you right there. Therapy is not about giving generalized advice. People are as unique as their fingerprints and the solutions that work for one person might not work for another. In therapy, I pains to understand you as you are. I tailor my approach to the needs of any given individual or couple. Problems may be universal (e.g., anxiety, depression, relationship difficulties), but the personal issues that drive those problems can be highly specific to a particular person. Because of this, generalized advice just won’t do. Therapy must be tailor made for you.
Q: On your “About” page it says you have an “exuberant” dog. What’s up with that?
A: I like dogs. Even dogs with high energy that live to play, walk, eat –- and play some more. As far as I’m concerned, dogs are pretty good teachers.
01/13/12 Filed in: Change
The concept of “willpower” seems to be making a comeback in psychology.
Two findings are emerging from the research. One is that your willpower can be depleted. It’s as if you only have so much self-control to go around, and once you’ve used up what you’ve got you’re much more likely to give in to desires and temptations.
Example: you manage to be “good” at breakfast, lunch, and dinner, but when the end of the day comes, you find yourself “giving in” to cookies or drinks.
Or course, some people have more success than others in the self-control department. But if the research is to be believed, it may not be that their willpower is so strong as much as they’ve hit upon a simple strategy that helps them preserve what willpower they’ve got. They go out of the their way to avoid temptation in the first place.
Example: instead restraining yourself in the cookie aisle, you avoid it entirely, thereby saving yourself from having to exhaust a precious resource.
The late Peter Jennings said he returned to smoking during the 9/11 crisis. Apparently the marathon coverage he provided exhausted him. He knew better than to revert back to an old destructive pattern, of course. But the stress of working so hard apparently depleted his supply of self-control. (He died of lung cancer.)
01/04/12 Filed in: Therapy | Change
- You aren’t as committed to change as you thought.
- The change you’re trying to make is too radical.
- You are trying to change more than one thing at a time.
- You let a “lapse” turn into a “relapse.”
- Your plan is missing something.
- You’ve lost your focus.
Okay, so what you can do about it?
First ask yourself a question: Are you really ready to make this change now? Don’t be afraid to admit it if you aren’t. There is no reason to think you have to work on something now just because you’ve flipped the calendar over to a new year.
On the other hand, if you’re serious about making a change, you’ll have make a deep and abiding commitment to it. One way to do this is to make a list of payoffs that the change would provide. The longer your list, the more likely you are to stay motivated. A benefits list also provides something you can refer back to on tough days.
Negotiate with Resistance. Your mind and body will resist change because of built-in homeostatic mechanisms. As you step into the zone of discomfort, your psyche may very well send you the signal that it much prefers the status quo, thank you very much. This can be true even when the status quo is hurting you. (Example: social anxiety holds people back and it costs them. Moving towards more social behavior will increases anxiety, at least for a while, but this doesn’t mean it’s the wrong thing to do.)
You probably won’t make resistance go away entirely. Change, at least the kinds that matter most, are rarely comfortable. But you can negotiate with it by changing just one thing at a time, or by making the change small. Either one of these strategies is more likely to lead to success.
Don’t let a lapse become a relapse. Reverting back to old behavior (falling off the wagon) is to be expected. This because change is rarely linear. Usually it’s more like two or three steps forward and one step back. What matters is the overall trend. When a lapse turns into a relapse, it usually means we’ve fallen into the trap of all-or-nothing thinking –- we’ve let ourselves believe one mistake (or one bad day) spoils the whole program. When that happens, it’s a short step to chucking the entire change business. Be mindful of the tricks cognitive errors can play on your progress: keep lapses in perspective.
Re-examine your plan. For example, if you’re decreasing old behavior, are you replacing it with something else? When discomfort, tension, fatigue, or anxiety sets in, how will you cope? Who will support your efforts? (Never underestimate the value of having emotional support.)
Track your change. If you don’t track your change somehow, it’s easy to lost sight of it and get distracted by other things. Tracking change helps you keep your goals and progress at the forefront of your mind. This is important because your attention is a limited resource. These days, there are countless ways to track change. You can find tools on the web, or simply create your own (e.g., spreadsheet, journal).