Sunday, June 30, 2013

More common human desires

One desire that seems to be common to almost everyone is the desire to be "normal."  I cannot tell you the relief many patients express  when I tell them their symptoms have a name and that other people share their experience.  Maybe this can be attributed to not wanting to feel alone.  People are comforted to hear that what they are feeling is "normal."  This is why support groups are often helpful.  Connecting with other people who have been through what you've been through or who have thoughts and feelings similar to your own creates a unique bond.  This is related to our need to be understood.  After all, who can understand you better than someone who has had a similar experience or whose suffering in some way mirrors your own?  When we connect with a group of people who have been through similar hardships we experience a sense of belonging. 

Another common need among people is the need for validation.  To validate another person is simply to say, "It is okay to feel what you feel.  It is okay to do what you're doing.  It is okay to be the way you are."  Validation both normalizes and communicates understanding.  It can also serve to remove shame.  People sometimes become convinced that they should not feel how they feel or that there is something wrong with the way they are.  This creates feelings of shame and guilt.  To hear from another person that the way you feel is okay or that there is nothing wrong with the way you are can provide an enormous sense of relief.  In some ways it gives a person permission to experience their feelings freely.

I am frequently struck by how many things seem to be common to all of us.  It reminds me again and again that no matter our differences, most of us want the same things.

Sunday, June 23, 2013

Things people want

As a psychotherapist, I have the unique privilege of witnessing all sorts of human behavior.  While every person is different and no single approach works for everyone I don't necessarally reinvent the wheel every time I encounter a new patient.  One of the reasons therapists tend to become better with experience is because when they meet a new patient they can eventually say to themselves, "I've had a patient with this type of problem before.  I remember what worked (and what didn't work) for him.  Maybe I'll try a similar strategy with this patient."  The longer you've been practicing the more likely you are to have seen even relatively rare variations of a given problem before.  (An unintended side effect: A lot of things seem "normal" to me that would probably seem strange to other people). 

Something else a therapist learns with experience is that even people who are completely different from one another posess common needs and desires.  For example, I've never met anyone, either personally or professionally, who did not have the desire to be understood.  This is something that probably evolved in concert with our capacity for speech and language.  On the most basic level, we want others to comprehend the meaning of what we communicate verbally.  After all, what good is the ability to speak if no one  understands what you're saying?  The significance of human language lies in its utility as a tool for creating common meaning among two or more distinct entities. 

We desire basic comprehension and yet this is not enough,.  We want others to understand us on a deeper level; we want them to really get what we're saying.  One of the most fundamental communication skills is something called reflection.  Reflection involves listening to another person and repeating his message back to him, either exactly as you heard it or in paraphrase or summary.  It sounds simple but it's more difficult than you might think.  So many of us have a habit of hearing a person's words without really listening to what they are saying.  I'll give you an example of a couple I once saw for marriage counseling.  I asked the wife to use an "I statement" to express her feelings to her husband.  The husband was asked to listen and repeat what he heard his wife say.  She started: "I feel frustrated and disappointed when you promise to do something and then do not do it."  Then it was his turn.  "I heard, "nag nag nag nag nag,'" he said.  My jaw dropped in surprise.  The wife started crying.

In sum, there is something profoundly affirming about being understood by another person.  Perhaps it helps us to feel less alone.

I'll share more observations about things people want later...

Sunday, June 16, 2013

Interpersonal connection

Some of my patients have been betrayed, abused, or otherwise mistreated so often in life that they give up on trying to have relationships with other people.  For the majority of these individuals, the maltreatment began in childhood.  Some were physically or sexually abused by a parent or step-parent.  Others were verbally insulted, criticized, or condemned on a regular basis by a parent or caregiver.  Still others were neglected or ignored.

Of course, some people have perfectly good childhoods and still decide as adults that it is safer to stay away from people than to risk falling victim to treachery.  Anyone who has been repeatedly deceived could conceivably reach this conclusion.  Even a single betrayal, if it is severe, can be enough to shatter one's ability to trust others. 

Perhaps it is "safer" to withhold trust.  It does solve the problem, at least in theory.  If you never give your trust then you will never be betrayed.  So why do I see patients like this in my office, again and again and again?  If the strategy is so effective, why see a therapist? 

Honestly, most patients do not identify lack of trust as their primary concern, although this does sometimes happen.  Typically the lack of trust comes out later, when we start digging into the problem and find the patient's inability to trust lying at its core. 

So what kind of problems come from witholding trust?  Depression and anxiety are probably the most common.  People have an innate need for interpersonal interaction.  The earliest humans (Cro Magnons) lived in small tribes or clans and these groups depended upon one another for survival.  A single human living alone was easy prey for large animals and would not have survived for very long.  As our species evolved, those who cooperated best were the most likely to survive and to pass on their genes to their offspring.  There were no "loners."  Now fast forward to the present day. 

People who intentionally prevent themselves from having close relationships with others are very rarely happy.  Humans truly are social creatures.  It is in our very nature.  Going against our innate tendencies often feels unnatural.  We get lonely.

Fortunately, we do not have to choose between being lonely or getting betrayed.  This is what I tell my patients.  We can learn to exercise caution while we're getting to know people.  We can allow trust to develop gradually.  We can learn that trust doesnt' have to be "all or nothing;" we can trust people to varying degrees.  We learn that it's okay to trust a given individual with some things while not trusting them with others.  We can discover that connection with others occurs on many levels, from very superficial to deeply intimate.

We do, however, have to be willing to accept some risk.  Inevitably as we begin to interact with other people we will encounter some who are untrustworthy.  So often my patients view such encounters as additional evidence that people simply can't be trusted and that they are better off keeping to themselves. I see things quite differently. Most of these experiences represent successes, not failures.  If you begin to interact with someone and soon discover that he is not someone you can trust then you have learned valuable information.  If you then decide that this is not a person you want in your life you have made a wise decision. How can a wise decision represent anything other than success?  \

Beginning to reconnect with others after a long period of isolation can be scary.  It's not easy.  In the end, however, the potential benefits are worth it.

Sunday, June 9, 2013


Whenever I spend time with my nieces or my stepdaughter, I am awed and intrigued to observe the process of child development in real time, as it unfolds.  As a psychotherapist, I am acutely aware of the wounds that are inflicted when something goes wrong during childhood and disrupts the normal process of development.  While it is true that we do not have to be defined by our pasts, events that happen in childhood influence the development of our very personalities and therefore affect how we perceive ourselves and the world.  If our basic physical, emotional, and psychological needs are not met during this critical time period, we are left with empty spaces that we long to fill but do not know how.

These are the people I see in therapy.  Popular culture pokes fun at psychotherapy for seeming to believe that every adult problem has its origins in a troubled childhood.  I sometimes joke about this myself when I inquire about a patient's childhood experiences.  Still, most stereotypes contain some kernel of truth and this one is no exception.  Children with parents who are controlling and extremely critical sometimes grow into adults who expect too much of themselves, whose self worth is tied to their achievements, and who beat themselves up when they make a mistake.  Children who grow up in chaotic and unstable households sometimes become adults who are obsessed with order, who become extremely upset when things do not go as planned, and who attempt to exert control over everything and everyone around them.  Children who are discouraged from or even punished when they express their thoughts and feelings sometimes become "people pleasers" as adults.  The have learned from their experiences that their needs do not matter.  As a result, they lack assertiveness, have trouble setting limits, and are often taken advantage of (partly because they never say 'no'). 

So I am profoundly impressed when I see evidence of these psychological and emotional needs in children.  About six months after my husband and I got married my stepdaughter came to stay with us for the summer.  One night she got upset about something trivial.  She started crying.  Her tears quickly escalated into sobs and loud wails.  I assumed she was throwing a tantrum and figured she would eventually stop crying if we simply ignored her.  She was still wailing after thirty or forty minutes, at which point my husband insisted on going to comfort her.  It wasn't until later that I realized my mistake; my stepdaughter did not know how to self-soothe!  In other words, she really had no way to calm herself down when she was distressed.  She was still at a stage developmentally where she needed help from an adult.  I'm sure no harm came from the incident but it made me think.  What if this happened often?  What if no one ever came to comfort her or to help her calm down?  That's the kind of thing that happened to my patients in childhood.

I observed an interaction between my eight year old niece and her parents last week that made me smile.  We were all at my parents' house getting ready to go for a walk.  My niece had to go to the bathroom before we left.  In the meantime, the rest of us went outside to wait for her.  "Watch," my sister said to her husband. "When she [my niece] comes out of the bathroom and sees no one in the house she's going to come running out here in a panic."  Sure enough, a few minutes later my niece came running out the door.  "I thought you left me!" she exclaimed.  Of course my sister and brother-in-law have never and would never leave her by herself at her age.  Still, the fear my niece felt was real.  And what happens to those kids who come running outside to find that all the adults have, in fact, left them home by themselves?  What happens to them when they become adults?

These are just some thoughts and observations...

Sunday, June 2, 2013

When to seek help after a tragedy

I mentioned a couple of weeks ago that there had been a crisis in my family.  In a recent conversation with my mom about what happened she asked me if I thought the family members most affected should seek counseling.  "It depends," I told her.  I realize my response was not particularly helpful.  Unfortunately, there is no universal rule of thumb about when a person should see a counselor or therapist in the immediate aftermath of a traumatic experience.  Many - if not most - people are able to work through a distressing experience by relying on their existing coping mechanisms and natural support networks.  Sadness, grief, anxiety, and anger are all normal emotional responses to tragedy.

"So how will we know if they need help?" my mom asked.  I had no easy answer for this question either.  (You might think having a therapist in the family is useful.  Not so much.  You're better off being related to a lawyer or a doctor).  Personally, I think it's preferable to allow the natural healing process to take place whenever possible.  From time to time I see patients who are struggling with feelings about something that happened a week or two earlier.  My strategy is to caution them against anything that might interfere with the process of healing: don't avoid thinking about it if thoughts arise; don't avoid people, places, or things just because they cause you to remember; don't avoid talking about it; share your feelings with someone you trust; let yourself feel.

As for my family, I think the best thing we can do is to spend as much time together as possible.  In this way we send a very powerful message: we are here for you and we love you.  It also allows us to see for ourselves how everyone is coping.  Hopefully, we will see those who were affected the most begin to resume  life.  If, after several months we realize this is not happening, we can reach out and encourage them to seek help.

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