I was asked by a fellow blogger to write about Buddhist views on the self. Since my interest in Buddhist teachings originated in my desire to integrate these ideas into my psychotherapy practice, I decided to compare and constrast how the self is conceptualized in Western psychology and in the Buddhist tradition. This is a rather big undertaking, and one that I will not attempt to complete in one blog post. "Self and No Self: Psychology and Buddhism" will therefore be my first "series" of posts on a single subject.
Over the past twenty years, Western psychology has become increasingly interested in ancient Eastern practices and traditions. Among the first to advocate the usefulness of Eastern precepts to Western mental health practice was Dr. Marsha Linehan, the well known pioneer of Dialectical Behavior Therapy (DBT). DBT is built around the Buddhist practice of mindfulness. Since the original publication of Linehan's DBT treatment manuals in 1993, mindfulness and other Eastern ideas and practices have gained widespread use among Western mental health practitioners.
Since the days when Freud fathered psychoanlysis -- the first form of modern psychotherapy -- the self has been among the primary foci of psychotherapy practice. As the number of psychological theories have grown, so have the ways in which the self is conceptualized. Almost every psychological theory has its own unique conception of the self. Thus, it is impossible to make any overarching statement to summarize how the self is perceived in the field of psychology. What can be said is that virtually every school of psychology has some conception of the self that influences its ideas about the causes and treatment of mental illness.
This seems to be completely at odds with Buddhist teachings. Fundamental to the Buddhist worldview is the concept of anatman (roughly translated as "no soul," "no self," or "egolessness"), which asserts that there is no such thing as an immortal soul or core self. The Buddha taught that nothing exists that is permanent. Things come into being and things disintegrate. Humans, like everything else in existence, are made of impermanent substances. Human beings have no separate soul or self that exists apart from our material bodies.
Buddhism asserts that the self, which is of central importance to the field of psychology, does not exist. Just as the concept of self is integral to the understanding and practice of psychology the idea of "no self" is fundamental to the understanding and practice of Buddhism. How is it, then, that psychology has embraced Buddhist teachings when the two fields are built around opposing fundamental tenets?
Despite differences in their basic beliefs, Buddhism and Western psychology share a common goal: they both seek to alleviate suffering. Each field approaches this goal in a manner consistent with its own belief system. The Buddha taught that "the self" is an illusion and that this illusion is the source of all suffering. Consequently, Buddhism asserts that the way to relieve suffering is by seeing through the illusion of self, thereby bringing the self to an end. In contrast, Western psychology tends to view the absence of a stable, integrated sense of self as among the most significant causes of suffering. Thus, many psychotherapists believe that building or restoring a strong sense of self is an important part of the treatment process (the primary goal of which is to alleviate suffering). In short, Buddhist practice aims to alleviate suffering through losing the self; psychotherapy seeks to alleviate suffering by helping to build, rebuild, find, strengthen, or define the self.
These are the ideas I will be exploring over the next few weeks. Next week, I will explore in more detail Buddhist views of the self (or no self). The following week, I will try to provide an overview of the major theories about the self in Western psychology. Finally, I will attempt to tie it all together by addressing questions like, "Are the ideas of Buddhist and Western psychotherapy practitioners about the self fundamentally at odds with one another?" "Is there any overlap betwen how Buddhists and Western psychotherapists think about the self?" and "What aspects of Buddhist practice have Western mental health practitioners embraced and what, if any, impact does this have on their ideas about the self?" This is an ambitious undertaking on my part so I ask that you please bear with me. I am also open to feedback throughout this process.
Thursday, April 26, 2012
Saturday, April 21, 2012
Dream killers
Most of us have had the experience of excitedly sharing a dream with someone only to receive negative feedback about why it won't work. If we're honest, most of us have also had the experience of hearing someone else's dream and immediately putting it down, almost without thinking. How many of us have been encouraged to follow our dreams wherever they lead us? And how many dreams have we decided to abandon because the people we love tell us it's a bad idea?
It always seems to be the people closest to us who put the most effort into killing our dreams. This is almost counterintuitive; shouldn't the people who love us the most be our most ardent supporters? And shouldn't we be among the loudest voices of encouragement cheering on the people we love? Why do we have such a hard time doing something that seems like it should be natural?
I won't pretend to know the answer to this, but I do have some ideas:
1. Selfishness: We discourage someone else's dreams because it interferes with our own interests. For example, it is not uncommon for a parent to have dreams for her child before he is even born. Parents have their own ideas about what their child should do with his life; these ideas are completely independent of what the child wants for himself. Parents often have beliefs about what constitutes success for their child, how their child should behave, where he should live, and what hobbies he should pursue. If the child has dreams that are inconsistent with what his parents want for him, the parents might discourage the child from pursuing these aspirations. Another example of deterring someone else's dream for selfish reasons might be discouraging a coworker from trying for a promotion because you want the promotion for yourself.
2. Jealousy: A friend shares her dream with us. It sounds great. In fact, it is something we want for ourselves. We doubt, however, that we could ever achieve this dream. We can't stand the thought of our friend achieving something we really want for ourselves but could never have; we'd be overcome with envy! Nobody likes to feel jealous (or inferior), so we disparage our friend's dream and discourage her from chasing it.
3. Guilt: The goal someone else is pursuing is one we should be pursuing ourselves. Unfortunately, we lack the motivation, self discipline, or whatever else we need to start working on the goal. We feel guilty about our own inaction when we see someone else working hard and actually making progress towards this goal. If, however, we can distract or deter this person from the pursuit of his goal we won't feel quite so bad. "No, I haven't lost any weight yet, but neither has Tom."
4. Genuine concern for the other person: Your loved one is chasing a dream that is going nowhere (or nowhere good). His goal is completely unrealistic, very dangerous, self destructive, or an otherwise bad idea. In short, your loved one is headed down the wrong path and you're concerned for his well being. You don't want to see him hurt, whether physically, financially, spiritually, or emotionally. You feel obligated to share your concerns with him, at the very least. Some of us feel obligated to do more. We might try to dissuade him from pursuing his chosen course or even to create obstacles to try to deter him. There is certainly nothing wrong with urging a loved one to use caution. The key in this situation is to know when to stop. Providing that the person in question is an adult, in the end he is free to make his own decisions -- even if they are bad decisions. There comes a point when you've said all you can say and have done all you can do. When you reach this point, your job is to accept the decision your loved one has made (regardless of whether or not you approve). Sometimes people have to learn from their own mistakes.
5. Reality testing: Let's face it. Some people have dreams that are so far fetched they could never become reality. Perhaps such dreams would be more accurately described as fantasies. Personally, I would feel bad encouraging someone to chase a dream he has absolutely no chance of ever achieving. It is important, however, to distinguish between having fantastical goals that have no basis in reality and having "big dreams" that, while it might be a long shot, could possibly be attained. Some people dream big and are willing to work hard to try to make their dream a reality. Most of us are inclined to give such people a "reality check." We are quick to point out that the odds are stacked against them. We encourage them to focus on "more realistic" goals. But where would the world be without big dreamers? People beat the odds all the time, with amazing results. Don't discourage someone you love from "dreaming big." You might, however, want to encourage them to have a back up plan, just in case it doesn't work out.
6. Pessimism: Pessimism is the tendency to expect the worst. It is characterized by a lack of hope or confidence in the future. Some people are pessimistic by nature; others have had bad experiences and have learned to view life negatively as a result. A pessimist is a pessimist, either way. If a person is a pessimist, it won't be a secret to the people who know him. Pessimism is not really something you can hide; it's an attitude that will reveal itself in almost everything you say and do. If you want someone to encourage and support you as your pursue your dreams, a pessimist is not your guy. Share your dreams with a pessimist and you can expect that he'll tell you all the reasons it will never work; negativity is a pessimist's default response to everything.
As with so many things, I think the important thing is to become more aware of how you respond when someone shares their hopes and dreams with you. Pay attention to your responses over time; are they unique to each situation or are they habitually the same?
It is also important to be selective in choosing the people you talk to about your hopes and dreams. When you know a person well enough you can often predict how they will respond when you reveal your deepest desires. If the person is always negative, you can assume he will have negative feedback about your goals. If the person is typically supportive, she will probably be supportive. If she isn't, you should listen to her concerns and take them into consideration.
For readers: Do you tend to be supportive when someone shares his dreams with you? Have you ever shared your aspirations with someone and not gotten the response you expected? Is there anyone you would absolutely never share your hopes and dreams with? Why?
It always seems to be the people closest to us who put the most effort into killing our dreams. This is almost counterintuitive; shouldn't the people who love us the most be our most ardent supporters? And shouldn't we be among the loudest voices of encouragement cheering on the people we love? Why do we have such a hard time doing something that seems like it should be natural?
I won't pretend to know the answer to this, but I do have some ideas:
1. Selfishness: We discourage someone else's dreams because it interferes with our own interests. For example, it is not uncommon for a parent to have dreams for her child before he is even born. Parents have their own ideas about what their child should do with his life; these ideas are completely independent of what the child wants for himself. Parents often have beliefs about what constitutes success for their child, how their child should behave, where he should live, and what hobbies he should pursue. If the child has dreams that are inconsistent with what his parents want for him, the parents might discourage the child from pursuing these aspirations. Another example of deterring someone else's dream for selfish reasons might be discouraging a coworker from trying for a promotion because you want the promotion for yourself.
2. Jealousy: A friend shares her dream with us. It sounds great. In fact, it is something we want for ourselves. We doubt, however, that we could ever achieve this dream. We can't stand the thought of our friend achieving something we really want for ourselves but could never have; we'd be overcome with envy! Nobody likes to feel jealous (or inferior), so we disparage our friend's dream and discourage her from chasing it.
3. Guilt: The goal someone else is pursuing is one we should be pursuing ourselves. Unfortunately, we lack the motivation, self discipline, or whatever else we need to start working on the goal. We feel guilty about our own inaction when we see someone else working hard and actually making progress towards this goal. If, however, we can distract or deter this person from the pursuit of his goal we won't feel quite so bad. "No, I haven't lost any weight yet, but neither has Tom."
4. Genuine concern for the other person: Your loved one is chasing a dream that is going nowhere (or nowhere good). His goal is completely unrealistic, very dangerous, self destructive, or an otherwise bad idea. In short, your loved one is headed down the wrong path and you're concerned for his well being. You don't want to see him hurt, whether physically, financially, spiritually, or emotionally. You feel obligated to share your concerns with him, at the very least. Some of us feel obligated to do more. We might try to dissuade him from pursuing his chosen course or even to create obstacles to try to deter him. There is certainly nothing wrong with urging a loved one to use caution. The key in this situation is to know when to stop. Providing that the person in question is an adult, in the end he is free to make his own decisions -- even if they are bad decisions. There comes a point when you've said all you can say and have done all you can do. When you reach this point, your job is to accept the decision your loved one has made (regardless of whether or not you approve). Sometimes people have to learn from their own mistakes.
5. Reality testing: Let's face it. Some people have dreams that are so far fetched they could never become reality. Perhaps such dreams would be more accurately described as fantasies. Personally, I would feel bad encouraging someone to chase a dream he has absolutely no chance of ever achieving. It is important, however, to distinguish between having fantastical goals that have no basis in reality and having "big dreams" that, while it might be a long shot, could possibly be attained. Some people dream big and are willing to work hard to try to make their dream a reality. Most of us are inclined to give such people a "reality check." We are quick to point out that the odds are stacked against them. We encourage them to focus on "more realistic" goals. But where would the world be without big dreamers? People beat the odds all the time, with amazing results. Don't discourage someone you love from "dreaming big." You might, however, want to encourage them to have a back up plan, just in case it doesn't work out.
6. Pessimism: Pessimism is the tendency to expect the worst. It is characterized by a lack of hope or confidence in the future. Some people are pessimistic by nature; others have had bad experiences and have learned to view life negatively as a result. A pessimist is a pessimist, either way. If a person is a pessimist, it won't be a secret to the people who know him. Pessimism is not really something you can hide; it's an attitude that will reveal itself in almost everything you say and do. If you want someone to encourage and support you as your pursue your dreams, a pessimist is not your guy. Share your dreams with a pessimist and you can expect that he'll tell you all the reasons it will never work; negativity is a pessimist's default response to everything.
As with so many things, I think the important thing is to become more aware of how you respond when someone shares their hopes and dreams with you. Pay attention to your responses over time; are they unique to each situation or are they habitually the same?
It is also important to be selective in choosing the people you talk to about your hopes and dreams. When you know a person well enough you can often predict how they will respond when you reveal your deepest desires. If the person is always negative, you can assume he will have negative feedback about your goals. If the person is typically supportive, she will probably be supportive. If she isn't, you should listen to her concerns and take them into consideration.
For readers: Do you tend to be supportive when someone shares his dreams with you? Have you ever shared your aspirations with someone and not gotten the response you expected? Is there anyone you would absolutely never share your hopes and dreams with? Why?
Saturday, April 14, 2012
Supporting others' dreams
My little sister wants to move somewhere far away. She works in the advertising and design field; she says that there are no good career opportunities for her here. She wants to go somewhere like New York, Miami, or Los Angeles, where, from what she tells me, the job prospects are plentiful.
She's talked about this for years, so it's nothing new. She was a bit of a late bloomer though -- she started and stopped going to school several times before she finally earned her degree about a year ago. When she was still in and out of school and jumping from one job to the next, the whole moving away and making it big seemed to me like one of those fantasies we all have when we're young, before reality sets in.
Once my sister finished her degree, she did what we all do -- she found a job and started working. The job wasn't perfect, but she was gaining a lot of experience and seemed to be enjoying it.
A few weeks ago, my sister and I were sitting in my living room, just talking and catching up. We started talking about our goals for the future. She told me that her dream is what it has always been -- to move to a big city to get a good job with a prestigious agency making a lot of money.
I'll admit I was less than supportive. I guess I assumed she'd outgrown her dream. After all, I remember having a similar dream of moving to New York and becoming a famous singer. (This despite the fact that I don't sing very well). At some point I realized that it wasn't a realistic plan and decided on something more practical.
I pointed out to my sister all the difficulties associated with moving to a new place -- saving enough money to pay for the move itself; securing a decent job in a distant city before moving there; finding an affordable place to live; making all new friends; etc.
"See, this is why I don't talk to anyone in the family about my dreams," she said. "You always put them down."
"No we don't," I replied without thinking. But then I thought about it. She had a point. Why was I discouraging her from following her dreams? Why was I trying to convince her that her goals were unattainable?
As it turns out, she had her own hypothesis. "You all want me to be like you. You want me to buy a house next door, get married, and raise a family without ever leaving home."
(Just an aside -- this is a more accurate characterization of my older sister than it is of me. I did in fact, leave home; I just didn't go very far away. I went to college in a city about an hour and half away from where I grew up. I moved back in with my parents for about a year after I graduated. When I moved out, I bough a house in a neighboring city, about forty-five minutes away from my parents' house).
"That's not true!" I protested. "It's just that we'd miss you if you move away," I acknowledged.
"Some families only see each other once a year," my sister countered. "Not that I want it to be like that," she quickly added. "I'm just saying."
I know, of course, that there are families that only see each other on special occasions. Some families are like that; just not our family.
I could be wrong, but it seems to me like most families that only get together once a year do so because they find it difficult to be around one another more frequently. Close knit families tend to see each other more often, even when its members live in different places. (Hell, I see my best friend two or three times a year, and there's a seven hour drive separating us)!
Ultimately, I told my sister that she has to do what's best for herself. Our family is mostly made up of adults; as such, we are responsible for dealing with whatever feelings we have about what she chooses to do.
I thought about it a lot over the weeks that followed our conversation. Shouldn't I encourage my little sister to reach for the stars? Why is it so difficult for me?
Most of it is that I will truly miss her. Somehow, I get the feeling that if she moves away she won't come back very often. (Part of me suspects that she's running away from something that she thinks is here but is really inside her). I fear that the little sister I love so much will become a stranger to me, someone who no longer has a place for me in her life. I'm afraid of losing her.
The other thing is that even though she's lived less than an hour from the family for the past year, she has been distant. She told me she felt like she had to get away from the family if she was ever going to learn to make it one her own. ("Making it on your own" is overrated, I think).
Since becoming an adult, I've always found comfort in my family's unwavering love and support. It makes me sad to think that my sister finds this same love to be stifling and restrictive.
Still, our experiences are different. She is the youngest of my parents' three daughters; I think even now my mother finds it hard to stop babying her.
It's probably selfish of me to begrudge my sister her dreams. Maybe the best thing to do is to share my fears with her. I'm not sure.
She's talked about this for years, so it's nothing new. She was a bit of a late bloomer though -- she started and stopped going to school several times before she finally earned her degree about a year ago. When she was still in and out of school and jumping from one job to the next, the whole moving away and making it big seemed to me like one of those fantasies we all have when we're young, before reality sets in.
Once my sister finished her degree, she did what we all do -- she found a job and started working. The job wasn't perfect, but she was gaining a lot of experience and seemed to be enjoying it.
A few weeks ago, my sister and I were sitting in my living room, just talking and catching up. We started talking about our goals for the future. She told me that her dream is what it has always been -- to move to a big city to get a good job with a prestigious agency making a lot of money.
I'll admit I was less than supportive. I guess I assumed she'd outgrown her dream. After all, I remember having a similar dream of moving to New York and becoming a famous singer. (This despite the fact that I don't sing very well). At some point I realized that it wasn't a realistic plan and decided on something more practical.
I pointed out to my sister all the difficulties associated with moving to a new place -- saving enough money to pay for the move itself; securing a decent job in a distant city before moving there; finding an affordable place to live; making all new friends; etc.
"See, this is why I don't talk to anyone in the family about my dreams," she said. "You always put them down."
"No we don't," I replied without thinking. But then I thought about it. She had a point. Why was I discouraging her from following her dreams? Why was I trying to convince her that her goals were unattainable?
As it turns out, she had her own hypothesis. "You all want me to be like you. You want me to buy a house next door, get married, and raise a family without ever leaving home."
(Just an aside -- this is a more accurate characterization of my older sister than it is of me. I did in fact, leave home; I just didn't go very far away. I went to college in a city about an hour and half away from where I grew up. I moved back in with my parents for about a year after I graduated. When I moved out, I bough a house in a neighboring city, about forty-five minutes away from my parents' house).
"That's not true!" I protested. "It's just that we'd miss you if you move away," I acknowledged.
"Some families only see each other once a year," my sister countered. "Not that I want it to be like that," she quickly added. "I'm just saying."
I know, of course, that there are families that only see each other on special occasions. Some families are like that; just not our family.
I could be wrong, but it seems to me like most families that only get together once a year do so because they find it difficult to be around one another more frequently. Close knit families tend to see each other more often, even when its members live in different places. (Hell, I see my best friend two or three times a year, and there's a seven hour drive separating us)!
Ultimately, I told my sister that she has to do what's best for herself. Our family is mostly made up of adults; as such, we are responsible for dealing with whatever feelings we have about what she chooses to do.
I thought about it a lot over the weeks that followed our conversation. Shouldn't I encourage my little sister to reach for the stars? Why is it so difficult for me?
Most of it is that I will truly miss her. Somehow, I get the feeling that if she moves away she won't come back very often. (Part of me suspects that she's running away from something that she thinks is here but is really inside her). I fear that the little sister I love so much will become a stranger to me, someone who no longer has a place for me in her life. I'm afraid of losing her.
The other thing is that even though she's lived less than an hour from the family for the past year, she has been distant. She told me she felt like she had to get away from the family if she was ever going to learn to make it one her own. ("Making it on your own" is overrated, I think).
Since becoming an adult, I've always found comfort in my family's unwavering love and support. It makes me sad to think that my sister finds this same love to be stifling and restrictive.
Still, our experiences are different. She is the youngest of my parents' three daughters; I think even now my mother finds it hard to stop babying her.
It's probably selfish of me to begrudge my sister her dreams. Maybe the best thing to do is to share my fears with her. I'm not sure.
Saturday, April 7, 2012
Anxiety and ego strength
In my last post, I talked about what happens when a person reaches his or her "breaking point." I have a particular interest in this topic because I think about it a lot when working with patients. It is important for me to have at least some idea of how much anxiety a patient can tolerate; this is especially true with those patients who have experienced some sort of trauma.
Even a single traumatic experience can leave a person feeling vulnerable and out of control. It can shatter a person's sense of safety and cause him to view the world as a dangerous place. This creates a significant amount of anxiety. (In fact, Posttraumatic Stress Disorder is classified as an anxiety disorder). The person becomes hypervigilant in an effort to identify and neutralize potential threats (which he believes are everywhere). Maintaining this level of emotional arousal is exhausting. His need to be ever alert and on guard, however, prevents him from relaxing to the degree necessary for truly restful sleep. As a result, he becomes even more exhausted. His functioning begins to deteriorate. What little energy he has is directed towards trying to keep himself safe from threats, both real and imagined.
This is often the state in which I first encounter a patient. His symptoms have started to become overwhelming and he is doing everything he can to "keep it together." Before I can even think about trying to help him I need to assess his "ego strength."
According to Brown, et. al. (1979), ego strength refers to an individual's ability "to hold on to his own identity despite psychic pain, distress, [and] turmoil, [from] internal forces as well as the demands of reality." In other words, how much distress can a person tolerate without falling apart? In her "Nueroscience and Relationships" blog (http://blogs.psychcentral.com/relationships/), Dr. Athena Staik describes ego strength as "the resiliency or strength of your core sense of self, the extent to which you can face challenging events or persons, without feeling so overwhelmed that you take desperate action, perhaps with little or no thought to consequences."
Exposure therapy (or prolonged exposure therapy) is one of the most effective treatment approaches for overcoming a traumatic experience. The treatment requires a person to access his memories of the traumatic event and to allow himself to experience whatever feelings these memories evoke. It also asks the patient to confront situations that now feel unsafe to him but that are, in reality, perfectly safe.
Exposure therapy can be pretty intense and would probably be overwhelming for someone with very low ego strength. (There are plenty of other treatments that are beneficial for patients with low ego strength). The problem is, it is not always easy to determine which patients have good ego strength and which do not. I've had the unfortunate experience of believing a patient could handle exposure therapy only to have him decompensate a few sessions into it. (This has happened on multiple occasions, actually, and not just to me. Several of my coworkers have had simliar experiences).
When I say a patient decompensates I mean that the therapy pushes him past his breaking point. I've seen patients become suicidal. One of my coworkers had a patient check herself into the psychiatric hospital because she couldn't guarantee she wouldn't try to kill herself. Some patients start to have intrusive flashbacks or their nightmares get so bad that they become afraid to go to sleep. A person who decompensates completely will become psychotic (and would probably have to be hospitalized), although this has never happened with any of my patients.
So therein lies my dilemma. How do I know when to "push" (i.e., encourage) a patient to stick with the treatment and when to back off? Is it my job to say to a patient, "Look, I don't think you can handle this?" And what if I'm wrong? Then I'm depriving him of treatment that could really be helpful. But what if I keep pushing and the patient decompensates? Is it my fault? Am I responsible for having pushed the patient "over the edge?"
There doesn't seem to be a clear cut answer to this. My solution has been to put the ball in the patients' court. I say something like this: "Only you know where your limit is. My job is to push you to that limit, but not beyond it. If you feel like you're close to going over the edge, please let me know. We'll stop, regroup, and figure out where to go from there."
Of course, the assumption here is that people know their own limits. This may not always be true. In fact, I cannot say for certain where my own breaking point lies. I know there have been times when I felt so overwhelmed that I wished I would just fall apart completely; at least it would provide an escape from myself and my life. In reallity though, I suspect I've never even come close to my breaking point. I am fortunate enough never to have been faced with stressors so overwhelming that I was not able to cope with them.
What about you? Where is your breaking point? How do you know when you're too close for comfort?
Even a single traumatic experience can leave a person feeling vulnerable and out of control. It can shatter a person's sense of safety and cause him to view the world as a dangerous place. This creates a significant amount of anxiety. (In fact, Posttraumatic Stress Disorder is classified as an anxiety disorder). The person becomes hypervigilant in an effort to identify and neutralize potential threats (which he believes are everywhere). Maintaining this level of emotional arousal is exhausting. His need to be ever alert and on guard, however, prevents him from relaxing to the degree necessary for truly restful sleep. As a result, he becomes even more exhausted. His functioning begins to deteriorate. What little energy he has is directed towards trying to keep himself safe from threats, both real and imagined.
This is often the state in which I first encounter a patient. His symptoms have started to become overwhelming and he is doing everything he can to "keep it together." Before I can even think about trying to help him I need to assess his "ego strength."
According to Brown, et. al. (1979), ego strength refers to an individual's ability "to hold on to his own identity despite psychic pain, distress, [and] turmoil, [from] internal forces as well as the demands of reality." In other words, how much distress can a person tolerate without falling apart? In her "Nueroscience and Relationships" blog (http://blogs.psychcentral.com/relationships/), Dr. Athena Staik describes ego strength as "the resiliency or strength of your core sense of self, the extent to which you can face challenging events or persons, without feeling so overwhelmed that you take desperate action, perhaps with little or no thought to consequences."
Exposure therapy (or prolonged exposure therapy) is one of the most effective treatment approaches for overcoming a traumatic experience. The treatment requires a person to access his memories of the traumatic event and to allow himself to experience whatever feelings these memories evoke. It also asks the patient to confront situations that now feel unsafe to him but that are, in reality, perfectly safe.
Exposure therapy can be pretty intense and would probably be overwhelming for someone with very low ego strength. (There are plenty of other treatments that are beneficial for patients with low ego strength). The problem is, it is not always easy to determine which patients have good ego strength and which do not. I've had the unfortunate experience of believing a patient could handle exposure therapy only to have him decompensate a few sessions into it. (This has happened on multiple occasions, actually, and not just to me. Several of my coworkers have had simliar experiences).
When I say a patient decompensates I mean that the therapy pushes him past his breaking point. I've seen patients become suicidal. One of my coworkers had a patient check herself into the psychiatric hospital because she couldn't guarantee she wouldn't try to kill herself. Some patients start to have intrusive flashbacks or their nightmares get so bad that they become afraid to go to sleep. A person who decompensates completely will become psychotic (and would probably have to be hospitalized), although this has never happened with any of my patients.
So therein lies my dilemma. How do I know when to "push" (i.e., encourage) a patient to stick with the treatment and when to back off? Is it my job to say to a patient, "Look, I don't think you can handle this?" And what if I'm wrong? Then I'm depriving him of treatment that could really be helpful. But what if I keep pushing and the patient decompensates? Is it my fault? Am I responsible for having pushed the patient "over the edge?"
There doesn't seem to be a clear cut answer to this. My solution has been to put the ball in the patients' court. I say something like this: "Only you know where your limit is. My job is to push you to that limit, but not beyond it. If you feel like you're close to going over the edge, please let me know. We'll stop, regroup, and figure out where to go from there."
Of course, the assumption here is that people know their own limits. This may not always be true. In fact, I cannot say for certain where my own breaking point lies. I know there have been times when I felt so overwhelmed that I wished I would just fall apart completely; at least it would provide an escape from myself and my life. In reallity though, I suspect I've never even come close to my breaking point. I am fortunate enough never to have been faced with stressors so overwhelming that I was not able to cope with them.
What about you? Where is your breaking point? How do you know when you're too close for comfort?
Saturday, March 31, 2012
Breakdown
We seem to be hearing about it a lot these days. Kony 2012 film creator Jason Russell strips naked on a San Diego street corner. He paces, apparently agitated, and begins beating his fists on the sidewalk. A JetBlue pilot exits the cockpit mid-flight and goes into a lengthy rant. He talks about Iraq and Afghanistan and at one point claims there is a bomb on the plane. He then starts banging on the cockpit door and has to be physically subdued by a group of passengers.
These are seemingly "normal" people, probably dealing with the same types of daily stressors we all face. They, like us, are going about the business of living life, with all the ups and downs that come with it...
Until something happens. They have a meltdown. They reach their breaking point; they snap. They crack up, have a nervous breakdown, fall apart, come unglued, etc. None of these are actual diagnoses, but the terms are part of our shared vernacular nonetheless. They all refer to the collapse of mental and emotional strength in the face of overwhelming stress. They all attempt to describe what happens when a person's stress reaches the point at which it overwhelms his ability to cope. This can be due to the accumulation of stress over time; it can also occur in response to a single traumatic event.
So what happens when a person reaches his breaking point? While no two people are the same, I believe it is possible to classify the majority of possible experiences into a few broad categories.
Psychosis: When a person becomes psychotic, his or her sense of reality becomes distorted. He may see or hear things that aren't really there (hallucinations). He may hold firm to beliefs that are inconsistent with what is actually taking place (delusions). His thoughts are often disorganized, making it difficult to think clearly or to make sense of his experiences. This is apparently what happened to Jason Russell.
Suicide: This refers not only to committing suicide but also to attempting or even seriously contemplating it. A person seeks to end his own life when he sees no other way to cope with reality as it exists. He reaches a point where he believes he has no other options.
Inability to function at the level required to complete activities necessary for survival: When a person reaches this point, he may not be able to bring himself to get out of bed in the morning. Instead of going to work or to school (or instead of getting his kids off to school or doing whatever it is he is responsible for doing in the morning), he simply stays in bed. He doesn't bother getting up to eat or to shower. He isolates himself from his friends and family. He lacks the energy and/or motivation to continue participating in life.
Extreme/erratic behaviors: Often the behavior in question is an impulsive one. For example, a person's boss criticizes him. Overwhelmed by a multitude of stressors, he simply snaps. He physically attacks his boss and has to be restrained by several coworkers. The behavior of the aforementioned JetBlue pilot also falls into this category. Sometimes the behavior is slightly less extreme but is completely out of character and not something the person would likely do under "normal" circumstances. For example, I once knew someone who had graduated college a few months earlier and was feeling overwhelmed by the stress of her first "real" job. She was a very responsible and conscientious person by nature. She was scheduled to work one evening but, when the time came, she just could not bring herself to go. Instead, she got in her car and just started driving. She ended up several hundred miles away, in a neighboring state. Her family became worried when her supervisor called to ask why she hadn't come to work. She essentially "ran away" from life, leaving behind everyone and everything.
Could this happen to anybody? Do we all have a breaking point? I've often wondered about this, particularly in the case of psychosis. Is it possible that any one of us could break with reality and become psychotic if faced with overwhelming trauma or stress? I honestly don't know. I am, however, fairly certain that we all have some sort of "breaking point." Naturally, we all vary in our ability to cope with stress; some people are able to tolerate higher levels than others. Still, nobody's ability to cope is unlimited; we all have limits to what we can endure. It is important for us to remember that we cannot allow stress to accumulate unattended and expect to remain unaffected by it. We significantly decrease the likelihood that we will ever reach our "breaking point" by coping with individual stressors as they arise and by making self care a priority.
These are seemingly "normal" people, probably dealing with the same types of daily stressors we all face. They, like us, are going about the business of living life, with all the ups and downs that come with it...
Until something happens. They have a meltdown. They reach their breaking point; they snap. They crack up, have a nervous breakdown, fall apart, come unglued, etc. None of these are actual diagnoses, but the terms are part of our shared vernacular nonetheless. They all refer to the collapse of mental and emotional strength in the face of overwhelming stress. They all attempt to describe what happens when a person's stress reaches the point at which it overwhelms his ability to cope. This can be due to the accumulation of stress over time; it can also occur in response to a single traumatic event.
So what happens when a person reaches his breaking point? While no two people are the same, I believe it is possible to classify the majority of possible experiences into a few broad categories.
Psychosis: When a person becomes psychotic, his or her sense of reality becomes distorted. He may see or hear things that aren't really there (hallucinations). He may hold firm to beliefs that are inconsistent with what is actually taking place (delusions). His thoughts are often disorganized, making it difficult to think clearly or to make sense of his experiences. This is apparently what happened to Jason Russell.
Suicide: This refers not only to committing suicide but also to attempting or even seriously contemplating it. A person seeks to end his own life when he sees no other way to cope with reality as it exists. He reaches a point where he believes he has no other options.
Inability to function at the level required to complete activities necessary for survival: When a person reaches this point, he may not be able to bring himself to get out of bed in the morning. Instead of going to work or to school (or instead of getting his kids off to school or doing whatever it is he is responsible for doing in the morning), he simply stays in bed. He doesn't bother getting up to eat or to shower. He isolates himself from his friends and family. He lacks the energy and/or motivation to continue participating in life.
Extreme/erratic behaviors: Often the behavior in question is an impulsive one. For example, a person's boss criticizes him. Overwhelmed by a multitude of stressors, he simply snaps. He physically attacks his boss and has to be restrained by several coworkers. The behavior of the aforementioned JetBlue pilot also falls into this category. Sometimes the behavior is slightly less extreme but is completely out of character and not something the person would likely do under "normal" circumstances. For example, I once knew someone who had graduated college a few months earlier and was feeling overwhelmed by the stress of her first "real" job. She was a very responsible and conscientious person by nature. She was scheduled to work one evening but, when the time came, she just could not bring herself to go. Instead, she got in her car and just started driving. She ended up several hundred miles away, in a neighboring state. Her family became worried when her supervisor called to ask why she hadn't come to work. She essentially "ran away" from life, leaving behind everyone and everything.
Could this happen to anybody? Do we all have a breaking point? I've often wondered about this, particularly in the case of psychosis. Is it possible that any one of us could break with reality and become psychotic if faced with overwhelming trauma or stress? I honestly don't know. I am, however, fairly certain that we all have some sort of "breaking point." Naturally, we all vary in our ability to cope with stress; some people are able to tolerate higher levels than others. Still, nobody's ability to cope is unlimited; we all have limits to what we can endure. It is important for us to remember that we cannot allow stress to accumulate unattended and expect to remain unaffected by it. We significantly decrease the likelihood that we will ever reach our "breaking point" by coping with individual stressors as they arise and by making self care a priority.
Saturday, March 24, 2012
Thanks, I just needed to vent
According to the free dictionary, to "vent" is to give outlet to thoughts or emotions. Alternatively, it is to unburden oneself of strong, pent up emotions.
We have probably all had the experience of needing to vent. We are upset about something and we feel like we might explode if we don't share it with someone. For most of us, the identity of that someone matters. We don't just go around venting to anyone who will listen. Rather, we have a small group of people we feel comfortable venting to. When we feel overwhelmed, we call one of these people and share our frustration. By the end of the call, we tend to feel a bit better. "Thanks for listening," we tell them. "I just needed to vent."
The experience is so common that we don't really think about it. Sometimes people need to vent; we vent, we feel better, right?
Actually, the research on venting is pretty clear. Venting negative emotions leads to an increase in their intensity. This is especially true when dealing with anger but seems to apply to other negative emotions as well.
This seems to conflict with what we know from our own experience, right? Not necessarily. The literature seems to equate venting with throwing a "temper tantrum." Personally, I refer to this tantrum-like activity as "bitching." Others refer to it as whining or chronic complaining. It implies the chronic, excessive expression of negative thoughts and feelings. It is expression that serves no purpose; the expression itself is the goal.
Now this is something I'm familiar with! I have, on occasion, had patients like this. In fact, it was my current frustration with just such a patient that led me to write a post about venting. My colleagues informed me that there is actually a name for this type of patient (or person, if the person purports to be asking for help): help-rejecting complainer. I know, it seems a bit perjorative. But if the shoe fits...
Let's go back to venting though. So that we don't confuse venting with throwing a temper tantrum, let's define it as "verbally expressing negative thoughts and emotions." When defined this way, can venting be therapeutic? The answer is yes. There are a number of circumstances in which verbally expressing negative thoughts or feelings to another person can be helpful.
When someone "vents" to me, my initial response is the same, whether I'm in the role of therapist, friend, spouse, sister, or daughter: I listen and I validate. I think that's what most of us want when we express our thouhts and feelings. We want someone to understand how we feel and we want someone to tell us it's okay for us to feel that way. For everyday frustrations, this is often enough to make the person venting feel better.
As a therapist, this is a good first step. Listening empathically and validating a patient's emotions helps to build rapport. The patient feels understood, validated, valued, and accepted; he or she leaves the first session with positive feelings about the therapist. Venting in and of itself, however, does not bring about lasting change. To be truly therapeutic, venting must be used as a catalyst for identifying patterns and gaining insight. For a patient to make use of venting in therapy, he or she must be willing to accept feedback about the material vented. The goal is for the patient to begin to consider alternative perspectives or to identify methods for accepting, tolerating, or coping.
All of us can benefit from considering a few things the next time we "need to vent." Venting is not always helpful and can sometimes cause our negative emotions to intensify. Do we simply need to be heard and validated? Do we just want to know that someone understands? Are you willing to accept feedback? Are you willing to consider other ways of looking at the situation? Are you asking for help? Or do you just want someone to listen? If the latter is true, let the other person know you just need them to listen.
We have probably all had the experience of needing to vent. We are upset about something and we feel like we might explode if we don't share it with someone. For most of us, the identity of that someone matters. We don't just go around venting to anyone who will listen. Rather, we have a small group of people we feel comfortable venting to. When we feel overwhelmed, we call one of these people and share our frustration. By the end of the call, we tend to feel a bit better. "Thanks for listening," we tell them. "I just needed to vent."
The experience is so common that we don't really think about it. Sometimes people need to vent; we vent, we feel better, right?
Actually, the research on venting is pretty clear. Venting negative emotions leads to an increase in their intensity. This is especially true when dealing with anger but seems to apply to other negative emotions as well.
This seems to conflict with what we know from our own experience, right? Not necessarily. The literature seems to equate venting with throwing a "temper tantrum." Personally, I refer to this tantrum-like activity as "bitching." Others refer to it as whining or chronic complaining. It implies the chronic, excessive expression of negative thoughts and feelings. It is expression that serves no purpose; the expression itself is the goal.
Now this is something I'm familiar with! I have, on occasion, had patients like this. In fact, it was my current frustration with just such a patient that led me to write a post about venting. My colleagues informed me that there is actually a name for this type of patient (or person, if the person purports to be asking for help): help-rejecting complainer. I know, it seems a bit perjorative. But if the shoe fits...
Let's go back to venting though. So that we don't confuse venting with throwing a temper tantrum, let's define it as "verbally expressing negative thoughts and emotions." When defined this way, can venting be therapeutic? The answer is yes. There are a number of circumstances in which verbally expressing negative thoughts or feelings to another person can be helpful.
When someone "vents" to me, my initial response is the same, whether I'm in the role of therapist, friend, spouse, sister, or daughter: I listen and I validate. I think that's what most of us want when we express our thouhts and feelings. We want someone to understand how we feel and we want someone to tell us it's okay for us to feel that way. For everyday frustrations, this is often enough to make the person venting feel better.
As a therapist, this is a good first step. Listening empathically and validating a patient's emotions helps to build rapport. The patient feels understood, validated, valued, and accepted; he or she leaves the first session with positive feelings about the therapist. Venting in and of itself, however, does not bring about lasting change. To be truly therapeutic, venting must be used as a catalyst for identifying patterns and gaining insight. For a patient to make use of venting in therapy, he or she must be willing to accept feedback about the material vented. The goal is for the patient to begin to consider alternative perspectives or to identify methods for accepting, tolerating, or coping.
All of us can benefit from considering a few things the next time we "need to vent." Venting is not always helpful and can sometimes cause our negative emotions to intensify. Do we simply need to be heard and validated? Do we just want to know that someone understands? Are you willing to accept feedback? Are you willing to consider other ways of looking at the situation? Are you asking for help? Or do you just want someone to listen? If the latter is true, let the other person know you just need them to listen.
Sunday, March 18, 2012
Do therapists practice what they preach?
Most people probably assume that their therapist is mentally and emotionally healthy. After all, the therapist seems to have it all together: a good job, nice office, nice clothes, and a consistently calm demeanor that is both comforting and reassuring. It certainly makes sense that a therapist should have good mental and emotional health; she has all the necessary tools and she knows how to use them. But do therapists practice what they preach?
I can't speak for all therapists; I can only speak for myself. Am I the picture of perfect mental and emotional functioning? Absolutely not. I do, however, practice what I preach. One of the reasons I am able to "sell" certain strategies to my patients is because I know from personal experience that they work. I'm a walking testimonial. I'm quite proud of this. I started out insecure and emotionally unstable. Learning to "do" therapy is an ongoing process that for me started when I got my first job out of college. From day one I started using what I learned to help myself. I've come a long way since then and I'm proud of myself.
Imagine my chagrin, then, when six months into my marriage my mother suggested that my husband and I needed marriage counseling. I resisted. "We don't need a therapist," I thought. "I am the therapist." (I've since reconsidered my position). Then I started thinking about all of the therapists I've worked with over the years; A LOT of them are divorced. Even some of the therapists I know who are trained specifically in marriage and family therapy are divorced! Apparently, when it comes to relationships there are a lot of us who have a hard time practicing what we preach.
I recently stumbled upon a research study that looked into this. (The article is entitled "Do psychotherapists have better marriages than nonpsychotherapists?" and is found in the journal Psychotherapy: Theory Research, Practice, Training, Vol. 41, No. 3. The authors are Murstein and Mink). The study measured marital adjustment in couples where neither spouse was a therapist, where one spouse was a therapist, and where both spouses were therapists. Overall, they found no difference in levels of marital adjustment between couples where neither spouse was a therapist and couples with one or more therapist spouse. In other words, couples with one or more therapist spouse did not have better marital adjustment than couples with no therapist.
They broke the results down into categories and found some very interesting results. The couples with the highest indicators of marital adjustment in both partners were those composed of a therapist husband and a non-therapist wife. The lowest ratings of marital adjustment came from husbands (both therapists and non-therapists) married to therapist wives.
This is, of course, extremely relevant to me, given that my husband is married to a therapist wife. I started thinking about our "marital adjustment" and how me being a therapist affects our relationship...
Early in our marriage, my husband had a terrible habit of not telling me when I did something to upset him. Instead, he'd accumulate these instances in his mind and then throw them at me one by one whenever we had an argument. This meant that if I complained about something he did that was really upsetting me, he would respond by going through a long list of examples of things I'd done to make him angry. As a therapist, I knew he was breaking one of the cardinal rules of fair fighting: stick to the subject and stay in the present (don't bring up issues from the past). I'd tell him, "Look, you're not supposed to do that when we're arguing." The thing is, he didn't know anything about the fair fighting rules and he hadn't agreed to abide by them. I know that at times he seemed to resent me telling him how we were "supposed" to communicate with each other (especially when I didn't always follow my own "rules").
I suppose my husband might have some theories of his own. I plan to ask him. I'll let you know if he has any interesting insights.
I can't speak for all therapists; I can only speak for myself. Am I the picture of perfect mental and emotional functioning? Absolutely not. I do, however, practice what I preach. One of the reasons I am able to "sell" certain strategies to my patients is because I know from personal experience that they work. I'm a walking testimonial. I'm quite proud of this. I started out insecure and emotionally unstable. Learning to "do" therapy is an ongoing process that for me started when I got my first job out of college. From day one I started using what I learned to help myself. I've come a long way since then and I'm proud of myself.
Imagine my chagrin, then, when six months into my marriage my mother suggested that my husband and I needed marriage counseling. I resisted. "We don't need a therapist," I thought. "I am the therapist." (I've since reconsidered my position). Then I started thinking about all of the therapists I've worked with over the years; A LOT of them are divorced. Even some of the therapists I know who are trained specifically in marriage and family therapy are divorced! Apparently, when it comes to relationships there are a lot of us who have a hard time practicing what we preach.
I recently stumbled upon a research study that looked into this. (The article is entitled "Do psychotherapists have better marriages than nonpsychotherapists?" and is found in the journal Psychotherapy: Theory Research, Practice, Training, Vol. 41, No. 3. The authors are Murstein and Mink). The study measured marital adjustment in couples where neither spouse was a therapist, where one spouse was a therapist, and where both spouses were therapists. Overall, they found no difference in levels of marital adjustment between couples where neither spouse was a therapist and couples with one or more therapist spouse. In other words, couples with one or more therapist spouse did not have better marital adjustment than couples with no therapist.
They broke the results down into categories and found some very interesting results. The couples with the highest indicators of marital adjustment in both partners were those composed of a therapist husband and a non-therapist wife. The lowest ratings of marital adjustment came from husbands (both therapists and non-therapists) married to therapist wives.
This is, of course, extremely relevant to me, given that my husband is married to a therapist wife. I started thinking about our "marital adjustment" and how me being a therapist affects our relationship...
Early in our marriage, my husband had a terrible habit of not telling me when I did something to upset him. Instead, he'd accumulate these instances in his mind and then throw them at me one by one whenever we had an argument. This meant that if I complained about something he did that was really upsetting me, he would respond by going through a long list of examples of things I'd done to make him angry. As a therapist, I knew he was breaking one of the cardinal rules of fair fighting: stick to the subject and stay in the present (don't bring up issues from the past). I'd tell him, "Look, you're not supposed to do that when we're arguing." The thing is, he didn't know anything about the fair fighting rules and he hadn't agreed to abide by them. I know that at times he seemed to resent me telling him how we were "supposed" to communicate with each other (especially when I didn't always follow my own "rules").
I suppose my husband might have some theories of his own. I plan to ask him. I'll let you know if he has any interesting insights.
Sunday, March 11, 2012
Good self, bad self
I think most of us want to be a "good person," although we all have different ideas about what that means. Personally, the thing I value most in life is my relationships with the people I love. This is where I derive my sense of purpose. To me, life is meaningful because I can share it with people I love. It quite naturally follows that my ideas about being a "good person" have to do with how I treat other people (especially the people I love). Fortunately, I tend to be very lenient with myself. I don't beat myself up or decide I'm a "bad person" if I don't feel like saying good morning to the people sharing the elevator with me. I don't even judge myself harshly if I am short with (or even rude to) a telemarketer who refuses to accept that I am not interested in buying anything. Of course I strive to be at the very least respectful to other people, but I don't necessarily feel like a "bad person" when I fall short of that standard.
What does make me feel like a bad person is when I say or do something unkind or hurtful to someone I love. (Why does it seem like the people I love are also the people I am most likely to treat unkindly)? It is extremely rare for me to be intentionally hurtful or unkind, especially to people I care about. I do, however, occasionally do this unintentionally.
You see, I am a rather moody person. This is especially true when I am tired or under a lot of stress. Over the years, I've gotten pretty good at recognizing when I am feeling tired or stressed out. This allows me to avoid being around people during these periods or to at least let them know that I'm in a bad mood and to apologize in advance for being less than friendly. This works out well for most people most of the time.
About a year and a half ago, however, I got married. It is extremely difficult to simply avoid interacting with my husband when I'm tired or stressed (it's possible sometimes, but definitely not all the time). I try to let my husband know when I'm in a bad mood. Sometimes, though, I'm under a lot of stress for an extended period of time; I know it must get old for my husband to hear from me every day that I'm in a bad mood and don't want to be bothered. I wonder if there are times when he feels like he has to walk on eggshells around me.
And, of course, there are times when I snap at him or even yell at him just because I'm feeling irritable. With everyone else in my life, I can structure my time in such a way that most of the time we spend together ends up being pleasant and enjoyable. Not so with my husband. He is with me at my best and my worst. What I've discovered that perhaps I didn't realize before we got married is that me at my worst is really ugly. There is this side of me that is impatient, demanding, intolerant, and unyielding. This part of me wants everything my way and only my way. She is selfish and lacks empathy. She is inconsiderate and short tempered.
Who is this person? I don't like the inevitable answer: she's me. Or at least she's a part of me. But she's a part of me I don't like at all and when she comes out, it makes me feel like a bad person.
I suppose this is what is meant by the "shadow self." If so, then I've taken an important first step; I've forced my "shadow self" out of the shadows and into my conscious awareness. I've taken ownership of the parts of myself that I don't like. I haven't quite figured out what to do next, but I know I'll keep working on it. I will keep you posted.
What does make me feel like a bad person is when I say or do something unkind or hurtful to someone I love. (Why does it seem like the people I love are also the people I am most likely to treat unkindly)? It is extremely rare for me to be intentionally hurtful or unkind, especially to people I care about. I do, however, occasionally do this unintentionally.
You see, I am a rather moody person. This is especially true when I am tired or under a lot of stress. Over the years, I've gotten pretty good at recognizing when I am feeling tired or stressed out. This allows me to avoid being around people during these periods or to at least let them know that I'm in a bad mood and to apologize in advance for being less than friendly. This works out well for most people most of the time.
About a year and a half ago, however, I got married. It is extremely difficult to simply avoid interacting with my husband when I'm tired or stressed (it's possible sometimes, but definitely not all the time). I try to let my husband know when I'm in a bad mood. Sometimes, though, I'm under a lot of stress for an extended period of time; I know it must get old for my husband to hear from me every day that I'm in a bad mood and don't want to be bothered. I wonder if there are times when he feels like he has to walk on eggshells around me.
And, of course, there are times when I snap at him or even yell at him just because I'm feeling irritable. With everyone else in my life, I can structure my time in such a way that most of the time we spend together ends up being pleasant and enjoyable. Not so with my husband. He is with me at my best and my worst. What I've discovered that perhaps I didn't realize before we got married is that me at my worst is really ugly. There is this side of me that is impatient, demanding, intolerant, and unyielding. This part of me wants everything my way and only my way. She is selfish and lacks empathy. She is inconsiderate and short tempered.
Who is this person? I don't like the inevitable answer: she's me. Or at least she's a part of me. But she's a part of me I don't like at all and when she comes out, it makes me feel like a bad person.
I suppose this is what is meant by the "shadow self." If so, then I've taken an important first step; I've forced my "shadow self" out of the shadows and into my conscious awareness. I've taken ownership of the parts of myself that I don't like. I haven't quite figured out what to do next, but I know I'll keep working on it. I will keep you posted.
Sunday, March 4, 2012
Motivation and Emotion
"I'm not sure if I really need this treatment," a patient recently told me. "I'm feeling a lot better than I was," he explained. I looked at the symptom checklist he'd filled out before our session. "According to this, you're still feeling anxious and on guard, you're still getting angry a lot, you're still not comfortable going anywhere that's crowded, and you're still having trouble sleeping," I pointed out. My patient laughed. "You have a good point," he said.
The following week I checked in with him. "You were having some doubts about whether you needed the treatment," I recalled. "How are you feeling about that now?" The patient again expressed doubt, stating that he really is feeling a lot better. "I'm to the point where I can contain the anxiety," he explained.
This happens a lot: a person starts to feel a little better and decides he doesn't need treatment anymore. Granted, feeling better can be an indication that a patient's issues are resolved and that treatment can be terminated. More often than not, however, feeling better simply removes the motivation to continue treatment; as a result, problems are left unresolved only to resurface again at some point in the future.
So what does motivate a person to invest in treatment? Most people are motivated by emotional pain (sadness, grief, anger, anxiety, etc.). More accurately, people tend to be motivated by their desire to be rid of emotional pain. As long as the pain is there, they are willing to do the work of therapy. Once the pain abates a little bit, the focus of therapy often shifts from acute symptoms to trying to get to the root of the problem. This can mean working to change deeply ingrained mental and behavioral habits. It is often a lot of work and without the pain, many people lack the motivation.
Ironically, a patient's emotional pain can be helpful to the therapist as well. A person in pain is more likely to reveal his thoughts; these provide powerful clues as to what factors might be driving the patient's symptoms. I find that, in therapy, people tend to be very short-sighted. They tend to focus on their present experiences and their experiences from the recent past. It is not unusual for a patient to come to my office and say, "I've been feeling good for the past few weeks. I don't really have anything to talk about." It then falls upon me to try to help the patient recall the times in his life when he was not feeling good, to identify what these times have in common, and to explore what ultimately helped him to recover so that he can use these strategies again in the future. Typically, however, when a person feels good he does not want to think about feeling bad. He doesn't want to remember; he wants to forget.
I an not trying to glorify emotional pain. I am simply making the point that even negative emotions can be useful. How many people would work to change and improve themselves in the absence of emotional pain? Sure, there would be some; most, though, would have no motivation to do so.
The following week I checked in with him. "You were having some doubts about whether you needed the treatment," I recalled. "How are you feeling about that now?" The patient again expressed doubt, stating that he really is feeling a lot better. "I'm to the point where I can contain the anxiety," he explained.
This happens a lot: a person starts to feel a little better and decides he doesn't need treatment anymore. Granted, feeling better can be an indication that a patient's issues are resolved and that treatment can be terminated. More often than not, however, feeling better simply removes the motivation to continue treatment; as a result, problems are left unresolved only to resurface again at some point in the future.
So what does motivate a person to invest in treatment? Most people are motivated by emotional pain (sadness, grief, anger, anxiety, etc.). More accurately, people tend to be motivated by their desire to be rid of emotional pain. As long as the pain is there, they are willing to do the work of therapy. Once the pain abates a little bit, the focus of therapy often shifts from acute symptoms to trying to get to the root of the problem. This can mean working to change deeply ingrained mental and behavioral habits. It is often a lot of work and without the pain, many people lack the motivation.
Ironically, a patient's emotional pain can be helpful to the therapist as well. A person in pain is more likely to reveal his thoughts; these provide powerful clues as to what factors might be driving the patient's symptoms. I find that, in therapy, people tend to be very short-sighted. They tend to focus on their present experiences and their experiences from the recent past. It is not unusual for a patient to come to my office and say, "I've been feeling good for the past few weeks. I don't really have anything to talk about." It then falls upon me to try to help the patient recall the times in his life when he was not feeling good, to identify what these times have in common, and to explore what ultimately helped him to recover so that he can use these strategies again in the future. Typically, however, when a person feels good he does not want to think about feeling bad. He doesn't want to remember; he wants to forget.
I an not trying to glorify emotional pain. I am simply making the point that even negative emotions can be useful. How many people would work to change and improve themselves in the absence of emotional pain? Sure, there would be some; most, though, would have no motivation to do so.
Friday, February 24, 2012
Compatibility
I never really ascribed to the belief that when looking for love you will "just know" when you've found "the one." Honestly, it sounded like a recipe for disaster to me. The first (but certainly not the last) time someone told me that, I'd already be in love enough times to know that I tended to fall for the wrong kind of men. If I experienced the feeling of "just knowing" with a particular love interest, it was probably a sign that the man had commitment issues or was emotionally unavailable (and not that he was "the one").
There was no sense of instantly "knowing he was the one" when I first met my husband. To the contrary, there were a lot of reasons that, at the time, he was completely wrong for me. In the end, however, my husband and I discovered that we are, in many ways, quite compatible. His personality is vastly different from mine, although I wouldn't go so far as to say we are exact opposites. We share many of the same goals and values; we'd be decidedly incompatible if we didn't.
So what is it that makes us compatible? What makes any two people compatible, for that matter? A book called, "The Love Compatibility Book: The 12 Personality Traits that Can Lead You to Your Soulmate" by Hoffman and Weiner attempts to answer this question. (Find it on Amazon here: http://www.amazon.com/Love-Compatibility-Book-Personality-Soulmate/dp/1577312260). The authors suggest that there are twelve factors that determine compatibility between two people. I'm going to list them and share my thoughts but check out the book for more information.
1. Need for companionship: It helps for you and your partner to prefer about the same amount of companionship. If one of you hates being alone and wants constant companionship and the other needs a lot of alone time, this is likely to cause problems.
2. Idealism: Are you a dreamer or do you tend to be very practical? A dreamer with an extremely pragmatic partner might end up feeling like her partner is always trying to step on her dreams.
3. Emotional intensity: This is an area where the most compatible partners seem to balance one another out. It would probably create problems in a relationship for both partners to have the same level of emotional intensity -- imagine two hot heads always flying off the handle or two emotionally distant people who never share their feelings with one another. It is also probably difficult for two partners to have exact opposite amounts of emotional intensity -- imagine an emotionally intense person trying to evoke feeling from a partner who is distant and emotionally contained. As I said before, the key word when it comes to emotional intensity is balance.
4. Spontaneity: Do you like everything to be planned or do you enjoy doing things on a whim? This is another area where balance is the key.
5. Libido: How often do you feel like having sex? Differences between partners in how often they want to have sex is a VERY common problem in relationships, especially in married or co-habitating couples.
6. Nurturance: Do you like to take care of your partner or do you prefer for your partner to take care of you? Honestly, I don't think you can put this into an "either/or" category. Personally, I don't want to have to "take care" of my husband (every once in a while is ok, but not all the time); I also really don't like being "taken care of" (I can take care of myself).
7. Materialism: How much stuff do you want to have? If one partner tends to spend a lot of money on purchases that the other partner sees as wasteful it could cause problems. In my opinion, this category should be replaced with "shared financial goals" or something to that end. "Shared financial goals" seems far more relevant to compatibility than "materialism."
8. Extroversion: A person does not necessarily want a partner with the same degree of introversion or extroversion as he himself posesses. In my opinion, what is most important is that each partner allows the other to be his- or her-self.
9. Aestheticism: This refers to how much you enjoy art, music, or the beauty of nature. To me, this category seems way too specific. A more general (and, I think, relevant) category might be "shared interests." Partners should enjoy at least some of the same activities (and should pursue individual interests as well).
10. Activity level: Are you a "homebody" or do you always seem to be going somewhere or doing something? Activity level depends a lot on energy level. For example, my husband has far more energy than I do. After a few hours out and about I'm typically exhausted. My husband, on the other hand, is full of energy and ready to do something else.
11. Subjective well being: Are you an optimist or a pessimist? If you are a pessimist, are you annoyed by people who are too "peppy" or positive? If you are an optimist, do people with a negative outlook tend to bring you down? Do you want a partner that shares your outlook on life or do you want someone who can help you look at things differently?
12. Intellectualism: Do you keep up with current events? Do you read anything you can get your hands on? Do you enjoy a good conversation about public policy, world history, the state of American society (or whatever it is you happen to be interested in)? I think it is also important to consider intelligence. People tend to select partners with levels of intelligence similar to their own.
I know, I've said A LOT more than I usually do. So I'm done, for now;-)
There was no sense of instantly "knowing he was the one" when I first met my husband. To the contrary, there were a lot of reasons that, at the time, he was completely wrong for me. In the end, however, my husband and I discovered that we are, in many ways, quite compatible. His personality is vastly different from mine, although I wouldn't go so far as to say we are exact opposites. We share many of the same goals and values; we'd be decidedly incompatible if we didn't.
So what is it that makes us compatible? What makes any two people compatible, for that matter? A book called, "The Love Compatibility Book: The 12 Personality Traits that Can Lead You to Your Soulmate" by Hoffman and Weiner attempts to answer this question. (Find it on Amazon here: http://www.amazon.com/Love-Compatibility-Book-Personality-Soulmate/dp/1577312260). The authors suggest that there are twelve factors that determine compatibility between two people. I'm going to list them and share my thoughts but check out the book for more information.
1. Need for companionship: It helps for you and your partner to prefer about the same amount of companionship. If one of you hates being alone and wants constant companionship and the other needs a lot of alone time, this is likely to cause problems.
2. Idealism: Are you a dreamer or do you tend to be very practical? A dreamer with an extremely pragmatic partner might end up feeling like her partner is always trying to step on her dreams.
3. Emotional intensity: This is an area where the most compatible partners seem to balance one another out. It would probably create problems in a relationship for both partners to have the same level of emotional intensity -- imagine two hot heads always flying off the handle or two emotionally distant people who never share their feelings with one another. It is also probably difficult for two partners to have exact opposite amounts of emotional intensity -- imagine an emotionally intense person trying to evoke feeling from a partner who is distant and emotionally contained. As I said before, the key word when it comes to emotional intensity is balance.
4. Spontaneity: Do you like everything to be planned or do you enjoy doing things on a whim? This is another area where balance is the key.
5. Libido: How often do you feel like having sex? Differences between partners in how often they want to have sex is a VERY common problem in relationships, especially in married or co-habitating couples.
6. Nurturance: Do you like to take care of your partner or do you prefer for your partner to take care of you? Honestly, I don't think you can put this into an "either/or" category. Personally, I don't want to have to "take care" of my husband (every once in a while is ok, but not all the time); I also really don't like being "taken care of" (I can take care of myself).
7. Materialism: How much stuff do you want to have? If one partner tends to spend a lot of money on purchases that the other partner sees as wasteful it could cause problems. In my opinion, this category should be replaced with "shared financial goals" or something to that end. "Shared financial goals" seems far more relevant to compatibility than "materialism."
8. Extroversion: A person does not necessarily want a partner with the same degree of introversion or extroversion as he himself posesses. In my opinion, what is most important is that each partner allows the other to be his- or her-self.
9. Aestheticism: This refers to how much you enjoy art, music, or the beauty of nature. To me, this category seems way too specific. A more general (and, I think, relevant) category might be "shared interests." Partners should enjoy at least some of the same activities (and should pursue individual interests as well).
10. Activity level: Are you a "homebody" or do you always seem to be going somewhere or doing something? Activity level depends a lot on energy level. For example, my husband has far more energy than I do. After a few hours out and about I'm typically exhausted. My husband, on the other hand, is full of energy and ready to do something else.
11. Subjective well being: Are you an optimist or a pessimist? If you are a pessimist, are you annoyed by people who are too "peppy" or positive? If you are an optimist, do people with a negative outlook tend to bring you down? Do you want a partner that shares your outlook on life or do you want someone who can help you look at things differently?
12. Intellectualism: Do you keep up with current events? Do you read anything you can get your hands on? Do you enjoy a good conversation about public policy, world history, the state of American society (or whatever it is you happen to be interested in)? I think it is also important to consider intelligence. People tend to select partners with levels of intelligence similar to their own.
I know, I've said A LOT more than I usually do. So I'm done, for now;-)
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