Although we talked a lot in college about the "bio-psycho-social" approach to treatment, most of the focus was on the "psycho" and "social" components. In college I learned that, as a process, therapy is emotional, psychological, and interpersonal; there is nothing physical about it. There was a lot of discussion about emotions but never any mention of how emotions are actually experienced. I only later learned that at their core, emotions are physical experiences. They are literally felt on a physical level. And yet not once during my formal education and training was this discussed. Instead, we talked about emotions as if they exist in our minds.
Most of my patients are people who have experienced trauma in one form or another. It turns out that physical experience is especially important to the coneptualization of posttraumatic stress disorder and other trauma related syndromes. Most of my patients are plagued by intrusive memories of past trauma and have extreme physical reactions to anything associated with their traumatic experiences. Some of my patients have panic attacks, which are defined by a variety of unpleasant physical sensations to include heart palpitations, sweating, trembling, chest tightening, shortness of breath, nausea, dizziness, tingling, chills, etc. Almost all of my patients complain of being hyper-alert and physically unable to relax. So while my patients may come to me for help with psychological or emotional problems, their difficulties are also very physical in nature.
When exposed to a life-threatening event, we automatically enter "survival mode;" our brains instinctively activate the "fight or flight" response by stimulating the autonomic nervous system. This activation creates a number of physiological changes in the body. Some of these changes include increased heart and lung action, inhibition of stomach and upper intestinal tract so that digestion slows or stops, constriction or dilation of blood vessels, pupil dilation, relaxation of bladder, inhibition of salivation, increased blood flow to the muscles, increased muscle tension, and increased blood pressure. The purpose of the "fight or flight" response is to provide the body with increased strength and speed in preparation for fighting or fleeing. Once the fight or flight system is triggered, the body feels compelled to do one or the other - either fight or flee. If neither response is possible in a given situation, the fight or flight system becomes overwhelmed. The result, according to Herman, is that, "each component of the ordinary response to danger...tends to persist in an altered and exaggerated state long after the actual danger is over." This explains the physiological symptoms experienced by people with posttraumatic stress.
There is a growing body of research suggesting that unresolved physical reactions associated with trauma must be identified and experienced physically for healing to occur. This is particularly true for people who experience their physical sensations as intolerable and overwhelming. This describes a lot of my patients.
I would therefore like to incorporate aspects of physical experience into my work with patients on a regular basis. Thus far I have only managed to do this in a few small ways. When talking about emotions, for example, I ask patients to describe the physiological sensations associated with various feelings. Sometimes I ask patients to identify where in their bodies they feel a particular emotion. Patients frequently describe these requests as strange or odd. Most have never thought of emotions as phsycial sensations taking place in the body. I suspect this is the case not only for my patients but for most people in general.
I suspect there are a lot of people who are not particularly comfortable inside their bodies. How often do most of us tune in to our internal body sensations? We live in our bodies yet we rarely listen to them. Experience tells me this is particularly true for men, who are often socialized to believe that displays of emotion are not masculine.
To be honest, "body centered" psychotherapy has always seemed too "touchy feely" for my taste. I've heard colleagues describe it as "hokey" and "froo froo." Some clinicians don't see it as "real" therapy.
Every therapist has his or her own personal "style" of therapy. Whether or not we adopt an unfamiliar technique depends a lot on how well it fits with our pre-existing therapy style. We choose techniques that feel natural to us. It's easy, however, to become too comfortable. When a clinician considers a new technique the primary concern should be potential patient benefit. If a certain tool or technique might be useful we should try it, even if it makes us uncomfortable. And so, in the coming weeks I hope to step outside of my comfort zone a little bit. I'll let you know how it goes.
Tuesday, March 25, 2014
Tuesday, March 18, 2014
Feel Good Moment
One of the primary reasons I went into the mental health field was to help people, yet there were times early on when I wasn't sure I was accomplishing this goal. I used to spend a lot of time worrying about this. I worried about it so much, in fact, that it became a distraction. I began to dread seeing those patients who didn't seem to improve. They made me feel helpless and ineffective. I eventually started to dread going to work altogether. I didn't want to see patients at all anymore.
I considered a career change. In search of guidance, I even completed a few online career assessments. To my chagrin, every assessment suggested "therapist," "counselor," or "social worker" as good career choices for me.
I became depressed. I hated my job but felt I'd invested too much in my education and training to do anything else. And honestly, I couldn't think of anything else I wanted to do. I started counting the years until retirement but that made me even more depressed: I had at least forty years to go. How was I going to make it?
And so obviously something had to give. I did a lot of soul-searching, a lot of reading, and some self-help exercises. At some point it occurred to me to stop pressuring myself to "make people better" and instead try to focus on just being present with my patients. I decided to simply do the best I could with patients, regardless of the outcome. I made a sincere effort not to take it personally when a patient didn't improve. "You can't help everyone," I told myself. "Just do the best you can."
Work became more tolerable as a result of these changes. I learned to accept that there will always be patients who don't get better. There are lots of reasons for this, many of which have nothing to do with my ability as a therapist.
Now fast forward. I am nine years into my career. As a therapist, I am more genuine and more engaged with my patients than I was early on. I don't spend much time thinking about how helpful I am...it's a slippery slope and I don't want to start sliding. I just do my job the best I can and hope some people benefit from it.
Last week, I had a very rewarding experience. Our clinic runs a two week therapy group for active duty service members who have experienced some sort of combat trauma. A former patient of mine sometimes speaks to the group about his own experiences with trauma and its aftermath. I know he does this but I've never had the chance to sit in on one of these talks. Last week the opportunity arose.
My patient walked to the front of the room and introduced himself. He then turned and pointed at me. "The reason I'm here today is because of that woman right there." I was a little embarrassed when everyone turned to look at me. My patient continued. He talked about being in Afghanistan and about the difficulties he encountered there. He talked about coming back home and the problems he started having. He related his attempts to seek help, the first of which was disheartening. Finally, he talked about coming to our clinic and starting therapy with me.
My patient shared what he learned in therapy and identified what he found most helpful. He shared things I'd said and insights he'd achieved as a result. He seemed to remember everything we'd ever discussed. I, on the other hand, had forgotten what we'd talked about until I heard him speak.
It's not that I don't think about patients after they've moved on from therapy. Often I recall a specific patient and think to myself, "I wonder how he/she is doing now." I have never, however, remembered a patient and thought, "Wow, I really did a great job helping him/her." It's just not something I do, primarily for the reasons I mentioned earlier. When my former patient talked about the work we did in therapy it was almost like he was talking about some other therapist. It wasn't until later that I said to myself, "He was talking about me. I did that." And it felt really good to know that I helped.
I considered a career change. In search of guidance, I even completed a few online career assessments. To my chagrin, every assessment suggested "therapist," "counselor," or "social worker" as good career choices for me.
I became depressed. I hated my job but felt I'd invested too much in my education and training to do anything else. And honestly, I couldn't think of anything else I wanted to do. I started counting the years until retirement but that made me even more depressed: I had at least forty years to go. How was I going to make it?
And so obviously something had to give. I did a lot of soul-searching, a lot of reading, and some self-help exercises. At some point it occurred to me to stop pressuring myself to "make people better" and instead try to focus on just being present with my patients. I decided to simply do the best I could with patients, regardless of the outcome. I made a sincere effort not to take it personally when a patient didn't improve. "You can't help everyone," I told myself. "Just do the best you can."
Work became more tolerable as a result of these changes. I learned to accept that there will always be patients who don't get better. There are lots of reasons for this, many of which have nothing to do with my ability as a therapist.
Now fast forward. I am nine years into my career. As a therapist, I am more genuine and more engaged with my patients than I was early on. I don't spend much time thinking about how helpful I am...it's a slippery slope and I don't want to start sliding. I just do my job the best I can and hope some people benefit from it.
Last week, I had a very rewarding experience. Our clinic runs a two week therapy group for active duty service members who have experienced some sort of combat trauma. A former patient of mine sometimes speaks to the group about his own experiences with trauma and its aftermath. I know he does this but I've never had the chance to sit in on one of these talks. Last week the opportunity arose.
My patient walked to the front of the room and introduced himself. He then turned and pointed at me. "The reason I'm here today is because of that woman right there." I was a little embarrassed when everyone turned to look at me. My patient continued. He talked about being in Afghanistan and about the difficulties he encountered there. He talked about coming back home and the problems he started having. He related his attempts to seek help, the first of which was disheartening. Finally, he talked about coming to our clinic and starting therapy with me.
My patient shared what he learned in therapy and identified what he found most helpful. He shared things I'd said and insights he'd achieved as a result. He seemed to remember everything we'd ever discussed. I, on the other hand, had forgotten what we'd talked about until I heard him speak.
It's not that I don't think about patients after they've moved on from therapy. Often I recall a specific patient and think to myself, "I wonder how he/she is doing now." I have never, however, remembered a patient and thought, "Wow, I really did a great job helping him/her." It's just not something I do, primarily for the reasons I mentioned earlier. When my former patient talked about the work we did in therapy it was almost like he was talking about some other therapist. It wasn't until later that I said to myself, "He was talking about me. I did that." And it felt really good to know that I helped.
Tuesday, March 11, 2014
Defensiveness and Blame in Conflict
Over the past couple of months I've expressed frustration about how conflict is handled in my marriage. Specifically, I've said I feel like I automatically get blamed when something goes wrong. I started doing some research because I wanted advice on how to deal with this effectively. I wanted my husband and I to learn to resolve conflict constructively.
Unfortunately, I didn't find the kind of advice I was looking for. While a lot of research has been done on conflict there was very little about how to respond to being verbally attacked and blamed. I did, however, discover a few helpful tips: Avoid responding to negative emotion with negative emotion; this only escalates the conflict. Express empathy (e.g., "I can see you are feeling hurt and angry"). And above all, try to remain calm.
This is good advice but it seems to be asking a lot. It is very difficult to remain calm when someone you love criticizes your very character and blames you for problems you didn't cause. When attacked, most people automatically become defensive. We quite naturally want to protect ourselves. A range of emotions are triggered, from fear to sadness to anger. In the face of this emotional torrent, rational thought and clear reasoning are severely compromised.
Not that I'm a complete hothead. There have been times my husband blamed or criticized me that I initially remained calm. In what seemed like a calm (but firm) voice I have replied, "Please stop blaming me." I said things like, "It doesn't matter whose fault it is," "If one of us 'wins' the other loses. That means the relationship loses," and "Let's focus on solving the problem, not on blaming each other." My composure gradually evaporated, however, when my attempts were met with continued blame and criticism.
It occurred to me that it might be easier to remain calm and express empathy if I could understand what was motivating my husband's behavior. You see, my husband is essentially a good man so I assumed his intent was not malicious. Maybe there was some underlying reason for his hostility during conflict.
And so I set out to learn about "conflict behaviors." My initial findings reinforced what I already knew: defensiveness and hostility during conflict is associated with high levels of "marital distress" and increased likelihood of divorce. Nobody had to tell me this. Each time a conflict went unresolved I felt a little more hopeless than the time before. A sense of distance arose in my marriage that had not been there before. For a marriage to work there must be away to resolve conflict.
I then learned that "aggressive denial of responsibility" (e.g., criticism, blaming) is employed most frequently by people with fragile and/or unstable self-esteem. I read about "contingent" self-esteem, whereby one's sense of self-worth is dependent upon maintaining certain self-imposed standards. (What if those standards include "always being right" or "never losing an argument?" If that were the case I was completely screwed)!
"Conflict behavior" is also related to "attachment style." Briefly, attachment style as a concept comes from attachment theory. Attachment theory states that an infant's relationship with his primary caregiver becomes a template for his interpersonal relationships throughout life. A healthy, secure infant-caregiver relationship facilitates "normal" social and emotional development. Problems in the infant-caregiver relationship disrupt social and emotional development. Inconsistent availability and/or responsiveness to infant needs by the caregiver leads to the development of an anxious or ambivalent attachment style. The defining feature of this attachment style is anxiety over abandonment. Adults with an anxious/ambivalent attachment style have a higher tendency than others to display hostility during conflict, to include the use of blaming, threatening, and other verbal aggression. When compared to adults with secure attachment, they show greater attempts to dominate conflict discussion.
My research led me to a tentative conclusion: "defensive hostility," "criticism," "aggressive denial of responsibility," and similar "conflict escalating behaviors" stem from underlying insecurities. (Incidentally, none of the research seems to suggest such behaviors stem primarily from "being an asshole." So that's good news). It is not immediately clear to me how to use this information. Assuming my conclusion is accurate, my husband is unlikely to ever acknowledge said insecurities, perhaps not even to himself. But perhaps just being aware will arouse my compassion in the midst of conflict. Maybe seeing criticism as motivated by fear and anxiety will help me to take it less personally.
Unfortunately, I didn't find the kind of advice I was looking for. While a lot of research has been done on conflict there was very little about how to respond to being verbally attacked and blamed. I did, however, discover a few helpful tips: Avoid responding to negative emotion with negative emotion; this only escalates the conflict. Express empathy (e.g., "I can see you are feeling hurt and angry"). And above all, try to remain calm.
This is good advice but it seems to be asking a lot. It is very difficult to remain calm when someone you love criticizes your very character and blames you for problems you didn't cause. When attacked, most people automatically become defensive. We quite naturally want to protect ourselves. A range of emotions are triggered, from fear to sadness to anger. In the face of this emotional torrent, rational thought and clear reasoning are severely compromised.
Not that I'm a complete hothead. There have been times my husband blamed or criticized me that I initially remained calm. In what seemed like a calm (but firm) voice I have replied, "Please stop blaming me." I said things like, "It doesn't matter whose fault it is," "If one of us 'wins' the other loses. That means the relationship loses," and "Let's focus on solving the problem, not on blaming each other." My composure gradually evaporated, however, when my attempts were met with continued blame and criticism.
It occurred to me that it might be easier to remain calm and express empathy if I could understand what was motivating my husband's behavior. You see, my husband is essentially a good man so I assumed his intent was not malicious. Maybe there was some underlying reason for his hostility during conflict.
And so I set out to learn about "conflict behaviors." My initial findings reinforced what I already knew: defensiveness and hostility during conflict is associated with high levels of "marital distress" and increased likelihood of divorce. Nobody had to tell me this. Each time a conflict went unresolved I felt a little more hopeless than the time before. A sense of distance arose in my marriage that had not been there before. For a marriage to work there must be away to resolve conflict.
I then learned that "aggressive denial of responsibility" (e.g., criticism, blaming) is employed most frequently by people with fragile and/or unstable self-esteem. I read about "contingent" self-esteem, whereby one's sense of self-worth is dependent upon maintaining certain self-imposed standards. (What if those standards include "always being right" or "never losing an argument?" If that were the case I was completely screwed)!
"Conflict behavior" is also related to "attachment style." Briefly, attachment style as a concept comes from attachment theory. Attachment theory states that an infant's relationship with his primary caregiver becomes a template for his interpersonal relationships throughout life. A healthy, secure infant-caregiver relationship facilitates "normal" social and emotional development. Problems in the infant-caregiver relationship disrupt social and emotional development. Inconsistent availability and/or responsiveness to infant needs by the caregiver leads to the development of an anxious or ambivalent attachment style. The defining feature of this attachment style is anxiety over abandonment. Adults with an anxious/ambivalent attachment style have a higher tendency than others to display hostility during conflict, to include the use of blaming, threatening, and other verbal aggression. When compared to adults with secure attachment, they show greater attempts to dominate conflict discussion.
My research led me to a tentative conclusion: "defensive hostility," "criticism," "aggressive denial of responsibility," and similar "conflict escalating behaviors" stem from underlying insecurities. (Incidentally, none of the research seems to suggest such behaviors stem primarily from "being an asshole." So that's good news). It is not immediately clear to me how to use this information. Assuming my conclusion is accurate, my husband is unlikely to ever acknowledge said insecurities, perhaps not even to himself. But perhaps just being aware will arouse my compassion in the midst of conflict. Maybe seeing criticism as motivated by fear and anxiety will help me to take it less personally.
Tuesday, March 4, 2014
Getting Offended
I am not a fan of meetings. They always seem to drag on forever. Conversation tends to stray from the intended topic. I do okay if I have something to read or a crossword puzzle to do. This doesn't work very well in small group meetings, however. When there are only four or five people in the room it's harder to hide the fact that you're doing something completely unrelated and are not paying attention to what's being said. In these types of meetings I end up talking too much in an effort to stay engaged.
It's always been difficult for me to just sit quietly and listen to someone talk for extended periods of time. You may recall that I have narcolepsy; extended periods of inactivity tend to put me to sleep, literally. In college, I used to read and take notes during lectures. It was actually easier for me to pay attention when I was simultaneously engaged in doing something else than it was for me to give my "undivided" attention.
Because I can't avoid meetings (which would definitely be my preference if given a choice) I try to cope with them the best I can. Since the strategy for paying attention I used in college worked well for me I naturally continued to use it when I joined the workforce. Unfortunately, this caused a lot of problems when I first started at my current job. My supervisor at the time made comments to others about how disrespectful it was of me to read during meetings and presentations. It was obvious to me (and to a lot of other people) that my supervisor did not like me very much. It wasn't until the comments he'd made got back to me that I understood why.
I decided it was in my best interest for my supervisor to like me. I started going out of my way to show I was paying attention in meetings. I participated and contributed way more than I wanted to. But it seemd to work. Over time, my supervisor gradually warmed up to me.
Something about me ...When I get excited about something (which isn't very often) I have a tendency to go overboard. I keep talking about it when I know I should shut up. I realize this is a personal flaw but I have a very difficult time controlling it. This sometimes happens in meetings at work. Because I feel compelled to engage (as I mentioned before) I go out of my way to participate in discussions. Occasionally something interesting comes up and I get excited about it. Because I'm excited I keep talking about it far longer than necessary. I'm sure this annoys people; it annoys me. On the other hand, everyone has flaws. Most of my coworkers know me well enough to realize my intentions are good.
But apparently this is not always the case. The other day my boss (not the same supervisor I mentioned earlier) came to my office. (I absolutely hate it when this happens because it's never a good thing). She wanted to tell me that one of my colleagues who'd attended a meeting the week before was very upset because I'd interrupted him. She was of the opinion that he could have easily handled the problem at the meeting by simply telling me to let him finish speaking. She didn't understand why he felt the need to complain to someone else (who then went to her for feedback). Nevertheless, she advised me to be mindful of this in the future.
I checked my email later that day. I noticed I'd received an email from the colleague who had complained about me. I opened it. The email was brief. He wanted to talk to me about "something that happened at the meeting last week" and wanted to know when I would be available.
At this point I was annoyed. Okay, so maybe I was already a little annoyed but now I was irritated. It seemed far too much was being made over a very minor incident. This guy's complaint had already gotten me scolded by my boss. Now I had to schedule a time for him to call and chastise me?
I didn't respond right away. Actually, I considered not responding at all. The more I thought about it the more pissed off I became. My mind went back and forth with itself. Was I being too defensive? Was I just upset because I'd been criticized? I know I don't like criticism -- nodbody does. But I make a conscious effort to try to accept it when it's warranted, no matter how defensive I feel.
Honestly though, I wasn't even sure it was the criticism itself I was upset about. Okay, so I interuppted him. I know I have a habit of doing this when I get excited. I know it's a problem. It might sting a little to have someone else point it out but it's probably the best thing to help me break the habit.
The thing is, the guy who complained hadn't pointed it out to me. Instead, the chain of events went something like this: 1. I unintentionally offend a colleague at a meeting. I do not know I have offended him. He says nothing about being offended. 2. He apparently pulls my coworker aside after the meeting. He tells her he is offended. He says if I am going to interrupt him then he is not going to come to the meetings anymore. He asks her to speak to me about it. 3. My coworker doesn't feel comfortable speaking to me about it. Instead, she goes to our boss for advice. My boss says she should advise the offended colleague to simply tell me he was offended. She was sure I didn't mean to offend him and would promptly apologize for doing so. 4. My coworker communicates this message to the offended colleague. 5. In the meantime, my boss comes in to my office to talk to me about another issue. She also mentions that a colleague was offended that I'd interrupted him. She asked me to be mindful of this in the future. I say okay. 6. The offended colleague receives the feedback advising him to address his concern with me himself. He sends me an email to schedule a time to talk about "something that happened in the meeting last week." You know the rest.
I was convinced that my offended colleague had not handled the situation correctly. There are a lot of un-offensive, socially acceptable ways to say, "Please don't interrupt me" or "Please let me finish speaking." If he'd said something, I probably would have apologized right then and shut up. No big deal. Still, I wasn't sure if this was a valid reason for me to be upset.
I ended up seeking advice from a trusted coworker. She agreed that the whole thing had been blown way out of proportion. She suggested I reply to the offended colleague's email telling him my boss had already spoken to me about the issue and apologizing for interrupting him. So that's exactly what I did.
He emailed a response. He accepted my apology. He also suggested that, in the future, I don't give any feedback unless someone asks for it. Ha!
It's always been difficult for me to just sit quietly and listen to someone talk for extended periods of time. You may recall that I have narcolepsy; extended periods of inactivity tend to put me to sleep, literally. In college, I used to read and take notes during lectures. It was actually easier for me to pay attention when I was simultaneously engaged in doing something else than it was for me to give my "undivided" attention.
Because I can't avoid meetings (which would definitely be my preference if given a choice) I try to cope with them the best I can. Since the strategy for paying attention I used in college worked well for me I naturally continued to use it when I joined the workforce. Unfortunately, this caused a lot of problems when I first started at my current job. My supervisor at the time made comments to others about how disrespectful it was of me to read during meetings and presentations. It was obvious to me (and to a lot of other people) that my supervisor did not like me very much. It wasn't until the comments he'd made got back to me that I understood why.
I decided it was in my best interest for my supervisor to like me. I started going out of my way to show I was paying attention in meetings. I participated and contributed way more than I wanted to. But it seemd to work. Over time, my supervisor gradually warmed up to me.
Something about me ...When I get excited about something (which isn't very often) I have a tendency to go overboard. I keep talking about it when I know I should shut up. I realize this is a personal flaw but I have a very difficult time controlling it. This sometimes happens in meetings at work. Because I feel compelled to engage (as I mentioned before) I go out of my way to participate in discussions. Occasionally something interesting comes up and I get excited about it. Because I'm excited I keep talking about it far longer than necessary. I'm sure this annoys people; it annoys me. On the other hand, everyone has flaws. Most of my coworkers know me well enough to realize my intentions are good.
But apparently this is not always the case. The other day my boss (not the same supervisor I mentioned earlier) came to my office. (I absolutely hate it when this happens because it's never a good thing). She wanted to tell me that one of my colleagues who'd attended a meeting the week before was very upset because I'd interrupted him. She was of the opinion that he could have easily handled the problem at the meeting by simply telling me to let him finish speaking. She didn't understand why he felt the need to complain to someone else (who then went to her for feedback). Nevertheless, she advised me to be mindful of this in the future.
I checked my email later that day. I noticed I'd received an email from the colleague who had complained about me. I opened it. The email was brief. He wanted to talk to me about "something that happened at the meeting last week" and wanted to know when I would be available.
At this point I was annoyed. Okay, so maybe I was already a little annoyed but now I was irritated. It seemed far too much was being made over a very minor incident. This guy's complaint had already gotten me scolded by my boss. Now I had to schedule a time for him to call and chastise me?
I didn't respond right away. Actually, I considered not responding at all. The more I thought about it the more pissed off I became. My mind went back and forth with itself. Was I being too defensive? Was I just upset because I'd been criticized? I know I don't like criticism -- nodbody does. But I make a conscious effort to try to accept it when it's warranted, no matter how defensive I feel.
Honestly though, I wasn't even sure it was the criticism itself I was upset about. Okay, so I interuppted him. I know I have a habit of doing this when I get excited. I know it's a problem. It might sting a little to have someone else point it out but it's probably the best thing to help me break the habit.
The thing is, the guy who complained hadn't pointed it out to me. Instead, the chain of events went something like this: 1. I unintentionally offend a colleague at a meeting. I do not know I have offended him. He says nothing about being offended. 2. He apparently pulls my coworker aside after the meeting. He tells her he is offended. He says if I am going to interrupt him then he is not going to come to the meetings anymore. He asks her to speak to me about it. 3. My coworker doesn't feel comfortable speaking to me about it. Instead, she goes to our boss for advice. My boss says she should advise the offended colleague to simply tell me he was offended. She was sure I didn't mean to offend him and would promptly apologize for doing so. 4. My coworker communicates this message to the offended colleague. 5. In the meantime, my boss comes in to my office to talk to me about another issue. She also mentions that a colleague was offended that I'd interrupted him. She asked me to be mindful of this in the future. I say okay. 6. The offended colleague receives the feedback advising him to address his concern with me himself. He sends me an email to schedule a time to talk about "something that happened in the meeting last week." You know the rest.
I was convinced that my offended colleague had not handled the situation correctly. There are a lot of un-offensive, socially acceptable ways to say, "Please don't interrupt me" or "Please let me finish speaking." If he'd said something, I probably would have apologized right then and shut up. No big deal. Still, I wasn't sure if this was a valid reason for me to be upset.
I ended up seeking advice from a trusted coworker. She agreed that the whole thing had been blown way out of proportion. She suggested I reply to the offended colleague's email telling him my boss had already spoken to me about the issue and apologizing for interrupting him. So that's exactly what I did.
He emailed a response. He accepted my apology. He also suggested that, in the future, I don't give any feedback unless someone asks for it. Ha!
Tuesday, February 25, 2014
Lying Liars: Normal versus Pathological Liars
I have a strong aversion to habitual liars. I'm talking about people who make up stories about the places they've been, the things they've done, and the feats they've accomplished. These are people who lie about stupid things - for example, they tell you they grew up in Seattle when they've never seen the West Coast. I don't like having to dig for the truth when I talk to someone. I don't like having to view everything someone tells me with suspicion. And most of all, I don't like being lied to. Discovering you've been deceived is painful. You feel angry, hurt, and betrayed. You feel embarassed about being played for a fool. You second guess yourself and your judgment.
But are habitual liars - pathological liars - all that different from the rest of us? Everyone lies. We may, as a society, condemn lying. We may say we value honesty. And maybe we do. But we still lie.
Apparently, lying is normal. We all do it and most of us do it quite frequently. Studies have shown that the average adult tells at least one lie per day. Mostly we lie to benefit ourselves (according to DePaulo, Kashy, Kirkendol, Wyer, and Epstein). We lie to enhance our reputations, to avoid undesirable consequences, or to gain an edge over others. Perhaps this is a natural consequence of individualism. If the needs of the individual are primary then anything that benefits the individual over the group is useful. Since lying often gives the individual an advantage over the whole, the individual sees lying as acceptable, or at least justifiable.
While most of our lies are self-centered, we also lie to benefit others. We do this mostly to spare the feelings of people we love ("That dress looks great on you," "This dinner you made is delicious," "I love the gift you gave me"). When we lie about our feelings we generally do so to benefit others and typically pretend to feel more positively than we actually do.
Saxe points out that lying is often situationally determined. Circumstances that increase the likelihood of lying include those in which the risk of getting caught lying is low, the potential benefits of lying are high, and the potential consequences of being honest are severe.
So if lying is such a widespread practice, at what point does it become "pathological?" Dike explains the difference between "normal" and "pathological" lying. Oridnary lying is goal directed; it is done for a specific purpose with a desired outcome in mind. Pathological lying has no identifiable purpose or, if it does, the lie is extremely disproportional to the benefit expected to be gained. Sometimes the lies are even damaging to the person telling them. For a pathological liar the benefit is psychological; lying in itself is rewarding.
What kind of person enjoys telling lies? Bursten suggests those with a "manipulative personality." According to Bursten, someone with a manipulative personality has a fragile self-image. He attempts to bolster this image by proving to himself that he is "better" than others. By telling lies and getting away with them, he gains a sense of power over those he deceives. He feels a level of contempt for his victims for lacking the ability to detect his deception. This enables him to feel superior.
Before we judge the pathological liar too harshly we should first consider the following. Pathological liars may not be able to control their lying. Some experts suspect lying is compulsive for the pathological liar. He lies in spite of himself; he cannot help it.
There may also be something different about the brains of pathological liars. Several studies have demonstrated a relationship between pathological lying and increaed white matter in the prefrontal cortex.
So what have I learned about pathological liars? Mostly I've learned that we don't know much. There is a lack of consensus among experts about how even to define the term "pathological liar." We don't know if pathological lying is a disorder unto itself or if it exists only as a symptom of other disorders. We aren't sure how much, if any, control pathological liars have over their lying. We don't even know if pathological liars always know they are lying!
What I do know is my own preference, which is to be lied to as rarely as possible.
But are habitual liars - pathological liars - all that different from the rest of us? Everyone lies. We may, as a society, condemn lying. We may say we value honesty. And maybe we do. But we still lie.
Apparently, lying is normal. We all do it and most of us do it quite frequently. Studies have shown that the average adult tells at least one lie per day. Mostly we lie to benefit ourselves (according to DePaulo, Kashy, Kirkendol, Wyer, and Epstein). We lie to enhance our reputations, to avoid undesirable consequences, or to gain an edge over others. Perhaps this is a natural consequence of individualism. If the needs of the individual are primary then anything that benefits the individual over the group is useful. Since lying often gives the individual an advantage over the whole, the individual sees lying as acceptable, or at least justifiable.
While most of our lies are self-centered, we also lie to benefit others. We do this mostly to spare the feelings of people we love ("That dress looks great on you," "This dinner you made is delicious," "I love the gift you gave me"). When we lie about our feelings we generally do so to benefit others and typically pretend to feel more positively than we actually do.
Saxe points out that lying is often situationally determined. Circumstances that increase the likelihood of lying include those in which the risk of getting caught lying is low, the potential benefits of lying are high, and the potential consequences of being honest are severe.
So if lying is such a widespread practice, at what point does it become "pathological?" Dike explains the difference between "normal" and "pathological" lying. Oridnary lying is goal directed; it is done for a specific purpose with a desired outcome in mind. Pathological lying has no identifiable purpose or, if it does, the lie is extremely disproportional to the benefit expected to be gained. Sometimes the lies are even damaging to the person telling them. For a pathological liar the benefit is psychological; lying in itself is rewarding.
What kind of person enjoys telling lies? Bursten suggests those with a "manipulative personality." According to Bursten, someone with a manipulative personality has a fragile self-image. He attempts to bolster this image by proving to himself that he is "better" than others. By telling lies and getting away with them, he gains a sense of power over those he deceives. He feels a level of contempt for his victims for lacking the ability to detect his deception. This enables him to feel superior.
Before we judge the pathological liar too harshly we should first consider the following. Pathological liars may not be able to control their lying. Some experts suspect lying is compulsive for the pathological liar. He lies in spite of himself; he cannot help it.
There may also be something different about the brains of pathological liars. Several studies have demonstrated a relationship between pathological lying and increaed white matter in the prefrontal cortex.
So what have I learned about pathological liars? Mostly I've learned that we don't know much. There is a lack of consensus among experts about how even to define the term "pathological liar." We don't know if pathological lying is a disorder unto itself or if it exists only as a symptom of other disorders. We aren't sure how much, if any, control pathological liars have over their lying. We don't even know if pathological liars always know they are lying!
What I do know is my own preference, which is to be lied to as rarely as possible.
Wednesday, February 19, 2014
We can't handle the truth! Self deception and why we lie to ourselves
We all lie to ourselves. Some of us do it more than others but all of us do it. There are obvious disadvantages to self deception. When we deceive ourselves about the nature of reality we are ill-equipped to cope with the problems reality presents. We can't deal with a reality we don't know exists. This makes us vulnerable to threats we don't see until it is too late. We are more likely to be blindsided by misfortune for which we could have prepared if we'd been more honest with ourselves. When extreme, self deception becomes obvious to others, who respond with anything from pity to ridicule. And yet, despite these disadvantages, we all engage in self deception.
So why do we do it? The most widely accepted theory is that - in certain circumstances - self deception serves a protective function. For example, self deception can preserve confidence and self esteem in the face of failure. In the aftermath of tragedy or trauma, self deception can preserve a sense of safety and security we need to move forward. Self deception can motivate us to persevere when the odds are against us. Self deception can help us endure hardship and maintain hope for the future. When the truth is too much to bear we lie to ourselves instead.
On the surface, self deception seems like a paradox. I'll explain. Technically, deception is an intentional act. If I do something intentionally then by definition I am aware that I am doing it. To deceive myself is to intentionally tell myself something that is not true. But if I do this intentionally then I must be aware I am doing it. If I know I am telling myself a lie then don't I also know the truth? And if I know the truth then I haven't really deceived myself, right?
The question, then, is how can someone lie to himself and not know it? To my surprise, there are actually a number of ways this can happen. One method involves information processing and attention. A person can deceive himself by encoding only desirable or welcome information into memory while preventing unwelcome or undesirable information from being encoded. This is essentially a matter of "selective attention," i.e. paying attention to certain aspects of available information while ignoring the rest. This can be done on a conscious level, an unconscious level, or somewhere in between; we may or may not be fully aware of what we're doing.
Another method of self deception is through avoidance. I can keep myself uninformed of information or truths I do not want to know by avoiding activities, situations, or circumstances that might reveal them to me. For example, a wife can avoid discovering her husband's affair by not calling him at work when he claims to be working late. If she did call his work she would be told he'd left hours ago. But she doesn't call because she doesn't want to know.
Self deception can also occur via biased interpretation. Imagine I am presented with a large amount of information, some of which confirms my stance on a particular subject and some that contradicts it. I accept the information that affirms my stance as empirically valid. I decide the information contradicting my stance comes from an unreliable source and is therefore not valid. I may reach this conclusions even if all of the information comes from the same source. Self deception does not necessarally follow the rules of logic.
I'll end with a couple of principles of self deception:
*People do not tell themselves the whole truth if a partial truth is preferable.
*In self deception, people tend to be motivated by what they want to be true.
So why do we do it? The most widely accepted theory is that - in certain circumstances - self deception serves a protective function. For example, self deception can preserve confidence and self esteem in the face of failure. In the aftermath of tragedy or trauma, self deception can preserve a sense of safety and security we need to move forward. Self deception can motivate us to persevere when the odds are against us. Self deception can help us endure hardship and maintain hope for the future. When the truth is too much to bear we lie to ourselves instead.
On the surface, self deception seems like a paradox. I'll explain. Technically, deception is an intentional act. If I do something intentionally then by definition I am aware that I am doing it. To deceive myself is to intentionally tell myself something that is not true. But if I do this intentionally then I must be aware I am doing it. If I know I am telling myself a lie then don't I also know the truth? And if I know the truth then I haven't really deceived myself, right?
The question, then, is how can someone lie to himself and not know it? To my surprise, there are actually a number of ways this can happen. One method involves information processing and attention. A person can deceive himself by encoding only desirable or welcome information into memory while preventing unwelcome or undesirable information from being encoded. This is essentially a matter of "selective attention," i.e. paying attention to certain aspects of available information while ignoring the rest. This can be done on a conscious level, an unconscious level, or somewhere in between; we may or may not be fully aware of what we're doing.
Another method of self deception is through avoidance. I can keep myself uninformed of information or truths I do not want to know by avoiding activities, situations, or circumstances that might reveal them to me. For example, a wife can avoid discovering her husband's affair by not calling him at work when he claims to be working late. If she did call his work she would be told he'd left hours ago. But she doesn't call because she doesn't want to know.
Self deception can also occur via biased interpretation. Imagine I am presented with a large amount of information, some of which confirms my stance on a particular subject and some that contradicts it. I accept the information that affirms my stance as empirically valid. I decide the information contradicting my stance comes from an unreliable source and is therefore not valid. I may reach this conclusions even if all of the information comes from the same source. Self deception does not necessarally follow the rules of logic.
I'll end with a couple of principles of self deception:
*People do not tell themselves the whole truth if a partial truth is preferable.
*In self deception, people tend to be motivated by what they want to be true.
Wednesday, February 12, 2014
A "Good" Apology
Dov Seidman nostalgically recalls a time when apologies really meant something. These days, he believes apology has become a sort of theater. This is particularly true for public figures, whose apologies more and more frequently seem like performances rather than genuine expressions of remorse. Seidman contends that the behavior of public figures simply reflects a broader societal norm. According to Seidman, people today use apologies as a "verbal escape route" or a way to "get out of jail cheaply." This trend has so cheapened the apology that it has become all but meaningless.
And so Dov Seidman, together with Andrew Ross Sorkin, have started a campaign to draw attention to the current "aplogy crisis." Their project is called "Apology Watch" and can be found at nytimes.com/dealbook. and on Twitter under the hashtage #ApologyWatch. Seidman and Sorkin are asking readers to help them track new public apologies in real time. The plan is to rate each apology on its level of overall sincerity.
I first heard about Apology Watch on NPR. I was immediately intrigued at the idea. As I do with most things that spark my interest, I decided to do a little research on the topic. While the focus of Apology Watch is primarily on people in the public arena, I am personally more interested in the function of apologies in interpersonal relationships. Still, I hoped that some of Seidman's ideas might be applicable on both the large and small scale.
Seidman believes that the sincerity of a given apology can be measured not so much by its content but by what comes both before and after it. Before issuing an apology, Seidman contends, an offender should take the time to do some soul searching. A good apology first requires a period of introspection.
An example of this, Seidman says, is the 2011 apology made by Netflix CEO Reed Hastings for raising subscription rates. The rate increase sparked an immediate backlash from consumers, who cancelled their subscriptions in droves. Stock prices fell over 7% in the weeks after the decision was announced. Two months after implementing the rate increase CEO Hastings issued an apology and restored prices to their original level. Hastings' apology was good, explains Seidman, because it began with "a complete vulnerable revelation" (i.e., success had made him arrogant and that this arrogance motivated his decision to raise prices). Seidman believes that Hastings could only have come to this realization by looking inside himself and being honest about what he found (i.e., introspection).
Seidman's suggestion, then, is that before issuing an apology an offender should take a complete moral inventory of himself. Ken Blanchard and Margaret McBride suggest an offender ask himself the following:
*What mistakes did I make?
*Did I dismiss the feelings, wishes, or ideas of another person?
*Why did I do this?
*Was it an impulsive thoughtless behavior?
*Or was it calcualted?
*Did I act out of fear, anger, or frustration?
*What was my motivation?
*How long did I let this go on? Has this behavior become a repeated pattern in my life?
*What truth am I not dealing with?
*Am I better than this behavior?
So according to Seidman, a period of introspection, self-examination, etc. should be undertaken before offering an apology. There are also certain things that should come after a genuine apology.
Seidman states that a genuine apology must be followed by intentional and sustained changes in behavior. If an apology is sincere, the person apologizing immediately begins to take action to repair, mitigate, or at least atone for whatever damage he has caused.
So often people want forgiveness but are unwilling to accept the consequences of their actions. Saying I'm sorry does not immediately restore trust once it has been betrayed; the restoration of trust takes time. The victim of a betrayal may need the offender to take certain steps to demonstrate his trustworthiness, above and beyond what would otherwise be expected. The offending party does not get to dictate what measures are "reasonable" or how much time it should take before trust is regained. If he is genuinely sorry and truly wants forgiveness he must be willling to do whatever it takes for however long it takes. These are the consequences of his actions. Aplogizing does not exempt him from these consequences.
This is something Seidman does not mention in his writing but that I think is relevant. Perhaps we, as a society, let people off too easily. Maybe we are too willing to forgive and forget once a public figure apologizes for bad behavior. A movie star does something appalling; we still watch his movies. A CEO takes advantage of his customers; we still buy his products or services. A company abuses its employees; we continue to shop there. A chemical company dumps toxins in the water supply? A slap on the wrist and a license to keep operating. We no longer hold anyone accountable. We're probably lucky that people bother to apologize at all.
And so Dov Seidman, together with Andrew Ross Sorkin, have started a campaign to draw attention to the current "aplogy crisis." Their project is called "Apology Watch" and can be found at nytimes.com/dealbook. and on Twitter under the hashtage #ApologyWatch. Seidman and Sorkin are asking readers to help them track new public apologies in real time. The plan is to rate each apology on its level of overall sincerity.
I first heard about Apology Watch on NPR. I was immediately intrigued at the idea. As I do with most things that spark my interest, I decided to do a little research on the topic. While the focus of Apology Watch is primarily on people in the public arena, I am personally more interested in the function of apologies in interpersonal relationships. Still, I hoped that some of Seidman's ideas might be applicable on both the large and small scale.
Seidman believes that the sincerity of a given apology can be measured not so much by its content but by what comes both before and after it. Before issuing an apology, Seidman contends, an offender should take the time to do some soul searching. A good apology first requires a period of introspection.
An example of this, Seidman says, is the 2011 apology made by Netflix CEO Reed Hastings for raising subscription rates. The rate increase sparked an immediate backlash from consumers, who cancelled their subscriptions in droves. Stock prices fell over 7% in the weeks after the decision was announced. Two months after implementing the rate increase CEO Hastings issued an apology and restored prices to their original level. Hastings' apology was good, explains Seidman, because it began with "a complete vulnerable revelation" (i.e., success had made him arrogant and that this arrogance motivated his decision to raise prices). Seidman believes that Hastings could only have come to this realization by looking inside himself and being honest about what he found (i.e., introspection).
Seidman's suggestion, then, is that before issuing an apology an offender should take a complete moral inventory of himself. Ken Blanchard and Margaret McBride suggest an offender ask himself the following:
*What mistakes did I make?
*Did I dismiss the feelings, wishes, or ideas of another person?
*Why did I do this?
*Was it an impulsive thoughtless behavior?
*Or was it calcualted?
*Did I act out of fear, anger, or frustration?
*What was my motivation?
*How long did I let this go on? Has this behavior become a repeated pattern in my life?
*What truth am I not dealing with?
*Am I better than this behavior?
So according to Seidman, a period of introspection, self-examination, etc. should be undertaken before offering an apology. There are also certain things that should come after a genuine apology.
Seidman states that a genuine apology must be followed by intentional and sustained changes in behavior. If an apology is sincere, the person apologizing immediately begins to take action to repair, mitigate, or at least atone for whatever damage he has caused.
So often people want forgiveness but are unwilling to accept the consequences of their actions. Saying I'm sorry does not immediately restore trust once it has been betrayed; the restoration of trust takes time. The victim of a betrayal may need the offender to take certain steps to demonstrate his trustworthiness, above and beyond what would otherwise be expected. The offending party does not get to dictate what measures are "reasonable" or how much time it should take before trust is regained. If he is genuinely sorry and truly wants forgiveness he must be willling to do whatever it takes for however long it takes. These are the consequences of his actions. Aplogizing does not exempt him from these consequences.
This is something Seidman does not mention in his writing but that I think is relevant. Perhaps we, as a society, let people off too easily. Maybe we are too willing to forgive and forget once a public figure apologizes for bad behavior. A movie star does something appalling; we still watch his movies. A CEO takes advantage of his customers; we still buy his products or services. A company abuses its employees; we continue to shop there. A chemical company dumps toxins in the water supply? A slap on the wrist and a license to keep operating. We no longer hold anyone accountable. We're probably lucky that people bother to apologize at all.
Wednesday, February 5, 2014
Rigid Personality
My husband says I'm inflexible. He's not the first person to tell me this. I don't deny it. I have a strong preference for structure over chaos. It takes me a while to adjust to big changes. I am easily stressed out, even over small things. I like my space to be clean (or at least tidy). Messiness makes me feel like the room is closing in on me.
If something needs to be done I prefer to go ahead and do it as soon as possible; I rarely procrastinate. I like to plan activities and/or events in advance. I don't like spur of the moment invitations and will typically decline them. I am very attached to my routines. If there is somewhere I've planned to go at a particular time or something I do regularly on certain days I generally resist any attempts by other people to intefere.
So no, I am not particularly flexible. I can bend and I do bend, but only under a limited number of extenuating circumstances.
I admit that I can be too "rigid" at times. This sometimes leads to negative consequences. As I said before, I get stressed out a lot. I'm not always anxious but I do struggle with anxiety. I am stubborn to a fault. I become irritable and unpleasant when I feel overwhelmed.
My husband highlights these consequences and insists that I change. I'm too rigid, he says. I won't listen to reason. (I completely disagree with the latter sentiment. I do listen to reason. It's just that I do not always find his "reason" compelling. I listen to it and then I disagree. I have a right to disagree. It doesn't mean I'm unreasonable).
While I disagree with the crux of my husband's argument, buried within it lies a valid point. I can be too rigid.
And yet this very same quality bestows so many benefits. I am consistent, steady, and reliable. I get things done. I am responsible. I am conscientious. I am predictable. This may not make me the most exciting person in the world but I'm okay with that. People know what to expect from me; there is something comforting about that. I finish what I start; I follow through with committments. Because of this I have, for example, no difficulty exercising regularly and maintaining healthy eating habits. In fact, I don't really have a problem maintaing any positive habit, once it becomes a habit. I'm good at habits. Habits are my thing.
It is difficult for me to know where to draw the line. Yes I'm a bit rigid but to a certain degree this works well for me. It enables me to structure my life in a way that ensures I have time to devote to every important person, activity, event, and/or obligation. I realize, however, that being too rigid creates problems. Sometimes I refuse to budge, even when I know I'm making things more difficult than they have to be. There is definitely room for improvement.
When it comes to my marriage, I know that trying to be more flexible will decrease conflict and increase harmony. I also believe, however, that a great deal of benefit would come from my husband putting effort into trying to understand and accept me as I am, for who I am, instead of wanting me to be a different "type" or "kind" of person. (And that goes both ways, of course, i.e., me learning to accept him as he is). I am open to self-improvement but I can't be a different person. I don't want to be a different person. And I don't want anyone to pressure me into being anyone other than myself. If I say to my husband, "This is who I am. Please try to accept me," am I just being rigid and obstinate? I am confused at this point about whether I should be working on changing myself or encouraging him to to accept me as I am...
If something needs to be done I prefer to go ahead and do it as soon as possible; I rarely procrastinate. I like to plan activities and/or events in advance. I don't like spur of the moment invitations and will typically decline them. I am very attached to my routines. If there is somewhere I've planned to go at a particular time or something I do regularly on certain days I generally resist any attempts by other people to intefere.
So no, I am not particularly flexible. I can bend and I do bend, but only under a limited number of extenuating circumstances.
I admit that I can be too "rigid" at times. This sometimes leads to negative consequences. As I said before, I get stressed out a lot. I'm not always anxious but I do struggle with anxiety. I am stubborn to a fault. I become irritable and unpleasant when I feel overwhelmed.
My husband highlights these consequences and insists that I change. I'm too rigid, he says. I won't listen to reason. (I completely disagree with the latter sentiment. I do listen to reason. It's just that I do not always find his "reason" compelling. I listen to it and then I disagree. I have a right to disagree. It doesn't mean I'm unreasonable).
While I disagree with the crux of my husband's argument, buried within it lies a valid point. I can be too rigid.
And yet this very same quality bestows so many benefits. I am consistent, steady, and reliable. I get things done. I am responsible. I am conscientious. I am predictable. This may not make me the most exciting person in the world but I'm okay with that. People know what to expect from me; there is something comforting about that. I finish what I start; I follow through with committments. Because of this I have, for example, no difficulty exercising regularly and maintaining healthy eating habits. In fact, I don't really have a problem maintaing any positive habit, once it becomes a habit. I'm good at habits. Habits are my thing.
It is difficult for me to know where to draw the line. Yes I'm a bit rigid but to a certain degree this works well for me. It enables me to structure my life in a way that ensures I have time to devote to every important person, activity, event, and/or obligation. I realize, however, that being too rigid creates problems. Sometimes I refuse to budge, even when I know I'm making things more difficult than they have to be. There is definitely room for improvement.
When it comes to my marriage, I know that trying to be more flexible will decrease conflict and increase harmony. I also believe, however, that a great deal of benefit would come from my husband putting effort into trying to understand and accept me as I am, for who I am, instead of wanting me to be a different "type" or "kind" of person. (And that goes both ways, of course, i.e., me learning to accept him as he is). I am open to self-improvement but I can't be a different person. I don't want to be a different person. And I don't want anyone to pressure me into being anyone other than myself. If I say to my husband, "This is who I am. Please try to accept me," am I just being rigid and obstinate? I am confused at this point about whether I should be working on changing myself or encouraging him to to accept me as I am...
Thursday, January 30, 2014
Blaming yourself when bad things happen
I've talked before about the role of self-blame in maintaining depression. As I've read more on this topic I discvoered that self-blame is not always associated with depression. (I guess I don't really see those people who blame themselves but aren't depressed. They don't tend to need therapy). Based on personal experience, it seems like self-blame often provides people with a greater sense of control. If I did something wrong that caused something bad to happen then all I have to do to keep it from happening again in the future is to change my own behavior. For many of my patients, gaining this sense of control decreases anxiety but also causes a lot of guilt which, over time, leads to depression.
According to the research literature, however, this type of self-blame should not lead to depression. Peterson, Schwartz, and Seligman explain that attributing a negative event to one's own behavior increases perceived controllability (as I said before) and creates the sense that one's bad behavior was situation specific. (In other words, a person sees his behavior in a given situation as a one time thing. He doesn't see it as representative of a broader pattern of bad behavior or as a reflection of who he is as a person). Peterson et al. call this phenomenon "behavioral self blame" and describe it as an "attributional defense mechanism...[that is] inconsistent with depression."
So what gives? Why do I see so many depressed patients who blame their bad behavior for causing significant negative events? According to research, this sort of self-blame is a defense mechanism and should protect them from depression. Why does this not seem to be happening?
I don't have a definitive answer but I do have some ideas...
One thing that stands out to me is how many of my self-blaming patients seem unable to forgive themselves for making mistakes. Theoretically, attributing a negative event to their own behavior should boost their sense of control, leading to increased hopefulness about their ability to prevent similar events from taking place in the future. And yet, I don't often see hopefulness. Instead I see a tendency to dwell on perceived mistakes, which creates an overwhelming sense of guilt and self-doubt. It's difficult to feel hopeful about the future when you're busy condemning yourself for mistakes you made in the past. Part of "behavioral self blame" is "admitting I did something wrong." For some, making a mistake is simply unacceptable. In such cases, "behavioral self-blame" equates to perpertual self-condemnation; this inevitably leads to depression.
Or perhaps certain kinds of negative events are simply so terrible that normal rules don't apply. The negative events experienced by the majority of my patients fall into one of two categories: 1. Combat-related incidents in which one or more people were seriously injured and/or killed and 2. Sexual assault. Rape and violent death are more extreme than most other negative life events. Perhaps the reactions people have to these experiences are therefore more complex.
Another possiblity for some is their inability to identify what exactly they did wrong. That is, they have the general sense that they did something to cause a negative event but despite replaying the event in their minds again and again they are unable to identify a specific behavior that would explain what happened. They feel compelled to continue replaying the event in their minds in an effort to figure out exactly what they did wrong. I imagine the people who do this are people who have a pre-existing tendency to blame themselves when things go wrong; the drive to blame oneself in the absence of any evidence seems to suggest this.
These are just theories...
According to the research literature, however, this type of self-blame should not lead to depression. Peterson, Schwartz, and Seligman explain that attributing a negative event to one's own behavior increases perceived controllability (as I said before) and creates the sense that one's bad behavior was situation specific. (In other words, a person sees his behavior in a given situation as a one time thing. He doesn't see it as representative of a broader pattern of bad behavior or as a reflection of who he is as a person). Peterson et al. call this phenomenon "behavioral self blame" and describe it as an "attributional defense mechanism...[that is] inconsistent with depression."
So what gives? Why do I see so many depressed patients who blame their bad behavior for causing significant negative events? According to research, this sort of self-blame is a defense mechanism and should protect them from depression. Why does this not seem to be happening?
I don't have a definitive answer but I do have some ideas...
One thing that stands out to me is how many of my self-blaming patients seem unable to forgive themselves for making mistakes. Theoretically, attributing a negative event to their own behavior should boost their sense of control, leading to increased hopefulness about their ability to prevent similar events from taking place in the future. And yet, I don't often see hopefulness. Instead I see a tendency to dwell on perceived mistakes, which creates an overwhelming sense of guilt and self-doubt. It's difficult to feel hopeful about the future when you're busy condemning yourself for mistakes you made in the past. Part of "behavioral self blame" is "admitting I did something wrong." For some, making a mistake is simply unacceptable. In such cases, "behavioral self-blame" equates to perpertual self-condemnation; this inevitably leads to depression.
Or perhaps certain kinds of negative events are simply so terrible that normal rules don't apply. The negative events experienced by the majority of my patients fall into one of two categories: 1. Combat-related incidents in which one or more people were seriously injured and/or killed and 2. Sexual assault. Rape and violent death are more extreme than most other negative life events. Perhaps the reactions people have to these experiences are therefore more complex.
Another possiblity for some is their inability to identify what exactly they did wrong. That is, they have the general sense that they did something to cause a negative event but despite replaying the event in their minds again and again they are unable to identify a specific behavior that would explain what happened. They feel compelled to continue replaying the event in their minds in an effort to figure out exactly what they did wrong. I imagine the people who do this are people who have a pre-existing tendency to blame themselves when things go wrong; the drive to blame oneself in the absence of any evidence seems to suggest this.
These are just theories...
Wednesday, January 22, 2014
Avoidance as a Coping Strategy
It's easy to understand why we tend to avoid certain situations, activities, people, or tasks that stress us out, make us uncomfortable, or otherwise generate negative emotions. Nobody wants to feel bad, especially if there is some way to avoid it. Thus, if there is a particular situation that creates anxiety we will most likely avoid that situation whenever possible. It makes sense. There's no reason to deliberately cause ourselves suffering.
Similarly, we are sometimes faced with problems that create distress whenever we think about them. To avoid distress we simply avoid thinking about the problem. Of course we are typically unable to do this indefinitely, but we can always put things off until the last possible moment.
Avoiding things that cause us discomfort can be an effective strategy. If there is a certain person who always manages to get under our skin it is best to deal with said person as little as possible. If we are under a lot of stress and feeling overwhelmed, waiting until later to deal with certain problems could be the best way to preserve our emotional and psychological well being. We have to prioritize. If certain places make us uncomfortable and we don't have to go there then avoiding these places is completely logical. If talking about certain topics upsets us and there is no compelling reason to do so then it makes perfect sense to avoid conversations about said topics. If there are certain memories that are unpleasant to recall it can be beneficial not to recall them.
There are also times when avoidance is a very ineffective strategy. A coping mechanism is ineffective when it creates more problems than it solves. Avoidance has the potential to become this kind of strategy. Because avoidance is so effective at alleviating distress we can inadvertantly begin to rely too heavily on it as a coping mechanism. Anything that alleviates distress is inherently reinforcing. We feel distress, we avoid, the distress is gone. We feel better. We avoid more.
So when is avoidance detrimental? What follows are a few examples. This list is by no means exhaustive.
*When avoiding discomfort or distress becomes the primary factor you consider when deciding whether or not to do something. (Avoiding distress becomes your primary motivation; everything else takes a back seat).
*When the list of things you won't do because they cause distress grows so long that the list of things you will do is actually shorter. (The end result is that you spend most of your time at home and only leave when there's something you absolutely have to do).
*When you put off dealing with a problem or conflict for so long that you end up simply not dealing with it at all. (The problem doesn't go away, of course. It probably gets worse while you are busy not dealing with it).
*When you avoid doing things you need to do or dealing with things you need to deal with, despite significant negative consequences for doing so.
*When avoiding starts to cause conflict in significant interpersonal relationships.
Similarly, we are sometimes faced with problems that create distress whenever we think about them. To avoid distress we simply avoid thinking about the problem. Of course we are typically unable to do this indefinitely, but we can always put things off until the last possible moment.
Avoiding things that cause us discomfort can be an effective strategy. If there is a certain person who always manages to get under our skin it is best to deal with said person as little as possible. If we are under a lot of stress and feeling overwhelmed, waiting until later to deal with certain problems could be the best way to preserve our emotional and psychological well being. We have to prioritize. If certain places make us uncomfortable and we don't have to go there then avoiding these places is completely logical. If talking about certain topics upsets us and there is no compelling reason to do so then it makes perfect sense to avoid conversations about said topics. If there are certain memories that are unpleasant to recall it can be beneficial not to recall them.
There are also times when avoidance is a very ineffective strategy. A coping mechanism is ineffective when it creates more problems than it solves. Avoidance has the potential to become this kind of strategy. Because avoidance is so effective at alleviating distress we can inadvertantly begin to rely too heavily on it as a coping mechanism. Anything that alleviates distress is inherently reinforcing. We feel distress, we avoid, the distress is gone. We feel better. We avoid more.
So when is avoidance detrimental? What follows are a few examples. This list is by no means exhaustive.
*When avoiding discomfort or distress becomes the primary factor you consider when deciding whether or not to do something. (Avoiding distress becomes your primary motivation; everything else takes a back seat).
*When the list of things you won't do because they cause distress grows so long that the list of things you will do is actually shorter. (The end result is that you spend most of your time at home and only leave when there's something you absolutely have to do).
*When you put off dealing with a problem or conflict for so long that you end up simply not dealing with it at all. (The problem doesn't go away, of course. It probably gets worse while you are busy not dealing with it).
*When you avoid doing things you need to do or dealing with things you need to deal with, despite significant negative consequences for doing so.
*When avoiding starts to cause conflict in significant interpersonal relationships.
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