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DEFINITION OF PSYCHOTHERAPY

For the purposes of this essay, I will use the term “psychotherapy” to refer to a particular type of interpersonal process intended to facilitate conscious awareness of that which had previously been unconscious.  It is not meant to include the direct attempt to modify behavior, whether overt as action or covert as thoughts and feelings, through medication or manipulation of the external consequences of behavior.  Similarly, it does not include counseling, coaching, advising, or teaching as its primary goal.

THE RECENT HISTORY OF PSYCHOTHERAPY

In its current form psychotherapy has been popular for only about a century, although its roots are ancient.  Freud called attention to the importance of the personal unconscious, repository of those thoughts and feelings which are unique to a particular individual and presumed to be a result of his or her personal life experiences and genetically transmitted instincts.  Jung invited us to notice the collective unconscious, where we find ourselves connected to all of humanity through shared patterns of thoughts and feelings.  Each of them found the contents of a person’s dreams to be of particular value in accessing the unconscious, whether personal or collective.   Many followers of these two pioneers have refined the methodology for accessing these two types of unconscious material and integrating it into one’s conscious awareness, particularly with regard to the manifestation of unconscious material in the transference and countertransference.  However, Freud and Jung deserve most of the credit for making popular in modern culture the idea that the exploration and integration of unconscious material is a very important task, perhaps even the most important task any person can undertake. 

THE GOAL OF PSYCHOTHERAPY

Interestingly, both Freud and Jung became interested in the unconscious through their role as physicians, whose goals are healing and the alleviation of suffering.  Each of them realized that these goals could be served through greater conscious awareness of the unconscious, although Freud’s model implied somewhat more modest goals than Jung’s.  Freud held that greater awareness of the contents of the personal unconscious might help one to adjust more comfortably to the demands of civilization, but that a certain degree of discontent was unavoidable.  Jung believed that the exploration of the collective unconscious could reveal the purpose of one’s life and bring one closer to a state of union with God.  It is important to note that, in spite of a difference in the ultimate goal of psychotherapy, the exploration of unconscious process, particularly as manifested in the contents of dreams and fantasies, were considered to be central in its achievement.

THE LARGER IMPORTANCE OF PSYCHOTHERAPY

As noted above, psychotherapy is a new name for an ancient practice.  Introspection in the broadest sense has ancient roots in practices such as contemplation, meditation, dream incubation and interpretation, fasting and other ascetic practices, prayer, religious ritual, music, ingestion of psychedelic plants, vision questing, sleep deprivation and the like, to facilitate it.  The intentional use of any technique which facilitates introspection implies that introspection is in some way of value.  Whether one limits that value to the alleviation of some psychological suffering, as Freud would, or sees the value as ultimate spiritual realization, as Jung would, there is no disagreement that there is value in the facilitation or enhancement of introspection. 

One way to examine the value of introspection is to think about one’s source of authority.  In particular, the external versus internal locus of the source of authority is important to consider.  If an external authority, such as parents, culture, or church, leads me to believe that I should feel guilty or fearful, then the alleviation of such guilt or fear may come about as a result of discovering a more powerful  internal source of authority which contradicts this belief.  Of course there can be no guarantee that one can contact a more powerful internal source of authority.  Similarly, there is not guarantee that, once contacted, it will indeed counteract a belief previously instilled from an external source of authority.  However, many examples of such a counteraction are part of the experience most psychotherapists.

Here is a personal example of the shift from an external to an internal source of authority.  I was born in Utah and raised a Mormon.   I left Utah in the first year of my life, and left the Mormon church in the second decade.  The final chapter took place in my fourth decade, after having cultivated my sense of inner authority in therapy for 8 or 10 years, when I managed to get myself officially excommunicated.  During the course of the trial which resulted in my excommunication, I was sternly admonished by some of the members of the jury that the price I was going to pay in the hereafter for having been cast out of the Mormon brotherhood would be high indeed.  This invocation of the external authority of the belief system of the church produced a brief surge of terror in me–what if they were right?  Realizing after a few moments that my great fear was the result of my having been abusively conditioned as a child by such frightening stories, my terror quickly converted to rage.   Now paying more attention to my inner authority, I managed to suppress expression of both of these strong emotions and to continue with a fairly interesting dialogue with my jurors, and even got invited to offer a closing prayer when the trial came to an end.  The most powerful experience of my inner authority came after I walked out of the church.  When I got to the parking lot, and was quite separate from those who represented external authority of the church, I spontaneous and exuberantly began to leap into the air and shout for joy. 

A more interesting question about internal versus external authority comes up when there are major philosophical or moral questions in need of answers.  Questions about the purpose of one’s life, the ultimate nature of reality, or what is intrinsically moral in response to a given situation, are examples of such questions.  These are the types of questions that come up repeatedly during the course of one’s life, and one is therefore well advised to have some ongoing way of introspecting deeply enough to be able to find answers as they are needed. 

As example of the need for such answers was presented a few years ago by the publication of the book, Hitler’s Willing Executioners (Goldhagen, 1996).  It told of the thousands of German citizens, seemingly normal and decent human beings, who willingly went along with one of the most ghastly examples of genocide the world has seen.  It is interesting to speculate about the response of a German bureaucrat to the news that he will no longer be managing the logistics of railroad cars filled with merchandise bound for market.  Starting tomorrow his job will be the same with the minor exception of the cargo, which will now be human beings bound for torture and death.  He goes home, has dinner with his family, helps his children with their homework, makes love with his wife, and goes back to work the next day to carry out his slightly revised duties.  What is missing from this picture?  I would suggest that introspection is missing.  If this man had a habit of introspection, whether through prayer, meditation, contemplation, or psychotherapy, it is hard to imagine that he would go to work the next morning believing that his participation in genocide would not be in violation of some intrinsic moral principle.  (For research supporting this rather broad generalization, see May, [1987].)  Without such introspection, he is at the mercy of external authority, in this case the German state, which clearly reports to him no moral conflict in his compliance.  In fact, quite the opposite is the case.

I am not suggested that a brief course of psychotherapy or meditation instruction would have stopped a German bureaucrat in his or her tracks in the weeks before genocide became the assignment of the day.  The development of moral awareness that I am suggesting such introspective practices might have fostered would have to begin much earlier.  The popular TV show, “The Sopranos,” makes an attempt to examine what might happen when a person whose moral development has arrested at an early age is exposed to psychotherapy as a adult.  The result is certainly not a rapid compensation for earlier deficiencies in such development.  What I am suggesting is that a habit of introspection over the course of one entire life, or at least one’s entire adult life, can make a difference. 

At the most generic level it would seem that the capacity for introspection may be something like a muscle.  With regular use it becomes flexible and strong and can be very helpful to its owner.  Without regular use it atrophies and becomes useless.  In the most extreme case of neglect of the inner life, one not only loses the capacity to introspect deeply; one also can lose the awareness that there even exists any significant internal territory to explore through introspection.  Such a loss makes one extremely vulnerable to the Hitlers of the world, which in turn makes all of us vulnerable.  Just as there is increasing evidence that regular mental activity can counteract the loss of cognitive capacity that often accompanies aging, so regular introspective activity could be expected to sustain the capacity to introspect.

Although the Hitlers of the world give a dramatic lesson about our vulnerability as a species if we lose sight of our internal resources, more mundane examples abound.  The young retail clerk who cannot make the simplest of change without using the calculator built into the cash register has lost sight of an internal ability to calculate.  The weatherman who tells us that tomorrow will be a miserable day because rain is predicted invites us to forget that we can decide for ourselves whether we enjoy rainy weather.  The increasingly bizarre warning labels that come with electronic appliances, telling us to refrain from all sorts of things that would only be done by a person too handicapped to live outside an institution or a person committed to a painful suicide, invite us to ignore our common sense.

However, it is the ignoring of our internal resources regarding how to live a meaningful and a moral life that presents the greatest possibilities for individual and mass misery.  A life without a conscious sense of meaning or purpose will generate a certain desperation of its own, which is in some way the manifestation of the unconscious as it tries to get one’s attention regarding the failure to heed one’s calling.  However, if one’s habits and culture do not generally support introspection under such circumstances, one is likely to express one’s desperation in harmful ways.  The situation is made worse by the absence of internal awareness of morality, leaving even greater room for destructive acting out of such desperation. 

The use of introspection to discern an inner moral awareness is particularly under assault in much of the world today.  Laws, regulations, ethics codes, religious creeds, mandatory sentencing, and other external constraints on behavior, are displacing our internal awareness of what is moral and what is not.  As such external rules proliferate, they invite us to forget that we ever had any internal way of knowing such things in the first place–like the  young clerk who scarcely is aware of having the capacity to make change without a cash register.  Psychotherapy is one way to facilitate a reconnection with our inner moral compass.

This is not to say that external constraints on behavior are always negative.  I am quite pleased to have external constraints when needed in the short to prevent injury and death to humans as well as other species.  They may also raise awareness by calling to the public’s attention certain problems that need to be addressed.  However, in the long run such external constraints run the risk of displacing and weakening our internal constraints.  These internal constraints seem to me to be our only long term hope.  If we rely on some of us to wield the power to constrain others of us, who will constrain the some of us who are constraining the others?  If power corrupts, where will those in power turn for the moral awareness that could prevent them from being corrupted?  If I take a maintenance antibiotic to combat any infection that I might get, having the antibiotic doing the work my immune system should and could, how can I expect my immune system to remain robust or even reasonable competent?  

ON THE TRIVIALIZATION OF PSYCHOTHERAPY

Given the significance noted above of reclaiming deep introspection through psychotherapy,  it is noteworthy that psychotherapy itself is in some ways under attack at the present time.  At the most superficial level this attack has to do with funding–i.e. payment for psychotherapy by private health insurance and public agencies.  Although a statistical case can be made for the proposition that good psychotherapy pays for itself in increased productivity and reduced utilization of other general medical resources, there seems to be a trend toward the restriction of third party funding for psychotherapy.  One theory frequently put forward to explain this strange trend is that it is simply a result of the greed and shortsightedness of the CEOs of managed care organizations.  No doubt these factors play a role.

At a deeper level a more pernicious trend is emerging–the trivialization of psychotherapy.  Those who find deep introspection to be personally threatening have always expressed their anxiety through deprecating references to psychotherapy as involving self-absorption, navel gazing, and mental masturbation.  More recently the ways in which psychotherapy is trivialized have become more subtle and perhaps even auto-immune in nature.   That is, even among those who describe themselves as psychotherapists there seem to be increasing numbers who see their work as little more than providing a mental tune-up so that the client can function more efficiently in his or her already prescribed role in society.   At the core those who dismiss all introspection as nonsense, and those who see psychotherapy as merely intended to relieve symptoms,  both seem to share a disregard for the importance of deep introspection and the human relationship in the conduct of psychotherapy.

If one assumes that the human relationship is important in psychotherapy, then the selection of a good psychotherapist for a particular person involves much more than finding one with certain academic or professional credentials.  It involves some exploration of the inherent compatibility, or fit, between the two persons involved before a prediction can be made of the probable outcome of the psychotherapy.  Such exploration is all but prohibited by most managed care arrangements.  First the psychotherapist is usually referred to as a “provider of services,” a term which seems to connote that the function is more important than the person.  That might be true for a person who delivers a pizza to one’s home, but it is most certainly not true for a person with whom one contemplates entering into a most intimate relationship.  After getting past the insult of thinking of one’s psychotherapist is a provider of services, one is told that it is necessary to select a psychotherapist from a preselected panel of candidates, a very small fraction of those who might otherwise be available.  The members of this panel have usually been chosen on the basis of some minimal academic requirements and the willingness to work under adverse conditions.  These adverse conditions include low pay and frequent violation of the privacy necessary for effective psychotherapy.

The trivialization of psychotherapy as a result of the conditions imposed by managed care is increasingly being matched by conditions imposed by the professional disciplines which provide formal training and credentials for most psychotherapists.  Psychology is probably the discipline with the most noteworthy case of identification with the aggressor.  It has actively promoted the “manualization” of psychotherapy.  This term does not refer to conducting psychotherapy without the use of machinery; it refers to the notion that for any given condition, like depression, there is a single correct therapeutic approach to be taken.  This approach can be described in a manual, and then any person who can read the manual and follow its instructions can perform the psychotherapy.  While it may be true that anyone who can read a map and drive a car can deliver a pizza, it is certainly not that simple with psychotherapy.  For psychology as a profession to pretend otherwise trivializes and demeans psychotherapy.   

I was recently involved in an informal supervision session, in which a very mature and sophisticated psychotherapist presented a complicated clinical dilemma which had arisen in one of her psychotherapy groups.  Several respected colleagues, all working within essentially the same theoretical framework, offered feedback.  Although the underlying premises about the importance of such things as authenticity, integrity, and respect were the shared by all, the actual recommended actions to be taken diverged greatly. The woman presenting the case thoughtfully took in all these recommendations, asked for clarification or elaboration regarding some of them, and then formulated her next intervention for her group.  She also commented that the diversity of opinion from highly respected colleagues was both disturbing and relieving, since it made clear that there is no single correct approach to any given clinical situation.  Clearly this woman is not a candidate for getting involved in anything the looks like “manualization.”  On the other hand, she is someone to whom I would refer, without hesitation, a person I love.  

The most recent example of the trivialization of psychotherapy in our culture has come in the form of legislatively mandated keeping of “Medical Records.”  In some instances legislation has been written in such a way as to include psychotherapists in general, and psychologists in particular, within its requirements.  For psychotherapists to keep such records has at least two trivializing implications for psychotherapy.  First is the implication that there would be some genuine utility in the keeping of such records.  This assumes that a person could move from one psychotherapist to another, have his or her “Medical Records” transferred to the new psychotherapist, and pick up where he or she left off with the previous psychotherapist.  This is a preposterous assumption when applied to as personal a relationship as is involved in psychotherapy.  The second, and perhaps more chilling, implication of such record keeping is contained in the actual act of writing down for possible future disclosure to others, as yet unnamed, any meaningful part of what transpires in psychotherapy.   It would be hard to imagine a mechanism more antithetical to the creation of the kind of trust and safety required for meaningful psychotherapy to take place.

WHAT IS TO BE DONE?

The problems arising from the trivialization of psychotherapy are the tip of the iceberg.  The trivialization of introspection lies below it, with grave consequences for the Titanic of humanity if ignored.  No amount of enforcement of current or future environmental laws have a chance of saving the earth in the long run unless a significant percentage of humans have a more immediate and personal experience of a deep connection to other humans in particular and to All Things in general.  A similar statement could be made about the possibility that international treaties, tribunals, and organizations will save us from future wars or nuclear holocaust through their ability to impose external constraints on our behavior.  As mentioned above, they may heighten our awareness of the problems we face, and they may helpful by starting meaningful dialogue between people who would otherwise be killing each other.  However, if such dialogue does not ultimately lead to a greater appreciation of The Other, genocide will merely be postponed.  Dialogue combined with introspection can provide the opportunity to genuinely experience “walking a mile in your enemy’s moccasins,” and this experience can in turn open us up to non-violent options for dealing with old hatreds and fears.  Anything that facilitates the kind of introspection which can lead to such deeply meaningful experiences increases our chances of survival, not to mention peace of mind.  Anything one can do to support the profound significance, as opposed to trivialization, of such a process should help.  The first step probably has to be a reaffirmation of the importance of deep introspection in one’s own life.  Clearly psychotherapy is not the only way to do this, but it is a very good place to start.   

References
Goldhagen, Daniel Jonah, Hitler’s Willing Executioners: Ordinary Germans and The Holocaust, 1996, Alfred A. Knopf, New York, 640 pages.

May, Gerald G. Will and Spirit, 1987, Harper, San Francisco, 368 pages.

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ADDENDUM
Since this paper was originally drafted and submitted to Voices, two things have occurred which call for additional comments.  The first of these is the series of tragic events which took place on 9-11-01.  The second is the response of the editor to the first draft.  Among other things she notes that deep introspection might lead to the desire for violence, rather than the opposite, and that many good and moral people do not introspect and have never experienced psychotherapy.

In the weeks after September 11, like many others, I found myself very curious about the motivational dynamics of those who had been willing to kill so many others.   What began to emerge for me was a picture of young men who had been completely cut off from meaningful interpersonal support for introspection since they were very young.   This means not only the deprivation of anything as structured and formal as psychotherapy, but also the absence of any opportunity for more informal interpersonal exchanges having to do with introspection or subjective experiences other than those prescribed by family, friends, religion, and one’s entire social milieu.  In the extreme I imagined what it would have been like for one of those young men, in the months before September 11, to have raised doubts or misgivings about the plans they were making.  A dream, a fantasy, or an emotion that had such implications would have to have been suppressed or repressed almost immediately.  Certainly to allow oneself such experiences, and to open discussion about them with one’s fellows, would have been to risk complete rejection as a minimum, and immediate death as a high probability.

At the opposite extreme would be the ancient mystical and meditative traditions of the world.  What little I know of Buddhist and other such practices is that an enormous variety of powerful subjective experiences are expected when the seeker enters into the particular form of deep introspection associated with a given tradition.  Vivid fantasies of unbridled sexuality and violence are common, but in the end give way to–or perhaps are part of– experiences which ultimately develop deep compassion and equanimity in the seeker.  Psychologically this process may be seen at least in part as a withdrawal of the projection of evil which, when projected, leads to the perception of “evil-doers” in external reality and the conviction that one’s holy task is to slay them.  The Vietnamese Buddhist monk Thich Nhat Hanh reports having been able to view the corpses of six young men he regarded as his sons, brutally murdered because of their opposition to the war in Vietnam, and still feel compassion for their killers.

Perhaps most people navigate a middle course, being somewhat introspective in a random or unconscious sort of way.  Thanks to sleep researchers we know that everyone dreams, whether or not the dreams are available for conscious recall upon awakening.  Similarly, everyone daydreams, although there appear to be enormous differences in the degree to which this experience is invited or suppressed.  In any case, a certain degree of introspection seems to be inherent in the human condition.   It is up to us to decide how much to nurture this tendency, as individuals and as a culture or society.  

©Copyright 2007 John C. Rhead, Ph.D.  All Rights Reserved. Permission to publish granted to GoodTherapy.org. Questions or concerns about the article can be directed to the author or posted as a comment to this blog entry. The article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Click here to contact John and/or see his GoodTherapy.org Profile

This relatively new area of therapy is emerging as an important part of the process for many women who choose to terminate their pregnancy.

The political controversy over abortion may make the process more confusing or upsetting for some. But even leaving politics aside, research indicates that having an abortion is a very difficult decision for the vast majority of women and that the aftermath is likely to lead to at least some emotional and psychological challenges, whether they are minor and short-lived, or more intense and long-lasting. Having second thoughts, guilt, internal conflict, grief, or other challenging emotions and thoughts is somewhat typical, and the nonjudgmental, compassionate ear of a good clinician can be very helpful in working through these thoughts and feelings.

Men whose partners have an abortion may also experience internal conflict or unpleasant feelings, and should not hesitate to talk about this in therapy. Couples work may be particularly helpful – if also especially challenging at times – when an abortion has occurred in the relationship.

Read More here: therapy for abortion

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Over the past decade research has found that for many women the onset of alcohol abuse coincides with changes in hormone levels – changes that many women are unaware of in the early stages. When this is combined with other stresses in their lives - job changes, health concerns, children leaving home - women can find themselves abusing alcohol for the first time in their lives.

In our teens, 20s and 30s, our ovaries and adrenal glands produce a form of estrogen called estrodiol. Later, during our mid to late 40s and early 50s, our ovaries begin producing less estrogen, leaving more of the work to our adrenal glands. As the adrenal glands take over the job, estrogen drops, spikes and drops again—rather erratically. At this point, many women report that they start to get forgetful and experience “foggy thinking” and moodiness. That’s because our brains work better when estrogen levels are steady. These are the first signs of menopause and, sometimes, the beginning of escalating alcohol consumption as a means of easing various unfamiliar discomforts.

While normal menopause is a gradual process that starts between the ages of 45 and 55, there are a number of things that can lead to this whole process starting earlier than normal, in other words - premature menopause. Sometimes these are a result of lifestyle choices that include the following:

1. heavy drinking (defined as more than 1 glass of wine, 12 ozs. of beer, or 1.5 oz. of liquor daily);
2. heavy smoking;
3. poor nutrition;
4. chronic stress to the body - including excessive athletic training.

Indeed, heavy alcohol consumption alone may hasten the onset of menopause by as much as five years.

As we reach full menopause, our estrogen production will have dropped by 75%-90% and we normally start experiencing other menopausal symptoms - hot flashes, tiredness, and difficulty sleeping. Many of us also experience a drop in libido (sexual desire) which can continue well beyond menopause.

Unfortunately drinking alcohol at this stage of life causes more problems than it solves. For example, alcohol itself can trigger hot flashes and increase sleep disruptions. For those of us in midlife who are already experiencing hot flashes and sleep problems (because of the night sweats that accompany hot flashes), alcohol only compounds the problem.

Additionally, Jasmine Lew, a researcher at the Howard Hughes Medical Institute, has found links between the amount of alcohol women consumed and a higher risk of cancer. In particular, Lew and her colleagues found that alcohol increased the risk for the most common types of postmenopausal breast cancer. And the more we drank, the higher the risk, so, while drinking one serving of alcohol resulted in only a 7% increase of risk, drinking three servings of alcohol per day resulted in as high as 51% increase in risk.

Further problems occur in the area of bone density because alcohol increases the amount of calcium excreted in the urine, causing a calcium deficiency and eventually osteoporosis. And of course heavy drinking increases our risk of liver disease, falls, DUIs, and motor vehicle accidents.

So what are we to do? Peri-menopause, menopause, and post menopause are clearly times of risk for those of us who find we are drinking too much. With that in mind, if you are over 40 you should consider hormonal shifts as a contributing factor in any change in your alcohol use. It should also be a consideration if you become concerned about alcohol abuse and seek help. Look for a program that will address all of the possible contributory factors, not one that consigns you to a “disease” model as well an unnecessary and inappropriate “lifelong recovery.”

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Anxiety is one of the most common reasons people seek therapy. Some level of anxiety is normal in human beings; excessive anxiety can interfere with relationships, sleeping and eating patterns, work and school, and all areas of life.

The Basics: Anxiety is defined as nervousness and an inability to relax. In the Body, people with anxiety may experience psychomotor agitation, pacing, shaking, trembling, quivering, sweaty palms, racing heartbeat, insomnia, tension, headaches, nausea, and difficulty breathing. A panic attack occurs when these somatic symptoms are severe and acute, sometimes mimicking the symptoms of a heart attack (though there is no record of panic attacks leading to actual coronary arrest). Read More here: Therapy for Anxiety

Depression is a state that affects mind, emotion and body, creating a dysphoric mood, lethargy or anxiety in the body, and thoughts of hopelessness, helplessness and, in a significant number of cases, suicidal ideation. Depression should not be confused with normal grief in the aftermath of a major loss, although extended grief may lead to true depression. Depression that is mild and chronic, with fewer symptoms, is known as dysthymia. Depression may present differently based on age or cultural factors. Adolescents tend to show an irritable and agitated depression; older adults may or may not be irritable; certain cultural groups may mask their feeling to varying degrees; women are known to be more likely to admit to depression than men. Depression is one of the most common reasons people seek therapy. Read More here: therapy for depression

Click here to contact Jennifer and/or see her GoodTherapy.org Profile

How many times have we begun a relationship, full of hope, only to have it crash and burn, or one party flee?

Many of us have relational injuries from the past. This often manifests as a “fear of intimacy.” Beneath this phrase, lurks not feeling safe in relationships. Our fathers may have had tempers, or our mothers may have been intrusive. A past partner may have been abusive, or perhaps their neediness or jealousy was a burden. A multitude of possibilities exist. Whatever the case, we found that relating to another could be costly. We learned to defend ourselves, to shut down, cover up, disappear, attack, or protect ourselves in some other way. We learned to not be too vulnerable, to only let the other in so far, or to run if we got scared. We learned to make ourselves safe by controlling the depth of the relationship in a variety of ways.

Often when we get scared, we react, we become irrational, we move into our limbic brain and rather than being rational, we respond from fight or flight. Some of us have trauma that is extensive enough that we move into dissociative states, fragments of ourselves that look like Dr. Jeckle changing into Mr. Hyde. Irrationality is scary to the other and a major problem in relationships. It can trigger a variety of defensive postures including early abandonment of a promising relationship. Anger, irrationality, and mood swings directed at the other almost always create a feeling of not being safe with that person.

Interactions with an intimate other ultimately trigger our deepest wounds, our attachment needs, feelings of vulnerability, and our need for safety. Anything unhealed is bound to get touched and come up. These wounds can vary from feeling judged, to not important, abandoned, or even abused. Regardless, these wounds trigger deep and primal feelings, feelings of desperation, anger, confusion, shame, etc and can cause us to react.

The real problem emerges however, when we cannot own our wound, but instead blame the other, or expect them to “take care of it” or not trigger us. Ultimately, we have to learn to tend to our own wounds, as well as ask the other to be kind and gentle with our fragilities, to be safe for us. Both parties have to take responsibility for his or her own behavior before we become safe for the other. This requires open and non-blaming communication.

What are your deepest fears in relationship to others? Are these fears related to how you were treated in your past? Have you started to take responsibility for them? Do you have a partner who is willing to stay open and talk to you when you are triggered, when you trigger each other?

A relationship has the potential to be a cauldron for growth and transformation, or pain, fear or flight. Everything unfinished and triggered in that particular combination emerges to step into the dance of that relationship. In the process, we get to decide if this situation is safe enough, or if we want or deserve more. If we are attempting an intimate relationship with somebody who allows us to feel nourished and safe enough, we can stay and do the work and play of learning to love and grow in the matrix of connection with another.

©Copyright 2008 by Jennifer Lehr, MA, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jennifer and/or see her GoodTherapy.org Profile

A review of 23 studies that looked at the results of long-term, psychodynamic talk therapy concluded that such therapy improved the symptoms of chronic mental problems, including anxiety and borderline personality disorder, better than some shorter-term therapies.

The studies included a total of 1,053 clients undergoing weekly, twice weekly, or three times weekly session for at least a year and often much longer. Most of the clients had 50 or more sessions, and all were followed closely by researchers in the original studies.

The authors, writing in the October 1 issue of The Journal of the American Medical Association, recommended that researchers focus more on psychodynamic therapy, noting that the managed care system has been loathe to pay for such treatment, citing other studies that seemed to show the superiority of cognitive behavioral, short term therapy.

This new study is the first modern literature review of the results of psychodynamic work, and the studies it examined were not widely known.

“This review certainly does seem to contradict the notion that cognitive or other short-term therapies are better than any others,” said Bruce E. Wampold, chairman of the department of counseling psychology at the University of Wisconsin. “When it’s done well, psychodynamic therapy appears to be just as effective as any other for some patients, and this strikes me as a turning point” for such intensive therapy.

Psychodynamic therapy, one researcher told the New York Times by email, “showed significant, large and stable treatment effects which even significantly increased between the end of treatment and follow-up assessment.”

Perhaps surprisingly, the review found no correlation between patients’ improvement and the length of treatment.

Dr. Barbara L. Milrod, a professor of psychiatry at Weill Cornell Medical College and a psychodynamic therapist, said further research was desperately needed.

“Let’s be real,” Dr. Milrod told the Times. “Major medical centers have been shutting down psychodynamic training programs because there isn’t an adequate evidence base.”

Now the foundation of such a base of evidence has been laid, with more, hopefully, to follow.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

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Yelling at Children

This is a topic that has meaning for everyone. All of us have raised our voices, probably more than once. No, I did not come from a home of screaming parents or siblings. However, I do see many families and couples who yell a lot at each other, and the short and long-term consequences of regular yelling/screaming are not pretty. Those of you who experience yelling know what I’m talking about.

Let’s start with the impact of yelling at children:

First, it teaches them how to yell, when to yell, and that yelling is an effective response to emotionally charged situations. By extension, it teaches them an ineffective way to process anger, as anger is usually associated with yelling.

Second, yelling scares most children—the younger the child, often the more fear they feel. In a state of fear it is next to impossible for a child to think about their mistake or misbehavior. If a child cannot think about their mistake, a child cannot learn from their mistake.

Third, regularly yelling at a child before the age of 3 or 4, or before they have an expansive developmental use of language, teaches them to replace useful language with yelling. In other words, a child will not learn useful, effective expression when yelling is their model. The short version is, ‘if mom and/or dad yell, then so can I.’ They are too young to know better.

Back to the fear induced by a yelling parent. Children are far less likely to learn the lesson you want them to learn when they are afraid. Instead of the lesson they might otherwise learn from natural, appropriate consequences associated with their mistake, they learn to be afraid. Fearful children often grow up to be fearful adults and parents. Sometimes they grow up to be yellers. No surprise.

Helplessness

Not only is yelling learned from our own parents in some cases, it also means a parent probably feels helpless. It is a sign that a parent does not know a more effective alternative at that moment. Helplessness is a very powerful feeling, and when the brain reads the ‘helpless signal,’ so to speak, it will do almost anything to reduce it. The antidote to helplessness begins with a four step process, which will aide in reducing/stopping yelling at the kids:

First, make a conscious, verbal decision to stop.

Second, make the commitment to learn the skills necessary for replacing yelling with effective responses. Go to The Love and Logic Institute, and invest in their parenting CD’s, books & DVD’s. From that material you can learn those skills (no, I do not get residuals for recommending their remarkable material, but I’d appreciate it if you would tell them I sent you!). All you need to know about replacing yelling, and learning how to really enjoy parenting is there. OK, now that’s your skills toolbox. But, now you have to reduce the reactivity that precedes your yelling–that’s the hard part. Parents who effectively manage their emotional reactivity do not tend to yell.

Third, if reactivity (which I will say more about below) and anger are problems for you, which frequently is the case with chronic yellers, professional counseling may be your best investment.

Fourth, try this new thought as a guide to changing your thinking about yelling as you consider making your decision to stop: There is nothing a child can do that calls for yelling at them—unless it will literally save their life.

By the way, in 29 years of practice, I’ve never met a parent who remarked: “Boy, do I regret not yelling a my kid, what a mistake that was.”

Yelling at your Spouse / Partner

Yelling at your spouse/partner induces fear, just as it does in a child. Brain research has shown that it is very difficult to think while in a state of fear. If you want your partner to think about what you say, the odds for that increase when you speak in a way that does not produce fear. When your partner hears yelling, the brain reads it as DANGER, and your partner experiences fear. It (the brain) immediately goes in to some degree of fight or flight mode—how much depends on the amount of perceived threat. The behavior from your partner at that point will probably range from yelling back/defensiveness (fight mode) to silence/withdrawal (flight mode). Neither will produce a satisfactory outcome.

Fight mode is sometimes referred to as “reactive.” In fight or reactive mode we tend to say things we regret or wish we could take back, which, of course calls for repair. Part of this pattern often includes your partner reacting defensively and/or critically when yelled at. That defensiveness triggers more frustration, anger and lashing out. Without knowing what to do, or how to respond differently, the cycle is repeated, and both partners suffer and struggle with a broken or unsatisfactory conflict management process. The next time an issue surfaces it will be anticipated with dread.

Flight mode is also referred to as silence/withdrawal. In flight mode, two common options arise: One, you either do not know what to say due shutting down with fear; or, two, you may know exactly what you want to say, but, you say nothing because a part of you believes that what you think and/feel is unimportant, so why bother. Either way you have no voice. In the end, both you and your partner are probably angry, hurt, disappointed and frustrated, and blaming the other for the “breakdown in communication.”

More accurately, there was no “breakdown in communication,” per se. In fact, there was plenty of communication, too much of it ineffective. More significant was the breakdown in reactivity management. All the good communication skills in the tool bag will be of little use in the face of unchecked or poorly managed reactivity. Why might professional counseling helpful at this point? Because chronic ineffectively managed reactivity almost always has some roots in our early history. A competent marital therapist can help connect early roots to current events, finish some old business, and help you develop reactivity management alternatives.

An Alternative to Yelling

I am aware that many of you prefer counseling as a last resort. If that’s the case, on your own, try the following:

1. Before you begin your discussion, each of you verbally acknowledge your willingness to break the pattern that is not working. It might sound like this: “The last time we discussed this, I did not react effectively. I am going to try some new behaviors.”

2. Next, each of you openly acknowledge to your partner how you aspire to be during the discussion. If you tend to be the yeller, acknowledge that you aspire to be calm, and what new behavior you plan to employ if you begin to feel activated. You might say, for example, “I’m starting to feel like I want to yell, my frustration is building, I would like to stop for a few minutes so that I can get calm again.” THAT WOULD BE NEW BEHAVIOR. If you begin to feel activated, take responsibility for it—do not blame your partner. What ever new behavior you decide to try, let it be known in advance of the discussion. No surprises, unless they’re pleasant ones.

3. Hold yourself to the healthy code of conduct to which you aspire; let your partner do the same for him/herself. How you aspire to be is all you have control over.

4. In advance, put a time limit on the length of the discussion. If you each feel comfortable continuing on, agree to another time limit. Repeat as necessary.

5. When either of you call for a time out, especially to lower your reactivity, decide on a time to resume. This reduces the chances of avoiding your way out of the discussion entirely.

6. After the discussion, and only if you both agree to, analyze YOUR own respective roles in how the discussion went. Talk about yourself, unless complimenting your partner. Determine where you might become more effective, and tell your partner. Focus on your behavior, not your partner’s.

Good luck in your attempts to break this difficult pattern. It’s not easy. The fact that you made an attempt builds trust and self confidence.

Wishing you a satisfying relationship, Jim

©Copyright 2008 by Jim Hutt, Ph.D., MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jim and/or see his GoodTherapy.org Profile

Click here to contact Sarah and/or see her GoodTherapy.org Profile

“You can outdistance that which is running after you, but you cannot outdistance that which is running inside you.” -African Proverb

My soul thirsted for down time, as if it was parched for the very fundamental nature of itself. Two weeks off from all that was my daily life and practice. Read. Write. Rest. Heal. Yet, as my soul and body thirsted for it, my ego struggled with the decision. My mind knew that I needed the time away to recover from a medical procedure. Not a big deal; it knew all of the valid reasons for it. I couldn’t imagine that my ego would argue with me. But, it did. And it yelled loudly.

The Hurricane

When is the last time that you focused on really, truly, not “doing” anything? My ego wanted me to stay busy, do usual activities, drive forward, and, ultimately, keep things the same. It was becoming agitated by the very stillness that the absence of those activities would create. Yet, my soul knew that the calmness was exactly what was necessary. And, by wanting to keep things the same, my ego wanted to distract me from whatever it was that I could not outdistance. Oscar Wilde once said, “Nothing is so aggravating than calmness.” For the first few days of my down time, I agreed with him.

I knew that I was in this place of anxiety because I had chosen to be. I was becoming agitated, not because of the change of pace, but because I knew something was just waiting to be “looked at.” There was something there that I could not outdistance. The more I avoided it, the more I “danced around it,” the stronger and more emphatic my ego’s energy became. It whirled around me as if a ferocious hurricane hovering over the horizon.

The Eye

So often, we don’t want to “look” at what is right in front of us. The ego helps us to make a “story,” a “reason,” a “distraction,” for things to appear as they are. Ironically, we all have different stories. But, whatever the reality is, once the ego can’t do its frantic “hurricane like” job anymore, what is inside, sits waiting to be acknowledged. It sits in the eye of the storm.

For me, it was accepting a significant loss in my life. A dear friend’s path was taking her on a separate one to mine. Distance. Time. Events. Whatever it was, it wasn’t malicious. It was just unfolding. Nevertheless, whatever the “story” my ego wanted to create, the reality is that I had to say goodbye, and acknowledge what was already gone, my control over it. The irony is that I had to allow my soul to let the grief in, rather than allow the hurricane of activity to distract me from it. Being in the eye of the hurricane, looking out from the inside, eventually became more calming, than trying to hold on to its stormy edges, for dear life. I had to dive into the hurricane, feel it, and let go of my ego’s illusion of control over it.

Perhaps you have had the awareness that you are holding onto something, staying distracted, or running from whatever it is on the “inside.” The ego wants to keep you away from the eye of the hurricane; the soul just wants you to be authentic, feel it, process it, and release the energy’s hold over you. I knew that I had to, and maybe you do too.

The Contract

I looked at it, not only because I needed to, but also because I believe wholeheartedly, that we have a responsibility to heal ourselves. What ever your story, or whatever it is that you are being asked to look at, maybe you can relate to this point. We are put on this earth to “do our work” as it were. And, because the universe is a stubborn but loving one, if we don’t, it just shows up again and again to send the message home.

It is my opinion that you, as I have, chose this path, or it chose us. Whatever the case may be, we cannot ask our clients, friends, loved ones to tread into the deepest, darkest places of their souls, without having the courage, tenacity, and compassion for ourselves, to do the same.

It is an energetic contract. To be allowed to do this work with my clients requires my continued willingness to accept and look at opportunities for growth. I was being asked to grow, and I had been blind sided by it, as if the hurricane tossed my body aside like a rag doll. But, I knew that the only choice to make was to look at it. Perhaps you too, will leap into the eye of your hurricane. Maybe we can all meet there, in stillness, even if Oscar Wilde disagrees.

©Copyright 2008 by Sarah Jenkins, MC, LPC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.
Click here to contact Sarah and/or see her GoodTherapy.org Profile

New research indicates that women are generally better at expressing emotions and articulating their presenting their problems in therapy. A new study of 18 men and 18 women, carried out by the University of Montreal department of Psychology, used the “Grille de l’Élaboration Verbale des Affects” (GEVA, or verbal elaboration chart) to measure verbal communication and emotional expression. It found that women (and French-speaking Canadians) were more apt to use metaphors, identify childhood traumas as causes of their emotional problems, and verbalize rather than act out anger.

Serge Lecour, the study’s author, also sees the GEVA as a potential tool for predicting the presence of personality constellations, success in therapy, and potential for aggression. The GEVA scale has five levels and it factors in four distinct ways of expressing emotion: somatization, motivity, imagery and verbalization.

For example, someone who is aggressive will be a “Motor 1” while a “Verbal 5” will rationally examine his or her emotions and potentially connect them to childhood experiences, and a ‘Psychsomatic 1,” is likely to have a panic attack, while “imagery” users are able to think abstractly and metaphorically (“I saw blue, I saw red”).

Researchers have long observed differences in how men and women verbalize differently, but according to Lecours, these findings are different. “Until now, most studies limited themselves to measuring the ability to articulate emotions” explains Lecours, who published his findings in the Bulletin of the Meninger Clinic. “Thanks to the GEVA test, our study takes it a step further by looking at how we talk or speak”

The GEVA may eventually be available to the public, but for now these initial findings indicate that men and women – and cultural subgroups – seem to have quite different means of self-expression and introspection. Therapists can begin to examine how to tailor interventions and expectations to account for these differences.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

The GoodTherapy.org Team is thrilled to announce that Google has recently promoted our organization’s website to PageRank (PR) Level 6. This new level is awarded on the basis of a number of things, notably: the quality of content and the number of websites that link back to us. GoodTherapy.org’s increased PageRank means increased rankings for all GT web pages, results the GT team have already seen. GoodTherapy.org is now ranked in the top 1, 2, or 3 positions in Google for nearly every location we aim to rank for. This development makes GT information about psychotherapy more visible to the general public and brings GT closer to achieving its goal of promoting collaborative and non-pathological forms of psychotherapy, all in an effort to reduce harm and to bring more “health” into the field of mental health.

Click here to contact Jennifer and/or see her GoodTherapy.org Profile

I was in a therapy session the other day when the person I was working with, who had been struggling with some challenges, said that he was taught that things had to be easy to be okay. I found myself responding…it is a privilege to struggle and have the opportunity to find out who we are, what we are made of.

When life is easy, we can enjoy ourselves and that is wonderful. But what about when life is not so easy? What about when we are up against challenges that really scare or overwhelm us?

It seems that it would be great if our lives were always easy and happy rather than challenging. But if we can only feel happiness when we are in the right situations or conditions, born into the right family or the right socio-economic group, we are trapped by the external. Adversity allows us the opportunity to find out what we are capable of, to access aspects of ourselves that we did not know existed, inner resources we didn’t know we had, and to develop our strengths.

Adversity can teach us that we have the ability to rise beyond our environment, that we are powerful beings who co-create our lives. This knowing brings not only inner strength and self-empowerment, but also ultimately wisdom. Instead of being victim to circumstances which shift and change throughout the years, we can choose to know that no matter where we find ourselves, we have the ability to grapple with both the external situation and our attitude about it. Like a small leaf being carried down a river, we can accept that we will move through different times and challenges. Rather than judging ourselves for what life hands us, we can trust that if life doesn’t dump us on pleasant shores, we will find a way to create what we desire, whether in attitude or actual circumstances.

Look at a difficult situation in your life right now. Are you using it to develop your strengths and compassion for yourself, or are you telling your self that you are bad, or that life isn’t fair?

Like Psyche, a goddess in Greek mythology, who despite tremendous obstacles, persisted in nearly impossible tasks and in the process made her soul complete, we can do the same. By owning our capacities and developing them, we create our lives and world. We come to find out who we are. Things do not have to be easy to be okay.

©Copyright 2008 by Jennifer Lehr, MA, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jennifer and/or see her GoodTherapy.org Profile

On Tuesday, the United States House of Representatives and Senate passed legislation to ensure parity between mental health coverage and other medical care. The law would apply to group health plans with 51 or more employees. Differences in the bills’ language must be worked out before it goes to President Bush, who is expected to sign it.

The legislation does not mandate that group health plans cover mental health or addiction treatment, only that when plans do so, the coverage must be equitable to other medical coverage.

Jim Ramstad, R-Minn., helped lead efforts to pass the bill in the House, and spoke inspiringly of his own experience as a person in recovery, ”I am alive and sober today only because of the access that I had to treatment following my last alcoholic blackout on July 31, 1981. I woke up that day in a jail cell in Sioux Falls, South Dakota, and I am living proof that treatment works and recovery is possible. But far too many people in our country don’t have the same access to treatment that I and other members of Congress, other federal employees have.”

Because private companies will be able to deduct more health expenses from federal income taxes, the projected cost to the government is about $3.4 billion over 10 years. There is also a loophole in the bill that may concern mental health advocates: the legislation allows employers to determine what types of care are covered. Since the bill only requires that mental health coverage, when offered, is equal to other coverage, but not that mental health coverage is in fact offered, plans and employers could opt not to provide mental health treatment at all.

But Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness, does not seem worried about that. ”We’ve made advances in scientific discovery and treatment,” Sperling told the New York Times, “so the excuse of less certainty about treatment and outcomes, I think we’ve gotten past that.”

And James Klein, president of the American Benefits Council, said, “Most of our members believe that this legislation strikes a very valuable balance.”

Time will tell.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

The economic downturn has lead to a spike in the demand for psychological crisis services, according to several sources.

In New York, calls to Hopeline, a telephone crisis service for people experiencing severe depression increased by about 75 percent between the summer of 2007 and the summer of 2008. Hopeline received a record 10,368 in July of this year, and expects a continued climb as the economy worsens and financial stressors – and the incumbent potential damage to self-esteem, hopefulness, relaxation, and other areas of ego strength and functionality – increase nationwide.

Meanwhile, the ComPsych Corporation of Chicago, which is the world’s largest provider of employee assistance, saw an increase of 21 percent in stress-related requests for services in that same one year period. Elsewhere, hospital admissions for psychiatric services are up 10 percent, according to UnitedHealth Group Inc., the largest health insurance company in the United States.
Richard Chaifetz, CEO of ComPsych, reported that “The 9/11 spike was probably higher initially, but this has been more sustained.”

A poll conducted this past spring by the American Psychological Association found that 75% of Americans report stress due to financial problems. A similar poll one year ago put the number at half of the respondents, who said financial stress is hurting their professional and personal lives.
“We’re reached a tipping point where anxiety about the economy is pervasive,” said Dan Abrahamson, an executive at APA. The stresses and anxieties are there all the time; you can’t get them out of your mind.”

Therapists should be aware that all clients are likely to experience an increase in stress during a recession, even those with steady incomes and strong assets.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

How many people have found solace by calling a friend on the telephone in a difficult time?

Northwestern University is reporting research indicating that telephone psychotherapy seems not only to be effective, it may be an even better treatment for depression than face to face meetings. The new study was small and more research is needed to draw any certain conclusions, but the initial data are compelling. In this study, only 7.6 percent of patients ended therapy, compared to the well-established attrition rate of nearly half in traditional therapy.

And before you ask: The researchers found no indication that telephone therapy is any less effective in improving mood.

There may be other benefits, as well. Time management is less of an issue if client can get therapy anywhere they happen to be at appointment time.

Perhaps more controversially, clients who are depressed or anxious may be unmotivated, agoraphobic, or otherwise experience barriers to showing up for appointments. Phone therapy may help overcome these obstacles.

Or will it enable them? Could such an approach inhibit growth in important areas of social functioning? This study did not address the point. A skilled therapist would ideally recognize such a circumstance as distinct from those times when phone therapy is the only way to engage a client.

Past research on phone therapy has shown similar results, especially in the treatment of depression.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

Click here to contact Deborah and/or see her GoodTherapy.org Profile

What is a Psychotherapy Process Oriented group and how does it work?

A process group usually consists of around eight people who meet regularly for the common purpose of finding out more about who they are and what it is perhaps that they would like to see change with in their personal lives and in their relationships with others.

The life of a process group from the beginning to the end parallels different developmental stages of growth and maturity. As the natural cycles of the group move progressively forward, the members and the “group-as-a-whole” are assisted with guided feedback and process comments from the leader and or co-leaders. The group inherently knits together with an abundance of experiences forming and emulating a social microcosm that bears its own unique culture and identity.

A remarkable and natural phenomenon in the earlier phases of a working group is the way in which individuals, and sub-groups alike repeat the many characteristic ways once developed to survive the stressors and strains in the very first group…the family. Members will remind each other of significant others in their past or present circumstances bringing feelings, thoughts, ideas and fantasies to the fore.

Central to the group process is the opportunity for members to talk as openly as they possibly can about their interactions and experiences of each other as well as any aspects of the group experience that may come to mind. Many thoughts and feelings associated with the activity of the group may arise and are often reflective of the particular stage of the life cycle in which the group is encountering. By engaging with one another on different emotional levels, individuals can freely gain wider perspectives about the various ways they relate to their inner world, or unconscious, and how this becomes reflected in their relationships with others.

As awareness increases individuals may begin to recognize newly found aspects of themselves. Individual’s and “the group as a whole” may actively and unconsciously attempt not to become aware of various emotional aspects of themselves to avoid uncomfortable and perhaps painful feelings. This is a common and normal phenomena of human behavior. Such conscious and unconscious pressures to connect and disconnect in automatic ways may hinder and block individuals from being fully present. It is within the supportive and relaxed atmosphere of the group experience that such feelings can be recognized, acknowledged and replaced with conscious, uncontaminated choices in social behaviors and verbal attitudes. The courage to allow these kinds of meaningful connections to take place can help to resolve emotional conflicts and difficulties with feelings of mastery and empowerment.

With in this ‘specialized small group process’, the vitality of an established group may lend to the potential of opening up channels of communication that can have the shared capacity of being experientially experienced as unique and profound. Stability, unification and a positive group climate are all aspects of a healthy mature group. Such identifying aspects help in creating room for innovative and creative risk taking with in the group. Personal disclosure with-in the group is expected and agreed upon to be kept in strict confidence. Communication in the group is in the service of increased mutual understanding and genuine dialogue.

For each individual the rewards of creating a place that is their own can be a place that is very real and fully connected. It is a place to be fully who they are without the need to ‘fit-in’ to a pre-determined pattern.

What is so different from a real life group is that the developmental framework within which the group works is less apt to be influenced to change from outside social pressures and cultural values. The group as a whole shapes its own unique culture, common values and norms thus, creating a meaningful context upon which it can evolve and grow at its own pace.

Just as individuals bring old learned behaviors and attitudes into the group they may take new ways of inter-relating outside the group. This may enable individuals to cultivate healthier inter-dependency with others, as well as increased expressions of mature and authentic intimacy.

By being in a psychotherapy process oriented group all members have the opportunity for considerable personal gains, ‘corrective emotional experiences’ and intrapsychic change that can last a life time.

References: ‘The Practice of Group Therapy.’ S.R.Slavson. International Universities Press, 1947

‘Analytic Group Psychotherapy with Children, Adolescents and Adults.’ S.R. Slavson. Columbia University Press, 1964

©Copyright 2008 by Deborah Reeves MGPGP, LPC, CGP. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

Click here to contact Jennine and/or see her GoodTherapy.org Profile

Many people have heard of the advice to never go to bed angry. This relationship advice has such a great value. It addresses the idea of how couples may feel if going to bed angry, such as feeling emotionally disconnected and unattached, or fear of having unresolved issues getting in the way. This advice is absolutely a great and valuable tool for staying connected and securely attached to your partner. Think about it…going to bed angry in the relationship can create a terrible feeling; it can keep people up all night, have terrible sleep, or many other painful experiences. For many couples, this advice is perfect for their relationship. Obviously, I am a therapist and I truly believe in resolving any and all conflicts, but this doesn’t work for everyone.

Couples faced with relationship conflict often attempt to resolve the issue to the best that they can. When in conflict, couples try to resolve the issue through continuous fighting, arguing, and then resulting into a more damaged relationship. Damaging a relationship is far more dangerous than going to bed angry.

The bigger issue is for those who keep trying to resolve an issue, and it keeps getting worse, escalating, and turning into a big disaster. Going to bed without the issue resolved might actually protect the relationship. Many people don’t see it this way, nor does it feel like that from the person on the receiving end. On the receiving end it might feel as if your partner doesn’t care, as if they give up on the relationship. But as a matter of fact, this might be a wise thing to do. It can protect the relationship from getting out of hand. If you have seen your relationship escalate in times of disagreement, then maybe taking a break, falling asleep, and addressing the issue when you are less emotionally reactive might actually benefit your relationship.

Remember, sometimes going to bed angry really isn’t that bad.

©Copyright 2008 by Jennine Estes, MFT Intern. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jennine and/or see her GoodTherapy.org Profile

Click here to contact Mary Ellen and/or see her Profile
Click here to contact Ed and/or see his Profile

We recently returned from a conference on alcohol treatment called “New Perspectives.” The conference, hosted by Edgewood treatment center in Nanaimo, Vancouver Island, British Columbia, was, indeed, as advertised. Presenters echoed the same theme: the usual methods of “treating” alcohol abuse and dependence don’t work. While this isn’t news to some of us who’ve looked at the statistics for over twenty years, it is the first time we’ve ever attended a conference that wasn’t hyping the same old failed models. Perhaps being Canadian – a country not quite as enamored with the Minnesota 12-Step Model – helped. Whatever the case, it was a refreshing change.

Happily, the conference’s focus was on differentiating between clients engaging in alcohol abuse and those suffering from true dependency, and differential treatment based on the individual’s condition, not a monolithic “one-size-fits-all” regimen. The presenters’ stats paralleled our own experience – 85% of people with alcohol problems are abusers and only 15% are the dependent ones for whom a “disease” label may be warranted. That estimate correlates with our experience, but we go a step further and suggest that the very few in the “dependent” category ever seek treatment and that the perspective client population is more like 95% alcohol abusers and only 5% dependent.

What difference does that make? For starters, it means that 95% of current treatment practices are only applicable to 5% of the client population, if that. Frankly, current practices serve no one but the industry that employs them – a revolving door business dependent on promoting ineffective methods and relapse in order to keep profitable beds filled.

Since current practices aren’t effective, what is? The research is clear, and has been for a long time: motivated clients with outside support and a belief in their ability to change their alcohol abuse have an excellent prognosis. Clients especially benefit from intense, short-term, outpatient treatment with support from anti-craving medications and the use of Cognitive Behavioral Therapy.

So why are we still stuck with ineffective programs? There really are two major reasons – first, treatment is a multi-billion dollar industry with no financial incentive to change. The marketing of the “powerless, disease, forever-recovering, 12-Step” model has been spectacularly successful and no one has any incentive to prune that money tree simply because it doesn’t help clients.

Secondly, effective treatment is hard work and requires staff with actual skills, knowledge, and expertise – something beyond merely having stopped drinking last month or last year. But residential programs require huge numbers of low level staff and have hundreds of hours to fill. How better to accomplish that than by employing “lifers” who can’t stay dry outside of continuous treatment, and an endless repetition of the “Steps” as “doing something,” and meetings passed off as group therapy?

Are things changing? Not really. Twenty years ago we were told that our research based methods were “twenty years ahead of the times.” Two decades later we’re still eighteen years ahead. The problem is that providers have no incentive to change, the public has been effectively brainwashed, and most programs start off based on false premises which even the best intentioned reinforce.

For now, the real message is clear – if you want help with your alcohol problem, be very, very careful where you get it. Most programs will not only take your money, but will also leave you drinking more within a few months, and frequently within a few hours, of discharge. Sadly, treatment centers have no motivation to do what actually helps – quite the opposite. Remember that when you look for help for yourself or someone else.

In our next installment we’ll take a look at the disease model and why it’s so popular, both with providers and with some clients

For more information about Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC visit http://www.non12step.com

©Copyright 2008 Mary Ellen Barnes, Ph.D. & Ed Wilson, Ph.D., MAC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Jeanine and/or see her GoodTherapy.org Profile

Because I am a huge comedy fan and was saddened by the recent passing of George Carlin, I have been watching many of Carlin’s comedy vignettes on television and on the internet. One of his central themes throughout the years was that of materialism. George was never shy to poke fun at our country’s insatiable and gluttonous desire for things. He observed again and again that Americans will work tirelessly for material things, pack their houses to the brim and then find themselves needing to buy a bigger house to accommodate all of those purchases. The jokes about inane spending always got a laugh for George because it invariably rang true for the audience.

Other comedians have also had a big tease regarding materialism. I once heard Robin Williams say during a stand up routine to a woman in the front row that her necklace was very beautiful and could coincidently easily feed the entire nation of Thailand. Similarly, in the British comedy television show Absolutely Fabulous, Jennifer Saunders leaves her home for a holiday wearing every conceivable signature piece of England’s Burburry line of high end plaid wear: raincoat, luggage, scarf, handbag, hat and umbrella. The writers are making their own statement of course. Conspicuous consumption is funny, if not somewhat tragic.

I recently saw a You Tube interview with musician Seun Kuti discussing the lack of resources in his home country of Lagos, Nigeria, Africa. He talked about the challenges inherent to daily life for his countrymen. His candidness about the suffering in his country stands in stark contrast to the bottomless desire for expendable things we seem afflicted with in the United States.

Many people are now coming to appreciate the life philosophy of minimalism. We don’t need to live as monks or ascetics to embrace this simple way of life. We can clear out our belongings and donate them to charity using the criteria “Does this item add real value to my life?” We can choose simple but expressive wardrobes. We can choose to live in homes and drive cars that are the right size for us and no bigger.

In the end, living a life driven by material desires is no laughing matter. After all, we can’t take it with us.

©Copyright 2008 by Jeanine Austin, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jeanine and/or see her GoodTherapy.org Profile

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Author’s Note: This article was written as a way of introducing the idea of inner selves and the benefits of Voice Dialogue to my new clients.

The word multiplicity means “the state of having many parts or aspects”. Recognizing that you have many different parts or aspects that make up the wholeness of who you are indicates that you are complex and that you’re able to accept that fact.

You might have grown up hearing about someone in the news or a character in a book or a movie who had “multiple personalities” and you learned to associate it with being crazy. You chose to think of yourself as one coherent self, with one inner identity, operating in one body because that was your idea of psychological health and normalcy.

But, in reality, healthy people have many different inner parts that make up their “I”. When you can get to know the many different aspects of your own personality, you’ll be more able to be proud of yourself when you meet your own standards and you’ll be more able to forgive yourself when you don’t. You’ll even be more able to question your own standards and be flexible, if that is what you wish.

And with others, you’ll have an easier time too. Especially when they don’t act consistently with who you thought they were. As you accept them as authentic, no matter what parts of themselves they are exposing to you, you will be less confused and more able to effectively respond to what it is they are saying or doing.

A good example of this is when you go through a relationship break-up. The person you knew to be kind and loving towards you seems to change into someone else. This someone else can be cold and selfish, and you begin to question whether the time you had spent together was ever “real”. When you recognize that we all have a multiplicity to our personalities, then you can appreciate what you and your ex once had together, and also recognize that another aspect of him or her is now coming out. This allows you to treasure the good from the past and also accept when it’s over and time to move on.

Another example is when you are parenting, and you recognize your child is in a pleasing part, seeking your approval and connection. And at other times, you see a rebellious part coming out in her, as your child disagrees with you and claims her independence, even if it means she gets in trouble. Both are authentic parts of your child, and both are necessary resources for the child to develop so she can be an independent individual (rebel) and a person able to be accommodating in a relationship (pleaser).

Making a decision can be confusing and overwhelming. It will get easier when you can separate your own opposing opinions and think of them as distinct inner selves. You might have a brave part of you that wants a particular outcome, but a fearful side of yourself is holding you back. Concern about what others might think of you could be a third inner self that would like to weigh in on the discussion.

On a more personal note, let’s look at weight loss. You might have a health-oriented part that really wants you to lose weight and is ready to help you change. You might have an inner critic part that criticizes you and undermines your progress. You might have an exhausted part that prevents you from exercising. You might have an impulsive part that gets you to eat without thinking or a comfort eater that chooses ice cream to change your mood whenever you feel down. And you might have a doubting part that fills you with hopelessness whenever you try to make changes for your health. The diversity of this group of inner parts can make weight loss challenging.

But if you can open to thinking of yourself as having different inner selves, each with its own beliefs, attitudes, emotions, urges and body sensations, you will be freer to experience them without being controlled by them. And once you can think of them as separate inner selves, you can develop your ability to be their leader by taking charge of them and managing them.

Voice Dialogue is a therapeutic method developed by Drs. Hal and Sidra Stone that can help you know and experience the energy of your many different inner selves so you can manage them with the leadership of an Aware Ego process.

Once you develop an Aware Ego process, you will be able to choose which