man cleaning stains off the tableEveryone has an image of a “perfectionist” in their mind—the person with the meticulously organized house, the work desk without a pencil out of place, who works fervently day and night to make sure not a mistake passes on their watch. Despite the stigma and stereotypes, perfectionism is neither inherently good nor all bad. And a lot of it depends on where the motivation for perfectionism begins.

Researchers have identified three main types of perfectionism. The first is self-oriented perfectionism, wherein the individual has high standards for the self. This person may think, “I need to do better on this because I know that it isn’t the best that I can do,” or, “I have to redo this. I never do anything right.”

The second type of perfectionism is socially prescribed perfectionism. This person feels the external pressure of family members, coworkers, and bosses, or society in general, to live up to a high standard. They may think, “If I don’t do better, I’m going to let everyone down!”

The third type of perfectionism is others-oriented perfectionism. This person holds others to intense scrutiny and, at times, unrealistic standards. They might be the micromanaging boss at work, the parent who nitpicks the child who left socks on the bathroom floor, or the child who is constantly correcting other students in class when they make minor grammatical errors.

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Recognize yourself in any of these? A family member or coworker, perhaps?

By recognizing the root cause of the perfectionism, anybody can work to engage in healthy perfectionism and avoid being torn down by maladaptive coping skills associated with unhealthy perfectionistic habits. This doesn’t involve changing the worldview or personality of the person with perfectionism; the first step is to recognize how thought patterns impact the way a person feels about a situation. Again, being a perfectionist is a strength in many ways! One would hope that the heart surgeon in the operating room has a few perfectionistic tendencies. But counterproductive thinking patterns associated with unhealthy perfectionism can cause a lot of worry and anxiety.

Here are five steps to breaking the patterns of unhealthy perfectionism:

  1. Learn to strive for excellence! The No. 1 thing that people with productive perfectionistic tendencies are able to do is enjoy the challenge of a difficult task without getting distracted and distraught by minor errors or perceived imperfections. (Remember: sometimes a mistake that a perfectionist sees would never be noticed by another person.)
  2. Change negative thought patterns to realistic, positive coping statements. Change the thought, “I always mess up everything!” to “I make mistakes. Sometimes I can fix them and sometimes I can’t, but if I’m doing my best, I know I can feel proud of myself.” It is important to focus on creating realistic coping statements; statements that are too positive (“I am great at everything I try to do!”) lose their power often because they are too general.
  3. Prioritize activities and tasks by importance. People who get caught up in the minor details sometimes lose sight of the big picture and may become procrastinating perfectionists. Prioritizing the importance of things can also be effective for the others-oriented perfectionist because it can help put into perspective the real impact of constantly critiquing others for minor flaws.
  4. Set specific and manageable goals. Perfectionists often become overwhelmed by the daunting nature of the tasks they undertake. At times, they may have difficulty delegating responsibilities to other team members (a form of others-oriented perfectionism). By finding one small goal that would improve the nature of one’s perfectionism and feeling the success associated with it, step-by-step progress can be made to move from unhealthy to healthier perfectionism.
  5. Find a buddy. One confidant who can share the struggle and help to (kindly!) bring awareness to negative thought patterns or destructive perfectionistic strategies can be great. Perfectionists often feel like they should be able to solve all of their problems on their own; by taking a team approach, it helps them to look at the unhealthy patterns from an outside perspective and make the changes that will ultimately lead to increased happiness and contentment.

AdobeStock 300149487People encounter those with narcissism in love, work, and family relationships. When I provide psychotherapy for survivors of narcissistic abuse, one of the first steps in the healing process is psychoeducation about narcissism and emotional abuse. Survivors are often beset with myriad complex posttraumatic stress symptoms, including panic attacks, intrusive thoughts, depression, and the shellshock of cognitive dissonance.

By understanding the tactics employed upon the target of abuse, survivors empower themselves to reduce the impact of the emotional abuse aftermath. Given the delicate and subtle nuances involved in the psychology of healing, working with a trained clinician skilled in trauma recovery specific to narcissistic abuse is essential.

The literature on the subject of narcissistic abuse recovery is replete with pseudonyms for various circumstances involving a person with narcissism. One such concept is “hoovering” by the emotionally abusive person. When the cycle of “idealize, devalue, discard” is complete, a person with narcissistic qualities will often return to prior sources of narcissistic supply to see if he or she can tap such individuals for more ego-fueling attention, emotional reaction, sex, money, business advantages, a place to live, or other affirmations of his or her existence. “Hoover maneuver” was coined after the name of a popular vacuum cleaner, alluding to the fact abusers often attempt to suction up narcissistic supply from prior sources (people).

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Individuals who have narcissistic tendencies typically lack solid, healthy self-concepts and must extract narcissistic supply from lovers, friends, colleagues, and/or family members to feel affirmed, adored, admired, attended to, nurtured, feared, or despised. Positive or negative, the reaction doesn’t matter, as long as the abusive person can excise a response from a target’s reservoir of emotional sustenance, thus rendering the abusive person “alive” by virtue of having his or her false self acknowledged.

When a survivor has gone no-contact—in other words, the survivor has chosen to disengage completely from the abusive person—often the person with narcissism will attempt to see if the door is still open for more narcissistic supply. He or she may “hoover” prior survivors by emailing, texting, phoning, or showing up at a survivor’s workplace or residence under the pretext of apologizing for transgressions, delivering flowers, hitting the reset button, or feigning illness or a need for assistance (money, return of belongings, etc.).

This cycle is akin to the Power and Control Wheel often referred to in the domestic violence recovery community. The hoover maneuver is an attempt to see if a prior target of abuse can be conned into another cycle of abuse, resulting in the abusive person reclaiming a sense of power and control by causing pain (emotional and sometimes physical) to a target.

Survivors of narcissistic abuse should not be fooled by the hoover maneuver. Such an action is not a sign that the abusive person loves the survivor or that he/she can change and suddenly develop reciprocity, authentically own responsibility for mistakes, and consistently show emotional maturity. The analogy of a vampire sinking fangs into the jugular vein works here. The abusive person may home in on the target’s vulnerabilities (wanting to be accepted, loved, attractive, etc.) and try to hook that person back into another abuse cycle, solely for the benefit of soothing the abusive person’s ego—no more, no less.

It’s advisable for a survivor to continue with no contact and block the abusive person from email, text, phone, and any other form of communication. In most circumstances, assuming the survivor does not reengage, eventually the “hoovering” will stop. However, if the abusive person harasses or stalks the target, the survivor may want to consider seeking legal action and/or getting the police involved, including but not limited to filing a restraining/protective order.

Awareness of the emotional abuse tactics deployed by a person with narcissism, and going no-contact, is the beginning of empowerment and healing for survivors of narcissistic abuse.

Parents Pointing at Daughter“Discipline just doesn’t work for my child! We have tried everything and nothing works!”

Does this sound familiar? Are you frustrated that timeouts, positive reinforcement, or even threats don’t seem to be effective at addressing your child’s oppositional behavior? Here are five reasons your attempts at discipline may not be producing the results you would like:

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  1. Giving up too soon: One tricky thing about implementing an effective discipline strategy is that things can sometimes get worse before they get better. There is a logical reason for this (no matter how disheartening it may feel): children are smart! They use the behaviors they use because they work. If throwing a fit, crying, and screaming in the store convinces you to buy a toy or treat that you did not intend to buy, then the strategy worked. If that strategy stops working, the child may increase the behaviors—scream louder, cry harder—to attempt to change the outcome. Before the child will abandon the strategy, he or she will have to become convinced that no matter how long or loud he/she screams or cries, it will not accomplish his/her goal. Give a new technique time to work. Behaviors take time to learn and unlearn.
  2. Poor execution: Children are not the only ones who need time to learn new behaviors! Parents do, too. Expect that you will make mistakes and that mastering new skills may take some time. Be patient and forgiving with yourself as you try out new strategies. I recommend choosing one skill to focus on at a time. Then, choose one specific issue, event, or time of day that you will practice implementing that skill. Once you have mastered that, consider what skill you would like to work on next.
  3. Inconsistency: All too often, parents implement a great strategy but it is not effective because they do not use it consistently. Children need repetition, predictability, and consistency to learn and to feel safe. Consistency is vital to the effectiveness of any discipline strategy. In fact, consistent implementation of discipline is more effective, and predictive of success, than harshness of punishment. Remember, discipline is intended to teach your child. Harsh punishments teach children to hide unwanted behaviors. Consistency teaches children where the boundaries are and allows them to anticipate the consequences of their choices.
  4. Stuck in a power struggle: If your child immediately disagrees with everything you say—regardless of what it is—you may be stuck in a power struggle. When parents sense they are losing control, the instinct may be to “tighten the reins” or “crack down” on unwanted behaviors. However, oppositional children rarely respond favorably to micromanagement or coercion. The truth is that it is a developmental task of children to seek independence and learn to express their own will and choices. To a strong-willed or oppositional child, it may feel like an insult to his or her very personhood to lose control of his/her choices. Unfortunately, this can lead to a cycle of increasing escalation between a parent and child who are struggling to gain control.
  5. Not following through: You have to mean what you say. There is just no way around it. If you tell your son he can play with Legos after dinner, he should be able to count on the fact that, unless something extraordinary happens, he really will get to play with Legos after dinner. (No, feeling exhausted after dinner does not count as something extraordinary happening!) Telling your daughter that you will put the crayons away for the rest of the day if she colors on the table will be effective only if your daughter believes that you will follow through and put the crayons away. Children have to trust what you say if you want to be able to provide effective guidance or discipline.

Woman walking in parkAuthor’s note: This article is written explicitly for women who have been sexually assaulted as teens or adults. Although many of the emotional and psychological issues resulting from rape are shared among all rape victims, survivors of child sexual abuse and people of other genders who have been raped may experience different symptoms from, and have different needs than, those of women.

I rarely meet a woman who has experienced rape and is comfortable using that word. In fact, in my experience most try to avoid it and instead use language such as “I had an incident,” “You could say that he touched me,” or “I had sex with him but didn’t really want to.”

There is a stigma attached to the word rape that often makes victims feel that if they say it aloud, it somehow means they are tainted or damaged. So let me be clear: While being raped can make you feel you are coming undone, in time it can become a life experience like any other challenge—that is, an experience that allows you to deepen your understanding of yourself and others, helps you grow and develop new skills, and helps you learn that strength and vulnerability are not incompatible. In other words, while being raped can shake your soul initially, with the right help and guidance, it does not have to stay that way forever.

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The stigma surrounding rape is so strong that many expect that the word “victim” not be used. We are told that there are no victims, that instead there are “rape survivors.” Well, I’m going to be a rebel today (as I am most days) and tell you that there are, in fact, victims. If you were raped, you were victimized. That’s the simple truth, whether we like it or not. The sad reality is that according to some estimates, almost one in four adult women will experience some form of sexual assault in their lifetime (Centers for Disease Control and Prevention, 2012); for most, it will feel like a victimization. But with time, psychotherapy, and personal growth, a woman who has been raped can feel empowered again, and eventually feel like her “normal” self—a woman who has had many life experiences: some wonderful, some difficult, but all of which contributed to growth.

There was a great scene in the television show NCIS: Los Angeles recently. Two federal law enforcement officers, Kensi (female) and Deeks (male and Kensi’s boyfriend), were talking when Kensi suddenly became quiet. Something in the conversation seemed to trigger a rape memory for her. Then Deeks said something along the lines of: “I know you want to forget it happened, but it will just keep screaming louder to get your attention until you acknowledge it.”

That’s what happens with rape. You want to pretend it didn’t happen and move on. I wish it were that simple, but there is something in our psyche that won’t allow that.

Here are five steps to slowly moving forward:

  1. Acknowledge it. Say aloud that you were raped. It may feel scary at first, but trust me—eventually it will likely feel empowering. In the beginning, it’s important to be selective about whom you tell. Some people are caught up in their own issues and thus unable to respond in an appropriately supportive manner. Your safest bet is a therapist. Many therapists are trained in helping you through rape recovery and are able to be supportive and compassionate. Best friends also tend to be pretty supportive and empathetic listeners. Start with one or, better yet, both. A rape crisis hotline is a good choice, too. (Note: If you were recently raped, going to the hospital for a rape exam and police report is an important first step.)
  2. Nurture yourself. It is very important to nurture yourself throughout this process. Be kind to yourself (don’t say anything to yourself that you wouldn’t say to a friend who was raped); be gentle with yourself; be patient with yourself; and do healthy things that make you feel good (a scented bubble bath, new hairstyle, exercise and yoga, buying yourself some flowers, etc.).
  3. Discover how you feel and get it out. There are two options for this step, and doing both is better than just one: write about your rape and talk about it. Talk about your rape with your therapist. Tell the story a few times. Tell it from different angles (for example, one time talk about what you were thinking and feeling, then another time talk about what your rapist was doing and saying). Tell a few more close friends, if you feel comfortable doing so. It’s OK to tell them that you don’t want or expect them to treat you any differently, but that you appreciate their sympathetic listening. Write in a journal. Perhaps even write a letter to your rapist. (In the vast majority of cases, it’s probably best not to send the letter—that’s something you can discuss with your therapist—but the act of writing the letter can be beneficial and help you sort through your feelings.)
  4. Learn. Learn about what other women have experienced. Learn about what is typical for you to be feeling, even if your experience was unique (and it was). Learn how to acknowledge and tolerate your difficult feelings. How can you do this? My favorite ways are books, workbooks, and support groups. Blogs, too! There is probably a sexual assault treatment center and/or support group in your city. Go check it out. Lean on others.
  5. Nurture yourself! Go back to Step 2! It can take a few years, and perhaps decades, to work through a rape. (Some might never quite work through it, but the important thing to remember is that it’s possible.) It’s important not to focus on it every day, while at the same time not ignoring your feelings. Staying the course will help you make progress and heal.

In closing, if you were raped, I want to say this: I’m sorry about what happened to you. I’m sorry you have to go through this; no, it isn’t fair. But even without knowing you, I know you can overcome this. The human spirit can overcome a lot and is stronger than you can ever imagine!

Reference:

Centers for Disease Control and Prevention. (2012). Sexual violence; Facts at a glance. Retrieved from www.cdc.gov/violenceprevention

Three at the jettyAs a therapist who specializes in working with LGBTQ (lesbian, gay, bisexual, transgender, queer) teens and their families during the coming-out process, I am often witness to the reactions parents have to a teen revealing his or her sexual identity. These reactions range from “We suspected for quite a while” to “We had no idea!”

As I work with these families, the expectation is that therapy needs to focus on the issues surrounding the teen coming out. While this support for the LGBTQ teen is vital, in my experience, parents may need just as much support. Parents are often in territory that is new to them and they may not have developed the language to speak effectively and sensitively with their teen, or the awareness to sort through their own changing perspectives.

One of the most basic things that I have parents focus on is that the child they have lived with and known for years is still the same person. One of the most supportive things any parent can offer at the moment of coming out is simply a hug and reassurance that there is still a relationship based on love. Remember that when a teen comes out to his or her family, he or she has probably been thinking about and building anxiety around how that coming-out experience will play out and be received. Simply connecting with the teen will help to relieve some of the anxiety and reassure the teen that there is still space for him or her in the family story.

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It is also important at the beginning to simply listen and support. Even with parents who suspect that a teen may be gay, it is important that they take time to process some of their own feelings before opening up a litany of questions and concerns. When parents are caught completely off guard when a teen comes out, it is vital to offer loving support to the teen and at the same time recognize that there are questions and concerns that there may not be answers to immediately. Parents may need time to adjust to this new information and to process it.

As parents begin the process of unraveling their feelings about their teen’s sexual orientation, it is also a good time to gather information and learn more about what it means to be a member of the LGBTQ community beyond stereotypes and popular conceptions. Parents can join organizations such as PFLAG and gather the latest info regarding LGBTQ teens on the GLSEN website. As parents become more educated, they can release some of their fears and build a foundation for conversation with their teen.

As the process continues, another question that may arise is, “Who gets to know?” The coming-out process is just that, a process, and how the information is disseminated is worth discussing. Often, a teen will come out to one parent first and then ask for that information to be held in confidence for a time. There is no need to force the conversation, and it can help the process a lot if the teen feels like he or she is in charge of who gets to know. It is also common for a sibling, friend, relative, or teacher to know first, so I encourage parents to be OK with the fact they may not be the first to know.

Finally, don’t forget that while it should be a priority to be open and available to converse with your teen about his or her sexual identity, it is not all that he/she is. He or she is still facing all of the same battles and angst that other teens go through as they develop their identity. Be sure to support LGBTQ teens in all their efforts in life, including school, hobbies, sports, friendships, and spirituality. Though it may seem like the coming-out story is the most important thing on the list at the moment, teens are complex, vital, intriguing, and amazing people who are open to guidance, acceptance, and love in all forms and areas.

Three rescue workers talkingFred is a 40-year-old firefighter who has been working as a first responder for more than 15 years. In his first year as a firefighter, he arrived at a car accident in which three children were killed. Since then, he has been among the first to respond to the scenes of countless injuries and dozens of deaths.

Although he tries not to think about the fatalities, he remembers each one. When asked how he and his colleagues cope with the trauma of witnessing such horrific events, he looks away, chuckles, and says, shaking his head, “We joke around and pretend it doesn’t bother us. You don’t want to be the one going to counseling. Everyone would call you a wimp.”

First responders such as firefighters, EMTs, and police officers face horrors in their work that most of us can’t imagine. In helping everyday people in the worst of times, they witness death, destruction, and much of the worst of what humans can do to hurt one another. A recent article from The Police Chief discusses the importance of seeking professional help for law enforcement officers. Physicians, physician’s assistants, nurse practitioners, nurses, and other medical professionals are also typically exposed to more human suffering than anyone should have to see.

The Boston Globe published an article a few months after the Boston Marathon bombings. It describes the experiences of several first responders whose lives were irrevocably changed by what happened that day. And this article in Counseling Today, aptly titled “First to Respond, Last to Seek Help,” lists the effects of traumatic experiences on first responders and the many barriers to seeking help these individuals face.

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Christine, 35, has been a hospital nurse in a children’s cancer unit for 10 years. While she can tell joyful stories of the children whose treatment succeeds in overcoming the cancer cells, there are many stories she doesn’t share. While she doesn’t speak about the pain and suffering she has seen, these memories haunt her at night when she tries to sleep. She is beginning to question her faith as she struggles to understand why children and their families have to experience such pain. Most days she cries in her car on the way to work, but she can’t stand the thought of leaving her job. Her supervisor has suggested she go to counseling and she views this recommendation as an insult to her professional skills.

Part of the problem is the environment in which firefighters, EMTs, police, and medical personnel do their heroic work. The fast-paced nature of their work settings limits opportunity for expressing feelings about what they see. Maintaining a clinical distance between patients and themselves helps first responders and medical professionals maintain their composure in the worst situations.

But there is a reason those of us who are helpers seek out helping work. We are caring people by nature, and it hurts to see others in pain. While most employers offer counseling through employee assistance programs, first responders and health care providers often feel, as Fred mentioned, that asking for help is a sign of weakness.

Exposure to trauma is an occupational hazard for first responders and medical professionals, and as such, it is necessary to practice self-care and know the signs that trauma is taking a toll. According to the Trauma Center of the Justice Resource Institute, the effects of exposure to trauma are cumulative. The longer one has worked as a first responder, the more likely he or she is to have a reaction to trauma.

What You Can Do about It

There are several great books available to help people who have experienced trauma firsthand. Two I recommend are Trauma Stewardship by Laura van Dernoot Lipsky and Compassion Fatigue by Charles Figley. Taking time away from work and seeking social support can be helpful. If needed, find a therapist or counselor who is specially trained in trauma to help you recover.

When to Consider Seeking Professional Help

According to the Trauma Center at the Justice Resource Institute, a first responder who is experiencing the following symptoms should seek professional help to assess and treat the effects of their traumatic experiences:

If trauma symptoms are interfering with your enjoyment of things you used to love, if you’re starting to hate your job and question why you went into the field, or if the way you look at the world has changed, counseling can help. Asking for help is a sign of strength.

References:

  1. First responders and traumatic events: normal distress and stress disorders. (n.d.) Retrieved from http://www.traumacenter.org/resources/pdf_files/First_Responders.pdf
  2. Gupton, H.M., et al. Support and Sustain: Psychological Intervention for Law Enforcement Personnel. The Police Chief 78 (August 2011): 92–97.
  3. Shallcross, L. (2013, August 1). First to respond, last to seek help. Counseling Today. Retrieved from http://ct.counseling.org/2013/08/first-to-respond-last-to-seek-help/

I’m so sorry you find yourself in this position. I imagine you feel like you either have to be disloyal to your mom and tell your dad, or be disloyal to your dad and keep this secret from him. That is a no-win situation.

So, let’s look at it differently.

Relationships between intimate partners are complex, and your mom and dad will have to figure their own stuff out. Your mom’s choices about her relationship with your dad and the consequences of those choices really are between the two of them. I am not here to pass judgment about your mom’s apparent infidelity. I will say that her asking you to hold her secret is a betrayal of her relationship with you. It is part of the unspoken parenting contract that parents don’t put their kids in a position to have to choose which parent to betray or be loyal to. That’s not right or fair. It doesn’t matter if this was a one-time thing or a pattern of behavior—it’s not your role to weigh out the details and possible consequences.

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I suggest you have a conversation with your mom but, for now, leave your dad and his feelings out if it. Focus instead on what her request is doing to you and to your relationship with her. Asking you to hold her secret is asking you to carry the responsibility for her choices. That is a breach of trust with you that could have long-lasting implications. It cannot be your responsibility to cover for her, nor should it be your responsibility to inform your dad. This isn’t about you loving her enough to keep her secret; it is about her loving you enough not to ask you to. You cannot force her to own her actions. If, however, when presented with your feelings she still chooses to put you on the middle, you may want to ask yourself what you are protecting.

None of this is easy, so if you find yourself struggling, I suggest finding a therapist near you to work through some of this with. No matter what happens, having some support may be beneficial in helping you move past this.

Best of luck,
Erika

Runner athlete legsWhen people think of eye movement desensitization and reprocessing (EMDR) therapy, they generally think about a treatment for trauma, which is partially accurate. Treating trauma is what EMDR therapy was developed for and continues to do. But since its development and introduction over 25 years ago, it has become more than an intervention and is now a comprehensive psychotherapy, one that is exceptionally effective in addressing multiple issues and challenges.

A common misconception is that a person has to be struggling with mental health or major life challenges to benefit from EMDR. On the contrary, one of the most interesting and innovative uses of EMDR has been in performance enhancement in addition to its ability to decrease fear, stress, or anxiety related to performance.

How EMDR Works

In short, EMDR therapy accesses and links the multiple facets of memory (image, cognition, emotion, and sensation) and uses bilateral stimulation/dual-attention stimulus (eye movements or tactile or auditory stimulation) in order to decrease disturbance associated with specific incidents in a person’s life. It taps into the brain’s natural ability to heal and helps it file away memory appropriately so that when the memory is recalled, there is no disturbance associated with the memory.

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Other Ways EMDR Can Help

EMDR has several wonderful applications. In addition to decreasing disturbance associated with trauma, it is effective in decreasing anxiety and targeting irrational or negative thinking, both of which may get in the way of performance. In addition, it can help a person to gain confidence in his or her ability to perform a task or reach a goal. EMDR works to achieve this by installing positive beliefs, and by having a person imagine doing the thing he or she is nervous to do or wants to improve in while doing bilateral stimulation. This has the effect of simultaneously decreasing the fear, anxiety, or stress associated with the task and boosting confidence.

It seems that EMDR helps the brain to think in a healthier, more adaptive way by removing blocks (such as negative self-beliefs) and helping the person to tap into his or her strengths.

An Example of EMDR in Practice

Sometimes EMDR is hard to conceptualize without a specific example. Here is a hypothetical one.

Alice wants to implement healthy habits into her life, so she has set a goal of exercising three times per week. However, she is self-conscious when she thinks of going to the gym. She worries about other gym members and trainers judging her.

She visits an EMDR therapist to help her reduce her anxiety and to boost her confidence in going to the gym. The therapist completes a thorough history and teaches her stabilization and calming skills to utilize between sessions and (if needed) during the desensitization phase. Once fully prepared for the next phase of EMDR therapy, Alice and her therapist assess and desensitize any past experiences that feel related to the current experience.

Once there is no longer any disturbance associated with past experiences, they then assess and target the current situations that are triggering for Alice. Specifically, Alice targets the image of the gym, the belief “I am not safe,” emotions (fear and insecurity), and body sensations associated with this target. They use bilateral stimulation and work through the target until no disturbance remains, Alice is able to fully believe the thought “I can keep myself safe,” and she no longer has any negative body sensations associated with the target.

Alice and her therapist then move to the next phase of EMDR therapy, during which future situations are targeted. During this phase, Alice plays a movie in her head, imagining herself packing her gym bag, getting in her car, driving to the gym, going into the gym, completing her workout successfully, and leaving the gym feeling a sense of accomplishment. Alice finds that when thinking about this scenario, she has some anxiety and another negative belief: “I am going to fail.”

Alice plays the movie through several times, all while the therapist provides bilateral stimulation. If Alice finds she gets stuck, she lets the therapist know and the therapist helps her to work through the sticking points. She finds that each time she plays the movie in her mind, she is less anxious and more confident in her ability to go through the actions she is imagining. She eventually finds that she no longer believes she will fail and, while playing the movie the last few times, instead holds the belief “I am strong and capable.”

The next time Alice goes through the actions of preparing for and going to the gym, she has far less anxiety and much more confidence.

Of course, every case and person is different, but this is a simple example of how EMDR may be helpful in not only addressing past and present issues related to performance, but also in enhancing future performance and decreasing anxiety related to potentially triggering situations. The number of sessions will vary from person to person, but it has been my experience as a therapist that EMDR is both efficient and effective. Contact a therapist trained in EMDR if you think it might be beneficial for you.

female-with-hand-upI remember when I first started out as a therapist. I loved offering advice. I had such important, good advice to share.

Actually, I was full of advice long before I became a therapist. I had good ideas for just about everyone in every situation starting from a fairly young age.

At one point in college, I decided to try an experiment. Instead of being so free and honest with my advice, I’d wait until people asked me for it. Why should I make it easy for everyone?

Strangely enough, no one asked.

Perhaps that’s part of what initially led me to this profession. Imagine my surprise when, three weeks into my first internship, my boss very directly told me and the other two interns, “Your job this year is to learn to listen and to not help anyone.”

What?

I found that to be glib and annoying. I figured he just wanted to say something bold, shocking, something to make us think twice. I mean, my earliest exposure to therapy was Lucy in the comic strip Peanuts. There was an advice giver if ever there was one.

Well, my boss was right.

Advice giving as a therapist should be a rare thing. Here’s why.

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None of this is to say I’m never concrete with people in the therapy room or that I never offer suggestions. I don’t think it’s all that helpful to hold back or to be deliberately vague. But in my years of doing this work, I’ve given advice less and less and people seem more satisfied.

Sometimes my lack of advice giving brings up some strong feelings. I think back to when I wanted someone to make a decision for me. When someone did, I missed an opportunity to be better prepared for next time.

It’s like your mother telling you to look up a word in the dictionary instead of simply telling you its meaning. I was always angry when she did that. I considered her to be manipulative, withholding, and smarmy.

But I know what “pompous” means.

painting-oil-canvas-013115About a year ago, I was working as an art therapist in private practice and I had a 12-year-old client struggling with anxiety and figuring out who she was in the world. I asked her to create a self-portrait—a great exercise for a girl trying to define herself. At one point I realized I had never made a self-portrait, at least not since grade school. So I went out, bought a canvas, took a “selfie,” and began my own personal process answering, “who am I?”

I began with a light sketch, trying to see myself from the observer view. Then I started painting, layering first in basic colors to assign shadow and light areas. I have a lot of experience painting, but painting a person is definitely challenging. Faces have complex layers of subtle shadows and highlights. I worked layer after layer. Too dark. Too light. Too dark again …

One night I came home and looked at the painting in process and wondered, “Have I gone too far? I just keep layering and layering, will it ever be finished? This painting is getting overworked.” I paused, contemplating this chosen word. That’s exactly what I had created: “overworked Michelle”. Working three jobs and always doing a lot, I was overworked and my self-portrait reflected this state.

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This is the beauty of art therapy: even though you’re not trying to do it, your self comes through in the art you create. There I was, “overworked Michelle,” in painting as in life. I didn’t like how she looked … and I didn’t like how it felt to be overworked Michelle, either. At that point, I stopped working on the painting and bought a new, blank canvas of the same size. “Who would I be if I wasn’t overworked Michelle?”

I challenged myself to make the Michelle I wanted to be, my ideal state of being. To avoid overworking the painting again I limited my work time to two sittings. In the beginning, I did not sketch anything, but started with paint on canvas, finding a portrait through color and strokes. Without a photo to reference I was free to make the face, body, and shading however I wanted. The result was a representation of how it feels to be me on the inside.

A few nights previously I had had a powerful dream about a mountain lion and when the hole in the chest appeared in my painting, I knew I wanted a cougar coming from the darkness. But how would I paint a cougar in such a short amount of time? Actually, I had already cut one out of a magazine and it was just hanging on my bulletin board nearby. Should I put collage in my painting?! I’d never done that before!

michelle fox art therapyI found freedom in creating this painting. All rules went out the window. I could be whoever I wanted to be! This is the truth of life. We create imaginary confines around ourselves that don’t actually exist. With the focus of actually creating the me I wanted to be, I found myself soft and open, vulnerable and dangerous, with strong roots hanging down, looking for soil.

Art is a powerful medium. It reminds us that we are creators, born to make what we want out of life. Art is an opportunity to ask yourself, who do you really want to be? I practiced what I wanted in this painting, and then my life followed suit. I am no longer “overworked Michelle.” Now I have one job, and it is my passion—the place where I share my heart with others and practice vulnerability and openness. I take care of myself first, every day. I don’t feel overworked, because I love what I do. I continue to draw and paint what I want out of life because, in the very near future, it could all come true.

Michelle Lynn Baker is an art therapist and owner of MBodied Art Studio in Westminster, CO. She teaches art classes to children and adults and runs therapeutic art groups for parents and children. Michelle enjoys the spectrum of art as therapy from learning to healing.

It’s easy to understand why you feel hurt; your experience with this therapist is a reminder of previous abandonments in your life. Perhaps those abandonments are even the reason you are seeking a therapeutic relationship—so you can work out your feelings. Good for you! Working through complicated feelings, and arriving at a better understanding of why you feel them, is one of the great benefits of psychotherapy.

You have an “ache in your chest,” need help, and have the courage and wisdom to seek it. Unfortunately, you did not find the help you were looking for this time, but I hope that this experience will not put you off of therapy, and that you will try, try again with someone new. Although I don’t know some of the specifics regarding your situation, it seems to me that your experience with this particular therapist is not typical.

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I am not sure of the exact timing of your sessions, such as when your treatment started, when the first three meetings took place, and when the hiatus occurred. Knowing the sequence and the rhythm of the proceedings would make it a bit easier to understand what might have happened. In any event, although you describe your relationship with the therapist as “on and off,” you were committed to the treatment and you felt surprised when you called to schedule your fourth session and found that she was unavailable. Clearly, you were expecting her to wait for you to come back and you felt hurt when she wasn’t there. In short, you were “on” but she was “off.”

Best I can tell, the therapist ended treatment over the phone. The usual practice is to meet together in person before terminating treatment. I agree with you that a face-to-face meeting would have been more appropriate. It is possible that the therapist’s time simply filled up while you were away and scheduling became more difficult, but I wish you had both tried to find a time that worked for the two of you to meet. That clearly would have helped you move forward, if only in the direction of another therapist you would feel more embraced by.

You wanted to say goodbye and achieve some closure to understand what was going on and maybe even feel better, as you mention in your letter. I’m curious as to what you feel a proper ending looks like—what you want to say to her, and what you want her to say to you. What are the “loose ends” you want to tie up? These are important issues, and I hope you discuss them with your next therapist.

You also asked for advice about what to do next. Again, I hope this experience won’t stop you from starting anew with another therapist. Find a therapist who can help you learn how to participate in a relationship that is, simply, “on.”

Best wishes,
Lynn

Sisters Comforting Each OtherIt is the nature of abuse within families to be as behaviorally nuanced and emotionally complex as the individuals involved. Relationship abuses nearly inevitably reveal a life-draining and self-perpetuating dynamic of power and control. It is within this dynamic that abuse is perpetuated.

Abuse may manifest as physical (throwing, shoving, grabbing, blocking pathways, slapping, hitting, scratches, bruises, burns, cuts, wounds, broken bones, fractures, damage to organs, permanent injury, even murder), sexual (suggestive flirtatiousness, propositioning, undesired or inappropriate holding, kissing, fondling of sexual parts, masturbation, oral sex, or any kind of forceful sexual activity), or emotional (neglect, harassment, shaming, threatening, malicious tricks, blackmail, unfair punishments, cruel or degrading tasks, confinement, abandonment).

Abuse may also involve what I call strategic accusation in an attempt to maintain perceived leverage in the context of families and social circles—for instance, communicating to family and friends that the victim has engaged in affairs that have not occurred, or even using the mere threat of spreading such a rumor. There may also be implicit threats, such as, for instance, the open display of weapons. Perpetrators may drive recklessly in order to generate fear and emphasize a position of control.

Financial or what you might call economic abuses may also exist. For instance, many perpetrators maintain individual, or even secret, bank accounts as a way to withhold money. They may also ensure that bills and credit cards be placed under the name of the victim as a measure of self-protection.

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In all of these, the dynamic of abuse commonly takes shape in varying modes of manipulation, intimidation, aggression, and terrorism.

And though we often think of abuse as being inflicted by a perpetrator on a victim, or else between two perpetrators, we must be careful to recognize another disposition, an often secretly performed dynamic of abuse, that is inflicted by an emotionally troubled person onto himself or herself.

Recognizing that those trapped in such dynamics embody varying forms of what psychology has long referred to as sadism and masochism, psychologist David Shapiro (1981) instructed:

Each disposition involves, in its own way, a defensive, usually angry assertion of will; each is driven by a sense of inferiority, shame, or humiliation; each is deeply and self-consciously concerned with relative position, rank, and measure, with superiority and inferiority—but the sadistic person from the superior position, and the masochistic person from the inferior one.

The sadistic impulse occurs when a person dominates others as a way of attempting to gain in a surrogate what they lack within themselves and in life: control. The masochistic impulse occurs when a person grasps for such control through harmful forms of self-soothing.

Eating disorders, cutting, and substance abuse are indicative of a masochistic coping style and often of entrenched emotional dominance or avoidance within a family system.

Child abuse occurs far more commonly than most people realize. The Centers for Disease Control and Prevention began a study in the 1990s that has tracked child abuse and reported that there are more than three million reports made each year involving more than six million children, and that between four and seven children die each day due to abuse or neglect in the United States.

And then there is violence between lovers. Michael Johnson (2006) identified four major types of intimate partner violence—situational couple violence, intimate terrorism, violent resistance, and mutual violent control—and defined them “in terms of the control motives of the violent member[s] of the couple, motives that are identified operationally by patterns of controlling behavior that indicate an attempt to exercise general control over one’s partner.”

Intimate terrorism, which most frequently involves men abusing women, is the most extreme form of domestic violence. Another form of chronic domestic violence is a pattern in which both husband and wife are controlling and physically violent, two intimate terrorists battling for control, what Johnson labeled “mutual violent control.” These types of chronic abuse are products of two quite different evolutionary histories and psychological profiles: “one type broadly sociopathic and violent, the other deeply emotionally dependent on their relationship with their partner” (Skolnick and Skolnick, 2003).

Lipman-Blumen (1984) defined power in relationships as “the process by which individuals gain the ability to impose their will on others.” Abuse is often preceded by a more subtle power dynamic. Newman (1999) noted that early stages of abuse may be primarily emotional and difficult to detect:

For instance, when a husband anticipates his wife’s angry response to his desire for her to do more around the house, he may decide not to voice his concerns in order to avoid conflict. Thus, she has successfully exerted power over him [by preventing him from speaking his mind] without any direct confrontation. Such invisible power is important since it can maintain inequality even in those marriages that appear harmonious and conflict free.

Victims of relationship abuses often enter into therapy in the midst of a dualistic emotional experience—an affectionate emotional bond interlaced with anger, resentment, and fear.

Those who find themselves in therapy are obviously often experiencing painful and isolating feelings and possibly ambiguity of emotions, such as love and anger, which may be felt simultaneously. Unless a therapist is highly empathic, victims may be unwilling to expose themselves. The first tasks in therapy should always be to empathize with the person amid the emotions brought into the therapy room and to ensure an immediate plan for safety should a disclosure of abuse be made.

References:

  1. Centers for Disease Control. Adverse Childhood Experiences (ACE) Study. Retrieved from http://www.cdc.gov/violenceprevention/acestudy/index.html.
  2. Johnson, M.P. (2006). Conflict and control: Gender symmetry and asymmetry in domestic violence. In Violence Against Women (12) 11, 1003-1018. Thousand Oaks, CA: Sage Publications.
  3. Lipman-Blumen, J. (1984). Gender roles and power. Englewood Cliffs, NJ: Prentice-Hall.
  4. Newman, D.M. (1999). Sociology of families. Pine Forge Press: Thousand Oaks, CA.
  5. Shapiro, D. (1981). Autonomy and rigid character. United States: Basic Books.
  6. Skolnick, A. S., and Skolnick, J. H. (2003). Family in transition (12th ed.). Boston: A&B.
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