Conflict between man and womanInsecurity is one of the trickiest relationship issues because it tends to create a self-perpetuating cycle. Insecure people frequently cling to their partners, which causes their partners to pull away, worsening the insecurity.

Feelings of insecurity often begin with family-of-origin issues or unhealthy early relationships. In many people, these experiences may interfere with their ability to choose good partners; some insecure people may choose partners who make the insecurity worse. There’s no quick fix for anxiety, and some people need therapy to move past anxiety in relationships, but there are several steps you can take to reduce it:

Determine the Cause

Not all insecurity is unwarranted. Objectively examine the behavior of your partner. Is he or she honest? Does he or she respond to your basic needs? Does he or she seem concerned about your feelings?
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If you’re not getting what you need in your relationship, your insecurity might be the other person’s problem, not yours. But this doesn’t mean you can force your partner to fix it. If your partner refuses to meet reasonable emotional needs, you can either end the relationship or find other ways to meet your needs, perhaps by taking up a hobby, expanding your circle of friends, or finding fulfillment in your work.

Negotiate Relationship Rules

Every relationship serves as a sort of mini-government that establishes its own rules and standards of behavior. Something that’s OK in your relationship might not be OK in another person’s relationship.
Talk to your partner about how you want your relationship to function and how each of you can get your needs met. You might, for example, agree that you need a lot of verbal reassurance, while your partner benefits more from favors and nice gestures.

When insecurity is a chronic problem, you should talk openly and honestly about it so that your partner knows you might need extra reassurance. If you have a disagreement about what constitutes a fundamental need, you might need to get out of the relationship or find another way to meet your needs.

Avoid Mind Reading

No two people think exactly alike, and what might mean absolute rejection to you could just be an oversight or misstatement by your partner.
Mind reading can contribute to insecurity when you make assumptions about your partner’s thoughts rather than asking him or her about them. If you’re feeling unsure of something, express this to your partner and ask for clarification.

Quit the Comparison Game

Almost any relationship, no matter how troubled, can look perfect from the outside looking in. Don’t compare your relationship to other people’s relationships, and avoid comparing your current partner to past partners.
It’s easy to find your partner’s weaknesses and assume that he or she doesn’t love you, and when you compare relationships, you’re much less likely to compare your partner’s positive traits to other people’s negative traits. Accept your partner for who he or she is and work on your relationship where it is rather than aspiring to emulate a relationship that might not even be real.

Look for the Positive

Confirmation bias is a psychological phenomenon that causes people to look for evidence of what they already believe to be true. If you’re convinced that your partner doesn’t love you, you might see his or her failure to say he/she loves you on the phone as irrefutable evidence that love has died.
But when you look for confirmation of the positive aspects of your relationship, you’re also more likely to find these. Focus on your partner’s positive traits, and interpret ambiguous statements and actions as positively as possible. In minor cases of insecurity, this can be all it takes to move past anxiety.

References:

  1. 20 ways to beat relationship insecurity. (n.d.). YourTango. Retrieved from http://www.yourtango.com/200948412/how-beat-relationship-insecurity
  2. Cassidy, J., & Shaver, P. R. (1999). Handbook of attachment: Theory, research, and clinical applications. New York, NY: Guilford Press.

Woman sits painting“Art washes away from the soul the dust of everyday life.” —Pablo Picasso

I am privileged to work with new moms in my private practice. It is tremendously gratifying to help women and their families move through what can be one of the most challenging life transitions—that of parenthood. In my work with mothers, I see many women who experience perinatal mood/anxiety issues (PMADs), perinatal loss (miscarriage), fertility challenges, and traumatic birth situations (see prior articles on these subjects on my GoodTherapy.org profile page). Most often, interventions with moms are a combination of evidence-based cognitive behavioral work and interpersonal approach to assist the client in full recovery.  I have also found great benefit in the use of expressive arts to assist this population in healing.

Expressive arts therapies are defined as the use of creative arts (art, dance, music, writing, drama) as a form of psychotherapy. The process of art making is emphasized versus the final product. In my practice, I employ the use of visual arts and crafts as a powerful intervention with clients of all ages. Although I am not an art therapist, I believe the use of art intervention is incredibly meaningful and assists in recovery from PMADs.

The American Art Therapy Association defines art therapy as a practice as “the therapeutic use of art making, within a professional relationship, by people who experience illness, trauma, or challenges in living, and by people who seek personal development.” Art therapy itself is considered a specific subspecialty in the field of psychology/counseling and requires an intensive registration and education process. With either expressive arts intervention or art therapy, the client does not need to have prior art training and need not feel pressured to produce a masterpiece. Again, the focus of the intervention is the process, not necessarily the product outcome.

I was initially exposed to the power of art to heal trauma in the drawings of child survivors of domestic violence in a San Diego shelter when I first began my career in clinical social work 20 years ago. In graduate school, I worked with a registered art therapist in a hospice setting, counseling children and families who experienced the loss of a loved one due to terminal illness. Art intervention was the primary modality in individual, group, and family work.

Moving forward through my career, most every setting I have been employed in involved the use of art as an intervention and source of healing. School and clinic-based settings provided ample opportunity to continue to bring art and creativity to the therapy process for children and adults managing depression, anxiety, trauma recovery, loss, life transitions, divorce, social skills issues, and medical traumas.

Art intervention is incredibly helpful for trauma survivors and those recovering from life challenges (including for clients feeling a sense of PTSD from perinatal depression). Art allows the right brain to be balanced and integrated with the rational, logical left brain. The bilateral movement of the hand moving across the page (mimicking the back-and-forth motion of EMDR) in turn assists in releasing trauma and integrating the experience in the brain.

Typically I will invite my client to participate in an art intervention at a point in her healing process in which she is beginning to feel the first glimpses of recovery. Sleep is beginning to be restored, mood is lifting, and anxiety is starting containment. Prior to art intervention, I will have helped to stabilize any crisis, link my client with other helping professionals and extended support networks (psychiatrists, lactation consultants, doulas, support groups, family support), and work with her to attain a level of recovery in which her focus and concentration are improving, along with her mood health. She may begin an exercise regimen; she may have hired a doula (caregiver) or enlisted the assistance of her extended family with baby care. She is beginning to feel biochemical relief, perhaps with the assistance of an SSRI, improving her nutrition with omega-3 fish oils, and she is sleeping for at least five consecutive hours (a full sleep cycle which restores serotonin).

Art interventions which I find particularly helpful for new moms contending with PMADs (which can also be adapted to other populations) can be created in individual or group modalities. Significant others of new moms may also participate in a couple/family session. The following are suggestions for use with new moms recovering from PMADs:

Materials needed: colored pencils/markers, large poster paper.

Have client draw images of symbols which represent the wishes she hopes to manifest (for example, “good health/vitality” may be a sunshine image); encourage client to add powerful affirmation to the page (“I am reclaiming the best of my health and vitality”) and label each image. Invite client to post “treasure map” in a prominent location in her house to be reminded of the goals she is setting for herself in active manifestation.

Purpose: a visual guide to affirm client’s goals and provide reassurance.

Materials needed: magazines with a variety of images, large butcher/poster paper.

Have client select images from magazines which represent her new identity transformation as a mother, or use theme in intervention above to guide client in goal attainment for self-care and balance as a new mom. Discuss images and invite client to verbalize how the images are important and meaningful to her.

Purpose: validation and support with role transition to new motherhood.

Materials needed: preformed paper/cardboard face masks (available in craft supply stores), feathers, colored markers, beads, yarn.

Ask client to create one mask which demonstrates how she presents to the “outside world.” The second mask will reflect how she feels “inside” as a new mom. Discuss how masks are similar and different and why. What is the purpose of each emotional mask?

Purpose: identifying how feelings inside often do not match what we show to the outside world.

Materials needed: sculpy clay, paint, paintbrushes.

Invite client to create image out of sculpy clay (that which can be baked and hardened at a later time, then painted). The image can be a symbol of new motherhood, an image of mother/baby, or an object representing courage and healing (perhaps a bead for a charm bracelet or necklace). Once completed, client gets to keep the object in a special place as a reminder of her strength and courage in her healing process.

Purpose: a transitional object/symbol of the work the client is doing in psychotherapy and a tangible representation of her inner strength and courage.

Materials needed: art journal, colored pencils/markers/paint/paintbrushes.

Many clients prefer to draw feelings in lieu of writing about feelings. Invite client to create image of her birth experience using vibrant color of her choice, and to narrate her story of the experience. This exercise is especially helpful in working with survivors of birth trauma. It is also helpful to add second exercise of an image in which client creates a symbol on paper representing healing and recovery.

Purpose: Recording emotions (written or drawn/painted) allows a container for the client to “place” her feelings so she is less overwhelmed. She is able to “master” any traumas by telling her story and her experience.

Materials needed: array of bead supplies (beads, bracelet/necklace wires, etc.).

Invite client to create jewelry representing her new identity as a mother, her connection with her child.

Purpose: affirmation of new role and connection/attachment to new baby.

Materials needed: shoebox, construction paper, markers/pens/paints, any supply to decorate a box or album.

Assist client with decorating a special box to hold keepsakes (photos, poems, cards, etc.) as she becomes a new mother. A scrapbook can be a similar project. Discuss her identity transformation and the joys/positives of this new life role.

Purpose: recording the most transformational journey a woman can ever go through and celebrating it.

Materials needed: paper, pastels, paints, pencils/pens.

Mandalas are circular images from ancient cultures and religions which represent the power of one’s healing process (see Mandala book). Invite client to create a mandala with the materials of her choice.

Purpose: for client to enjoy process (versus product) of art making and generating an image which represents healing and recovery; practicing self-care through creativity flow.

Materials needed: paper plate, yarn, beads, feather, single-hole punch, scotch tape.

Assist client in constructing a native American dreamcatcher, which can symbolically protect her from nightmares and scary, intrusive thoughts at night. Discuss the dreamcatcher as symbol of nighttime inner peace and tranquility.

Purpose: Most moms with PMADs have horrible sleep initially and need comfort at night. This craft is a great visual to calm the nerves and assuage the soul. Add some lavender- and vanilla-scented oil to the dreamcatcher, and invite client to place above her bed.

Materials needed: clothespin, yarn, tongue depressors, colored pens, fabric scraps.

Invite client to create a Guatemalan worry doll which can hold her worries before she goes to sleep at night or when she begins her day (see The Kid’s Multicultural Art Book).

Purpose: Women with PMADs are anxious. They need a “container” in which to place their worries and fears; worry doll may represent transitional object of the therapist in between sessions.

“The aim of art is not to represent the outward appearance of things, but their inner significance.” —Aristotle, 384-322 B.C.

The following are books and websites which have been, and continue to be, a source of inspiration and enlightenment:

  1. Allen, Pat (1995). Art Is a Way of Knowing, Shambala.
  2. England, Pam (1998). Birthing from Within: The Extraordinary Guide to Childbirth Preparation,Partera Press.
  3. Fincher, Susanne (2009). The Mandala Workbook: A Creative Guide for Self-Exploration, Balance, and Well-Being.
  4. Malchiodi, Cathy (2006). The Art Therapy Sourcebook, McGraw-Hill.
  5. Malchiodi, Cathy (2006). The Soul’s Palette: Drawing on Art’s Transformative Power,Shambala.
  6. McNiff, Shaun (1992). Art as Medicine,Shambala.
  7. Terzian, Alexandria (1993). The Kid’s Multicultural Art Book: Art and Craft Experiences from Around the World,Williamson Publishing Company.
  8. Arttherapy.org:  American Art Therapy Association.
  9. Atwb.org : Art Therapy Without Borders: Promoting international art therapy initiatives in mental health, health care, and education worldwide.

Angry toddler sitting with arms crossedI was talking recently with a friend about surviving the “terrible twos” and she made a joking comment about how she couldn’t wait to do it again in the teen years. That got me thinking about the parallels between those two phases of life and how we react to them in similar ways.

In part, the “terribles” are a social construct. We are primed to expect as parents that those will be the most difficult stages of our parenting. Popular culture proliferates this idea through television shows and movies. Parents share “war stories” of toddlers and teens acting out. That said, there is some truth to the hype. In both phases, kids seem to challenge authority, push limits, and demand control and privacy. Frustration tolerance (for both kids and parents) is low. Relationships can get strained. Parents may feel pushed away. I’ve heard parents refer to both stages of life as a time when some alien creature seemed to come in and take the place of a previously loving, cooperative child.

What we don’t really hear a lot about is the important function that those phases serve in our children’s development.

For both the twos and the teens, the testing of limits, challenging authority, and trying to establish control all serve important developmental functions. Psychologist Erik Erikson, in his eight-stage model of development, identified specific tasks we navigate as we grow and develop. He suggested that successfully mastering the skills in each stage leads to healthy growth and development, whereas not doing so leads to issues that could impede healthy development.

According to Erikson, toddlers around age 2 are tasked with developing independence and a sense of control over their bodies. Potty training is an important piece of this puzzle, as is learning to control elements in their environment. If the 2- to 3-year-old is able to develop a sense of his or her ability to regulate his or her body, to do things for himself/herself, and to feel confident in his or her ability to do both of those, he/she develops a healthy sense of autonomy. If the child is not able to, shame and doubt in himself/herself and his or her abilities may result. So, when that previously loving, snugly, even-tempered little one starts refusing to comply with basic requests, when there is a major meltdown of nuclear proportions due to Mom or Dad putting the sock on the wrong foot first, these are actually signs that your child is exactly where he or she needs to be.

For teens, the task is to develop a strong sense of individual identity. Teens are trying to figure out who they are and what their place in the world, independent of others, should be. Establishing an identity for most teens means defining what they are not. Usually, that includes establishing beyond a shadow of a doubt that they are not their parents.

Sometimes the only way for them to declare that they are their own selves is to pull away from their parents. They may challenge expectations and rules. It’s not unusual to see a teen reject an activity or a goal because he or she fears that it was what the parents wanted for him or her, not what he or she wanted. The drive to figure out who he or she is, what he or she wants, what he or she believes, and what matters to him or her are all important elements of this stage. Usually, this means challenging conventions, testing out different identities until he or she finds one that fits, and pushing against authority as he or she seeks independence. It can lead to withdrawal, mood swings, and parents not being sure which child is going to show up at the table for dinner.

These stages are important. These stages are hard—for both parents and kids. The distancing that can be necessary for independence and autonomy to develop can be really painful. We, and they, feel the loss keenly. The undercurrents of our conflicts usually contain the messages “I want my child back” for parents or “I’m feeling alone and scared” for kids. The behaviors might manifest differently (a toddler tantrum is very different than a teen tantrum), but our role as parents is the same.

Just when our kids are pushing us away the hardest is when it is most important for us to reassure them that we aren’t going anywhere. We need to give them space to explore, but not withdraw from them. They can push and yell and pout and cry and withdraw—but if we can be constants for them, if our parental love can be consistent, stable, and unconditional, we help them have the confidence to navigate these important tasks, and we help ensure that they will find their way back to us eventually.

How do we do this? One way is by allowing them more choices (though choices we can live with) and helping our kids accept the consequences of those choices. This can be as basic as letting the toddler choose which pants to wear (as opposed to whether to wear pants at all), or the teen to choose when to do homework (as opposed to not doing it at all). We give them increasing autonomy over choices in their world that are age appropriate, that are not likely to have dire consequences, and that give them a sense of having some control over their own lives.

The second task for us is to avoid judging their choices. Sometimes they have to learn the hard way. The teen who chooses to do homework late at night, falls asleep, and doesn’t finish does not need to be scolded for choosing poorly. Instead, we can ask how that worked for him or her, if there’s anything he or she wants to change, and how we can help. That keeps an open dialogue, conveys that we respect his or her ability to make good choices, and can reduce defensiveness.

It isn’t easy. Often, we’re feeling hurt and scared and helpless too. It helps to remember, though, that it isn’t about us. We aren’t terrible, mean parents because we made him or her wear shoes on the correct feet or held him or her to a curfew. The challenge is to hold boundaries with a firm but loving hand and not react to the testing of those boundaries with fear, anger, frustration, or sadness. If we respond to our children with consistency, patience, warmth, and compassion as they work through these stages, we might find that the twos and the teens aren’t so terrible after all.

Worried man trying to talk to sad womanIt’s a classic dynamic in nearly every relationship: One partner tends to be the more vocal, outwardly emotional communicator, while the other partner is stoic, bottled-up, and emotionally reserved. Sometimes, one partner can be both. When the communicator tries to get the bottle to open up, the result can be a tug of war that ends in criticism and distancing. In a recent article, licensed clinical social worker Terry Gaspard describes why the “pursuer-distancer” pattern can be lethal to your marriage. Gaspard says that even though the pursuer partners, usually women, have nothing but good intentions when they try to coerce their spouses to crack open their emotional vaults, they approach it the wrong way.

Harassing and nagging a reserved person to communicate will usually cause that person to close up more tightly. They can become avoidant, angry, defensive, and even hostile. The nagging partner will then escalate the nagging, maybe throwing in a little criticism as a negative motivator, all with the goal of creating a more intimate union with their spouse. Relationship expert Dr. John Gottman also warns against pushing your relationship into this downward spiral. He believes that gender differences are at the core of how partners communicate. He suggests that if communication issues are developing in a relationship, the couple should examine how they are addressing those issues before they find themselves in the pursuer-distancer­ vortex.

Gaspard notes that our culture is partly responsible for perpetuating this destructive dance. “The irony of the pursuer-distancer pattern is that it’s reinforced by popular self-help books and websites to save your marriage,” said Gaspard. Even therapists encourage their clients to develop healthy communication strategies. But without proper guidance, couples can enter into a dialogue without boundaries that can quickly take on a life of its own. Gaspard suggests that couples remain open with each other and think of communicating honestly as a way to share information with each other. Learning more about your partner’s feelings should be a pleasure, not a chore.

Reference:
Gaspard, Terry. (2013). How the pursuer-distancer pattern can destroy your marriage. (n.d.): n. pag. Huffington Post. Web. http://www.huffingtonpost.com/terry-gaspard-msw-licsw/how-the-pursuerdistancer-_b_2856533.html

Individuals have different reactions to trauma. People who have experienced significant childhood trauma, including childhood sexual abuse, physical abuse, or emotional abuse may develop serious psychological problems as a result. Some people who suffer the loss of a loved one can develop symptoms of depression and children of depressed parents may have impaired ability to express their emotions, leading to externalizing or internalizing behaviors. When trauma affects daily functioning and leads to extreme anxiety, it can be seen as a predictor of posttraumatic stress (PTSD). And although it has been well established that people with PTSD have decreased emotional regulation via hyper-vigilant threat bias and limited brain region accessibility, it is less clear whether these same deficits are present in individuals without PTSD who have experienced trauma.

Karina. S. Blair of the National Institute of Mental Health and the Department of Health and Human Services in Maryland recently conducted a study to determine the difference in parietal and frontal cortex accessibility in individuals with and without PTSD. Blair performed MRIs on 14 trauma-exposed individuals without PTSD, 14 with PTSD and 19 nonclinical participants who were not exposed to trauma. She measured their brain activity while they performed attention tasks using the Stroop test and found that there were significant differences between the groups. Specifically, the individuals with PTSD had difficulty performing the task when compared to the non-PTSD and control groups. They had limited accessibility to certain regions of the brain responsible for emotion regulation. However, other regions caused overstimulation of attention, which when focused on threat could perpetuate symptoms of PTSD.

When Blair looked at the control group, she found more cortex accessibility and better performance on the Stroop. But surprisingly, the non-PTSD trauma exposed group had enhanced, not diminished levels of cortex accessibility and brain recruitment during the Stroop task. “These regions of the lateral superior and inferior frontal cortices and parietal cortex are repeatedly implicated in emotional regulation,” said Blair. Perhaps this enhanced recruitment acted as a buffer, insulating individuals exposed to trauma from developing symptoms of PTSD. Blair believes that although this finding has positive implications, more work needs to be done in this area to determine how to prevent or decrease PTSD in individuals who have experienced trauma.

Reference:
Blair, K. S., et al. (2013). Cognitive control of attention is differentially affected in trauma-exposed individuals with and without post-traumatic stress disorder. Psychological Medicine 43.1 (2013): 85-95. ProQuest. Web.

GoodTherapy | Are You Being Manipulated? Keys to Hidden AggressionWe all engage in manipulation from time to time. When your boss asks you what you thought of his or her terrible presentation and you render lavish praise, you’re concealing your real feelings in an attempt to elicit the reaction you want from someone in power. But in close interpersonal relationships, manipulation can take on a much darker hue, leaving its targets never quite knowing where they stand.

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The very nature of manipulation makes it challenging to know when you’re being manipulated. Manipulators attempt to conceal their motives and feelings, and their targets—who often struggle to sustain an honest, open, and manipulation-free relationship—may have to do some detective work to determine whether they’re being played.

What Is Manipulation?
Manipulation is the process of trying to change another person’s feelings, beliefs, or behaviors through indirect tactics. Rather than asking for what they want, manipulative people tend to use deception, coercion, even threats to get their needs met.

Manipulation is associated with a number of mental health conditions, including borderline personality disorder, passive-aggressive personality disorder, addiction, antisocial personality disorder, and narcissism. Not all manipulative people have mental health issues, but when manipulation becomes a primary style of interaction, it can indicate an underlying psychological issue.

Tactics Manipulators Use
If you’re concerned that you’re being manipulated, examine the tactics the other person is using. If you find yourself caught up in a web of deception and unclear motives, it could be manipulation.

Some common tactics manipulators use include lying, withholding information, denying feelings, playing the victim, blaming the victim, minimizing others’ feelings, pretending to be confused or ignorant, guilt, shame, and pretending that his or her tactics are intended to serve a higher calling such as God or a political cause. Manipulators also frequently use gaslighting—the process of provoking someone into an extreme or angry reaction, then blaming the other person for his or her reaction.

While anyone can be manipulated, expert manipulators tend to target people with and take advantage of certain personality traits. These traits include:

Why People Manipulate
For some people, manipulation may be an inadvertent strategy for dealing with a cutthroat world in which discussing feelings is often taboo. Manipulation is part of the normal range of behavioral tactics, and most people engage in manipulative strategies from time to time. People whose primary style of interaction is manipulation, however, tend to share some traits in common. These include:

How to Handle a Manipulator
Many of us are highly aware when we’re being manipulated, but are still left unsure of what to do. Because manipulators often play the victim, some victims of manipulation might excuse their behavior or insist that the manipulator doesn’t really know what he or she is doing. Manipulators thrive on hiding their motives, so it can be challenging to get them to admit their true intentions, and many people will refuse to do so even under pressure. Instead, try the following tactics:

References:

  1. Psychological harassment and psychological manipulation. (n.d.). Psychological Harassment Information Association. Retrieved from http://www.psychologicalharassment.com/psychological_manipulation.htm
  2. Simon, G. K. (n.d.). Dealing with manipulative people. RickRoss.com. Retrieved from http://www.rickross.com/reference/brainwashing/brainwashing11.html
  3. Spotting emotional manipulation. (n.d.). Cassiopaea. Retrieved from http://www.cassiopaea.com/cassiopaea/emotional_manipulation.htm

GoodTherapy | Emotion Regulation in Dialectical Behavior TherapyThe third module of dialectical behavior therapy (DBT) is emotion regulation, which teaches clients how to manage negative and overwhelming emotions while increasing their positive experiences. This module encompasses three goals:

  1. Understand one’s emotions
  2. Reduce emotional vulnerability
  3. Decrease emotional suffering

An important aspect of emotion regulation is understanding that negative emotions are not bad, or something that must be avoided. They are a normal part of life, but there are ways to acknowledge and then let go of these feelings so that one is not controlled by them.

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Often, clients with extreme emotional sensitivity go through cycles that begin with an event that triggers automatic negative thoughts. These thoughts then prompt an extreme or adverse emotional response, which may subsequently lead to destructive behavioral choices. The detrimental behavior is then followed by more negative emotions, such as shame and self-loathing.

Understanding and Labeling Emotions
The first skill in emotion regulation involves recognizing and naming emotions. Clients are taught to use descriptive labels such as “frustrated” or “anxious,” rather than general terms like “feeling bad,” because vaguely defined feelings are much more difficult to manage.

Another important distinction is that of primary and secondary emotions. A primary emotion is the initial reaction to an event, or to triggers in one’s environment, while a secondary emotion is a reaction to one’s thoughts, i.e., feeling depressed about having gotten angry. Secondary emotions are often destructive, making an individual more vulnerable to unhealthy behaviors. Therefore, in addition to naming both primary and secondary emotions, it is important for clients to learn to accept their primary emotion without judging themselves for experiencing it.

In DBT skills sessions, group leaders also discuss myths about emotions, such as the misconception that there are “right” and “wrong” ways to feel in certain situations. An additional topic is the purpose that emotions serve—which is to alert us that something in our environment is either beneficial or problematic. These emotional responses are stored in memory, and we are then more prepared when encountering similar situations in the future. Additionally, our emotions communicate messages to others through our words, facial expressions, and body language.

Reducing Emotional Vulnerability
The acronym for the first skill set in reducing emotional vulnerability is PLEASE MASTER:

PL – represents taking care of our physical health and treating pain and/or illness.

E – is for eating a balanced diet and avoiding excess sugar, fat, and caffeine.

A – stands for avoiding alcohol and drugs, which only exacerbate emotional instability.

S – represents getting regular and adequate sleep.

E – is for getting regular exercise.

MASTER – refers to doing daily activities that build confidence and competency.

The second skill designed to reduce emotional vulnerability is the building of positive experiences in order to balance life’s negative incidents and feelings. To accomplish this, clients are encouraged to plan one or more daily experiences that they can look forward to and enjoy. This might be participating in a hobby or sport, reading a book, spending time with a friend, or anything that brings the individual contentment. It is important to engage in these activities mindfully, centering attention on what one is currently doing. If an individual has difficulty focusing on the activity, he or she is advised to try something different. The client is also encouraged to identify long-term goals that will bring increased positive experiences into his or her life, such as learning a new skill or making a job change.

Decreasing Emotional Suffering
The last component of this module, decreasing emotional suffering, is comprised of two skills:

  1. Letting go
  2. Taking opposite action

Letting go refers to being aware of the current emotion through mindfulness, naming it, and then letting it go—rather than avoiding, dwelling on, or fighting it. This might involve taking a breath and visualizing the thought or feeling floating away, or picturing the emotion as a wave that comes and goes.

Taking opposite action means to engage in behaviors that would be typical when one is experiencing the emotion that is in direct contrast to the current feeling. For example, if a client is sad, he or she might try being active, standing straight, and speaking confidently—as the person would if he or she was happy. When an individual is experiencing anger, the person behaves as if he or she were calm by speaking in a soft voice and doing something nice for someone. This skill is not aimed at denying the current emotion; the individual should still name the emotion and let it go. However, acting opposite will likely lessen the length and severity of the negative feelings.

Some of the emotion-regulation skills may sound a bit vague to those unfamiliar with dialectical behavior therapy. In group sessions, DBT leaders cover these skills with clients in more detail, incorporating role playing so that the clients can transfer the new skills to situations in their own lives. Ultimately, these skills empower people to manage their emotions, rather than being managed by them.

Man in wheelchair at gateMany who live with disabilities are burdened by a chronic sense of shame that can be as difficult to live with as the actual disability. Shame is not the same as guilt. Shame is persistent and represents how we feel about ourselves (“I am a shame and disgrace”) rather than how we feel about something we did or did not do (“I feel guilty and embarrassed”).

The term “ashamed” is often used interchangeably with “humiliated.” Shame may be the result of humiliation, but not humility. Humiliation entails stripping a person of his or her sense or worth—of wounding the person’s very being. Humility is more a sense of meekness or equality with others. Dr. Brené Brown has been researching shame and vulnerability for a few years, asking people how they experience shame. Many say it makes them feel small and vulnerable; it includes an almost physical sensation of being kicked in the gut; it takes them to place that feels wounded; and they want to disappear.

How does this happen? How do we begin to feel wounded? Small? Vulnerable? Shamed? Humiliated? It is usually a response to something that happens to us—that is done to us. We are somehow victimized, humiliated, or traumatized by the actions of a person or people who inflict injury upon our sense of self—our very being.

This wounding may be intentional or inadvertent: The shame of a child whose first-grade teacher refused to allow her to go to the bathroom, resulting in an accident in her clothes in front of the whole class. The man who can’t read well enough to complete a job application being verbally harangued by an uncaring receptionist in front of an office full of people. A person in a wheelchair who is “holding up the line” for an elevator when a busy executive is in a hurry. The family with an older autistic child boarding an airplane in advance while others accuse them of making excuses to avoid waiting.

Regardless of the source, this pervasive sense of shame can result in a lifetime of fear, avoidance, and anxiety when faced with issues that trigger similar feelings. The triggers may be subtle and seemingly unconnected, but that feeling of being diminished remains.

For the first-grader who was humiliated by the refusal of her teacher to allow her to go to the bathroom, triggers may transfer to a dislike for authority figures, issues with toileting, or avoidance of school.

The man with difficulty reading who was humiliated by the lack of awareness or disregard of the receptionist may avoid looking for work, find that he is defensive with people working in offices, or resist going to the doctor if it requires filling out forms.

A person in a wheelchair who was humiliated due to holding up the elevator and inconveniencing the busy executive may avoid leaving home, resist taking the safety precautions necessary in a busy location, or feel “less than” people in white-collar jobs.

The family of the child with autism may avoid traveling by plane, become defensive when in need of special treatment, or limit interactions with people waiting in line.

I recommend that those who have feelings of shame learn more about the causes and triggers by getting professional help to address these feelings. Two types of therapy—EFT (emotional freedom technique, aka tapping) and EMDR (eye-movement desensitization reprocessing)—may reduce or eliminate shame reactions.

Hands resting on prison barsAlthough jail time might seem like a distant possibility for most people, incarceration rates in the United States are steadily rising. One study published in the journal Pediatrics found that 41% of young adults have been arrested by the time they are 23. The U.S. Department of Justice (DOJ) reports that 6.6% of people serve time in prison at some point in their lives, and the statistic rises to a shocking 32% for African-American men. More than half of inmates are diagnosed with a mental health disorder.

As state mental hospitals continue to close and mental health services remain financially out of reach for many people, this number may rise. Moreover, prison itself can exacerbate preexisting mental health issues and create new mental health challenges among those who had never experienced them.

Mental Health Care Behind Bars

Jails and prisons are required to provide basic health care for inmates, but the quality of this care varies greatly. Often, prison-based mental health care focuses on stabilizing, rather than treating, inmates. A person experiencing hallucinations or psychosis might get medication to control the most severe symptoms, but people with anxiety issues, depression, posttraumatic stress, and other mental health conditions that don’t cause radical changes in behavior may go untreated. Prisoners rarely, if ever, get therapy or comprehensive treatment, so mental health issues that were previously controlled with medication and therapy may get much worse during incarceration.

Prison and Trauma

Even for the most hardened criminals, prison can be a scary place. The DOJ reports that 70,000 prisoners are sexually abused every year, and assaults, fights, and other acts of violence are common in a prison setting. But violence isn’t limited to inmates; prison guards work in a high-stress environment that can increase their likelihood of becoming violent. With little hope for reporting abuse by guards, some inmates may endure verbal abuse, threats of physical violence, and even severe attacks. Women inmates are at an increased risk of being sexually assaulted by jail and prison guards. This ongoing climate of trauma can create anxiety, depression, phobias, and PTSD in prisoners who previously had no serious mental health issues.

Lack of Support

Prisoners are, by definition, cut off from the rest of society, and their access to supportive friends and family may be limited. Many jails have instituted mail policies prohibiting letters and magazine subscriptions, and these policies can eliminate prisoners’ ability to communicate with and receive support from loved ones. Phone calls from jail can be costly, and prisoners from impoverished backgrounds may have families who can’t afford to cover the costs of collect calls, however infrequent. There’s little hope for getting any support in prison, as many prisoners are concerned more with gaining respect and avoiding fights in a relentless pursuit of safety. Support from loved ones can play a critical role in helping people overcome mental challenges, and isolation can increase a person’s risk of mental health issues such as depression and anxiety.

Getting Out

Most prisoners have ignored basic rules of society, so it can be difficult for prisoner rights issues to garner much public sympathy. But many prisoners are incarcerated for nonviolent drug crimes that are the result of substance addiction. And even inmates incarcerated for violent crimes do not typically serve life sentences. Most prisoners are ultimately released, and the mental health issues they develop in prison can increase their risk of reoffending and make it difficult to reenter society as a productive, nonthreatening citizen. Almost 70% of people who have been incarcerated are arrested again within three years, and the dire state of mental health care in prisons could play a significant role in this high rate of recidivism.

A mental health professional can help people who have come into contact with the prison system. A therapist can help prisoners reenter society or reestablish bonds with friends and family. Loved ones of incarcerated individuals can also get necessary emotional support in therapy. Therapy is a safe and confidential place for any and all people to get help.

References:

  1. Chaddock, G. R. (2003, August 18). US notches world’s highest incarceration rate. The Christian Science Monitor. Retrieved from http://www.csmonitor.com/2003/0818/p02s01-usju.html
  2. Gann, C. (2011, December 19). Study: Significant number of young Americans get arrested. ABC News. Retrieved from http://abcnews.go.com/Health/arrests-increasing-us-youth/story?id=15180222
  3. James, D. J., & Glaze, L. E. (2006, December 14). Mental health problems of prison and jail inmates [PDF]. Washington, D.C.: U.S. Department of Justice Bureau of Justice Statistics.
  4. Purdy, M. (1995, December 19). Brutality behind bars. The New York Times. Retrieved from http://www.nytimes.com/1995/12/19/nyregion/brutality-behind-bars-special-report-prison-s-violent-culture-enveloping-its.html?pagewanted=all
  5. Recidivism. (n.d.). Bureau of Justice Statistics (BJS). Retrieved from http://bjs.ojp.usdoj.gov/index.cfm?ty=tp
  6. Sakala, L. (2013, February 7). Return to sender: Postcard-only mail policies in jails. Prison Policy Initiative. Retrieved from http://www.prisonpolicy.org/postcards/report.html
  7. U.S.: Federal justie statistics show widespread prison rape. (2007, December 16). Human Rights Watch. Retrieved from http://www.hrw.org/news/2007/12/15/us-federal-statistics-show-widespread-prison-rape
  8. U.S.: Number of mentally ill in prisons quadrupled. (2006, September 6). Human Rights Watch. Retrieved from http://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

GoodTherapy | Counseling Issues for Arranged Marriages remain relatively rare in the United States, but are a common cultural practice in many countries. As many as 55% of all marriages globally are arranged, most of them in South Asia, Africa, the Middle East, and Southeast Asia. Immigrants and children thereof are sometimes involved in marriages arranged by third parties in the United States. Although the practice remains controversial due to concerns such as freedom of choice and the oppression of women, abuse is not the norm in arranged marriages.

Many people willingly enter into arranged marriages, believing that their parents are well equipped to choose a lifelong partner for them. People in arranged marriages face many of the same issues as people who marry for love—communication, infidelity, the death of romance, fights about money, and different parenting philosophies—and sometimes seek counseling to resolve these issues. Therapists counseling clients involved in arranged marriages must be sensitive to cultural practices, and may need to take a closer look at some common issues in arranged marriages.

Cultural Awareness and Ethnocentrism
In a culture that focuses on marrying for love, it’s easy to look down on arranged marriages and to view them as products of force. But many people enter into arranged marriages of their own accord, and the low divorce rate among arranged marriages globally—between 4% and 6%—clashes greatly with the high divorce rate in the United States (around 50%). Therapists counseling couples involved in arranged marriages should suspend judgments and display respect for cultural practices, even if they disagree with them.

Premarital Counseling
Some people believe arranged marriage involves a couple meeting for the first time at their wedding, but many couples in arranged marriages know their spouses for years before getting married. However, they don’t typically live together and may not spend much time together prior to marriage. Some couples are introduced to each other by third parties but left to make the ultimate decision as to whether to pursue marriage. Premarital counseling can greatly benefit couples involved in arranged marriages and help them prepare for the stress of adapting to a shared life.

Values Within Marriage
Married couples come from all walks of life, and every couple has its unique set of values. Some couples may relish religious-based counseling, while others may struggle with establishing equality within marriage. Couples involved in arranged marriages may have a wide variety of values, and therapists should investigate the core beliefs of their clients early in the process. For some couples in arranged marriages, divorce may not be an option due to family values, beliefs about marriage, or a simple commitment to see the marriage through. Therapists should not make assumptions about marital values; for example, some couples within arranged marriages may highly value gender equality, while others might see separate roles for men and women as a fair approach that promotes marital harmony.

Abuse and Coercion
There are many happy arranged marriages, but abuse of women and coercion into marriage remain a sad legacy of some arranged marriage practices. In cultures where women are not treated as equals, women may be hesitant to report abuse, and may not even recognize abuse as a problem. Therapists should be prepared to intervene if they see signs of abuse and to educate both partners about steps they can take to end abusive behavior. Some abused partners may benefit from meeting with the therapist individually, as they may be hesitant to report abuse or other marital issues in the presence of a spouse. Consequently, therapists should consider meeting with each spouse individually from time to time.

Family Issues
In cultures that practice arranged marriages, families often play a central role in the relationship. Spouses may have conflicts with their in-laws or struggle to establish proper boundaries. Therapists should determine each spouse’s comfort level with family involvement before making recommendations. Some couples, for example, may welcome the input of parents or in-laws but need help determining how much input to accept or whether living with parents is an appropriate strategy. Others, however, may want to establish completely separate lives from their families and may need advice about how to establish boundaries and navigate conflicts.

References:

  1. Delp, V. (2006, November 20). Lessons from an arranged marriage. Families.com. Retrieved from http://www.families.com/blog/lessons-from-an-arranged-marriage
  2. Lee, J. H. (2013, January 20). Modern lessons from arranged marriages. The New York Times. Retrieved from http://www.nytimes.com/2013/01/20/fashion/weddings/parental-involvement-can-help-in-choosing-marriage-partners-experts-say.html?pagewanted=all
  3. Pre-marital counseling. (n.d.). Between Us Relationship Helpline RSS. Retrieved from http://betweenus.bharatmatrimony.com/?p=263

Close up of man pointingOne of the aspects of existential psychotherapy that I most value is the idea of personal responsibility. On one hand, we humans are free to live our lives the way we choose (within reason), while on the other, we are responsible for the choices we make. Freedom and responsibility go hand in hand, whether we like it or not.

Often, clients who enter psychotherapy have complaints about their lives, including their marriages, children, work environments, and many other interpersonal situations. Just as often, the clients are steadily looking outward at other people they deem responsible for the trouble. It is the spouse who is selfish, the children who just won’t listen, the unreasonable boss and the inconsiderate friends who drove the person to seek therapy. It is less often that a client comes in with a strong sense of personal responsibility and willingness to change in the beginning stages of therapy.

That is one of the challenges therapists face: how to help the client assume responsibility for his or her life without shaming or blaming. Without the clients taking on personal responsibility, no change can ever really happen because, as we all know, we can change and improve only ourselves. When faced with this challenge, I like to ask my client, “In all of the bad relationships, failed communications, and frustrating encounters in your life, what is the one common denominator?” That question allows the client to begin focusing on his or her role in whatever situation he or she is facing. Even if his or her role is as little as 1% of the issue, that 1% is where we start working. That 1% is where the change begins, and generally, the acceptance of responsibility of that small amount is what leads the client to being able to recognize other ways of being that may cause problems in his or her life.

The ability to take responsibility for one’s life is one of the greatest gifts we can offer ourselves and our clients. Although the weight of responsibility may seem heavy at times, it carries within in the seeds of freedom. When a person assumes responsibility for himself or herself, the person becomes empowered to be the person he or she chooses to be. Holocaust survivor and psychiatrist Viktor Frankl reminded us that the “last of the great human freedoms is to choose how to behave in any given circumstance.” Indeed, we have complete authorship over our attitudes, interactions, and responses.

Philosopher Jean-Paul Sartre states that to be responsible is to be the “uncontested author of an event or thing” and means that each individual, alone, is responsible for the creation of his or her life, including “self, destiny, life predicaments, feelings, and if such be the case, one’s own suffering” (Yalom, 1980). Becoming the author of one’s own life may start with something as simple as taking ownership for the 1% that is you, but will likely lead to a much deeper sense of ownership and freedom in one’s entire life. Therapy, done well, will assist participants in grasping a greater sense of self by way of freedom and responsibility.

Man admiring himself in mirrorHealthy narcissism is an accurate picture of the self properly valued, without shame and without overblown estimations. But most of the time when we talk about narcissism we’re thinking about the other kind, where the person thinks he or she is perfect in every way; you are just the opposite, a total loser, and the “Perfect One” is an expert at making sure you feel that way. Now, I’m not saying this is a plot, something done on purpose. It can be unconscious, but that doesn’t make it easier to live with.

Everyone knows a Perfect One, and might even admire the person a little. Perfect Ones are always in the know, or seem to be, but what they know best is how to take the bad feelings they have about themselves and shovel them onto whoever is around and ready to accept them. They lower your feelings about yourself so they can feel better. Putting you down raises them up. And if you’re lacking in self-confidence, you’re their perfect companion.

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Could that be you? If you’re self-confident and aware of your abilities, taking credit when it’s coming to you should be a pleasure. But if you lack self-confidence, accepting a compliment can be pretty hard. Instead of feeling good, you may even feel ashamed. How come? And can you do anything about it? If you sometimes react with feelings of discomfort or shame when you’ve done something really well and been told about it, you may be responding to early feelings of worthlessness that were part of faulty family situations. Maybe your parents lacked self-esteem, too, and passed that on to you, or maybe you’re related to a Perfect One who trained you to be his or her audience, or perhaps you endured bullying in school. Perfect Ones make good bullies.

It could be that when you were a kid you were subjected to the envious feelings of others, so every time someone tells you something good about yourself you don’t believe it, or you expect something bad to happen, because that’s how you’ve been trained, so you’d rather put the spotlight on someone else, and who better than a Perfect One? Perfect Ones expect all compliments to come their way. If this applies to you, try to figure out who around you might be part of the problem. You can talk to them about it, but—even better—you can talk to yourself about it, remembering that what Perfect Ones are saying has more to do with their own feelings about themselves than about you. In fact, if you listen to the negative things they say, you’ll learn a lot about their secret, shameful feelings about themselves, proving that, deep down, they know they’re not really perfect after all.

Shame and narcissism are fellow travelers, a continuum of feelings about the self. Picture a seesaw with shame on the bottom and narcissism on the top. Envy accompanies the up-and-down actions of the seesaw. Perfect Ones feel envy all the time, and process that feeling by making others feel envious so Perfect One can feel superior. Perfect Ones’ feelings of superiority go with the expectation that they are better than everybody else and deserve favorable treatment in the world. They use others to get what they want, they believe they have it coming, and when they don’t get what they think they deserve they react with intense anger, called narcissistic rage. Perfect Ones don’t see others as equals; they see others as tools. Their internal feelings about themselves are unsteady, and they have to work hard to keep feeling good.

We’ve been talking about a make-believe person called Perfect One. The use of the word “one” is important here. Think ONE. A universe of one, where Perfect Ones want YOU to love THEM, but they are not capable of loving you or anyone else back. It’s a pretty cold world when you are the only Perfect One. If you’ve spent any time with Perfect Ones, you may have felt very lonely. Inside, the Perfect Ones feel lonely too, because no one is good enough to share their world. You might feel sorry for them, but don’t let the Perfect Ones take advantage of your ability to feel for others. Perfect Ones are expert manipulators.

After you have learned the game and how it’s played, you can stop playing with Perfect Ones and find humans who aren’t perfect but play fair. You’ll have a better time all around.

Remember my image of the seesaw? Perfect One on top? Well, Perfect One will fall down with a thud when you get off the seesaw. And then you can get back on and come to a good balance with someone else.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.