Our circumstances don’t define us. Regardless of what happens in life, we always have the power to choose our attitude. So what’s the difference between someone who remains hopeful despite experiencing great suffering and the person who stubs his or her toe and remains angry the rest of the day? The answer lies in the person’s thinking patterns.

Psychologists use the term “cognitive distortions” to describe irrational, inflated thoughts or beliefs that distort a person’s perception of reality, usually in a negative way. Cognitive distortions are common but can be hard to recognize if you don’t know what to look for. Many occur as automatic thoughts. They are so habitual that the thinker often doesn’t realize he or she has the power to change them. Many grow to believe that’s just the way things are.

Cognitive distortions can take a serious toll on one’s mental health, leading to increased stress, depression, and anxiety. If left unchecked, these automatic thought patterns can become entrenched and may negatively influence the rational, logical way you make decisions.

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For those looking to improve their mental health by recognizing pesky cognitive distortions, we’ve compiled a list of 20 common ones that may already be distorting your perception of reality:

How to Change Thinking Patterns and Cognitive Distortions

For many, one or more of these cognitive distortions will look familiar. You may fall into one or more of these traps or know someone who does. The good news is that cognitive distortions don’t have to weigh you down like an anchor.

Thought patterns can be changed through a process referred to in cognitive therapy as cognitive restructuring. The idea behind it is that by adjusting our automatic thoughts, we are able to influence our emotions and behaviors. This is the basis of several popular forms of therapy, including cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT).

If you feel that one or more of the above cognitive distortions is contributing to feelings of anxiety, depression, or other mental health issues, we encourage you to consider finding a qualified therapist you trust to work with you and help transform your negative thoughts and beliefs into empowering affirmations that inspire and uplift you.

References:

1. Beck, Aaron T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.
2. Beck, Aaron T. (1972). Depression; Causes and Treatment. Philadelphia: University of Pennsylvania Press.
3. Tagg, John (1996). Cognitive Distortions. Retrieved from http://daphne.palomar.edu/jtagg/cds.htm#cogdis

Marsha Linehan’s groundbreaking introduction of dialectical behavior therapy (DBT) through her 1993 treatment and skills training manuals has brought effective therapy to many people living with the symptoms of borderline personality. Linehan worked with women who had histories of suicide attempts, self-harm, frequent experiences of crisis, and difficulty managing intense emotional states. She found that the people she worked with in therapy experienced standard cognitive behavioral therapy as invalidating due to its consistent emphasis on changing thoughts, emotions, and behaviors.

Dialectical behavior therapy is a type of cognitive behavioral therapy that is based on a balance between acceptance of where a person is right now together with the need to push for change to help the person have more effective relationships and manage emotional states. The “dialectical” in its name refers to a philosophy in which seemingly opposing ideas can exist at the same time. We’re constantly balancing needs, values, and ideas that may appear to be opposites. Our task is to find the synthesis in these differing ideas.

A key component of dialectical behavior therapy is skills training, which includes the teaching and application of skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

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Mindfulness practice is nothing new—it is a core component of many religious traditions—but increasingly we are able to study and measure its brain benefits.

In the years since Linehan released her first treatment and skills training manuals, DBT has been tried and tested in many settings, including with people who do not have borderline personality but who are living with other mental health conditions such as depression, anxiety, and addictions.

The skills training and treatment model of DBT is applicable to people living with a range of mental health conditions. Practicing mindfulness helps people with and without mental health conditions to improve well-being, attention to the present moment, and increasing positive emotional experiences while decreasing negative emotions and distress. This is why people with depression, bipolar, anxiety, eating disorders, and other mental health conditions may benefit from mindfulness practice and the other skills that form dialectical behavior therapy.

DBT for Depression

Dialectical behavior therapy offers skills specifically designed for people dealing with depressive feelings. DBT empowers people with depression to add positive emotional experiences to their lives in order to have better relationships and experience more joy. DBT includes evidence-based behavior activation skills to give people concrete tools to use when feeling depressed. By knowing what works, people with depression can take charge of their lives and do what they need to feel better.

DBT for Bipolar

People with bipolar often benefit from therapy to help them learn skills for tolerating distress and managing intense emotions. There is such an overlap between the symptoms of borderline personality and bipolar that some experts have proposed that borderline personality be considered part of the bipolar spectrum. People with bipolar often benefit from help managing stressors that can increase vulnerability to depression and mania.

DBT for Anxiety

Dialectical behavior therapy gives people skills to live in the present moment and to observe, alter the intensity of, and change feeling states. People with anxiety benefit from being able to tolerate intense feelings and modify behaviors in order to create new emotional experiences. Mindfulness skills in DBT give people with anxiety the tools to set aside worries about the past or future in order to address what is happening in their lives right now.

DBT for Addictions

The new DBT skills manual, published in 2014, includes a section on skills for tolerating distress in people with addictions. Linehan includes in this category not only people with addictions to alcohol and other drugs, but also people who are addicted to gambling, sex, shopping, and more. The skills are based on a philosophy of dialectical abstinence, which uses the understanding that harm reduction and abstinence are both important and can coexist on an individual’s path to recovery.

DBT for Eating Disorders

People with eating disorders benefit from skills to regulate intense emotions and to pick up on trigger emotions that lead to behaviors that cause problems. DBT views food restriction and binging and purging as attempts to manage painful feelings. The skills training component of DBT offers new skills to regulate these difficult feelings.

Dialectical behavior therapy is based on learning theory and is not diagnosis-specific. People with a wide range of problems have found DBT helpful. If you think DBT may be for you, don’t delay in seeking out a therapist trained to offer this effective evidence-based treatment.

Have you ever tried to shed an old, troublesome habit? Ever made a New Year’s resolution you couldn’t keep? If so, welcome to the human race. And welcome to your brain.

We Are Creatures of Habit

A few weeks ago, I made a mixture of nuts and dried fruit and settled in for a few minutes of television in the evening. The next night, I did the same. By the third night, I was craving the nuts as I contemplated watching a show I had recorded. I was astonished how quickly I had developed the nutty TV habit. I felt like Pavlov’s dog, salivating when the bell rang. Or, in my case, salivating as I thought of TV, now associated with my new favorite snack.

While on the first night I was genuinely hungry, by the third I was eating out of habit, mindlessly heading to the nuts even though I was still pretty full from dinner. Neuroscience gives us insight into the power of habit in our lives—and why we can become victims of our own habitual behaviors.

The Anatomy of Habit

Everything we do, feel, or think is reflected in circuits of neurons in our brains. Neurons, or brain cells, communicate with each other at a gap, called the synapse. One neuron releases chemicals—neurotransmitters—into the synaptic space, where it is picked up by the receptors of the next neuron. There are billions of neurons in the human brain; each neuron connects with up to 10,000 other neurons, resulting in trillions of synaptic connections. These interconnected neurons become circuits that underlie our habits.

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The more we do something—eat nuts while watching TV, ride a bike, play an instrument, study a new language—the stronger the neuronal circuit becomes that supports that habit. Donald Hebb, a Canadian neuroscientist in the 1940s, noted that once a circuit of neurons is formed, when one neuron fires, the others fire as well—strengthening the whole circuit. This has come to be known as Hebbian theory: “Neurons that fire together wire together.” Circuits of neurons maintain our habits, and our habits strengthen those neuronal circuits. The bio-behavioral influence goes both ways.

You Are What You Do

Scientists have shown that experience changes the connection between neurons. Everything you do changes your brain. If I continue my nightly TV-with-nuts ritual, that habit will become “wired” into my neuronal circuits. My behavior will change the structure of my brain. This is a rather sobering thought. From this perspective, you are what you do … so be careful what you do!

The more you do something, the more likely you are to do it in the future. The habit-driven brain doesn’t distinguish between good and problematic behaviors; it just builds repeated behaviors, thoughts, and feelings into stronger and stronger neuronal circuits. So what’s a person to do? Are we doomed to live on automatic pilot, driven by our lower brain and our habits?

While my nuts-and-TV behavior affects only me, other habits can cause damage to relationships. If I repetitively treat my husband with disrespect, that behavior becomes a part of who I am in the relationship. And it may evoke a less-than-ideal response in him, creating a negative relational dance that can erode our bond. We then become victims of our own relationship behaviors.

Prisoners of Our Habits?

We do have a choice: We can mindlessly play out problematic behaviors over and over again, becoming essentially prisoners of our own habits. Or we can step back, use our higher brains, and reflect on our actions. After three nights of my new TV-nuts habit, I realized I was acting like an automaton, and I didn’t like it. So I made a choice, using my prefrontal cortex, the part of my brain that allows me to think about what I do. I thought about the extra calories and, more importantly, the fact I didn’t want to engage in mindless eating. I stopped my habit in its tracks. Now if I decide to eat nuts, it’s when I’m actually hungry, not because I’m Pavlov’s salivating dog.

In my marriage, I work hard not to act mindlessly or to get caught up in habits of emotional reactivity. I try to think about my higher goals and to behave in accordance with my values. I don’t have to be a prisoner of my automatic response. I have learned to pause, take a breath, and think about how I want to be in my relationship. I have the power to choose, and the ability to change when I fall into thoughtless relational habits.

We Are Creatures of Change and Adaptation

It turns out that although we are creatures of habit, humans are also creatures of change and adaptation. Our brains are constantly changing in response to our changing environment. Our adaptability is the secret to our success as a species. The challenge is to harness our adaptability and use it toward positive ends, to make choices about who we want to be in our world.

You don’t have complete freedom to create yourself; you do come with genetic gifts and limitations, or temperament. But you have a lot more power to become the person you want to be than you might think. You are not predetermined by your genes. The secret is neuroplasticity, the ability of the brain to change.

Until a decade or so ago, neuroscientists thought that neuroplasticity was possible only in children’s brains. Indeed, the young brain is highly adaptable and shaped by experience, changing and growing with the nurturance (or lack of it) a child receives from parents and other caregivers. Everything is new to a young child; he or she absorbs it all, and is molded by the world around. (This is the nurture part of nature-and-nurture that makes us who we are.)

In recent years, scientists have made the amazing discovery that the adult brain is also plastic (changeable); we can learn and grow—changing our brains in the process—throughout life. And, it turns out, experience not only changes the connections between neurons, it affects the expression of genes. Genes are turned on or off by experience and environment (this is called epigenetics).

This remarkable new perspective on the adult brain’s capacity for change is heartening to those of us who want to keep growing and learning as we age. It is empowering to know that we can change bad habits and learn new skills throughout life; we don’t have to be victims of our past or of our genes. But it’s much harder for the adult brain to change than the child’s brain. With all of our wired-in habits, we have to work at what comes naturally to the young child.

Neuroplasticity Is a Double-Edged Sword

Neuroplasticity is responsible for both habits and change. Since everything you do changes your brain, you can get trapped in habits by doing them over and over—or you can make a decision to change those habits, choose a new path, and create new habits that are more in keeping with your values. You can live mindlessly, on automatic pilot. Or you can choose a different path and live in a more mindful way. The choice is yours.

Conversion therapy—sometimes called reparative therapy and other names—is a widely discredited form of therapy that attempts to change people’s sexual orientation or gender identity. In recent years, a number of states have moved to ban the practice for minors, and dozens of mental health advocacy and professional organizations have produced statements against it. In spite of research showing that conversion therapy can be harmful, an Oklahoma state House committee in February 2015 approved legislation designed to protect the practice.

Concerns with Conversion Therapy

Mainstream mental health organizations and the American Psychiatric Association’s Diagnostic and Statistical Manual have long accepted that homosexuality is not a mental health diagnosis, yet conversion therapy typically focuses on changing one’s sexual orientation to heterosexual. According to the American Academy of Pediatrics, “therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.”

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Though there are many ways to approach therapy, ethical therapy works to increase self-awareness and self-acceptance while offering judgment-free treatment in the context of a safe therapeutic relationship. Conversion therapy can include a range of approaches such as talk therapy, prayer, re-education, or aversion therapy. In some cases, techniques used in conversion therapy may be abusive and/or dangerous. For instance, a therapist might electrically shock the person every time he or she expresses interest in a person of the same sex. A group of people who experienced abusive conversion therapy recently sued their therapist, claiming he forced them to strip naked in front of him and engage in other questionable practices.

For some people, conversion therapy is an involuntary form of treatment. Parents of gay children (or children who display behavior culturally associated with the opposite sex) sometimes force their children to undergo conversion therapy, though conversion therapists may decline to work with children who do not want the treatment. Leelah Alcorn, a 17-year-old transgender girl, sparked national outrage in late 2014 when she committed suicide after being exposed to conversion therapy.

Legal Issues Regarding Conversion Therapy

California, New Jersey, and Washington, D.C. have banned conversion therapy for minors, and states such as Arizona, Colorado, Florida, Iowa, Ohio, Oregon, Washington, and West Virginia have taken preliminary legislative measures to eliminate the practice or methods associated with it. In 1997, the American Psychological Association passed a resolution disavowing conversion therapy, and since then, many leading mental health governing bodies have come out against the practice.

Nevertheless, Oklahoma legislators are diligently working to protect conversion therapy. Republican Rep. Sally Kern introduced the bill to “protect” parents’ ability to pursue such treatment for their children; the bill was later amended to prohibit “physical pain, such as electroshock or electroconvulsive therapy, touch therapy, pornography exposure, or vomit-induction therapy,” controversial tactics which not all therapists who practice conversion therapy use. Kern argues that the freedom to pursue conversion therapy for minors is a parents’ rights issue.

A host of professional organizations in the field of mental health and social work have spoken out against the bill. On March 4, 2015, GoodTherapy.org affirmed its opposition to conversion therapy, and declines to list in its therapist directory mental health professionals who advertise conversion therapy as a service they offer.

References:

1. APA resolution on “reparative therapy” (1997). Retrieved from http://psychology.ucdavis.edu/faculty_sites/rainbow/html/resolution97.html
2. Fox, F. (2015, January 8). Leelah Alcorn’s suicide: Conversion therapy is child abuse. Retrieved from http://time.com/3655718/leelah-alcorn-suicide-transgender-therapy/
3. Gay conversion therapy bill clears Oklahoma House committee. (2015, February 24). Retrieved from http://newsok.com/gay-conversion-therapy-bill-clears-oklahoma-house-committee/article/5396127
4. Homosexuality and adolescence. (1993). Retrieved from http://pediatrics.aappublications.org/content/92/4/631.full.pdf
5. Iowa senate panel approves ban on conversion therapy. (2015, February 17). Retrieved from http://stlouis.cbslocal.com/2015/02/17/iowa-senate-panel-approves-ban-on-conversion-therapy/
6. Michael Ferguson, et al. v. Jonah, et al. (n.d.). Retrieved from http://www.splcenter.org/get-informed/case-docket/michael-ferguson-et-al-v-jonah-et-al
7. Steinmetz, Katy. (2014, June 30). California Ban on Gay Conversion Therapy Stands. Time. Retrieved from http://time.com/2940790/california-ban-on-gay-conversion-therapy-stands/

It should go without saying: conversion therapy is an outdated mode of treatment for an issue that is not, and has not been, a mental health diagnosis for quite some time. GoodTherapy.org does not endorse conversion therapy —also known as reparative therapy or sexual orientation change efforts (SOCE)—for homosexuality, nor does it permit mental health professionals to advertise those services to website visitors.

On March 3, 2015, The Huffington Post published an article in which Human Rights Campaign, a leading LGBT rights group, condemned Psychology Today, an online therapist directory, for allowing its therapist members to advertise conversion therapy on its profile pages. A representative of Psychology Today told The Huffington Post that the company did not intend to begin removing or refusing membership to therapists who offer conversion therapy. The backlash and criticism from health professionals, human rights advocates, and others was immediate.

Within 24 hours, Psychology Today had changed its position. In a statement issued March 4, the company asserted that it does not condone conversion therapy, and has notified therapist members that they would be de-listed if their profiles advertised this practice. Their updated stance is in line with what the majority of the mental health community has come to believe: conversion therapy has no place in mainstream mental health care.

Flaws in the Conversion Concept

Conversion therapy, also known as reparative therapy, is a controversial type of treatment aimed at changing a homosexual person’s sexual orientation on the assumption that homosexuality is an inherent flaw or disorder that must be altered. While homosexuality was once listed in the Diagnostic and Statistical Manual (DSM) as a mental health diagnosis, it was removed from the DSM by the time the third edition was published in 1980 with support from the professional mental health community.

In addition to rejecting conversion therapy as a useful treatment, GoodTherapy.org does not acknowledge homosexuality as a mental health disorder. The American Psychiatric Association (APA) agrees; a statement issued by the board of the APA in 1998 states: “The American Psychiatric Association opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/ her homosexual orientation.”

The APA isn’t the only organization to reject conversion therapy, as research over the course of years has affirmed concerns over conversion therapy as a treatment modality. The American Association for Marriage and Family Therapy, the National Association of Social Workers, the American Psychological Association, and the American Medical Association, among others, have issued statements against reparative therapy. Many cite research that suggests conversion therapy is likely to lead to harmful outcomes, such as contributing to anxiety, depression, relationship problems, self-loathing, and other issues. According to the Pan-American Health Organization (PAHO), “Services that purport to ‘cure’ people with non-heterosexual sexual orientation lack medical justification and represent a serious threat to the health and well-being of affected people.”

Several states consider conversion therapy detrimental enough that they have enforced or are considering bans on it. California, New Jersey, and Washington, D.C. have banned the use of conversion therapy on minors. Other states that have pending legislation to ban reparative therapy include New York, Massachusetts, Illinois, Iowa, Minnesota, Michigan, Ohio, Vermont, Pennsylvania, Colorado, and Hawaii.

Given a lack of research that supports the effectiveness or safety of conversion therapy, the American Psychiatric Association “recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to ‘First, do no harm.’ ”

GoodTherapy.org Philosophy of Membership

GoodTherapy.org is founded on a mission and vision to reduce harm in therapy by educating consumers so they can be equipped with resources and services that will help them achieve their mental and emotional health goals.

When mental health professionals sign up to be listed in the GoodTherapy.org therapist directory, applicants are required to certify that the services they provide accord in orientation and attitude to its Elements of Healthy Therapy Statement. A peer-review team verifies each clinician’s credentials and screens his or her profile content to ensure the person’s practice is in line with elements of good therapy. Profiles are reviewed for questionable content, such as homophobic, sexist, racist, or other discriminatory or harmful practices or beliefs. GoodTherapy.org does not list conversion therapy or reparative therapy as a type of therapy that members can select.

[fat_widget_left]Because the review process for inclusion in GoodTherapy.org’s therapist directory is done on a case-by-case basis by human beings, and because members are able to update their listings at any time, it is possible that an inappropriate listing could appear for a period of time in its directory. However, GoodTherapy.org addresses any such listing as soon as it becomes aware of it and takes action to remove the individual from its directory. Since GoodTherapy.org was founded in 2007, situations like this have been extremely rare.

It is important to note that there are people who seek therapy as part of an effort to change their sexual orientation. GoodTherapy.org’s position is in no way an invalidation of these individuals’ desires to work toward their chosen goals in therapy. GoodTherapy.org respects individuals’ rights to identify their treatment goals and choose treatment modalities that appeal to them for any reason.

It is perfectly acceptable for individuals to discuss, explore, and evaluate their sexual orientation in the context of a therapeutic relationship. Trained therapists should be equipped to support people in these efforts without prejudice or discrimination. GoodTherapy.org works to ensure that it offers people seeking treatment quality choices so they can find a therapist who meets their unique needs.

GoodTherapy.org was founded in 2007 with the mission of:

• Reducing harm in therapy
• Advocating healthy and ethical psychotherapy practices
• Encouraging therapists to work collaboratively and nonpathologically
• Depathologizing diagnostic-based language and therapy practices
• Educating consumers about the differences between healthy and unhealthy therapy practices

Toward this end, GoodTherapy.org makes every effort to avoid and remove from its site any content—including blog material and therapist listings—that contains a homophobic, sexist, racist, ableist, or otherwise discriminatory message. Dan Fajans, director of member services at GoodTherapy.org, explains, “Everything we do, from our therapist directory, to our Continuing Education Program, to The Good Therapy Blog, to our GoodCause program and beyond, is first and foremost an effort to put this mission into action. Providing an advertising platform for conversion therapy would be directly at odds with our mission.” GoodTherapy.org takes this stand based on mounting evidence that conversion therapy causes harm; leading mental health organizations do not view it as ethical; and it requires the therapist to operate from a fundamentally pathology-based understanding of the person who is seeking therapy.

Noah Rubinstein, GoodTherapy.org’s founder and CEO, stands behind GoodTherapy.org’s position on conversion therapy both professionally and personally. As a licensed marriage and family therapist who has worked in the mental health field for over 25 years, Rubinstein elaborates:

“In general, any psychotherapy that focuses on trying to depreciate, banish, or exile a psychological aspect of a person at the expense of curiosity, appreciation, and compassion is not in the best interest of the individual. Even with issues such as depression, anxiety, addiction, anger, self-criticism, and nearly every other symptom which motivates a person to seek help, the only agenda ever set by the therapist, in my opinion, should be to help the individual understand the purpose, function, and existence of such an aspect. The decision to help a person change some aspect of themselves should be made by the person in therapy only when he or she is in a psychological state of calm and self-compassion.

“I can only imagine how difficult it is in this culture for some individuals to recognize, accept, and explore their sexuality when it differs from the majority. I assume that those who want to change their sexual orientation are under enormous pressure internally and/or externally to assimilate and that any desire to alter their sexuality does not originate from self-compassion, unless their sexual practices are harmful to self and others—which homosexuality in and of itself is not. The only way to tell, I imagine, would be to first work with an individual to access the internal resources to transcend any internal or external pressures. At that point, one could reach a place of understanding, acceptance, and self-compassion for his or her own sexuality.”

As an organization, GoodTherapy.org reiterates its support for individuals experiencing any type of mental health challenge, in any stage of their mental health journeys. No person should be made to feel inadequate or broken because of a psychological concern, and all people are worthy of healing and love—especially self-love. If you feel discouraged or troubled, or if you feel you have been treated unfairly in therapy, there is hope and help available.

We invite you to share your thoughts or comments in the “Leave a Reply” section below.

References:

1. APA Board of Trustees. Position Statement on Issues Related to Homosexuality. March 2000. Retrieved from http://www.aglp.org/pages/LGBTPositionStatements.php#Anchor-55000
2. Herek, Gregory M. Facts about Homosexuality and Mental Health. Retrieved from http://psychology.ucdavis.edu/faculty_sites/rainbow/html/facts_mental_health.html
3. Millar, Katharine S. The Myth Buster. February 2011. Retrieved from http://www.apa.org/monitor/2011/02/myth-buster.aspx

When 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.

About 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!

I 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.

We like to think we are in charge of our own life, master of our ship. We do in fact have the ability to choose how to act, what we say, who we are—up to a point. Neuroscience gives us a perspective that is rather humbling. It turns out that we share a great deal with lower creatures in terms of our basic survival instincts, and in terms of how the brain works. Like other animals, a lot of what we do is on automatic pilot. We share 98% of our DNA with chimpanzees. The 2% difference is mostly in the prefrontal cortex, the most advanced part of the brain that is unique to us humans. We are animals, but animals with a difference.

The Amygdala: Threat Detector

Most of the time, our brain is humming along, working on automatic pilot without our awareness. The amygdala, a key part of the emotional brain, is always scanning for danger. When it senses threat, the amygdala kicks into high gear, prompting a cascade of neurological and chemical messages throughout brain and body to deal with the crisis. The fight-or-flight response is triggered. This is very helpful if you’re hiking in the woods and see a snake. Your amygdala gets you to run away before you’re fully aware of what you’ve seen. But perhaps it was just a stick and you overreacted. The amygdala doesn’t dabble in niceties; it is biased toward the negative, and can save your life in a pinch. Its job is to protect you from danger, and a few false alarms are part of the deal.

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The amygdala is a great ally in a dark alley; one whiff of danger and it’s efficiently doing its job. The heart races, the feet make us run, and we (hopefully) escape the bad guy. But the amygdala isn’t very smart; it often sees danger where none exists. Let’s say you’re in your living room with your partner and he or she gives you a look of disapproval. Your amygdala registers danger, and you have two choices: fight or flight. You start defending yourself or you counter-criticize your partner for being so critical (two forms of fight); maybe you storm out of the room, slamming the door for good measure (flight).

Success! Your amygdala has saved you from a threatening moment with your partner. The problem is, he or she is now in the living room stewing over how you abandoned him/her, and more trouble lies ahead. Perhaps it would have been smarter for you to ask about his/her concern and address it calmly. If only you hadn’t reacted so rashly! Now he or she is going to be angry for days, and you’re going to feel guilty. It’s a mess.

Prefrontal Cortex to the Rescue

Your animal instincts are protective, but they also can lead to a lot of heartbreak. Fortunately, we do have a higher brain; the prefrontal cortex (PFC) allows us to pause, think, and choose to act according to our higher values. It also allows us to repair with a partner when we have acted badly.

The prefrontal cortex calms the amygdala, helping us regulate our emotions. You don’t have to be a victim of your own reactivity, anger, or defensiveness. If you have the intention to be your best self, you can stop and make a better choice. I know this from personal experience. When I was a little girl, I had red hair—and a temper to match. My father shared with me some wisdom from an ancient Roman Stoic philosopher, Seneca, who said: “Most powerful is the person who has himself in his own power.” This had a big impact on me, even though I was only 8 years old. I understood that I could be powerful by taming my temper.

I’ve been working on my temper ever since, and these days I am often able to catch myself before I blow up at my husband. I pause (activating my PFC) and think before I yell or get reactive. Then I raise my concerns with him in a more loving and respectful manner—getting much better results than if I blast him with anger. In these moments, I am acting according to my higher values. When I can pull this off (not always!), I am choosing who I want to be in my marriage.

Emotion Regulation

The goal is not to stamp out our emotions. Emotions give color and vibrancy to our lives. They inform our decisions, allow us to love, and orient our moral compasses. But we do need to learn how to deal with our feelings, identifying and regulating them so we are not victims of our own reactivity.

Some people never learn to read their emotions. Men especially are socialized early in life to tune out or become numb to their vulnerable feelings: “Big boys don’t cry.” But if you can’t name your emotions, how are you going to regulate them? It’s not that the emotions go away—they’re just not available to consciousness. Let’s say Ted feels vulnerable when his wife, Amy, turns her attention away from him and he feels unimportant. But he’s never learned to recognize or understand his vulnerability. He may blow up at her if he’s felt ignored too often; neither he nor she has any idea where his tantrum comes from.

Neuroscientists point out that emotions start in our body; the information travels from the gut or heart up the spinal cord to the brain, where we become aware of our feelings. Ted needs to learn to identify his body cues when he is feeling left out or ignored by his wife, name the feeling, and take more constructive steps to address this issue with her.

Step one is identifying the emotion; step two is regulating it. When Ted feels upset with Amy, it’s not OK to just lash out. He needs to work with his feelings so he can raise his concerns respectfully. There are many ways to regulate emotions when we are upset. Deep belly breathing is particularly helpful; the out breath activates the parasympathetic nervous system, which calms down the sympathetic nervous system (part of the fight-or-flight response). Mindfulness meditation likewise calms the emotional brain. Counting to 10 or taking a break for a few minutes are other ways to settle down when upset. Cognitive reappraisal or reframing is also helpful (“my husband didn’t leave his shoes by the back door to trip me up on purpose; he just forgot to put them in the closet”).

Living and Loving Intentionally

Rather than living with knee-jerk reactivity, driven by our animal instincts for self-preservation, we can choose to live intentionally, thanks to the prefrontal cortex that differentiates us from other animals. I encourage couples to who come to me for therapy to identify their own higher goals and values; I then help them operationalize these values into concrete skills to improve their relationships.

Identifying your values and intentions helps you maximize the power of your prefrontal cortex. It allows you to develop relational virtues and reach for your best self—even when you start to get reactive. Instead of lashing out at my husband in a fit of temper, I can take a deep breath and say to myself, “This is the man I love. I want to act in a caring manner, not fly off the handle. I want a relationship of mutual respect.” In these best-self moments, I am relationally empowered, as my father and Seneca taught me so many years ago. It takes work to be able to calm yourself down and act in accordance with your higher values. The payoff is well worth it.

Humanistic in nature and concerned with the existential qualities of human relationships, Virginia Satir was considered a founder and leading catalyst in the evolution of experiential family therapies.

Satir’s method revolved around two core elements—family life chronology, in which she sought to understand the developmental patterns of relationships in the family as a basis for change; and family reconstruction, in which she attempted to guide families through a process of engaging positive change using experiential interventions from guided fantasy, guided contemplation, hypnosis, psychodrama, family sculpting, parts parties, and role playing (Gross, 1994; Satir, 1988; Winter and Parker, 1991).

One of Satir’s chief concerns was communication within families. Satir (1988) went as far as to write, “Once a human being has arrived on this earth, communication is the largest single factor determining what kinds of relationships she or he makes with others and what happens to each in the world.”

Satir developed within her model five conceptual styles of communication: placating, blaming, computing, distracting, and congruent communication. In Satir’s conception, placaters act as pleasers and are often self-effacing, blamers act self-righteously and often accuse, computers are emotionally detached and often rigidly intellectual, distracters are unfocused and seemingly unable to relate to what is actually being communicated about or going on in the family, and congruent communicators are expressive, responsible, seem genuine, and articulate themselves clearly and in the appropriate context.

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Satir utilized experiential techniques that allowed families to explore, acknowledge, and modify their own communication patterns in-session. Role plays, family sculpting, and guided contemplation were three prevalent forms of experiential communication therapy used by Satir in her work with families.

In observing a family, Satir centered her focus on family interconnectedness, especially triad units, the relationship emotional system between three members of a family. The mother-father-child triad frequently held the center of her attention, as she believed that it is most powerfully in the crucible of this triadic relationship that children begin to learn about and practice intimacy (Baldwin, 1991).

Satir held four assumptions: (1) All people await the potential of growth and are capable of transformation; (2) people carry all the resources they need for positive growth and development; (3) families are systems wherein everyone and everything impacts and is impacted by everyone and everything else; and (4) the beliefs of counselors are more important than their techniques (Satir and Baldwin, 1983).

Satir was concerned with family members’ uniqueness and potentials, and she was always concerned with their spiritual development as well. Satir (1988) wrote, “I believe [spirituality] is our connection to the universe and is basic to our experience, and therefore is essential to our therapeutic context.”

She challenged behavioral and cybernetic epistemologies, criticizing that, in the effort to change behavior, people’s spirits are often crushed, “crippling the body and dulling the mind.” She saw error in equating the value of a person with the nature of his or her behavior. “Remembering that behavior is something we learn,” she wrote, “… we can simultaneously honor the spirit and foster more positive behavior.”

Satir viewed poor communication as a perpetuator of unhealthy relationships, and she championed more open and congruent communication between and within individuals as a key to increasing awareness, compassion, and connection in families and society (Satir, 1983).

Satir (1986) stated, “[People] use their past to contaminate their present, which in turn creates a future that replicates their past, a stuck place, and often a hopeless quagmire” (changed from past to present tense). She added, “It is the learnings from the past that form the approach to the present. To change the perception and the experience of the present so it can become a steppingstone to a healthier future, I need to somehow introduce ways to stimulate new learnings to take place.”

Satir, unlike her contemporary Carl Whitaker, for instance, was concerned with directly identifying and addressing symptoms. Satir held that symptoms of individuals in families express family pain and that children’s symptoms are related to marital difficulties in which they become triangulated (Luepnitz, 2002).

For Satir, the goal of therapy was essentially to increase self-worth and nurturance within families.

Deborah Luepnitz (2002), a prominent feminist voice in the field, criticized Satir’s theoretical simplicity:

Satir’s fallacy is the fallacy of believing that one can change the world by appealing to principles of therapeutic change alone, ignoring the global political changes that must be understood and grappled with. Satir said in our 1984 interview: “If tomorrow morning, every school, every family, every workplace had a transformation in the middle of the night to love and value themselves and treat others likewise, you know we would transform like that!” [snapping her fingers]. This is hardly a theory of social renewal. It cannot help us understand the extraordinarily complex problems of development in the Third World nations, nor the dismantling of weapon systems, nor the bitter mystery of AIDS. There are reasons that people do not decide in the middle of the night—or by the light of day—to love and work as well as they might … Satir, however, has no theory that will help explain violence or the evil that has broken individuals and entire peoples on the wheel of history. Low self-esteem simply cannot account for the eradication of entire nations.

Luepnitz reasoned that Satir’s concept of “self-esteem” is nothing more than a derivation from ego psychology or else just a crude and imprecise conceptual oversimplification.

Satir’s lack of theoretical clarity and precision cost her equal respect alongside other major family therapy pioneers. Alan Gurman and David Kniskern (1981) chose not to represent Satir’s work in their Handbook of Family Therapy because “no discernible school or therapeutic method has evolved from her contribution.”

Nonetheless, many important family therapy trailblazers who have followed after extol Satir’s inspirational genius. Another distinguished family therapy authority, Lynn Hoffman (1981), attested to “the power of her presence with families” and her “extraordinary and unique contribution” to the field.

References:

1. Baldwin, M. (1991). The triadic concept in the work of Virginia Satir. In B.J. Brothers (Ed.), Virginia Satir: Foundational ideas. Binghamton, NY: Haworth.
2. Gross, S. J. (1994). The process of change: Variations on a theme by Virginia Satir. Journal of Humanistic Psychology, 34 (3), 87-110.
3. Gurman, A., and Kniskern, D. (Eds.) (1981). Handbook of family therapy. New York: Brunner/Mazel.
4. Hoffman, L. (1981). Foundations of family therapy. New York: Basic Books.
5. Luepnitz, D. A. (2002). The family interpreted: Psychoanalysis, feminism, and family therapy. United States: Basic Books.
6. Satir, V. (1983). Conjoint family therapy (3^rd ). Palo Alto: Science and Behavior Books.
7. Satir, V. (1986). Foreword. In W. F. Nerin, Family reconstruction: Long days journey into light (pp. v-xii). New York: W.W. Norton & Company.
8. Satir, V. (1988). The new peoplemaking. Mountain View: Science and Behavior Books.
9. Satir, V., and Baldwin, M. (1983). Satir step by step: A guide to creating change in families. Palo Alto: Science and Behavior Books.
10. Winter, J. E., and Parker, L. R. E. (1991). Enhancing the marital relationship: Virginia Satir’s parts party. In B. J. Brothers (Ed.), Virginia Satir: Foundational ideas. Binghamton, NY: Haworth.

I find myself looking at this person; I feel for him, knowing that he is tormented by his anxiety and sense of isolation. While he has made amazing strides in therapy, especially through eye movement desensitization and reprocessing (EMDR), there is something that keeps “blocking” him from reaching the point of accepting that the past is truly “over.” There is something that pulls at him, drags him down into the murky depths of his sadness, telling him that he can’t reach that positive belief that he is “good enough.”

His story is not unique. He is like many of the people I work with in therapy who struggle to loosen themselves from the hold of trauma. He is like many who walk into my office wanting to feel free of the past, to fully integrate what they know “logically”—that they are “OK, lovable, worthy, safe, here now”—with their emotional selves, who are just not buying it.

As you are reading this, perhaps there is some aspect of your healing work that you feel “stuck” in. It’s a common theme; folks do amazing trauma healing work and perhaps might find that they have hit a wall. They want to feel healed, but on some level it just won’t budge. “I don’t know why” is a common statement. What we often find is that there is some next layer of the person’s experience that is revealing itself. In EMDR therapy, we call it a “blocking belief.”

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Why does this happen? Why is it that, on the one hand, we can know that the past is behind us, and yet there is also a sense that it is not? We can begin to explore this question not only through the perspective of trauma therapy, but specifically EMDR therapy.

A blocking belief essentially blocks us from shifting our core beliefs about ourselves. For example, in processing deep-rooted trauma through EMDR therapy, the person I described was working through a core belief (EMDR therapists call it a “negative cognition”) of “I’m not good enough” and then, right when it was getting to a decreased intensity, found another layer—a blocking belief that “I shouldn’t get over this.” That same blocking belief kept the trauma from decreasing in intensity from a 10 (most disturbance) to a zero (neutral/no disturbance). It wasn’t until we shifted that blocking belief—“I shouldn’t get over this”—that the core belief of “I’m not good enough” could release its hold as the trauma was processed.

Blocking beliefs can come up often in EMDR therapy when we ask about the SUDs (subjective units of disturbance scale). It’s a scale we use to find out how the person’s distress about the event has shifted. Keep in mind that it doesn’t mean that the event is not disturbing. That it’s disturbing doesn’t change. It will be a disturbing event as a trauma, by its nature of being a trauma. But the person doesn’t have to continue to feel disturbed by it.

When we start to explore our core beliefs about ourselves, and the traumas that have driven them, be sure to explore any blocking beliefs that may show up. It may just mean that you are that much closer to healing those traumas than you may have thought. It may just be that deepest layer waiting for you to discover it.

Believe it or not, it is possible to get to a neutral or zero about traumatic events and the disturbance we feel about them, even for the most upsetting and distressing experiences. But there may be some reason we hold on. Unconsciously, perhaps we think we need to keep some fear, just enough, to help us feel safe and prepared for next time. Perhaps we think it’s “impossible” to heal from those experiences. Perhaps there’s a mistaken, unconscious belief that it’s not “something we should get over,” that it’s not OK that we heal this event: “It’s just too painful; if I feel neutral or no disturbance, then I am not honoring the experience(s) and the impact on my life.”

The fact is, and this comes up a lot for folks when they do EMDR, it is possible to heal trauma.

It is possible to feel differently about our lives, whether it be to feel safe, calm, or even feel and know that the past is over. Yes, it can change; I’ve seen it. I’ve also experienced it. That said, it can take time, even with EMDR therapy, especially with multiple of types of traumas, and when traumas span across the developmental stages of our lives.

Problems that make their way to family therapy tend to involve self-reinforcing—or circular—dynamics and, as such, are commonly called “vicious cycles” or even “vicious circles.” When people become “stuck in a rut,” so to speak, a problem has morphed into a cycle of cause, effect, and attempted solutions.

In other words, even legitimate attempts to solve a problem seem to somehow perpetuate it.

By the time a person (or couple, or family) enters therapy, they are often aware on some level of the nature of the cycle they are stuck in, and motivated to try something new.

This is therapy’s opportunity.

People thoroughly entrenched in problems have underlying resiliency. Family therapist Carl Whitaker (1989) wrote, “Psychopathology is proof of psychological health. The individual who is distorted in his thinking is essentially carrying on an open war in himself rather than capitulating …”

Effective therapy need not reinvent a person; rather, systemic therapists wrestle with people in their care to stir their own latent creative energies to free themselves from being stuck in their quagmires. It is ultimately always the people in therapy who become free and responsible over their lives, not the therapist.

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Therapeutic experiencing invokes a kind of psychological immune response. In the best of cases, multiple interdependent systems experience simultaneous positive effect. In the course of therapeutic work, I utilize interventions that turn circular tailspin into dialectical liftoff.

I must credit these ideas, broadly, to the pioneering integrative systems theory of Gregory Bateson, to whom many of the founding mothers and fathers of our field owe their inspiration.

Isomorphism

The use of feedback to engage the parallel emotional process.

At every turn, I believe it is my responsibility to circle back around to mindful reflection of my therapeutic interaction with people. I tell them about my experience of them—what I have felt, wondered, observed, and thought, including my evolving hypotheses.

I sometimes go to great lengths to understand and cajole them to understand some of the basic relational dynamics taking place between us in therapy to stir perspective outside the therapy room.

Isomorphism as intervention is about intentionality as a therapist in cultivating emotional-relational transparency oriented toward therapeutic intimacy.

When built on openness, respect, and curiosity—and while maintaining a practice of accountability with people in therapy—engaging at this level has the potential to infuse transformative power into the therapy process.

Circumnavigation

The use of evaluative assessment to gain contextual perspective.

Recently the Rosetta space probe arrived at its destination after a 10-year journey of more than 600 million miles through our galaxy. When it arrived, it spent months carefully orbiting around comet 67P, aka Churyumov-Gerasimenko, in order to study it from afar. Rosetta first had to get a sense of the shapeliness of the mass, understand a bit of its terrain, and strategize where best to send its lander.

Philae, the landing module that Rosetta had brought along, eventually made its careful descent to the comet. Unfortunately, despite careful planning, the lander bounced at least twice after landing on the surface, and when it landed, it was in a shadow, near the bottom of a towering ridge, unable to absorb the sunlight necessary for its own battery and the continuity of the mission.

After the mishap, scientists reassessed that the unthinkable position of the lander may have a serendipitous upside—as the comet nears the sun, the lander may find itself exposed to the beams of sun necessary to charge itself yet remain shielded enough to carry on for much longer than planned.

As we survey territory, I must be skilled enough to avoid major obstacles, and we must be joined well enough together to traverse through pummeling, disorienting space dust in order, ultimately, for people in therapy to gain an awesome, sometimes catalyzing, perspective of larger processes governing their lives. And we must roll with resistance in the process, reframing stumbles as opportunities.

Oh, and just in case it crossed your mind—yes, assessment is intervention!

Abduction

Analyzing perceptual alongside communicative patterns in order to disentangle them.

Bateson (1979) described how people become stuck in their own rigidity—how, for instance, presupposed ideas are supported by a social system which conversely supports the presupposed ideas because the social system itself is a vast recursion full of individuals with presupposed ideas.

The proverbial “chicken or the egg” really cannot do justice at this level of complexity.

Bateson commonly called abduction “the double description,” and he by this referred to extrapolating patterns of mental processes alongside patterns of adaptive processes. It is fascinating to consider—all forms of communication truly are adaptive; and perception is nearly inextricably tied into it.

We must move far beyond learning as insight-comprehension to a kind of learning-while-learning, with, for instance, communicative shifts occurring simultaneously alongside perceptual shifts and each reinforcing the other—Bateson (1972) called this “deutero-learning” or “Learning II.”

As people in therapy grasp shared aspects of the perceptual and communicative processes within themselves and their families, the possibility increases that as they decode interrelationships, they will learn to disembody the problem transfixed within them. In other words, they may learn increasingly to dissociate themselves in some way from their problem and thereby become disentangled from it.

Bateson (1977) once wrote, “As you become aware that you are doing it, you become in a curious way much closer to the world around you,” and this is its therapeutic power. This, Bateson (1991) argued, is because “meaning is not internal. It is between parts.”

Recapitulation

Practicing the problem in order to demystify and rend it less powerful.

Once people in therapy have come to experience a problem differently in-session, they will come to experience it differently in life. Experience will beget experience, as it nearly always does.

And so I find it of the highest necessity that the people I work with in therapy bring their problem(s) into therapy. This may seem to be stating the obvious. What I mean, though, is that for our therapeutic relationship to affect change in the lives of the people I help, we must somehow experience the problem together in vivo.

When people are tempted to go on recursively explaining problems, I let them know they can choose between carrying on, remaining in the safe position of knowing what they know already, or experientially exploring with me aspects of presence, emotion, or communication to risk gaining what they may have never known.

Summoning the spirit of the problem may necessarily come of its own accord, as its cajoling may constitute an ethical breach for the therapist, depending on the nature of the problem. Nonetheless, nearly inevitably, and often in the midst of a presumed period of improvement, the therapy room becomes proving ground.

Evocation

The spontaneous and creative stirring of images and feelings to energize positive changes.

When the positive end of one magnet is placed against the negative end of another, an invisible force pulls them together. Likewise, when the magnet’s positive end is placed against the positive end of another, they repel one another. Two pieces of uncharged metal neither attract nor repel.

There is magnetism in the emotional systems of families and, to greater or lesser degrees, between every family member. The force between two is skewed by an intervening third, and so on.

The challenge of therapy is of how to work therapeutically with processes that bind and unbind, generating flexibility and instilling resilience. To grow, people must experience freedom within the felt pushes and pulls of powerful self-perpetuating forces in which problems—and families—maintain themselves.

Bateson (1972) himself suggested that painting, poetry, music, dance, and other metaphoric art forms serve as a bridge between the conscious and the unconscious, a way of communicating outwardly what dwells inwardly, abductively and evocatively affording us opportunities to enter into the relationships they express.

Whitaker (1989) taught us that what is therapeutic is not necessarily the experience itself but the meaning the person in therapy attaches to it. Quite so, if the person is to change, then transformative experiencing must occur. Success is quantum leap from one state—or state of meaning—to another.

And who but the therapist must invoke it?

(Incidentally, these modes of intervention spell “I CARE.” You can credit the acronym to me.)

References:

1. Bateson, G. (1972). Steps to an ecology of mind. Chicago: University of Chicago Press.
2. Bateson, G. (1977). Afterword. In J. Brockman (Ed.). About Bateson: Essays on Gregory Bateson (pp. 235-247). New York: E. P. Dutton.
3. Bateson, G. (1979). Mind and nature: A necessary unity. New York: Bantam.
4. Bateson, G. (1991-published posthumously). A sacred unity: Further steps to an ecology of mind. New York: Harper/Collins.
5. Whitaker, C., and Ryan, M. (1989). Midnight musings of a family therapist. New York: Norton.

By the mid-20th century, family therapy pioneers were overturning conventions. Chief among them stirred Carl Whitaker—country boy-turned-OB/GYN-turned-psychotherapeutic provocateur who Rich Simon, editor of Psychotherapy Networker, once called “fearless and idiosyncratic.”

In the vein of existentialist philosophers, Whitaker largely regarded his treatment paradigm as protest against the reduction of human existence to mere behaviors, cognitions, or even theories.

There were at least 10 integral elements of Whitaker’s richly evocative therapeutic ethic. These are explored below.

Psychopathology as Distraction

Whitaker saw “symptoms as mere signals of, or even noisome distractions from, the real existential problems faced by families—birth, growing up, separation, marriage, illness, and death” (Luepnitz, 2002).

Whitaker contended: “Psychopathology is proof of psychological health. The individual who is distorted in his thinking is essentially carrying on an open war in himself rather than capitulating to the social slavery. His delusion system and his hallucinations are a direct result of this war with his lifetime situation—the stresses of his living and his efforts to defeat those stresses rather than become a non-person and a social robot” (Whitaker and Ryan, 1989).

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Responsibility of People in Therapy

Whitaker’s emphasis on personal freedom and responsibility derived from philosophers, such as Martin Heidegger and Edmund Husserl, who considered the psychological implications of existentialist thought. Ludwig Binswanger (1967) assimilated these ideas into psychotherapeutic formulation, emphasizing “freedom and the necessity to discover the essence of one’s individuality in the immediacy of experience.”

Throughout Whitaker’s writings and therapeutic example, he conveyed existentialist presuppositions: anxiety and suffering can be growth inducing; people have power to choose to be responsible; elements of the human condition which exist in clients’ relationships with each other exist between clients and therapists.

Rousing awareness of change processes, Whitaker coaxed people toward ownership. He declared, “The integrity of the family must be respected. They must write their own destiny” (Neill and Kniskern, 1982).

Value of Courage

Whitaker regarded existential anxiety as an “irresolvable dialectic,” contending: “The effort to solve living as a problem is impossible. … The process of facing the dialectic life … is endless, irresolvable, and poorly understood. … Security alone equals slavery. Exploration alone equals danger and death. The flux is always exciting but never an answer, only a courage-inducing impetus to more of the individual’s right to decide on the next move and to discover more and dare more” (Whitaker and Ryan, 1989).

Transformative Nature of Vulnerable Encounter

By daring to be vulnerable with people in therapy, Whitaker exposed families to an existential encounter. When the family comes “face to face with part of your insides, they have to decide what to do. … They’re free to produce their own extrapolations, depending on how it reverberates inside of them” (Whitaker and Bumberry, 1988).

The concept of the “I-thou” relationship stems from the writings of Buber (1937), who philosophized that the nature of our interactions with others are often more “I-it” than “I-thou.”

One of Whitaker’s common therapeutic goals was for family members to begin to experience themselves more openly and nondefensively with one another; that an existential shift occur on a systemic level.

Primacy of Affective Experiencing

During one session, Napier and Whitaker (1978) hypothesized, “They [are] most afraid of what many couples find the threatening aspect of their marriages: deadness.”

Keith and Whitaker (1982) wrote, “We presume it is experience, not education that changes families.”

Whitaker often redirected attentions from the content of conflict to the emotional process: “I would guess that almost anything you focused on together would bring out this disagreement. … It feels more like a fear of conflict that’s the problem, rather than some particular issue you are fighting over” (Napier and Whitaker, 1978).

Power of Artful Communication

Whitaker developed the notion of symbolic communication as interactional metaphor based largely on George Herbert Mead’s concept of symbolic interactionism. Whitaker stressed the importance creating and shaping meaning between people and, consequently, facilitating shifts within the family emotional system.

Whitaker saw his role as engaging a family by raising the intensity within its relationships and communicating symbolic meaning through experiential interaction in such a way as to catalyze the family toward intimacy.

Spontaneous Evocation as Healthy

Whitaker advocated a spontaneous and evocative presence with people in therapy as a means of engaging them at the hidden symbolic dimensions of awareness. Perhaps his most well-known display of spontaneity in therapy was when he wrestled with a teenage boy who had knocked Carl’s glasses off in a moment of rage: “As Don had struck out in panic and anger at Carl, Carl had tackled him, and the two of them went down onto the Oriental carpet, a tangle of limbs” (Napier and Whitaker, 1978).

This unplanned and, arguably, unprofessional encounter was certainly one of Whitaker’s more radical therapeutic moments. Yet it was also indicative of Whitaker’s view of therapy.

Whitaker went as far as to advocate “craziness”—nonrational, right-brain experiencing—as a measure of health in both therapist and family (Whitaker and Keith, 1981). Whitaker explained, “My craziness [has given] other people the freedom to be more spontaneous, to be more intuitive, to be crazy in their own ways.”

Necessity of Present-Centeredness

Whitaker was careful to observe and allow himself to react quickly and intuitively to interactions between family members, both to prevent unhelpful more-of-the-same dynamics and to highlight potential signals of underlying emotional patterns, often the very mire in which the family is stuck.

Whitaker saw the problems that families brought to therapy as failures to adapt together to common problems of life and the here-and-now as the necessary moment for creative intervention and change. He urged, “Life isn’t mind over matter, it’s present over past and present over future” (Keith and Whitaker, 1982).

Developmental Growth as Necessarily Relational

Every person must counterbalance needs for individual autonomy with needs for relational connection. Whitaker believed that therapy must stimulate the growth of the person alongside the growth of the system.

Whitaker worked to facilitate family cohesion, ensure family members were meeting each other’s needs in the process of their own individuation, and were developing increasing proclivities for spontaneity, creativity, and attunement within the family unit. For Whitaker, the individual cannot grow in a relational vacuum.

Need for Holistic Versus Reductionist Goals

Whitaker saw the trajectory of therapy moving toward, for example, a heightened sense of competence, well-being, the development of compassion, self-esteem, role flexibility, awareness, self-responsibility, greater sensitivity, learning to recognize and express emotions, achieving intimacy with a partner, and so on.

Carl Whitaker died in 1995, and this April will be the 20th anniversary of his death.

References:

1. Binswanger, L. (1967). Being-in-the-world: Selected papers of Ludwig Binswanger.Needleman, J., translator. New York: Harper & Row.
2. Buber, M. (1937). I and Thou (2^nd), translated by Ronald Gregor Smith. Edinburgh: T. and T. Clark.
3. Keith, D. V., and Whitaker, C. A. (1982). Experiential-symbolic family therapy. In A. M. Horne and M. M. Ohlsen (Eds.), Family counseling and therapy. Itasca, IL: Peacock.
4. Luepnitz, D. A. (2002). The family interpreted: Psychoanalysis, feminism, and family therapy. United States: Basic Books.
5. Napier, A. Y., and Whitaker, C. A. (1978). The family crucible. New York: Harper & Row.
6. Neill, J. R., and Kniskern, D. P. (Eds.). (1982). From psyche to system: The evolving therapy of Carl Whitaker. New York: The Guilford Press.
7. Whitaker, C. A., and Bumberry, W. M. (1988). Dancing with the family: A symbolic-experiential approach. Levittown: Brunner/Mazel.
8. Whitaker, C. A., and Keith, D. V. (1981). Symbolic-experiential family therapy. In A. S. Gurman and D. P. Kniskern (Eds.), Handbook of family therapy. New York: Brunner/Mazel.
9. Whitaker, C. A., and Ryan, M. O. (1989). Midnight musings of a family therapist. New York: Norton.