Child with head downWhen I think of the people I work with in therapy, it is astonishing how many have had to grow up fearing a parent’s powerful responses if they fail to maintain their parent’s emotional equilibrium. Shame, anger, hurt, retaliation, and emotional and physical abandonment are just some of the serious consequences for children who attempt to be themselves in some families.

When subjected to these forms of physical and emotional mistreatment, children learn to protect themselves by becoming acutely sensitive to the feelings of their caregivers. To keep themselves safe, they quickly learn that they have the responsibility to soothe and get rid of their parent’s anger, hurt, uncertainty, confusion, and any other intolerable and unwanted feelings the parent may experience. If they can’t prevent unacceptable parental feelings, they must fix the parent’s feeling state through apology, soothing, or even acceptance of the parent’s lashing out with shaming, humiliating treatment.

If the child is unsuccessful at this, the parental assaults, sometimes subtle and other times powerful, convey many messages: “It’s your fault I’m hurt, upset, sad, etc.”; “You have failed in your responsibility to make me feel good”; “You are a bad person.” Most prominent is the message: “To safeguard my feelings, you must be who and what I need you to be.”

This has many repercussions for the development of the child’s identity, sense of self, and agency.

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Living in Fear

Cynthia, 47, is married woman with an 11-year-old son, Jason. She describes herself as having been depressed and anxious for as long as she can remember. She attributes her severe anxiety to her relationship with her mother, who lives nearby. Cynthia explained why she decided to seek therapy:

“I have always been anxious and depressed. But I just can’t take it anymore. I’ve been careful around my mother my whole life. I’m so afraid to hurt her feelings or get her angry. I bend over backward to sound cheerful, never ask for anything, tell her how wonderful she is. Even when I don’t think I’ve done anything wrong, I always apologize. Now she is doing with my son what she has always done with me. She’s trying to run his life. She gets all weepy or angry and makes him feel like a bad person when he doesn’t go along with what she wants. My life goal has always been to keep my mother happy. I know I never let myself think about or go after what I wanted for myself. Now I can’t let her do that to my son. But it’s just so scary to try and protect him. She will tell me what a horrible mother I am and then get icy cold to me. I don’t think I can withstand that rejection. I probably am a terrible mother.”

Working with Cynthia, I soon discovered that her life was organized around her need to be vigilant. She rarely made a decision or undertook a meaningful action without obsessively worrying about how her mother would feel and respond:

“Jason has been begging Howard (her husband) and me to let him go to a travel camp this summer. His best friend is going, and they would mostly be going to some national parks out west. Howard thinks it’s a great idea. But I know my mom will think it’s dangerous and that he’s too young. If I don’t do what she thinks is best, my mom will be so hurt and upset. I’ll be the one who has made her an anxious mess. Then I will be a wreck. It scares me that I’m actually more worried about her feelings than about whether this is a good idea for Jason. I’m always thinking ahead about how everything will be seen by her. Her feelings rule my life. I know if I agree to let Jason go traveling, I will be attacked and then get the cold shoulder. It’s wrong that I’m more afraid of my mother making me feel so rejected and like such a bad person than I am about whether this is OK for Jason. I think I am even more afraid that if we send Jason to the camp, my mother will start on Jason like she has in the past. When he wants to do something that she doesn’t approve of, she gets that distant, frigid look and tells him that he is being mean to her and doesn’t love her. I don’t know what to do. I’m frightened all the time.”

In our therapeutic work, we began to realize how Cynthia’s vigilance was designed to protect her from the painful and frightening consequences of her mother’s behavior toward her. As we uncovered and explored Cynthia’s memories and associations, Cynthia became aware of how terrified she was of her mother. In one session, Cynthia began to cry and tremble as she recalled:

“I remember when I was in kindergarten—oh, it was so awful. I had peed in my pants, and the teacher was very kind. She called my mother to bring me some fresh clothes. All I can think of is my mother’s face when she showed up.”

Cynthia began to sob: “She looked so angry and scary. She took me into the bathroom at school and yanked my clothes off. She yelled at me and with a twisted face said something like, ‘How could you embarrass me like this? You are disgusting.’ I felt so ashamed and humiliated. I kept crying and saying, ‘I’m sorry, I’m sorry.’ ”

The more we talked and the more memories that Cynthia recalled, the clearer it was that Cynthia’s mother terrified her. Not only did Cynthia have to protect herself from repeated shaming, she always felt at risk of being abandoned by her mother emotionally and sometimes physically. Cynthia described how she knew she had to be good:

“One time, I must have been about 7 or 8; we had a housekeeper who gave me a present for my birthday. When my mother learned about it, she made me give it back. Then she screamed at me for taking something from someone who had no money. And yelled things like, ‘What kind of person are you?’ Then, as usual, she told me I had embarrassed her and that I didn’t deserve to have her for a mother. I think I remember being stunned. Then she slammed the door to my room and left the apartment. I was all alone. I don’t remember how long she was gone, but I was so frightened. I never knew what would set her off. But I soon understood that I was always in danger of being rejected or shamed and humiliated.”

Impact on Separation and Individuation

It is easy to understand how Cynthia’s fears necessitated compliance with her mother. The only means she had to protect herself was to live in her mother’s shoes and anticipate her wants, needs, and demands. Growing up, her emotional life was stunted. The constant need to be prepared to prevent or soothe her mother’s destructive behaviors had a huge mental and emotional cost.

Because Cynthia needed to be available for her mother’s use, her head was always preoccupied with anxieties about what her mother wanted and how to provide it. This left no emotional space to discover her own wishes and desires. Indeed, it would be dangerous to be too aware of being separate from her mother: to even know her own needs would run the risk of conflict and the painful consequences that would follow. This left Cynthia as a person who has no sense of herself as a person who knows who she is or what she wants.

As long as Cynthia succeeded in regulating her mother’s emotional state by keeping her feelings positive, Cynthia could stay safe. She could shield herself from the pain inflicted by her mother’s outbursts of terrifying feelings and reduce the risk of being rejected, as when her mother became cold and abandoned her emotionally or physically.

As Jason is getting older, it is becoming more difficult for Cynthia to maintain her disconnection from her own undeveloped self. While she has not had much opportunity to become a separate, individuated person, there are nascent wishes and dreams for herself that are beginning to emerge and grow. Her awareness of the destructiveness of her mother in relation to her son has helped her to emotionally understand what her own experience with her mother has been like and what the consequences have been. This has made it more difficult to ignore the steadily increasing volume of her own needs.

Cynthia is slowly becoming less afraid of her mother and of her own emerging, differentiated self. She wants something different for Jason: “I am going to try and fight for him. It is getting more scary to think that he is going to repeat my history than that I am going to be rejected by my mother.”

Cynthia understands that the power and hold of the early fears of her mother and the terror of shame and rejection are not easy to overcome. But the desire to help her son provides powerful motivation as she struggles to differentiate and separate. She knows that her challenge is to become less afraid so she can tolerate the feeling that she is harming her mother and will lose her if she asserts herself. Cynthia is committed to developing herself and learning who she is and what she wants.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

Body-ImageBody image, your internalized sense of your physical shape and appearance, isn’t just about confidence, nor is it an issue reserved exclusively for teenagers. Negative body image affects people of all ages, genders, and races, and is intricately linked to a host of mental health concerns, including eating disorders, low self-esteem, shame, isolation, anxiety, and depression.

Although it’s quite normal to feel some dissatisfaction regarding aspects of your body or appearance, if such self-criticism dominates your thoughts, limits your overall life satisfaction, or otherwise affects your school, work, relationships, or ability to function in a healthy way on a day-to-day basis, seeking help is imperative. Persistent negative body image can set the stage for serious mental and physical health complications, including body dysmorphia (sometimes referred to as “imagined ugliness”), compulsions and avoidance behaviors, and even suicidal ideation.

Eating disorders are of particular concern among people with body image issues, as they can be life threatening if left untreated. Anorexia nervosa, in fact, has the highest mortality rate of any psychiatric condition. Widely misunderstood and mischaracterized as a phase or lifestyle choice, eating disorders—also including bulimia nervosa and binging and purging—are strongly linked to body dissatisfaction.

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When it comes to body image, the elephants in the room, of course, are the unavoidable media and advertising messages that permeate our culture. Television, movies, magazines, websites, and other forms of media peddle unrealistic and often unhealthy standards, and younger people can be especially susceptible to the suggestion that these images reflect an ideal. In one study, 69% of American elementary school girls who look at magazines said the images they contained influenced their concept of the ideal body, and 47% said the images made them want to lose weight.

Addressing body image issues is complicated, but seeking the help of a qualified therapist is a highly recommended step. For our part, we’ve compiled a list of the 10 best online resources for body image issues and support—GoodTherapy.org excluded—in 2014. Our selections are based on quality and depth of content, presentation, and functionality.

Have a website you would like to see in our Top 10? Recommend it here.

References:

  1. Body Dysmorphic Disorder. (n.d.). Retrieved from http://teenshealth.org/teen/your_mind/body_image/body_image_problem.html
  2. Get the Facts on Eating Disorders. (n.d.). Retrieved from https://www.nationaleatingdisorders.org/get-facts-eating-disorders
  3. Martin, J. B. (2010). The Development of Ideal Body Image Perceptions in the United States. Nutrition Today, 45(3), 98-100. Retrieved from http://www.nursingcenter.com/pdf.asp?AID=1023485
  4. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848.

2014 top ten websites for sStress affects us all. From minor instances, such as experiencing a poor night of sleep or arriving a few minutes late to work, to major instances, such as divorce, severe illness, or injury, stressors large and small will plague us throughout life. Our personal and professional lives are impacted when we’re stressed—we may lash out at loved ones, for example, or withdraw from friends; we may resort to using food, alcohol, or other substances to mask the tension; or the stress may manifest as physical symptoms. Sometimes stress becomes part of a vicious circle in which feelings of stress are compounded. Perhaps we feel uneasy due to stress, and this affects our resilience and ability to manage daily stressors, which ultimately leaves us feeling more stressed and susceptible to illness or mental health challenges.

Some of the most common sources of stress in the United States include workplace stress, financial strain, chronic illness, relationship difficulties, sleep problems, or excessive media consumption, including social media, television, or Internet usage. Symptoms may include muscle tension, irritability, anxiety, headaches, nausea, fatigue, or feeling emotionally overwhelmed or weepy.

Recognizing stressors, managing symptoms, and employing self-care strategies are some of the most critical preventive steps we can take to keep from feeling overwhelmed by stress. To facilitate these efforts, we’ve compiled a list of the 10 best online resources for help with stress—GoodTherapy.org excluded—in 2014. Our selections are based on quality and depth of content, presentation, and functionality.

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Have a website you would like to see in our Top 10? Recommend it here.

stopHistorically, if a human being did not belong to a social group, he or she would more than likely die due to harsh conditions. It took a village to survive and you needed to be a part of that village. In an article titled The Pain of Social Rejection, written by Kirsten Weir for the American Psychological Association, she wrote that our need to belong, for acceptance, links back to our early survival skills.

Weir quotes Kipling Williams, PhD, at Purdue University as saying, “Evolutionarily speaking, if you’re socially isolated, you’re going to die and it’s important to feel that pain.” Weir also cites brain research which reveals that the areas of the brain that register pain due to physical injury, the dorsal anterior cingulate and the anterior insula, also register the emotional pains of rejection.

It’s quite smart of our bodies to create such a strong reaction to rejection. Due to our early programming, rejection—a lack of belonging, a lack of acceptance—meant death. So the brain sends us strong signals of pain to warn us that if we don’t try to reconnect, our lives are in jeopardy.

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Rather than value this warning sign, this important bodily communication, we fear it. The pain becomes unbearable. We attach all kinds of meanings to the pain, to rejection itself. We perceive rejection as an absolute truth about who we are or what we can achieve. Somehow, this primitive survival signal creates a slow, painful death—of our spirits.

We stop reaching out. We stop trying. We give up on finding the right partner, the right job, the right friends. While our modern-day culture allows us to survive in isolation, what quality does that bring to our life? We may not die physically, but what about mentally, emotionally, and spiritually?

Romantic relationships include various forms of rejection. You may reject your partner macro style, the total breakup, or micro style, such as the quiet zingers you launch over dinner. You may reject in obvious ways, such as sleeping in a separate room, or less direct ways, such as developing and feeding a sexual dysfunction.

As a result of these rejections, you may continue to coexist in your relationship but shut down connection. Or the whole relationship might break apart. This separation can wound so deeply that you may fear ever trying to form another relationship.

If you want to overcome your fears of rejection, here are five ways to transform how you respond to this difficult experience:

  1. Rejection is not about you and it is about you. This tenet is twofold. On the one hand, rejection usually has more to do with the person rejecting and less to do with you. That person has his or her own history that influences the person’s ability to connect with and accept you. The person may have his or her own emotional obstacles to confront. At the same time, there may be threads of truth woven into the person’s perspective about you. It behooves you to try to learn what you can from the experience. It takes two to make a relationship work or to tear it apart. How does this rejection become a learning opportunity for you? How do you become constructive instead of destructive with these threads of truth?
  2. Expect rejection SOME of the time. I have no idea where I heard this, but someone once said to me, “You see that gorgeous girl? Someone, somewhere, is sick of her [crap]!” Like that girl, you, too, will be rejected, no matter how attractive you are, how much money you have, or how nice you are—someone will “get sick of you” in some form. Not everyone is compatible, and you will not meet everyone’s needs at all times. If you can accept this, you can decrease the personalization of rejection, maintain faith, and keep trying.
  3. Stop making rejection your whole life story. Assuming the identity of “victim” will not attract or keep a mate. The more you cling to the “rejected” role, the more you suffer. There is more to you than your rejection. Surround yourself with friends and family who support you. These people serve as a reminder of your worth. They are a part of your love story. To overcome rejection, you must connect with people who love you.
  4. Vulnerability is a relationship requirement and a rejection target. If you fear rejection, you might hold up a bulb of garlic when you see the word “vulnerability.” Yet without this vital relationship skill, your mate cannot ever truly connect with you, and may, in turn, reject you. Real intimacy is possible only when both partners become vulnerable. If you can transform what you choose to do with rejection, vulnerability might not feel so scary.
  5. Risk is necessary for your emotional growth. When you choose to love someone, you risk loss. Whether by death, divorce, or separation, the risk of rejection is present. Is it better to love and risk loss or rejection than to not love at all? The answer is yes, plain and simple. Science shows us that we are wired to seek connection, belonging, and acceptance. Avoiding rejection closes the doors to many potentially fulfilling relationships.

Destructive responses to rejection shut you down to all relationships. Constructive responses teach you about yourself and others. Rejection is not easy. Your response sets the stage for your relationship experiences. What do you choose?

Reference:

Weir, Kirsten (2014). The Pain of Social Rejection. American Psychological Association. Retrieved from: http://www.apa.org/monitor/2012/04/rejection.aspx

BullyingWhether it takes the form of teasing, threats, violence, or other acts, bullying is a significant issue in schools and communities around the world. In the United States alone, nearly a third of students report being bullied each school year, and most who are bullied never report it. The rates of bullying are even higher among students who identify or are perceived as LGBTQ, students with disabilities, and minority students.

In addition to any physical harm that may be inflicted, bullied children can experience a variety of mental health concerns as a result of their exposure to bullying, may struggle academically, and may experience a variety of negative health effects. Bullied children are also 2.4 times more likely to report suicidal ideation than non-bullied peers.

Although awareness of bullying has grown with the Internet and social media, so, too, have opportunities for bullying. Cyber bullying may include the posting of hurtful messages, rumors, photos, or videos, and some cyber bullies have been known to create false profiles or even websites to harass their targets. Cyber bullying is compounded by the fact that what is posted online isn’t always easily erased.

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Most experts agree that if a person knows of or witnesses bullying, the best course of action is to talk to a teacher, school administrator, parent, or other trusted adult who can intervene and pursue appropriate prevention measures.

Education is a big part of the solution, of course. With that in mind, we’ve compiled a list of the 10 best online resources for bullying awareness and prevention—GoodTherapy.org excluded—in 2014. Our selections are based on quality and depth of content, presentation, and functionality.

Have a website you would like to see in our Top 10? Recommend it here.

References:

  1. Bullying Statistics. (2013). Retrieved from http://www.bullyingstatistics.org/content/facts-on-bullying.html
  2. Bullying Statistics. (n.d.). Retrieved from http://www.pacer.org/bullying/about/media-kit/stats.asp
  3. Espelage, D. L., and Holt, M. K. (2013). Suicidal ideation and school bullying experiences after controlling for depression and delinquency. Journal of Adolescent Health, 53.

Cosy mature couple lying in bed smilingPeople have it all wrong about married sex. Somehow many Americans have created a fantasy that sex in marriage should look like sex when you’re dating or sex in movies—the type of sex that is urgent, quick, spontaneous, lustful, and passionate. Sure, it can happen, and it’s wonderful when it does, but this is certainly not the norm. As a sex therapist, I see time and time again that expectations are part of the issue when it comes to low sex drive and sexless marriage. People come to my office all the time and say that when they have sex they enjoy it, but they rarely seem to desire it.

Successful couples have realistic expectations about what sex should look like. They set date nights or schedule sex so that they make time for one another. They set aside time to try to get in the mood. They make intimacy a regular part of their relationships by knowing what to expect and when to expect it.

Are you one of those people who think scheduled sex is boring or cannot be pleasurable? Allow me to persuade you that if you change your thinking, not only will you and your partner likely have more sex, but you will enjoy it more as well.

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1. You Don’t Need Desire to Precede Intimacy

Do you always feel hungry for breakfast? No, but you eat it anyway because it’s an important meal.

Are you often dirty and “in need” of a shower? Probably not. But you likely shower daily, or every other day, anyway.

Do you feel utterly exhausted every night when you go to sleep? Maybe. But you might just go to bed around the same time because you know that rest is good for your body and so you won’t be tired the next day.

Do you always feel the urge to exercise? Many people would say no, definitely not! But people do it because it’s healthy.

Well, sex is the same way! You push yourself to start sexual intimacy because it’s good for your body, your mind, your marriage, and your family.

2. Dating Is Not Spontaneous

The idea that sex when you’re dating is spontaneous is simply not accurate. When people are dating and live apart, they make time to see each other. They often dress up, do their hair, apply perfume or cologne, or wear more flattering clothes. You planned sex when you were dating, but you didn’t realize you were planning for sex because you tricked yourself into feeling like it was spontaneous. It was anything but. All these steps you took helped your brain anticipate sex at the end of the night.

3. Planning Sex May Make You Happier

Why is spontaneous good and planned bad? Do you enjoy a vacation less because you planned it and looked forward to it? According to a recent study in the Journal of Applied Research in Quality of Life, participating vacationers were happier before their trips, in anticipation. Other research shows, as well, that people derive happiness from anticipating a positive experience.

Anticipating a sexual encounter may make you more responsive in, and happy before, the actual act.

4. For Many Women, Desire Comes after Arousal

According to Rosemary Basson’s model of female sexual response, desire more commonly occurs in women after arousal. In contrast, the male model of sexual response dictates that desire generally comes before arousal. Women are not men!

If you, like many people, can enjoy sex and feel connected during intimacy but have a hard time initiating, try these steps:

If you enjoy sex with your partner but never seem to find the time or occasion to be intimate, it might be that you are waiting for the stars to align. Shift your perspective to a more functional and realistic point of view. You can have passion and desire and perhaps even orgasm, but initiation is the first step.

References:

  1. Kumar, A., Killingsworth, M.A., and Gilovich, T. (2014). Waiting for Merlot: Anticipatory Consumption of Experiential and Material Purchases. Psychological Science. Vol 25, No. 10. Pp: 1924-1931.
  2. Nawijn, J., Marchand, M.A., Veenhoven, R., and Vingerhoets, A.J. (2010). Vacationers Happier, but Most Not Happier After a Holiday. Journal of Applied Research in Quality of Life. Vol 5, Issue 1, pp: 35-47.

GoodTherapy | How to Build a Backbone in 3 Easy StepsDo you allow others to take advantage of you? Do you avoid speaking up for yourself? Well, now’s the time to build your backbone! One that works, doesn’t wobble, and gets stronger when used.

What is a backbone, anyway? A backbone is a symbol of strength in character, an unwillingness to be used or taken for granted, and a firm commitment to uphold one’s decisions and feelings. We’ve all seen and heard of people who have a backbone; they are the strong ones, the ones who get what they want.

How do you know if you have a backbone? Ask yourself these questions:

  1. Do you resent someone in your life?
  2. Do you feel taken advantage of?
  3. Do you often complain but nothing changes?
  4. Do you keep all of your emotions in?
  5. Do you avoid conflict?
  6. Have you said yes when you meant no?
  7. Have you allowed your anger to build up and come out in other ways?
  8. Have you compromised self-care for others-care?

If you answered yes to any of these questions, you could use a backbone adjustment!

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First, let’s understand why backbone building is so hard. Often, we’ve been hurt and have learned to give in to avoid a conflict or, worse, getting hurt even further. Another possible reason we may not use our backbone is that we lack self-esteem and confidence. But it costs us in the long run: we don’t speak up, we don’t make waves, and we allow ourselves to be treated disrespectfully in order to keep the peace.

The benefits of a backbone are many. A backbone, or confidence in our strength, allows us to feel:

We may feel a compromised sense of strength in our marriages, our parenting, our work, with our extended family, or with ourselves. In our marriages, our strength is compromised when we ignore important issues, stop communicating, and don’t speak honestly. Similarly, when we are disrespected at work or when parenting, and the issue isn’t resolved, we may feel walked on and relationships may suffer. Our extended family exposes a compromised backbone when we don’t communicate our needs properly to them, when we are available even when our schedule does not allow for it, and when others dictate our lives. We can be compromised with ourselves as well. Haven’t we all been irresponsible, ignored truths, and improperly cared for ourselves?

There are three easy steps to strengthening your backbone.

Deal, Heal, and Reveal

The first step, dealing, means observing when we are being backbone-less. Make a mental note when you shrink, when you feel lowered, and when you inappropriately compromise. Think of the consequences of speaking up, saying no, or quitting. What’s the worst that can happen? Can you deal with the discomfort? If yes, move to step two. If not, repeat step one until you feel stronger.

Step two is about healing. Using your instincts or your gut reaction, make a small decision and stand by it. Say no once. Next, make a few more decisions and say no a few more times. Do not ruminate on past mistakes and decisions. Keep going. Feel yourself getting stronger. Now you know better, and you’ll do better.

Step three is to reveal the new, updated version of you—backbone intact! Use your newfound character firmness to create a life plan with balance and reciprocity. As you gain strength and stand straighter, others will notice. You’ll be respected more, you’ll have more self-esteem, and you’ll no longer be allowing your life to be determined by others. Get out there and grow your backbone!

One woman and three men meet for coffeeJealousy can be a painful and even fatal emotion, but according to one new study, it may also help spice things up in the bedroom. According to research published in the Journal of Comparative Psychology, when heterosexual men are jealous of their partner’s male friends, couples have more sex.

Couples Have More Sex When Women Have Male Friends

It’s notoriously difficult to find out how frequently people have sex, but research suggests that many couples have much less sex than cultural norms tell them they should have. One study of more than 20,000 found that only 26% of couples have sex once per week. To explore how jealousy might affect sexual frequency, researchers relied on self-reported survey data from 393 heterosexual men in long-term relationships. The average couple had been together for 36 months. Researchers asked questions about the men’s partner’s social lives, the men’s experience of jealousy, and the frequency with which the couple had sex.

Survey results revealed that couples had more sex when the woman had more male coworkers and friends, but only when the man believed his partner was attractive to these potential male rivals. This jealousy, researchers believe, encourages men to initiate more sex with their partners. [fat_widget_left]

Perceived Sexual Rivals Inspire Jealousy

The study’s authors didn’t investigate why men were more likely to have sex with their partners when those partners evoked feelings of jealousy. They speculate this may be due to what evolutionary psychologists term “sperm competition” that occurs when sperm from two or more males “compete” to impregnate a female. This phenomenon is not uncommon among nonhuman males. The researchers argue that men who perceive their partners’ male coworkers or friends as sexual rivals may be more likely to initiate sex so that their partners are not impregnated by another man. However, the study did not test fertility, pregnancy, or sperm competition.

The study also did not evaluate the role women played in the initiation of sex, so we don’t know what their role may be in this phenomenon. They study’s authors suggest that further research is necessary to validate their findings and to explore potential causes.

References:

  1. Montgomery, H. (n.d.). How often do ‘normal’ couples have sex? Retrieved from http://www.everydayfamily.com/how-often-do-normal-couples-have-sex/
  2. Pham, M. N., Shackelford, T. K., Holden, C. J., Zeigler-Hill, V., Hummel, A., & Memmering, S. L. (2014). Partner attractiveness moderates the relationship between number of sexual rivals and in-pair copulation frequency in humans. Journal of Comparative Psychology, 128(3), 328-331. http://dx.doi.org/10.1037/a0036602

Lighting a candleBy 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 (2nd), 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.

Girl hiding beneath the tableTrauma often leaves us living in a seemingly hostile world, feeling ineffective, believing that help cannot be expected.

To some degree, the concept of limited internal power and limitless external power remains an essential component of complex trauma. Fatalism (or “learned helplessness”) is a debilitating side effect of experienced oppression. In many, the freeze response includes disengagement from life—an intentional separation from anger, power, and movement.

Internalized Oppression and the Freeze Response

The human body has a few options when threat is detected. If we look around and find physical signals of safety from another, our anxiety recedes. If support is not available, we move into fight-or-flight mode, mobilizing for self-protection. Especially for children—when physical size renders fight useless and dependence precedes flight—freeze is the next step.

Like fight or flight, freeze is a biological resource. It serves a purpose. It effectively preserves within our core what we deem most fragile and valuable, as if moving into hibernation or hiding in a safe until safety once again presents itself. We lie dormant.

While the mechanism is an effective one, the experience of life in a freeze state is not always pleasant. We still access fight and flight, often more readily than others, as if we are living on the border of that biological response. In fact, we are. As freeze is a drop after fight or flight, the experience of fight/flight becomes the wall between us and the world. Life itself becomes a protected bubble, with little action—sometimes indiscernible movement. Just breathing. Waiting. Sometimes minutes. Sometimes decades.

We live on as a sliver of our whole: eating food, maintaining, avoiding any risks that might bring us closer to whatever dreams we hold. We may carry some fantasy of being recognized or saved one day, or eventually finding courage and overcoming our self-imposed prisons. One major challenge lies in the fact the only route to freedom includes a journey through the impenetrable panic of fight/flight, and we still carry the template of our last experience there. So we end up living—or at least maintaining—in cages of our own making, feeling frustrated, depressed, powerless to escape or change.

This is a form of internalized oppression. On a macro scale, internalized oppression (also known as self-directed oppression) is when a marginalized or oppressed population begins to accept and act on stereotypes and other inaccurate beliefs related to it. On a personal level, internalized oppression happens when we impose limits on ourselves in pursuit of safety.

This is a form of internalized oppression. On a macro scale, internalized oppression (also known as self-directed oppression) is when a marginalized or oppressed population begins to accept and act on stereotypes and other inaccurate beliefs related to it. On a personal level, internalized oppression happens when we impose limits on ourselves in pursuit of safety.

Noticing Our Power

Many of us have seen the violence of power and want no part of it. We divorce from power within ourselves. We feel weak and, at the same time, fear our strength.

When we look from a distance, we see violence and oppression at a global scale. Zooming in, it becomes apparent between cultures and classes. Then, in the family unit, violence presents as abuse (physical, sexual, verbal, etc.) or neglect. Using therapeutic models such as Hakomi therapy or Internal Family Systems, we zoom in still further, witnessing the pain and “stuckness” of internal conflict and oppression.

In simple moments—maybe sitting in a garden or a counseling office—we recognize the power in ourselves. We recognize a conflict as we feel the physical sensation of shifting our awareness between the part that judges/contains and the part being contained. We notice the part contained using anger as a resource to build power, to break our own walls. We realize how dependable and valuable our own containment system has been, and may even feel gratitude noticing that part of ourselves valued us so completely. Maybe we feel the contained part in our throat, moving upward, while the other part—the tension in our shoulders—acts as the dam that holds back forbidden parts of ourselves: the precious and preserved parts.

Leaving the Island

Much like Tom Hanks in the film Cast Away, the island serves as a metaphor for our own self-containment. It is isolating, endlessly frustrating, lonely, and safe. It is a place one could live out a lifetime in the experience of nothingness. The only escape represents potential death … and simple change: the unknown. This is the experience of the freeze state. A giant ocean lies between you and the world, with no direction or guarantee of reaching that life of which you dream.

Reminders, Tips, and Tricks for Overcoming Internalized Oppression

You may notice a sense of overwhelm in considering reaching out for help for internalized oppression. I often recommend simple self-compassion and permission to take things slow. This is gradual exposure to life, building tolerance for change. Even two minutes at a time can help. Consider support groups or one-on-one counseling with a specialist in complex trauma, childhood abuse, or learned helplessness.

A senior couple holding hands watches the seaEditor’s note: Mona Fishbane, PhD is a clinical psychologist and the author of Loving with the Brain in Mind: Neurobiology & Couple Therapy. Her continuing education presentation for GoodTherapy.org, titled Neurobiology and Couple Therapy, is scheduled for 9 a.m. PDT on December 12, 2014. This event is available at no additional cost to GoodTherapy.org members and is good for two CE credits. For details, or to register, please click here.

Falling in love is easy, and delicious. I remember the moment I fell in love with my husband—what I was wearing, how beautiful his eyes looked, the bright, cold February day. I saw the two of us in Technicolor and the rest of the world in black-and-white. It was a heady time; I was crazy in love.

Now I understand the science behind what was going on in my brain back then. Neuroscientists have studied madly-in-love folks, putting them in the fMRI machine while they look at a photo of their beloved. The parts of the brain that “light up” while looking at the lover are the same brain areas activated by cocaine—the reward centers. These researchers concluded that love is like a drug. I’ve never tried cocaine, but I’ve certainly tried love, and it is indeed a high.

Mona Fishbane
Mona Fishbane, PhD

We were awash in the chemicals of early love: testosterone (the hormone fueling the sex drive in both men and women), dopamine (focusing on “that special someone”), and oxytocin (the bonding hormone/neurotransmitter). I didn’t notice my lover’s flaws, nor he mine. It turns out that in early love, the critical part of the brain goes quiet. This is the science behind “love is blind;” we see our lovers through rose-colored glasses. Perhaps this is nature’s way of helping us bond with the beloved, oblivious to the problems that lie ahead.

Waking from the Spell

Crazy in love is a temporary state; the brain can’t stand the intensity forever. At some point the critical parts of the brain come back online, and we see our partners, warts and all. The jazzed-up chemicals settle down, and our drug high gives way to a calmer brain state. Romantic love, researchers find, yields to a tamer version, called companionate love. This happens somewhere between a year and three years into a relationship. Many couples are deeply disappointed when their romance fades into a more sedate version. They crave the high of early love, dopamine and all. Some have affairs, or divorce and remarry, seeking another hit of the drug. But eventually the new relationship will become old. The challenge: How to nurture love over the long haul? 

From Crazy in Love to Lazy in Love

When the newness and the magic fade, many of us become lazy in our relationship habits. Instead of dressing up for our beloved, we wear sweats to dinner. We become lazy in our interactions, blaming our partners when upset, not giving them the benefit of the doubt.  We become reactive to the negative, and overlook the positive in our relationships. We expect unconditional love, no matter what we dish out. But adult love is not unconditional; our partners may leave us if we behave badly.

Proactive Loving vs. Passive Loving

“I still love my wife, but I’ve fallen out of love with her,” a man said to me recently. He’s missing the hit of the drug, and is thinking of looking elsewhere for that love high again. To my mind, “falling out of love” sounds so passive—like falling into a pothole! I propose a more proactive view of long-term love, in which both partners work to create a great relationship. Once the initial glow wears off, the real work of loving begins. The stakes are high; while happy relationships are associated with health and longevity, the stress of an unhappy marriage can result in illness and earlier death. [fat_widget_relationships_left]

Researchers such as John Gottman have identified the secrets to successful relationships. In longitudinal studies, he compared happy couples (he calls them the “masters”) and unhappy couples (the “disasters”). Happy long-term lovers are emotionally and socially intelligent. They nurture positivity and don’t get lost in negative reactivity with each other. They are generous, fair, and kind, practicing what I call “relational virtues.” When they hurt each other, these successful partners apologize. It turns out that love means having to say you’re sorry—a lot!

Nurturing the Positive in Your Relationship

So how can couples develop these skills of emotional and social intelligence? One of the most important skills is the ability to regulate your own emotions when you get upset. It’s so easy to “let it rip” and have a temper tantrum when your partner does something you don’t like. But staying calm in the face of stress is vital if you want to be a good lover. You also need to take responsibility for your own reaction rather than blaming your partner. As the wise Roman stoic philosopher, Seneca, said long ago, “Most powerful is the person who has himself in his own power.” Rather than getting into power struggles, each person can try to be his or her best self in interactions with one another. And partners can make room for mutual empowerment; research shows that happy relationships are more equal and respectful.

Happy couples do a lot to cultivate a positive tone in their relationship. This can be challenging, though, because our brains are biased toward the negative—better safe than sorry, so we notice an attack or danger more readily than we see the lovely things our partners may offer us. To counteract this negativity bias, many psychologists now encourage actively focusing on, noticing, and savoring the positive. One couple I know has a “Blessings Jar;” each time they notice something positive the other one does, they jot a note and put it in the jar.

For couples caught up in cycles of negativity, unable to notice the positive and having difficulty regulating their own emotions, couple therapy can be enormously helpful. Most people don’t act in nasty ways intentionally; they get triggered in interactions with their partners, and have a meltdown. And then they may blame their partners for the whole mess. Therapy can help partners take responsibility for their behavior, learn skills of emotional and social intelligence, and cultivate positivity. This is empowering, as they share the responsibility for building a relationship in which they can flourish. Rather than feeling like victims who blame each other, these couples become co-authors of their relationship.

The bottom line: To be a good long-term lover, there’s no free lunch, and there’s no free love. Love that lasts takes work. Happy couples do this work gladly, reaping the benefits in body and mind.

Stressed woman in metro station holds her head in her handsSix million Americans—almost 3% of the population—have panic disorder, a condition that causes sudden, overwhelming sensations of fear called panic attacks. Studies on twins suggest panic disorder may be partially genetic, and there’s good evidence that panic runs in families. Researchers know little about which, if any, specific genes cause the condition.

New research into a so-called “suffocation alarm,” though, may shed light on panic’s genetic underpinnings. The study, published in Biological Psychiatry, suggests that the shortness of breath so common to panic attacks might be linked to the body’s suffocation prevention mechanism.

Could a Suffocation Alarm Cause Panic Disorder?

Shortness of breath and feelings of suffocation are common among people who have panic attacks. These symptoms are so terrifying that many people who experience a panic attack believe they are dying; panic attacks account for more than 20% of emergency room visits. Previous research into these sensations suggests that breathing in carbon dioxide can trigger panic attacks in people with panic disorder, but not with people who don’t have panic disorder.

Based on that research, this study’s authors theorized that panic attacks might be linked to an excessively sensitive “suffocation alarm” in the brain. Previous research on mice showed that a protein called ASIC1a helps detect carbon dioxide in the brain’s amygdala, an area that’s also linked to feelings of fear. To study the role this protein might play in humans, researchers genotyped variants of the gene in 414 people with panic disorder, then compared them to 846 controls without the disorder. They also used brain imaging and genotyping to evaluate amygdala volume in a second group of 1,048 participants, as well as amygdala function in 100 people. [fat_widget_left]

They found that people with variants of the ASIC1a gene were more likely to have panic disorder. Moreover, people whose panic attacks caused respiratory symptoms such as shortness of breath were much more likely to have the gene. The researchers also found that the ASIC1a gene can affect the size of the amygdala, as well as people’s emotional responses to threats. The effect held even among people who had the gene but who did not have panic disorder.

Avoiding suffocation is one of the many tasks associated with survival. It’s possible, the study’s authors speculate, that fundamental survival mechanisms cause panic attacks. The ASIC1a gene could be a helpful mutation in environments that pose a high risk of suffocation, but a source of panic and distress in people who have the gene and who do not regularly face suffocation dangers.

References:

  1. Facts & statistics. (n.d.). Retrieved from http://www.adaa.org/about-adaa/press-room/facts-statistics
  2. New York-Presbyterian/Weill Cornell trial is first to show effectiveness of psychodynamic psychotherapy for panic disorder. (2007, March 13). Retrieved from http://weill.cornell.edu/news/pr/2007/03/newyork-presbyterianweill-cornell-trial-is-first-to-show-effectiveness-of-psychodynamic-psychotherap.html
  3. The brain’s “suffocation alarm” – new study reports on a genetic clue to fear. (2014, December 3). Retrieved from http://www.medicalnewstoday.com/releases/286343.php
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