Couple of two friends together in a parkWe’ve all heard that life’s problems don’t disappear because of a romantic relationships. But according to a new German study, love really might conquer all. Researchers found that positive romantic relationships can help stabilize people who tend toward neurosis. Neuroticism is dismissed by many in the mental health community; many mental health professionals see that it pathologizes personality traits, reducing mental health issues to an overall personality flaw. For the purposes of this article, we are recognizing neuroticism as a collection of traits including anxiety, insecurity, low self-esteem, and unhappiness.

The Study

Psychologists have long viewed neuroticism as a relatively stable personality trait. People who score high on measures of neuroticism tend to continue to score high months and even years later. But researchers wanted to see how a romantic relationship affected people who tended to be labeled neurotic. They followed 245 couples ranging in age from 18 to 30 for three months.

Using questionnaires, researchers identified some participants as having neurotic tendencies, then asked participants about their relationship satisfaction. Because people with neurotic tendencies often react negatively to everyday events, researchers also presented participants with various scenarios and asked them to evaluate how these scenarios might affect their relationships.

Researchers found that, as the duration of a romantic relationship increases, the negative reactions that people reported on questionnaires decreased. The researchers speculate that this may be because a romantic relationship increases the frequency of positive emotions, and that this process can help people with neurotic tendencies unlearn negative emotions.

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Will Romance Treat Anxiety?

The prospect that romance can treat anxiety and negativity is a promising one. However, researchers only looked at people in a romantic relationship. They did not evaluate whether the positive effects continued after the relationship ends, and this leaves open another avenue for potential future research.

It’s also important to note that rushing into a relationship is still not a good treatment for anxiety. The study only looked at people in relatively stable, healthy relationships. The results might look much different for people in abusive or unhappy couples, and the effects of such a relationship on an already anxious person could be even more pronounced.

We already know, for example, that a bad relationship can lead to physical illness, so people with neurotic tendencies shouldn’t pursue relationships solely to “cure” their anxiety. Ultimately, this study is part of a mounting body of research that shows that a healthy relationship yields healthy results.

References:

  1. Hodgekiss, A. (2013, February 18). How a bad relationship can make you ill—by damaging your immune system. Retrieved from http://www.dailymail.co.uk/health/article-2280629/Being-anxious-relationship-make-ill–damaging-immune-system.html
  2. Love makes you strong: Romantic relationships help neurotic people stabilize their personality. (2014, May 9). Retrieved from http://www.sciencedaily.com/releases/2014/05/140509074114.htm

heart vision board collage“When you wish upon a star,
Makes no difference who you are.
Anything your heart desires
Will come to you.”

“When You Wish Upon a Star” is a song written by Leigh Harline and Ned Washington for Walt Disney’s 1940 adaptation of Pinocchio.

Over the past few years a relatively new tool has changed how people manage their own destinies. The tool, called a vision board, is created to represent in a visual manner what a person wants in life. The practice suggests that visualization can lead to the realization of goals. This is a helpful and therapeutic technique for people as they work on goal-oriented outcomes.

Vision boards are collages of images, photographs, and phrases glued or taped to a surface like a poster board. Your selection of items on your board typically represents the dreams you want to materialize in your life. The idea behind the board stems from the reasonable hypothesis that positive thinking leads to a positive outcome. Positive thinking is one result, but the process of creating an inspiring vision and working toward it creates the energetic vibration to manifest it.

We all can agree that a positive outlook is a precursor to positive results in one’s life, but how exactly can the imagery you choose on your board make things happen? The premise of this increasingly popular tool suggests that if you glue a picture of your favorite house from a magazine onto your vision board, you will enable the dream or fantasy to become a future reality. Your vision can be anything from a house to a new car, or something of a more personal nature like fostering a new relationship. All things on the board are what you want or what you are passionate about.

The vision board speaks to the fundamental principles of the Law of Attraction. The basic tenet offered by the Law of Attraction is that a person can attract anything into their lives by “being” more of the emotional vibration they wish to have. By choosing images or phrases the person can begin igniting their emotions with a passion that will lead inevitably to the manifestation of those things they desire.

[fat_widget_right]When working with clients, this can support them to focus on the positive emotions associated with those images. Therapists will inevitability have opportunities to work with whatever resistances come up and support people to work through them. Emotional Freedom Technique is one such method for working with resistance within the Law of Attraction principles.

The vision board has been popularized in recent years by the enormously successful publication of the book The Secret. The Secret, a best seller from 2006, is a self-help book written by Rhonda Byrne. The book is based on a film of the same name. Both the book and the film promote the Law of Attraction and the power of positive thinking. As the official website of The Secret states on its home page, “Everything is possible, nothing is impossible.” In the actual film, success expert John Assaraf tells his story of using vision boards to realize his dreams.

Its proponents from the self-help field have embraced the tool. Christine Bagley-Jones, a psychologist from Brisbane, sees vision boards as a motivational tool. “It’s not like the vision board itself has some magical properties. But it helps to create a platform for the individual to identify and conceptualize what they most want in life, and through their actions they can then manifest it.”

The tool has been adopted by a variety of disciplines in the self-help field, including art therapy. Advocates insist vision boards can help people build self-esteem, teach goal setting and prioritizing, and make individuals more proactive.

Carolyn Mehlomakulu, a licensed Marriage and Family Therapist and Registered Art Therapist, states on her Creativity in Therapy blog, “Through the process of choosing my images, I was able to clarify my goals and hopes, think about what I consider truly important in my life, open my mind to the possibility of having the life and business that I want, and inspire myself to keep moving forward.”

I also have a vision board that I’m always working on. It supports what I believe in, what I want to manifest in my life, and primarily how I want to feel. I also notice that my vision board has things on it that I don’t want on it—things I’m not interested in attracting: reminders, a phone list, a business card, etc. Note to self: keep your vision board clean of distractions! As you grow so will your vision board change and grow with you.

Not everyone is into the joy of creating their own vision boards. There are detractors who see the practice of using boards as counterproductive. Some argue that people who use vision boards spend too much time in the fantasy and not enough time establishing a realistic plan to achieve them. Troubled by the reliance on the cultural forced feedings of positivity, some thinkers see the energy in this area of thought as a waste of time.

Barbara Ehrenreich, a much respected writer, states, “Besides, the constant effort of maintaining optimism in the face of considerable counterevidence is just too damn much work. Optimism training, affirmations, and related forms of self-hypnosis are a burden that we can finally, in good conscience, set down. They won’t make you richer or healthier, and, as we should have learned by now, they can easily put you in harm’s way. The threats that we face, individually and collectively, won’t be solved by wishful thinking but by a clear-eyed commitment to taking action in the world.” Hard work has to be an integral part of the vision. Accepting the possibility of failure is equally important as it teaches significant life lessons.

It is how you use the board that matters. Working with resistances, enjoying the dream, and taking action are all part of the vision board process. It is clear that vision boards are valid tools with therapeutic value to a great many people. Equally apparent are the critics who claim users are only setting themselves up for failure if their vision boards become wallpaper.

The real answer lies more likely somewhere in between the opposing arguments. No one should ever tell anyone not to dream. Just remember there’s always some sweat and tears. The vision board is an expressive tool to support your “being” attractive in attracting the things you most desire.

I’ll leave you with this final quote from Bob Doyle:

“The sooner you can move from ‘trying to be’ to actually ‘being,’ the sooner you will see your desire fulfilled.”

References:

  1. Loo, Tristan.How to Use a Vision Board to Activate the Law of Attraction. Retrieved from: http://www.selfgrowth.com/articles/How_to_Use_a_Vision_Board_to_Activate_the_Law_of_Attraction.html. Retrieved on: 19/04/2014.
  2. Byrne, Rhonda. The Secret. Retrieved from: http://thesecret.tv/. Retrieved on: 22/04/2014.
  3. Doyle, B. (2011). “Follow Your Passion, Find Your Power.” Charlottesville, VA: Hampton Roads Publishing Company.
  4. Body and Soul website. Why You Need a Vision Board. http://www.bodyandsoul.com.au/health/health+news/why+you+need+a+vision+board,29981. Retrieved on: 22/04/2014.
  5. Mehlomakulu, Carolyn. Realizing the Future—Creating a Vision Board. Retrieved from: http://creativityintherapy.blogspot.ca/2013/02/realizing-future-creating-vision-board.html. Retrieved on: 21/04/2014.

Girl in white capEditor’s note: This article is an excerpt from Sarah Burleton’s New York Times bestselling child abuse memoir Why Me. The article contains sensitive detail about physical violence and abuse that some readers may wish to avoid.

My name is Sarah Burleton and I am the spokesperson for Prevent Child Abuse Illinois. Looking at me now, one would never guess that I endured such a horrific childhood—a childhood full of extreme physical beatings and mental abuse at the hands of my own mother. One would never guess that my own mother pushed me into an electric fence and watch me writhe on the ground in agony.

One would never guess that my beloved animals were murdered cruelly at the hands of my mother for her own sick enjoyment. And one would never guess that not once in my life did I hear my mother say the words “I love you” or feel her arms wrapped around me in a loving, warm, motherly embrace.

One would never guess this about me and my life because I made the conscious choice at a very young age not to let my child abuse define me. I refused to walk around like a victim and wear my child abuse as a badge for the world to see and pity me for.

As many of you can relate, the last thing a child abuse victim wants is pity from people who have no idea what we have had to endure. We don’t want anyone to know what we have been through because there is a shame attached to child abuse, a sense of self-blame, as if we deserved to be beaten or called names. Personally, I would bottle my emotions up inside and put on a tough façade to everyone around me, masking my true feelings of pain with sarcasm and aloofness.

[fat_widget_right]When it became too much for me to bottle up my emotions anymore, I opened my laptop and poured out my life story into a Word document, self-published it, and fell over the day I found out my little book had made the New York Times. Being on the list was great; however, the most rewarding part of my job has been traveling and speaking to adult survivors, CPS workers, and foster children.

I realize that there are many of us out there, thousands of us who have been hurt by people who were supposed to love and protect us the most. But I’m here to tell you that we are not victims; we are survivors. We are here today because of our will to survive and our determination to overcome the demons from our childhood.

Each of us has the power to use our horrible pasts as stepping stones to our bright, positive futures and as examples of how not to act. Every story matters and every voice should be heard. I love you all.

Man alone on benchLife is a far more predictably bumpy ride than anything you are likely to encounter in your daily commute, so why not fasten your emotional safety belt to keep you feeling a bit more protected?

Start by assessing your level of psychological safety right now. Just sit back, close your eyes, and ask yourself: “On a scale of one to 10, with 10 being the most safe, where would I place myself in this moment?”

Next, get more specific. Grab a piece of paper and write down your thoughts on:

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Once you have taken the time to look at what helps or hampers your sense of safety, you can willfully choose to seek or avoid those things that make you feel safe or unsafe.

Luckily, there are many ways to increase your sense of safety. Some will seem fairly easy and straightforward, while others might be quite challenging. Some can benefit from tangible modifications, others are more elusive and slippery. Some you can implement on your own, and others, especially those involving long-held patterns, might be easier to eclipse with a therapist.

Before you delve into all the psychological and situational triggers that might be conspiring to leave you feeling emotionally wobbly, try the following exercise:

Starting at either the crown of your head and working down, or the soles of your feet and working up, start noticing whatever physical feelings you can. It might be tension, tingling, heat, cold, numbness, tightness, clamminess, itchiness, pressure, pain, emptiness, burning, humming, motion, twitchiness, or even a scent, color, or shape.

Once you describe it, just sit with it. Allow yourself to have that experience without judging, criticizing, or trying to push it away. This enables you to bypass the story behind what you might be feeling and let yourself mindfully attend to this moment. Usually, a sense of balance, calm, or safety will come over you.

If there are certain people in whose company you feel unsafe, consider steering clear of them. Remember, it pays to pay attention to your intuition. If seeing someone fills you with dread, it may be best to avoid that person until you feel differently. While therapy can help, there are situations that time itself will heal, and others that will never feel good.

Since there is not one right or wrong way to live, only the right way for you in any given moment, it is crucial to give yourself permission to act on what feels right for you today. If that brings up guilt, anger, depression, anxiety, or grief, sit with your feelings. Allow yourself to feel them in your body and to examine what you are telling yourself, especially the repetitive thoughts. If you feel overwhelmed, please contact a therapist.

Practicing sitting with discomfort is one thing, but having trouble coping is another. On the other hand, just because a feeling is unpleasant doesn’t mean it’s unworkable. Learning to find safety in yourself, even when waves of intense feelings wash over you, is a skill you can hone every time something difficult arises.

One way to skillfully navigate unpleasant emotions that make you feel unsafe is to remind yourself how transitory everything is. Most people find that hard to embrace, as it implies all the great, wonderful, ecstatic feelings you love so much wane along with the undesirable ones, but it’s really a small price to pay for a greater sense of equanimity.

Try some of these ideas and let me know how they work for you.

Note: If you are in a situation where you feel physically or psychologically abused, please get help. There are many free resources and shelters available.

Young shy boy clinging to his motherIt’s fairly common to see a child sheepishly hide behind a parent when greeting a new person, and some adults vividly remember the anxiety they experienced in childhood upon entering new environments. Recently published research, which tracked children over 15 years, argues that shyness isn’t just a personality quirk. It frequently indicates anxiety, and is often a precursor to high fearfulness in adulthood.

Childhood Shyness: The Study

Koraly Pérez-Edgar is a developmental psychologist who began studying children’s social interactions when she was a postdoctoral fellow. She found that children who displayed extreme shyness were more likely than other children to face anxiety as adults. A brief moment of trepidation meeting a new person wouldn’t rise to the level of such shyness, but a child who lurks anxiously in the background in an attempt to avoid other children is displaying severe inhibition.

Why Childhood Shyness Matters

Drawing upon previous research,Pérez-Edgar calls extreme shyness a form of behavioral inhibition. This inhibition involves more than just a case of nerves about trying something new. The personality trait appears as early as infancy, and involves an ongoing fear of new stimuli. Most babies might startle in response to a jack-in-the-box, then laugh as they realize the toy isn’t dangerous. Behaviorally inhibited babies are more likely to panic and cry.

[fat_widget_right]For children with behavioral inhibitions, meeting a new person is just one more frightening stimulus. These children aren’t just shy. They’re displaying a temperamental quality that is stable across the lifespan and a relatively accurate predictor of adult fearfulness.

Drawing Children Out of Their Shells

Behaviorally inhibited children tend to limit their own environments, giving them few opportunities to practice social interaction—a behavior that can make anxiety even worse. Consequently, Pérez-Edgar isn’t sure whether behavioral inhibition is an innate trait that appears early in childhood, or a learned disposition that shy children practice daily.

She wants to help shy children overcome their inhibitions, in the hope that doing so might reduce adult anxiety. In a new study, she and her colleagues are using behavioral therapy to help ease children’s anxieties. By drawing children’s attention to something other than the source of fear, researchers hope that they might train the brain not to fixate on sources of anxiety. If the approach works, it could work to undermine the connection between early shyness and adult anxiety.

References:

Inhibited children become anxious adults: Examining the causes and effects of early shyness. (2014, April 17). Retrieved from http://www.sciencedaily.com/releases/2014/04/140417155901.htm

dr. phil tv therapistGoodTherapy.org is dedicated to ethical therapeutic practices, but the images people see in the media can color their perceptions of what therapy should and should not be. These portrayals might seem like mere entertainment, but they can intimidate some people about therapy, subtly discouraging people who need help from seeking it. Among those already in therapy, television portrayals of abusive or unethical therapy practices could cause clients to mistakenly believe that unethical, abusive practices are normal and healthy.

Hannibal

Hannibal tells the tale of a serial killer psychiatrist who eats his victims—a scary enough prospect. The questionable ethics don’t end there, though. Without receiving consent, Dr. Chilton and Dr. Lecter both use questionable hypnosis techniques to alter memories of the people who see them for therapy and change their behavior. Dr. Lecter continues to see Will Graham, a client who is investigating him for murder and who himself tried to have Dr. Lecter murdered. The show also portrays psychiatrists as all-knowing people who can exert significant control over people’s behavior. This is a particularly frightening portrayal in a television show where psychiatrists are murderous monsters.

Mad Men

In the first season of Mad Men, the anxious and insecure Betty Draper sees a psychiatrist to find a solution to recurrent numbness in her hands. The psychiatrist reveals details of Betty’s sessions to her husband, Don, without Betty’s consent. He uses her husband’s comments as his primary source of information about Mrs. Draper, completely ignoring Betty’s statements. In one session, Betty becomes concerned her psychiatrist is looking down her shirt.

Celebrity Rehab with Dr. Drew

Confidentiality is a hallmark of good therapy. People are more likely to reveal relevant pieces of life history and important feelings with their therapist when they know their privacy is protected. But Celebrity Rehab with Dr. Drew completely abandons this therapeutic norm by showing “therapy” sessions with celebrities. The ethical issues here are compounded by the fact that many of the people on Dr. Drew’s show seem troubled by the lack of privacy their celebrity status has yielded.

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Dr. Phil remains one of the most popular talk shows, but the series suffers from the same confidentiality challenges as Celebrity Rehab with Dr. Drew. Dr. Phil frequently yells at his guests and promotes a very specific set of values. Guests who disagree with Dr. Phil’s proclamations are lambasted and told they’re resistant to improving their own lives. Good therapy, by contrast, doesn’t force any particular value set onto someone in therapy, but instead builds upon his or her own values to help him or her create a more fulfilling life.

How I Met Your Mother

If therapy clients believed what they were told on TV, they might thinkdating your therapist is not only normal, but beneficial. In How I Met Your Mother, Robin dates her previous therapist. The pair justifies the relationship by arguing that she wasn’t in therapy very long, but such justifications have no place in the world of real therapy. A therapist is not an appropriate romantic partner, and therapists who engage in sexual relationships with their patients are taking advantage of a power imbalance.

Ethical therapy helps clients transform their lives without fostering dependence or demanding a client accept a predetermined set of values. To learn more about ethical therapy, check out this GoodTherapy.org guide to warning signs of bad therapy.

References:

  1. Code of ethics. (n.d.). Retrieved from https://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx
  2. Potential ethical violations. (n.d.). Retrieved from https://www.apa.org/topics/ethics/potential-violations.aspx

Cat head tilted and bookshelvesMeow! I am a cat therapist. No, I don’t have the fancy degree and years of experience like my human does—but like other pets in animal-assisted therapy settings, I collaborate with my human to help in the therapy process.

 

Man with cat and dogsSo what is it like to work with a therapy cat? First of all, I’ll introduce myself and welcome you in to the office. Therapy cats are here to make you comfortable; we’re pretty laid back and we like to go with the flow. Therapy cats are used to being handled and being around humans big and small, as well as other animals.

Nervous about going to therapy? Studies show the presence of a therapy cat will lower your anxiety as well as your stress level. Go ahead—pet us. We lower your blood pressure and help your brain release feel-good endorphins like oxytocin. This might help you talk more openly with our humans.

 

British Shorthair Cat on the ChairNow, have a seat—I’ve already warmed it up for you.

There are many of us—probably in therapy offices all over the world! Consider us a perk of therapy if we happen to be in the room to accompany you in your journey to better mental health.

My human and I know that working through therapy can be hard. Therapy cats see a lot of people who are in pain, but we can help comfort them in hard times. We’re here for you, just like our human is.

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beautiful girl with fluffy kitten in her armsI can help people of all ages learn and grow while working through mental health issues. Humans have proven that cats like me can even help children with learning difficulties. Some kids read to me. I love the stories of faraway places, but the ones about dogs can be a bit ruff!

I can also lend an ear to someone working out language difficulties or someone experiencing problems with social interaction or anxiety. See, in our many lives we develop many talents!

 

 

 

 

cat-sleeping-on-stacks-of-paperPeople like visiting my office—excuse me, my human’s office—because both of us can listen to you without judgment. As for the paperwork? We’ll leave that up to the humans.

 

 

 

 

 

 

 

 

 

 

GoodTherapy | Authoritarian and Authoritative Parenting Styles: Which Is Best?People have their own unique style when it comes to parenting. It is not just about a set of rules; the style of parenting caregivers take on is a reflection of who they are, their culture, and their value systems.

It’s important that parents be able to adapt their parenting style to integrate the best practices of other styles. This article will focus on two styles in particular: authoritarian and authoritative.

Authoritarian Parenting Style

Using an authoritarian parenting style hinders children’s capacity to verbalize what they want and need within the family system and hinders communication between parents and children about the reason for certain rules and expectations. When parents implement an authoritarian parenting style, the family is operating under what I would call a “closed system,” meaning that there is no room for discussion, options, alternatives, or negotiation between parents and their children. Parents who use an authoritarian parenting style send the message that children must cooperate with their parents “because I said so” by implementing techniques such as shaming, withdrawal of love, or arbitrary punishments.

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An authoritarian parenting style may get children to be compliant on a short-term basis. However, children will not feel that there is a “democracy” in the household. As a result, they may be compliant due to fear of being punished. In addition, children will perceive that their feelings don’t count, which encourages them to feel powerless.

An authoritarian parenting style creates an oppressive environment for children to live in (particularly for children who are adopted and/or in foster care). An oppressive environment prevents children from thriving. In order for children to thrive, parents need to create an environment that is based on warmth, which allows children to learn to self-regulate.

Children also need to learn self-discipline, and they learn this from internalizing limits from a loving perspective as opposed to having limitations placed on them without empathy.

An authoritarian parenting style can create insecure attachment patterns in children, which prevents the emotional bond necessary that creates trust between parents and children that their physical and emotional needs will be met. As a result, children are more vulnerable to low self-esteem, depression, and anxiety, which are among the most common mental health issues among adolescents.

Parents who choose an authoritarian parenting style most likely were not securely attached as children themselves, which increases the chances of passing on insecure attachment patterns to children.

Authoritative Parenting Style

Of the four primary and widely acknowledged parenting styles, research shows that an authoritative parenting style achieves the most positive results with children. (Permissive and uninvolved are the other two styles.)

An authoritative parenting style responds to the emotional needs of children while setting limits and boundaries. Research on parenting styles shows that when parents are authoritative and engaged, children thrive in their environment and develop secure attachments with parents, an emotional bond that allows children to trust that their physical and emotional needs will be met.

Children feel a sense of empowerment when there is balance between choice and responsibility. Authoritative parents expect their children to meet high standards while also being willing to reason and be flexible with children when they make mistakes. Authoritative parents allow children to have a voice in what happens in their lives, and children perceive that their parents are open and sensitive to their needs. As a result, children have the opportunity to learn how to negotiate, become self-reliant, achieve academic success, develop self-discipline, be socially accepted, and have increased self-esteem.

If children are not provided with these opportunities, they build resentment and act out their feelings, which may cause behavior problems and increases the odds of delinquency and drug use during adolescence.

To implement an authoritative parenting style, parents should:

For most adults, parenting is one of the most challenging tasks they will take on in life. It can also be one of the most rewarding experiences in life. All parents want their children to grow into happy and well-functioning adults. In order to achieve the best possible outcome, parents should integrate acceptance, firmness, and encouragement of autonomy into their parenting practices.

cory f newmanEditor’s note: Cory F. Newman, PhD, ABPP, is a psychology professor at the University of Pennsylvania and the author or co-author of several books. His continuing education presentation for GoodTherapy.org, titled Core Competencies in Cognitive Behavioral Therapy: Becoming an Effective and Competent Cognitive Behavioral Therapist, is scheduled for 9 a.m. PDT on May 16. This event, free to GoodTherapy.org members, is good for two CE credits. For details, or to register, please click here.

Much has been written about the methods that comprise cognitive behavioral therapy (CBT). There is an abundance of research supporting CBT’s efficacy in treating a range of psychological maladies across a variety of groups (age, gender, ethnicity, etc.). As such, CBT is more accurately described as an entire set of psychotherapies, with key features in common but also demonstrating differences depending on the problem and person being treated, that have been designed and tested to meet the highest standards of care.

Over the past few decades, great strides have been made in developing CBT so that it helps people even when they demonstrate psychological difficulties on the more serious side of the spectrum, such as chronic mood issues, suicidality, debilitating anxiety, addictions, posttraumatic stress, eating disorders, and many other areas of mental health concern. Furthermore, the field is always improving, owing to the CBT tradition of refining and researching new ways of delivering care. Although CBT is not a magic “cure,” it is a powerful psychological technology that is helping more and more people, providing ever-increasing hope for even better outcomes in the future.

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It is easy to think of CBT as comprising a set of “techniques,” mainly because there is indeed a set of core methods that are most often associated with this modality that have been identified as being key components in helping people to cope and live more effectively. The list below is just a sample of such techniques, all of which have been described in great detail in CBT texts and CBT treatment research protocols:

These are just some of the CBT methods that can be used effectively, not only in the therapist’s office but also as part of homework assignments—another powerful part of treatment that improves people’s sense of self-efficacy, consolidating their memories for the interventions and their skills in performing them, and leading to good maintenance of therapeutic gains.

Additionally, the CBT literature is clear that the therapeutic relationship is an indispensible part of a positive, efficacious intervention, as is a well-conceived cognitive behavioral case formulation. This is where CBT begins to go beyond techniques and into the realm of the therapist’s personal qualities, thinking style, interpersonal manner, and skills in listening, understanding, and communicating. CBT is not delivered by machines, and it does not come in prepackaged “doses” that are passively “taken.” It is delivered by fellow humans called “therapists,” a rather diverse lot of individuals with varying years of clinical experience and training histories, as well as individual personality characteristics that naturally play a role in their competency and expertise in conducting CBT. What are the qualities of therapists who are most likely to be highly competent? What should people look for in a therapist so as to be confident that the CBT they are receiving is top-notch care?

Most people think of competency and expertise as being related to training and experience, and there is more than a kernel of truth to this assumption. When a therapist is licensed, board certified in cognitive behavioral therapy (e.g., via the American Board of Professional Psychology and/or the Academy of Cognitive Therapy), has a substantial history of treating people and supervising trainees, and has a track record of publishing and lecturing on CBT, there is a good chance that this therapist will be knowledgeable and effective in the clinical sphere. However, there is evidence that even novice practitioners can deliver CBT very competently if they are well-supervised. Therefore, there is more to competency than repetition of methods and recognition of patterns over time.

What are some of the habits, attitudes, and personal qualities of therapists that amplify their competency and help get the best clinical results, whether they practice CBT or any other evidence-based treatment? The following may seem obvious, but they warrant more discussion and attention than they typically get. If the information below simply validates and reinforces what you already do as a therapist, I will have accomplished my goal with this post. Here is a sample list of suggestions, with some accompanying commentary:

Show respect for a person’s time: Make a concerted effort to be on time for sessions, to stay focused on the person in the session (e.g., rarely attending to your incoming calls, messages, or other distractions), to give them their full allotment of session time, and to try to see them as soon as your schedule will allow. Return their phone calls as promptly as you can, and be understanding when their legitimate life demands make it difficult for them to attend sessions and/or to do their therapy homework as regularly as would be optimal.

Do your homework and be organized: Be a good role model for taking care of business, being prepared, and being up to date on a person’s situation. This includes taking good therapy session notes, reviewing those notes so you are aware of and conversant in the matters that are on the person’s agenda, following through with extra-session tasks such as consulting with the person’s other practitioners and releasing records when requested, and being willing to review the person’s homework assignments as part of your own homework. Anything you can do to facilitate your memory of the details of the person’s current life and history (including the names of family members, important events in their lives, and noteworthy things they said in previous sessions) is very powerful in conveying the message, “I value you as an individual and I am providing a treatment that is focused on you, not just your diagnosis.”

Be professional, ethical, and respect cross-cultural issues: This covers a broad area, including speaking to people in a caring, supportive, confident tone, maintaining professional boundaries while still being friendly, attentive, and personable, going over the details of informed consent, explaining both your role and the person’s role in treatment, handling uncomfortable requests in a calm way that is not sanctimonious, speaking in a way that shows self-respect and respect for the other person, and being sensitive and responsive to his or her cultural identity and related issues.

Don’t just provide instructions; provide hope and inspiration: In thinking back to our school days, most of us can remember at least one teacher who was particularly adept at inspiring us to learn and to get the best out of ourselves as students. Be like that teacher when you treat people. Many people feel lethargic, distracted, helpless, and hopeless. It is not enough for us simply to provide instructions in a neutral tone. We need to “lean in” and speak in a way that gets their attention, promotes hope, and that expresses confidence in them. Express a commitment to help the person even when he or she has difficulty making a commitment to treatment. Give positive feedback even when people can’t believe it themselves. Be a role model for persevering in the face of obstacles and adversity, and for not giving up. Share some appropriate humor at the right time to make people smile and laugh, and to add some positive energy to the therapeutic dialogue.

Be open and eager to learning: One of the most rewarding aspects of being a therapist is meeting so many people who have so much to teach us. We can provide people with an education about using CBT effectively in their lives, but they provide us with lessons about life itself. Don’t just be aware of and open to the idea that people are often our teachers, embrace the idea. It is very empowering for people when their therapists thank them for sharing their knowledge and wisdom, and it enriches the therapist—both in his or her personal life, but also in terms of being that much more aware and sensitive toward a diversity of people in the future. It also demonstrates a respectful humility that amplifies the validity and meaningfulness of what therapists communicate when they do show confidence and authority in teaching CBT methods to people.

Find the “picture that is worth a thousand words”: A little bit of creativity can go a long way in therapy, especially if it makes a positive impression on people and helps them remember important concepts for the long term. Using metaphors, analogies, images, hypothetical questions, and stories with which people can personally relate are powerful learning vehicles. When therapists make it a point to pay attention to the things that matter to people most (and that define them as individuals), such as their hobbies, their profession, their cultural practices and beliefs, their most important relationships and memories, and their views about life and the world, the therapists are in a position to give feedback that deeply resonates. Brief examples include:

In sum, CBT is a powerful technology for psychological change, but the human element is part and parcel of CBT methods. Competent CBT practitioners know how to use the core techniques that have been demonstrated to be efficacious, but they magnify the positive impact of these methods via their personal qualities, habits, and attitudes that communicate care, convey accurate understanding and respect, and inspire people to remember and use the most important aspects of treatment for the long run.

References:

  1. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.
  2. Butler, A. C., Chapman, J. E., Forman, E. M., and Beck, A. T. (2006). The empirical status of cognitive behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
  3. Dobson, D., and Dobson, K. S. (2009). Evidence-based practice of cognitive behavioral therapy. New York: Guilford.
  4. Gilbert, P., and Leahy, R. L. (Eds.). (2007). The therapeutic relationship in the cognitive behavioral therapies (pp. 106-142). New York, NY: Routledge.  
  5. Greenberger, D., and Padesky, C. A. (1995). Mind over mood. New York, NY: Guilford.
  6. Hays, P. A., and Iwamasa, G. Y. (Eds.). (2006). Culturally responsive cognitive behavioral therapy: Assessment, practice, and supervision. Washington, D.C.: American Psychological Association.
  7. Kazantzis, N., Whittington, C., and Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavior therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144-156.
  8. Knapp, S. J., and VandeCreek, L. D. (2006). Practical ethics for psychologists: A positive approach. Washington, D.C.: American Psychological Association.
  9. Kuyken, W., Padesky, C. A., and Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford.
  10. Newman, C. F. (2012). Core competencies in cognitive-behavioral therapy: Becoming a highly effective and competent cognitive-behavioral therapist. London: Routledge.
  11. Newman, C. F. (2011). Cognitive behavior therapy for depressed adults. In D. W. Springer, A. Rubin, and C. G. Beevers (Eds.), Clinician’s guide to evidence-based practice: Treatment of depression in adolescents and adults (pp. 69-111). Hoboken, NJ: Wiley.
  12. Nezu, A. M., Nezu, C. M., and D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual. New York: Springer.
  13. O’Donohue, W. T., and Fisher, J. E. (Eds.). (2009). General principles and empirically supported techniques of cognitive behavior therapy. Hoboken, NJ: Wiley.

eye of manWhen I was in college, my friend Matt hit an old woman with his car and killed her. Every time he passes the street where she died, he remembers what happened and feels scared and sad. She died on a dark and windy night; it was raining hard. She came out from between two cars, suddenly, into the middle of the street, probably in a hurry and trying to avoid getting too wet.

Matt didn’t see her, didn’t know she was there until the moment of impact. He stopped his car, tried to help her, and called for the police and an ambulance, but it was too late. He is filled with remorse and has nightmares. Even if it was a mistake, he killed someone’s mother and grandmother. Matt lives feeling sorry, but he cannot make up for this tragedy.

Matt’s story, of course, is not unique—many similar tragedies unfold every day. The lives of all involved and their families are permanently stained. How will they sleep? How will they come to terms with what happened, even though it may have been an accident? Are friends and relatives of the deceased ever able to accept the tragic consequences, or should they extract revenge? What would that look like? Perhaps as time passes they no longer feel angry, although they will probably carry the sad memory of the incident forever. History can’t be changed, but the way we relate to it and remember sometimes can be.

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A person can’t be brought back to life, but there are circumstances that are less dire and sometimes our feelings about what happened can change. I’m thinking here about breach of trust, about infidelity, about people who thoughtlessly hurt the people they love. In a moment, or maybe a series of moments, they have an affair, and then, after some time, they are caught by their partner. “I’m sorry,” they might say. “It didn’t mean anything. I didn’t mean it.” And perhaps they are genuinely regretful, filled with remorse, about the loss of trust they’ve caused, about the wound to their relationship.

Is their remorse worth anything? Should they suffer, to make up for the suffering they’ve caused? Is it possible to make up for anything?

Can they ever be trusted again? Can they trust themselves, can their partners trust them, or will there always be questions? “Where did you go?” “Who were you with?” “How come you’re home so late?” “Who were you just talking to on the phone?”

In the Dear GoodTherapy.org section of this site, there are many people asking themselves, “Can I forgive?” “Can I ever trust again?” “How can I get even?” These are unbearable, painful, suffering questions—tears seem to seep through the Internet and onto these pages.

I started off with examples of a woman who was killed in a car accident. An affair is not a car accident—nobody dies—but there is a murder of trust. My friend Matt lost trust in himself after the accident and never wanted to drive again, although he had to and does, regularly. The people writing about their partners’ infidelity lose trust in their partners and in themselves, too. Seems paradoxical, doesn’t it? They ask, “What do I do now?” “Should I leave?” “Get divorced?” “End the relationship?” “Should I forgive?” “I want revenge! I want them to know what I suffered. I want them to suffer even more than I did!”

Who deserves revenge? Maybe people who have been wronged feel like they do, but the cycle of revenge can be endless—eyes for eyes until we are all blind. So I think no one deserves revenge, really, even if you feel like you do, even if you’ve been treated unfairly, even if people or circumstances have been horribly mean to you. Do what helps you live your life well now.

Destroying trust is a hateful action, and sometimes people take a long time to get over it, but we need to get on with our lives, to make ourselves whole. You know what they say: “Living well is the best revenge.”

contemplationPeople think of depression as really bad sadness, but it’s actually much more complicated. To be diagnosed with depression, a person has to have several (but not all) of the symptoms from a diagnostic list outlined in the Diagnostic and Statistical Manual (DSM). Sadness is one of these symptoms, but it is possible to have enough other symptoms on the list to be depressed and yet not feel sad.

The list of depression symptoms includes:

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Most people who are depressed feel sad, but there are several reasons some people can be depressed without feeling sad. These reasons may include:

Differences between Sadness and Depression

Another important twist is that people can feel sad, even intensely sad, without depression being involved. When people experience a loss, they usually feel sad, but don’t necessarily feel depressed. Sadness and depression have similarities, but they have some important differences.

When people are sad and express their sadness, they feel better, whereas when people are depressed, expressing their pain may not give them relief.

When people are sad and express their sadness, they feel better, whereas when people are depressed, crying and expressing their pain may not give them relief. Sadness doesn’t involve mean thoughts about oneself, or hopeless or suicidal thoughts, but depression often does. Sadness doesn’t involve distortion in perception, or loss of perspective, whereas depression usually does. Finally, sadness doesn’t interfere with feeling other emotions, while depression often prevents a range of specific emotions.

In my experience, most people who are depressed have some sense that something is wrong, and if they don’t, people around them usually do. It really doesn’t matter whether suffering fits neatly into the DSM diagnosis for depression or not.

It’s not necessary to diagnose yourself or your loved ones. If you or someone you love is suffering, get professional help to assess what is causing the suffering and what would help relieve it.

Sad woman sitting on the bedWe all have at least one memory that makes us cringe, but some bad memories are more than just sources of embarrassment or mild grief. Bad memories can plague the mind, serving as a ready source of nightmares, self-doubt, and sadness.

For some people who have experienced serious trauma such as military combat or rape, bad memories lead to posttraumatic stress. Researchers at the Beckman Institute at the University of Illinois hope to lessen the negative effects of bad memories, and their research suggests there’s a better way to move past bad memories.

The Effects of Bad Memories

It’s easy to conceive of a bad memory as just a small annoyance, but some bad memories can be life-altering. Memory plays a role in everything from self-esteem to how we conduct our romantic relationships. The worst bad memories can even make it difficult to function. People with posttraumatic stress experience intrusive flashbacks, during which they relive the traumatic event. They may also experience trauma via nightmares, and stimuli such as smells and sounds that remind them of the memory can reignite feelings of fear and trauma. For the 7.7 million Americans who experience posttraumatic stress every year, bad memories are much more than just an annoyance.

Anastasia Pollock, LCMHC, a GoodTherapy.org trauma Topic Expert, emphasizes the role of memories in trauma, explaining, “In my own experience working with clients dealing with trauma, I have found it necessary to help them develop positive neural networks in order to counteract the negative networks created by trauma, by focusing on times in their lives when they felt safe, in control, or good about themselves.”

Getting Over Bad Memories

[fat_widget_trauma_ptsd_right]In their ongoing memory research, researchers have found that contemplating the emotion associated with a memory makes the memory more pronounced and less difficult to forget. But thinking about the context of the memory—the setting, weather, who was there—can help reduce the effects of bad memories. People have a tendency to dwell on negative emotions associated with bad memories, and this can contribute to the development of depression and posttraumatic stress. Focusing on the context of a memory makes it harder to ruminate on negative emotions.

Dr. Sunda Friedman TeBockhorst, a GoodTherapy.org trauma expert, says that getting “stuck” in a bad memory can lead to posttraumatic stress. “This development fits nicely with what we already know about how memories continue to cause distress well after an event. One of the primary working hypotheses about how trauma-related problems develop is that traumatic memories get ‘stuck’ in the emotional part of the brain and aren’t stored in other areas of the brain that can make sense of them. So, it stands to reason that having these two areas of the brain ‘talk’ to each other will defuse the negative charge of the memory and facilitate a more adaptive storage and retrieval process of that specific memory. By focusing on the specifics of an emotionally-laden memory, you can get these two areas of the brain to ‘talk’ to each other and ‘unstick’ the memory,” she says.

At this point, the research is preliminary and has only shown that focusing on context can reduce the short-term effects of negative memories. The researchers associated with the project hope to eventually find ways to mitigate the long-term effects of negative memories.

References:

  1. Better way to deal with bad memories suggested. (2014, April 18). Retrieved from http://www.sciencedaily.com/releases/2014/04/140418141121.htm
  2. Denkova, E., Dolcos, S., & Dolcos, F. (n.d.). Neural correlates of ‘distracting’ from emotion during autobiographical recollection. Social Cognitive and Affective Neuroscience, 9(4). doi: 10.1093/scan/nsu039
  3. The numbers count: Mental disorders in America. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml
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