Tuesday, September 27, 2011

Emotions come in waves

I stumbled across this little article today, which reminds us that emotions come in waves. They have a beginning, a middle, and an end. And most importantly, emotions do not last forever.

A quick quote:
An emotion cannot hold you permanently. Every individual wave of emotion is merely a temporary state. Your mind and body are constantly in motion and are, in fact, incapable of maintaining a permanent, singular state of being. We're dynamic by nature and time rolls on, utterly unstoppable.
I often say this to clients. The one thing that I can confidently say about any emotion is that it will not last forever. It will change, shift, and mostly like it will go away after time. It's important, in the middle of intense fear or sadness or whatever, to be able to remember that emotions are temporary states.

Here is the full article. 

Monday, September 26, 2011

Inner landscape: a reflection on praxis

I am partial to decorating my office with photos and paintings of landscapes. When I was in graduate school (which seems like forever ago now), I described psychotherapy as "the process of exploring an inner landscape." At the time, the professor for whom that paper was written very much liked this description, and I believe he read it aloud to the class. (Side note: Isn't it fascinating how things can be both embarrassing and validating at the same time?)

I still think that turn of phrase is a good description for what we do in therapy. I do not think that happiness is necessarily the goal of psychotherapy--happiness is elusive and can be obtained through other means. Sometimes, happiness is a goal of therapy to be sure, but more often clients come in with concerns that start with the same interrogative pronoun: "Why." "Why do I feel sad?" "Why do I feel anxious?" "Why am I lonely?" "Why do I do things that I cannot control?" Interestingly enough, the question "Why am I not happy?" is not a question about happiness--telling for grammaticians who will notice that the subject in the sentence is not "happy," but the pronoun "I", which points accurately that the question reflects more in the person asking it than on the state of happiness.

In any case, the questions asked by a client in therapy are often resolved through introspection and questioning. The metaphor of exploring a landscape is a good one here, and I often ask clients, "Just talk about that--explore the territory." In the same sense, my job as therapist is not quite the job of being a guide--it's more the job of being an outfitter. I am prepared to cope with whatever terrain we may find, but I am not leading the expedition.

This kind of therapy is becoming less and less popular with the people who get to tell us what kind of therapy we should be practicing--HMOs are a popular target, but many academics must share the blame for the shift in focus from process-orientated psychotherapy to outcome-orientated psychotherapy. I suspect the shift from academic circles came from a desire to make psychotherapy measurable--social scientists who wanted clinical psychology and social work to stand up next to fields like biology and chemistry, in which hypotheses are measurable and testable. The ironic part is that the drive to measurablity has actually made the process of psychotherapy less measurable: The focus on outcome has overshadowed the means by which the therapist-client dyad actually reaches this outcome.

But why do we assume this is a good idea? Is the goal of therapy to provide good therapy, or is the goal of therapy to provide standardized outcomes? Why does our profession assume that the best process is that which provides easily-comparable outcomes across a wide swath of humanity? Consider two clients who both present with that most common therapeutic concern: Depression. One client is a young, successful and wealthy male who feels that he has achieved everything he has ever wanted in life, but is unhappy and does not understand why he is not pleased. The other client is a middle-aged, working-class male who has been depressed his entire life, and despite going through multiple courses of therapy, has not ever been able to reach a point in his life in which he does not feel depressed. These two people are different and present with different concerns--but likely they would be met with the "Cognitive-Behavioral therapy is an evidence-based intervention for depression" clinical disposition, and given very similar treatments.

But when it comes time to measure the outcome, what have we measured?  We measure symptoms--do you sleep better? Are you crying as much? Are you as sad as you were 3 months ago? While that may be useful information, I have to ask the question: Do you have any further grasp on why you feel depressed? Do you have a sense of whether or not this may be a life-long concern for you? And can you accept your depression, if it is? In other words, are you any closer to answering the question that brought you into therapy? Do you have an understanding of your inner landscape, or are you just more likely to answer questions about your behavior in ways that make researchers happy?

Wednesday, September 21, 2011

Quick update: Two good articles

I came across two interesting articles today. The first one, by Robert Weiss LCSW, asks the question, "Can women be sex addicts?" Certainly, the answer seems to be, "Yes." But then, why is it only male sex addicts we hear about in the news, and why do men seek treatment for sex addiction more than women do? (The author points out that the percentage of women entering treatment for sex addiction mirrors the percentage of men entering treatment for eating disorders.) He suggests that our cultural context has everything to do with how we view sexual addiction. 

A quote:
Even the woman whose sexual and romantic behaviors are causing her profound problems  (health, family, relationship, career, etc.) is not likely to identify as having a sexual problem, she is more likely to use terms like, “I have relationship issues” or “I tend to pick the wrong partners.” 

The full article is here

The second article, also by Robert Weiss, is "The Do's and Don't's of Healthy Dating for Sex Addicts," has some great tips on how to approach dating in a way that is healthy and, more importantly, enjoyable. The article is good reading for everyone, not just sex addicts. (I would suggest that the article be re-titled, "The Do's and Dont's's of Healthy Dating for Everyone.")

Some of the common-sense (but surprisingly uncommon!) tips he gives are:
Do look at your dates as potential friends. Ultimately a having a solid friendship is how you build anything long-term.

Do try to learn about the person you are dating. Find out their passions and interests. Make sure to focus on them as much as you share yourself.

Don’t go to bars alone looking for a date – you may get laid, but not likely loved.

Don’t call, email or text them daily, no matter how good it felt being together. Try to let the dating take its own course.

The full article is here

Saturday, September 10, 2011

Philosophy and psychotherapy

I came across this article in the Washington Post about "Philosophical counseling." I had heard of philosophical counseling before, when I was an undergraduate majoring in philosophy at Michigan State. I seriously considered philosophical counseling as a career--and today, I would consider myself a philosophical psychotherapist.

Here's a quote from the article:

Patricia Anne Murphy is a philosopher with a real-world mission.
Murphy may have a PhD and an intimate knowledge of Aristotle and Descartes, but in her snug Takoma Park bungalow, she’s helping a broken-hearted patient struggle through a divorce.
Instead of offering the wounded wife a prescription for Effexor — which she’s not licensed to do anyway — she instructs her to read Epictetus, the original cognitive therapist, who argued that humans often mistake their feelings for facts and suffer as a result.

I support their intentions, with one major caveat: It is  incorrect for philosophical counselors to assume that they are the only ones applying philosophy to every-day problems. I have asked many of my clients to read Epictetus and Sartre. (Well, not as much Sartre, as he can be a big obtuse.) I have quoted Nietzsche and Kierke­gaard to clients. I frequently encourage clients to discuss epistemology or ethics when they are confronting difficulties in their lives, as appropriate. And I am not a philosopher; I am a therapist, with a master's degree in social work. (Side note: One of the nice things about being a social worker is that I had a very broad liberal arts education before I got my master's degree.) And I am not alone--I know dozens of other psychotherapists who apply philosophical principles to their practice.

Never the less, the article is good, and addresses the reality that philosophy (and literature and art, as well) are means through which people can examine the concerns they have in their daily lives.

Read the whole thing here.

Friday, September 2, 2011


Over the course of the past week I've heard clients say, in some way or another, that they hate their own weakness. I want to take a minute today to write what my feelings are on the subject. 

So I have to ask: What's so terrible about weakness? Where did we ever learn that we have to be strong all the time, regardless of circumstances? And what is the cost of pretending to be strong?

There is not shortage of messages that tell us we should be strong, in our media, from our families, from our jobs. Signs of weakness are undesirable in so many situations. Consider what happens if a presidential candidate cries, if a doctor says "I don't know," or if a parent admits making a poor decision. 

Beyond that, our reluctance to express weakness can keep us isolated. If I am not willing to show my weakness, I am reducing the quality of intimacy I can have with other people. Maybe I am not willing to be that intimate with everyone, but if I never show weakness, I am keeping an important part of myself from other people. 

One of the costs of ignoring or avoiding our weakness is that we lose our opportunity to develop actual strength in that area. I am fond of physical metaphor, so let me use one here. Suppose I am a powerlifter who has a weakness on one of my lifts. Or, suppose that I am a baseball player who has a weakness in some part of my game. If I am training for my particular sport, be it lifting or baseball, should I train the things that I do well, or should I train my weakness? If I train my weakness, I take the risk of looking foolish. But if I do not train my weakness, I will not improve my overall performance. 

Likewise, when we avoid that which we perceive as our weakness in our mental or emotional health, we avoid the opportunity to address our weakness, and possibly overcome it. 

The truth is that we all have weakness. We can compensate for them in various ways, but if we want to develop resiliency, if we want to face our worlds with our best possible selves, then let us acknowledge our weaknesses--and try to do it despite our fears.