Tuesday, July 3, 2012

Anderson Cooper

It's all over the internet: Anderson Cooper has come out of the closet. The narrative out around Cooper's disclosure is more of the "Anderson finally admits that he's gay" variety, rather than  "Anderson takes a brave step." It is interesting to read some of the reactions to Cooper's announcement.

Some have suggested that coming out is more of a low-key process these days than it used to be. The culture around coming out is more of a "let's just assume that I've always been out" rather than "I've got a big announcement to make." Michelangelo Signorile makes a good case for this. 

Jennifer Vanasco reminds us that the struggle for queer acceptance is not over, and coming out as gay is still a big deal. After all, there are still many people who do not want to give equal status to gay men, and Cooper's coming out is the kind of personal-is-political action that tends to change hearts and minds about gay people. 

I think that one of the reasons that there are so many "it's about time" comments is not just that Cooper's sexual orientation has been an open secret for years. I think it has something to do with the expectation that queer people will come out, that somehow LGBT people owe it to the public to identify themselves as such. I wonder if we are moving in this direction as a society--where being queer is seen as the kind of identity that is expected not to be a big deal. 

Monday, July 2, 2012

The things that hold us back

In therapy, we often talk about childhood injuries, and often we mean emotional injustices or slights. But I remember one time that a client told me a story about a physical childhood injury. The client was a vibrant woman. She started about something unrelated, but went on a tangent and shared that she was a gymnast when she was a girl.

Once, while learning something new, she landed badly and injured herself. She told me that as soon as she felt the injury, she knew that she was finished with gymnastics. She did not quit practicing or competing directly, but she never learned a new move again. The injury held her back, kept her in the familiar, and prevented her from growing in the sport. Eventually, she grew bored and quit.

In what ways do we hold ourselves back due to injuries? In what ways to we still carry around the belief that we will hurt ourselves if we strive?

This client had a second lesson to learn—that she could hurt herself and still heal from the injury. She took a risk and injured herself. But she did not leave the sport, which means she healed from that injury. What might have been different for her if she had learned instead that she can take risks, fail, and still recover and go on?

How do we view our failures? Are they crippling, or do we recognize that the very fact that we have failures in our lives means that we have survived them? That every failure is evidence that we are built to strive, to achieve, and to cope with struggle?

Friday, June 1, 2012

Friday Culture: The Open Goldberg Variations

The Open Goldberg Variations is an open source, Creative Commons licensed recording of Bach's Goldberg Variations that was released on May 28, 2012. The idea behind the project is to create a way for people to share and listen to this work.

The Goldberg Variations, for those who do not know, consist of an aria and thirty variations. The variations do not follow the melody of the aria, but are based on its harmonic structure. The variations are each unique in character, and include dazzling displays of the performer's technical proficiency (Variation 5, for example), slow and sophisticated developments of chromatic harmonies (Variation 25), a musical joke (Variation 30), and more. Together, the Goldberg Variations are a complex and wonderful artistic accomplishment

There is much to like here before one even hears the music. Kimiko Ishizaka is the pianist, and she is an interesting person: Not only is she a great musician, she is also a competitive powerlifter. In this recording, she plays a Bösendorfer 290 Imperial CEUS piano, which is a 9-and-a-half foot long piano with 97 keys. The performance itself is very well done. To quote The Simpsons"It may not be a Glenn Gould performance...but I'd say it's 'Good as Gould."

I encourage you to take the opportunity to get to know the Goldberg Variations. Share them with a friend.

Listen here:  http://www.opengoldbergvariations.org/

Tuesday, May 29, 2012

Is tanning an addiction?

I noticed this article in the NYTimes reporting that frequent tanning mimics the effect of drug use. A teaser:
A study in 2005 did show that a large proportion of sunbathers met the psychiatric definition of a substance abuse disorder, based on their answers to a variation of a test often used to help diagnose alcohol addiction... Brain images later showed that during regular tanning sessions, when the study subjects were exposed to UV rays, several key areas of the brain lighted up. Among those areas were the dorsal striatum, the left anterior insula and part of the orbitofrontal cortex – all areas that have been implicated in addiction.
There is a on-going debate in mental health communities on what meets the definition of an addiction. There are many who suggest that neuroscience provides the defining characteristic--simply stated, that there are certain ways that the brain responds to stimulus that are classified as "addiction." This theory has been advanced to make the case for sex addiction, shopping addiction, gambling addiction, and so on. But the question of what is and what is not an addiction remains open for discussion.

Those are just my thoughts this morning. Read the whole article here.

Tuesday, May 22, 2012

Waiting until it is safe to feel happy...

A client in my office recently said, “I want to say that I am happy in my life, but I'm afraid that if I say that, then I'll be inviting trouble.” I have heard this—and said it myself—enough to know that my client is not alone in this thinking. Many of us have been taught or conditioned not to allow ourselves to feel happy for fear that the very act of feeling happiness will cause bad luck.

Are you keeping yourself from experiencing the full happiness of the moment, for fear that acknowledging it will jinx it? Not only is this what therapists call “magical thinking,” it is also a self-defeating way of managing our emotions: This belief prevents us from experiencing our happiness in the moment, keeping us waiting for a future time when it is safe and OK to feel happy.

Of course, there may not be any such future time, as our human lives and all the constructs of human lives are finite. There may not be a better time to enjoy your relationship, or to feel satisfied in your job. So, instead of allowing ourselves to be happy, or to feel satisfied, we dwell in the anxiety of not knowing if it is safe for us to feel good. The great irony is that our circumstance will certainly change, and there will be a time when we are not able to enjoy the life that surrounds us. And rather than enjoying what we had when we could, we borrowed from our future discontent.

In essence, we are waiting until we have permission to be happy. And, because we are conditioned to believe that the here-and-now is not the place for happiness, we will never be in a place where it is safe to feel happy. Each time something comes into our lives that we would be happy about, we will instead minimize it, refuse it, and worry that actually being happy would be back luck.

I remember asking that client, "What permission are you waiting for? What holds you back from feeling good, happy, in the moment?" I think that applies to many of us beyond the therapy room as well. I would invite you to try and recognize this pattern when it comes up for you, and to allow yourself to be happy in the moment.

Friday, May 18, 2012

Friday Culture: Mary Cassatt

Mary Cassatt was born on May 22 in 1844 in what is not Pittsburgh, Pennsylvania. She became a professional artist in a time when the field was mostly closed to women. She often painted portraits, especially women and children. Cassatt's work captures the bond between women and children for many. Critics at the time said that Cassatt's colors were "too bright" and that her portraits were "too accurate." However, these are the characteristics that make her artwork so enduring.

Here are some of Cassatt's works.

 Self-Portrait, c. 1878

The Child's Bath, 1893

Child in a Straw Hat, 1886

Tuesday, May 15, 2012

Self Love II

I wrote a post about self-love last week, and I wanted to continue to write about that theme. As I mentioned in that post, I believe that self-love is overrated in many parts of our culture; but I also believe that it is important to feel good about who we are in order to be mentally and emotionally healthy. 

 It should go without saying, but it does not, so I am putting it here: Feeling good about who we are does not come from other people telling us that they like us. It does not come from being socially desirable, or from being popular. It does not come from being attractive or wealthy or successful in business. Feeling good about ourselves will never come from anything or anyone outside of ourselves.

Feeling good about who are comes from inside of us. It comes from recognizing when we have done something helpful or kind for someone else. I remember one client who was very successful in his profession, and he was making a great deal of money. He came to see me because he felt “worthless.” We worked to identify the origins of these feelings, and discovered that he had been pursuing financial achievement for years and neglecting any kind of service for others, and this was causing him the feelings of worthlessness. He began to volunteer his time—tentatively at first, and then more and more—working at a homeless shelter. He reflected, at the end of our time together, “I feel that I do more good in those hours than in all the boardrooms and meetings I've had in my entire life.”

We also feel good about who we are when we accomplish something difficult, something that took effort and hard work and time. I had a client once who came to see me for depression. At our first session, I noticed he was wearing a class ring, and I asked him about it. He said it was not his ring: He had purchased it at a second-hand store. He then disclosed that he had never finished college, and that this was one of the most painful parts of his life. As we worked together, he decided to go back to school and get his degree. At this point in his career, the degree he was working on would not be helpful to him professionally, but it made an enormous difference to his sense of himself. He eventually did finish his degree, and at the same time his depression gradually lifted.

Feeling good about ourselves also comes from stopping when we are about to do something that we know we will regret. I once worked with a woman who was struggling with a long-lasting heroin addiction. She only used about once a month, but during that time she would be gone from her family for two or three days. She had tremendous shame around her addiction. We worked together for a long time. It was difficult, frustrating work for both of us. She would make progress, and then go back to using. But overall, her use did decrease. She eventually stopped using, and we agreed that she would graduate from therapy. One day about a year later, she was diagnosed with a serious illness and was told she would only have about six months to live. She called me and came back into therapy. When I asked her how she felt about dying, she said, “I'm surprised, but I am OK with it. I mean, I'd rather not die. But I always said I didn't want to die an addict—and now I know that I won't. And that gives me peace.”

These are the things that help us feel good about ourselves—that help us develop self-love. It does not come from other people reassuring us that we are good or worthy; it comes from knowing in ourselves that we have done the difficult thing, or the thing that was valuable and helpful to another person which we did not need to do. It does not come quickly from reading a self-help book or watching a lecture, and it is not cheaply purchased with platitudes. Self-love builds over time, and it comes from the things we do when we choose to live up to our potential to be our best self.  

Friday, May 11, 2012

Friday Culture: Mary Biddinger

Mary Biddinger is a poet and professor living in Akron, Ohio. She was born in California, she attended the University of Michigan, Bowling Green State University, and the University of Illinois at Chicago. Currently, she is an Associate Professor of English at the University of Akron.

Biddinger's work is wonderfully Midwestern in character, and she brings that lens to topics like love and relationships. She blends social commentary and personal awareness without sacrificing beauty. Take a moment today and get to know this poet. I'll let her work speak for itself... here are three poems:

A Hex Symbol and Bildungsroman

Portrait of Myself as a Piece of Red Candy in Your Mouth

Tuesday, May 8, 2012


I hear and talk about "self-love" often in therapy, and it occurs to me that the term is usually define pretty badly. If I'm going to be honest, the phrase "love yourself" tends to conjure up an image in my mind of the worst kind of fluffy pop-psychology. But I think that self-love is a worthy goal indeed, so I wanted to write about what I believe self-love to be, and how to cultivate it.

1. It's not narcissism.

Many of us were raised with cautions against becoming too full of ourselves, or being too proud. And while narcissism is a real problem, self-love is not narcissism. Narcissism is an absorption with the self, a sense of grandiose self-importance, and is often characterized by a lack of empathy for others. Self-love is an unconditional respect, compassion and affection for one's self. One can be a narcissist and have self-love--but interestingly, many narcissists do not have authentic self-love.

2. It's worthwhile, but it's not an answer to everything

"Self-love" is sometimes conceived of as a panacea for every possible psychological wrong, from depression to abusive relationships to alcoholism. And while many people may find increasing their love for themselves to be a part of their overall mental health, it is not a magic cure-all. There are plenty of people out there who deeply love themselves, but engage in self-destructive behaviors. It's too simple to just say, "Well, those people obviously don't love themselves." What is more realistic is that mental health is complex and there is no one single fix for the incredibly diverse difficulties that humans can experience. But even so, self-love is important and worthwhile.

3. It requires self-knowledge

Self-knowledge is the answer to the questions, "Who am I?" and "What am I like?" Think about the process of falling in love with another person--one of the first steps is to get to know that person. We go on dates; we ask questions; often we are fascinated by every little detail of their lives. This knowledge of the beloved object is as important to the love of someone else as it is to our own love of our self. When we have a good working knowledge of our selves, we can being accept and understand what drives us.

4. It's an active process, not merely an attitude shift

"Love" is both a verb and a noun, and as humans we are only capable of "doing" verbs. In other words, we cannot possess self-love without actually taking steps to love ourselves. "Love" is something we do. Think of the things that people do to fall in love with one another--among other things, they get to know each other, share intimate details, share new experiences, and touch each other in intimate ways. All of these steps help cultivate and deepen love. The same thing is true about self-love: It's not a realization we come to once. It's an active process we choose each and every day.

Friday, May 4, 2012

Friday Culture: Keith Haring

I wrote a personal blog years ago, and I had a tradition of posting something "cultural" every Friday. Usually, this was some poetry, or a piece of music, or selections from a visual artist. During the month of May I'm going to bring this tradition back. I think it's relevant here on my professional blog because I believe that art has much to say about mental health and self-actualization. After all, artists philosophers, poets, writers, and musicians throughout history have had commentary of the human condition.

With that said, today is the birthday of Keith Haring. After moving to New York at the age of 19, Haring achieved public recognition with chalk drawings in the New York subways. Haring's art famously addresses the HIV/AIDS epidemic, but he made art about a wide range of social and political themes of his time, such as apartheid and the crack cocaine crisis. Haring himself was diagnosed with AIDS in 1988, and continued  to increase awareness about the AIDS crisis. Haring died of AIDS-related complications in February of 1990, leaving behind a legacy of art commentary on social issues.

Haring's work is still under copyright, so I cannot post any of it on this blog. Instead, I'm giving a link to a video about Haring. The video is an overview of an exhibit of Haring's work at the Contemporary Art Center in Cincinnati from 2011. It includes an interesting history of Haring's development as an artist.


 Also, today's Google doodle is in honor of Keith Haring.

Wednesday, April 25, 2012

The problem of evil in psychotherapy

Recently, one of the clinicians I supervise asked me which direction to take with a client struggling with the question, "Why do bad things happen to good people." This is a question that comes up often in the psychotherapeutic session. It can be raised in a multitude of ways--"Why did I get sick," or "Why did my loved one die," or "Why did I have to get laid off?" These kinds of questions are posed frequently in therapy.  Often, there is an aspect of "What did I do to deserve this?" to these questions.

(Side note: I call this issue "the problem of evil" because it  is a philosophical question of how evil can exist in a just world. For those who believe that there exists a God who is omnibenevolent, omnipotent, and omniscient, the problem is often phrased as "How could God allow evil in the world?". However, the problem of evil is not limited to theists--many people believe that "what goes around comes around," or in some other kind of force that rewards goodness and punishes transgressions. The success of the book The Secret shows how much traction there is in a belief that the universe reciprocates our thoughts and actions.)

If we are working in a existential framework, we admit that there are no reasons for the good things or bad things that happen, and it is our own storytelling processes that create such meanings. I encouraged the clinician with whom I was working to examine the client's belief underlying the idea that there are reasons why bad things happen, with the idea that this exploration may assist the client in coming to some kind of acceptance of the things that have happened.

The truth is that the things that happen to us are not a referendum for how we are living our life--our outcomes are not evidence of how good or bad we are. In the specific case brought to me, this client is religious, so I suggested that this clinician would examine this belief in the framework of the client's religion. And, as with any cognitive distortion, I recommended that the client gather evidence to support or refute the idea that only good things should happen to good people.

I'm playing a winning game here and I know it. No religion in the world has failed to address this problem. In fact, a strong case can be made that one of the functions of religion is to address the problem of evil. And many people will find the classical explanations of why there is evil in the world satisfactory--explanations that do not blame the person for the things that have happened. For example, it is often comforting to believe that "God is testing me," or "I'm supposed to learn something from this," or "God never gives us more than we can handle."

But what about those for whom these beliefs are not comforting?

The alternative explanation to the question, "Why do bad things happen to good people?" is that bad things happen to everyone, and selection bias produces our belief otherwise. The world is not just, and misery comes to us all. So in the process of therapy, we could then look at our selection bias, which can be helpful, but it does not address the larger and more frightening reality that we live in a world that is not just.

Frequently, there is no answer to the question "What did I do to deserve this?" Somethings things just happen to us for no good reason. And while this can be comforting in one way, as it relieves us of responsibility for actions which are truly beyond our control, it can also be deeply terrifying because it may lead to the conclusion that the world is chaotic, painful and unpredictable.

For example, think of a child that assumes control for the condition of her family, her parents' relationship, or even abuse or neglect. Of course a child has no control of any of this, but it may be easier to assume that one has control than to face a world which can be painful for no good reason.

And so it can be difficult to face a world in which bad things happen to good people--or even simpler, in which bad things happen--and mitigating that difficulty is sometimes the object of existential psychotherapy.

While it may be terrifying to face a reality that the world can be a dangerous, threatening place, it is also redemptive. Facing this difficulty reality allows for a person to take responsibility for the things that she or he can actually have responsibility over. I can take responsibility for the ways that I act, or whether/how I accept my life circumstances. I can stop tilting at windmills and I can take responsibility for the things that I can control. Instead of believing, "If I do good things then only good things will happen to me," I can instead consider how I can best exist and thrive in a world in which things both good and bad happen to us.

Thursday, April 12, 2012

Who are your people?

It is a cliché in a session when the therapist asks, "Tell me about your parents." In educating new therapists (which I have the privilege to do for the University of Michigan and Wayne State University) I encourage them to avoid this kind of a statement. I encourage them not to say anything that sounds too much like it might come from a New Yorker cartoon. So the phrases, "How does that make you feel?" is out. And so is "tell me about your mother."

That said, the reason for avoiding the cliché is so that the therapist doesn't come off looking too much like a stereotype to the client, not because it isn't a good question. In fact, it is an excellent question—one of the most important parts of a good psychotherapy is coming to terms with one's family of origin. ("Family of origin" being the clinical way of saying "your folks.")

These days, many clinicians are trained in behavioral methods that minimize the relevance that the client's family has on the the client herself. I was in these methods, and practice them often. "We don't look at the past," I was instructed by well-meaning professors and others. "We stay in the here-and-now. We look at what is going on for the client in the now, and then we work with them to make the changes they want to make."

That sounds wonderful. And frequently, it works—in that it reduces some symptoms that often cause people to feel unhappy. And for people who are seeking symptomatic relief, this is a perfect fit, and where they stop psychotherapy. Success.

But the trouble is that some people want more out of therapy. Some people want inquiry and insight. They don't just want to have a specific symptom reduced; they want to get better. And, contrary to what the behavioralists may tell us, our families are a part of our here-and-now. The parts of my parents that I carry around in me won't be silent just because a therapist wants to focus on some new intervention or technique. Those voices and those memories are loud and clear in my head, even if I am no longer encouraged to share them.

Our culture has prepared a fertile ground for this kind of forgetting of our past. We are reminded of Miss America that we can be anything we want. We are encouraged to get the latest and greatest technological gadget every time a new one comes out. We view adults who live at home as having "failed to launch." Everywhere we look for the quick fix, and for the easy way out. Teach me to be a millionaire in a year, or how to work a "4-hour-week." Quick fixes are in; long processes of hard work are out. It is not hard to see why psychotherapists are encouraged to provide a 12-week cure.

Let me digress for a minute, and in doing so I am going to say something cliché: As I get older, I begin to appreciate the wisdom of my grandmother. And while I appreciate both of my grandmothers, I'm thinking here of my father's mother. She was a quiet, humble, and devoutly Christian woman who lived in a very small rural town in the northern part of Michigan's lower peninsula. One of the things that I remember her talking about is the families of the folks who lived in and around her town. "Blood will out," she would say, as well as "The apple doesn't fall far from the tree."

It's interesting to me that the sciences of mental health are beginning to come back to some of these old-fashioned ways of thinking. If you want to be happier, they tell us, make a list of everything you are grateful for. If you want to feel good about yourself, tend to your close relationships. If you want to have a positive emotional experience, focus on forgiving yourself and others. How fascinating that, as we go forward in psychology, we seem to go backwards in values: Count your blessings. Be kind to other people. Forgive. Don't be a stranger. These days, a convention of mental health professionals can sound a lot like a small-town quilting bee-—and for a good reason: These particular techniques are the tried and true strategies that kept people sane, kept them close together, and helped our ancestors survive.

And so I wonder how long will it be before we come around to "who are your people?" I suspect that this will be presented as a revelation in mental health science--that your family matters in who you are in the world. I cannot help but believe that there is value in knowing where we come from. And so I think there is a place in good psychotherapy for understanding one's family, because by knowing who our people are, we know who we are.

Our legacy, our inheritance, is not a punishment or a curse. It is nothing less than the sum total of the forces that brought us into existence, and that shaped us into who and what we are. The stories of triumph and anguish, the world-view of our families, the attitudes and beliefs about the world that we learned from our parents... As humans, we are a combination of all of this added to our own authentic selves. There is tremendous power in looking that legacy in the eye, and consciously choosing to engage it. And I think that is valuable work worth doing.

Wednesday, April 4, 2012

The Closet as a Given

I've noticed something in my work with GLBT people that I wanted to mention.

Over the years, I've begun to recognize that people conceptualize "being in the closet" as a default state. Queer people are thought to be "in the closet" unless they tell someone about their sexual/gender/romantic orientation. And so, it can seem that the normal state is for queer folks to be closeted.

But really, the opposite is true: The dishonesty that queer people engage in to be in the closet is an action, not the lack of action. It is not accurate to say, "I'll just do nothing and stay in the closet." One cannot stay in the closet by doing nothing; one must make an effort at being perceived as heterosexual or cisgender.

The heterosexism and cisgenderism that our society maintains--that consciousness that presumes heterosexuality and cisgender status for everyone--is a web of actions, not the lack of an action. Heterosexism and cisgenderism are not default states, either: They require work to maintain.

So "being in the closet" requires work--but so does "coming out." And one reason that coming out also requires work is that so many of us queer folk have internalized the avoidance, the dissembling, and the general dishonesty as part of our lives. But make no mistake: Presenting a false-front to the world is an active process.

There are implications for therapy, and for social justice, in the recognition that being closeted is the created structure. Maybe I will go into detail about how that has played out in my practice in later blog posts.

For today, I just want to make this point: The process of being in the closet requires action. Of course, the process of coming out, of living authentically, also requires action--but not because being closeted is a default state, but because queer folks who come out are in resistance to a society that is also acting--the active process of assuming all individuals are heterosexual and cisgender.

(PS: This makes me wonder what the "default" state for queer people is, in regards to our identities. Perhaps it is that our society has eliminated any possible default state for queer identities--and perhaps this is just another reason why the word "queer" is so appropriate: There is no default for that which is queer.)

Image credit: "MCCALL'S MAGAZINE, KIDS IN LINEN CLOSET," from the George Eastman House Collection. The commentary below the image is mine.

Tuesday, March 27, 2012

Why Trayvon Martin's case matters to therapists

By now you likely know the basic details in the Trayvon Martin case: Trayvon Martin was a 17-year-old African American child who was shot and killed on his way home after purchasing a bag of Skittles and an iced tea; Trayvon was unarmed; the man who killed him was patrolling his neighborhood with a gun, and he chased Trayvon against the advice of the 9-1-1 operator; the man who killed Trayvon has not been arrested or charged with any crime; Florida has a broad-ranging self-defense law called "Stand your Ground" which may provide a defense for Trayvon's killer.

You have probably also heard some of the responses. Some very intelligent people have commented on what the Trayvon Martin case means, and I encourage you to read those commentaries. (Including these two on the psychology of guns and self-defense laws: Here and here.) There have also been some ill-reasoned responses, including the idea that children of color wearing hoodies in public are somehow asking for violence.

I keep asking myself why Trayvon's killer carrying a gun while on a neighborhood watch in a gated community. I wonder why he chose to run after Trayvon, and most importantly, why this killing is not being investigated further by the police.

But the question that motivated me to write today is this: Why aren't more mental health professionals talking about this? So let me explain briefly why I am asking that last question, and why I believe that we therapists have a responsibility to speak up against racism and other forms of oppression. (Of course, it matters to us because we are people, and this is a human issue. Let me be clear that I mean to say why it matters to us as professionals.)

Imagine, for a moment, that Trayvon Martin was your friend, or student, or neighbor. Whomever you choose--just imagine that he was more than a name in a newspaper. And further, imagine that you were walking with him that terrible night. And, that despite your best intentions, that you were unable to stop him from being killed. Because that can be similar to the reaction of those of us reading the story, hearing the details, seeing the pictures, asking ourselves how we would have reacted.

Further, imagine that Trayvon Martin looks like you do (or like you did when you were 17). How much stronger would your feelings of anger, helplessness, and fear be if you looked into a mirror and saw Trayvon Martin's face? (President Obama hinted at this when he spoke, saying "If I had a son, he would look like Trayvon.")

"Minority stress" is the term researchers use to describe the negative feelings that come from being a member of an oppressed minority. The idea of minority stress was novel when it was first researched, but now it has become an accepted reality in the mental health community.

In other words, we have known for years that merely being a member of an oppressed group is damaging to one's mental health.

But minority stress is different from other kinds of stress, in that it is cultural. Minority stress cannot be viewed as a part of normal human life, because the circumstances that produce it are not necessary. It is the result of the cumulative total of all of the Trayvon Martins through history; it is the result of a society in which we send the message repeatedly that one group is not entitled to the same safety, liberty and rights.

It falls on each of us to work to change the culture in which a case like Trayvon Martin's is possible. It is not an abstract concept or a job for the activists of the world--the psychological reality of racism goes deep into each of our hearts and minds, as the culture in which oppression exists is co-created by each of us every day. For those of us who are mental health professionals, we must be aware that each individual lives in a society which impacts that individual, and just as much as we have a duty to those who seek help from us, we have a responsibility to engage with our society and culture, which impacts all of us who live in it.

The fallout of the Trayvon Martin case is important for any of us who want to live in a society of law, in which justice is valued and pursued--and it should be of great concern for those of us who have dedicated our professional lives to the alleviation of human suffering.

Monday, March 26, 2012

Emotional Security

I had a conversation with a client recently about a subject that comes up often in therapy--emotional security.

Feeling safe emotionally is not the lack of feeling fear about bad emotions. It is very possible to feel fear when we are not actually in danger. When we see a horror movie, for example, we feel frightened, although we know we are safe.

Likewise, emotional security is not the absence of emotions, or the ability to turn emotions "off." Emotions are a part of our lives, and important both for our survival and for our well-being.

Basically, the idea of emotional security is the ability to cope with the emotions that we have in our lives. Some things are big and will produce big reactions, and those times might be more difficult. But even so, emotional security means being OK with strong feelings, and being able to face them.

So I propose that emotional security is being able to say, "No matter what happens, I believe that I will be able to cope with it." Saying that--and really believing it--I think that's a goal that's worthy of striving for.

Image credit: Syd Connelly and winning safety slogan, Library of Virginia.

Monday, March 19, 2012


Last week I flew to Dallas, Texas for to deliver two lectures to other clinicians. The weather was wonderful, and the people lived up to their reputation for southern hospitality.

During the course of both talks, I asked for the participants to give a definition of "strengths-based perspective." I got two different definitions, both of which I thought were pretty clever. At one talk, a woman said that "strengths-based perspective is what's strong about a person, instead of what's wrong about a person." At the other, another woman said (in a deep Texas accent), "Even someone who's 'tore up from the floor up' has something strong about them."

I liked both of these, and I started thinking about strengths-based work. Basically, it's what these definitions suggest: Starting therapy (or anything, really) from a place of where we are strong, where we have skills and resources, and then bringing those strengths, skills and resources to bear on the problems we want to change.

One of the beautiful things about strengths-based work is that it has the potential to succeed where other interventions do not. It is extremely practical, and applicable to a client's daily problems. The downside is that it can be difficult for clinicians. It requires reframing of concepts like "non-compliant," "resistant," and "dysfunctional."

However, strengths-based perspective is becoming common practice in many different mental health settings. I have heard clinicians of all different stripes talk about how a client's behavior is only dysfunctional in a particular setting, or how a client's maladaptive coping skills were developed as a way of coping with a difficult setting.

I also want to highlight that strength is often developed as a result of stress. Sometimes, strengths from one endeavor are easily transferable to another kind of endeavor. And sometimes, it is necessary to go out and experience new kinds of stress--intentionally--to build one's strength. Part of a strengths-based perspective is an understanding of how we get strong, where strength comes from, and what we can do to build on the strengths we already have.

Photo credit: Anthony Topper, used under Creative Commons Attribution 2.0.

Tuesday, March 13, 2012


This caught my eye this morning, and I thought I'd share it.

Thursday, March 8, 2012

How depressed is that mouse?

Before a drug can be brought to market, it goes through a lengthy testing period. And because there are limits to the kinds of experiments that can be done on humans, it is necessary for those researching pharmaceuticals to do experiments on animals--frequently mice.

This presents a particular problem for medications designed to improve mood--after all, we cannot ask a mouse if she feels more or less sad, or if she feels more like going to work than before the antidepressants. And, just like in humans, there is no blood test or brain scan that can diagnose depression.

So, how does a researcher measure depression in mice? This article in Scientific American answers that question--researchers use proxy measures. That would be behaviors that seem to indicate that the mouse is more or less depressed. For example:
The rat or mouse is placed into a cylinder partially filled with water from which escape is difficult. The longer it swims, the more actively it is trying to escape; if it stops swimming, this cessation is interpreted as depressionlike behavior, a kind of animal fatalism.

I'll leave it to others to decide if these proxy measures are actually measuring what they purport to measure.

Read the whole article here.

Tuesday, February 28, 2012

Why Existential Therapy? (Reflections on Praxis)

I have an eclectic style, but one school of therapy that informs much of how I practice is existential therapy. I wanted to write a bit about how and why I came to this kind of practice.

First, I think it's important to say exactly what I mean when I say "existential therapy." Basically, the brief distinction is this: Existential psychotherapy addresses concerns that arise out of existence itself. Some of the most common existential concerns are death, meaning in life, responsibility, freedom and choice.

That may sound a bit opaque and irrelevant to the actual lives of people, but ironically it was because of the immediate relevance of these issues that I began to practice existential therapy.

Since the beginning of my career as a therapist I have worked with individuals who are HIV positive. In particular, I had developed a niche within that field of those who are recently diagnosed with HIV.

For years, I sat with hundreds of clients who had just found out that they were infected with HIV. And while each individual is unique, I did notice some common themes. People would be frightened that they were going to die. They had guilt and shame around contracting the virus. Many of them wondered, "How could this happen?" Some of them questioned their faith in a higher power--"Why did God let this happen to me?" And almost every single client wrestled with concerns about how HIV would effect relationships with family, friends and romantic partners. I noticed all of these themes, and found ways to address them in session.

One spring day I was attending a conference on dialectical behavioral therapy (which is a wonderful practice that I employ as well), and I made the 'healthy' decision to scarf down some McDonald's in my car. While eating my lunch and I picked up a book I had just purchased--Irvin Yalom's Love's Executioner--and began to read. Yalom wrote that there are four main topics of concern in existential therapy: Death, responsibility, meaning in life, and isolation. I think I choked on my french fries at that point--he had just identified the four major reasons that my clients were seeking therapy!

As I read more about existential therapy, I began to suspect that there was an immediate applicability to my practice. This was not abstract--it was something that my clients related to as daily struggles.

I remember one critique that I heard early on was basically this: "Your clients are mostly poorly educated individuals. They are not going to understand or relate to these 'existential' ideas." I might have even believed this at one point, but it is not true.

For example, one of my clients--a woman who had dropped out of school at age 13 and had spent years as a sex worker to support her heroin addiction--quoted Nietzsche at me: "What doesn't kill me makes me stronger," she said. I took the ball and ran with it: "You know, that's from the work of a philosopher named Frederich Nietzsche. He believed that our struggles are the things that define us; that in the moment of difficulties, we have a chance to grow and improve." We then had a brief dialogue about how that applied to her life. Later, when she was struggling with a particular issue that she believed she had previously resolved, she said: "It's so frustrating that I have to deal with this again!" I took that and went back to dear old Frederich. "Remember how we talked about Nietzsche once? About how 'that which doesn't kill us makes us stronger?' Well, he also said, 'When we are tired, we are attacked by ideas we conquered long ago.' Does that make sense for you now?" And in fact, this client did relate to what Nietzsche had written, and her therapy was richer and more successful overall due to some of the existential material that we worked with.

I began to realize that the applications went beyond my work with HIV+ people, and I began to practice existential therapy with a broad range of clients. I have come to see how the existential concerns are frequently present in human distress, and are frequently just under the surface of the concerns that clients come to therapy to resolve. And ultimately, that's why I practice existential psychotherapy: Because it is relevant.

Wednesday, February 8, 2012

Proposition 8 struck down

"Let us realize the arc of the moral universe is long but it bends toward justice."
--Dr. Martin Luther King, Jr.
Yesterday the 9th circuit court struck down "Proposition 8," which is California's after-the-fact ban on gay marriages. Because the ban was enacted after marriage had already been granted, the court was clear that this decision was limited to California. Even so, this is a victory for the rights of same-gender couples.

This issue is far from settled. The Prop 8 legal wrangling will now make its way to the US Supreme Court, which will weigh-in on same-gender marriage. Legal scholars and pundits will debate what this means for the political scene in America. Those who support equal rights for same-gender couples will triumph this as a victory, and those who oppose those rights will use this as pabulum for their cause. Of course that second thing worries me--as we enter another election year, politicians will likely continue to use the civil rights of an American minority as a leverage tool for political gain. I expect that we will see more animated anti-LGBT rhetoric, with all the damaging effects that has on the queer population in this country.

But this decision is a victory for equal rights. And I am excited and encouraged by one particular statement in the court's opinion:
Proposition 8 served no purpose, and had no effect, other than to lessen the status and human dignity of gays and lesbians in California.
And that is important--the court recognizes that denying rights to same-gender couples lessens those couples, relegating them to the status of second-hand citizens. I think it is always a cause for celebration when the truth comes out.

Tuesday, January 31, 2012

Reflection on Praxis: Authenticity and its limits

One of the chief reasons people tell me they are in therapy is to "work on relationships." And often, we find that the people who want to work on relationships are really working on addressing the anxiety that comes from being in relationship with other people.

There is a vulnerability in relationship that cannot be denied: If I am my authentic self when I am in relationship, I run the risk that I will be rejected. If I play the role of someone else in a relationships, then I am never giving anyone a chance to connect with me on an authentic level, and my relationships are less real because of it.

Ideally, when we are young, we have families and caregivers that model balancing the need to fit in and be accepted--which is a real human need--and the desire to be ourselves. Sometimes, these models do not do such a good job, and they emphasize one over the other. Other times, they actually harm our ability to find this balance by actively encouraging conformity or exceptionality.

In therapy, the general idea is that the client learns to be authentic with the therapist, and then translates those skills to others. One difficulty here is that no one can have an authentic relationship in a vacuum (or to quibble about verbiage, anyone can have an authentic relationship in a vacuum, since that tension I mentioned earlier does not exist). So the therapist needs to provide some kind of feedback of authenticity as well--and there is the difficulty for the therapist.

As a therapist, I find that the balance between therapeutic authenticity and clinical stance is one of the most interesting challenges of the profession. I am not just talking about self-disclosure (what the therapist tells the client about the therapist's life); I am talking about the ways that the therapist reacts to the client's presentation of the client's self.

The question that comes to me today is this: Is it really possible to have an authentic relationship in therapy, when therapy itself is seen as a relationship intentionally constructed to be artificial? In fact, some of the most significant benefits of therapy come by very nature of the fact that it is in a very specific kind of constructed relationship. So, then, how can a therapist be truly authentic?

I suppose that the answer to this situation is the obvious one: The therapist can be authentically a therapist. The relationship is defined by contracts, policies and informed consent agreements. But in that is the authenticity--no one is under any false pretenses that the relationship between the therapist and the client is anything other than a clinical relationship. We are not friends; we are not companions. And, in order for the relationship to be authentic at all, this must be in the awareness of both parties.

Maybe this does not seem like much of a revelation, but I think that many therapists who practice "authentically" would rather blur this distinction. I hear "We are fellow travelers," or "I am a wounded healer" and similar refrains that are designed to reduce the distinction between the client and the therapist.

As I practice, I cannot help but think that there is something fundamentally misguided about the attempts to minimize the demarcation between the two roles. Rather, I think it is essential to recognize that therapists are like clients in all the important ways--therapists are human and have all the accompanying human failings and frailties, of course. But these must stay outside of the therapeutic relationship not because the therapist needs to occupy a special position, but because the therapist needs not to. The therapist must be honest about her/his own relationship to the client--which should be, at core, a professional relationship. The therapist can still model ways of addressing the dilemma I mentioned earlier--fitting in vs being yourself, but in the context of a professional vs a humanistic role.

This honesty, I believe, leads to more authentic relationships, not less.

(Also... Greater minds than mine have written about this subject--see Carl Rogers and Irvin Yalom, for a start.)

Monday, January 23, 2012

NPR on the serotonin hypothesis

I want to point out this story from NPR entitled, "When It Comes To Depression, Serotonin Isn't The Whole Story." here is a teaser quote:
"I don't think there's any convincing body of data that anybody has ever found that depression is associated to a significant extent with a loss of serotonin," he says.

Delgado also makes this argument. In the 1990s he carried out a study that showed that if you take a normal person and deplete them of serotonin, they will not become depressed. He says he feels this demonstrates that low serotonin doesn't cause depression.

I am happy that this is appearing on a national platform like NPR. Certainly, serotonin is important in depression somehow, but the truth is that we do not know what causes depression, and we cannot say that it is an "imbalance of chemicals in the brain." The only evidence that we have for this claim is this: People who are giving medications that increase the amount of available serotonin in the brain recover from depression. But taking that as a premise and then concluding that low serotonin causes depression is exactly like saying that high cholesterol is caused by an deficiency of Lipitor, or that a headache is caused by an imbalance of aspirin.

Read or listen to the whole story here.

Friday, January 20, 2012

Ouroboros (A reflection on praxis)

I was in session with a client recently recently speaking about vicious cycles. For almost any problem that an individual has, it seems that some theorist has created a model of a vicious cycle that supports and deepens that problem. For example, there are cycle of domestic violence, sex addiction, obsessive-compulsive behavior, anger, substance abuse, depression, eating carbohydrates, and so on.

I think that these cycles do define real phenomena, certainly. But what I think is interesting to notice is that there are so many accurate descriptions of human behavior that are cyclic. It makes me wonder if the validity in these cycles really implies that the cycles are self-perpetuating, or if they are merely patterns of reoccurring behavior.

The mere presence of a recurring cycle does not require that the cycle is self-perpetuating. I think this is a fine point that is often missed in therapy. For example, in most cycles, there is a period in which the individual is "performing" or "functioning." In the cycle below, it's called "moral resolve." But essentially, it is the period of relative calm in which the individual is not engaging in whatever behavior is causing the problem.

But notice how "Moral Resolve" leads right into "Pain Returns." And it's this way across the board--the "functioning" part of the cycle leads right into the "non-functioning" part of the cycle. Why is that? Is the one a necessary consequence of the other? And, does this conceptualization of a cycle take power away from a client in some way? Because, after all, isn't this the state at which a client engages in recovery?

The title of this post is "ouroboros." I like using myth, symbol and story as a vehicle for understanding the human psyche. I think that the good, long-standing myths that have been passed down to us have a resonance with the daily struggles of humanity, and that viewing our modern concerns through the lens of age-old problems and ideals gives them deeper meaning, as well as providing us with insight into ways to address some of our more persistent problems. And when I think of vicious cycles, I think of the ouroboros. From Wikipedia:
The Ouroboros is an ancient symbol depicting a serpent or dragon eating its own tail. The name originates from within Greek language; οὐρά (oura) meaning "tail" and βόρος (boros) meaning "eating", thus "he who eats the tail."

I wonder if the image of the ouroboros is useful for the idea of a vicious cycle, since it fully implies that the control for the continuation of the cycle is fully contained by the individual who creates the cycle, rather than a necessity of the cycle itself. The ouroboros also suggests the self-destruction inherent in the cycle. I can't help by comment on the mythic symbolism of the ouroboros encircling the earth--the way that those who are trapped in these kinds of cycles often feel that their entire worlds are circumscribed by the cycle itself. When I am describing cyclic behavior to clients--"vicious cycles"--I will add details to show the snake eating its tail.

Wednesday, January 11, 2012

Sex and Politics

I wanted to point to this great article in Psychology Today, "What Rick Santorum Doesn't Know about Sex," by Christopher Ryan. (Ryan is the author of Sex at Dawn.) I think Ryan makes great points that are applicable not just to Santorum, but to politicians in general who speak about regulating and legislating sexual morality.

A teaser quote:
For Homo sapiens, sex is primarily about establishing and maintaining relationships—relationships often characterized by love, or at least affection. Reproduction is a by-product of human sexual behavior, not its primary purpose.

I am a big fan of Ryan's work, and I think he's dead-on here. But I also think it is extremely important to recognize that, when it comes to sex and politics, this is just half of the story. Imagine that Rick Santorum wrote a response to Ryan's piece entitled "What Christopher Ryan Doesn't Know about Politics." The salient pieces of such a piece would certainly be that issues of "family values" have been historic drivers for right-wing candidates for decades, and right-wing politicians can drum up support for their campaigns by bringing out these iseeus. In fact, I think it is interesting to note that LBGTQ equality, abortion rights, and religious tolerance are brought up as political issues by those candidates that oppose them far more frequently than by those candidates that support them.

There is something in that, I think, that is relevant to mental health. Two very cynical possibilities emerge: Either the candidates are bringing these issues out just because they are vote-getters, or the candidates who are getting votes are the ones that bring these issues up. The end result is the same--The candidates selected are frequently those who stand opposed to LGBTQ equality and abortion rights. (Of course, there are other family value issues beyond these, but for simplicity's sake, let's leave it here.) So, what Christopher Ryan doesn't know about politics is this: History has shown that us-vs-them thinking and moral superiority are effective in getting out votes, and will likely remain a part of the political system. It has, unfortunately, nothing to do with the reality of how sexuality functions in humans, and everything to do with how humans consolidate political power.

(Apologies to Christopher Ryan, who I suspect actually does understand how politics work, despite my rhetorical device. As a sign of my contrition, I recommend you all go purchase a copy of Sex at Dawn, which is a fantastic book.)

Sunday, January 8, 2012

Making Philosophy Matter

I came across this article--"Making Philosophy Matter-Or Else"--in the Chronicle of Higher Education today, and I could not agree more.

A number of years ago I was a philosophy major at Michigan State University (Go Spartans!) and the unfailing question I was asked by those to whom I had just disclosed my chosen field of study was, "What are you going to do with that?"

At the time, I was young and naive enough to believe that the purpose of a university education was to improve the quality of one's thinking, to provide a foundation for a life of examination, and to strengthen one's ability to reason. And while I am still young and naive enough to believe that, I am now old enough and experienced enough to recognize that this is considered, by many, to be a liability rather than an asset. Why spend four (or more) years accumulating enormous quantities of debt in order to get a piece of paper that does not have a job title associated with it? I can understand the appeal of degrees in accounting or finance (in fact, my other BA is in French language, which opens up a great many employment opportunities in translation), but I believed, as did Socrates, that examined lives are, all things considered, preferable to those that are unexamined.

Perhaps it is because I am now in the business of helping people examine their lives that I have never regretted my study in philosophy. In fact, I know that my studying philosophy has helped me in my chosen field and made me a better therapist. When my clients ask questions about purpose or the meaning of life I believe that I am able to engage them in these conversations in ways that I could not if I had not studied philosophy. I want to be clear that studying philosophy is certainly not the only way to educate a therapist! But when I think back at all the times that I was asked to justify my choice in field of study, I can honestly say that I have benefited from my undergraduate work in philosophy, and indeed I use it every day in the practice of my profession.

Back to this article--Lee McIntyre makes a good case for moving philosophy from the realm of the academe and into the popular consciousness, not just for the good of philosophy, but because "[i]t is rather philosophy's historical mission, which is not merely to find the truth, but to use the truth to improve the quality of human life." I agree completely.