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.