“To love means to open ourselves to the negative as well as the positive - to grief, sorrow, and disappointment as well as to joy, fulfillment, and an intensity of consciousness we did not know was possible before.”—Rollo May
Do some therapists cry with their patients? Does it mean he or she has poor boundaries?
Well, I certainly can’t speak for all therapists, but in my own experience there are absolutely therapists who tear up—or even openly cry—with a client. And I don’t think it speaks to poor boundaries at all, but rather to a therapist’s openness to what’s happening in the room. If you’re a psychodynamically-oriented therapist, working with a client over a long period time, you’re simply going to feel for them at times, whether in their struggles or in their joy. I don’t think it’s appropriate to breakdown and weep as a therapist, but I think tears on the therapist’s part can actually be a fairly powerful thing in the right context, and add to, rather than detract from, the therapeutic relationship.
"[therapists] reported they experienced their last in-session cry due to sadness (75%), “feeling touched” (63%), warmth (33%), gratitude (15%) and joy (12%). According to the researchers these findings challenge the idea that therapists cry “due to the therapist being overwhelmed by intense negative emotions that arise in therapy, and instead signals a moment of potentially positive emotional connection, even if amid painful negative affect.”
Is there really a good reason to keep on going? I work a minimum wage job, have never been in a relationship, my family life is shit and abusive...honestly, aren't there some people who don't have anything going for them? Why shouldn't I end it?
Okay. I’m going to do something rather unorthodox:
I’m not going to tell you to keep living.
But I’m also not going to tell you to stop living.
I’m not privy to the details of your life and I am not going to blow sunshine up your ass and tell you it’s all gonna be rainbows and unicorns if you just try to smile a little more. I can only tell you what I’ve found based on my own experience. Here, in brief, are the highlights of my philosophy on situations such as yours:
1.) In almost all cases, life can get better with your effort. This means taking steps to get counseling from a psychologist or psychiatrist or social worker, make healthy choices (counseling being one of them!) and fill your life with better humans, avoiding the shittier ones where possible (and it ain’t always possible). You may need to cut some ties. You may need to do things you don’t want to do, like admit to your own mistakes and missteps. But I promise you it can be done. And if you put in a ton of effort and it fails, so what? You tried. Better to attempt to make your life better than just ending it without even trying. Because what’s the fucking point of that?
2.) Every major improvement is the result of many tiny steps. For example, let’s take your general unhappiness. You want to be happy. I’d wager you will at least feel better if you have someone to talk to. I think a counselor is a great option because that person is (hopefully) unbiased. But to get into the counseling session, you’re going to need to do a few things. You’re going to need to get on the computer and Google counselors in your area. You’re gonna need to make some phone calls or emails to find out who provides free or low-cost care (sometimes they will say they have a “sliding scale” fee. That’s what you’re looking for.) You’re gonna need to make the appointments and write down the appointments and remember the appointments and show up to the appointments. See what I mean by “many tiny steps?” It ain’t gonna happen overnight. This may seem overwhelming, but just focus on mapping out the steps to your goal (feeling less shitty). Then take just one of those steps today. Just one. Then if you’re feeling motivated, you can take the next step. Saving your own life takes some planning and it’s the most important thing you can possibly do, so it’s worth putting in some effort.
3.) EVERYTHING LOOKS SHITTY WHEN YOU’RE STANDING INSIDE A GIANT GLASS PRISON SMEARED WITH SHIT — shit job, shit family, shit love life. That’s how depression works. The rest of the world is so obscured that you can’t see the beautiful and amazing things and opportunities just waiting for you right outside. Killing yourself is not the only way out of this prison. There’s a door. There’s a window. There’s a hole in the roof that’s just your size, and there’s a ladder to help you down from the roof to the ground below. And remember that you can always smash your way out. It’s a glass prison — it’s impermanent and ultimately can’t stand up to the force of your desire to lead a better life. It’s going to be tough and it’s going to hurt sometimes, but it’s going to be the best decision you ever made.
4.) We have some agency in that we are able to determine our own path to a certain degree. You can’t choose whether an anvil drops on your head while you are walking down the street. You CAN choose to keep your eyes open, be aware of your surroundings, get enough sleep at night, eat good food, drink water, and stay sober enough to notice this “DO NOT WALK HERE. CONSTRUCTION IN PROGRESS.” sign. To a certain extent, your life is in your own hands. Recognize that you have some power in this situation.
5.) Blood relation is not an obligation. Your family fucking sucks and they treated you like shit. They still do. I assume you’re an adult. This means you get to leave. You get to make your own choices. You get to take care of the kid inside you who couldn’t leave or make his/her own choices. Ask friends for help. Ask your counselor (remember, the psychologist or psychiatrist or social worker you’re going to seek out!) Ask a pastor for help if God is your thing or if you know a decent clergy member. Tell your story. Keep telling it until somebody listens. Keep telling it until you feel better
6.) Do not waste time on either guilt or self-pity. Neither will do you any good. Focus on forward momentum. Guilt and self-pity will only serve to hold you back. I have wasted far too much time on both these things and I would like to save you the time.
8.) I’ve wanted to kill myself and I never went through with it, and thank God for that, because I’ve gotten to experience an amazing life. If God or fate or science or a speeding bus end it all for me tomorrow, I’ll know I had a great adventure on earth. Or maybe I won’t know it, because I’ll be fucking dead, and who can say what happens? Who can say if death is better, or worse, or just a fat load of nothingness? I figure it’s better to deal with the devil I know (this life) than the devil I don’t (the afterlife — if such a thing exists).
9.) If you can do nothing else — just keep breathing for as long as you can. One breath after the other after the other. Put them all together and you’ve got a lifetime.
I hope you keep living. I trust that you will. You wrote to me, after all. You wouldn’t have done that if you didn’t retain some hope and some understanding that life has better things in store for you. I think you ought to stick around to see what those things are. Sometimes they’re shiny and taste like chocolate. It’s worth it.
I wish you good luck. But more than that, I wish you good effort.
And thanks for reminding me of the things I sometimes forget.
We are a psychologically sophisticated society. Emotional difficulties are now shared openly — not only by celebrities but by your average person. It’s not unusual for people to tell friends that they have an anxiety disorder, anger management problem, depression, panic attacks, phobias, eating disorder, substance abuse problem, OCD or ADD.
Yet, there is a widespread psychological disorder that most people know little or nothing about. Why? Because its symptoms are largely interpersonal, causing many to view it as a relationship issue, not a mental health one. Also, people shy away from the term because of its unflattering name: Borderline Personality Disorder.
“Borderline? Am I going over the edge into an abyss? Oh my gosh! Next topic.”
Enough ignorance. Let’s review the major symptoms of people who have borderline personality disorder (BPD):
They have turbulent and stormy relationships, making it difficult to keep a job or maintain a close relationship.
They have frequent emotional outbursts, often expressing their outrage with verbal abuse, physical attacks or acts of revenge.
Though they’re acutely sensitive to being abandoned and rejected, they’re harshly critical of those closest to them.
They view others as “good” or “bad.” A friend, parent or therapist may be idealized one day, yet viewed the next day as a terrible person for failing to live up to their expectations.
They may act out with self-destructive activity (i.e. reckless driving, compulsive shopping, shoplifting, cutting, bingeing with food, alcohol, drugs or promiscuous sex) as a way to fend off feelings of unbearable emptiness.
If you’re living with someone with BPD, life probably feels like an emotional roller coaster. So what can you do? Certainly, suggesting psychotherapy is a good idea. Don’t be surprised, however, if he or she uses therapy not to seek understanding but to rage about others. So, if therapy for your loved one is not moving forward, try a few suggestions:
““Bots like this show you that you exist,” says social media theorist and sociologist Nathan Jurgenson, who studies the interactions between our digital and IRL selves. (He’s also pretty well known for his job as Snapchat’s in-house sociologist.) “You’ve posted all these status updates, they really did matter, they haven’t gone away, they were recorded, and they say something about you. It’s the same thing people said when Friendster came around: We want proof that we exist.”
Jurgenson says that’s the most basic impulse behind our desire to engage with and share these reflective tokens, but the reason they actually succeed in entertaining us – why we find these statuses hilarious enough to share with our friends – is a little more complex. According to Jurgenson and other social theorists, “apps” like What Would I Say? (which isn’t really an app, but it interacts with Facebook’s API as such) mimic human behavior, but not quite perfectly, which also makes it less unnerving.
“It’s an uncanny valley situation, where [the app] reflects the self, but not too well, and not too poorly,” he says. “It’s enough of you that you recognize yourself, but it’s a distorted-enough reflection where it’s not creepy.”
The most impressive people I know are all terrible procrastinators. So could it be that procrastination isn’t always bad?
Most people who write about procrastination write about how to cure it. But this is, strictly speaking, impossible. There are an infinite number of things you could be doing. No matter what you work on, you’re not working on everything else. So the question is not how to avoid procrastination, but how to procrastinate well.
There are three variants of procrastination, depending on what you do instead of working on something: you could work on (a) nothing, (b) something less important, or (c) something more important. That last type, I’d argue, is good procrastination.
That’s the “absent-minded professor,” who forgets to shave, or eat, or even perhaps look where he’s going while he’s thinking about some interesting question. His mind is absent from the everyday world because it’s hard at work in another.
That’s the sense in which the most impressive people I know are all procrastinators. They’re type-C procrastinators: they put off working on small stuff to work on big stuff.
What’s “small stuff?” Roughly, work that has zero chance of being mentioned in your obituary. It’s hard to say at the time what will turn out to be your best work (will it be your magnum opus on Sumerian temple architecture, or the detective thriller you wrote under a pseudonym?), but there’s a whole class of tasks you can safely rule out: shaving, doing your laundry, cleaning the house, writing thank-you notes—anything that might be called an errand.
Good procrastination is avoiding errands to do real work.
Good in a sense, at least. The people who want you to do the errands won’t think it’s good. But you probably have to annoy them if you want to get anything done. The mildest seeming people, if they want to do real work, all have a certain degree of ruthlessness when it comes to avoiding errands.
Some errands, like replying to letters, go away if you ignore them (perhaps taking friends with them). Others, like mowing the lawn, or filing tax returns, only get worse if you put them off. In principle it shouldn’t work to put off the second kind of errand. You’re going to have to do whatever it is eventually. Why not (as past-due notices are always saying) do it now?
The reason it pays to put off even those errands is that real work needs two things errands don’t: big chunks of time, and the right mood. If you get inspired by some project, it can be a net win to blow off everything you were supposed to do for the next few days to work on it. Yes, those errands may cost you more time when you finally get around to them. But if you get a lot done during those few days, you will be net more productive.
In fact, it may not be a difference in degree, but a difference in kind. There may be types of work that can only be done in long, uninterrupted stretches, when inspiration hits, rather than dutifully in scheduled little slices. Empirically it seems to be so. When I think of the people I know who’ve done great things, I don’t imagine them dutifully crossing items off to-do lists. I imagine them sneaking off to work on some new idea…
Do you know someone who needs hours alone every day? Who loves quiet conversations about feelings or ideas, and can give a dynamite presentation to a big audience, but seems awkward in groups and maladroit at small talk? Who has to be dragged to parties and then needs the rest of the day to recuperate? Who growls or scowls or grunts or winces when accosted with pleasantries by people who are just trying to be nice?
If so, do you tell this person he is “too serious,” or ask if he is okay? Regard him as aloof, arrogant, rude? Redouble your efforts to draw him out?
If you answered yes to these questions, chances are that you have an introvert on your hands—and that you aren’t caring for him properly. Science has learned a good deal in recent years about the habits and requirements of introverts. It has even learned, by means of brain scans, that introverts process information differently from other people (I am not making this up). If you are behind the curve on this important matter, be reassured that you are not alone. Introverts may be common, but they are also among the most misunderstood and aggrieved groups in America, possibly the world.
I know. My name is Jonathan, and I am an introvert.
Oh, for years I denied it. After all, I have good social skills. I am not morose or misanthropic. Usually. I am far from shy. I love long conversations that explore intimate thoughts or passionate interests. But at last I have self-identified and come out to my friends and colleagues. In doing so, I have found myself liberated from any number of damaging misconceptions and stereotypes. Now I am here to tell you what you need to know in order to respond sensitively and supportively to your own introverted family members, friends, and colleagues. Remember, someone you know, respect, and interact with every day is an introvert, and you are probably driving this person nuts. It pays to learn the warning signs.
What is introversion?
In its modern sense, the concept goes back to the 1920s and the psychologist Carl Jung. Today it is a mainstay of personality tests, including the widely used Myers-Briggs Type Indicator. Introverts are not necessarily shy. Shy people are anxious or frightened or self-excoriating in social settings; introverts generally are not. Introverts are also not misanthropic, though some of us do go along with Sartre as far as to say “Hell is other people at breakfast.” Rather, introverts are people who find other people tiring.
Extroverts are energized by people, and wilt or fade when alone. They often seem bored by themselves, in both senses of the expression. Leave an extrovert alone for two minutes and he will reach for his cell phone. In contrast, after an hour or two of being socially “on,” we introverts need to turn off and recharge. My own formula is roughly two hours alone for every hour of socializing. This isn’t antisocial. It isn’t a sign of depression. It does not call for medication. For introverts, to be alone with our thoughts is as restorative as sleeping, as nourishing as eating. Our motto: “I’m okay, you’re okay—in small doses.”
Read: the rest of the original Atlantic article here
See also:Interviews: “Introverts of the World, Unite!” A conversation with Jonathan Rauch, the author who—thanks to an astonishingly popular essay in the March 2003 Atlantic—may have unwittingly touched off an Introverts’ Rights revolution.
"We’re more accustomed as readers to the memoir model, where depression — or addiction, or even ordinary anxiety — appears as a monster from the past, one against which you still have to bolt the door every day, but one that’s not there right now, not interfering with your writing about it, not writing about it with you.
But there’s something to be said for the currency of Brosh’s vivid, sometimes nervous-making chronicles, or of Glover’s scribbled notes. It’s very sterile and very misleading to hear about battles only from people who either have already won or at least have already experienced the stability of intermediate victories. It presents a false sense of how hard those battles are. It understates the perilous sense of being in the middle of them. It understates how scary they are. Compare the feeling of listening to a 911 call from inside someone’s house while they’re afraid a burglar is inside to the feeling of hearing them tell you a week later what it was like that one time they were afraid there was a burglar in the house. The second will give you their reflective version of what happened; the first will give you their out-of-breath panic.
There is a developing candor about depression, addiction, and ordinary day-to-day struggles that can feel uncomfortably intimate to people who either are very private themselves or prefer other people to be very private. There are absolutely times when you read something and feel that you’re encountering details you shouldn’t be seeing, perhaps offered from a person not in the right frame of mind to be deciding how much to give away.
But consider the brief but indelible post about depression that comedian Rob Delaney wrote in February 2010, which makes the rounds on social media periodically, simply because writing it was an act of service. It begins, “I deal with suicidal, unipolar depression and I take medication daily to treat it.” It goes on to discuss things that people who’ve never been depressed might find hard to imagine: “My mind played one thought over and over, which was ‘Kill yourself.’” At the time Delaney wrote the post, he was only a year and a half past his second major episode of depressive symptoms, and the immediacy of not waiting until he felt entirely safe is part of what gives the post power, and part of why people who are depressed know that he’s not lying when he says he knows what they’re feeling.
First-person cultural narratives about major battles are often written through the distorting haze of a long memory — that’s what David Carr was trying to counter when he investigated his own past for his memoir Night Of The Gun. But there’s no substitute, really, for the necessary honesty that comes with currency. Allie Brosh is Allie Brosh right now. You can wish her well, but she’ll tell you she’s not sure how it’s going. That’s part of why people with depression believe her. It’s part of why they trust her so much. She told The Telegraph about depression: “It’s sort of like a thing that is maybe a tunnel, but also maybe a giant tube that just keeps going in a circle. And you can’t tell which one it is while you’re in it. There might be light, but there might just be more tube.”
If you want to know how hard it is, she’s telling you that’s how hard it is. Not was, is. And as uncomfortable as that might be, it’s a perspective worth offering.
There is a motif, in fiction and in life, of people having wonderful things happen to them, but still ending up unhappy. We can adapt to anything, it seems—you can get your dream job, marry a wonderful human, finally get 1 million dollars or Twitter followers—eventually we acclimate and find new things to complain about.
If you want to look at it on a micro level, take an average day. You go to work; make some money; eat some food; interact with friends, family or co-workers; go home; and watch some TV. Nothing particularly bad happens, but you still can’t shake a feeling of stress, or worry, or inadequacy, or loneliness.
According to Dr. Rick Hanson, a neuropsychologist, a member of U.C. Berkeley’s Greater Good Science Center’s advisory board, and author of the book Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence, our brains are naturally wired to focus on the negative, which can make us feel stressed and unhappy even though there are a lot of positive things in our lives. True, life can be hard, and legitimately terrible sometimes. Hanson’s book (a sort of self-help manual grounded in research on learning and brain structure) doesn’t suggest that we avoid dwelling on negative experiences altogether—that would be impossible. Instead, he advocates training our brains to appreciate positive experiences when we do have them, by taking the time to focus on them and install them in the brain.
I spoke with Hanson about this practice, which he calls “taking in the good,” and how evolution optimized our brains for survival, but not necessarily happiness…
Researchers at the University of Exeter have been bridging the gap between art and science by mapping the different ways in which the brain responds to poetry and prose. The team used state-of-the-art functional magnetic resonance imaging (fMRI) technology to visual how the brain activates certain regions to process various activities.
Before this study, no one had specifically examined the brain’s differing responses to poetry and prose. The results, published in the Journal of Consciousness Studies, revealed activity within a “reading network” of brain regions that were activated in response to any written material.
The team also found that emotionally charged writing activated areas of the brain which are known to respond to music. Predominantly on the right side, these regions had previously been shown to give rise to the “shivers down the spine” feeling caused by an emotional response to music.
The researchers found that when study participants read one of their favorite passages of poetry, regions of the brain associated with memory were stimulated more strongly than “reading areas.” This suggests that reading a favorite passage is like a recollection.
When the team specifically compared poetry to prose, they found evidence that poetry activates brain regions associated with introspection – such as the posterior cingulate cortex and medial temporal lobes.
interdisciplinary team of researchers from the fields of psychology and English. They recruited 13 volunteers, all faculty members and senior graduate students in English, then scanned their brain activity. These scans were compared when reading literal prose – such as an excerpt from a heating installation manual, evocative passages from novels, easy and difficult sonnets, and their favorite poetry.
According to Zeman, “Some people say it is impossible to reconcile science and art, but new brain imaging technology means we are now seeing a growing body of evidence about how the brain responds to the experience of art. This was a preliminary study, but it is all part of work that is helping us to make psychological, biological, anatomical sense of art.”
“This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”—
There are many reasons clients decide to end therapy. According to clinical psychologist Deborah Serani, Psy.D, “Sometimes they’ve reached their goals. Sometimes they need a break. Sometimes the connection with their therapist isn’t there.” Sometimes they notice a red flag. Sometimes they’re about to face a new fear or realize a new insight, said Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy.”
“Whatever the reason, it’s vital to bring it into your sessions as soon as you feel it,” said Serani, author of the book Living With Depression. Howes agreed. Wanting to end therapy is a critical topic to explore, he said. And it could be as simple as telling your therapist, “I feel like it’s time to end therapy, I wonder what that’s all about?”
Therapy gives people the opportunity to have a positive ending, unlike most endings, which tend to be negative, such as death and divorce, Howes said. An end in therapy can be “more like a bittersweet graduation than a sad, abrupt, or complicated loss. Ideally, you can have a satisfying closure to therapy that will help you end relationships well in the future.”
That’s because our relationship with our therapist frequently mirrors our relationships outside their office. “We often unconsciously recreate dynamics from other relationships with our therapist,” said Joyce Marter, LCPC, a therapist and owner of the counseling practiceUrban Balance. “Processing negative feelings can be a way to work through maladaptive patterns and make the therapeutic relationship a corrective experience. If you avoid this conversation by simply discontinuing therapy, you will miss this opportunity for a deeper level of healing resulting from your therapy.”
Tips on Ending Therapy
Below, clinicians share additional thoughts on the best ways to approach your therapist when you’d like to end therapy.
1. Figure out why you’d like to leave. According to Jeffrey Sumber, M.A., a psychotherapist, author and teacher, the best way to end therapy is to delve into why you’d like to leave. Ask yourself: Is it “because I feel disrespected, stuck or incompatible or [am I] actually feeling uncomfortable dealing with certain things that the counselor is pushing me on?” It’s common and part of the process of changing problematic patterns, he said, to feel triggered and even angry with your therapist.
2. Don’t stop therapy abruptly. Again, it’s important for clients to talk with their therapists, because they may realize that their desire to part ways is premature. Even if you decide to leave therapy, processing this is helpful. “A session or two to discuss how you feel and what kinds of post-treatment experiences you may go through will help ease guilt, regret or sadness that often arises when wanting to stop therapy,” Serani said.
Plus, “Honoring the relationship and the work you have done together with some sessions to achieve closure in a positive way can be a very powerful experience,” Marter said.
But there are exceptions. Howes suggested leaving abruptly if there are ethical violations. He reminded readers that you’re “the boss” in therapy:
If there have been significant ethical violations in therapy – sexual advances, breached confidentiality, boundary violations, etc. – it may be best to leave and seek treatment elsewhere. It’s important for clients to know they are the boss; it’s your time and your dime, and you can leave whenever you want. If the violations are serious enough, you may want to tell your therapist’s boss, your next therapist, or the licensing board about them.
3. Talk in person. Avoid ending therapy with a text, email or voicemail, Marter said. “Speaking directly is an opportunity to practice assertive communication and perhaps also conflict resolution, making it is an opportunity for learning and growth.”
4. Be honest. “If you feel comfortable and emotionally safe doing so, it is best to be direct and honest with your therapist about how you are feeling about him or her, the therapeutic relationship or the counseling process,” Marter said.
When offering feedback to your therapist, do so “without bitterness or judgment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “After all, this person will be working with others in the future, and your thoughts may change his or her style, and help them to better serve their clients in the future.”
“A good therapist will be open to feedback and will use it to continually improve,” added Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health.
5. Communicate clearly. “Your best bet is to be as direct, open, and clear as possible,” Hibbert said. Articulate your exact reasons for wanting to end therapy. Hibbert gave the following examples: “’I didn’t agree with what you said last session and it makes me feel like this isn’t going to work,’ or ‘I’ve tried several sessions, but I just don’t feel like we’re a good match.’”
(“’Not being a “good match’ is a perfectly good reason to terminate therapy, since so much of it has to do with a good personality fit and a trusting relationship,” she added.)
6. Be ready for your therapist to disagree. According to Serani, “It is not unusual for a therapist to agree with ending therapy, especially if you’ve reached your goals and are doing well.” But they also might disagree with you, she said. Still, remember that this is “your therapy.” “Don’t agree to continue if you truly want to stop, or feel persuaded to keep coming for sessions because your therapist pressures you to stay.”
7. Plan for the end in the beginning. “Every therapy ends, there’s no reason to deny this fact,” Howes said. He suggested discussing termination at the start of treatment. “Early in therapy when you’re covering your treatment goals, why not talk about how and when you’d like therapy to end? Will you stop when you’ve achieved all your goals? When the insurance runs out? When and if you get bored in therapy?”
Again, therapy can teach you valuable skills to use for your other relationships. According to Marter, “Even if after expressing your negative feelings, you choose to end the therapeutic relationship, you can rest assured that you took good care of yourself by advocating for yourself in a way that was direct and honest. This is a skill you can bring with you to other relationships that are no longer working for you.”
Psychotherapy is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent.
This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.
As well they should: for patients with the most common conditions, like depression and anxiety, empirically supported psychotherapies — that is, those shown to be safe and effective in randomized controlled trials — are indeed the best treatments of first choice. Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.
So what explains the gap between what people might prefer and benefit from, and what they get?
The answer is that psychotherapy has an image problem. Primary care physicians, insurers, policy makers, the public and even many therapists are largely unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries — industries that, not incidentally, also have the money to aggressively market and lobby for those practices.
For the sake of patients and the health care system itself, psychotherapy needs to overhaul its image, more aggressively embracing, formalizing and promoting its empirically supported methods.
My colleague Ivan W. Miller and I recently surveyed the empirical literature on psychotherapy in a series of papers we edited for the November edition of the journal Clinical Psychology Review. It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).
In the short term, these therapies are about as effective as medications in reducing symptoms of clinical depression or anxiety disorders. They can also produce better long-term results for patients and their family members, in that they often improve functioning in social and work contexts and prevent relapse better than medications.
Given the chronic nature of many psychiatric conditions, the more lasting benefits of psychotherapy could help reduce our health care costs and climbing disability rates, which haven’t been significantly affected by the large increases in psychotropic medication prescribing in recent decades.
Psychotherapy faces an uphill battle in making this case to the public. There is no Big Therapy to counteract Big Pharma, with its billions of dollars spent on lobbying, advertising and research and development efforts. Most psychotherapies come from humble beginnings, born from an initial insight in the consulting office or a research finding that is quietly tested and refined in larger studies.
The fact that medications have a clearer, better marketed evidence base leads to more reliable insurance coverage than psychotherapy has. It also means more prescriptions and fewer referrals to psychotherapy.
But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.
There is a lot of organizational catching up to do. Groups like the American Psychiatric Association, which typically promote medications as treatments of first choice, have been publishing practice guidelines for more than two decades, providing recommendations for which treatments to use under what circumstances. The American Psychological Association, which promotes psychotherapeutic approaches, only recently formed a committee to begin developing treatment guidelines.
Professional psychotherapy organizations also must devote more of their membership dues and resources to lobbying efforts as well as to marketing campaigns targeting consumers, primary care providers and insurers.
If psychotherapeutic services and expenditures are not based on the best available research, the profession will be further squeezed out by a health care system that increasingly — and rightly — favors evidence-based medicine. Many of psychotherapy’s practices already meet such standards. For the good of its patients, the profession must fight for the parity it deserves.
Brandon A. Gaudiano is a clinical psychologist and assistant professor of psychiatry and human behavior at the Alpert Medical School at Brown University.
Hello! Just wanted to drop a quick note to everyone out there and let you know that I’ll be returning to far more frequent and regular posting as of this week. I’ve been crazy busy the past few months, and this site was (sadly) one of the things I had to leave on the side of the road for a while…but I’m ready to jump back in. A heartfelt thanks to all those who’ve stuck around!
“I was sitting on a plane next to a psychiatrist and I said to her, “I’ve just written this book and it has another abandoned child in it. Another loveless person abandons another child in the beginning. What is it about abandonment?” This psychiatrist, who had a deep, scratchy voice, said, “My dear, we are all abandoned.”—Louise Erdrich
You need to build an ability to just be yourself and not be doing something. That’s what the phones are taking away, is the ability to just sit there. That’s being a person. Because underneath everything in your life there is that thing, that empty—forever empty. That knowledge that it’s all for nothing and that you’re alone. It’s down there.
And sometimes when things clear away, you’re not watching anything, you’re in your car, and you start going, ‘oh no, here it comes. That I’m alone.’ It starts to visit on you. Just this sadness. Life is tremendously sad, just by being in it…
That’s why we text and drive. I look around, pretty much 100 percent of the people driving are texting. And they’re killing, everybody’s murdering each other with their cars. But people are willing to risk taking a life and ruining their own because they don’t want to be alone for a second because it’s so hard.
And I go, ‘oh, I’m getting sad, gotta get the phone and write “hi” to like 50 people’…then I said, ‘you know what, don’t. Just be sad. Just let the sadness, stand in the way of it, and let it hit you like a truck.’
And I let it come, and I just started to feel ‘oh my God,’and I pulled over and I just cried like a bitch. I cried so much. And it was beautiful. Sadness is poetic. You’re lucky to live sad moments.
And then I had happy feelings. Because when you let yourself feel sad, your body has antibodies, it has happiness that comes rushing in to meet the sadness. So I was grateful to feel sad, and then I met it with true, profound happiness.
One day you finally knew what you had to do, and began, though the voices around you kept shouting their bad advice— though the whole house began to tremble and you felt the old tug at your ankles. "Mend my life!" each voice cried. But you didn’t stop. You knew what you had to do, though the wind pried with its stiff fingers at the very foundations, though their melancholy was terrible. It was already late enough, and a wild night, and the road full of fallen branches and stones. But little by little, as you left their voices behind, the stars began to burn through the sheets of clouds, and there was a new voice which you slowly recognized as your own, that kept you company as you strode deeper and deeper into the world determined to do the only thing you could do— determined to save the only life you could save.
There isn’t any point in denying that the outburst of sympathy and support that followed my confession to an attempt at self-slaughter last year (Richard Herring podcast) has touched me very deeply.
Some people, as some people always will, cannot understand that depression (or in my case cyclothymia, a form of bipolar disorder) is an illness and they are themselves perhaps the sufferers of a malady that one might call either an obsession with money, or a woeful lack of imagination.
“How can someone so well-off, well-known and successful have depression?” they ask. Alastair Campbell in a marvelous article, suggested changing the word “depression” to “cancer” or “diabetes” in order to reveal how, in its own way, sick a question, it is. Ill-natured, ill-informed, ill-willed or just plain ill, it’s hard to say.
But, most people, a surging, warm, caring majority, have been kind. Almost too kind. There’s something a little flustering and embarrassing when a taxi-driver shakes you by the hand, looks deep into your eyes and says “You look after yourself, mate, yes? Promise me?” And there’s something perhaps not too helpful to one’s mental health when it is the only subject people want to talk to you about, however kindly or for whatever reasons.
But I have nothing to complain about. I won’t go into the terrible details of the bottle of vodka, the mixture of pills and the closeness to permanent oblivion I came. You can imagine them and I don’t want to upset the poor TV producer and hotel staff who had to break down my door and find me in the unconscious state I was in, four broken ribs thanks to some sort of convulsive fit that must have overtaken me while I lay almost comatose, vomit dribbling from my mouth. You can picture the scene.
The episode, plus the relationship I now have with a magnificent psychiatrist, has made made my mental health better, I think, than it’s ever been. I used to think it utterly normal that I suffered from “suicidal ideation” on an almost daily basis. In other words, for as long as I can remember, the thought of ending my life came to me frequently and obsessively. But then it’s the thought behind the most famous speech in all history. To be, or not to be:
To be, or not to be: that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them? To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause: there’s the respect
That makes calamity of so long life;
For who would bear the whips and scorns of time,
The oppressor’s wrong, the proud man’s contumely,
The pangs of despised love, the law’s delay,
The insolence of office and the spurns
That patient merit of the unworthy takes,
When he himself might his quietus make
With a bare bodkin? who would fardels bear,
To grunt and sweat under a weary life,
But that the dread of something after death,
The undiscover’d country from whose bourn
No traveller returns, puzzles the will
And makes us rather bear those ills we have
Than fly to others that we know not of?
Thus conscience does make cowards of us all;
And thus the native hue of resolution
Is sicklied o’er with the pale cast of thought,
And enterprises of great pith and moment
With this regard their currents turn awry,
And lose the name of action…
Take time to read it slowly to yourself or out loud. I don’t have Hamlet’s wit (or Shakespeare’s of course) but every logical or doubtful step from line to line expresses better how hard I thought about the advantages and cursed (as I thought) disadvantages against suicide. The speech, for the most part, stayed my hand. As it did Hamlet’s.
But medicine, much as some don’t like to hear it, can help. I am on a regime of four a day. One is an SNRI, the other a mood-stabilizer. I haven’t considered suicide in anything other than a puzzled intellectual way since this pharmaceutical regime “kicked in”.
But I can still be sad. Perhaps you might go to my tumblr page and see what Bertrand Russell wrote about his abiding passions (it’s the last section of the page). I can be sad for the same reason he was, though I do so much less about it than that great man did. But I can be sad for personal reasons because I am often forlorn, unhappy and lonely. These are qualities all humans suffer from and do not qualify (except in their worst extremes) as mental illnesses.
Lonely? I get invitation cards through the post almost every day. I shall be in the Royal Box at Wimbledon and I have serious and generous offers from friends asking me to join them in the South of France, Italy, Sicily, South Africa, British Columbia and America this summer. I have two months to start a book before I go off to Broadway for a run of Twelfth Night there.
I can read back that last sentence and see that, bipolar or not, if I’m under treatment and not actually depressed, what the fuck right do I have to be lonely, unhappy or forlorn? I don’t have the right. But there again I don’t have the right not to have those feelings. Feelings are not something to which one does or does not have rights.
In the end loneliness is the most terrible and contradictory of my problems. I hate having only myself to come home to. If I have a book to write, it’s fine. I’m up so early in the morning that even I pop out for an early supper I am happy to go straight to bed, eager to be up and writing at dawn the next day. But otherwise…
It’s not that I want a sexual partner, a long-term partner, someone to share a bed and a snuggle on the sofa with – although perhaps I do and in the past I have had and it has been joyful. But the fact is I value my privacy too. It’s a lose-lose matter. I don’t want to be alone, but I want to be left alone. Perhaps this is just a form of narcissism, vanity, overdemanding entitlement – give it whatever derogatory term you think it deserves. I don’t know the answer.
I suppose I just don’t like my own company very much. Which is odd, given how many times people very kindly tell me that they’d put me on their ideal dinner party guestlist. I do think I can usually be relied upon to be good company when I’m out and about and sitting round a table chatting, being silly, sharing jokes and stories and bringing shy people out of their shells.
But then I get home and I’m all alone again.
I don’t write this for sympathy. I don’t write it as part as my on going and undying commitment to the cause of mental health charities like Mind. I don’t quite know why I write it. I think I write it because it fascinates me.
And perhaps I am writing this for any of you out there who are lonely too. There’s not much we can do about it. I am luckier than many of you because I am lonely in a crowd of people who are mostly very nice to me and appear to be pleased to meet me. But I want you to know that you are not alone in your being alone.Loneliness is not much written about (my spell-check wanted me to say that loveliness is not much written about – how wrong that is) but humankind is a social species and maybe it’s something we should think about more than we do. I cannot think of many plays or documentaries or novels about lonely people. Aah, look at them all, Paul McCartney enjoined us in Eleanor Rigby… where do they all come from?
The strange thing is, if you see me in the street and engage in conversation I will probably freeze into polite fear and smile inanely until I can get away to be on my lonely ownsome.
“Nobody ever gets blamed for getting physical illness – even when those illnesses do result from lifestyle choices – so why on earth do we still talk about depression like it is the fault, and the lifestyle choice, of the depressive? Believe me, nobody who has had it would choose it for themselves, nor wish it on their worst enemy.”—Alastair Campbell
Gabbard and Gabbard (1999) categorized psychotherapists (all disciplines) in pre-1950s films into three stereotypes: the Alienist, a 19th century term, e.g., The Front Page; His Girl Friday;the Quack, e.g., Carefree, with dancing psychiatrist Fred Astaire; and, the Oracle, an intelligent, mystical psychotherapist, e.g., Blind Alley. Schneider (1987) found three common stereotypes, which he termed: Dr. Dippy, e.g., Peter Sellers in What’s New, Pussycat?; Dr. Evil, e.g., Michael Caine in Dressed to Kill; and, Dr. Wonderful, e.g., Judd Hirsch in Ordinary People. [The “Dr. Dippy” term comes from the first film portrayal of a psychiatrist, Dr. Dippy’s Sanitarium (1906).] Wedding and Niemiec (2003) expanded these categories into eight primary themes: Arrogant and Ineffectual; Cold-Hearted and Authoritarian; Dangerous and Omniscient; Learned and Authoritative; Motivating and Well-Intentioned; Passive and Apathetic; Seductive and Unethical; and, Shrewd and Manipulative. [In Wedding, Boyd, and Niemiec’s 2005 edition of Movies and Mental Illness: Using Films to Understand Psychopathology, they further discuss film portrayal of mental health treatment and offer a small collection of “balanced” and “unbalanced” portrayals.] Schultz (2005) specifically considered the portrayal of psychologists in the movies and added two more categories to Schneider’s three: Dr. Rigid, e.g., “store” psychologist in Miracle on 34th Street; and, Dr. Line-Crosser, e.g., Dr. Sean Maguire in Good Will Hunting.
Are you uncomfortable with ambiguity? It’s a common condition, but a highly problematic one. The compulsion to quell that unease can inspire snap judgments, rigid thinking, and bad decision-making.
Fortunately, new research suggests a simple antidote for this affliction: Read more literary fiction.
A trio of University of Toronto scholars, led by psychologist Maja Djikic, report that people who have just read a short story have less need for what psychologists call “cognitive closure.” Compared with peers who have just read an essay, they expressed more comfort with disorder and uncertainty—attitudes that allow for both sophisticated thinking and greater creativity.
“Exposure to literature,” the researchers write in the Creativity Research Journal, “may offer a (way for people) to become more likely to open their minds.”
Despite the fact that their sexual preferences are listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as potentially problematic, people who play with whips and chains in the bedroom may actually be more psychologically healthy than those who don’t.
A new study finds that practitioners of bondage, discipline, sadism and masochism, or BDSM, score better on a variety of personality and psychological measures than “vanilla” people who don’t engage in unusual sex acts. BDSM is a sexual practice that revolves around those four fetishes.
BDSM is listed in the DSM-5, the newest edition of the definitive psychiatrist’s manual, as a paraphilia, or unusual sexual fixation — a label that has caused controversy between kinky communities and psychiatrists, who themselves are mixed on whether sexual predilections belong in the catalog of mental disorders. As written, the DSM-5 does not label BDSM a disorder unless it causes harm to the practitioner or to others.
Nevertheless, some psychiatrists see the inclusion of BDSM and other kinks in the manual as stigmatizing, particularly because studies have failed to show evidence that enjoying sex with a side of pain is linked to psychological problems. The new study, published May 16 in the Journal of Sexual Medicine, finds that, in fact, BDSM practitioners may be better off psychologically than the general public.
BDSM practitioners “either did not differ from the general population and if they differed, they always differed in the more favorable direction,” said study researcher Andreas Wismeijer, a psychologist at Nyenrode Business University in the Netherlands who conducted the research while at Tilburg University.
Wismeijer did not set out to study the psychological health of BDSM aficionados. His research typically focuses on the psychology of secrets and secrecy. A chance meeting with the founder of the Netherlands’ largest BDSM Web forum convinced him the group might make an interesting study population to look at how secrets are kept and who keeps them.
Wismeijer and his colleagues put out a request on the forum for people in the BDSM “scene” to take a variety of psychological questionnaires online. They also sought participants who didn’t do BDSM via a women’s magazine website, a personal secret website and a university website.
None of the participants knew what the surveys were about, other than they were on “human behavior.” All told, 902 BDSM practitioners and 434 vanilla (non-BDSM) participants filled out questionnaires on personality, sensitivity to rejection, style of attachment in relationships and well-being.
The researchers chose these baseline measures because previous research on those in the BDSM community has focused on dire outcomes — whether they’re more likely to have mental disorders or report rape and abuse compared with the general public. (They aren’t, studies have found.)
The new results reveal that on a basic level, BDSM practitioners don’t appear to be more troubled than the general population. They were more extroverted, more open to new experiences and more conscientious than vanilla participants; they were also less neurotic, a personality trait marked by anxiety. BDSM aficionados also scored lower than the general public on rejection sensitivity, a measure of how paranoid people are about others disliking them.
People in the BDSM scene reported higher levels of well-being in the past two weeks than people outside it, and they reported more secure feelings of attachment in their relationships, the researchers found.
Of the BDSM practitioners, 33 percent of the men reported being submissive, 48 percent dominant and 18 percent “switch,” or willing to switch between submissive and dominant roles in bed. About 75 percent of the female BDSM respondents were submissive, 8 percent dominant and 16 percent switch.
These roles showed some links to psychological health, such that dominants tended to score highest in all quarters, submissives lowest and switches in the middle. However, submissives never scored lower than vanilla participants on mental health, and frequently scored higher, Wismeijer told LiveScience.
"Within the BDSM community, [submissives] were always perceived as the most vulnerable, but still, there was not one finding in which the submissives scored less favorable than the controls," he said.
The study is somewhat limited by a self-selecting response pool and by the fact that BDSM practitioners could have been answering in ways to make themselves look better and avoid stigma, Wismeijer said — though the fact that the participants didn’t know the reasons for the study ameliorates that concern somewhat. The findings are reason for mental health professionals to take an accepting approach to BDSM practitioners, Wismeijer said.
"We did not have any findings suggesting that people who practice BDSM have a damaged psychological profile or have some sort of psychopathology or personality disorder," he said.
Wismeijer isn’t exactly sure why BDSM practitioners might be psychologically healthier than the general public. They tend to be more aware of their sexual needs and desires than vanilla people, he said, which could translate to less frustration in bed and in relationships. Coming to terms with their unusual sexual predilections and choosing to live the BDSM lifestyle may also take hard psychological work that translates to positive mental health, he said.
One study alone shouldn’t determine whether a condition is placed in the DSM or not, Wismeijer said, but added that combined with other research, the new findings suggest BDSM is better seen as a lifestyle choice, if a slightly strange one.
"I’m not so convinced that BDSM should be placed within the DSM-5," he said.
Have you ever listened to the Dr.Drew Podcast on Itunes? Thursday an episode with Dr. Stephen Porges, who discussed his Polyvagal Theory aired. Do you have any understanding of this theory or just how to communicate better with the face/voice? I have noticed my face and voice become monotone at times and I would like to improve this. Thank you for your help, I really appreciate your blog and I find myself taking a lot away from each and every post.
Thanks for the kids words about the site, they are much appreciated.
I haven’t heard the Dr. Drew Podcast, but I do know a bit about Polyvagal Theory. I’m certainly not an expert in that area though, but rather more of an interested observer, watching and learning more about the theory as it continues to evolve. I think a great place to start, in order to understand a bit more about the theory and how it works, is to read this interview with Porges: http://www.nexuspub.com/articles_2006/interview_porges_06_ma.php
“I think it is unnatural to think that there is such a thing as a blue-sky, white-clouded happy childhood for anybody. Childhood is a very, very tricky business of surviving it. Because if one thing goes wrong or anything goes wrong, and usually something goes wrong, then you are compromised as a human being. You’re going to trip over that for a good part of your life.”—Maurice Sendak, who would have turned 85 today.
“Let’s face it. We’re undone by each other. And if we’re not, we’re missing something. If this seems so clearly the case with grief, it is only because it was already the case with desire. One does not always stay intact.”—Judith Butler, Precarious Life: The Powers of Mourning and Violence
“We need to accept our age. We need to accept many physical and mental illnesses and addictions. We need to accept the past. We need to accept others as they are. This isn’t to say we need to like it, or that we can’t work to make the best of each of these entities, but we need to relinquish the idea that we have any power or responsibility to change them. Once people realize they can accept instead of fighting things beyond their control, they realize they have much more time and energy for things they can impact.”—Ryan Howes, clinical psychologist
But let’s also recognize the positive attributes of the opposing team!
Come on, Knicks! But please note that I’m supporting the Knicks because I live in the same city as the team’s arena, which is a distinction as arbitrary as what players are assigned to what team! That is, I could just as easily be supporting the other team were I to live in their arena’s city!
Melo, you suck! And in some cultures you would be revered for such behavior! The Yanomami tribe, for example, will affect a sucking motion to indicate safe passage to a neighboring tribe!
Ref, are you blind? If so, it would be amazing that you’ve been so accurately officiating up until this last play, which, for vantage reasons, appeared to me to be called incorrectly! Of course, I’m judging this as a layman and you have a far more appropriate view to fully evaluate what just occurred! I honor your craft and insight and, in a way, I value your incorrect calls! It means you’re human, and that’s healthy! Feel good about yourself and, in moments like this, remember how many calls you got right! The world is complicated!
DEFENSE! DEFENSE! But also, OFFENSE! OFFENSE! Lest we forget how quickly the offense becomes the defense! These frameworks are constantly in flux!
FOUL? Are you kidding me? If you are, I will say, simply, thank you! Laughter and joke-telling is healthy and can be used to convey messages that may otherwise be too difficult to express!
Get your head out of your ass, you must be the most flexible person I’ve ever seen!
Go for a three! I want to see this game go to overtime! I know it’s difficult to hear, but I believe there is a future for you both! Right now, you’re in the thick of it, you’re blinded by anger, which is normal and understandable! Frankly, I’d be surprised if you weren’t upset! The wounds haven’t yet healed!
There were flagrant fouls, yes! And there were missed opportunities! But there were good moments as well! The national anthem! The jump ball! The halftime show! These were good and right and real! And to discount these good moments is as irresponsible as to count only the bad moments!
In fact, may you both win, regardless of the score! What is a “score” anyway? An arbitrary number assigned in accordance with how many times a ball goes through a hoop? How silly compared to the amount of times you’ve overcome adversity together! Why don’t we count those times? Like when there was a loose ball, and everyone tried to pick it up, regardless of allegiance—there were no “teams” then! There were no egos! There was just a ball that needed picking up!
If we’re going to count the score, why not count smiles? Or pats on the back? Or simple gestures that tell the other person, “Hey, I get it”?
What’s that? I’m being kicked out of the game? Why? What’d I do?
I’m talking too much? I’m being too loud and ruining the experience for those around me?
Well, that’s perfectly understandable! Here we are trying to enjoy a sporting event, and I’m distracting everyone with my misguided enthusiasm, unending commentary, and meticulous analyses that conflict with the spirit of the game!
I can totally understand where you guys are coming from and I will leave on my own accord! In fact, I thank you for your blunt dismissal of me! I don’t think I deserve to explain my position, as my actions have already indicated my lack of regard for the other fans, the teams, and, frankly, the sport at large!
O.K., O.K., I’m leaving!
I hope you all enjoy the rest of the game! May the home team prevail! Or the visiting team! Or, if possible, may they both prevail by transcending the false notion of prevailing!
Marvin Tolkin was 83 when he decided that the unexamined life wasn’t worth living. Until then, it had never occurred to him that there might be emotional “issues” he wanted to explore with a counselor.
“I don’t think I ever needed therapy,” said Mr. Tolkin, a retired manufacturer of women’s undergarments who lives in Manhattan and Hewlett Harbor, N.Y.
Though he wasn’t clinically depressed, Mr. Tolkin did suffer from migraines and “struggled through a lot of things in my life” — the demise of a long-term business partnership, the sudden death of his first wife 18 years ago. He worried about his children and grandchildren, and his relationship with his current wife, Carole.
“When I hit my 80s I thought, ‘The hell with this.’ I don’t know how long I’m going to live, I want to make it easier,” said Mr. Tolkin, now 86. “Everybody needs help, and everybody makes mistakes. I needed to reach outside my own capabilities.”
So Mr. Tolkin began seeing Dr. Robert C. Abrams, a professor of clinical psychiatry at Weill Cornell Medical College in Manhattan. They meet once a month for 45 minutes, exploring the problems that were weighing on Mr. Tolkin. “Dr. Abrams is giving me a perspective that I didn’t think about,” he said. “It’s been making the transition of living at this age in relation to my family very doable and very livable.”
Mr. Tolkin is one of many seniors who are seeking psychological help late in life. Most never set foot near an analyst’s couch in their younger years. But now, as people are living longer, and the stigma of psychological counseling has diminished, they are recognizing that their golden years might be easier if they alleviate the problems they have been carrying around for decades. It also helps that Medicare pays for psychiatric assessments and therapy.
“We’ve been seeing more people in their 80s and older over the past five years, many who have never done therapy before,” said Dolores Gallagher-Thompson, a professor of research in the department of psychiatry at Stanford. “Usually, they’ve tried other resources like their church, or talked to family. They’re realizing that they’re living longer, and if you’ve got another 10 or 15 years, why be miserable if there’s something that can help you?”
“It’s never too late, if someone has never dealt with issues,” said Judith Repetur, a clinical social worker in New York who works almost exclusively with older patients, many of whom are seeking help for the first time. “A combination of stresses late in life can bring up problems that weren’t resolved.”
That members of the Greatest Generation would feel comfortable talking to a therapist, or acknowledging psychological distress, is a significant change. Many grew up in an era when only “crazy” people sought psychiatric help. They would never admit to themselves — and certainly not others — that anything might be wrong.
“For people in their 80s and 90s now, depression was considered almost a moral weakness,” said Dr. Gallagher-Thompson. “Fifty years ago, when they were in their 20s and 30s, people were locked up and someone threw away the key. They had a terrible fear that if they said they were depressed, they were going to end up in an institution. So they learned to look good and cover their problems as best they could.”
But those attitudes have shifted over time, along with the medical community’s understanding of mental illness among seniors. In the past, the assumption was that if older people were acting strangely or having problems, it was probably dementia. But now, “the awareness of depression, anxiety disorders and substance abuse as possible problems has grown,” said Bob G. Knight, a professor of gerontology and psychology at the University of Southern California, and the author of “Psychotherapy With Older Adults.”
In years past, too, there was a sense among medical professionals that a patient often could not be helped after a certain age unless he had received treatment earlier in life. Freud noted that around age 50, “the elasticity of the mental process on which treatment depends is, as a rule, lacking,” adding, “Old people are no longer educable.” (Never mind that he continued working until he died at 83.)
“That’s been totally turned around by what we’ve learned about cognitive psychology and cognitive approach — changing the way you think about things, redirecting your emotions in more positive ways,” said Karl Pillemer, a gerontologist and professor of human development at Cornell, and author of “30 Lessons for Living.”
Treatment regimens can be difficult in this population. Antidepressants, for instance, can have unpleasant side effects and only add to the pile of pills many elderly patients take daily. Older patients may feel that they don’t have the time necessary to explore psychotherapy, or that it’s too late to change.
But many eagerly embrace talk therapy, particularly cognitive behavioral techniques that focus on altering thought patterns and behaviors affecting their quality of life now. Experts say that seniors generally have a higher satisfaction rate in therapy than younger people because they are usually more serious about it. Time is critical, and their goals usually are well defined.
“Older patients realize that time is limited and precious and not to be wasted,” said Dr. Abrams. “They tend to be serious about the discussion and less tolerant of wasted time. They make great patients.”
Members of the Tylenol groups reported feeling less upset following conversations about death and other existential topics.
“Nobody has shown this before, and we are surprised that the effect emerged so robustly,” said lead researcher Daniel Randles, “that a drug meant primarily to alleviate headaches also prevents people from being bothered all that much by thinking about death. It was certainly surprising.”
The researchers found that those who had taken the Tylenol did not experience feelings of existential dread and “looked just like the control group that hadn’t talked about their death or watched the unpleasant [film] clip.”
“Gracious acceptance is an art - an art which most never bother to cultivate. We think that we have to learn how to give, but we forget about accepting things, which can be much harder than giving…. Accepting another person’s gift is allowing him to express his feelings for you.”—Alexander McCall Smith
New research suggests that babies’ brains can process emotional tones of voice, a capability that could potentially lead to problems in dealing with stress and emotions.
Researchers from the University of Oregon found that infants respond to angry tone of voice, even when they’re asleep.
Babies’ brains are very malleable, allowing them to develop in response to the environments and encounters they experience. But this adaptability comes with a certain degree of vulnerability: Research has shown that severe stress, such as maltreatment or institutionalization, can have a significant, negative impact on child development.
Graduate student Alice Graham and psychologists Drs. Phil Fisher and Jennifer Pfeifer wondered what the impact of more moderate stressors might be.
“We were interested in whether a common source of early stress in children’s lives — conflict between parents — is associated with how infants’ brains function,” said Graham.
Graham and colleagues decided to take advantage of recent developments in fMRI scanning with infants to answer this question.
Twenty infants, ranging in age from six to 12 months, came into the lab at their regular bedtime. While they were asleep in the scanner, the infants were presented with nonsense sentences spoken in very angry, mildly angry, happy, and neutral tones of voice by a male adult.
“Even during sleep, infants showed distinct patterns of brain activity depending on the emotional tone of voice we presented,” Graham said.
The researchers found that infants from high conflict homes showed greater reactivity to very angry tone of voice in brain areas linked to stress and emotion regulation, such as the anterior cingulate cortex, caudate, thalamus, and hypothalamus.
This finding is consistent with lab studies on animals that discovered these brain areas play an important role in the impact of early life stress on development.
As such, the results of this new study suggest that the same might be true for human infants.
Researchers believe the findings show that babies are not oblivious to their parents’ conflicts, and exposure to these conflicts may influence the way babies’ brains process emotion and stress.
The study is to be published in the journal Psychological Science.
“Practice giving things away, not just things you don’t care about, but things you do like. Remember, it is not the size of a gift, it is its quality and the amount of mental attachment you overcome that count. So don’t bankrupt yourself on a momentary positive impulse, only to regret it later. Give thought to giving. Give small things, carefully, and observe the mental processes going along with the act of releasing the little thing you liked.”—Robert A.F. Thurman
Re: Ask Me Friday. I am about to go back to school to become a psychotherapist, myself, and am dying to get started on reading some literature. Please direct me to what you recommend as seminal/classic/important works - where to begin? Where to go? I'd love any recommendations. Thanks!
Well, I tend to be a rather obsessive and wide-ranging reader, and as a result my initial impulse is to recommend thousands of books to you, which I know is now what you’re looking for. I think learning goes on forever, and many different kinds of books can offer many different kinds of things to a therapist, aspring or established. Most days I think there’s probably a good deal more to be learned about human nature by reading Tolstoy or Virginia Woolf or David Foster Wallace than there is from a psychology text book of any kind.
But since your question was specifically regarding important and/or seminal psychological literature, I will try to keep myself to that. :)
So, for starters, read anything you can get your hands on from Irvin Yalom (especially Love’s Executioner and The Gift of Therapy), Carl Jung, Carl Rogers, Karen Horney (especially Neurosis and Human Growth), Erich Fromm, and William James. If you need more specific suggestions than that, feel free to let me know…
Do you have any advice for someone considering therapy/counseling as a career? I don't want to go to school forever but if it's absolutely necessary I'm open to it. Is there anything I should know beforehand?
Well, I guess the first thing I should tell you is that you absolutely don’t need to go to school forever to be a therapist or a counselor. There are many different paths to the career, most of which require an undergraduate degree of some kind (not even necessarily in psychology) and then a graduate degree (typically a 2 year program). You can always go to school longer to obtain a Ph’D or PsyD or become a full-on psychiatrist, but none of these are necessary paths to becoming a licensed therapist.
I’m not sure where you’re currently at in your schooling, so I’m not sure how many years that will mean you have to do, but assuming you’d at least planned to get an undergraduate degree in something already, then you’d only need to consider going to school an additonal two years to get yours Masters in a related-field (an MA in Counseling, an MSW, an MFT, etc). Once you have your graduate degree, you typically have to do a few years of post-graduate work in order to acquire the necessary client and supervision hours required to take the licensure exam for your particular state. And, once you’ve done all that, you will be a licensed therapist.
As far as non-schooling or training-related advice, in general I’d say it’s quite helpful to have a huge and deep curiosity about people if you want to do this work for many years, to view psychotherapy as far more an art than a science in general, and to make sure you can take good care of yourself on a personal level while doing the work (including good self-care habits, building and maintaining a fulfilling life outside of your work, and having your own therapist so that you can be aware of your own issues, struggles and blind spots).
“We are imperfect mortal beings, aware of that mortality even as we push it away, failed by our very complication, so wired that when we mourn our losses we also mourn, for better or for worse, ourselves. As we were. As we are no longer. As we will one day not be at all.”—