2010

Second Marriages

In this country, the divorce rate for first marriages weighs in at a whopping fifty percent. But the divorce rate for second marriages is even higher: sixty percent.

When people get divorced, it’s not uncommon for them to feel a strong desire to put the past behind them and move on. This is understandable, even laudable.

But if you move on without taking stock of what went wrong, you do yourself and your new partner a disservice. Marriages rarely fall apart because one party and one party alone was at fault. Typically, a pattern emerged in which both parties in the relationship contributed. It takes courage to explore this pattern and to identify your own role in helping to create it. It’s much easer to blame a former spouse for everything. But if you do that, what are the chances that you’ll escape the mistakes of the past?

As it turns out, couples can learn skills that help them communicate better. A little pre-marital counseling, whether it's your first marriage or your second, might save you some heartache later.

Seeing a Psychologist for the First Time


First, it's okay to be nervous. Just about everybody is. If you think about it, this normal because you're about to meet with a stranger to talk about your personal life.

If you're like most people, you've already begun to think about what you might say. And yet, even as you say it to yourself, well, it sounds crazy. You wonder, do you really need therapy, after all? And who says this process will actually help anyway; it's just talk, after all. How does talking help people? Can't your just talk one of your good friends?

Then again, you're tired of feeling the way you feel. Whatever the problem is, you're sick of it and you want it to go away. You're tired of feeling stuck. If the problem is serious, maybe you feel stuck and embarrassed or ashamed. How did it come to this? What will this guy think of you? Will he judge you? Diagnosis you?

So you go to your first appointment. When you arrive in his waiting room––is this the place?–-you see that it's not nearly as big as your physician's office. No one else is there. Just you. And then him, when he comes out of his office to greet you. He invites you into his office. Oh my, he actually has a couch. Are you expected to lay down? Is this psychoanalysis? If it is, this isn't what you signed for. He smiles. No, he says, the couch is for sitting. The couch comes in handy when couples come to his office.

So you sit down. Your anxiety has spiked a bit, especially when he asks you where you'd like to start. Hey, isn't that his job? Isn't he supposed to ask lots of questions...?

###

Hi. I'm Dr. Gibson, but please feel free to call me John.

Take a moment to settle yourself. A deep breath sometimes helps. And take your time; we're not in a hurry. Start anywhere. Yes, I'll help you with questions. (What's the problem? Can you give me and example of the problem?) My goal at this point is to listen to carefully to you to make sure I understand things from your point-of-view.

You may wondering whether I’ll think your crazy, bizarre, or abnormal. Well, I’ll let you in on a little secret: everybody has problems and issues, even psychologists. It's difficult to be human and not have problems of one sort or another.

You may be worried about whether I’ll secretly pass judgment on you, especially if you reveal some of your darkest thoughts and feelings, your problems, or stuff you done that you’re proud of. To the contrary, passing judgment rarely helps anybody. Showing compassion, however, does.

You may worried you’ll be “just another case of [x],” and that I’ll come across as too clinical. But nothing could be farther from the truth. My clients are people, not cases. They have distinct personalities, feelings, hopes and dreams, and yes, distress. I'm in the business of investing in people, in helping them create new possibilities. A case is something you study; a client is someone you help.

Although first session often feels unsettling, most people find themselves relaxing into it as we proceed. In part, this because they are putting their problems into words, and frankly, this can be helpful in and of itself because it often permits the release of negative emotions. But also, most clients come to experience me as an ally, a person who joins forces with them against their problem. Obviously I cannot do psychological work for my clients, but I do know the territory pretty well. I am a resourceful guide.

At the end of your first session, you'll want to ask yourself how comfortable you feel talking to me. In therapy (as in life) fit is everything. Not every individual or couple naturally fits with every therapist. You want to feel understood, and know that this therapist has experience with your type of problem.

Therapy is not friendship; it's a professional relationship that's asymmetrical relationship by design. Unlike friendship, which has a natural give-and-take, in therapy the focus is always on you.

Welcome. Let's make therapy a productive experience for you.



Anxiety


Sometimes people will come to therapy hoping that I can make their anxiety disappear, as if by psychological surgery. Almost as if anxiety is the psychological equivalent of an appendix. But therapy doesn't remove anxiety so much as help you learn to dial it back.

If your anxiety (apprehension, worry, panic attack, social discomfort, performance anxiety, etc) is running at about an 8 or 9 on a scale of 1 to 10 with ten being high, dialing it back to a 4 or 5 can make a huge difference.

But we never really eliminate anxiety altogether, any more than we eliminate other negative emotions like fear, anger, or sadness. Our emotions make us human, but they also help us make decisions. (Without emotions, we would have no values. Values tell us what's important to us.)

Anxiety is an emotional state that signals danger or threat or concern. We don't want to cut this out of your psyche. You need this signal. Life is sometimes dangerous or threatening. But too much anxiety, especially without the governing power of reason, spells trouble.

Or rather, avoidance.

Avoidance becomes its own problem. Avoidance robs you of life.

If anxiety is robbing your life, get help. Dare to try to therapy. Sure, you can read this blog post or read a book, and these are great ways to get information, raise awareness. But therapy helps you implement information. Therapy is an experience.

If you dial back your anxiety by just a few percentages points, you might live just a bit more fully. You might enjoy being alive again.


Related post: Brief Thoughts About Anxiety

The Hypothetical Client



I do not post information about my actual clients on this blog because therapy is a strictly confidential. This is as it should be.

And yet I also think it's helpful for people who are thinking about trying to therapy to get a feel for how therapy works and what we talk about.

Enter the HYPOTHETICAL client.

He could be young, old, male or female. He could be white, black, latino. He could be you, me, or your neighbor.

Our Hypothetical Client is depressed. Over the course of my practice, I've seen hundreds of depressed persons. Though I do not subscribe to the notion of putting people in categories (every client's depression is, in some ways, unique), depression tends to have universal symptoms. Our hypothetical client is struggling with depressed mood, low energy, loss of hope, and sleep problems. His concentration is not what it was and, perhaps more than anything, he just can't get going -- the depression is weighing him down. Maybe he spends too much time inert, sitting in a chair or on a couch, or maybe he forces himself to go work, but it's exhausting. Our hypothetical depressed person finds himself thinking that maybe he should just end it all...

If I were to work with our Hypothetical Client, here are three things I'd want to know:

1. What are the sources of his depression? Not the causes; causes are an entirely different matter, and they are complicated. But the sources. Most people who become depressed ruminate over certain aspects of their lives. Job, family, kids, failures, whatever. What I'd want to know is where does the rumination take him? First we follow the problems.

2. How can we make the problems solvable? Frequently when people become depressed, they become overwhelmed. Problems become mountains to climb and oceans to swim. In a depressed state, problems often seem impossible. As first step, however, we need to break the problems into solvable parts to make them more manageable. Therapy isn't just about talking out your feelings, it's about finding new actions to take.

3. Can we take a close look at his thinking patterns? Depression is a sad emotional state, true, but it is also a kind of thinking disorder. In the throes of depression, thinking gets muddled and distorted. Has our Hypothetical Client fallen into the trap of black or white thinking? (e.g., either I'm a success or a failure. Either I can do it right, or I can't do it at all. Hint: where is grey?) Or has he become a master of extracting negative information from all situations, while ignoring or dismissing the positive? We're not always aware of our own thinking patterns. We just think the way we think, and it feels natural to us. This is where I come in. I've spent countless hours helping people identify ways their own thinking is making problems worse.

This isn't the full story of what treatment for our Hypothetical Depressed Person would look like. Therapy is a complex business that is tailored to a specific individual (or couple). But maybe this gives you a taste of how a therapy for a depressed person might start.

For more information, check out these related posts: The Downward Spiral of Depression. And Tip for Coping with Depression.

Work and the Soul




What are the consequences of soul-less work?

You fantasize about getting out.
You are bored, disengaged, or numb.
You are not creative or original.
You are not as productive as you could be.
You fantasize about a miracle or a savior. ("Help! Get me out of here!")
You postpone living until retirement -- then you can live.
You compensate. Food. Alcohol. Possession lust. Mindless entertainment.
You become selfish, ego-centered, uncaring, immune to the pain of others.
You feel disaffected, demoralized.

Is it time for a change?



(Image by Manuel De Weijer)



Fatherhood



For the dads who stop by my blog every now and then, Happy Father’s Day.

Some years ago, when my daughter was a toddler, a friend who was not a parent asked me what it was like to be a parent. I thought for a moment, and then told her that so much of parenting could be assigned to two categories: sacrifice and joy.

So much of good parenting is about putting your kids first. Good parents sacrifice time, energy, needs, money, sleep, and more for the sake of their children. This is just part of the job description, and good parents do it willingly.

But being a parent is also about great joy. Few things in life have given me as much joy as being a father. Whatever else I am, or try to be, I am that guy in the stands of life who is always rooting for his daughter. The joy I get from watching her grow and discover life is worth more to me than I say.


(Image by Angela7dreams)

Psychodynamic Therapy is an Evidence-Based Practice

Although it’s very common for individuals to call my office in search of Cognitive-Behavioral Therapy, it’s rare for someone to call and ask for Psychodynamic Therapy.

And yet recent research has now shown psychodynamic therapy to be an “evidence-based” practice. In other words, research shows it works.

(Click here to see the article featured in Scientific American. This article highlights the work of Jonathan Shedler, who conducted a meta-analysis to show that psychodynamic therapy is indeed effective. Meta-analysis is a sophisticated statistical technique for putting studies on a common yardstick so that can be quantitatively compared).

What is psychodynamic therapy?

Well, for starters it’s not psychoanalysis, though many people erroneously equate the two.

Whereas cognitive therapy places emphasis on cognition or thought, distorted thinking, and dysfunctional beliefs, psychodynamic therapy places emphasis on emotion, processes of self-deception, anxiety, and hidden feelings -- in the context of relationships.

Whereas cognitive therapy stays strictly in the here-and-now, psychodynamic therapy places symptoms and problems in the context of one’s personal history.

Whereas cognitive therapy relies heavily on psycho-education (how thoughts influences emotions and behaviors), psychodynamic therapy relies on discovering patterns and themes in the patient’s psychological life, which may be just outside of the patient’s everyday awareness.

Cognitive therapy has received a great deal of air-play in the last couple decades, so people are aware of it. And frankly, unlike psychodynamic therapy, cognitive therapy is easy to understand. But some problems do not yield to cognitive interventions. Sometimes we really do need to get dig just a bit deeper into the psyche to resolve certain types of difficulties. Psychodynamic therapy is one way to go about that. It’s nice to see researchers put their stamp of approval on the method.







The Consumer Reports Survey on Anxiety and Depression

A recent article in the July 2010 Consumer Reports presents the results of a survey they did with their readers about getting help for Anxiety and Depression.

Conclusion: their sample of readers felt both that both “talk therapy” (psychotherapy) and medication were each effective, but combining the two yielded the best results.

No surprise, here. These findings are very much in line with the behavioral research on the topic. (True clinical studies typically measure outcomes and employ appropriate control groups.)

I often see people in my practice who do not want to go on medication, largely because of side effects. I’m not against medication; I just happen to provide therapy. If my patients want medication I will happily refer them and let them come to their own conclusions about the value medicine in their lives, which I think is the best way to do it. On occasion, I will also see a patient who does not want talk therapy, but only wants the pills. I have no objection to this, either.

What I do find, however, is that often medication treatment alone is good so long as one stays on the medication. If the medication is discontinued -- without psychotherapy -- the symptoms may relapse. This, too, is in line with current research.


A different view of antidepressants was discussed in this post: Antidepressants Don’t Work...Can this be true?

Looking for a Change? What's holding you back?


Maybe you want to feel better or do better or make some personal habit change. Maybe you’re fed with the emotional or behavioral status quo, whatever it is, and you tell yourself you want to change, but something -- something almost as powerful as a magnetic force -- pulls you back. What is that something?

Could be any number of things. Here are some possible candidates.

• Awareness
• Motivation
• Willingness to tolerate anxiety or discomfort
• Know-how
• Support from others
• Willingness to exert effort

Awareness. Obviously, changing anything about yourself starts with awareness. First you must be aware that you have a problem. Of course, it’s not awareness that holds you back so much the things that block awareness: minimization, rationalization, blaming others, and denial. These things are like veils that keep you from seeing the true consequences of the problem or issue. First step: lift the veil. See reality clearly.

Motivation. Recognizing that something is a problem doesn’t necessarily mean you’re motivated to do anything about it. Indeed, many people wait until the consequences of having the problem outweigh the discomfort of facing it before they embark on change. But it doesn’t have to be this way. You can make a list of the consequences to build motivation. And you can make a list of the benefits of change.

Willingness to tolerate anxiety or discomfort. Almost of any change generates anxiety or discomfort as you move out of your comfort zone and experiment with new thinking and action. Human beings are nothing if not self-consistent. Stepping out of old grooves, even grooves that are ultimately not in your best interests, will trip the alarm in your psychological system. Anxiety or discomfort is an uncomfortable state. To make it go away, you revert back to old patterns. But this is a trick. This is what keeps your stuck. If you’re serious about change, you must be willing to bear a bit of discomfort.

Know-how. Knowing how-to lose weight is not the same as knowing how-to get undepressed or how-to conquer agoraphobia. Problems vary and solutions vary. Do your homework. Study the strategies that others have used to solve your particular problem. Don’t re-invent the wheel if you don’t have to.

Support from others. Change is something you can do alone, but it’s probably easier when you have someone in your camp who is willing to root for you. Someone who knows not only what you’re doing, but why you’re doing it. Someone who cares enough about you to pick you up when you stumble. Never underestimate the value of supportive relationships. Conversely, be wary of those individuals who have something to gain if you fail. (e.g., domestic violence).

Willingness to exert effort. If only the infomercials were correct: that there really was such a thing as effortless change. But real change -- change that endures -- requires hard work. You must focus on the problem, think about it, feel the discomfort associated with it, come up with strategies or solutions, and start anew when lapses occur, as they most certainly will. If a problem is really a problem, you must be willing to throw some effort at it to make it different. Maybe that means reading books, tracking progress, attending therapy sessions, or just keeping the problem front and center for a while. No one will do for it; indeed, no one can.


Else:

If you are trying to change, don’t be discouraged by lapse, relapse, or resistance. To the contrary, expect these things. They’re simply part of the process.

If you are trying to change, know that change is seldom linear. It’s two steps forwards, one step back (or maybe sideways). Learn to look at the trend, not the moment.

If you are trying to change, celebrate your victories. We never outgrow our need for praise. Being an adult, however, means that sometimes we must provide it for ourselves.

If you are trying to change, but you are not there yet, give yourself the gift of self-compassion. There is little be gained by treating yourself badly when you aim at a target and miss. The rule of change is always about successive approximations, not absolutes.

For so many problems, the secret to real change is not in the strategies but in the persistence. You must try and then try some more. Persistence, along with the belief that you can change, wins the day.



Brief Thoughts about Anxiety


The National Institute of Mental Health has a great page devoted to anxiety disorders. You can find it here.

According to the site: “Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.”

Here are the five kinds of anxiety disorders:

--Generalized Anxiety Disorder
--Panic Disorder
--Obsessive Compulsive Disorder
--Social Anxiety
--Post-traumatic Stress Disorder

Generalized Anxiety is worry, worry, worry, and then more worry. The worry switch just won’t turn off.

A panic attack is akin to intense fear or terror -- but without any obvious event or stimulus to provoke it.

OCD is repetitive behaviors (compulsions) and repugnant thoughts (obsessions) that one cannot stop.

Social Anxiety is dread of common social circumstances.

PTSD is intrusive thoughts, flashbacks, extreme avoidance, intense anxiety, all tied to a prior highly stressful event.

We must differentiate normal anxiety for disordered anxiety. Anxiety in and of itself is not bad; indeed, we are all biologically equipped to feel it. When it comes to performance, for instance, anxiety can be quite helpful. Without some anxiety, the athlete, the musician, and the test-taker would suffer. A moderate amount of anxiety increases alertness, focus, and energy. As it turns out, performance tends to suffer when anxiety is either too low or too high.

When anxiety is too high, it disrupts our abilities to concentrate and focus, to remember and process information, to feel calm, and to function. Although we think of anxiety as an emotion, it affects thinking, behavior, and body as well. Anxiety disorders frequently coexist. One may be both a worrier and a panicker at the same time. This probably because the disorders -- which are really symptom patterns -- may share the same underlying mechanisms.

The goal of treatment is not to eliminate anxiety, but to dial it back to acceptable levels.

Anger Management


The American Psychological Association has posted a good article on anger. You can find it here.


The Power of Savoring


So the other day my daughter and I were sitting at a coffee shop in the middle of the afternoon, her eating a muffin and me drinking a cup hot chocolate. As it happens, we were sitting very close to a young man who was grinding coffee beans. Although I’m not a coffee drinker, I commented to my daughter that I liked the smell, and she agreed. But then she said, “If you really want a good smell trip, you should walk by Kilwin’s in the summer.”

(My daughter is in middle school. She says things like smell trip.)

I knew exactly what she walking about, of course. She and I have a shared fondness for chocolate.

Which is what got to me thinking about savoring.

We all know what the word means. But years ago, when I was at Loyola, I learned that Fred Bryant, a psychology professor there, had been studying the concept of savoring. So, being the good graduate student that I was, I hunted down a couple of his papers and read them. Mind you, these were research papers. Not exactly what you think of when you think of savoring. Now, however, years later, the savoring concept has found new life in the field of positive psychology.

Savoring is defined as “attending to, appreciating, and enhancing positive experience.”

Reading about it, and practicing about it, changed my life. Even though I read about years ago, it is one of the few things that I continue to do to this day.

I’m almost embarrassed to tell you some of things I savor. But I will. I savor the smell of a good used bookstore. I know several around the Chicago area, and whenever I walk into one, especially after not having been there for months, I inhale the smell of books.

I also have a special stone that sits on office desk. Picture an arrowhead only bigger–– more like a spearhead. Although it was given to me by my grandfather, its value to me is not sentimental. I like because of it’s shape and texture. Especially its texture. I savor the way the stone feels in my hand. Its rough edges and heft satisfy my sense of touch.

When you think of savoring, do you think only of food and taste? What Fred Bryant showed through his studies was that any virtually any positive experience could be savored. Even the memory of a positive event can be savored. Savoring is close to the experience of pleasure, but it’s not identical to it. Savoring is about drawing pleasure out, almost as if your suspending it your mind. If I eat ice cream, I experience pleasure. But if I eat it slowly, and let the sweetness of it linger in my mouth and mind, I’m savoring it.

And why, you ask, does savoring matter? Why make a big deal of it?

Well, for one thing, by enhancing positive experience, we buffer ourselves again stress. Maybe not hugely so, but just enough.

But there’s more to it than that, I think. We have a bias in our culture about looking towards the big events in our lives as the main sources of our happiness. Who among us, for instance, does not wish he or she could win the lottery? Of course this would make us feel good.

But what the savoring research has to tell us is that, when it comes to well-being, small experiences also matter. Indeed, I would argue that small experiences, because they are so common and so frequent, may even matter more than some than some big events. In my case, I remember certain key events in my life that made me feel good. The birth of my daughter is a prime example. But how often do things like that happen? In contrast, I savor something about the particulars of life almost every day.

We can savor any number of experiences. It’s not act of experiencing pleasure per se, but the act of attending closely to that pleasure, appreciating it, and dare I say elongating it.

Which is pretty much what I was doing that day I was sitting with my daughter in the coffee shop. The taste of the hot chocolate. The smell of the coffee beans being ground. The sound of daughter’s voice.

Savoring.

The Happiness Project

If you haven’t already seen it, you might check out Gretchen Rubin’s Happiness Project.
She is the author of the book by the same name. Hers is one of my favorite blogs.


On Finding a Therapist


It takes a bit work to find the right therapist, doesn’t it?

Do you go with a psychologist (PhD), social worker (MSW), or counselor (MS or MA)? Do you search for a therapist who is the same gender as you, or who is about the same age? Can you rely on your insurance company to point you in the right direction, or should you ask around to find out who’s good? Or do you just figure they’re all pretty much the same, so why not hunt for the therapist with the lowest rates?

Well, folks, here’s what the research says.

Age, gender, and academic degree have not been show to be strong predictors of therapist effectiveness. In other words, men can do effective work with women (and vice versa) and young therapists can work effectively with older clients. Moreover, psychologists tend to be just as effective as social workers or practitioners with other degrees.

What does matter is whether your therapist has had experience with your type of problem, and how comfortable you feel when you talk to him (or her). These are the two things you should be looking for.

It’s relatively easy to determine the therapist’s level of experience (you can do this from a website, or a quick telephone conversation). But the only way you can truly figure out how comfortable you feel talking to the therapist is to make an appointment and try him out for a session.

So much of what happens in therapy depends on the therapy relationship itself. Our dentist or physician may work on us, but our psychotherapist can only work with us. We must trust her enough to disclose highly personal and private information, and we must rely upon her support as we confront those aspects of ourselves that we feel least proud of.

Don’t pick your therapist on the basis of gender, age, credential, race, reputation, or price. Pick him (her) on the basis of his experience and how comfortable you feeling sitting across from him in his office.






Tip for Coping with Agorophobia

Anxiety tip: Retreat vs. Avoidance

Anxiety and avoidance go hand-in-hand. Where you fine one, you find the other. When I help people reduce or eliminate panic attacks, we often have two goals: reducing the panic attacks themselves, and reducing the accompanying agoraphobia.

A panic attack is an intense state of fear or terror without an obvious external stimulus. When people experience panic attacks over a period of time, they tend to avoid those places where the attacks occurred. When the avoidance gets to a point people have many places they simply refuse to go (e.g., busy traffic, large city, a large supermarket), we give it fancy diagnostic label: agoraphobia.

When you’re trying to break an agoraphobic pattern, it helps to differentiate between avoidance and retreat.

In the former, you avoid a physical place like crazy and try never to come back. In the latter, you may back away, but only because you can’t do it right this moment. The kicker is, with retreat you make agreement with yourself to come back to it. Maybe later today, maybe tomorrow, maybe next week or next month. But sooner or later you come back to it and -- this hard part -- you hold yourself to it.

Some clients will say I’m splitting linguistic hairs. And to degree that’s true. But the truth is, our ability to cope is not static. Some days we are better others: more rested, less stressed, more ready to face challenges, more courageous.

When you are trying to break an avoidance pattern you will most likely not get it right on the first try. You need to try and try again, and keep trying.

So if you approach something you fear, and can’t do it, you can either throw up your hands and give up, or make an agreement with yourself to come back to it. This is really all about building the right mindset. If you simply avoid, you build a mindset of failure. If you retreat, you build a mindset that makes allowances for approximations, false starts, and variable coping patterns. You also build a mindset of self-compassion, which is a critical ingredient in the world of personal change.



Another post for anxiety and/or stress: A natural cure for anxiety and stress: belly breathing.

Tip for Coping with Depression


The Cut-it-in Half rule.

Usually when people are depressed they struggle with motivation, fatigue, low energy, or inertia. It’s so tempting just to sit in a chair for hours, go to bed, or come to a complete stop. Why bother doing anything?

But this only makes depression worse. Curiously enough, the human body makes energy by exerting energy. Whereas more stopped-ness makes more inertia.

The cut-it-in-half rule says, If you can’t go what you usually do, cut your efforts in half. Don’t succumb to all-or-nothing. (Either I worked to my usual capacity, or I didn’t. EIther I succeeded, or I failed.) If you can’t manage your usual effort, try cutting it in half. When it comes to depression, some effort is always better than no effort.


Related post: The Downward Spiral of Depression.



Self-Help

I was reading Seth Godin’s blog the other day and he made the this statement: “The only real help is self-help. Anything else is just designed to get your to the point where you can help yourself.”

(Seth’s blog posts are pithy, which is one the reasons I read him.)

I agree with his statement. Psychologists, for instance, do not change people. But they do help people change themselves.

What’s the difference? Better yet, why bother consulting a psychologist if all help is self-help?

Answer: what psychologists really do is help you understand the emotional elements behind resistance. When we try to change something about ourselves, we take a step or two but soon fall back to old patterns. Why? Why do we have this contradiction in ourselves?

This is what a psychologist tries to help you understand. You may consciously will new behavior to come about, but if it fails, is there a belief or feeling or schema that’s holding you back? Probably.

Human beings are remarkably self-consistent, even when the behavior in question is maladaptive. If you want to change, you’ll have to de-automate the pattern. (Yes, I just made that word up.) If the problem is serious -- depression, anxiety, eating disorder -- it’s not likely to yield to willpower alone. You’ll have to dig deeper.

Fortunately, you don’t have to do this alone.


Related post: Digging Deep in the Psychological Soil

Brief Thoughts about Happy Marriages




I'm in the middle of a workshop by John Gottman, surely one of the most knowledgeable marital researchers on the planet.

Gottman and his colleagues have studied couples in distress, but also what he calls master couples, couples who are satisfied with their marriage over time.

As you might imagine, these two groups differ in important ways. One of the findings that grabbed my attention was that master couples have about a 5 to 1 ratio of positive emotion to negative emotions, whereas distressed couples have a ratio closer to 1 to 1. It's not that master couples don't experience anger, hurt, sadness, and so on in the context of the marriage. It's just that they experience so much more joy, interest, and laugher when they're together.

What he's really talking about is the emotional glue that holds a marriage together. It looks a lot like friendship, but of course it's more than just being friends. Part of how master couples create this glue is by making bids for each other's attention--and getting it. Attention comes in many forms: intimate talk, emotional support, affection, and sexual connection. For instance, it's nice to know your partner cares about what you care about, and will listen to you, right? But if you make consistent bids for your partner's attention and don't get it, eventually you'll stop trying. Gottman says this is how people become lonely in marriages. And it's one of the ways marriages can die.

When master couples do have conflict, they manage it well. For instance, they do what he calls a soft start-up. When one partner presents a problem to the other, they go easy on the criticism (careful not to attack partner’s personality). And when the opposite partner listens to the complaint, they try to take responsibility for at least some piece of the problem. In other words, they are open to their partner’s influence. And when negative emotions do run high, as they invariably will during a disagreement, master couple quick to repair the relationship when damage has occurred.

There is a lot more to good marriage, of course, than what I’ve presented here. If you’re interested in knowing more, I’d recommend Gottman’s book, Seven Principles for Making Marriage Work.

Antidepressants Don't Work...Can this be True?



According to research published last month in THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, antidepressants are being challenged as an effective treatment for depression.

The cover story for NEWSWEEK (Feb 8, 2010) gives an excellent report on these new findings.

For mild, moderate, and severe depression, antidepressants are virtually no better than a placebo. However, antidepressants have been found to be effective for very severe depression.

These conclusions were reached using meta-analysis, a statistical technique that allows researchers to put the effects of any given study on a common metric so that an overall effect size can be calculated. (Don't let the jargon bog you down. Meta-analysis simply puts separate studies on the same yardstick so they can be compared.)

In this case, Irving Hirsh used 48 studies, taking pains to gather all of the studies he could find. He went so far as to use the Freedom of Information Act to obtain unpublished studies by drug companies that were available through the Food and Drug Administration.

The end result? For the most part, antidepressants are no better than a dummy pill.

Ouch.

The drug companies have some explaining to do. Incidentally, they are not disputing the findings of their own studies, but they are trying to point out the depression is an individualized illness and that patient responses may vary. Still, we're talking about a multi-billion dollar industry here. We're talking about big news.

No doubt, we're bound to here more on this story in the comming months. In the mean time, if you are taking an antidepressant, do not stop abruptly. This can be dangerous. Consult the person who prescribes them to talk over what's best for you.

One last point: psychotherapy has been show to effective in treating depression. And compared to antidepressants, the relapse rate is lower, too.


Marital Ambivalence: Should You Stay? Or Should You Go?

Often people will come to therapy when they are trying to decide if they want to stay married.

On the one hand, something isn't working, they’re not happy, they’re fed up, or they’ve lost whatever love they once felt. On the other hand, they do not want to be divorced, alone, without the kids, broke, or stressed out by nightmarish legal proceedings. The thought of staying feels unbearable, but the thought of leaving feels equally unbearable. In short, they're caught on the horns of a dilemma.

Therapists tend to have a lot of respect for dilemmas. They make people crazy. Or at least they make people feel crazy. Which isn’t the same thing.

By definition, a dilemma is when we are being forced to pick the best of bad alternatives. We study the options, but they all look bad. No matter which direction we go, we see hardship, discomfort, or emotional pain ahead. And we'd rather avoid going down that road, thank you very much.

But can we?

In a true dilemma, we can't. And that's precisely what makes us feel crazy. Sometimes we secretly hope for miracle to resolve it. Surely they're has to be an option that won't cause such distress and havoc, right? Perhaps if we try not to pick an option for as long as possible something new will pop on the horizon? Please?

Well, maybe. But I doubt it. Generally the options to most dilemmas are relatively easy to identify. The problem isn't knowing what the options are; it's that we don't like them.

When people feel ambivalent about their marriages, they will often disengage emotionally from their spouse but not leave. This can be painful for both parties, but it makes a certain amount of sense. After all, dismantling a marriage isn't easy and the stakes are generally high. Better to try a holding pattern, least you jump before you are ready.

And this will probably work for a while.

But eventually, you'll be forced to choose. Because your spouse, who is on the other side of your dilemma and is probably feeling hurt, angry, or confused, will lose patience. Oh, he or she may tolerate your ambivalence for a time. Indeed, your spouse may even try to woo you back. But if you fail to re-engage in the relationship in a meaningful way, even a patient person will eventually tire of the arrangement.

This is often the moment when people will consult a therapist. Sometimes it's person who is ambivalent, other times it's the person who’s lost patience.

No therapist should try to solve a personal dilemma for you. Dilemmas are part of the human condition; sooner or later, most of us will get caught in some form of one. This is simply part of being human. None of us is exempt from pain or hardship.

What a therapist can do, however, is help you clarify your true feelings (which is often more difficult than it sounds). And he can help you think through the ramifications of the options, whatever they are. What he can't do is make the decision for you.

I suppose dilemmas teach us not only what it means to be human, but what it means to be an adult. Because sometimes the only solution to pain is face it, experience, and bear it. This is one of the ways we become grown-ups.

Digging Deep into the Psychological Soil



Sometimes in therapy we need to focus on emotional reactions to situational problems. A common example of this is the person who is in the throes of a stressful experience. A divorce perhaps, or a job loss, or maybe the death of a family member. In these instances, we try to help the person marshal their resources and figure out healthy ways to cope with a difficult and painful situation.

But what does it mean to dig deeper into the psychological soil?

Symptoms related to depression and anxiety are often tied to underlying issues that have to do with dysfunctional beliefs about oneself (or others), or with feelings that have been avoided because they are simply to painful to tolerate.

Sometimes we speak of schema -- packets of information that contain beliefs, emotions, memories, sensations. Schema help us navigate the world because they allow us to make use of prior knowledge. But schema about oneself, especially if it is negative, can color the way we evaluate our personal experiences. If one has a schema, for instance, that one is inadequate, inferior, or defective in some way, one is much more apt to selectively filter out information that refutes this notion but allow information in that confirms it.

In therapy, going deeper often means uncovering these schema and examining them for truth. The thing about schema is, we often develop them when we are very young, which is say, when we are not yet mature, experienced, or wise. And because they've always been there, or so it seems, we seldom question their validity and we don’t always appreciate the long shadow they cast over our lives.

Because schema are often planted early, they are not easy to uproot, especially by oneself.

But this is precisely what a therapist can help you do. We can dig deeper. Uproot the bad. Save the good. Help replant as necessary.



Related post: Core Belief: Inadequacy








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