Tag Archives: Mental Health

Looking for Love in All the Wrong Places

All throughout my practice and over the years, for both couples and individuals, I see many who find themselves in difficult if not downright abusive relationships.  That has often been an ongoing pattern in their past relationships and their current relationship may continue and mirror those problems.  Also there are many who are still looking for just the ‘right’ person but haven’t a clue as to what makes a relationship ‘right’.  Now sometimes relationships become abusive after time and it can be because two people are not right for each other so that conflict and anger become part of the dynamic.  Or sometimes stresses destroy what was once good.  But more often it is a pattern.  Someone once said to me about her friend “I can always tell which kind of guy she will gravitate to.  She always goes for the one with a certain ‘attitude’ and of course good looking.  It is those guys who are really womanizers”.

More often it is women who find themselves with angry or emotionally unavailable men who take out their frustrations on their partners, but I have also worked with men who find themselves with cold, derisive, and ‘bitchy’ women who offer little warmth or love and mistreat them.  Now relationships don’t  normally start out that way.  People usually fancy themselves ‘in love’.  But the chemistry and that mystery we call ‘attraction’ can fade pretty quickly with the reality of life’s stressors.

There are many who repeat past patterns of abuse whether it stems from original family dynamics or from past relationships.  One person I worked with had a cold, distant, alcoholic mother, and every woman he ends up with has an addiction problem of some sort.  He takes care of them and does his best to offer them the love he feels in the hopes that it will change them.  I often feel that people have a certain kind of radar that puts them in the same situation over and over again.  The key to change is understanding the behavior and the willingness to stop trying again and again to accomplish what may be impossible.  Easier said than done!

 

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“Is There Anything Worse Than Being Ordinary”

Someone said this to me recently and in a way it made my heart ache.  In my opinion, being ordinary is much underrated.  It is what most of us are and if you are your own brand of  ‘ordinary’ you are ahead of the game.  you don’t have to be famous or fabulous or extraordinary to be special and wonderful.  Trying to be the best, the smartest, the prettiest, most talented, most creative, – the ‘most’ of anything is a recipe for disappointment, self criticism, self-hatred and low self-esteem.  If you are always comparing yourself to others you will always fall short in some way.  To be the best that you can be is quite enough, even though that is a cliché.  Labeling yourself as ‘ordinary’ in a pejorative way is so very sad.  All we have to do is look around to know that fame, fortune, success, and talent does not guarantee happiness. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Technology’s Influence on Psychotherapy

The age of technology is amazing.  From when I first started as a psychotherapist, it is a different world as regards information and communication.  I am definitely a fan of technology. However, as it is used in certain situations, it has a significant downside.

The internet offers a wealth of information on all sorts of issues related to mental health.  It gives people a better understanding of psychological problems from theoretical points of view.  You can also find tons of ‘how to’ literature on techniques to approach symptoms, solve and resolve problems.

But from my perspective there can be major problems with people jumping to conclusions from this information.  Like with medicine, they read and think they know what’s wrong.  They self-diagnose and may put off seeing someone until things have gotten much worse.

One of the most alarming outcomes of technology (in my opinion) is the use of social media – texting, tweeting & email etc., as a major means of interpersonal communication.  That is not to say that these communication methods don’t have their place.  For factual information such as when & where, it is great. But many use this instead of face to face interaction for more complex communication.

When you talk via text or email, there is no ability to get a ‘read’ on the other person.  There is no access to the nuances of body language such as eye contact or emotions that enhance communication in so many ways when you are face to face. For some this is helpful.  Many feel they can communicate better via the written word.  But mostly this leaves way too much room for miscommunication and misunderstanding.  It also prevents the experience of re-framing in the moment.  The internet doesn’t listen and is not a substitute for live interaction.

For very isolated people it can offer a means of contact and communication that they would otherwise not have.  I do not downplay the benefit for those who have difficulty communicating in interactive situations.  But it also can reinforce this avoidance.  People can manage their communications like they were writing a term paper.

Communication via the internet is intrinsically sterile.  When you think of children in institutions who have no one interacting with them physically and then compare that with parents who are always holding and playing & engaging in eye contact, the difference is monumental.  In institutions, the result can be a failure for the baby to thrive.

When I see people who get together but somehow always manage to spend time on their devices, I groan.  Think of a TV commercial – I think it’s for online gambling – where conversation is quickly replaced by individual game playing.  This is very different from interactive games and appears to be a new cultural trend.  Why is it necessary to always have the device handy?  I often feel it’s a subtle means of diluting the actual experience with friend, family or significant others.   Its effect is to interrupt the flow of the relationship.

In therapy, there are no devices and most turn them off unless there is an extraordinary circumstance.  The communication between therapist & patient is much more immediate and that lends itself to deeper understanding.  I see the person and can gain greater insight that way.  We have a relationship that can’t be duplicated online.   I hope that in the rest of life technology is not causing us to lose the gift of human presence.

Although the internet offers wonderful things, unfortunately it also offers new opportunities to indulge in addictions of all sorts.  It can be its own addiction.  It enables avoidance of the world and real life and real problems.  Just as with TV it can offer a respite from the stresses of life.  Great!  But it’s abuse tempts us all.

The internet has dramatically changed how people find medical & mental health providers.   You can look up anyone’s credentials and check out their reviews. That is amazing.  However it used to be that people got  personal recommendations.  Now I am not sure which is actually better.  But the internet as well as insurance companies have made finding a provider a much more anonymous endeavor.

Then there are the online support groups which I actually think of as pseudo-support.  They are anonymous, but unlike AA and similar groups, there is no actual emotional or even physical touching.  You don’t get to deal with trauma in person.  You may get lots of information & helpful hints, but the methodology itself reinforces the interpersonal disconnect.

In actual therapy sessions, and even as regards the reasons people seek treatment, I can’t say I have noticed that technology has affected much of what goes on or the problems people come in with.  What I have noticed is that different addictions are ‘easier’ to accommodate.  Infidelity is easier to hide and more and more people are looking for a mate using internet dating sites.  That has both up & down sides. In any case, the issues that confront couples and what makes relationship difficult are still the same.

I have concerns about how the younger generation is learning to relate or have relationships.  Technology is an essential part of children’s lives.  They see adults using devices and are growing up with them.  Hopefully they are also learning to relate in a more personal way.  I would hate to think we are losing something as important and valuable as human bonding which has always occurred naturally and without the interface of whatever new device comes down the pike.

 

 

 

 

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Addiction & Social Anxiety Disorder

Over the years I have worked with many people who suffer from addictions of all sorts –drugs, alcohol, food, sex – you name it.  Most were/are in recovery or have attempted to deal with their addictions in other ways.  But one thing I’ve noticed that they have in common is that most have Social Anxiety Disorder as an underlying problem.  That is not to say that all addicts have this.  But when you think about it, for many it makes sense.  Addictions mask emotions and help with symptomatology.   They initially make things easier – brighter if you will.  Drugs & alcohol lower inhibition and can help ease the way for social interaction.  For most, alcohol lightens the mood and lowers inhibitions and may make things more pleasant.  But social discomfort is major problem for those with Social Anxiety Disorder.  People can shake, stutter, withdraw, become mute and can’t make contact even in the seemingly most benign circumstances.  Think of Rojesh from TV’s “Big Bang Theory”.   He is a caricature for sure, but not so far from hitting the nail on the head.  The powerful underlying truth of what many with Social Anxiety Disorder deal with is that their discomfort is so great, they can’t connect.  Or they suffer greatly when trying to interact.  Drugs or alcohol can produce a major shift for them.  It is self-medicating, and many even forget what is lurking underneath – especially if they become chronic users.  But when sobriety is achieved it is there – just as it was from the beginning.  The trick is to find other ways of dealing that might bring about some real change.

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The Prevalence of Social Anxiety

Scratch the surface and there it is.  Social anxiety is much more prevalent than people realize.  I hesitate to use the word ‘disorder’ because many people who suffer from it don’t meet the DSM criteria.  In more lay man’s terms they would be considered painfully shy.  Saying one is very shy seems more acceptable than saying they have ‘social anxiety disorder’.  Severe shyness is often something that’s been there since childhood.

In my practice over the years, I would say that more than a third of those I see have social anxiety in varying degrees, even if never diagnosed.  Many are able to hide it so well, no one would ever know.  They are good actors & often that helps.  But more often they are avoiders, afraid to deal with the world. Then there are those with more overt symptomatology who suffer from panic attacks, are almost are unable to speak, shake visibly, and will actually faint if the stress is enough.  Medication has been very helpful for some as well as psychotherapy along with the use of CBT.  In my practice I have noticed it gets significantly better but it rarely goes away completely.

Most people have a certain amount of anxiety in obvious situations like making a speech or meeting new people or confronting a difficult situation.  But for people who have social anxiety, the triggers are not necessarily visible.  They can be afraid to make phone calls, get on a bus or walk down the street for fear they may meet someone, talk with shop clerks, have difficulty going out in general, and without a drink or two, barely function in social situations.  It may not always be apparent, but inside they are struggling.   They are severely self-conscious.  I believe that many alcoholics suffer from social anxiety and that that may be a contributing factor to their disease.  Intimacy and social anxiety is another difficult combination.  Meeting people is hard enough for those who suffer from it, but add the pressure of relationship, and the situation can become impossible.  Loneliness and social anxiety are not strangers.

Over the years I have noticed that not only is the anxiety itself dehabilitating, but the shame and judgments that accompany it make it much more painful and problematic.  Often those who suffer from it consider themselves, wimps, cowards and just plain stupid for not being able to do things that seem to come so easily for others.  Self-hatred & self-criticism are very common.  They are aware that most of the fear is irrational and hate themselves for not being able to overcome it.  It constricts their lives and they feel they are at fault.  Consequently the self-hatred is continually reinforced, and that makes the anxiety even worse.  It’s bad enough to have it to begin with, but with the added  constant erosion of self-image, the pain is that much greater.

Unfortunately, like most things, intellectual knowledge does not always help with how one feels.  Most social phobics have been chipping away at their self- esteem for a long time.  These judgments about themselves can feel like a religion.  In their core they know how bad they are. It’s a long standing belief system that has offered a certain amount of protection & explanation for their plight.  That makes it harder to help alleviate the anxiety.   Acceptance is the friend of someone with social anxiety.  It takes away the added burden of self-hatred which in turn makes life easier.  Getting to a place of acceptance is very difficult for most.  There are usually some very unrealistic fantasies about what they would be like if they weren’t so shy. But it is the first step in the healing process.  Liking oneself better usually is.

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The Changing Face of Psychotherapy

Many years ago when I first started out in the field it was not uncommon for people to be in psychoanalysis or psychotherapy 3 – 4 times per week.  These days someone coming even 2 times per week is rare.  This change is partly because of the intrusion of insurance into medical treatment of all kinds.  Insurance controls what services are reimbursed and the frequency of visits, tests, etc.  This is especially true for mental health services, often considered by many as the stepchild of medicine.  Few can afford to see a psychotherapist more than weekly.

We can blame insurance companies & say “they’re the culprits”.  Insurance companies are offering less and reimbursing less for services they do approve, making it harder to get needed mental health services.  But this change is also because of the availability of different forms of psychological treatment, including medication, the difficulty in providing studies which can ‘prove’ the efficacy of psychotherapy, and the evolving nature of our culture at large.

The popular culture has become one of ‘quick fixes’, a ‘just do it’ mentality, and one of instant gratification.  Medication has changed the way people deal with issues. They often look first to a pill to solve their problems.  I have said before that I believe in medication.   But it’s not the magic answer and it is not right for all.   Studies have shown that medication in combination with psychotherapy is most effective.  But just as important a factor is that people are less willing to ‘go deep’.  And I don’t know if that’s all negative.  Sometimes Cognitive Behavioral Therapy – CBT makes a dent and I use it.  But there is a vast difference between knowing something intellectually & have it filter down into emotional understanding.  There are many who know the right ways they should think but can’t make the switch even with workbooks and reminders.  Then there are those who don’t make the effort because of underlying issues that stand in the way.  Our quick fix society wants to believe that these things work, but in my experience they are an aid for some but definitely not for all.  Just like medication, there is no magic.  I often say that if there was a magic pill or if I had a magic wand I would use it & find another line of work.

My friend reminds me that readers today have very short attention spans – no more than a paragraph for a blog.  I don’t know if that’s true or not but, there is definitely a trend toward shortening all aspects of communication.  I don’t know if that is good or bad or just a fact of the modern world and our busy lives.  The jury is out.  But it has certainly affected the practice of psychotherapy from the time I began working.

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Observations on my work with Couples continued

Deal Breakers

Some problems can be divided into what I call ‘deal breakers’ and then everything else.  And not every ‘deal breaker’ ends a relationship.  Issues regarding religion, money, children, location, and whether someone wants to be in a relationship at all, are potential ‘deal breakers’.  But often the obvious is not ever dealt with prior to getting together.  People hope that these problems will magically disappear.  They ignore the elephant in the room.   It is only human.  We are taught that “love conquers all”.  So we pretend and hope for the best.  Also, some ‘deal breakers’ are covers for other underlying feelings, and until you explore, you can never be sure.

More to follow.

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Observations on my work with Couples

Couples therapy helps people make decisions about their relationship. They will either stay together better or decide to separate. Sometimes they decide to stay together even if things are no better. I can never predict because sometimes I have been really surprised. The only thing I can say is that if two people really want it to work, there is a better chance that it will. Love, commitment & connection count for a lot in helping couples resolve major issues. It helps if they come before things are at the breaking point, if they stay for more than a few sessions, and if both have the same agenda. I always try to remember that they didn’t start out this way. They wanted things to go well and to have a good life together. The following are some major issues that turn things awry.

Communication

The biggest problem in communication between couples is the illusion that it has taken place. It amazes me how often there are assumptions and reactions to those assumptions, & reactions to those reactions, without ever finding out what each other means or is trying to say. Resentments build. People accuse, get angry – either verbalizing the anger or holding it in. Holding it in can be with awareness or without. Often there are triggers that can make someone extremely reactive because of past issues and vulnerabilities. Almost no one comes into a relationship without ‘baggage’. In my opinion, the trick is to have baggage issues that don’t collide too much. This is rare for couple’s I see.
Communication is by far not the only problem I have encountered in my work with couples. And also there is no guarantee that if communication improves things will get better. But usually it does.

More to follow.

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Mixed Thoughts on Medication

Medication and its efficacy is a very hot topic and these are just my observations over a very  long time period in both private practice and a clinic setting.

My feelings about medication are mixed.  Neurology & chemistry effect how we all see things.  Over the years medication has dramatically helped the very severely disturbed, but for others, the feedback is more ambivalent.  And even for those that ‘really’ need it, the side effects can be daunting.

It is often said that medication changes the black to gray (if one is lucky), but the way people approach their problems and how they interpret themselves and their world, is not changed much by medication – in my opinion.  Pathways that are more adaptive need to be created by self understanding and hopefully by softening the effects of trauma.  This is not easy to do by any means. Tons of CBT work books & self help books attest to how hard it is. It helps to know, but it is no guarantee that it will filter into our beings.  What the brain knows intellectually is very different from what is experienced emotionally.

I often recommend medication in conjunction with psychotherapy and have worked with some excellent psychiatrists.  But I do not push it unless it seems critical.  People I see are often very reluctant if not down right opposed to medication.  Partly because of the side effects but mostly because it feels like that means they are ‘really sick’ and it signifies a loss of self-esteem.  Also, many would like to try more ‘natural’ products.  Often people improve without medication & others decide at a later time to try it.  I have never kept statistics because I never see individuals as numbers.  I have also noticed that for some people, medications that were helpful stop working after about 2 years..  And there are so many medications & cocktails out there that the choices are enough to make you dizzy as well as cautious.

All this being said, there is no question that psychotropic medication has been a godsend for many.  But it is no panacea and for those who think it is, there is often a let down.  There is no magic wand.  If I had one, I would use it.

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Grief & Loss

I have often thought about how disability or deformity or age or grief can significantly effect the psyche. There is much written in books & articles, but to connect with the experiences as I have experienced these things in my own life and in those of patients, has made me appreciate with an even deeper understanding, what people go through. This enables me to deal with these issues better in my work.
I recently came across an article on grief & loss in the New York Times that really spoke to me. Copy & paste the link is below and I hope it touches others too.

http://www.nytimes.com/2013/08/04/opinion/sunday/the-trauma-of-being-alive.html?src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fopinion%2Findex.jsonp&pagewanted=print

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