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.
Tag Archives: Therapy
Psychotherapy: Have The Issues Changed Much in 30+ Years?
Someone asked me if the problems people come to see me about have changed much over the course of my practice. I had to think about it, but the answer I gave is basically “no”. The externals or presenting problems can look very different and how people approach things and what they look for in the way of solutions has changed. We live in a high stress world but in my view the underlying issues are essentially the same.
The only real difference that I can pinpoint is that people are more open in talking about certain things. A good example is that people are less reluctant to talk about sexual issues. Sex in general is talked about more openly. Sexual orientation and identity are no longer taboo topics. Adoption and fertility issues are talked about more openly. Addictions too are not hidden or denied as much. As a culture I think we are more open and accepting – at least in my neck of the woods. And so because the culture in general has changed, there is very little that is off limits. Topics that used to be considered shameful or impossible to even mention, are talked about. That is not to say that people don’t feel shame and pain. They do. But at least the world gives them permission to speak. I consider that one of the most positive outcomes resulting from the diversity and transparency in our modern world.
Most people can talk about what was once off limits even if it is hard to open up and takes a while. But the underlying problems regarding relationships, intimacy, self-esteem, trauma, abuse, feelings of loss of control, depression, anxieties, self- hatred – the list can go on – those remain much the same. We are all creatures of the human condition and so the problems we experience in our core are still the same. It’s one of the reasons I believe in psychotherapy. It’s a methodology that can hopefully reach us in that core.
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.
I am a psychotherapist in private practice for over 30 years. I see individuals & couples in therapy & counseling from all walks of life and with all manner of issues. I hope you will find this blog interesting and informative. Every therapist is different and works differently. These are just my musings.
Today I would like to share an experience that to me illustrates how some people worry about what therapists think. I was once at a dinner where a woman said of my work that it must be awful because I see people at their worst. I told her that in fact it was just the opposite. I see people at their best – when they are the most sincere, most vulnerable and most real. Except for a very few who don’t stay anyway, I like them all. I am never put off by the presentations because I can understand and empathize. That people think so many things are shameful amazes me.
That’s all my musings for today. I liked the following article from Psychlology Today.
Related articles
- How Do You Know Your Shrink Is Helping You? (psychologytoday.com)
Paula Zuckerman, LCSW. Random thoughts on a 30+ year psychotherapy practice 