Thoughts from a Therapist

Category: Therapy Explained, Simplified, and Un-Jargoned

The ‘Therapy explained, simplified, and un-jargoned’ category contains posts which will explain why a given therapeutic intervention is used and how it is designed to help you.

  • Externalization – you are with the problem… you are separate from the problem

    Quick summary – externalization is a technique from Narrative therapy which uses language to separate a person from their problem so that the person is better able to manage that problem. The basic idea is that it is easier to fix a concern if the concern is not rigidly attached to the person’s identity or personality (you are not stubborn… you use stubborn behavior). In this way the therapist would help a person to see that they are not a depressed person… but rather they are a person living with depression. This process offers perceptual freedom to a person… If they no longer view themselves as innately depressed then they can choose what to do with the depression which is with them (as it never was truly part of them). Narrative theory tends to view diagnosis as counter productive as a diagnosis encourages a person to over identify with the label… this takes away the person’s freedom and hope.
    Let me start with some quick examples: the first quote will use over-identification language and the second quote will use externalization. Which wording seems more solvable?
    I am a cancer patient – I am living with cancer
    I am an anxious person – I am person who carries anxiety
    I’m fat – I hold extra weight
    I’m a bad parent – I am a person with underdeveloped parenting techniques
    Are these just euphemisms? (Nicer ways of saying the same thing)
    Yes and No
    –         The secondary benefits of this technique are based on positive psychology principles.

    • Narrative therapists believe that you create your own reality through the stories that you tell yourself… and with the stories that we agree upon collectively.
    • Yes – if you tell yourself more positive stories then you will live within the reality of those more positive storylines. This is one of the more controversial aspects of positive psychology, narrative therapy and other constructionist and postmodern views.

     
    –         No… not just

    • The main benefit of this technique is that it allows a person to see himself or herself as separate from the problem which then makes it easier for that person to look at the problem from a different perspective.
    • The technique also encourages people to stop using unhelpful generalization so that they can see when the problem has less or no impact on their life.
      • Example: if you are a depressed person then you have made the generalization that you are always depressed. If you are a person with depression than it is easier to perceive the times when depression was not ‘with’ you.

     
    Externalization is also perhaps a more helpful and compassionate way to communicate with a person concerning a problem that they hold.
                * For example – would your rather be told that you are a messy person or that you are a person with some messy habits? Would you want someone to say that you are a mean person or would you rather he or she said that you are a person that uses less sensitive language?
    Over-identification causes suffering – certain Buddhist beliefs suggest that our over attachment to labels, material items, identities etc are the root of our suffering.
     
    Hope – hope is a statistically significant variable in relation to therapeutic and medical outcomes – hope has a positive correlation with recovery. The more you believe that you will heal = the more likely you are to heal.

    • It is easier to foster hope in a person when that person believes that they are separate from their problem… If a person believes that they are the problem then they believe they have to change themselves – that process is far more difficult than changing an externalized problem.

     
    Externalization trick – Something that you can practice in your life.
     
     * Try adding a verb and/or a preposition before your descriptors.
     
    I am depressed – I am living with depression
    I am learning disabled – I am a person who has a learning disability
    I am unhappy – I am a person who notices unhappiness in my life
    My cousin in developmentally disabled – my cousin has a developmental disability
    “Word choice effects your perception and your perception affects your emotions.”

    “I am with the snow balls … the snow balls are separate from me.” – Lucy the dog

  • Mindfulness Exercise – notice your senses without judgment =54321 present

    Quick overview: I will be offering my favorite mindfulness exercise that will help you to get into the present moment (as opposed to being in your head, which is usually concerned with the past and the future). The technique is very simple and I call it the senses 5 4 3 2 1 – it probably has many different names (I did not develop it). The point is to try and observe or to notice what your senses are sensing without placing judgment on the stimulus. I tend to use sight, tactile (feeling), and hearing… smell and taste can also be used in more specific settings. You will start by listing 5 things you see, then 5 things that you feel, then 5 things that you hear – then 4 of each… then 3 of each etc.
    You can do this exercise anywhere and I prefer to do it in nature. 
    I have blog posts concerning why a mindfulness state is great for wellness – click on the mindfulness category to your right and the articles will pop up.
    Start by engaging in a breathing exercise (read my blog on breathing if you would like more information)

    • Take a deep breath in for about 5 second and a breath out for about 4 seconds (or whatever taking deep breaths means to you).
    • Notice the feeling of the air as it passes down your throat.
    • Feel the air as it glides in and out of your nose.
    • Let you abdomen (stomach) expand to take in a belly full of air.
    • Notice the touch of your clothes on your skin as your body expands and contracts with your breathing. 

    It is your choice in relation to what words your mind uses as you notice a sense. There is no correct way to notice your senses – you are simply asked to notice without placing your individual beliefs, thoughts, feelings, opinions, judgments and/or other automatic reactions etc on the sense.

    • Your words can be sounds.
      •  For wind I often say ‘whhhhshhhuu’ in my head instead of ‘wind’.
    • You can state the color or another objective adjective instead of the object.
      • Ex. you could say ‘green’ or you could say ‘leaf’ for the same stimulus.
    • You may acknowledge without labeling – for feelings I visualize where I am having a sensation without adding an internal narrative
      • Ex. I will visualize my hair instead of saying “wind rustling my hair.”
    • You can be as specific or as un-specific as you choose.
      • you may say ‘ten foot aspen tree with autumn colors’ or simply ‘tree’
    • When judgments and unwanted thoughts pop up… allow them to be… do not resist them… they will pass.

     
    Seeing – Let your eyes scan the environment and list 5 things that you notice without using judgments or other descriptors which are more influenced by your subjective perception (the way you individually and uniquely view the world ex. good is more subjective while ‘purple’ is more objective).
    –         Example: tree, blue, little bird, my dog, and path
    –         Remember to continue to breath and if a judgment or an unwanted thought comes into your mind – notice it without resistance… as the thought arrived without reason so will it leave without reason if you kindly allow it to be.
     
    Tactile (feel) – Let you awareness turn to what you literally feel (ex. wet, dry, hot) as opposed to what you emotionally ‘feel’ (ex sad, glad, mad). Notice 5 things that your body is sensing.
    –         Example: wind on forehead, pulse in my foot, tightness of my belt, moisture in my hair, and dry air on the top of my mouth.
    –         Remember to continue to breath and if a judgment or an unwanted thought comes into your mind – notice it without resistance… as the thought arrived without reason so will it leave without reason if you kindly allow it to be.
    Audible – turn your awareness to what you hear – sounds in your presence. List 5 things that you hear.
    –         Example: the wind rustling the tree, my dog breathing, the crickets hopping in the grass, the air leaving my lips, and the snow falling from the tree.
    –         Remember to continue to breath and if a judgment or an unwanted thought comes into your mind – notice it without resistance… as the thought arrived without reason so will it leave without reason if you kindly allow it to be.
     
    You can do this with smell and taste… you will often have to set up the situation differently.

    • Example – eat something and notice its’ different tastes, the texture, the water content – etc.
    • Example – open your refrigerator and close your eyes while smelling some of the food that you have.

     
    You may now continue the exercise this time notice 4 things for each of the three senses…then notice 3 things each… then two…. then one… you are done.
    You may use the same sense twice or more if you so desire (you are not required to come up with 45 different senses though you could)
    You have just spent a little bit of time doing your breathing exercises –which have been studied to have significant positive impacts on your health (many studies say just 15 minutes a day has a statistically significant positive impact).
    You just spent time focusing on the current moment and your current surroundings.
     
    You just learned how to give yourself a moment to notice and to give full appreciation to your senses – sometimes your body knows how you are emotionally feeling before you are aware of those feelings.
    You just gave your mind something to do so that you could stop ruminating, or thinking about the past and the future for a little while.
     
    How do you feel? Perhaps it is hard to articulate what a mindful state feels like… is wellness present?
     

  • Can you be too close? – Enmeshment and automatic emotions transfer

    Quick summary: When I say ‘too close’ I mean to say that there are some relational bonds which are so intertwined that the individuals in the relationship have a difficult time deciphering what is their ‘stuff’ and what is their partner’s or other person’s ‘stuff’. One of the most common aspects of an enmeshed (too close – completely intertwined – no significant boundary between the individuals) relationship is the inability to avoid mirroring or taking on the emotional disposition (mood) of the other person. In such a relationship the individual will empathically ‘feel’ the emotions of the other person and will automatically feel the same way or a set way (if one person gets embarrassed the other will feel embarrassed as well). When a relationship is enmeshed the individuals can also tend to have a limited ability to accept that the other person can hold a differing subjective perception or opinion than themselves (this will be covered in another blog – today’s topic is emotional transfer). Increasing self-awareness while creating an awareness of the existence of enmeshment in the relationship are the first steps towards reducing the phenomenon.
    Do you have a person in your life (typically a partner) with whom you have a difficult time in not ‘over-reacting’ to their mood (or visa-versa)? If yes – you might have a bit of enmeshment in your relationship?

    • If this person were upset, confused, sad etc you would feel overwhelmed.
    • Perhaps you would feel the need to ‘fix’ that person’s emotions or mood. (as opposed to offering them space or comfort etc.)
    •  It feels like your emotions are completely dictated by the emotions of the other person.
      • “I can’t be happy until he wakes up and gets less grumpy.”
      • “Of course I’m upset my wife had a difficult day at work.”

    Solutions –
    Awareness of the existence of enmeshment – “the first step to solving a problem is recognizing that it exists.”

    • Couples counseling is a very good setting to be assisted in this area – the therapist will often use many experiential (in the session activities) to help you work though this.
      • Immediacy – this is a technique in which your therapist points out aspects of your non-verbal reactions in order to give you (the client) greater insight into your automatic responses.  

    Self-awareness and body scans

    • How does you body react to specific occurrences?
      • by allowing yourself to observe without judgment the way that you physiologically respond to different stimuli you can learn to identify emotions and thoughts that you might be unaware of by ‘listening to your body’.
    • What is it about your life and your family of origin that greatly impacts who you are and how you react?
      • The more we understand our families and ourselves the better we are at understanding why we emote a certain way to certain occurrences.
        • Example – a person is more likely to have a stronger emotional reaction to people being late if their father forgot them at school numerous times when they were a child.
          • Your awareness of such will impact your ability to not project these feelings onto other people.

    Anchoring – I use a mindfulness technique know as ‘anchoring’ which encourages myself to recover if I am experiencing automatic emotional responses in response to another person’s emotions.

    • Anchoring is technique in which you attach an ‘anchor’ or a ‘reminder’ to an event, feeling, stimuli etc that reminds you to stop acting automatically so that you can consciously react the way you choose.
      • I have many environmental stimuli and physiological occurrences which remind me to begin engaging in breathing exercises – this takes me out of my head and into the present moment.
        • Many political conversations can cause me to have an excessive emotional reaction and the tendency to ruminate – I have an anchor on all things political – my brain sends out an alert – and I then stop any interaction with the topic and start breathing exercises. (I had a therapist who really helped me with this).
      • If I notice that my physiological and emotional response is significant I have an anchor which reminds me to…
        • Slow down and ask myself – “is this my emotion or someone else’s emotion.”
        • “Is this emotion about right now or does this have something to do with my past?”
        • “Is this the most beneficial emotion for this interaction?”
        • “This is not my emotion to hold… it is an emotion that I will be compassionate towards.”

    Individuation – create a balance of independence and dependence.

    • Enmeshment can be the result of being too dependent – there is no definition of self which is separate from the relevant person.
    • “I am I and I am we” – this is the balance.
    • Engage in activities which help you see yourself as separate from the other person.
      • “if you love someone set them free”
        • This does not need to be done literally- you simply need to love the person without needing them.
        • Free your self from over identification – you are your own separate person – free the loved one from being your identity.

    Identify cognitive distortions (mistaken beliefs that you allow to govern your life).

    • Some relevant cognitive distortions –
      • “I can not be happy unless everyone around me is happy.”
      • “Love involves expressing the same emotions as my partner.”
      • “It is helpful for me to express the same way my partner is.”
      • “If I get mad too then I am showing an understanding or compassion.”

    As with every psychotherapeutic theme that I will discuss – there is good reason for the existence of enmeshment, and it is something to work on in certain relationships.
    The ability to be enmeshed comes from a very honorable place = one’s empathic ability (the ability to walk in another person’s shoes and to feel what they feel).

    • In an enmeshed relationship the person confuses their empathic feelings with their own feelings.
    • Feeling other people’s emotions is not the concern – this ability is a very helpful skill in maintaining a healthy relationship.
    • Learning to discern what emotions are your own and what emotions are from other people is a great skill.


     
     
     

  • Trauma – What happens to a person who has experienced trauma and why.

    Quick overview: Trauma is a normal reaction to an abnormally difficult circumstance. The brain has an adaptive method of dealing with traumatic instances in the moment, which can have a negative impact on a person once the traumatic instance is no longer present. In this blog I will briefly explain what happens to a person who has been traumatized, why this happens, and then I will set the stage for future blogs in which I will describe the recovery processes. There are many aspects to the trauma recovery process such as support, empowerment, finding new meaning, and engaging in techniques which help to ‘rewire” the brain.
    In the face of sever trauma a person will go into their fight or flight mode. These modes are adaptive for survival as they allow us to act quickly to protect ourselves from physical injury and/or from emotions that are too powerful to experience all at once. Usually a brain will ‘numb’ our emotions and senses while a person acts without wasting time to think.

    • The fight or flight response will inhibit a great percentage of our ‘normal functioning’. This means that during the experience a person might not be able to make meaning of the occurrence, or to successfully access their emotions relevant the occurrence.
    • We will also stop processing information about stimuli that is unrelated to survival – ex. If you had a stubbed toe you would probably not feel it during your fight or flight response.
    • Sometimes flight involves disassociation, which essentially means that a person leaves their body while the body endures the trauma.
    • There are often too many emotions for the person to process at the time of the trauma, and this can have a visible effects on the brain. Often professionals will describe the brain to be like an electrical circuit board – if you put too much information in at once (if you are flooded with emotions) the circuits can be damaged. The result is that a person will hold the emotions though they were never able to process them.

     
    The brain of a traumatized individual will be hard wired to respond more quickly (to fight or flight responses – such as hyper vigilance or automatic responses) to events that remind the person of the traumatic experience (this is a simple explanation for Post Traumatic Stress Disorder – PTSD).

    • This is neurologically substantiated – using brain imaging neurologist can see the result of trauma on the brain.
      • Your brain has many different connections (synapses) and some connections are turned on more than others (ex. if you smell your favorite food you will salivate and if you smelled that same food before you learned to love it, you might not salivate)
      • During trauma or extreme stress a hormone (cortisol) is released into the brain which will make your fight or flight responses ‘easier’ to turn on when a stimulus similar to the traumatic stimulus is present (ex this is why a war veteran will duck for cover (flight) upon hearing a loud crashing noise).

     
    Every one has a stress response to trauma, but everybody will react differently and will be affected to differing degrees.

    • No one is immune to being traumatized, but some people do have a higher tolerance.
      • It might take a disaster like hurricane Katrina to cause a traumatic reaction in one person while another person could be traumatized by being in a 10 mile per hour car accident.
    • Cortisol is released in different amounts from person to person (this is a hormone released into the blood stream during a fight or flight response).
      • Cortisol is very important for every day functioning, but if levels are too high a person will feel as though they are in a constant state of stress.
    • A person who has not yet benefited from a trauma recovery process might feel as though they are in a constant state of stress
      • A cortisol feedback loop is created – meaning something in the environment ‘brings up’ the traumatic instance and the person engages in a fight or flight response and the body releases more cortisol… having more cortisol increases the likelihood that a person will engage in a fight or flight response again in the future…therefore the process also increases the chance of releasing even more cortisol.

     
    When a person lives through a traumatic instance often times their whole world is turned upside-down and no longer makes sense to them – Existential turmoil.

    • A world that seemed fair, just, and safe will no longer feel that way and a person can struggle with what meaning to draw from their suffering and the apparent chaos that seems to dictate the world.

     
    Often the concept of trust and safety are impacted when a person experiences trauma.

    • Even if the trauma had nothing to do with a loved one… a person might experience that no one is safe and no one can be fully trusted.
    • Child abuse is more common than we like to admit in this country and the abuse will generally have an impact on an individual’s ability to maintain positive relationships, as they grow older.

     
    It is not uncommon for a person who has survived a traumatic experience to continually re-engage in experiences that are likely to let them re-experience the trauma again.

    • People do this under the unconscious belief that if they re-experience the trauma… they will make sense of it… and the experience will then cease to be traumatic.
    • This is why children that were either physically or emotionally abused often end up in abusive relationships.

    Substance abuse is very common in individuals that have survived sever physical or emotional trauma.

    • Substance abuse can temporarily alleviate the symptoms of the stress cycle – unfortunately there are very often other negative side effects.
    • It is important to note that a greater percentage of substance abuse in this country is the abuse of prescription drugs though we hear more about alcohol and illegal drugs.

     
    Recovery can involve many processes either together or separate. I will offer a list of recovery strategies that will be covered individually in future blogs.

    • Catharsis (emotional release), re-experiencing the event verbally with support and safety, techniques to reduce or eliminate the stress cycle, techniques for non-invasively re-wiring the brain, spiritual journeys, systematic desensitization (generally for less severe trauma such as falling off your bike), empowerment, making meaning, finding support, guided visualizations, re-building trust, family of origin work, finding different more adaptive reactions, and joining with a group of people who have survived similar trauma to name a few.

  • Mindfulness – Why it is helpful and what 'being in the present moment' means

    Quick summary – Mindfulness is a state of existence in which 100% of your consciousness is on the present moment (as opposed to the past or the future). It is characterized as being a state which is free from judgment in which you engage your environment with a childlike curiosity and innocents – you see the world as novel. The benefits include a greater awareness of the mind-body-spirit connection, reduction in suffering, reducation of stress and anxiety (which tend to be the result of the mind’s fixation on the future or the past) and an ability to experience the present moment with the full richness of your senses. Many would suggest that a state of perpetual mindfulness is the gift of enlightenment.
    The observer – who or what is being mindful? Answer these questions to understand what you subjectively believe to be the difference between the thinker and the observer.
     * What or who produces the thoughts in your head?
    * Can you control all the thoughts in you head?
    * Who is it that is noticing or observing the thoughts and images in your head?
    * Are you the creator of your thoughts, the observer of your thoughts, something different (you are the consciousness (or part of a collective consciousness) which is conscious of your existence’s apparent consciousness) both (you create your thoughts and observe them, or neither (your mind (or God or a greater energy etc) creates the thoughts and observes them, and you have no control over either)?
    Everyone will answer these questions differently and this process tends to give you insight into your theoretical, philosophical or spiritual orientation.
    In a state of Mindfulness you are simply the observer – you accept yourself separate from your mind and body along with all of ‘your’ emotions, judgments, preferences, beliefs, knowledge and character traits etc. (don’t worry you get to keep them if you want them – on my best days I tend to be in a state of mindfulness perhaps 10 – 30 percent of the time depending on my setting and my activity.)

    • In such a sate you are aware of your senses, emotions, and thoughts without being controlled by them.

    What’s the point of being present of being mindful?
                To give your self peace from an over functioning mind – I personally have one of those minds that is a bit overactive – I am constantly thinking about random scenarios, creative projects, things to do, blog ideas, future plans, relationship variables or trying to come up with solutions to problems that have little to do with me etc. I have been very fond of mindfulness practices as they quiet my mind so that I can enjoy my current setting as opposed to the constant chatter of my mind.
                To reduce suffering, stress and anxiety – the majority of suffering, stress and anxiety are not actually taking place in this exact current moment (in the present moment). It is the mind which imposes memories of suffering to add conflict to the present moment. It is the mind which tells you what you ‘should do’, ‘have to do’, or ‘didn’t do well’ etc that stirs up stress and anxiety when there is nothing in the present moment to evoke such a response.
                It frees you to see the novelty, beauty and uniqueness of stimuli in your current setting – our mind categorizes our environment for survival purposes – we therefore unconsciously label most things as benign, unimportant, not interesting, ordinary, boring, or uneventful etc and we therefore to not attend to the vast majority of what is happening in our current setting. Being mindful gives you that artistic eye which lets you appreciate the subtle beauty of most everything.
    What would be an example of a person experiencing mindfulness?
    Children – why do the kids seem to notice the weird looking bug that you almost stepped on, how were they able to find that perfectly heart shaped rock, and why are many of them so happy to stick their hand in and out of the sand for an extended period of time? The answer is that children tend to be very present – they do not yet have minds filled with chatter about what they should do or could do and their world quite literally is novel to them– and as such, they are much more observant of what is going on (marketing directed towards kids has not helped this – if you take a child to a grocery store they can lose themselves to ‘wanting’ – which is a future focus). Though it might be hard to believe – you too can re-experience the bliss of a childlike view of the world by practicing mindfulness.
    Do I have to do all that yoga and meditation? – Though these practices are very helpful and will perhaps augment or enhance your ability to be mindful – you can be mindful without practicing those two disciplines.

    • Both yoga and meditation tend to have the result of creating a state of mindfulness.
    • Practices in which you are focusing on the breath tend to increase mindfulness as your mind is given the task to breath which frees up your consciousness to focus on your surroundings.

    How do I ‘not judge” – Observe that your mind in creating judgments and accept that is happening while turning your attention back to observation.

    • Some people with mentally objectify their thoughts as a way of separating their thoughts from the observer – ex. they will imagine their thoughts to be clouds floating through the sky.
    • This is indeed one of the hardest aspects of mindfulness, and most medication practices for that matter.
    • Resistance tends to make things worse – (tell yourself not to think about a certain subject… now your thinking about it).
    •  There is also an inherent double bind– you are judging yourself concerning your ability to avoid judgment.
    • Accept your judgments and free yourself to be separate from them – simply notice them as opposed to reacting to them (resisting your judgments would be a reaction).

    “Have I ever been in a state of mindfulness as an adult?” – Most likely you experience multiple moments of mindfulness everyday.

    • Often when people use the word surreal – they are describing a moment of mindfulness.
    • We also tend to be more mindful in situations that are new to us –if you are visiting a culture which is very different from yours.
    • In traumatic or life threatening situations you will likely become hyper sensitive to your environment (though you will sometimes still be controlled by your thoughts and emotions).

     
    My future blogs will offer techniques to help you to arrive in a state of mindfulness.

  • Existentialism – meaning, meaninglessness and your life

    Quick summary:  “It is not about finding the correct answer to questions pertaining to life, death, suffering, bliss, meaning, and meaninglessness… it is about creating a meaning which is most helpful, comforting, and peace provoking to you as an individual.” In this blog I will talk about some of the affects that existentialism (or the innate drive to make meaning) has on peoples lives, and how existential themes contribute to therapy.
    Existentialism is a school of thought which is concerned with meaning and meaninglessness; the philosophy attributes more significance to the meaning we individually place on occurrences and existences than on an objective truth concerning an occurrence or an existence.
    Some existentialist believe that we make decision based on the meaning that we assign to different actions and our decisions are not always based on the facts pertaining to an action (facts dictating an action is rationalism).
    Existentialism is another one of those philosophically complex terms that ironically “means” something different to different people.  
     
    Have you ever asked yourself any of the following questions? –
    – What is the purpose of my life?
    – Why did this happen to me?
    – What is the meaning of life?
    – Why do I do the things that I do?
    – How could such a terrible thing happen?
    – Why do people die?
    If the answer is yes (you have asked yourself one of these questions), then you have asked yourself an existential question.
     
    What impact does your answer to any of the above questions have on you? Existentialism appears in the field of therapy under the belief that the answers that you give to yourself (the meaning that you assign) will have a significant impact on how you perceive your existence – or how you perceive the quality of your life.
     
    –Note – I would propose that any ‘why’ question is an existential question – to any answer that you give to a ‘why’ question, the question ‘why’ can be asked again – until there in no answer = meaninglessness.

    • Example – why is the sky blue? – The refraction and reflection of light. – Why? The process enables the longer wavelength to be perceived. – Why? Longer wavelengths are blue and shorter wavelengths are red. – Why are longer wavelengths blue? Color pertains to light wavelengths and colors are on a spectrum. – Why aren’t short wavelengths blue instead or why does the color spectrum exist? – Meaninglessness…

     
    As humans many of us our conscious of the fact that there is no one correct answer to the above questions… Our inability to know the answer to those questions is believed to be a major source of anxiety, despair, and dread etc.
     
    The existential solution to the anxiety caused by the meaninglessness of life and death is an individual’s freedom to create your own meaning and your own purpose to life.
     
    One of my top ten books of all time is Victor E. Frankl’s – “Man’s Search for Meaning” Victor was a Jewish psychiatrist (among other things) that was sent to various concentration camps during the Nazi occupation. He attributes a large degree of his ability to survive the concentration camps to his ability to maintain a sense of meaning throughout the chaotic and meaningless suffering that he and others were forced to endure. I highly recommend reading this book – it offers perspective on the resilient potential of the human spirit that can arise from within one’s self without altering the suffering which inevitably surrounds us.
    You might have heard that there are ‘existential therapists’… what does this mean and what do they do? In my opinion, existential therapy simply implies that the therapist believes that he/she can help a client by assisting that client in creating meaning pertaining to an event which is causing the client distress (and in some cases that distress might be producing very observable mental health concerns).

    • There are no set techniques in existential therapy and the therapy process can differ dramatically from one therapist to the next.
    • The goal can be to assign meaning or to change the meaning that a person attributes to a certain occurrence (person, place, thing, action etc) – the client changes the meaning and not the therapist. This is done under the belief that a person relieves distress by embracing their freedom to assign their own meaning to the meaningless.
    • Meaninglessness is thought to be fundamentally universal – Individuals have the freedom to subjectively assign meaning to an existence that has no universal meaning.
    • This can be both theologically based and not – for some philosophers it was god who gave humans the freewill to find meaning, and for others, they believe that there is no god and our drive for meaning comes from nowhere.
    • Sometimes the drive to create meaning out of a traumatic situation leads us to continually engage in self–destructive or socially destructive behaviors. Some in the therapy field believe that this is part of the reason why people who are perpetrated on sometimes end up perpetrating on others or why people who grew up in abusive households end up in a relationship with an abusive partner – In both examples the individual is unconsciously re-engaging in the meaningless suffering to try and ‘find’ meaning.

     
    In short – my existential quotes to provoke discussion and thought –
     “It is not about finding the correct answer to questions pertaining to life, death, suffering, bliss, meaning, and meaninglessness… it is about creating a meaning which is most helpful, comforting, and peace provoking to you as an individual.” -Will
    “It is responsibility that offers a meaning to liberty is an attempt to address the chaos inherent in freedom.” – Will
    “You can look endlessly for purpose and meaning only to ultimately find that you held the freedom to create your own meaning and purpose the entire time.” -Will
    “Suffering is both inevitable and infinite… peace then is not found in the annihilation of suffering and chaos (as this is not possible), but in the meaning that a person assigns to that suffering and chaos.” – Will

  • Genograms – reducing blame and finding solutions in your family tree

    Quick summary – When visiting certain therapists (trained in family therapy) you might have the opportunity to do a genogram to shed some light on some of the themes or patterns in your multi-generational family – your family tree. A genogram typically lists 3 to 4 generations of your family (ex. your children, their siblings and their cousins; you, your siblings and your cousins; your parents and their sibling) and uses a combination of shapes and lines to visually symbolize how all the people are connected.  A Genogram can be used for many different purposes – I enjoy helping clients to look for commonality to reduce self-blame and to look for instances in which another family member resolved an issue similar to the client’s presenting concern.
       Example of a genogram (higher = older generation),(square = male and circle = female)(I would have names and ages next to each person’s symbol)       
                 
    Families have rituals, customs, behaviors and beliefs that are passed on from generation to generation – Often people are unaware that they are making choices based on fairly set family values – “what influenced you to parent as you do?” – client answers “I don’t know… that is the way that my parents did it I guess,” (or – “I didn’t want to parent like my parents did.”) Looking at a family tree (genogram) can give you insight into why you make some of the choices that you make.
    Reducing Blame – Often clients (especially parents) will come to a family therapy session feeling really awful as they blame themselves for the difficulties that someone in their family is facing. As a therapist I will often ask clients to point out where this problem exists in other areas of the family to help the client to see that the problem is related to the family as a whole and not a solely to a set individual. (As strength-based therapist I tend to believe that finding fault is less beneficial than finding strengths and solutions).

    • The problem could have a biological explanation, which is easier to identify if you can see that many people in a family have similar symptoms. (ex. “perhaps he is irritable do in part to his digestive issues that I see many men in you family deal with.”)

     

    • The problem could be based on a family ritual that started 80+ years ago (ex. the family tends to drink alcohol when there are financial problems – this ritual started with the clients grandfather during the depression.)

     

    • Genograms can offer a reasonable explanation for a behavior that a client is not proud of. Ex. If a client is blaming himself or herself for emotionally shutting off to their partner it can be helpful for them to identify where in the family that behavior also exists, and why that behavior is adaptable, which will help in the process of finding a replacement for the behavior.

     

    • This is not about transferring blame – chances are you could probably trace many issues for multiple generations. I will talk about trauma in a future blog, but in short it is possible that a problem facing a client today is in some way related to a trauma in the family that happened 100+ years ago. (Ex. If your great grandfather was held in a prisoner camp before he came home to father your grandfather, this experience might affect the way males emotionally engages their children in your family for multiple generations. Ultimately in this example the only thing to blame is an abstraction, being –  a human’s natural reaction to violence and oppression)

     
    Solutions – My absolute favorite set of questions concerning a genogram are-
    – “Who else in your family went through what you are going through in their own way?”  I will then use a colored pen to mark all the people in the client’s family who have experienced a similar concern.
    I then get a different color pen and ask
    – “Out of the people that have experienced a concern like yours, tell me the people that you believe were able to attain a solution that you find agreeable?” (I will name the concern specifically –ex. problems with the legal system).
    After all the people are marked I will ask the client or clients to talk specifically about a family member that overcame their difficulty.
    – “Tell me about this person; how were they able to resolve or overcome this difficulty?”
     
    – “What is it about this person that you admire or what are their strengths?”
    – “In what ways are you similar to this person?”
     
    -“Lets talk about how this family member’s solution might work for you and what changes you would have to make to the solution to meet your specific needs.”
     
    This process has three purposes – it reduces blame, it isolates strengths and solutions that already exist, and it creates a sense of hope (as someone else already succeeded).
     
    “We are what we eat and we are our family” – me
     
    Again I focused this blog on reducing blame and finding solutions, future blogs will cover all the other benefits of the genogram experience. (Often a client will simply look at their genogram and the image will bring about revelations that the therapist could not have anticipated – and sometimes simply naming everyone in the family raises subjects that need to be worked through in therapy – ex. the uncle you admired that passed away too soon.)
     

  • Why Feeling Questions? – Emotional Expression Enhances Bonding

    Quick summary: Exciting new research done by therapists such as Dr. Sue Johnson (the pioneer of emotionally focused therapy) have added efficacy to therapeutic interventions which help clients to express emotions. By sharing your most intimate feelings to your partner you can increase the overall intimacy and relational strength of your union. This makes common sense if you think about it – when you decide to trust someone and to confide in him or her – most believe that this makes you closer or more bonded to that person.
    Couples therapy can offer a safe place for partners to finally release the emotions that they have been holding; the therapist is available to help the couples to sit with and to support the expressed feelings. – In this way there does not need to be anything ‘wrong’ in the relationship for people to seek couples counseling; If a person chooses to heal with their partner present they will gain in two ways – they will overcome their difficulty and they will strengthen their relationship.
    Need the scientific answer? – new research is finding that emotional intimacy (which can be arrived at by sharing emotions with your partner) can increase Oxytocin levels – (there is too much information about this for this blog) – in short Oxytocin is the hormone/neurotransmitter that is released during birth which elicits the love and bonding feelings. Oxytocin is also thought to be responsible for that “crazy – can’t sleep at night – miss the partner after minutes” type of love found typical in the beginning of relationships – this, by the way, goes away naturally (the ‘honeymoon period’ in biologically substantiated – so if after between six months to a year and a half do not fret when your love changes in feeling). So in short, there is a biological explanation for why sharing emotions increases bonding.
    The “how do you feel” question has long been the punch line for satires about therapists… In reality some therapists are very interested about the client’s feelings, but they are significantly more tactful in their questions than Hollywood typically portrays.
    The goal is for the clients to feel the emotions (both for themselves and empathetically for their partner), the reason that therapists get the reputation for asking lots of feeling questions is that it is very common for people to ‘tell’ about their emotions without allowing themselves to experience the emotions.  Most people have probably witnessed what I am talking about (as we all do it) – we watch people talk in a ‘matter of fact’ way about something incredibly emotional… it is not that these people are cold – they have just learned throughout life that restraining emotions in adaptive. For example -after a job I had in which I had to display and extremely high degree of emotional control I had to re-teach myself to cry… there was nothing to cognitively fix… I just needed the comfort of my wife’s presence and the freedom and safety of our bond to express myself.
    Telling about your emotions instead of allowing yourself to feel your emotions has become very important in today’s professional cultures. There are unwritten rules at work which state that you are to restrain from expressing emotions fully (both laughing hysterically and crying tearfully tend to be looked down upon.)
    Restraining emotions is also an adaptive way of ‘getting on with life.’ For many it would be hard to function if they were not avoiding, denying, or rationalizing etc. their emotions.
    We all do it (or most at least) and I can only begin to tell you how good it feels to have your partner hear and care for the emotions that you express. A therapist can be very helpful as we have a tendency (men and women) to try and ‘fix’ our partner’s ‘problem’.
    Emotions can get really bottlenecked… which often leads to stress, anxiety, and irritability.  Sometimes acknowledging an emotion to your partner is the best way to unburden yourself while reaping the benefits of increasing your intimacy. Again, a therapist can help to ensure that your partner does not “pick up” the emotional weight that you are sharing – supporting an emotional does not need to involve taking the emotion.
    We can all struggle with blaming, defensiveness, avoidance and denial – so sometimes it is best to let a therapist help you on this journey.
    In closing, I had a teacher who used the word dignity in relation to how to empathize with a person expressing emotions that you are supporting.
    Allow your partner the dignity to carry his/her own emotions – your partner’s emotions are not for you to carry, but for you to support with your love, hope, compassion and trust.