litosttheory

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Something helpful. I came across and bought this therapy journal on Etsy. It’s $20 plus shipping and well worth it. The journal is a bit above pocket size. I find it very helpful to use immediately after a session to help me remember what was said.

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On Terming.

Hey, man,

I really think I’m going to terminate my relationship with my therapist. I’ve been seeing him for years now and for years I don’t think I’ve made a lick of progress.  The thing is, I genuinely like this guy. He’s a good guy, but ...

He tends to talk way too much about himself and his life. I know many facts about his life and I wonder, Should I?? And, often, when I’ve made comments in distress, like, “I feel like my life is over because of my age!” He said, his face with a cross expression, “We’re close in age. You’re not saying MY life is over, are you??” I then said, “No! I’m talking about ME.” 

I understand a therapist saying things to establish a rapport or to “normalize” things, but at this point, we established a rapport long ago. I mean, this isn’t The View! It’s my session! 

So, how ever can I do this? The psychiatrist said, before he left, that I should maybe write down what I want to say in a letter and then read it to him, so that everything is said. 

I will admit that I’m a little nervous. It is time, though.

xo

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Tell me about this Alice.

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Sundance fun with Esquire and photographer Mark Leibowitz! 😎

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by Therese Borchard

Finding the right therapist can involve almost as much energy and time as finding the right spouse. Instead of meeting for coffee, or appetizers and drinks, you’re spilling your guts inside a bunch of psychotherapists’ offices, trying to gauge whether all that notebook scribbling is going to translate into help or not. If you don’t know what you’re looking for, the important work of therapy can be delayed by months or years. Luckily, there are therapists like Ryan Howes, PhD, who are our tour guides inside the counseling walls. He’s like our Match.com concierge, equipping us with the right questions to ask so that we don’t spend years on the couch sitting across from the wrong notebook scribbler.

Dr. Howes is a board-certified psychologist in Pasadena, California, where he’s in private practice and is a clinical professor of psychology at Fuller Theological Seminary. He writes the blog In Therapy for Psychology Today, as well as an interview column for Psychotherapy Networker magazine. In 2012, Howes and some of his students formed National Psychotherapy Day (September 25th), a day to demystify therapy and reduce the stigma surrounding both it and mental health issues. As part of that campaign last year, he held a storytelling event called Moments of Meaning, in which therapists told true (but non-identifying) stories of powerful moments from their own work.

“Therapists are eager to tell you about things that aren’t directly related to your question of whether or not they can help you solve your problem,” explains Howes. “They will tell you where they went to school, where they were trained, what modalities they learned, what they researched, and so forth.” Instead of asking for their resume, he recommends you ask these six questions, and explains why.

1. My problem is _______. How would you go about treating that?

This is pretty straightforward. Of course, you have to know what your problem is, but even describing symptoms would help. “My problems are insomnia, worry, and anger outbursts. How would you treat that?” Hopefully the therapist’s response will either resonate with your game plan or will make sense so you’re willing to adopt a new game plan. The most important thing is that therapists are able to describe their process in a way that you can understand it. If they present a flashy, jargon-filled approach that goes over your head, you can expect to feel similarly confused in therapy with them.

2. Some therapists are more comfortable addressing the immediate problem, while others want to focus on the deeper issue. Which are you? 

Many cognitive-behavioral based therapies are focused on treating immediate symptoms, while deeper, psychodynamic-based therapies focus on the root causes of a problem. The preferred answer depends on your needs: If you need quick, immediate relief, you’ll gravitate to CBT, but if you’re willing to wait a while to reach a deeper insight, the psychodynamic theories are probably more your style. Again, the therapist’s ability to clearly communicate their approach is key here, even if they say they combine approaches.

3. Do you tend to lead the session, or follow my lead?

Another key distinction is whether a therapist is “directive” or “non-directive,” which is fancy talk for a leader or follower. Some therapists have an agenda for your session before you sit down: The gameplay is set, and you’re a passenger on this ride. Other therapists wait for you to set the agenda, either with a pre-determined topic or whatever comes up for you as soon as you sit down. Again, this is a matter of your personal style — directive appeals to some, while non-directive appeals to others.

4. What role does our relationship play in our work?

Some therapists view therapy as a laboratory: The problems you experience in the outside world will come up between us, and that’s a great opportunity to do important work. For others, therapy is more of a lecture hall — a place where you learn tools and tips to apply outside the session. It’s good for you to know which you’re stepping into. If you want to learn to confront people and want to practice that with your therapist, you’ll want therapy to be a laboratory. If you want tips for managing your OCD and just want therapy to be a resource for information and exercises, you’ll want the lecture.

5. What are your strengths as a therapist?

Not many clients ask this question, but I think they should. By asking, they’re inviting the therapist to make an honest appraisal of their strongest attributes, and at the same time asking them to point out what they believe are important therapist traits. If they say “my ability to earn fame and fortune,” well, you know what you’re getting into.

6. Have you been in therapy?

This may be an optional question for the most bold among you, but I think it’s a valid and important one. It’s essential for a therapist to spend a significant amount of time in their own therapy. In fact, as a therapist myself, I intend to be in therapy as long as I see my own clients. Why? Because it reminds us what it’s like to be on the other couch, because it helps me discern between my garbage and my clients’ garbage, because it models a lifetime process of constant introspection, and because I can learn things from my own therapist that may help my clients. You don’t need to ask specifics — or names and dates — but I think asking if a therapist has been in therapy is a legit question.

But your work is not over there. Howes thinks it’s even more important to have questions for yourself, such as:

How soon did you feel relaxed when speaking with the therapist?

Did you feel rushed to ask your questions, or were you able to go at your own pace?

Did the therapist seem to “get” your questions, or did they misinterpret or need to ask for several clarifications?

Did you feel like the conversation flowed, or was it clunky and awkward?

Did you understand the response, or was it filled with technical jargon or vague statements?

Imagine your deepest, darkest secret — could you imagine telling this person about it?

“Study after study shows that successful therapy depends on the quality of the relationship between the therapist and client,” Howes explains. “You’re much better off seeing a graduate student you connect with than a 40-year veteran and author with whom you don’t feel understood.”

In the end, he advises folks to go with their gut, much like you would with a blind date over coffee.

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Despair is the price one pays for self-awareness. Look deeply into life, and you’ll always find despair.”

Irvin D. Yalom, MD   (via psychotherapy)

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“Most of my experience with therapy has been with psychodynamic psychotherapists who’ve had psychoanalytic training but who tend to sit face-to-face with their patients, talking things through an hour at a time, once or twice a week, for months or years on end. For about six months out of those nine years, I’ve also tried Cognitive Behavioral Therapy (or CBT).

As Oliver Burkeman explains in a wonderful essay for The Guardian, CBT has been on the rise over the past few decades, with analytical approaches to therapy under relentless critical assault. Therapy in the Freudian tradition is supposedly unscientific, interminable, and expensive. Worst of all, there’s no proof that it works. CBT, by contrast, is in most cases quick, easy, and “evidence based."Or so we’ve been told for decades. But as Burkeman also notes, this hasbegun to change. Recent studies have cast doubt on the effectiveness of CBT while also raising the possibility that Freud-inspired talk therapy may work much better than once seemed to be the case.

This shift in the consensus jibes quite well with my own experience. Which is to say, CBT isn’t the panacea its boosters like to think it is, and psychodynamic therapy is far more efficacious than its detractors claim. Each has its place. Each is well-suited to certain kinds of people and problems. I’ve had positive experiences with both myself. Yet the psychodynamic model of the mind ultimately comes much closer to making sense of my psychological experience.

The greatest virtue of CBT is its studied superficiality. Whereas classical Freudian psychoanalysis is all about diving deep into the psyche to probe the subconscious regions of the mind that we conceal from ourselves — a process that can be wrenching and painful, and take years of hard work and struggle — CBT treats human beings as for the most part self-transparent and capable of achieving rational control of negative emotions with relatively modest effort (and sometimes a little help frompharmaceuticals and mindfulness meditation).

Say I’m unhappy about something in my life: Whenever something surprising or unexpected happens in my daily routine I grow agitated, anxious, and angry. So I sit down with a CBT therapist and begin to problem-solve. She might explain that these negative emotions arise because I irrationally presume that things will always go badly, maybe even catastrophically, when I’m forced to think on my feet and make a last-minute change of plan. This inference triggers a panic response in my amygdala, the part of the brain responsible for emotional reactions — the one that might lead me to leap out of the way of a truck bearing down on me at high speed when crossing the street.

If I’m about to hit by a truck, such a panic response is good, and rational, since it might save me from a mortal threat. But why does my brain treat a minor last-minute change in my schedule as the equivalent of a life-threatening injury? There are all kinds of possibilities, many of them rooted in my past. But it doesn’t really matter for CBT. What does matter is that I recognize the response as irrational and seek to short-circuit the invalid inference. I might do this by keeping a diary in which I record every time something unexpected happens in my life, and the outcome. Before long, I’ll notice that most changes of plan don’t lead to catastrophe, and some of them actually make my life more interesting and fun.

And that’s the point: teaching myself to adjust my irrational associations. My life doesn’t fall to pieces when something unexpected happens. It’s not a catastrophe. After a while — maybe a dozen sessions with my therapist, maybe more, maybe fewer — I’ll begin to see changes of plan as a part of life that shouldn’t be dreaded. Sometimes they should even be welcomed.

Once I achieve this change, I might be done with therapy. Or I might have other areas of my life where I need help. Maybe my spouse and I need to work on improving how we communicate. Or perhaps I find myself getting irrationally angry at my colleagues at work. Or I could be having trouble sleeping. I can place each of those problems on the table, too, one at a time, figuring out with my therapist how to solve each of them by making a series of incremental changes in how I think, act, and feel, with the final goal being an overall increase in my happiness.

But what if I don’t want to be happy?

Or rather: What if I think I want to be happy but act in ways that clearly, obviously make me sad, angry, anxious, or depressed? And what if I begin therapy by telling my therapist that I want help in figuring out how to be happier, but then immediately begin to resist every effort to explore the sources of my unhappiness?

What if I don’t have the foggiest idea of why I’m unhappy?

Unlike CBT, the psychodynamic approach to therapy sees human beings as strangers to themselves — unsure of what they want, self-subversive in their actions, and opaque in their motives. It therefore presumes that the obstacles to achieving rationality and happiness — which involves determining what we truly want and taking reasonable action to get it — are far greater than CBT presumes.This means that psychodynamic therapy involves not simply listing problems and troubleshooting solutions, but making a concerted effort to achieve self-understanding — a process that takes time and often an enormous amount of work (and courage). Only then can we know what the true problems are and determine what kind of enduring solutions might be possible.

Though few psychodynamic psychotherapists these days accept Freud’s conclusions in all (or even most) of their details, they do affirm his overall model of the mind as containing sedimented layers of thinking, including a subconscious teeming with repressed images, desires, fantasies, hopes, and fears that can affect conscious thinking, acting, and feeling in strange, unpredictable ways. The mind does this by way of pre-rational forms of archaic thinking that take shape in childhood.

One example is transference, the process whereby the mind transfers associations connected with one person to another, usually of the same gender. The classic example is the tendency to experience emotions and act out unresolved conflicts from childhood over and over again with men and women who take on the roles of vicarious fathers and mothers. Depending on the nature and intensity of the emotions and the character of the conflicts, this can result in confusing feelings, skewed judgment, and fraught relationships.

Transference and other forms of archaic thinking can’t be changed or stopped just by pointing to surface-level behavior and feelings and labeling them "irrational.” The only way to change them is by working through the subconscious associations, emotions, and conflicts over and over again at the conscious level — in conversation with an analyst trained to look for clues of archaic thinking at work below the surface.

The psychodynamic approach suits me better than CBT — for all sorts of reasons. For one thing, I experienced acute emotional abuse and trauma at a young age when my bipolar mother suffered a complete breakdown and disappeared. For another, I have a complex history of spiritual and ideological shifts that are hard to explain in superficially rational or irrational terms. And then there’s my philosophical education, which makes me both keen to seek deep self-understanding and highly adept at using ideas to conceal emotions when there’s something I would prefer not to face. I need a therapist who’s able to detect when I’m engaging in intellectualized forms of misdirection and willing to call me out for it.

Which isn’t to say that psychodynamic therapy is for everyone — or to deny that CBT can be helpful for many and has even been helpful to me on occasion. But it is to say that, if my nine years on the couch have taught me anything, it’s that the mysterious, conflicted, self-deceptive, and self-subversive vision of the mind that comes down to us from the Freudian tradition — in which our happiness depends on a level of self-knowledge that our own minds make exceedingly difficult to achieve — comes much closer to hitting the mark.

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Maturity begins with the capacity to sense and, in good time and without defensiveness, admit to our own craziness. If we are not regularly deeply embarrassed by who we are, the journey to self-knowledge hasn’t begun.

Alain de Botton (via psychotherapy)

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Earth below us.... Drifting, falling, floating weightless.....

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Every day.

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So interesting.

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hüzün; from Arabic حُزْن (ḥuzn)

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Either you will be inspired or completely relieved that you’re not in one of these classes.

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Part of W.H. Auden’s syllabus from his year at the University of Michigan. 

Some light reading. 

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Jim Morrison and The Ha-Ha

One summer, just before I was to begin grad school at Carnegie Mellon, my mood had reached a true nadir. For a short bit, I was at a place called Western Psych. In the morning, the head psychiatrist was coming to see me next. She walked toward me, her brow furrowed, her face stern. I remember feeling that she was angry with me, maybe. I didn’t know how to react. “I’m Dr M,” she said brusquely. She sat on the other unused bed, asked how I was feeling, but before I could answer, a fight broke out in the common area. You could hear howling and “Ouch! Ouch! OUCH!” a few times. Immediately, Dr M and her assistant jumped up and rushed toward the fracas. Looking over, I noticed that my chart was there. Lying open, just like that. I peered over. Of course I did! Ain’t no shame to my game.

But what I read took me aback. Patient greeted me with no facial affect, it read. But, seriously, this woman was mean muggin’ me from the start! How was I to greet someone cheerily when she was coming at me like that? It was then that I realized the precarious nature of observation and diagnosis. The problematic factor is that we are human, even the doctor who read me all wrong. 

As we all sat together watching the local news, a story aired about a man who had tried to commandeer a city bus, but was soon apprehended. His face flashed across the screen in a fuzzy photo. “Oooh!” The other patients could barely contain their glee, “We gettin’ someone new!” 

Later, a young man of about 16 years named Will was brought in fighting the orderlies with all of his might. He was so combative that he was put for his own safety in a jacket and then put in the rubber room. This stuff really exists.

Another equally angry young man was in the safe room across from will. I sat with the aide flipping through magazines quietly when we started to hear the singing. It began slowly. Mister Mo-jo ri-sin’......Mister Mo-jo ri-sinnnn..... It was the two young men and they were singing a duet. RIIISiN! RIIIIISIN’! they screamed together, as gruffly as Jim Morrison had. I looked up - because, honestly, I had to laugh. The nurse’s aide kept reading the magazine as though she heard nothing, as if two young men weren’t screaming the lyrics of LA Woman just feet away. For a second, I wondered who was denying reality and who wasn’t. I heard it. It was funny. I laughed. The staff kept their poker faces amidst this madness. The psychiatrist made it over to the area. His expression on his face was pretty neutral, but his eyes - his eyes! - you could totally see he was laughing, too. 

Never ignore the ha-ha, my friends, for life is full of the ha-ha.

NB: Mr Mojo Risin is an anagram, I believe for Jim Morrison.