Experiential psychotherapy

Posted on August 31, 2010 by Marc Handelman, PhD

We know this, even if we have to stop and make ourselves think about it – everything we know begins with our perception of it. The color of a car parked in the shade; the firmness of a peach at the market; the smell of dinner cooking; the mood of the man walking across the street – all these things we know as a function of our perception of them. We trust our perceptual systems so much that they are a relatively invisible part of the process. Equally true, if less obvious, is that even a physician’s or researcher’s ostensibly objective knowledge of our internal physiological states – including neuropsychological events – is filtered by their perception of them.

Whether we can know anything outside the world as we experience it is an interesting philosophical question, but it has profound implications when we try to understand another person. This is particularly true in the context of psychotherapy and trying to help another person heal.

Much of modern day psychiatry, psychology, and psychological research operates under the illusion that physiology is primary. In fact, our experience is always primary, and this includes our experience of our physiology.

Though depression may have some relationship to fluctuating serotonin levels in your brain, depression is not your fluctuating serotonin levels. Depression is part of your experience. It is a mood that overcomes you or a shift in the way you experience the world. You may feel you cannot keep up with the world’s demands. Nothing matters. Both the world and your future feel grey.

Or consider anxiety: You can’t concentrate. You’re worried. You feel like you can’t stand still. You may feel dizzy, faint, sweaty, you feel the world has become far away. It can appear as though you are looking through the wrong end of a telescope. Though anxiety may have some relationship to changes in anxiety-specific neurotransmitters, anxiety is not changed neurotransmitters.  It is an experience.

In both examples – depression and anxiety – your experience of these circumstances or events is at issue.

Psychotherapists must always start off trying to meet their patients on an experiential level. Failing to do so leads to objectification and dehumanization of the other person. Whether or not various psychological techniques are used, or physiological interventions such as medication are administered, a therapist’s primary task begins in finding access to the patient’s emotional state. The work of a therapist must involve the experience of the patient in all its nuance and complexity.

For the therapist who works within an experiential framework, a large part of the work must involve finding access to the experiences of his patients in himself. While being a ‘warm and caring’ therapist may be important, it is relatively hollow in contrast to the therapist actually having a sense of how it feels to be you, how it feels to be experiencing the world as you do. A therapist must be comfortable sitting with feelings, both yours and his own, if he is to be helpful. The need to objectify patients and rely primarily on a conceptual or theoretical understanding of their problems, or a categorical diagnosis, often serves as a defense and blocks truly knowing the patient’s suffering and struggles.

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the basics: the fundamental attribution error

Posted on August 17, 2010 by Lori Stone, PhD

You and a guy are standing at a bus stop. It’s late in the day, and you’re tired. You idly glance over at him and watch him throw his Coke can on the sidewalk. You’re a little bit shocked, and you may even think “litterbug!” if that kind of thing matters to you.

Another day, you and a guy are standing at a bus stop. It’s late in the day, and you’re tired. You finish your Coke, glance around quickly and note that there are no trash cans anywhere in sight. Your bag is stuffed, and you don’t feel like carrying the can all the way home on the crowded bus, so you casually drop the can on the sidewalk.

You’re unlikely to call yourself a litterbug, right? Because you know that you’re not really a litterbug, you always put trash away. You even recycle! But this time, this one time, there was no trashcan anywhere in sight.

The social psychologist observing this situation would say that you made a situational attribution for your behavior (no trash can), and a personal attribution for the other guy’s behavior (he is a litterbug). Both behaviors were identical – throwing trash on the ground – but the explanations were very different.

The fundamental attribution error, also known as the correspondence bias, is obviously most visible when we explain others’ behavior. We undervalue situational factors, and tend to go with a personality, or dispositional explanation. That guy who threw the can on the ground, he just IS a litterbug. Since we have a lot of information to explain our own behavior, including our thoughts and feelings and our perception of the situation, we are selective in explaining why we do things. If we do something that receives praise, we’ll likely accept it as a reflection of who we are. If we do something that receives criticism, we’ll likely deflect the criticism by pointing to the situation. But we don’t have all that information at hand to explain others’ behavior, and we don’t usually have (or take) the time to reflect on all those factors when we make a casual observation about someone.

In the early research investigating what came to be called attribution theory, Jones and Harris asked their experimental participants to read a pro-Castro or anti-Castro essay aloud, and observer participants were asked to rate the pro-Castro attitudes of those reading the essays (this research was conducted in the late 1960s). Even when the observers were told that the readers’ positions were determined by a coin toss, they still rated the attitudes as more strongly pro-Castro if the pro-Castro essay was read, than if the anti-Castro essay was read. In other words, even with the knowledge that the essays were randomly assigned, observers were unable to properly reflect the power of the situation.

arguingThis bias, the fundamental attribution error, may not matter much when you make attributions for a stranger’s behavior as you walk past. But it does have important implications in your personal relationships. If you and your partner are fighting, you might think that she is being mean – but you, you’re upset because fighting with the one you love is so upsetting it’s hard for you. If you are able to stop and reflect about how the situation is influencing her behavior rather than deciding that her behavior reflects who she is, you open the door to a more honest conversation. If your mother becomes argumentative when she comes to visit, rather than think “she’s always so cranky,” try to think about the influence of the situation on her behavior. You might find that she is not a cranky person, but when the TV is blaring it’s hard for her to think and so she struggles to sustain an easy conversation.

Luckily, you’ll have a lot of opportunities to explore the fundamental attribution error. And if you want to read a personal account of the researcher who originated this work, this is a delightful and engaging article written by Dan Gilbert, a psychologist at Harvard who was Ned Jones’ graduate student.

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finding meaning: existential psychotherapy

Posted on August 16, 2010 by Marc Handelman, PhD

loneliness and emptiness

For many people, the big questions are the most interesting: Why are we here? What meaning does my life have? What happens when I die? What is the purpose of my life, of any life? These are existential questions – questions pertaining to existence. They are the stuff of Philosophy 101 courses, they are the questions that might keep you awake at 2am, and they can be the questions you debate with friends and family.

For some people, these questions are not simply an intellectual exercise. Some answers to the questions (such as “life has no meaning“) can produce very deep despair, and depression. And sometimes the absence of an answer produces similar despair or depression. In these instances, therapeutic approaches such as cognitive behavioral therapy (CBT) will be of little or no comfort; the problem isn’t faulty thinking! The reality is that these questions don’t have “answers;” there is no back-of-the-book to look them up. You may not be able to know for certain what happens when you die, but you can wonder what the various answers might mean for living your life. The questions about meaning may be life-long concerns, and your conclusions might change in any number of ways.

Existential despair, dread, anxiety, and depression can benefit from deep work with a therapist who takes an existential approach. The well-known philosopher, Martin Buber, made two distinctions in ways of relating to other people: I-Thou, and I-It. The I-It relationship is characterized by one person interacting with an objectified other; some therapists may take this approach, if their interaction with their patient has the form of healthy person treating sick person. On the other hand, an I-Thou approach occurs when the therapist accepts the patient and acknowledges his or her portrayal as valid, stressing the mutual, holistic existence of two beings. Existential psychotherapists meet their patients where they are, and work through the very real struggles that stem from these mighty questions.

In contrast to the existential approach, and although professing to be nonjudgmental, the psychiatric and psychological establishments tend to be embedded in a proscribed vision of normalcy and socialization. One of the most obvious ways this is true is in the use of diagnostic nomenclature – but even setting that aside, there is a more subtle idea, in the view of many mental health professionals, about how people should or shouldn’t be, or what must be going on inside them. Unfortunately, these conceptions are not necessarily in keeping with what is accurate or best for that person, or what may help them develop a positive sense of themselves and their world. (These ideas tend to be culture-bound and/or have a basis in political or economic expedience. The most blatant examples of this may be seen in political regimes that hospitalize and label as “mentally ill” people expressing ideas which are contrary to the interests of the powers that be.)

This proscribed vision of normalcy interferes with creativity, deep personal growth, and points of view which might bring important and critical changes to the way the larger world functions. Although a therapist may have reasonable ideas of what turns out to be useful or positive for a patient, the final analysis must still be placed in the context of that individual’s experience. Further, the existential therapist must be able to understand and empathize with the patient’s experience of these difficult existential issues.

Ultimately, the existential approach to people and to treatment of their emotional struggles and discomfort is based on helping people find meaning in their lives, and avoids trying to apply external objective criteria and schemas. Victor Frankl, considered to be one of the early existential therapists, believed the striving to find a meaning in one’s life is the primary, most powerful motivating and driving force in humans. His approach was developed during and after his imprisonment in a Nazi concentration camp.

In fact, the struggle for all of us is to put our lives and life histories in a meaningful context. This may be primarily an unconscious emotional endeavor for some, but for others it may also be important to find an articulable structure or credo. Without a meaningful way of making sense of things, we are almost by definition left with a deep sense of emptiness and a feeling of an inner void. From there we are often left with nothing to do but despair and feel hopeless.

[previously published in The Examiner, Aug 16 2010]
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the anxiety spiral

Posted on August 14, 2010 by Marc Handelman, PhD

There’s a reason people use a spiraling image to signify anxiety. The image is instantly recognizable, and even a little anxiety-provoking! Anxiety often operates as a kind of spiral of repetitive thoughts, turning on themselves. You start with a bit of anxiety about something, and your anxiety spreads and grows, and then you become extremely anxious about being so anxious. If you experience social anxiety, you may begin with an anxious thought that people are focused on you which leads you to become extremely focused on yourself, which produces still greater anxiety.

The experience of anxiety falls along a spectrum, or continuum. You may have a bit of difficulty concentrating; perhaps you’re restless; you may be worried and have repetitive thoughts; and/or you may feel an unpleasant self consciousness. On the extreme end, you may have panic attacks, a feeling of impending doom, you may fear that you’re losing control or dying or ‘going crazy’; you may be dizzy and lightheaded, faint, sweaty, you may have difficulty breathing, you may have chest pain or heart palpitations. You may even experience depersonalization – the feeling that you have changed, and the world has become far away.  It may seem like you are looking through the wrong end of a telescope.

Too much anxiety (and interestingly, too little anxiety) has a negative effect on performance, and researchers have discovered an inverted-U curve of anxiety. Without some anxiety, you can be sluggish and unmotivated but with too much anxiety you have difficulty focusing and feel disorganized.  Performance goes down on both ends of the curve. The optimal level is in between, when you are energized enough to function yet not so agitated you can’t concentrate or get things done.

Anxiety is not just an emotion; it has obvious physiological components – the sweatiness, dizziness, flushing, and difficulty breathing, for example. Anxiety is sometimes treated with beta blockers, which can reduce some of these symptoms by blocking the chemicals that cause them. Speakers, actors, and musicians who experience performance anxiety often experience some relief from beta blockers because they can reduce the extreme symptoms to a manageable level.

There are cognitive components of anxiety, too; if you’ve experienced anxiety, you probably understand the tyranny of repetitive thoughts, the kind of groove your mind falls into, where no matter how hard you try to think of other things that are less anxiety-provoking, or no matter how hard you try to stop focusing on the anxiety, you just can’t. You’re stuck, going around and around and around. Anxiety fear anxiety fear anxiety dread, stuck.

People attach anxiety to all kinds of things. Perhaps you experience anxiety when your mother is coming to your home. Perhaps you experience anxiety when it’s time to pay the bills and you may not have enough money. Perhaps work is anxiety-provoking.  Perhaps you feel anxious about driving in a car or getting in a plane. These are relatively concrete “causes,” issues that may be addressed by avoiding what triggers your anxiety. This is not to say that it’s a simple story: fix problem, eliminate anxiety; rather, the point is that anxiety often has an immediate referent.

Anxiety can also be existential; Kierkegaard talked about ontological anxiety related to questions about life itself. “Where am I going with my life?” “Is death the end of everything?” “Does my life have any meaning?” These are existential questions, and they may quite readily provoke deep anxiety. The issues may need to be addressed differently, the consequences feel enormous and vast, and the questions are possibly unanswerable.

Anxious thoughts  and obsessions might also provide an illusory attempt at control. You may have been very worried about something in your life, and even though you know that worrying can’t help, hanging on to that worry gives you the feeling of doing something. Anxiety might also serve as a distraction from something underneath the issue you’re focusing on. Anxiety about going on a date may be a mask over your deep fear of being lonely for your whole life or your fear of extreme helplessness.  Anxiety may be distracting you from a seemingly unbearable hurt, or fear, or anger. As unpleasant as the anxiety is, it’s more bearable than facing those deeper concerns which are rooted inside. Of course, you may not be consciously aware of those painful depths.

Real therapeutic work may have to involve working through the feelings which are under the experience of anxiety rather than working through the thoughts alone. Cognitive behavior therapy (CBT) may walk you through a process of identifying extreme thoughts, etc., but it doesn’t address the deeper issues which cannot be resolved with such concrete steps. For deeper resolution and integration to occur, one needs to confront, experience, and work through the issues underneath the anxiety. It’s important to note that anxiety and depression frequently occur together and they must be addressed together to resolve them both.

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depression: struggling in the dark

Posted on August 5, 2010 by Marc Handelman, PhD

Although people may use the word lightly in their everyday speech – “I’m so depressed, there were no peaches at the market today” – there is nothing light about being depressed. The words people use to describe this bleak emotional state frequently invoke heaviness, weight, and darkness. In the extreme, depression may cause such profound suffering that suicide seems to provide the only relief.

Depression occurs along a continuum. At a minimum, it is characterized by an inability to experience pleasure; lethargy, sadness, lack of motivation; feeling unengaged in life, disconnected, and uninterested in being involved with others. A depressed person may grapple with a general sense of meaninglessness, and perhaps a mild despair. This emotional state may be mild, and even occasional. At the other extreme, the experience of depression can be deep and pervasive. Your body feels heavy, getting from one moment to the next feels burdened. Colors may not appear bright, or distinct – and in severe cases, colors may not even be noticed. The world feels and looks gray. The future is not bright, but only contains more of the same unremittingly sad experience.  Deep depression is a profoundly lonely state; nothing brings pleasure, the experiences that once may have produced pleasure are bled dry and now only remind you that nothing helps, that nothing matters. You watch other people living, and you feel even more isolated. You may trudge through your daily routine, managing to fulfill your obligations, or you may not be able to get out of bed. You may sleep all the time, or you may be unable to sleep. You may eat and eat and eat, or you may be unable to eat. The world simultaneously feels like too much, and not nearly enough. Some despair over the emptiness and meaningless of everything – life, experience, themselves, the world – and others no longer even have the ability to think about whether there is any meaning.

Depression can be a chronic state, beginning at a young age and lasting across the course of a lifetime. People sometimes say, when their depression is finally addressed, that they must always have been depressed, because they do not recall ever feeling relief. Some people live with mild depression for years, in a state just painful enough to affect their experience of life but not so painful that they withdraw from living. Others may develop depression and experience an ongoing increase in suffering leading to deep despair and thoughts of suicide. However pervasive depression may be for an individual, having people simply tell them to “snap out of it” or “just go out and do something fun” can indicate a lack of understanding, and often reflects the sense of helplessness and discomfort of the one offering the advice.

The bleak landscape of depression has been part of the human condition for centuries. The ancient Greeks believed that depression (which they called melancholia, or ‘black bile’) was due to an imbalance of one of the basic bodily fluids. By the 18th century, depression was believed to be caused by electrical and circulatory imbalances in one’s body. Some believed it was due to soul sickness. Psychologists in the 20th century developed theories relating it to deep mourning, to a kind of neurosis, and to existential emptiness. By the mid-20th century, theories of depression returned to the beginning, in a way, ascribing depression to an imbalance in bodily fluids/chemicals – this time, neurotransmitters. Today, some psychologists think depression is due to habits of thought.

Beliefs about the causes of depression are important, because they inform the way we think about helping people who suffer with depression. If the cause is seen as a chemical imbalance, the treatment is rebalancing those chemicals. If the cause is seen as unresolved mourning, the treatment must address those feelings of grief and loss.  If the cause is seen as a sense of meaningless and emptiness, then addressing the way the person makes meaning of his or her life is essential. Chemical causes need chemical treatment. Faulty habits of thought are relieved by training new ways of thinking.  A sense of isolation is addressed by feeling a connection.

A recent study that compared the usefulness and long-term effects of psychodynamic psychotherapy (which focuses self-reflection and self-examination to get at the root of suffering), antidepressant medication, and cognitive behavioral therapy for depression found that psychotherapy is as effective as CBT but considerably more long-lasting, and that psychotherapy is about three times as effective as medication in producing relief from depression.

From my perspective, one must always start from an understanding of the depressed person’s experience. Beginning the process by training you to think differently does not typically address the underlying issues that bring you to needing help. Beginning the process by prescribing an antidepressant medication may be useful for some and produce relief of your symptoms, and may help you enough to reemerge from the bleakest places, but medication alone is unlikely to address the factors that led you to such a state of suffering. Issues of loss, and pain, and meaning, cannot usually be resolved so simply. Finding a meaningful way of understanding your experiences may provide comfort even if the “causes” are ongoing, and therapy can help you understand your personal history and yourself, so you can develop your own sense of meaning within the context of your life.

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codependency: being dependent on others’ dependency

Posted on July 23, 2010 by Marc Handelman, PhD

You take care of others, you help, you go out of your way for….but when do you cross the line from being a compassionate friend or partner or family member to being “codependent”? There may not be a simple test, or a clear marker, but if you consistently put someone else’s needs first, to the detriment of your own, you may be codependent with your friend or partner etc. This pattern may be an example of enabling — your behavior helps maintain someone else’s destructive or dependent behavior. A simple example of enabling might be your calling in sick for your husband, when he is too hungover to go to work.

Codependency may be a justification for allowing yourself to be mistreated based on your low self esteem — your sense that you don’t deserve better. On one end of the continuum, examples might be remaining in a relationship that doesn’t support you or your personal growth, while on the extreme end, codependency might mean not being able to leave a relationship, even when you are being abused emotionally and/or physically.

Codependency really involves behaviors that go above and beyond normal caretaking behaviors, or the everyday kind of self-sacrificing that happens within relationships. Some examples that are common in people who struggle with codependency include:

  • Denial patterns, such as having difficulty identifying your feelings, or minimizing how you really feel;
  • Low self esteem patterns, such as judging yourself harshly and believing you are never good enough, or feeling unable to ask others for help;
  • Compliance patterns, such as compromising your own values and integrity to avoid rejection, or staying in harmful situations for too long; and
  • Control patterns, which include believing that others are incapable of taking care of themselves, or needed to be needed in order to have a relationship with others.

For a more thorough exploration of these patterns, which includes a wide range of behaviors not listed here, you might wish to read this webpage.

It is important to note that there are criticisms of the label “codependent.” For example, caring for an individual with an addiction is not necessarily synonymous with pathology. To name the caregiver as a codependent responsible for the endurance of their partner’s negative behaviors can pathologize caring behavior. You may only require assertiveness skills and the ability to place responsibility for negative behaviors on the other person. Also, when this idea is pathologized, the codependent person may swing from an extreme of excessive sacrifice to an extreme of excessive assertiveness or selfishness and an aversion to empathy, which is a positive human capacity. A healthy approach would be to develop a sense of balanced and healthy assertiveness, which still leaves room for caring and helping.

Tendencies and behaviors that can be identified as codependent frequently emerge from a childhood in a dysfunctional family; perhaps one or both parents were alcoholic or had some other profound problems, so these patterns have deep roots. For this reason, codependency may show up in a wide range of your relationships including work relationships and friendships. Some people find 12-step groups such as Al-Anon/Alateen or Codependents Anonymous helpful, although some people do not. Therapy can be a useful tool to help you understand the complexities associated with these patterns, and to help you balance your own needs against those of others.

Visit Dr. Handelman’s website, Psychotherapy NYC

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the failure of categories

Posted on July 11, 2010 by Marc Handelman, PhD

Names have power. People who are sick tend to feel a kind of relief when their illness is named – ah, I have lupus; even though it’s a terrible diagnosis, there is relief in knowing. Having a name for the illness means others know what it is, perhaps how to treat it, and it means it’s “real,” in some way. It’s not uncommon for individuals to go from one doctor to another, to another, to another, in an effort to get a diagnosis for troubling symptoms.

Most psychologists and psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose emotional suffering. The DSM undergoes revision every few years, and those revisions reveal an important flaw in the concept of categorical labeling of emotional suffering. For example, homosexuality was categorized as a mental disorder in the DSM until 1986; political and cultural views clearly have an influence on the DSM categories.

More importantly, though, experience does not neatly fit into a category. If you tell me that you have been diagnosed with bipolar disorder, that communicates a list of potential criteria – mood swings, cycling, etc., but it does not tell me anything at all about your experience. I often hear therapists or counselors refer to people simply by a DSM category designation: “She’s an Axis II” (borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, etc.), or “He is a cluster B” (dramatic, emotional, or erratic) without any other description of the person as a human being.  Perhaps worse, I have heard people refer to themselves that way.

This diagnostic approach to understanding people has profound implications for treatment. Most broadly, it does not involve the therapist in really getting to know you. It interferes with understanding you as a whole person, ignoring the larger context of your life and experience. When someone focuses exclusively on diagnostic criteria – your ‘symptoms’ – you become nothing more than a pathological entity. You are not merely a bundle of ‘symptoms.’ These diagnostic categories serve the pharmaceutical industry and the insurance industry, not you.

Therapists who take a humanistic approach, on the other hand, try to understand the patient’s reality, rather than trying to force the patient into their own reality. Humanistic therapy is more a process of discovery, in which the patient and therapist seek to understand the person as a whole, and to understand what works and what doesn’t work. No effort is made to necessarily fit you into “the norm,” which can suppress radical and creative points of view; instead, the goal is for you to understand who you are, and to find your own way of being in the world that works well for you.

Visit Dr. Handelman’s website, Psychotherapy NYC

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therapy and the 12 steps

Posted on July 4, 2010 by Marc Handelman, PhD

People with addiction issues might hear this from a therapist: “Twelve-step programs are a good start, but only therapy will help you understand yourself and address deeper issues.” And they might hear this in the rooms: “Everything you need, you get by working the steps.”

Of course, the truth is much more complex than either simple statement. For people who struggle with addiction-related issues, the integration of psychotherapy and the 12 steps is often the best approach; many of the elements of good therapy, and of 12-step programs, are similar or complementary. Undertaking the work of recovery can bring up a host of old patterns, ways of being in the world, and relationship dynamics that benefit from the more individualized and exploratory work of therapy; if your therapist understands the principles of 12-step programs, he or she can better understand your struggles and be supportive around an important part of your life. In this article, I will illustrate some ways in which therapy and 12-step programs are similar, and other ways in which the two approaches are complementary.

Similarities

The first step – admitting that you are powerless over your addiction and that your life has become unmanageable – is also the critical beginning for therapy. You acknowledge that you have a problem and step outside of yourself to fully comprehend the destructive nature of the compulsions that undermine your life, conflict with your interests, and interfere with your ability to mature and to grow.

Step 2 (coming to believe that a Power greater than yourself can restore you to sanity) and Step 3 (deciding to turn your will and your life over to the care of God as you understand God) have an analog in therapy. For change to occur, you come to trust your therapist and have faith that he or she can help you. You open up to them and believe that they can have compassion and caring, and that they have your best interests in mind.

Steps 4 and 5 are also similar to therapy, in that they address self-exploration, self disclosure, and confession. Step 4 involves making a searching and fearless moral inventory of yourself, and step 5 is admitting to God, yourself, and another person the exact nature of your wrongs. In a 12-step program, it is often your sponsor who listens to your inventory or your expression of secrets that you have hidden and feel shame about. Trust is an essential and necessary element in both relationships.

It is important to note that if you have experienced serious trauma, and early victimization, therapy with a professional is often the best place to talk about these experiences. Although doing a 12-step inventory focuses on your part in contributing to negative situations in your life, it can be destructive to look for “your part” in situations where you have in fact been victimized, and had no responsibility.

Working together

In other ways, therapy and the 12 steps are complementary. Your recovery community provides a sense of belonging in a group and of feeling accepted – fellowship, in program terms. Overcoming addiction requires that you develop a sober social network as an alternative to the people, places and things that trigger the addictive behaviors you are working so hard to set aside. Therapy is also augmented by the 12th step, which exhorts addicts to carry the message to other addicts, and to practice these principles in all your affairs – to give back. Therapy does not offer a sense of community, and may have less focus on taking action; therapy will encourage you to understand yourself and integrate your insights throughout your own life. In this way, combining therapy with a recovery community provides you with a powerful and holistic approach to dealing with addiction issues.

Step 3, turning your will and life over to the care of God as you understand God, provides direction and structure.  It also provides a spiritual connection, helping you let go of a need to control.  It helps you finally relax into your life. Twelve-step programs are not religious, but rather they are spiritual programs. People in the rooms talk about your ‘higher power’ purposely, because you may not refer to that as God, or you may have a different name for God. ‘Higher power’ refers to the spiritual connection you have with something greater than yourself, something outside yourself. The 11th step encourages you to continue to take action and maintain a spiritual connection, to seek knowledge of what is good for you, and the power to carry that out. Therapy can support this effort.

Belonging to a group may be something you never experienced before in a positive way.  Perhaps you were not supported by your family of origin, which is your first group experience. Twelve-step groups are cohesive, yet there is no leader, no authority figure telling you what to do; instead, other members offer suggestions, allowing you to take what you can use and leave the rest. By their nature 12-step programs provide an accepting group experience. Being part of a non-judgmental group can have a number of positive effects for you. First of all, you are not judged, but importantly, you also learn how to react with compassion to others.

Twelve-step programs and psychotherapy are not mutually exclusive.  Rather, they can reinforce each other and provide help for you as a whole person.  While there is some overlap, and there are some differences between the two, the differences are not in conflict. In fact, they can provide synergy to promote your overall welfare spiritually, emotionally, socially, and physically.

Visit Dr. Handelman’s website, Psychotherapy NYC

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stressed OUT

Posted on July 1, 2010 by Lori Stone, PhD

Everyone knows stress is bad for you, right? It’s a common experience in our society — commenting on our stress levels, experiencing our lives as stressful, etc. Psychologists have been thinking about stress for more than 50 years, since Hans Selye fumbled with the mice in his lab.

Selye was an endocrinologist working at the Université de Montréal. He injected his mice with a wide variety of extracts from various organs, expecting to find different effects on the mice as a function of the various extracts. Instead, all the mice suffered the same consequences – stomach ulcers, swelling of the thymus and adrenal glands, and other dreadful effects. These consequences were not caused by the injections, but instead by Selye’s clumsy handling of the mice! He dropped them, he fumbled with them, he required several desperate grabbing attempts before he caught them, etc. This environment was very stressful for the mice, so the physical consequences Selye noted were due to the overall stressful environment, not the different substances being injected. The scientific process can unfold in surprising ways.

You are probably familiar with the common feelings of stress: perhaps your heart races, or pounds; your muscles become tense; perhaps you get a headache; maybe your jaw becomes clenched. These experiences are not pleasant, but they do not represent the real damage that stress can cause. The real damage to your body is due to stress hormones that are released in response to your body’s demands. These hormones – by themselves – are not bad! They mobilize you to run from danger. They enable your body to use its resources in the most efficient way, to save you from trouble. If you turned a corner and came face to face with a lion, you’d need to be able to run away, and fast. Your body would not expend energy digesting the food in your stomach, it would direct energy towards helping you run away.

This is fine, in short bursts. Our bodies were made to use stress hormones in this way. The problem comes when we are in chronic stress; Robert Sapolsky, a professor of biology and neurology at Stanford University and a research associate with the Institute of Primate Research, National Museum of Kenya, wrote a fascinating book called Why Zebras Don’t Get Ulcers with this central idea. Zebras are the prey of lions; they may indeed turn a corner and face a lion, which might kill them. Stress hormones mobilize the zebra’s resources and help it escape. The system “turns on,” and then it “turns off.” In a way, zebras live in the moment.

The turning off aspect is critical; these stress hormones are expensive! Stress hormones – adrenaline, glucocorticoids – can help save your life in a momentary crisis, but if they stay active, the physical prioritization become quite damaging to your body. As Sapolsky notes, “The body doesn’t work on expensive long-term building projects when it’s under stress. If a tornado is bearing down on you, it’s not the day to paint the garage; if the lion’s on your tail, worry about ovulating or growing antlers or making sperm some other time.” So your body is helping you deal with this chronic stress and must neglect some of the very basic functions required to stay healthy and happy over time.

Chronic stress can weaken your immune system. It can sap your libido, increase your risk of heart disease, exacerbate depression. Generally speaking, it makes your life unpleasant, and possibly shorter.

Unfortunately, there isn’t a one size fits all approach to dealing with stress. Exercise helps, if you like exercise. You have to begin by recognizing that stress is a potentially dangerous problem, and take that seriously. Yoga, mindfulness, exercise, meditation, therapy, massage, walking, engaging in activities that you enjoy, these activities may help you manage your stress. Future posts on this topic will address psychological research on stress, health and coping.

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trauma and memory

Posted on June 28, 2010 by Marc Handelman, PhD

Memory is a delicate thing. You might pass a woman on the sidewalk and her perfume brings a flood of memories of your mother. You might see an object and experience a full and complete recall of a memory, and say “I had completely forgotten about that!”As a Chinese proverb states, the palest ink is better than the best memory.

For people who have experienced a trauma, this issue of memory — and trusting memory — is particular difficult, and carries an incredible weight and importance. When a traumatic event happens, the experience can be dissociated. In psychology and psychiatry, dissociation refers to a perceived detachment of the mind from the emotional state, or even from the body. Dissociation is characterized by a sense of the world as a dreamlike or unreal place and may be accompanied by poor memory of the specific events. The traumatized individual literally dis-associates himself or herself from the traumatizing event as it occurs, in an extraordinary feat of taking care of him- or herself.

When traumas occur repeatedly, as in chronic physical or sexual abuse, the experiences may be gathered together in the child’s mind and present a single memory that stands in for all the experiences. The recalled memory may not be “true” in terms of representing the very specific event it recalls, but it is true in terms of representing the full range of horrific experiences, many of which might not be recalled in their specificity.

Owning these memories is very difficult, and painful. When the events were happening in the past, people may have told you that they were not happening. If you told someone what was happening, they may not have believed you – perhaps because they could not tolerate knowing this truth themselves, or perhaps because they had their own reason to discount your story. Because the very nature of dissociation makes the memories feel unreal to you, it may be easy for you to doubt yourself, and wonder if you made them up. And finally, the memories may feel unreal because you cannot bear to acknowledge that they are real. You may even doubt your sanity at times.

Therapy is sometimes described as peeling the onion. Early work removes the outer layers – you uncover what you can, you work with what is bearable, and then there is another layer. Another therapist I know describes therapy like a slinky spread out on the table; you go around the coil, and even though you find yourself back at the same place on the coil, you are farther along. Working with dissociated memories takes compassion, patience, and courage. The goal seems terrible – you know what happened to you and you believe it – but integrating the memories can relieve them of their ghostly, haunting nature, and heal the fractures.

Visit Dr. Handelman’s website, Psychotherapy NYC

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