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Compulsive Behaviors

I'm off to a workshop on compulsive behaviors this weekend. Ill let you know about it in next weeks post. Enjoy your week!


I Wish It Were That Simple

Could you imagine that life could be so easy as to just be told the right answers, and then our problems would be solved? I often joke with clients that I do not have all the answers, but if I did I'd write a book and be rich. I think we live in a society in which there is an expectation of immediate quick fixes. Often times people come to therapy, or read self help groups or follow the latest guru with this in mind.

There is a certain type of therapist, one that I refer to as a "football coach therapist," the type that is blunt and direct and tells people what he/she thinks is wrong with them and exactly what to do (think Dr. Phil).

I have found, however, that people are infinitely more complicated and complex than this and the world is much less predictable then we think.  Clearly there is a time for pulling punches and a time for confrontation but often times much of the work of therapy is figuring out the timing as well as the content of an intervention.

This is very true in dealing with those who have substance abuse difficulties. As we spoke in a recent post, defense mechanisms can serve both good and bad purposes, and often times, to keep up a life of substance use, many defenses must be (unconsciously) in use; think denial, rationalization and justification to name just a few.

There is a style of intervention and treatment called Motivational Interviewingwhich focuses on a persons awareness of and motivation for change. This is the guide-book of my work with clients in this area. Based on where a person is, the style and content of the therapeutic intervention is crafted. For example, a person may not even be considering change (in MI this is called "Pre-Contemplation"), and therefore it would be foolish to start offering options of treatment at this time. It is more helpful, and reasonable, to focus on raising a persons doubt or clarifying the perceptions of the client. This is where connecting the dots of seemingly unrelated experiences takes place. This is meeting the client where they are. Sometimes, this is the stage the client stays in and is unable or unwilling to move forward.

For example I recently spoke with a young man who told me of getting into a fight in a bad neighborhood while just standing around with his friends. He took pains to point out to me that at the time of the fight, he and his friends hadn't even purchased the alcohol they were planning on drinking, so in fact how could this incident be related to alcohol?

I pointed out that had he not been a certain type of drinker (hard parties, enjoying the pub crawl with like minded friends) he would not have been in that place with those people at that time. It was connected to his drinking, although no alcohol was present at the moment.

So the point of this is to say that change is possible, it just takes lots of time and diligent hard work. Don't sell yourself short by presuming your just not "getting it" because you haven't completely changed overnight merely because you were told to. You are much more complicated than that. Who knows what your genes, upbringing and life experience contribute as well as your current level of motivation.

I wish life were like the Dr Phil show. It's not. Be grateful!


What's Your Type?

We often wonder about how people are attracted to each other and why it seems that certain people have a "type." Certainly we have preferences for various physical characteristics and personality traits, but is it any wonder why people seem to go for the same type of person again and again, (even after vowing to never make the same mistake)?

This point was brought home by a conversation I had with a young women recently. She was the product of a high school (short lived) relationship and had no contact with her biological father. Her mom subsequently married a man who adopted her at 10 months old and whom she considers her father. This marriage was tumultuous and ended when she was 18 (she is now 24).  Last year, through the magic of Facebook her biological father tracked her down. With much trepidation she allowed herself to engage with him only to be disappointed by him once again. However, what was most remarkable was the similarities between her biological and adopted father. Both are immature, impulsive, unreliable and rash. Both are involved in dramatic relationships with women (her newly found biological father had a wife who immediately began attacking her via email, her father has had a series of unhealthy relationships since being divorced from her mother and his current girlfriend is volatile and has been verbally aggressive towards her and her siblings). Both are motorcycle guys with tattoos.

What astonishes her is that her mom picked the exact same type of man to father children with. She is able to make light of the situation by way of expressions like "been there done that." By the way, she has chosen very carefully to date in a limited way because she fears that she too will attract unhealthy guys into her life.

Why does this happen?

Well there are some basic thoughts about this, the original coming from Sigmund Freud himself. What Freud called the Repetition Compulsion was a process by which we re-enter relationships over and over throughout our lifetime to gain a sense of mastery over them. Another theory is put forth by relationship experts, most notably Harville Hendrix and his idea of the Imago. Your imago is that all of the characteristics of your primary care givers, both good and bad are stored in your primitive brain. The negative characteristics are the ones that held the largest threat to you as a little child. In this way, your primitive brain is drawn to those that have both the good and bad characteristics of your early childhood care givers, and in a form of Repetition Compulsion, we try and resolve the issues that caused us most fear (the negative ones) in childhood through our current love relationships.

Does this seem like a reasonable explanation for why people seemingly tend to go towards the familiar, even unhealthy, even if they lament that they will "never go through that again?"

Do you have stories from your own personal experience that are like these?

How did you deal with them or resolve them?

I'd love to hear from you.


The Nudge

As is often the case, we humans don't think in detail about what we do unless we are forced to explain ourselves. This is one of the many reasons I enjoy teaching. Invariably I will inject information about my work as psychotherapist and students typically love to hear about this. This is how I recently realized that often what I do is "nudge" people in a particular direction.

We humans have various defense mechanisms which can both help and hinder us. They serve as a means for preserving our ego and keep us from feeling too much psychic discomfort.  Part of my work as a psychotherapist is to identify peoples defense mechanisms, how they are used and whether they are helpful or not. Over time I may make these observations known in the therapeutic relationship. Most of the time my work is done through the back door not the front. It is a natural response for a person to raise their defense mechanisms when feeling a frontal assault (even a professional supportive constructive one, as comes from a therapist). I find that it is in these back door interventions that I implore the "nudge."

People have different capacity for insight and self awareness, different personality's and are at different levels in regard to making change. Often times my "nudge" is intended to assess the aforementioned, or to assist a person in taking the next step (say from contemplating making change to preparing to take action). It is my opinion that this practice, the practice of "nudging" is done with beneficence at all times.

Our society does this is many ways as well.

If you forget to put your seatbelt on your will hear a bell, this is a nudge. If you look closely at labels to see the calorie content, this is a nudge. Opting in and opting out are nudges as well. Organ donation is a good example. In the United States if you want to be an organ donor you need to indicate this on the back of your drivers license, you must opt in. In other countries, you must opt out of this process. Both allow the complete free will of the individual, it is just that the default setting is different. It is no surprise that countries that opt out have a much larger percentage of organ donors then those that have opt in. The motivator is of beneficence, for the greater good, and free will is not at all infringed.

These are all forms of manipulation. In common parlance we associate manipulation to mean something bad but this is not so. Opening a window to cool down a room is manipulation. So is preparing the kids lunches the night before school.

So I leave you with this. Is this idea of "nudge" (something studied endlessly by economists, psychologists and sociologists), a beneficent manipulation as it were, good or bad?

Id like to know your thoughts?


The ABC's of CBT

One of the method's of psychotherapy is called Cognitive Behavioral Therapy (CBT).

In a nutshell CBT focuses on ones thinking patterns, values, beliefs, expectations and self-talk patterns. These of course come from our upbringing, personality and life experiences. As related to last weeks post, this is where our subjective experiences of feelings comes from, not the event itself.

Lets suppose that my friend calls me "stupid."  Depending on my values about how people should talk to their friends, or my beliefs about friendship, what my past life experience has been and what I say to myself, I will have one of a variety of reactions.

If I say things to myself like "He is such a nasty person" or "Now I know the truth, he feels like he is better than me" or "All of my life people have been putting me down and I've let it go, its time to stand up for myself." If I have beliefs that people should do their best not to offend others, if I go out of my way to protect my friends from negative feelings or if I get caught up in the should's and supposed to's "Life should be fair" "Friends should always say good things." Or if I am feeling a little insecure that day or my father called me stupid as a kid, you better bet I will react in an intense way or this experience has the potential to ruin my day.

Now you may ask me "Well are you supposed to sit there and take it?" "Are you suggesting we should like being called names by our friends?" The answer is, a qualified "no." No-one likes being called names, however the level of distress I would feel in that situation has everything to do with the above and almost nothing to do with my friend.

This is where the ABC's come in. Friend calls me stupid (A), I have beliefs values etc... of which I express to myself (B) and then I experience feelings (C). The feelings are NOT based on A but based upon C.

I am sorry to tell you, but it is not rational to think that friends will always be kind or that life is fair. This sets up expectations that are bound to be dashed. In working with people I attempt to tease out some of the thoughts and beliefs they hold that set them up to be angry, disappointed, hurt, etc... Then we discuss re-framing these beliefs in a more rational way, based on the reality of life. We may also uncover why certain words, tones of voice or body language illicit a powerful feeling or response.

If your waiting for life to be fair, for everyone to treat you right and for stress to be non existent, you will die an unhappy person. Better to examine and reframe some of the things that cause you distress. It doesn't mean you'll like being called stupid, just that, on a scale of 1-10, your response can be a 2 instead of a 9.

This is something I practice each and every day and have varying degrees of success with. Like a muscle, the more you use it, the larger it grows.

That's the lesson for today.