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Sunday, October 30, 2011

Be Kind to Your Therapist and Say Goodbye

I sometimes have clients leave therapy not by saying goodbye (having a termination session) but by just not showing up again.

I'm not sure why this is.  Maybe the client is afraid I will try to talk them out of stopping therapy.  They may be concerned that I will tell them they are not ready to leave therapy.  Maybe they feel embarrassed. Maybe they don't know how to say goodbye.

This type of termination leaves the therapist hanging and not sure what happened.

Perhaps the client may be worried that the therapist will try to convince them that they are not ready to leave therapy.  But actually, in a strange sort of way, having difficulty saying goodbye to the therapist could actually be evidence that the client is not ready to end therapy.  Put another way, being able to be assertive and to say directly to their therapist that they are ready to stop therapy, is a sign of taking responsibility for one's life and being assertive.  It can be seen as a sign of health.

It's not like therapists don't expect termination.  The last statistics I saw were that the average number of therapy sessions for a client is eight, and the median number is six.  Quitting therapy after even a few sessions is not unusual.

Unfortunately, it leaves the therapist hanging when there is no explanation, no goodbye, and no termination.  There is a sense of incompleteness.  And perhaps there is some lack of closure for the client as well.

Let your therapist know your specific reasons, such as not feeling that you are making progress, not being able to afford it, or not feeling that you need it anymore. 

Be kind to your therapist and say "goodbye" when it is time. But be good to yourself, too. Take responsibility for your feelings, and if it is time to leave therapy, then do so in a straightforward manner. 

Friday, October 21, 2011

Dealing with Our Hidden Neuroses

Sometimes when I get into the elevator, there is a mirror in front and a mirror in back.  The result is that I can see the back of my head by seeing the reflection of the reflection.  This would not be a problem, except that I have a bald spot back in the back of my head that I would rather not see.

This got me to thinking about the fact that all of us have a blind spot.  We think we know ourselves, and we think we know how others see us, but there is always some part of us that we are not aware of.

In my case, there are two reasons I don't think about my bald spot.  One is I normally can't see it, even in a regular mirror.  The other is that I don't want to think about it.  The latter is a defense mechanism.   I only want to think about what I want to think about.  For some people, the things they avoid thinking about are just too painful for them.

Defenses can be healthy or unhealthy.  We can't think about painful things all of the time.  We can't contemplate world hunger and misery all of our waking hours and still function.

Psychologists have divided psychological defense mechanisms into the more or less healthy ones and the more or less unhealthy ones.  An example of a healthy defense would be sublimation--the taking of aggressive energy or sexual energy and turning into something useful for ourselves or for society.

One of the least helpful defenses and the most primitive (primitive because its develops at a very early age and involves a high degree of distortion) is denial. In denial, we disown a part of ourselves--some type of thought or feeling.  In the most extreme form, a person can have dissociative periods in which they later don't remember what they did.  They may deny that they did it.  (This is different from an alcoholic blackout which is chemically induced.)  Another primitive defense mechanism is projection.  I project all of my own negative feelings and concerns onto you.  You become the evil one, the bad one, and the source of all of my problems.  At its strongest, this might cause paranoia.

One of the purposes of therapy is to help us to quit disowning parts of ourselves.  If we feel secure enough in the therapy relationship, we may be able to reincorporate aspects of ourselves that we didn't want to acknowledge.

An excessive use of primitive defense mechanisms can lead to neurosis.  Now this term has been used in so many different ways that it has become confusing.  Many professionals refuse to use it at all because of the multiplicity of meanings and because of its association with somewhat outdated Freudian meanings.  However, I find the term useful in a particular way.  Many of us have a behavior which:
  • Harms us and/or others.  I say "and/or" here, but what I really mean is that it harms us in some way and it may or may not hurt others as well.  If a behavior only hurts others, the I would not use the term neurosis.  It might be a part of a personality disorder.
  • It is repetitive.  That doesn't mean that it happens every day or every week; but it happens enough that it becomes a pattern in our lives.
  • It is beyond the understanding of the individual.  In traditional terms, one could say that it is unconscious.  However, I am not sure that all repetitive self-defeating patterns come from unconscious issues.  Nevertheless, they are definitely beyond the understanding of the individual.  If we understand what we are doing, then they are merely a choice.  In a neurotic behavior, the individual is getting blind sided by their own past memories, hurts, needs, defenses, and so on.
So what is one to do?  If we are blind to something, then we can't fix it, right?The resolution of neurosis is hard to achieve on one's own.  Maybe even impossible.  We all have our blind spots, and we are not aware of them.  We are not even sure where to look for them.  Thus, if we don't know that we have a blind spot, and we don't know where to look for it, we are surely not going to find it.  But even if we find it, we are likely to rationalize its existence.  We are likely to think something like the following: "There is a reason I do this [particular behavior].  I know that other people have neurotic issues, but this is not neurotic.  What I am doing is logical."Our blind spot protects itself.  The defense mechanism does not want to go away.

Many neuroses start with experiences of hurt, pain, and fear.  The neurosis forms a wall or barrier so that we don't have to deal with the true pain; and we sense at some level that if we give up our neurosis, we may be faced with a loss of meaning.  Without it, we may be forced to deal with painful memories; or we may be left without a sense of direction left in life.

Because of our vulnerability to very painful feelings in childhood, and because of our lack of sophistication, we can develop unhealthy ways of thinking and behaving to defend ourselves psychologically.  Then later in life, we generally stick with the belief systems we developed in childhood  (for example, "Men can't be trusted," or "I must have a woman in my life to feel worthwhile," etc.) 

The above explanation(s) are the typical ones found in the psychological literature.  However, I think that in addition to these there may be other possible causes as well.  I think one reason we might stay with old, neurotic beliefs and behaviors is that doing so conserves energy.  A second reason might be that staying with old beliefs makes us more stable.

We can't change our paradigms (basic templates for how we look at the world) and basic rules for understanding ourselves without a considerable energy expenditure. If we changed our paradigms very often we would be unstable people. Something major needs to happen to make me change something so fundamental. I am not going to suddenly change from being staunch Republican to staunch Democrat without a really good reason. I am not going to suddenly going to believe in Communism or Buddhism, without a darn good reason. Thus, I remain more stable and energy is conserved.  Unfortunately, I may then also hold onto beliefs which are not good for me.  It might have worked for me as a child to believe that I should never question authority and that I should always follow the lead of others; but this would definitely be a bad idea as an adult.

The opposite of neurosis (at least in the way I am defining it here) is openness.  Openness to our own feelings.  Openness to our own thoughts. Openness to feedback from others and how they see us. Openness to the possibility that we are not perfect.  Under these conditions, we can grow psychologically.  We can start to see where we need to grow.  We can see when our old coping skills are not working and when we need new ways of approaching things.  That takes effort and a mindset that realizes that change can be good. 

Friday, October 14, 2011

Has the Narcissistic Generation Finally Arrived?

For a long time, I have been hearing from some therapists that the primary psychological problem of the next generation will be narcissism.  The logic behind this is that many youth today were raised to look after their own needs first and the needs and rights of others secondarily, if at all.   However, I have never been convinced.  First, I am a hopeful person, and I thought that this idea was overly pessimistic.  Secondly, I knew that such a statement would have to be an overgeneralization.  I don't trust overgeneralizations.  There are always differences between members of a generation.  Not everyone in the "Greatest Generation," written about by Tom Brokaw, was really great, or even good.

When things change, they change slowly, until something is strong enough that it hits you in the face.  Well, maybe something has happened to make the trend to narcissism real to me.

I had the opportunity the other night to attend a party for a new startup company.  It was attended by a group of mostly young, mostly good looking, and mostly very intelligent people.

Ourderves and drinks were provided.  It was a fun party.  After people had a chance to eat and talk for awhile, the business executives sponsoring it wanted an opportunity to say a few words.  But surprisingly, when they started talking, a significant minority, maybe a third or a fourth of the people there, just would not stop talking.  This continued throughout the speeches--about twenty minutes.  The acoustics of the building made everything worse.  It was absolutely maddening for the people trying to listen.  Even speaking with a microphone, the hosts could not be heard very well.  The older ones of us present, and some of the younger ones, couldn't quite believe the lack of manners being shown.

Why did the guests keep talking?  I don't know.  But their thinking must have gone something like this:  "These speeches are only a formality.  They don't really expect me to listen.  And I am just one person, so it won't matter if I talk.  Besides, what I have to say to this person in front of me right now is really soooo important."

Well, I'll never know if that was what was going through the minds of the talkers.  But it seemed to me at that moment that the narcissistic generation had arrived after all.

Tuesday, October 11, 2011

Finding Motivation in Life No. 2--Wanting to Want to, or Creating Motivation For Ourselves

(This is a followup post to my previous one on finding motivation.)

I have many clients who want to do more with their life.  However, for one reason or another they find themselves being lethargic and not doing the things they would really want to do in the long run--the big goals in life.  In the short run, they come home, fix dinner, watch TV, and go to sleep.  The next day they start over again.  They do what comes naturally and what is right in front of them.  Or they do what is easiest or what absolutely has to be done.

For many of my clients that is not how they want it to be.  They want to do more with their lives.  But they can't find the energy.  Or they can't find the motivation.  Or the time never seems to be there.  (Another thing which stands in people's way is a fear of failure; but that is a different post.)

Sometimes, in this situation people call themselves "lazy."  But as you know (if you have read my previous blogs), I consider the word "lazy" to be a confusing non-explanation, and one which is likely to lead to low self-esteem, depression, and perhaps more lethargy.  So let's not go there.  Calling ourselves "lazy" explains nothing and fixes nothing.

And so as a counselor working with a client facing this issue, what we may be left with is a big gap between them "wanting to want to do something" and actually doing it.

And if you have read some of my other blogs, you probably realize that I would first look for the explanation of such a problem in the executive functions associated with the frontal lobes.  These executive functions are shaped by our genes, our biological history, and our life experiences.  Sometimes depression, aging, ADHD, or some other issue interferes with our motivation to do things.  (All of these can involve the frontal lobes and executive functions.)

So I am left with trying to help people who want to to want to [do something] but don't.  I think that when this happens, there are possible detours around the lack of motivation.

Here are some possible strategies.

Number One.  The lethargy is not permanent and 100% of the time.  Otherwise, there would be no problem in the person's mind.  They would never want to do more, and there would be no problem.  When the moment of wanting to want to [do something of significance] strikes, do something which commits you.  Join a club.  Call a friend and make arrangements to do something.  Commit yourself.

Number Two.  Find a weekly venue.  For me, I have jazz piano lessons every two weeks.  I have oil painting lessons every week.  So, when my motivation wanes, I know that I will still have to be at my next lesson.  (I don't really HAVE to go, but I will.  If my teacher is expecting me, I will show up.  That's just my personality).

Number Three.  If I pay money for something ahead of time, I am likely to follow through with it.  Go ahead and buy tickets.  That may give you the motivation to follow through.  (I know this doesn't always work.  Look at all the people with gym memberships who don't go.  But it works for some people.)  My art lessons require a monthly payment up front.  That encourages students to go ahead and show up.

Number Four.  Join a group.  Sometimes they will urge you to come along and even drag you along even if you don't have the motivation to go.  My social group sometimes plans get togethers at the lake, at a musical, or something like that.  I would probably not plan one tenth of these for myself and my wife, but I will go along with everyone else.

Number Five.  Prime the pump.  Sometimes, if I lose interest in painting, just walking the aisles of an art supply store will help me get interested again.  I have suggested to clients that they go to the sporting goods store and just look at the hunting or fishing supplies to see if that will stimulate some motivation.

Number Six.  Have goals that can be worked on at the spur of the moment.  My blog is a great activity for me because I can do it a little at a time.  I can do it if I'm bored.  I can do it if I get a new idea.  I can do it if I wake up in the middle of the night.  It's easy to log on to my computer and type.

Number Seven.  It is helpful to make a list.  It doesn't have to be a big list.  In fact, I wold recommend that there is a primary list with only three to five items on it.  There could be a secondary list with more items.  Put it someplace that you will see it often.  Mine comes up when I bring up my online calendar of things to do.

I hope some of these ideas are helpful.  If you have some more ideas about how to motivate yourself, please leave a comment.

Sunday, October 09, 2011

Finding Motivation in Life No. 1--Finding a Passion in Life

I was meeting with a group of fellow psychologists the other day. We meet once a month to discuss professional issues.  The issue came up that some people do not seem to have any kind of passion in life.  They go to work.  They come home.  They have some fun now and then.  But to  a great degree, their actions are guided by what they just have to do next or what is right in front of them in the moment.

Many of us want to do something important with our life but don't  know what it could be.  We may end up just doing what is in front of us rather than setting golas and accomplishing things that would be really satisfying in the end. We may become bored or dissatisfied with our lives.

Ideally, each of us will find at least one passion in life.  Finding a passion in life means finding something worthwhile in life beyond just doing our job and what we have to do.  And something beyond just pursuing the pleasures of the moment.

Another way of saying this is doing more than just the social and biological imperatives.  Let me explain what I mean.  To some degree we are programmed to do certain things.  We might say that we are programmed to eat, move around, have sex, and sleep.  To some degree we are programmed by society to go to school, get married, have kids, and advance in our career.  The programming may be social, biological, or both.

But some people seem to go well beyond these imperatives.  They volunteer.  They find sports that they really enjoy.  Or they are involved in the arts.  Or they become involved in a hobby.  Or in spirituality and religion.

For some people their job is their passion, and that may fit what I am talking about here if it fully utilizes their creative powers.  But when I talk about finding a passion, I am talking about something different from just being a workaholic.  Being a workaholic can actually be an excuse not to be creative and not to discover what is truly self-fulfilling.  Being a workaholic can mean just putting one foot in front of another and not really having to think about what is important. On the other hand, starting a business can be a passion, and it can take tremendous time.  It can be self-expressive.  And that is why I might make an exception for that type of work.

There is one area where I think it makes sense for our biological imperative to be our passion.  And that is our biological programming to raise children.  Our passion could be our children.  I may be biased here.  I just had a new grandchild, and so I am fairly enamored of him and focused on him.  Some people have said, and rightly so, that the most important thing we can do in life is raise our children well.  But even child rearing can be a trap, however, because in the end the children leave home.  If that is our only passion, then we may end up feeling aimless after the kids leave home, at least until the grandchildren arrive.

Another biological imperative could be just staying alive.  Finding ourselves in extremely stressful financial circumstances or facing a terminal disease, I think that the healthiest thing one can do is to pour all of one's energy into staying alive and putting food on the table for one's family.

But what about when such circumstances don't exist?  When leisure time exists and when there is enough money to do more than just stay alive? 

What makes it hard for some people to have a passion, I think, is that they come out of a very under stimulated childhood.   It used to be that as children they were simply left to grow up on their own.  After doing their chores and going to school, if there was any time left, they could do what they wanted.  There is much to be said for that.  It allows for play and spontaneity. 

But I also believe that ideally children need to be encouraged to try things out.  They need to be exposed to things--allowed to see things and do things and hear things that may stimulate them.  Soccer, basketball, painting, music, volunteer activities, travel--all of these give a child a chance to sample the world and learn that there is more in life than just their own neighborhood and what is on TV.  If a person comes from an under stimulated childhood, then the motivation to do more and seek out more may never develop.

Another thing which may assist in this or impede it is biological temperament.  Some people just have more energy and enjoy things more than others.  Some have a higher capacity to take risks, and some people are more likely to just stay home and avoid risks.  Someone with a "hyper" temperament is more likely to pursue physical activities than someone with a more passive temperament.  So I don't want to turn this into a moralistic lecture.  This isn't about being bad or good.  Sometimes, we just are what we are, and there is no sense moralizing about that. 

But there are other times, when a little reflection on our short time on this blue sphere might lead us to take some risks, get off the couch, and try something new. 

This leads to the question, "What do we do if we want to do more but we just never get around to doing it?"  I am going to try to tackle this in my next blog on "Wanting to Want To," which discusses strategies for motivating ourselves.