What is Psychotherapy All About

What is psychotherapy all about- for individuals? What will you do to me? What is the process?

How do I Answer?

These, and more, are questions that people have asked, whether in casual conversation or when deciding whether or not to come to therapy. The way I’ve answered has changed a bit over the years but I’d like to think that they’ve been consistent. [Ed.: of course you would! 🙂 ] Perhaps I’ve been changing perspective on the process or emphasising different aspects (another way of saying the same thing).

This blog is the description that I seem to be settling towards.

Diagnosis or description of experience?

One aspect of therapy that perhaps you might find off-putting shows up in the question “Will you diagnose me as crazy/mentally ill/…?”  Dr. Jeff Rubin has two interesting blog posts looking at this here and here. He classifies psychiatric diagnosis as “name-calling” rather than diagnosis for cogent reasons. He sees the common DSM “diagnoses” more as classifications of “expressed personal concerns”.

I like his remarks because they fit well with how I describe the psychotherapy process [Ed.: of course you would! 🙂 ]. Many people who wonder about doing therapy function at least well enough to hold down a job, maintain an intimate relationship and find at least some enjoyment in life.

What is psychotherapy all about?

However, there may be aspects of our experience of ourselves or our relationships which we’re uncomfortable with. We also may feel that they hold us back from greater enjoyment of life, greater engagement in our work, less contentious relations with our loved ones or friends. These are all “personal aspects” with which we are “concerned” in Rubin’s language.

So what is therapy like with that orientation? Therapy then becomes an exploration, with you controlling the process, in conversation and somatic experience of

  • how you can feel safe in the therapy setting
  • what your personal concerns are
  • how/when the behaviours or feelings show up
  • how they relate to those aspects of you which you feel work well, your strengths
  • how they might work as a protection for you and why
  • how to move these aspects to a position in your life which you feel is, at least, less concerning.

Therapy when there’s significant disruption

For people whose aspects of concern cause significant life disruption, the basic pattern is the same but the process may be longer and may involve exercise to trauma integrate traumatic or disempowering experiences and memories, once you are able to feel safe doing them.

Bottom Line

That is the high level description. In this setting, per Dr. Rubin, depression is a description of how you experience yourself, as also is anxiety. These certainly have bio-chemical and physiological implications and addressing them, at least in part from that direction, can definitely help therapy.

They are never a final statement about who you are.

Are You Looking for Help?

If you would like help dealing with difficult emotions or strains in your relationship , then please CALL me to see if we can work together or send me an email via my Contact Page. I look forward to hearing from you.

Breathing for Mental and Bodily Calm

Meditation, sports psychology, emotional intelligence and relationship counselling all give a central role to breathing for mental and bodily calm. Whether taking deep slow breaths, doing patterned breathing (like 4-7-8 breathing) or simply being aware of the breath, this basic bodily function is a gateway to calm.

This is established practical knowledge in all the fields mentioned above and I use it in mindfulness training, executive coaching, doing therapy, cross-fit and occasional disagreements with Vivian. However, the physiology underlying this effect is only now being investigated in detail.

We’ve known that breathing biases the body towards parasympathetic autonomic states but not how that happens. This NYTimes article (I think this might be pay-walled) refers to a couple of recent articles in the journals Nature and most recently Science (this takes you to the abstract) describing the identification of a bundle of about 3000 molecularly differentiated neurons in the brainstem (reptilian-ish brain) which sense and influence each others’ activity and the body’s breathing state which in turn then influences the body’s arousal state which then influences …..

(Complex, recursive feedback systems seem to be the rule in our physiology.)

It is still early days and the articles describe the actions of only (that’s an ironic “only”, folks) two of the cell varieties and their function but I’m sure we’ll be seeing more detail from these folks over the next year or so.

So we’re beginning to get down to physical causation of this marvellous aspect of our embodied selves.  I always like to have practical experience backed up with as much detail on how things work as possible. There’s the definition of a “user” and a “tech” which says that a user only cares THAT things work where the tech cares HOW they work. I’m a hybrid: happy enough when I have a practice which works but even happier when I know, even in a sketchy way, how it works.

If you’re happy just knowing THAT breathing is a great tool for calming or self-soothing, great! Keep using it in confidence. If you’re like me in having your confidence grow as you increase your picture of HOW it works, keep using it and enjoy the articles. I hope they build your confidence in these natural and powerful practices of breathing for mental and bodily calm.

Are You Looking for Help?

If you would like help dealing with difficult emotions or strains in your relationship , then please CALL me to see if we can work together!

Recovering from Trauma of Adverse Childhood Events

Adverse Childhood Events Trauma

Adverse Childhood Events Trauma is finally beginning to be part of a wider conversation about the effect of childhood experience on mental and physical health. Twenty years ago, the US CDC sponsored a large scale, epidemiological study on the effects of what the study called Adverse Childhood Events (ACE) on health and behaviour in adulthood. These two articles in Psychology Today look at, first the effects of ACE on brain function, health and behaviour and, second, the ways in which people affected by ACEs can help themselves and be helped by therapists.

What are ACEs?

The study grouped events into three categories: Abuse (emotional, physical, sexual), Household  Challenge (violence, divorce, substance abuse) and Neglect (emotional, physical).

Physical and Mental Impact

This is not only about impact on mental health: the study shows that the correlation of number of ACEs with a range of physical conditions is very strong. The first article discusses how this link between childhood trauma and adult disease comes about. The ACE Pyramid below summarises the relationships:

ace-pyramid-cdc

 

Major findings of the study are:

“Adverse Childhood Experiences (ACEs) are common. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs.

The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response[1] relationship between ACEs and negative health and well-being outcomes across the life course.”

As the number of ACEs increases so does the risk for the conditions including:

Alcoholism and alcohol abuse Chronic obstructive pulmonary disease
Depression Fetal death
Health-related quality of life Illicit drug use
Ischemic heart disease Liver disease
Poor work performance Financial stress
Risk for intimate partner violence Multiple sexual partners
Sexually transmitted diseases Smoking
Suicide attempts Unintended pregnancies
Early initiation of smoking Early initiation of sexual activity
Adolescent pregnancy Risk for sexual violence
Poor academic achievement  

 

Is This Common?

The study found that nearly two thirds of participants had experienced at least one ACE and almost 20% reported 3 or more. If anything the demographics were skewed toward the more affluent. 75% of participants had at least some university education and almost 40% had graduated with a degree.

In my practice almost all clients, couples and individuals report at least one ACE. Some of the event types are severe, some less so. All have left their mark with particular impact on overall happiness and ability to thrive in their intimate relationships. The most common effect is a more or less profound feeling of pain, distress, inadequacy, ….

The Good News

The second article discusses a variety of ways in which we can moderate the effects including writing to ourself about our experiences, mindfulness meditation, yoga. Where the emotional effects feel too much to handle alone, there are now a range of trauma aware therapies which can make major changes to our felt self experience. My recent training, for example, has been in how to do effective therapy with folks who have experienced multiple and prolonged ACEs resulting in complex childhood trauma.

Does This matter to You?

If you feel chronically unhappy, anxious, depressed, angry, often with no immediately apparent cause; if you find regular difficulties in your relationship with your partner or in your work or family relationships; if you have difficulty regulating eating, gambling, drinking or substance use: then it may very well matter to you.

If any of these sound distressingly familiar then answer the ace-questionnaire. If you would like help in dealing with chronic unhappiness or relationship disturbances then please contact me for a ten minute chat to see if we might work together to help you improve your situation.

[1] “Dose-response describes the change in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g. ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases.” CDC

 

Therapy and Contemplative Spiritual Practice

The twin pillars of my internal life have been Buddhism and various encounters with psychotherapy, both as therapee and therapist.  This parallels the frequent intersection of, particularly, Buddhist spirituality and psychotherapy in the wider world (e.g. Welwood, Epstein, Kornfield, Siegel in USA and Barzaghi, Dawson and others here in Australia). So questions as to similarities and differences between these two modes of internal development and exploration often arise and this blog is an attempt to provide a very particular perspective. Let me emphasise that while I am a trained  psychotherapist, I am not a spiritual teacher in any tradition, simply an experienced and inquisitive lay practitioner of a very secular take on Buddhism.

A large difference between the two worlds is that many therapies, and certainly all psychodynamic therapies, are based on a developmental model of some level of specificity.  That is, some theory which describes our progress as beings with/of a subjective affective and cognitive world from the relative simplicity of infancy to the complexity of adulthood. Many models regard adulthood itself as a unitary state, others at least imply a continuum of development which can span our adult lives. The more recent examples of these models emphasise the critical interplay of subjective-intersubjective experience in that development.  In contrast, to my knowledge, Buddhism does not deal at all with our transition from infancy to adulthood but concentrates on a description of  phenomenology of adult experience.  As an aside, that sentence gives away my own very secular understanding of Buddhism which is definitely not the mainstream view of Buddhism; reader beware[1].  Buddhism does recognise stages on the path to awakening but these seem to be specific to the path rather than part of a general developmental trajectory.

Another difference is the implication common to psychotherapies that we are seeking to overcome dysfunction of some sort where in Buddhism we are dealing with the shared nature of human (and possibly the sentient) minds and the illusions (cognitive, affective and experiential) to which they are prone. Both speak of relieving suffering[2]; therapy sees the relief of suffering as resulting from the righting of painful dysfunction where Buddhism sees the relief of suffering arising from a clarification or transformation of our view of and relation to the pain inherent in existence.

Ethical behaviour is critical and intrinsic to the Buddhist path of transformation whereas explicit valorisation of ethical behaviour, or even a demarcation between the ethical and the unethical, is rarely advised as a component of therapy. Therapists themselves are subject to strict ethical guidelines but ethical analysis is not a prominent part of most therapies. There are exceptions of course: existential therapy encourages taking responsibility for our actions and their effects and couples therapy usually has clear guidelines about the inappropriateness of, for example, violence and psychological abuse in a relationship.

The final difference I’ll touch on here is the difference of focus on mental experience. In psychotherapy, even very body centred therapies like Hakomi or Focusing, we explore what the experience is about for the client.  What is its meaning to/for/within the client’s life? To some extent we are interested in the content of experience.  In Buddhist meditation (let’s stick to pure vipassana) we are looking more impersonally at the characteristics of the experience and its participation in the three marks of existence: transience, unsatisfactoriness and not-mine.  We are invited to see that the experience begins and ends or comes and goes. We may look at the experience as arising from a particular set of conditions but we won’t necessarily be interested in exploring those conditions. The important lessons are that it is not permanent; that without the conditions the experience wouldn’t happen; and as a direct result of these two aspects of the experience it cannot really be said to be mine or an essential part of me.  In therapy we will be trying to bring the experience and our appreciation of how it arises in a particular life into conscious awareness.  Note that the Buddhist process is dependent on the experience being available to conscious awareness from the start.

Perhaps a summary of differences could be that psychotherapy helps us integrate disowned and troublesome aspects of our personal history where the Buddhist path helps us integrate and reach a deep, felt understanding of our shared circumstances as sentient, subjective beings-together-in-the-world. Perhaps one outcome of this is that it helps us become more humble: this is a lifetime process and, though we have the navigation beacon of the Buddha’s awakening, there is no “end-goal” towards which we strive in secular Buddhism.

I’m sure that other therapists and practitioners will have their own take on the similarities and differences in the two ways of looking at human growth or development.  These are offered simply as part of the view from this body…today.



[1] To expand a little: I see Buddhist spirituality as a collection of practices and a framework for life (the 8-Fold Path) by which we transform our experience of, and relation to our experience, and thereby transform our relations to self, others and the world.

[2] The difference between “pain” and “suffering” is one which I’ll expand in the future.

I don’t want to meditate today.

Human growth is a contradictory experience.  We feel the boundaries of self expanding and the experience of humility growing at least as fast.  Our humanity means we are the inheritors of strengths and weaknesses and some of the more embarrassing among those weaknesses is the tendency to overestimate our strengths. The explosion of psychological research since the 1960s has helpfully exposed many of our misapprehensions.   Some of these need to be accounted for in our quest for psychological and spiritual growth.  Take the bias of illusory superiority to which we are chronically prone: Far more people think of themselves as better than average drivers than is posible.  There’s also the Dunning-Kruger effect, also known as the “sophomore” effect (sophomore = wise fool, hinting at the ego inflating effects of introductory knowledge).

Some specific examples?  Well, meditation and its effect in enhancing day to day mindfulness is such a powerful aid to living happily that it is sometimes astonishing it is not a more common practice than it is.  It is also typically a practice that is often non-practiced by its, ummm,  adherents: “I don’t really need to meditate, I’m already quite/very/extremely mindful.”  Or “I get as much relaxation out of a beer/glass of wine/cigarette as I do out of a half hour of meditation.”

I’m hoping that neuro-psychological investigation of the physical brain changes that arise from meditation will, however slowly, erode the mind-sets that support these sorts of.  If one is thinking of meditation as enhancing an abstract and desirable quality like “mindfulness”, our normal tendency to see ourselves as illusorily superior can easily convince us that “I’m already quite mindful.”  However,  it is a melancholy truth that, as one grows in meditation practice, one becomes more and more aware of the gaps in mindfulness, past and present.

However, if we’re thinking of meditation which, by changing our brains’ structure and activity, enhances our ability to be mindful, that might help us decrease the very human perils of over estimation of our positive attributes.  It’s much harder for me to think “oh, I’m quite fit” when I have physical evidence to the contrary or when I think honestly about the amount of exercise I have actual done to enhance my fitness. “I’m quite fit despite not exercising” doesn’t sound particularly convincing, even to myself.

An article by Alice G. Walton in Forbes magazine found here: Eat, Smoke, Meditate: Why Your Brain Cares How You Cope discusses the effect of regular meditation on the brain/mind’s tendency to  uncontrolled chatter and particularly to chatter about our worries, obsessions and dissatisfactions, actual and imagined, and the effect of this on our general happiness/calmness.  The chattery mental content is typical of the output of what’s known as the Default Mode Network (DMN) within the brain: thinking about self and circumstances.

Says Walton:

“New research by Judson Brewer, MD, PhD and his group at Yale University has found that experienced meditators not only report less mind wandering during meditation, but actually have markedly decreased activity in their DMN. Earlier research had shown that meditators have less activity in regions governing thoughts about the self, like the medial prefrontal cortex: Brewer says that what’s likely going on in experienced meditators is that these “ ‘me’ centers of the brain are being deactivated.”  So we spend less time thinking about ourselves and our problems. “

Brewer found also that meditators show this pattern of lower activation of DMN and “me” centres even while not meditating.  This confirms the experience of those of us who have a regular practice that the mind does quieten over time and that unnecessary thinking, what Martine Batchelor calls “proliferation” which in turn generates unnecessary anxiety, declines with practice.”

Other research by Andy Newberg, MD shows that, unsurprisingly, areas of the brain involved in attention and concentration are activated and external awareness de-activated.   So, combining the two findings, meditation seems to be a practice of going inward to get out of oneself.

The article also compares the effects of meditating with the effects of giving in to a craving as an attempt at self calming.  While she uses the specific example of smoking, the second para below deals with the poor results obtained even by satisfying cravings healthily.  The calming is only temporary and has no effect on our between treat mindset.

Brewer uses the example of smoking to illustrate why addiction fuels negative thoughts rather than abates them. In addition to the pleasurable associations, smoking actually creates a negative feedback loop, where you are linking stress and craving with the oh-so-good act of smoking. So whenever you experience a negative emotion, craving returns and intensifies over time, so that you are actually even less happy than before. A cigarette may quiet the mind temporarily – during the act of smoking – but in between cigarettes is where things get bad, because craving creeps in. Though we’re using craving as the example, unhappiness, self-referential thoughts, or everyday

Substituting a carrot stick or other behavior for your actual craving (or other form of unhappiness) is a typical method of treatment, but it doesn’t often work, says Brewer, because the feedback loop is still there. Addressing the process itself with other methods (like meditation), which allow you to ride out the craving/unhappiness by attending to it and accepting it, and then letting it go, has been more successful, because it actually breaks the cycle rather than masks it.

So, if you meditate….please meditate.   Don’t let your unreliable minute-to-minute “I wants” distract you or convince you that that glass of wine is better for you  or, essence of self deception, that you don’t really need it.

 

Developmental Coaching: What’s it about?

While our development as human beings is experienced as a unity, it is useful  to temporarily and artificially segregate individual facets to clarify what seems to be happening and to allow us to gain some traction in making changes.  Each of the services I offer through this site is aimed either at directly facilitating development or at transcending blockages impeding or distorting development.  This post will try to provide some background on two particular facets of our development which can be enhanced via directed coaching.

Following Otto Laske, we can talk about the cognitive side, how we make sense of the world, and the social/emotional side, how we make/find meaning and values in the world.

With cognition, we can be said to move forward on (at least) two fronts:  Epistemic Position: how we conceive of truth and our ability to know; and Cognitive Complexity: how well we use the strengths and weaknesses of logical thinking and, simultaneously, how well we marshal trans-logical or dialectical thinking while avoiding the incoherence of illogic.

In the social emotional dimension we move forward in our ability, simultaneously, to be our own person in making decisions that match or define our values AND to be respectfully, and even lovingly, integrated in our relationships with others and work.

Both aspects combine in a growing ability to manage our emotional reactivity, to be more creatively constructive and to live a more satisfying, productive life which is both emotionally and spiritually rewarding.

It’s important to note that the discomfort and even pain that precedes a developmental transition is not necessarily a signal of emotional or psychological dysfunction.  While we all carry our share of emotional blockages and pain, development itself is frequently a discomfiting process, whether we see it in the travails of childhood and adolescence or the transitions through which, with luck and effort, we proceed as adults.  The good news is that, while these discomforts are inherent in our human situation, the growth that we attain usually reduces the suffering they cause us.

Our primary means of cognitive development is formal education while social/emotional development is mediated by school, family and friends.  As we progress through our schooling and growing within our family, our body (including our brain) and mind are maturing and, ideally, our life circumstance matches or slightly exceeds the levels of complexity our developing body and mind can handle.  This helps us become more competent in our current level of development and leads us, sometimes kicking and screaming, toward the next. If we are lucky in our teachers and environment, this dance of stretch, master and stretch again continues through our school years.

Once we finish our formal education however, we are usually presumed to be fully developed and it’s supposed that mastery of new tasks, relationships, levels of responsibility or, indeed, environments will be simply a result of learning new skills rather than the development of new levels of mental complexity.  Various researchers like Elliot Jaques, Robert Kegan, Michael Basseches and others have demonstrated that this “skilling up” theory is inadequate to explain either the demands of work at higher levels of complexity or the mental characteristics required to meet that demand.  Kegan and Basseches in particular have demonstrated that there are developmental paths that can allow us to attain levels of cognitive and social/emotional sufficient to meet these demands constructively.

Kegan, in his book “In Over Our Heads” uses as his opening example the demands of the transition from being a son/brother or daughter/sister in the family of origin to being the mother/father of a new family.  The transition usually requires the new parents to establish balances in their relationship with each other, their relationships with their own children, their relationships with their own and their partner’s work and with their own and their partner’s parents and siblings.  This is a huge leap in complexity in interpersonal relationships and, for millennia, the literature, theatre, movies/TV and theatre of all cultures have been built on the ramifications, dilemmas and conflicts inherent in it.  In this example, the husband’s strong orientation to his parents is interfering with his relationship with his wife and he is struggling to re-balance and re-orient his feelings of obligation and central value toward what is now his family.  Indeed he is struggling even to understand that the discomfort and awkwardness that he is experiencing is arising from his inability to contain these two conflicting sets of obligation simultaneously.

Coaching at this developmental level involves, at minimum, helping the client see their situation in ways which reveal rather than conceal its complexity.  This can sometimes mean introducing the idea that the conventional view of the simplicity and obviousness of our lives is a large factor in generating the conflicts in which we so often find ourselves.  This in turn often helps the client see themselves in new ways which increase their ability to see themselves as both unique and self-responsible AND as embedded in the mutuality of affective and intellectual relationship.

This process is both congruent with and complementary with the material which we teach in Cultivating Emotional Balance.