A Therapist Tells You a Secret. Do You Really Want to Know Everything?

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In the search for information and closeness to your therapist you can’t predict what you might discover. I will use the subject of race to illustrate. Two subjects, then: racial bias and yours truly, a retired psychologist who was not always admirable as a stand-in for your counselor. The question of self-knowledge, too, is on my agenda, absent in most of our prejudices, replaced by the ability to rationalize our thoughts and actions.

Ugh, I hear you say: what can one offer about race that hasn’t been uttered to the point of numbness. I’ve groaned myself. More often I’ve grumbled about unfairness to minorities, blamed the big bigots, or written a check to a noble cause. My buddies from Mather High School even established a college scholarship program for disadvantaged teens of all races, ethnicities, nationalities, and religions.

Sounds admirable, right? Read on if you dare. You might find something out you don’t like, something to knock me off any pedestal given me by your generosity, a coin flip, or my own effort to climb on top.

We come by vulnerability to racial bias as part of our evolutionary inheritance. Humans who didn’t notice differences became someone else’s lunch. The tribe next door was quickly identified as “other.” Otherness made both sides wary. Those who were too welcoming too fast suffered a bad end. They are not our ancestors. Yes, cooperation was essential to survival, but care had to be taken about anything signaling danger.

We also want to think of ourselves as “better than” someone, more in control, deserving a more advantaged life than they. The “other” comes in handy here, too, for the sake of drawing contrasts. Read Ernest Becker’s The Denial of Death to investigate this light subject.

Still more of us seek simple advantage by becoming a top dog over the Untermenschen, which has typically included benefits like money, power, status, and mating opportunities.

The trickle-down theory of prejudice applies as well. The one who is mistreated — the one who is hated — becomes the hater. And not necessarily aiming his animus at those who inflicted the injury. But sometimes racial resentment derives simply from emulating the deeds and words of the ones you love or the culture in which you live. Then, in bad times, the fire is fueled, whatever its first cause.

Such tendencies do not make anyone evil. But they do require that we catch ourselves leaning.

At least in my generation — the leading edge of the post-war baby boom — most of the white folk were not untouched by racist messages and, more significantly, many absorbed some of the bias. I was one such.

Maybe the most shameful day of my life happened early in graduate school. My roommate and I had a one-year lease on an apartment in residential Evanston, IL. He soon was swept away in romance and wished to move in with his girlfriend. Jim, a quiet, mysterious, handsome fellow — his new fiancé was a beauty too (and they both had terrific abs, having met in a fitness center) — was also a man of honor: he agreed to pay half the rent until I could find someone to take his space. He and I understood, “the sooner the better.” Neither of us was wealthy.

I advertised, of course. The first person to call sounded perfect on the phone, another student at Northwestern. He came with a companion to see my digs. We agreed on the timing for his move-in. Within a couple of days I backed out of the arrangement. Why?

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Though he was born in the USA, his skin suggested an Indian subcontinent origin. Do understand, what I’d learned about race never referred to people who lived in Pakistan or India, other than they might be starving. Such references were common among parents of the time. They wanted their children to “clean the plate,” encouraging us to benefit from the bounty that the unfortunates on the world’s far side lacked.

I had no additional opinions about people from the spot on the map from which this NU student’s ancestors launched themselves. Moreover, he wasn’t starving — he could have been the guy next to Jim in the weight-lifting room. This young man, just a bit more green than myself, was clearly intelligent, displayed good manners, and dressed in the fashion of college students of the day. Well, obviously, he was not green in every sense, the clear point of my prejudice.

By now I had another roommate in line who would replace my replacement for Jim. Larry, the newer guy, was whiter than white. Blond. No better or worse, probably not as smart, different only in individual peculiarities I did not yet know, except — a big exception — for the fairness of his skin tone. I make zero excuses. My act was reprehensible, prejudiced. I looked in the mirror (eventually) and learned from it, too late for the man I discriminated against.

Most of us don’t think of ourselves as racist. The group in denial includes those who behave in a way consistent with bigotry, tell jokes dependent upon stereotypes, and vote for candidates who intend to disadvantage minorities while wrapping themselves in their country’s flag. The last of these adopt a faux patriotism that Samuel Johnson called “the last refuge of a scoundrel.” We are, almost all of us, pretty well-rationalized. Our sleep is undisturbed, our friends shake our hands, and we receive applause for acts of public generosity. But there are secrets, too, and now you know one about me.

I offer you no grand take-away here. I cannot tell you the meaning of life or even whether one is waiting to be found. But I believe part of my guidance for myself is to do better, learn more, be more understanding — enlarge my humanity and add some little good to the world. Hard to do any of that unless you begin the endless and ancient task of knowing yourself.

The friendly social scientists at Harvard have made it easier. They offer a free psychological instrument designed to help you understand your implicit, unconscious preferences or beliefs: to be more precise, a tendency to prefer “white” over “black.” It’s called the  Implicit Association Test (IAT). Consider the measure akin to the mirror of the evil queen in Snow White.

There are actually a great many tasks you can undertake on the site, but the one I’m talking about is the one labeled Race IAT in blue.

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The Harvard creators take the time to quote Fyodor Dostoyevsky:

“Every man has reminiscences which he would not tell to everyone but only his friends. He has other matters in his mind which he would not reveal even to his friends, but only to himself, and that in secret. But there are other things which a man is afraid to tell even to himself, and every decent man has a number of such things stored away in his mind.”

These lines from Dostoyevsky capture two concepts that the IAT helps us examine. First, we might not always be willing to share our private attitudes with others. Second, we may not be aware of some of our own attitudes. Your results on the IAT may include both components of control and awareness.

Now, you are likely to ask whether there is a connection between preferring “white” over “black” (or the reverse) and acts of discrimination/racism. The answer is in the FAQ (Frequently Asked Questions) section of the site. In general, they inform us, “not necessarily.”

Of course, I don’t know how you, dear reader, will score. Are you, to quote Dostoyevsky once more, a hostage to “those things which a man is afraid to tell even to himself?”

Do you have the courage to find out?

Again, here is where you can: Implicit Association Test.

Now, say, after me: “Mirror, mirror, on the wall … ”

For sure, this psychologist is not the fairest of them all. In any sense.

Following the Disney images of the evil queen and her mirror (from Snow White and the Seven Dwarfs) comes Vasily Perov’s 1872 portrait of Dostoyevsky, sourced from Wikimedia Commons.

When Therapy is Long Does Your Therapist’s Patience Grow Short?

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Some phrases never grow old, never become routine. “I love you” is one.” So is “I don’t want you anymore.” It is not that we’ve never heard the words before, but that they are so powerful and fraught with significance (or so hard to say or mean so much) either to the one who utters them or the one to whom they are delivered. In therapy the dread-laden expression is different: “I can’t do more. I need to refer you. Treatment has been long. The lack of progress means we must stop.”

Yes, perhaps it is said differently or becomes evident not through language, but impatience or facial expression or indifference. Where once enthusiasm and intensity bloomed, now the counselor seems to be enduring you, too conscious of the time, growing weary of your moments together. Two of my readers, Claire and Rosie, asked me to write about what permits a therapist not to take this dreaded path, the one leading to his desire to dump you — hoping you “never again darken my door” even if he doesn’t say the precise words I just used. Thanks to them I will try. I speak for myself, but know many therapists who would agree with much of what they will find below.

  • I like people. I like stories. I like individuals, not groups. I try to provoke meaningful conversations even with friends, not small talk. The time I spent with my patients was the perfect environment for me to look into a person’s history, history being a favorite subject from my early school years on.
  • I learned to notice small signs of progress. Sometimes we advance in microscopic steps. We reach a plateau on the mountain climb of treatment and then must catch our breath or wait for the storm to pass. The old Chinese saying tells us, “A journey of a thousand miles begins with a single step.” Therapists measure their work in moving toward a goal, not reaching it in quick time.

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  • The work is gratifying. Where else do people come to you, rather than requiring your travel? Watching others grow — helping them grow — generates good feeling on both sides. You receive thanks.
  • The work is an honor. New counselors find the responsibility almost overwhelming: another person places his well-being in your hands. A wiser, more experienced, older doc should know (or remind himself) of the implicit tribute his patients give him by their consultation and expectation of his help.
  • I received payment for my effort. It was easier to be patient with patients in the knowledge some of my compensation came in a material way. That said, in a handful of cases, long-term clients were thousands of dollars in debt to me before the sessions ended and they achieved the life they wanted. Yes, they did then pay me, usually over time. Healers must not be so self-sacrificing that they become resentful of those they treat.
  • The patient’s life was not mine or that of my spouse or children. While clients sometimes wish to be closer to their doctor, the therapeutic distance created by him makes it possible to put treatment still-points in perspective. I am less calm and understanding with my wife and adult children than with those who sought my professional skills. I cared about the people I treated, but (usually) not to the point of a disruption of my equanimity. Thus, I tended to be patient with a lack of movement, thinking of such episodes as a rather commonplace experience not usually requiring a desperate and immediate remedy.
  • I was responsible for making therapy fresh. A therapist’s job is to bring his intense focus to every session. He must also reflect periodically on whether he has missed something important. I reevaluated my patient and my approach, made course corrections as needed. A therapist who is often bored or unable to change perspective and look anew at the client is in the wrong profession. I kept it interesting both for myself and for those who put their trust in me. A patient is not your entertainer. The counselor should be emotionally and intellectually engaged on his own
  • Of course, if you aren’t putting in the effort, you might wear the therapist down. If you are simply paying for a friend, buying his time because you have affection for him (or using him to replace a missing social life) then he should recognize this and talk to you about it. So long as you rededicate yourself to “the work” of therapy, no ouster need be expected.

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  • Progress isn’t linear. I once asked my money manager, a professional analyst of financial markets, what he expected in the near term from the stock market. He answered, “It will fluctuate.” What he said was funny, but his comment acknowledged that no one predicts economic busts or booms, much as many people claim to. Therapy doesn’t move in a straight line of ascent from start to finish, anymore more than the stock market goes straight up or down in perpetuity. There are bursts of change, but more often, periods of little movement. I didn’t expect patients to be elite prodigies of self-analysis and courage, sprinting to psychotherapy’s finish line, so I wasn’t desolated if treatment took its time.
  • The therapist discovers value in challenges. If therapy were always smooth sailing, counselors would become bored with it.  They would learn nothing new because no greater progress could be made by doing so. Since I lacked a magic wand, I had to continue to consult colleagues, read books, and attend classes. Those who posed therapeutic dilemmas generated some of my growth as a counselor and a person. Why would I wish to cast aside people who were, in effect, helping me to do better?
  • Elite athletes are useful models for clinicians. Baseball players grind out a 162-game schedule from April through September, longer if they reach the playoffs. Successful athletes learn to put today’s failure behind them, lest they worry themselves into being unable to perform well tomorrow. I was better than many in my capacity to go home and think about other things, relate to my loved ones, and set the therapist hat on a closet hook. To do otherwise would have burned me out. I was not available 24/7, nor did I guarantee rapid responses to email or phone messages. I made sure I didn’t get used up. A doctor who takes good care of himself is less likely to get tired of you.
  • Buddhists provide yet another excellent example for therapists. You know the frustration of a long static line: a line where there is but one indolent checker or ticketing agent taking care of all those in the queue. You have places to go, people to see. Yet your reaction to just this type of setting — one seemingly out of your control — might determine whether you lead a satisfying life: 1) You can be frustrated and make yourself miserable. 2) You might jump to the line’s front and complain, which will not usually make the line shorter or the ticket agent more efficient. 3) You can reframe the experience. A Buddhist would say, in fact, you should be grateful for the line and the plodding employee because they are giving you the opportunity to learn patience. A lengthy term of treatment where every inch of progress is dearly won offers the same opportunity.
  • My job was a gift. I performed work that was not always “work.” A summer job during my school years in the 100-degree heat of a metal-stamping factory taught me how soul-killing “work” can be. I later came to make a good living in clean, climate-controlled surroundings as a psychologist. My patients helped me become more patient, more thoughtful, more loving — more grateful. I was my own boss and I took meaning from the relationships and the privilege, the stories and the intimacy. I used my brain, one of my favorite body parts! Living this professional life and remaining (mostly) grateful defused many frustrations.

The task of a therapist is not to say, “You’re fired,” but to find a way through or around, under or over; whether running, crawling, pushing, pulling, cajoling, asking questions, waiting, reconfiguring, staying silent, or getting his own help. Much as some of our patients worry about being put into a dumpster, we are working to get them out of one.

Rest easy.

The top photo is called Doraemon by istolethetv from Hong Kong, China. The second is named I’ll Miss You Dad by Cecilio M. Ricardo, Jr., USAP. The final image is a highway Sign at the Truth or Consequences, New Mexico Exit taken as part of an August 24, 2009 road trip by CGP Grey.

The Therapeutic Search for Your Past

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Unless your symptoms can be relieved without an excavation of your ancient history, most counselors will encourage discussion of your past. For some patients this is at their fingertips in fine detail and painful intensity. For others only the emotions are reachable, without being joined to specific memories. A blank slate is found in still another group of clients: they own few recollections, feelings, or interest in bygone days. Yet if the healer believes you were damaged early, he must find a way to assist you in the search for them.

Perhaps you’ve had the experience of a particular aroma or flavor evoking a childhood recollection. The most famous literary example comes in Swann’s Way, the first volume in Proust’s In Search of Lost Time. The narrator unknowingly refers to the therapeutic dilemma of retrieving the past when it does not come easily of itself:

It is a waste of effort for us to try to summon it, all the exertions of our intelligence are useless. The past is hidden outside the realm of our intelligence and beyond its reach, in some material object (in the sensation that this material object would give us) which we do not suspect. It depends on chance whether we encounter this object before we die, or do not encounter it.

The narrator tells us how the enormous world of his early memories was opened by the simple act of eating the crumbs of a petite madeleine (a small French sponge cake) mixed with tea, reminding him of this treat offered by his aunt and leading to more and different recollections. Here is the attentive therapist’s key to assisting his patient: a knowledge that the sensory world can help unearth the client’s excavation of his early life. You must dig with your bare hands — get your fingers dirty, literally — if you spent youthful time playing in your backyard in the grass, clay, and soil. There, in the movement, scent, and contact might you find a piece of yourself.

We all recognize our five senses: sight, sound, touch, taste, and smell. Thus, the therapist can suggest his client return to his old neighborhood and walk the path he took to school or the playground, or once again ride the bus along a familiar route. I have even known people who persuaded the new occupant of their old apartment to permit a brief tour. If the patient lives far from this place, an imaginary journey is still possible.

Photos of yesteryear can do some of the work — the heavy lifting of evocation. Songs of the time or those sang by babysitters can spring the release of powerful emotions. Proust’s example leads us to recall what foods we ate when we were small, what sounds were present in our flat and nearby, what games we played and TV or radio programs we watched and listened to, what childhood possessions we treasured. None of this is foolproof, guaranteed to open yesterday’s locked door. Yet such efforts sometimes work like a domino game, one toppled piece striking the next and that piece hitting another in turn, as if each object were a newly triggered memory. Nor should consultation with an old friend or relative be ignored. Their recall may trigger your own.

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A similar occurrence recently happened to me. Since crayons will find their way into my grandson’s hands before long, those coloring sticks became a topic of discussion. In my early school years, Crayola Crayons — the Cadillac brand of coloring hardware — were on the equipment list for the summer’s end march to your new daytime captivity. Mom, ever frugal because of her own impoverished childhood, bought an economy size for me, perhaps only the smallest box of eight or the next step up. To my chagrin, however, all my classmates (or so it seemed to me) had larger boxes, several hugging and lugging the giant 48 (or was the number 64?) cardboard container to Jamieson School. Apart from saving me from a possible hernia, I can now remember a sense of shame and loss of status connected with my small Crayola box. Size, long before I understood anything about sexuality, did matter.

Recollections like these are grist for the treatment mill, capable of revealing the origin of insecurity, depression, anxiety, and more. You can also use them as adjuncts to self-understanding outside of therapy. Distant memories tend to be available for retrieval because of an attached emotional charge, whether joyful or dispiriting. The thrill or disappointment or humiliation of a childhood event seems to bind the occurrence to a place somewhere in our consciousness, even if we must struggle to find it.

As Harvard psychologist Robert Kagan said:

The task of describing most private experiences can be likened to reaching down to a deep well to pick up small, fragile crystal figures while you are wearing thick leather mittens.

Searching your past is not for the faint of heart: you do not know what you might find. Yet among the detritus uncovered in your archeological dig, there may be sharp-edged treasures, perhaps even a key to release you from invisible tethers restricting your enjoyment of life’s fullness.

The old joke tells us that if you find yourself in a hole you should stop digging.

Funny how psychotherapy advice is sometimes just the opposite.

The top picture of the Madeleines de Commercy is the work of Bernard Leprêtre. The photo of the very First Version of the Crayola No. 64 Box comes from Kurt Baty. Both are sourced from Wikimedia Commons.

The Secret Role of Hope in Psychotherapy

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I am always amused when a TV pitchman offers to sell a secret “they won’t tell you about,” promising to make you a million dollars. Well, the “secret” I’m about to disclose is something rarely discussed, but not intentionally hidden: a form of hope. This type of optimism, however, is not what most imagine when they think of such words.

The standard well-acknowledged place of hope in therapy is for the therapist to communicate that the future can be better. His authority and experience are implied and therefore increase the chance of belief in him. They tell the patient, in effect, “I’ve seen others recover. People can overcome depression and anxiety. This is also possible for you.”

For some of his clients, however, his cradling of hope takes an additional form. Too many of us live in a psychological concrete canyon, like ones found in the narrow avenues bordered by tall buildings in major cities. We cannot witness what is behind these skyscrapers, nor a sunrise that is the gift of the horizon. Less metaphorically, we cannot recognize what role we might occupy in the world, beyond filling an unsatisfying, modest or disadvantaged place similar to those in our past. Dr. Seuss gave this encouragement:

You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose. You’re on your own. And you know what you know. And YOU are the one who’ll decide where to go…

Oh the places you’ll go! There is fun to be done! There are points to be scored. There are games to be won. And the magical things you can do with that ball will make you the winning-est winner of all.”

This is not meant to be fanciful. As one of the founders of the Zeolite Scholarship Fund at an inner-city public high school in Chicago, my friends and I met too many youngsters who, by age 16, couldn’t imagine themselves achieving a life past what was available in a dead-end community. For some, a hopeful future died aborning. Imagination died, as well.

A therapist faces this, too, in the blinkered vision — the crumpled expectation — of the person sitting opposite him. His patient might not be able to conceive of a different, more adventurous life of high level skill, romantic abandon, achievement, and abundance. He is, in a sense, like a child who hears early she can be President of the United States, but discovers this has never happened — not yet anyway —  in the USA’s 240-year history and therefore crosses off the goal. Yes, some individuals periscope beyond the concrete canyon, their parents’ bleak lives, and their country’s prejudice without a counselor’s help. Yet others need their therapist’s belief to develop an x-ray vision piercing invisible barriers, the walls so taken-for-granted one might not even be aware of them.

Hope of this kind is not simply founded in the counselor’s confidence you can overcome symptoms. Rather, it is aspirational — the hope beyond hope to a world of possibility your peers laugh at if you are one of the 16-year-olds I mentioned.  For those who never beamed at a respected person’s consistent belief in them before, the words come as a revelation.

Therapy is an enterprise driven by heartbreak in the direction of hope. “I’ll try anything,” you say to yourself, “even this.” Usually, however, the wish is to remove the negatives, not obtain a sense of fulfillment in life. Make no mistake. The two may not be mutually exclusive. Envisioning a future worth living is more than encouragement to wellness, but a step toward it.

What Robert Kennedy said on several occasions applies no less to changing the world than changing ourselves:

Some men see things as they are and say why.

I dream things that never were and say why not.

 The top photo by Jessie Eastland is described as 72 Seconds Before Actual Sunrise, Southern California, USA. It comes from Wikimedia Commons.

Understanding Rebound Romance (and the Rest of Life)

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A heart in pain is like a falling star, fascinating until you realize it might become a meteorite about to burn and crash. Will the object splatter? Will the rock survive? Will it bounce in the wrong direction? Such is the life of romance on the rebound.

Unrequited love offers a chance to understand life’s “slings and arrows of outrageous fortune,” not only those puncturing the bubble of romance.

What causes us to make a rapid jump back into the dating pool after the ex has left the water? The easiest band-aid for rejection is to blame the former love and pick yourself up quickly, as if to say “I’ll show him!” Or perhaps solitary time frightens you, having never learned to be independent. A long stretch being without a sweetheart to lean on is unimaginable for the insecure.

Fair enough, but this is a reminder to become self-sufficient, not to substitute a fresh body. Moreover, we must learn about our part in love’s failure — one’s own fingerprints on the broken pieces of the loving cup. Was he the wrong mate, yet the type we routinely pick? What motivates our repeated errant choices? Which of our personal characteristics require change — the ones that fray a relationship’s fabric?

Just as essential is the need to grieve the loss. Without doing so, plotting a course forward has but a blind man’s chance of success. We run backward into unfamiliar arms because of the preoccupation with those that previously encircled us. Too late do we turn to look closely at the one now holding us, so great is our desperation to flee the pain of dismissal. Accidents are expected if you don’t see the Mack Truck coming your way. Might the unknown man be just a distraction? Might he remind you of the bygone boyfriend? Do you want to make the ex jealous by displaying an updated, successful, stud puppet? Or is the replacement beau a bodily application, flesh against flesh — a kind of salve — not to heal soreness but to sooth the soul?

Perhaps the fresh darling represents a flight from pain and loneliness, as drugs, alcohol, and overwork often do. The world is now too much. Deadening and distraction can take a human form in the new beloved. You feel powerless over memories and the emotions attached. These unwanted intruders inflict anguish to head and heart. The awfulness seems eternal, as if each second of woe is like a person in a line stretching over the horizon, where the queue’s length (to the point past suffering) signals a journey without end. So you interrupt the grieving you need and escape to someone untried.

Sometimes you are so foolish as to persuade yourself that you won’t permit strong emotions about the new person. I cannot tell you how many patients told me this only shortly before they were again “in love,” again with a bad match.

A rush to get past sadness — as if sorrow can be outrun — often leaves you unstrung. Your head swivels: first looking back, then looking away, finally looking without seeing.

We need to abide with the pain, learn what it can tell us.  Affliction is endurable, albeit one second at a time. Blinder yourself (if you can) against the imagined endless emptiness. After all, perpetual sadness is a possibility, not a guarantee. The catastrophized future leads to desperation, despondency, and poor decisions. Hearts heal, but only if we attend to their needs.

Just as you would not dismiss your grief after the death of a parent, so must you not race past it when love vanishes. The disappearance of affection, no matter the kind or cause, is a stern taskmaster. Pay now or pay later, but you will pay.

We need human attachment to mend the broken heart strings. Before you flee to a passionate embrace, however, are there those who would embrace you in sympathy? Friends, family, or (figuratively speaking) a therapist? They can be enough.

Life asks us weighty questions. How much of the human experience will we let in? How much of living and sensation do we wall off in order to survive? The round world has sharp edges. Walls must be built. We all do it and, to some extent, we have to. How high, how completely, and in what manner are the only relevant considerations. And what do we give up to make life manageable, prevent feeling overwhelmed?

In pondering our psychological defenses and their cost, whether we have love in our life or not, we are all summoned to the same solemn self-interrogation.

How will you answer?

The top photo, Angel with a Broken Heart (Tomba Famiglia Ribaudo) is the work of Jeff Kerwin, sourced from Wikimedia Commons.

Treating Insecurity and Anxiety: Eight Roads to a Solution

512px-Anxiety_cloudImagine you are considering therapy for the first time. Or perhaps your treatment isn’t working. You stand at a crossroads, like the hub of a wheel where eight spokes beckon for attention. How should you choose among them?

Not all are good and you may even realize that as you decide. Here is a guide to thinking about what to do (and what not to do) with the weighty package of insecurities velcroed to your life. Click the link for a comprehensive list of the signs of insecurity.

ALCOHOL AND DRUGS. The issue of substance dependency should not be ignored. Recall the old Chinese proverb, “First the man takes the drink, then the drink takes the man.” Alcohol’s comforting relief and buoyancy is commonly replaced by longer term emotional darkness. Marijuana (cannabis) might mellow the smoker out but leaves underlying insecurity and anxiety untouched when sober. If you are attempting psychotherapy, best to tell the counselor the extent of your substance use straight away. The deepest wounds are slippery things. Grasping them is harder (if not impossible) when alcohol or drugs add to the excess lubrication.

WILLPOWER AND SELF-ANALYSIS. The old saying tells us, “When the going gets tough, the tough get going.” Yes, some few people manage their own psychotherapeutic project. Indeed, Freud analyzed himself. What is required? Although I know of no research on this, I suspect one needs a strong capacity for self-reflection, high intelligence, some degree of emotional openness, the courage to look in the mirror, tenacity, and knowledge gained through reading about treatment. Willpower is necessary because the self-analyst must inevitably get out of his head and leap the wall of fear to master behaviors blocked by insecurity: good eye contact, self-assertion, saying no, asking for things, making uncomfortable phone calls, inviting someone on a date, public speaking, etc.

THE SEARCH FOR A STRONGMAN. Some rely on a mate to perform avoided tasks. The significant other becomes a caretaker or body-guard, an individual who is sought to do the jobs the hesitant one believes he cannot: return a product to a store, accompany him to events otherwise avoided, and so forth. This is no solution to anxiety or insecurity, but a human crutch to sidestep the need to change. Another danger: too often the protector becomes an overlord, pushing you around or worse; the mister turned monster you hoped he would protect you against.

PSYCHOTROPIC MEDICATION. Medications, like other drugs, carry possible side-effects. Antidepressants can impair sexual performance, anti-anxiety tablets often have addictive properties. While a good psychiatrist will carefully watch for these, pharmaceuticals do not create a sense of security and confidence beyond the time you use them. Moreover, to the extent that the psychotropics help you feel better, your motivation to tackle underlying reasons for your symptoms may be reduced. That said, sometimes susceptibility to anxiety and depression is inherited and biologically-based, making the booster of drugs a necessary and permanent mode of treatment.

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AVOIDANCE AND THE INTERNET. Anticipation of discomfort, humiliation, or failure translates to turning down invitations — limiting chances for growth, accomplishment, and joy. The troubled soul is assaulted by hatchet-bearing ideas that have become permanent, non-rent-paying residents in the head. The data set of the insecure is based on an unfortunate history. The job of recovery translates to writing over your old history by gradually taking on social challenges and accumulating successes reinforcing your effort.

Beware the false god of the internet! The more time you worship at its alter and “let your fingers do the walking” on the keyboard, the less you have for direct human contact (involving actual walking out of the apartment). For all its marvels, this deux ex machina can become a screen behind which to hide the human face, trading yours for a virtual one. Yes, social media can be a stepping stone to a life beyond the keypad. For many, however, it’s another form of concealment and self-distraction. You can identify too fervent online social network disciples by the pain they will suffer for their god: a malady called text neck, the product of bending over their smartphone.

PSYCHODYNAMIC PSYCHOTHERAPY. Psychodynamic treatment, the traditional talking cure, can be a foundational part of counseling. It helps one clear the life-history undergrowth undermining a healthy self-image, planting  seeds of sturdiness to deflect the inevitable defeats we all encounter. Such counseling also lifts the weight of self-blame by recognizing the fingerprints of others on one’s problematic background story. It cannot stop there, of course. Grief and grieving demand attention.

Beyond relieving submerged pain, one must eventually take psychoanalytic insight for a test-drive: try new behaviors just as one would a new car before purchase. However much a “depth psychology” approach is needed, empirically based (research supported) interventions provide the practical impetus for emotional availability, symptom reduction, and behavioral change.

COGNITIVE-BEHAVIORAL THERAPY (CBT). Many of the well-researched and effective treatments just referred to fall into the category of CBT. Obsessive-Compulsive Disorder (OCD), for example, is among those problems amenable to this set of tools. Indeed, attempting a solution for OCD psychodynamically is, in contrast, a therapeutic cul-de-sac. CBT can often, however, be combined with more traditional talking therapy to join the best of both worlds.

ACT (ACCEPTANCE AND COMMITMENT THERAPY). ACT is described in the following way on its website: “Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.”

Plowing through this technical language, ACT deals with the losses most patients have sustained, traveling from a grieving process toward acceptance of those life circumstances that can’t be changed, reduced avoidance, learning to live in the moment via meditation, deciding what is most important to you, and choosing behavior consistent with your stated values.

WE ALL TAKE TURNS at life’s crossroads. Sometimes the best advice is to make no movement, patiently waiting for the traffic to clear. Do remember, however, not choosing is also a choice. The clock is always ticking, even if, in the digital age, we must strain to hear it.

The top image by John Hain is called Anxiety Cloud sourced from Wikipedia Commons. The photo beneath it is Girl Suffering from Anxiety by Bablekahn at Kurdish Wikipedia.

How Well Do You Fit in? The Therapeutic Dilemma of the Introvert in an Extroverted World

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In my therapy practice I encountered many people who didn’t quite fit into the world. Sometimes it was because the world valued beauty and they were not beautiful, sometimes because they had no interest in sports where others cheered for a team, and sometimes because their skin color and religion were out of place. More often they believed their internal life didn’t match up with those around them: too sensitive or unlikeable or too serious; peculiar, different, odd. Quiet in a loud world, thoughtful in an impulsive world, gun shy in a world where many shoot first and don’t even ask questions later. Most importantly, they lacked a niche, a social group, a family or family substitute in which they felt safe and cared for — a place of solidarity and belonging — or an institution (like a small community church) offering something bigger than the commonplace mission of “getting and spending” and personal success at any cost.

To provide therapy for such people one must acknowledge that, indeed, some of us fit better into a different time and place. I’d like to look at the therapeutic model from which the counseling field grew and ask the question: does it still offer the best possible assistance to a person who is isolated, perhaps by his nature and temperament, perhaps by a society prone to discounting his human qualities, perhaps by a world transformed from being too closed to too open; perhaps by all of these.

Psychoanalysis, Freud’s method, developed in a Victorian Era, tailored to the values, customs, and morals of the time: a repressive society in which a woman who showed her ankle in public could cause a small scandal. Polite social gatherings didn’t permit discussions of sex. Revelation of personal problems betrayed weakness and breached decorum. One suffered silently. Not surprisingly, Freud offered a treatment designed to open those topics not disclosed elsewhere, fashioning the counseling apparatus to lift the gurney of a disapproving society off patients who had been crushed by it. In other words, psychoanalysis was a therapeutic approach tailored to a different social world than we live in today, at least for those of us in the West.

There was, however, a positive side to the era. Values identified in bold letters were supported by strong institutions. The family and church might crush you, but they also provided decisive direction and unconditional, although superficial, acceptance, at least if you followed the rules. You  weren’t on your own, adrift, and uncertain about how to lead your life. The restricted set of permitted choices made the day less complicated and overwhelming. The life map presented by family and social institutions, government and military, offered easy-to-follow steps.

If Freud were alive today would he have used a different model for treatment after his world vanished?

I suspect so. He could not fail to notice how the closed, restrictive, prescriptive social order has been replaced by one more permissive and open. A society requiring unquestioning acceptance of your parents’ religion, vocational advice, and veto power over a potential spouse has been set aside.

Now, for example, you are considered free to determine not just your faith, but whether you want a religion at all. Yes, parental direction and disapproval are still present, but they have lost a good part of their grip. A federal government that once ordered you to perform military service, today leaves the defense of the country to volunteers. Sex is everywhere (as are exposed ankles and more). There is no place to hide. Loud voices predominate. Extroversion trumps introversion. Freedom to make personal choices comes with the expectation you will make good ones instead of being overwhelmed by the array of possibilities. Few behavioral menu options are forbidden and most are public.

We live in a garden of delights or a world of confusion that would have seemed dreamlike, disorienting, and scandalous in the time of Freud’s early work. We cannot escape a Kardashianized existence of energetic, fast-talking, self-promoting performers who are role models no introvert recognizes in himself. Meanwhile, he has the vague sense of missing someone he has never met.

What components should therefore be added to the traditional “talking cure” in the second decade of the 21st century?

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I’d begin with recognition that the social world of today is tipped to the advantage of extroverts. At least one-third of us, however, are not so classified. Methods of self-enhancement and personal validation for introverted clients must go beyond an effort to make them into fake extroverts. Temperament is more or less fixed by biological inheritance and very early experience. An introverted and insecure patient can become more self-confident with the help of therapy, but his preferences for privacy, quiet time alone to recharge his energy, and one-to-one contact over an affinity for large groups are likely to persist.

The introvert is not true to himself if he tries to become a chattering machine: the “Bigger Than Life” of the party. Treatment must value his qualities as an introvert and support him in his effort to find a useful niche within the work and social worlds that makes the best of his unique skills. His temperamental strengths include an ability to listen, reflective thought as opposed to impulsive action, seriousness of purpose, persistence, and a good eye for risks. Susan Cain’s book Quiet: The Power of Introverts in a World That Can’t Stop Talking offers a place to start.

A second component consists of helping clients find or create socially supportive, cohesive institutions and groups where they can attach to something less isolative, more fulfilling, and bigger than hollow self-interest. As noted by Sebastian Junger in his short, but powerful new book, Tribe: On Homecoming and Belonging, our ancestors in prehistory lived in small groups (50 or fewer) whose survival depended upon pulling together. The tiny society was largely “classless and egalitarian.” Sharing was essential and little personal property existed. Loyalty was prized. Status, to the extent it was present, came from providing for the group and defending it in war. It was a place where quietly doing your part was enough for acceptance and approval, membership and the availability of a mate. Everyone fit.

Contrast such a living situation to the endless, senseless, heart-deadening contemporary competition to be as good or better than your peers and survive on your own or, if you are lucky, in a family including only a spouse and children. Our ancestors were bound together by a mutual necessity and support now replaced simply by sharing an address: living in apartment buildings and neighborhoods of nameless strangers. Isolation is the inevitable result of having little intimacy, as well as sham closeness dependent only upon the accident of sharing a cubicle or the ties of occasional after-hours good times that do not bind.

The therapeutic project of the urban, anonymous 21st century must recognize the present historical moment as especially challenging for the introvert. More than most others, he wants relationships of depth. The therapist’s transfigured and transfiguring task is to creatively enable his client to locate some way to connect, belong, and find meaning instead of settling for alienation — the extent of which few are permitted to know.

Treatment is a serious job for this serious person, it is true. What could be more fitting?

The first image is called Alone by PiConsti. Look closely for the tiny creature in the picture. The photo beneath it is Isolation Lake (5) in Chelan County, WA by Bala. Both are sourced from Wikimedia Commons.