acceptance and commitment therapy

October 2, 2009

What Happens in Psychotherapy?

What does psychotherapy do and how does it do that? Good questions, and even some therapists might have a hard time answering them. Of course, some of the goals are obvious: reduce depression, have better relationships, eliminate anxiety, enjoy your life more, and stop worrying. But what are the elements that get you there? I’ll give you a sense of some of the factors that permit those goals to be achieved.

1. Trust. Many people entering treatment have trust issues: they trust too easily or not at all, usually the latter. Trust will start with the relationship between you and the therapist. Simple things: does he listen? Does he understand? Does he seem interested and dedicated? Is he dependable? Does he care? If the answers to these questions are “yes,” then it will be a bit easier to begin to trust others. The experience of a benign relationship with one person can open you to the possibility that this experience can be achieved elsewhere in your life.

2. Validation. Many people coming into psychotherapy having been told that they should “get over it,” that they “shouldn’t feel that way,” that they shouldn’t complain or “whine;” or having been ignored, dismissed, or criticized too often when trying to express themselves. Some folks believe feelings are unimportant; others might state that it is not “masculine” to feel too much, and so forth. As a result, many new patients have so buried their feelings that they are alienated from themselves and don’t know whether it is appropriate to think or feel as they do. A good therapist creates a safe place for talking about such things (trust again), and gives the person a sense that there is value in what they feel and think. Over time, this action, by itself, can help improve self esteem and reduce sadness and alienation.

3. Grieving. If one has not had supportive relationships (with people who are both trustworthy and validating), the sense of loss or absence contributes to sadness, and sometimes to depression. The relationship with the therapist allows you to express the emotions related to loss (both sadness and anger) to someone who listens patiently and shows concern. As you process those feelings of loss, your sadness should gradually diminish. The therapist serves as a witness and again, as someone who validates your pain. Grieving in isolation too often contributes to the feeling of disconnection and alienation from the world. Grieving with someone who cares reconnects you to one of the things that can be good in life: human contact.

4. Learning new things. Any good therapist needs to provide some guidance and tools that enable change. This might come in the form of helping you learn and practice new social skills (including acting these skills out with the therapist), assisting you in changing how you think (cognitive restructuring) that helps you reduce self-defeating thoughts, training in how to be assertive (again with role playing in the therapy session), or meditation.

5. A change in perspective. A good therapist will provide you with new ways of thinking about the world and about your life. Since he can see you from the outside, he is more likely to see you in a way that you cannot see yourself.

6. Facing things, not avoiding things. We all practice avoidance some of the time, and some of the time it is a useful thing. Unfortunately, many of us practice it all too much. We distract ourselves from pain and avoid challenging situations. We can use food, TV, shopping, sex, drugs, alcohol, the internet, and computer games to get us away from whatever it is we can’t handle. We worry about problems rather than coming up with a plan of action and taking them on. We don’t ask out the pretty girl for fear of rejection, or say “no” to people who want to befriend us for the same reason. We stay at a “dead-end” job because of our insecurities. And, of course, unhappiness is the result.

A therapist can assist you in identifying the patterns of avoidance, help you to gradually become able to tolerate anxiety (by use of such things as cognitive restructuring, role playing or meditation) and give you tasks that gradually increase in difficulty so that you reduce avoidance and begin to take action that works.

7. Acceptance. By acceptance I am referring to acceptance of the nature of life and the discomfort that comes with living; acceptance of the fact that being open to life allows you to experience satisfaction and joy, but also opens you to pain; and awareness of the temporary nature of most of that discomfort. The more that you take life on its terms, the less you will be trapped by it.

Remember playing with the Chinese Finger Puzzle as a kid, the cylindrical woven structure made of bamboo, open at both ends? You put your two index fingers into it, but when you pulled hard to get your fingers out, you became more stuck. Only by releasing the tension and moving your fingers toward the center of the device, did it collapse and no longer held you tight. Life is a lot like that to the extent that we must stop engaging in behaviors that only make us more “stuck.”Acceptance allows you to free yourself, at least somewhat, from what is distressing about life.

8. Valued Action. If you are caught in the struggle with your emotions, or focused on avoidance of pain, what is good in life will be hard to achieve. Therapy can help you to think about the life you would like to lead, the life that is consistent with your values, and help to relieve you of the habits that keep you so wound-up that you don’t have time to think about what it is you would really like to do, and what it is that would lead you to a sense of satisfaction and accomplishment. What is your true self? Therapy can help you find out and encourage that person to exist in the world.

The description I’ve given you is based, in part, on my experience in life and training, especially training in such therapeutic approaches as cognitive behavior therapy (CBT), mindfulness-based behavior therapy, Acceptance and Commitment Therapy (ACT), and psychodynamic psychotherapy. Other therapists may have a different view of what is important and how to help you get to the point that your life is more satisfying and less fraught with depression, anxiety, or chronic relationship problems. But here, at least, I hope that I have given you some sense of direction and some reason to be hopeful about the possibility of change in your life.

September 27, 2009

The Meaning of Life is…

Thoughtful people since the beginning of time have looked for the answer to the biggest question of all: what is the meaning of life? But recently I’ve begun to wonder whether perhaps it is the wrong question. The existentialists have long suggested that it is our job, each of us, to find our own meaning. But even if you believe in the idea that we must take responsibility for the one life that we have and view it as a creative act, to make what we can of it, I’m still not convinced that the question is the best one available.

What then might be a better question? The question I’m thinking of is, what are the meanings of a life, the purposes to which one puts that life? In other words, the meaning of a life, its target or goal, would be viewed as a changeable and changing thing, not just different from one individual to another as the existentialists suggest, but different depending upon the moment that the question is asked of any single life. It might be one thing when you are 15 and quite another when you are 50, still another at 75.

But first let us consider very briefly the answers to the original question, what is the meaning of life? One could go on at length about the various “isms: hedonism, stoicism, and so forth. I will not do this. Others know more about them and have already discussed them at great length. Still, one must give a nod in the direction of the meaning of life being the simple biological fact of procreation, continuing the human race. The religious might argue that the will of God for each individual as the meaning for that particular person, along with doing honor to God’s law. Then there are those who believe that life is intended to increase one’s understanding and knowledge, or to have the maximal amount of pleasure, or to perfect oneself by fulfilling your innate talents and capacities, or to make the world a better place than you found it, or quite simply to love in a deep and abiding fashion.

But, my current thought is that there is no single meaning for all persons, but changing meanings as we grow up and age. Early-on, the meaning of our lives is perhaps to be found in discovering what we can do, who we are, and mastering the extraordinary number of things any little person has to learn just to get out the door and off to school. Not far into the process one must determine how to relate to people, how to honor yourself without disrespecting others, figuring out where you stand in the pecking order of athletic, intellectual, and social competition. Discovering one’s vocation must be on the list, since most of us take so much meaning from what we do for a living, be it as a captain of industry, a scholar, a salesperson, or parent. All the better if what we do for a living provides a sense of fulfillment, creativity, acknowledgment, accomplishment, and growth.

Meaning is to be found in a life-partner too, in love, in family, in raising a child, and in risking your heart. And over time, friendships, especially if they are life-long, have great value and define us as people and as members of a tiny group of two or more friends or part of a community, pulling-together to do something worthwhile.

In war-time, loyalty, comradeship, and courage take special meaning; even to the point that, a few years before World War II, the Japanese government proclaimed loyalty as essential to the national morality. And, in the war itself, the idea of behaving honorably in the face of certain death, never allowing himself to be captured, guided the Japanese soldier and gave meaning to his service. Emperor, country, and comrades counted for a lot; even the importance of family sometimes diminished in the heat of battle, by comparison, when it was necessary to steel one self against the terror of combat.

Under less severe circumstances, learning is something that gives purpose as we work to understand ourselves and the human condition, as well as particular things about the world. Later on in life, for many people comes a certain generosity of spirit, a desire to help those who are coming after us, to lend a hand. And the shortness of time contributes to intensity of feeling, making the beauty of the earth, a smile, a song, an act of kindness, or an embrace all the more touching because we know that before too long, the sweetness of life will no longer be ours to savor.

Having taken all this time on the question I’ve raised, I think there is danger in spending too much time on trying to answer the question, “What is the meaning of life? If one has learned anything from life itself, it is that the time is precious and waiting in contemplation for a revelation of what we should do risks squandering the time we have. But most of us are comforted by a sense of direction, and one should try to determine what is of value, and to conform one’s behavior to what is important and worthy of effort and time. Indeed, mindfulness and commitment-based psychotherapies work very hard to encourage the person to become detached from things that are not important, and instead to focus him on his values and how to “live” them.

There is worth, then, in simply knowing that the clock is ticking and that the day is short; but only if that knowledge creates a sense of urgency in you and the desire to make the most of the time.

As John Donne wrote so long ago:

“Therefore, send not to know

For whom the bell tolls,

It tolls for thee.”