What’s Stopping You from Going to Therapy?

One could almost say people require therapy in order to decide to go to therapy. Many needful of the help don’t make it. What is the way there and why do some go and others stay away?

Here are a few of the obstacles:

  1. Sensitive souls want to be seen, but are terrified of being seen. History tells them disclosure is dangerous.
  2. Psychological defenses were created before the counseling profession existed. Our ancestors needed emotional armor to survive. Those who were defenseless in the face of crushing reversals of fortune (poverty, disease, loss of loved ones) were less likely to endure. We are therefore the descendants of creatures equipped with instinctive fortifications. Many are still useful under the right conditions. Hesitation before a psychotherapeutic project designed by Freud to dismantle you should not be a surprise. A good therapist, however, will be aware of the dangers of tearing these down before providing a better alternative.
  3. Those emotional barriers include over reliance on the following: avoidance, denial, rationalization, distraction, emotional constriction, dissociation, fantasizing, compartmentalization, intellectualization/over-thinking, alcohol, food, drugs, and sex. Once ingrained, the defense tends to choose us more than be chosen by us. Reflection on one’s default tendencies is uncommon. Were we to inventory the mental habits and behaviors working for and against us, psychotherapy might appeal more. Successful defenses established in your formative years are not always the best ones to use as an adult, when your life situation is different.
  4. Many who don’t avail themselves of psychotherapy’s benefits are lost, like “a man who knows the price of everything and the value of nothing” (Oscar Wilde). They believe their vision of the world is complete. A need for treatment goes unrecognized. Their sense of relative emotional health is part of their problem.
  5. Most people think they understand themselves. Few therapy virgins, however, try to systematically look for repetitive patterns of behavior in their past. George Santayana famously said,”Those who cannot learn from history are doomed to repeat it.” Others remind us that history rarely repeats itself literally, but often rhymes.
  6. Depending on ethnic, religious, economic, or national origins, treatment faces social prohibitions. For example, fundamentalist religions sometimes point to significant depression as evidence of a failure of the suffer’s faith. Reliance on God and a reorientation of one’s relationship to God is believed to be the solution. Psychotherapy is judged a misunderstanding of what the believer identifies as the problem.
  7. The most troubled doubt counseling will help.
  8. A preference for a passive, rapid solution: medication. The individual ignores (or may not know) that some disorders are better treated by talking than a trip to the pharmacy.

Nine more:

  1. Social and economic obstacles to therapy include the stigma of being “weak” or “crazy,” fear that self-disclosure will lead to betrayal (including the sharing of sensitive medical information with their employer), the expense of treatment, guilt at the idea of talking negatively about one’s parents, and the time in session and traveling to sessions. “Real men” comment that one should be able to solve problems without the emotional crutch of expert help. Your mom might even agree. If you fear what she thinks about your decision, you need the fix more than you need her judgement.
  2. More than a few of us persist in trying to change others. Rather than look inside, we try to alter the peopled world. While in vigorous and hopeful pursuit of this goal, the turn inward is hard to come by. Some will never realize the material for change is at hand within themselves, the only being they control. You might recall the mythic figure of Sisyphus, whose punishment for eternity was to roll a ball up an incline, watching the inevitable and dismaying roll back down each time. Those who take on the comparable job of changing another adult will first need a long period of frustration before they recognize they must begin to work on themselves. Here, then, is a hint to the kind of painful experience required to get us into the counselor’s office.
  3. Many people cannot imagine a new way of living — something substantially different from their normal existence. They lack not only the will to transcend themselves, but the imagination of what transcendence might look like. Such people are similar to the residents of Plato’s imaginary cave, who believe their shadowy cavern is the entire world.
  4. Counseling takes many forms. The potential client often has no idea how to choose from the array of options and helping professionals. This difficulty is exacerbated if the treatment candidate lacks even minimal understanding of his own psychology and well-targeted therapeutic goals.
  5. Horror stories of therapy-gone-wrong abound.
  6. The internet allows a virtual life for those who would otherwise live in seclusion. While it can serve as a stepping stone to richer human contact, the brightly lit screen may instead just prevent them from reaching for more satisfaction in the face-to-face world.
  7. Simple alternatives to therapy are appealing: move to California, get a different job, dump your mate, have an affair to remedy a mid-life crisis, etc.
  8. Self-help books can prove a waste of time or a method of avoidance.
  9. The slave in the magic mirror used by the Evil Queen in Snow White and the Seven Dwarfs is unwelcome when she says Snow White is fairer than the Queen. Such a mirror also tells us when bad luck and betrayal are no longer sufficient to explain our unhappiness. Until you are willing to accept the glass’s truth and take responsibility for your life, psychotherapy will not be in your immediate future.

With all these obstacles and more, what gets a person beyond the contemplation of treatment to a voluntarily meeting with a counselor? This list of factors is shorter than the previous one:

  • Advice from a trusted friend, relative, cleric, physician, or former patient.
  • Research to discover what therapy entails.
  • Pain is almost always the key. If every other alternative has been tried and the suffering remains great enough, even the hesitant will sometimes take the leap.

Two jokes apply to the question of change through psychotherapy. The first is the better known:

How many therapists does it take to change a light bulb?

One, but the light bulb has to want to be changed.

The second emphasizes the hesitation of an introvert who is offered group therapy:

How many introverts does it take to change a light bulb?

Why does it have to be a group activity?*

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*Thanks to Life in a Bind for the introvert joke. The top image is a screen capture from the public domain film Carnival of Souls. The second is called Modern Stress by outcast104. Finally, a picture depicting the Shyness of Tamil ANGEL by Sureshbmani. All three are sourced from Wikimedia Commons.

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.

Why We Choose to Look the Way We Do

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We are perceived, objects beheld, lab specimens under a microscope. A human being is akin to a car in a showroom window. While you can drive yourself batty worrying about the opinions of those who are watching you, ignoring them completely is usually a recipe for loneliness. Equally, your own evaluations have consequences for those you observe. Sometimes you can tell a whole book by its cover, sometimes a few pages, and every so often you mistake a Donald Duck comic strip for Anna Karenina. 

When a person enters our field of vision we receive a rush of incoming data: clothing, jewelry, hair style, hair color, and portable objects (phones, purses, brief cases). We might notice what is in the mouth (gum, food, tobacco), head coverings, and exposure of skin. Aids to movement (walking sticks, bikes, wheel chairs) and facial hair are hard to miss.

Even what people are looking at is sometimes obvious. Gait, posture, and facial expressions are clear. Passersby text and talk. The physique itself is part of the visual array. Let’s not neglect eye contact, body punctures, tattoos, glasses, headphones, and backpacks.

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Individually or in combination, intentionally or not, all these create an impression. What conclusions might others draw from what they see of us? What might we surmise from what we notice of them?

  • His tribe. In other words, group affiliations such as nationality, school, sports team, and religion.
  • Whether he is a friend or a foe. 
  • Attitudes toward sexual allure and modesty. Advertising sexual availability is as simple as a bare ring finger or as obvious as a leer.
  • The transmission of fear from the terrifying one being inspected to the watcher.
  • Signs of wealth or power.
  • An attempted disguise (for example, makeup, wearing a beard to cover a weak chin or a combover).
  • Physical fitness. Attitudes toward food and diet are inferred from this. Conclusions about self-control or its absence might also occur.
  • Information about values, as reflected by religious symbols or clothing identified with a particular culture. For example, a green wrist bracelet with the words “Save Darfur” declares support of a cause. The surveyor may further conclude something about the wearer’s politics.
  • Adherence to social convention is demonstrated by unremarkable, mainstream attire. Conversely, unconventional appearance rejects those same standards.
  • The importance of clothing itself is implied if the person dresses in finery.
  • A wish for attention or for anonymity, the latter by blending into the crowd. Equally, an attempt to generate attention by those who have become “invisible” due to advancing age: a war with time fought in retreat. Past a certain age, it is harder to draw the eye of the audience. Instead, we fade into it.

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  • Encouragement of social contact from others or simple openness to such contact. (As easy to convey as a smile, a wink, or a frown).
  • A uniform (literal in the case of soldiers or those required to wear work attire; figurative, in the case of a business suit or the tuxedos sported by symphony conductors).
  • Subtle intimidation. The “power” tie of a litigator, perhaps. Or outfits chosen to minimize intimidation and reduce anxiety in the other. (Therapists are motivated to make themselves approachable. Some select casual, unostentatious clothing to accomplish this).
  • Confidence or its absence. The insecure risk transforming themselves into targets without even wearing a “kick me” sign. Their combined characteristics create a kind of metaphorical bullseye sensed by potential tormenters.
  • Other values. Perchance, a preference for comfortable clothes over expensive or impressive ones.
  • Habit (particularly true of older people who wear their hair in styles long out of fashion, or clothes unbecoming to someone past his body’s “use by” date). In effect, these people are also informing us they either don’t see themselves as they are or don’t care what the onlooker thinks.
  • Incidental information. On occasion you witness such things as whether a person is aware of his literal impact on neighbors, as when he clobbers another with his backpack or purse. Perhaps you will note how tied he is to his cell phone while at dinner with a companion, etc.

When a fellow human passes in review we instinctively size him up. We control many (but not all) of the characteristics of appearance leading to the impression we are trying to project.

It is worth knowing how people read you. Indeed, this is just as important as recognizing what self you’d like onlookers to see. Introverts often believe their shyness is obvious, when in fact they are frequently misidentified as arrogant. The failure to “join in” is interpreted as being “stuck up.”

Unless a good friend delivers difficult feedback or you have heard unflattering commentary in a therapy group or from your boss, you might not recognize your impact on others. Not even your counselor will be frank with you unless he believes it is in your interest and that you can take the pain of such a message without dissolving on his office carpet. Messy, by the way.

Not everyone works hard to manage his impression, but you leave clues whether you are making the effort or not, aware of what the impression is or not. You are a kind of walking, talking advertisement.

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Regrettably, many spend more time (and money) putting a brand on their “package” than improving what is inside it. Frequently, the person conveying characteristics required to get a job or spouse anticipates disaster when time exposes his true self. In the end, the proof of the pudding is in the eating, no matter how velvety and enticing the dish looks.

On the other hand, some qualities are only on the surface. Attempts at finding their depth is the equivalent of fishing for tuna in a desert: they are not there to be found. If, for example, “I am beautiful” is the intended message of the one drawing your eye, there is nothing but the outside — nothing more below the surface with respect to that characteristic. And qualities like intimidation also depend on the exterior of things, at least in part. Competence, intellect, morality, and companionability are less likely to be correctly and completely inferred from how we look.

All of us, at one time or another, try to sell the product named “me.” Best, of course, if the underlying goods are worthy of the value suggested by externalities. Making it so can be a lifetime project. Do remember, however, that the object inside the gift-wrapped box needn’t be perfect to do the job.

The shine on everything wears away. The ideal is to possess something underneath more worthwhile and lasting than an alluring glow. Time is going to alter the package. Few grow up wanting to look like a 60-year-old as fast as possible.

Some of you doubt that you have much extraordinary under the surface — or any idea how to obtain such qualities as you wish were present. Yet they may already be there, in which case all you lack is confidence in what you offer.

A pleasant surprise is in store if only you can recognize what is in the package. The bubble wrap might safeguard the tender contents, but can also obscure what is protected.

Here’s hoping the container, like a box of Cracker Jack, holds a prize you want and tastes as sweet.

The gift box icon is the work of Zeus Box (kuswanto) and is sourced from Wikimedia Commons.

Are We There Yet? The Problem of Boredom

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The closest I ever came to murder (don’t worry, not close) was on a visit to Cambridge, MA. I’d posted an ad in Harvard Yard, searching for a companion to share the expense of my car ride back to Evanston, IL. Within a few days a pleasant-enough young woman and I set out for the Midwest. The plan required us to stop at the University of Michigan, where she was to begin grad school. I would then continue to Northwestern University on my own.

The 750 mile trip from the Boston area to Michigan takes about 13 hours, plus stops along the way, and more time if you decide to break it up over two days, as we did. It is not an interesting ride. After you get out of Pennsylvania, long stretches of flat ground and bland horizons dull your senses and stretch the time. The conversation didn’t enliven things unless you count the growing disquiet inside of me. A disquieting disquiet: rage.

Indeed, whatever my companion said or didn’t say (I can no longer remember any details) I became ever more irritated with her. As we closed in on her campus, I couldn’t bear being with her for five more minutes. Had Ann Arbor been just a few extra miles, I’d be doing hard time in a Michigan prison for murder. My imaginary plea to the judge? “The car ride, sir, was the cause. The boredom just got to me.”

Irritability and anger, not to mention disgust, are among the characteristics of boredom described in Peter Toohey’s excellent book, Boredom: A Lively History. The book is an easy read and relatively brief — the better, I assume, to avoid boring the reader.

Toohey tells us boredom is adaptive: it signals that we need to get out of the situation we are in and on to something less “toxic.” I’m sure you can create your own list of boring situations, probably not so different from those identified by the rest of us: watching someone else’s home movies, waiting in line, monotonous lectures and sermons, repetitive work, and the like.

I can actually identify the most boring day of my life. I was a college student, just having finished my junior year. The place was a non-air conditioned metal-stamping factory, the site of my summer job. I had two mind-deadening tasks. One was bending the backs of metal bucket seats using a simple machine. The other was assembling a small gasket. Each job took a matter of seconds. Once you learned how to do them you never got better and the assignment never changed. You just did the same thing interminably: for eight hours, five days a week, while swimming in a river of sweat.

I started by clocking-in at 7 a.m., which meant I had to awaken at 5 a.m. If I stayed out late the night before, I paid for it with the extra-strenuous effort alertness required. You know the sensation — each eye lid seems to weigh 600 pounds and even Arnold Schwarzenegger doesn’t have the muscle to keep one open.

The summer was hot and the factory absorbed everything the sun could give it. Water was essential to avoid dehydration. Nonetheless, it was peculiar to be drenched in perspiration at 7 a.m. even in a building where the thermometer registered over 100º Fahrenheit. Dutiful as ever, I did my best to keep from buckling. Three hours must have passed before I looked at the wall clock. Seven-fifteen a.m.! It seemed impossible.

Like a bad science fiction film, time had come close to stopping and eternity was nearer than the end of the work day. A second look at the clock revealed it was actually 7:14 a.m. and two muscular-looking gremlins were working to push the minute hand back.

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What produces boredom? Peter Toohey points to predictability, monotony, and confinement. He cites research suggesting low levels of the neurotransmitter dopamine can make one “boredom-prone,” needing to stir up excitement and break some rules in order to escape the internal torpor. Unmedicated children with Attention Deficit Hyperactivity Disorder are thought to be short on this substance. Consequently, they are at risk of misbehavior, alcohol or drug dependency, and criminal conduct. Extroverts are more boredom-prone than introverts, needing the external stimulus of an eventful environment to avoid the stolid state of stupefaction.

Even so, everyday boredom is something all of us encounter. A 2009 on-line survey sponsored by the website http://www.triviala.com/ found Britons complaining of six hours per week spent bored. But Toohey suggests another kind of boredom, an “existential” condition. This has variously been called ennui, world-weariness, and spiritual despair, and can spill into frank depression.

The existential variety of boredom is present in those who find life empty and meaningless, usually accompanied by a lack of close community or social connections. If you are familiar with French existentialist writers you’ve encountered Sartre, who even wrote a book called Nausea, a fictional riff on the condition. Toohey’s tome argues several historical factors have led to this. He cites the breakdown of religion as a source of life’s meaning and organization, the rise of individualism, and the way in which large cities inhibit the possibility of intimate human contact while shrinking the average man’s sense of importance (the last is my idea, not Toohey’s).

I’d add materialism to the list. We spend far too much time shopping for “things” with the expectation of receiving satisfaction in the package. Habituation happens as often for adults as for a child on Christmas day: having waited all year for a special toy, he (and we) discover that having it doesn’t deliver all that wanting and waiting promised us. Bored, the toy is shelved, while the adult version (say, a new car) loses its new car smell and the first-drive thrill.

Another thought: “wage-slavery” of most modern work may rob us of the sense of pride and control, while reinforcing the notion of being small, disposable people who hardly matter. Contrast this to the old days, when a free man worked on a project he fashioned from start to finish. The act of total responsibility for creation or completion of a job contributed to a meaningful, engaged, and less alienated life, especially when others in his small community depended on his labor and his presence.

Of course, as Toohey is careful to point out, for much of human history the danger of daily existence and the work required to make a living left little room for leisure; and the sheer hardness of life offered minimal amounts of the idle time during which boredom and unsettling self-reflection might metastasize.

Contemporary living presents more entertainment, activity, and distraction than ever, without having eradicated boredom. TV channels and websites beyond numbering, exercise programs and classes — none of these seem capable of erasing the experience or the word from our day and vocabulary.

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Historically, many have looked to travel, sex, and alcohol as solutions to everyday boredom, not to mention getting back to work. Changing one’s routine and reorganizing one’s life can also help. Learning new things, exercise, and performing music are recommended. Communities of friends or association with like-minded people within social organizations provide prophylaxis against invasion by the B word: the sense of time stretching into an empty, endless void. Meditation can be helpful and keep each moment alive. TV doesn’t, by the way. Channel changing should tip you off.

How is it possible that we get bored with a plethora of internet sites to visit, criss crossing tweets, and movies to watch? We have plays to attend, games to play, and great books to read. Still we are bored.

Perhaps an evolutionary psychologist might point at those early humans who sat around and were entertained simply by twiddling their opposable thumbs. They weren’t interesting, didn’t attract mates, and failed to notice the hungry animal about to make them into a meal. In other words, we are not the descendants of early men and women who effortlessly defeated boredom.

Thomas Carlyle, the famous Scottish philosopher and writer, said, “I’ve got a great ambition to die of exhaustion rather than boredom.”

I lean toward Carlyle’s view, but suspect I am already too tired to make his goal my own. Exhausted first and bored soon after, the sound you just heard was me yawning.

Top image: A Bored Person by GRPH3B18. Below that is a photo of a Bored Young Girl by Greg Westfall. Finally, the Souvenir Seller, Moscow by Adam63. All are sourced from Wikimedia Commons.

 

The Causes of Insecurity

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Insecurity is in the nature of being human. It is a commonplace, even if most people make a serious effort to disguise it. Too many things to know, too many to learn, too many rejections — most everyone has had significant experience of the things that undermine confidence. But, what makes for more than the usual amount of insecurity? What contributes to some people becoming “insecure?” Here are a few of its causes:

  • Temperament: Little human personalities can be different from the moment of birth. Just as not all children have the same color eyes or hair, neither do they have the same temperament. Pre-school kids have distinctive and lasting characteristics on such dimensions as being reactive vs. calm, tending to approach or avoid new situations, and being introverted or extroverted. While not guaranteeing fractured confidence as an adult, inborn qualities can make a contribution to it.
  • Overly Critical Parenting: Security can be undermined by parents who are too critical, neglectful, or frankly abusive. Sometimes neglect is unavoidable, as it tends to be in families where there are lots of children or the parents are working long hours outside of the home to put food on the table. But sometimes the insecurity develops because of something more subtle. If you are born to extroverted parents and you are introverted (while your siblings are more like your folks), you may feel like an odd-duck, not quite fitting in. If your dad was hoping for an athlete and you are an artist, the same sense of parental disappointment might be hard to miss.
  • Bullying: Kids can be targeted by the classmates for all sorts of reasons including the way they look, where they live, how they dress; and racial, religious, or ethnic differences. Gender matters too, especially if you are the sole female in a physics class with a wise-guy classmate who makes fun of you and a teacher who hasn’t the capability to stop it, as I witnessed back in high school.
  • Body Image: In a society filled with spectacularly beautiful advertising images, it is difficult to be plain; and worse yet, unattractive in any way. Too tall, too skinny, too fat — God help you. Too much acne, bad hair, a lack of finely-tuned motor coordination, same problem. Some of us continue to see ourselves in terms of that early self and struggle with the sense of insecurity produced back then.
  • Learning Problems: This can take the form of a learning disability, Attention Deficit Hyperactivity Disorder (ADHD), or even being average in a school filled with high achievers.
  • Multiple Changes of Residence: Being the new kid is not usually fun, especially for introverted young people who struggle with fitting in and finding friends. Insecurity can follow.
  • Parental Overprotection: When parents prevent their children from doing things that are simply a part of growing up, they can communicate to the child that he isn’t up to the task. Moreover, they rob the young one of the chance to grow from experience, learn what he needs to know in the social sphere, and become more confident. He may also be at risk of being seen as “different” by his peers, because he is the kid who “isn’t allowed” to do things most other parents freely permit.

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  • Parental Expectations: For some parents, life won’t be complete until their children go to Harvard, become famous, and have a building named after them. Even an objectively accomplished person can be insecure if he feels he has failed to reach that standard, unless he throws off this requirement by dint of self-examination or therapy. In today’s civilized world, we compete with the best brains and ideas on an international scale, quite a change from most of human history, when you could easily feel great being a big fish in a small pond; that is, standing out for athletic or scholarly excellence in your tiny community.
  • Money: If your classmates and their parents have more money, nicer homes, or better clothes than you do, this can cause you to be noticed in an uncomfortable way and make you feel less worthy than the others.
  • Guilt: Do you have a secret? Do you feel guilty about something others don’t know about? Are you adopted or is your father alcoholic or your mother depressed? Such things can make you feel vulnerable, in the belief others would disapprove “if only they knew.” And if they do, the talk behind your back is predictable.
  • Being in Someone’s Shadow: While there are a great many good things about being the child or sibling of a person who is extraordinary, it can create a high bar to any kind of recognition or acceptance of you for your own sake, someone who has his own identity and is worth knowing even if he isn’t an Olympic champion or a captain of industry.
  • Blushing and Sweating: We all get nervous, but some of us do stand out in a visible way. President Richard Nixon was famous for the amount of perspiration he generated during the Kennedy-Nixon Presidential Debates in 1960, so much that most people who saw him on TV thought he lost, but the majority of those who only heard him over the radio thought he won. Whatever insecurity you are prone to can be amplified by knowing your discomfort will sometimes shine like a lighthouse beacon.

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  • Isolation: Children whose living conditions offer little opportunity to socialize with same-aged kids are at a disadvantage. The talented and extroverted among them are more likely to have confidence when they enter the social arena, while the introverted may have more difficulty. Living at a distance from other kids your own age or being home-schooled can fuel this problem. The distance also doesn’t afford the opportunities of living in challenging social situations that contribute to a growing sense of competence and mastery. Once behind the curve, whether through the peculiar circumstances of childhood or your own avoidance of challenges as an adult, you might come to feel you are now too lacking in practice and even further behind others in any number of work, social, or sexual situations.
  • Life Failures: The frustrations of life can take their toll. Confidence might be undermined by too many jobs lost, goals unfulfilled, rejections, and relationship failures.
  • The Depredations of Aging: If your self-image depends largely on just one thing, a loss of that thing can make a big difference in your sense of security. Athletic prowess fades, as does beauty. Worse yet, the former prom king and queen can discover their bodies no longer demand positive attention (or perhaps now get the wrong kind of attention). Some feel mocked by the photos of their youth.
  • Instinctive Biological Insecurities: Evolution contributed to our tendency to pick up on the signs revealing disapproval or anger in others. Those pre-historic humans who didn’t notice their compatriots were unhappy with them risked being thrown out of a protective group. Worse still, they failed to detect hostility in their enemies. Only individuals who were sensitive enough to notice passed their genes to us. For more on this, read Insecurity and Our Preoccupation with Appearances/

None of these factors will undermine every person. Many of them interact with one another, making confidence more difficult. But getting over what is past and challenging yourself to master new and difficult situations tends to be productive. Therapy can be helpful in coming to terms with a history anchoring you to the ocean’s bottom, as well as a present that looks too daunting given your internal shakiness. The important thing is moving forward.

Metaphorically speaking, humans are like the Great White Shark, which must swim in order to breathe: either we keep moving forward or we die.

You might also find this of interest: On Being Insecure and Alone/

The top image is called Shamed Man by Victor Bezrukov, The second photo is called Cutest Girl Ever by Lindsay Stark. Both are sourced from Wikimedia Commons.

Social Anxiety Disorder and Its Treatment

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Social anxiety isn’t unusual. Since you are reading this, you might well be wondering whether your own experience of anxiety (or that of someone you love) constitutes a Social Anxiety Disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), such a condition exists when someone experiences a “marked and persistent fear of one or more social and performances situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The person fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.”

The essence of this condition is a preoccupation with what others might think of you.

Now, we all are concerned with this some of the time.

Think of hoping to get a job promotion or wanting to impress a potential romantic partner. But consider the language of the diagnostic manual carefully, especially the words “marked and persistent fear.” One hallmark of this disorder is avoidance. When the anxiety is so great that you do your best to get out of doing something (e.g. asking someone on a date, giving a speech, attending a party, returning an item to the store, etc.) then you very well may have a clinically significant condition that can benefit from treatment. In effect, you are trying to avoid both the uncomfortable situation and the feelings that you believe will come with it.

In addition to avoidance, the individual will commonly be aware that his fear is greater than that which would be experienced by most people in a similar set of circumstances, and that the condition is very distressing and/or interferes with his life in significant ways. In fact, one of the ways that Social Anxiety Disorder complicates one’s life is by making it difficult to do the things and have the relationships that would make that life interesting, enjoyable, and fulfilling.

Is it hard to take a compliment, be the center of attention, or talk to a stranger? Do you worry what others will think of how you look and sound? Is it hard to be spontaneous in a conversation and are you too distracted by your own worries to fully concentrate on what the other person is saying? Do you get tongue-tied when trying to make an impression or have the sense that your voice is quivering or that you are perspiring too much?

Do you hesitate to state a strong opinion for fear of sounding stupid or being rejected for your ideas? Do you try to prevent others from getting to know you very well because you believe they will eventually conclude that you are inadequate and reject you? These kinds of preoccupations are typical of Social Anxiety Disorder.

The good news is that with persistence, an accomplished therapist, and the right program of treatment, you have an excellent chance of significant improvement. On the order of 80% of those who receive a systematic cognitive-behavioral (CBT) program will likely experience such change.

A good CBT counselor first makes sure that social anxiety is your major problem. For example, its not unusual for people with a Social Anxiety Disorder to have had one or more panic attacks. If those episodes occur outside of social or performance situations and lead the person to focus on their physical health, they likely indicate that a Panic Disorder is present and that the panic itself should be the focus of treatment.

However, about 50% of people who have clinically significant social anxiety also have had panic attacks. Therefore, if your preoccupation is more about how you look to others and what they think of you than it is about the symptoms of panic, treatment is likely to target your social issues.

CBT assumes that bodily sensations (such as shakiness, blushing, or a lump in your throat), behavior (such as having difficulty making eye contact or avoidance), and thoughts (such as the belief that others will reject you or that you will lose your job) all interact to fuel your social anxiety problems.

Thus, for example, the more your thoughts focus on the belief that you need to be perfect or the likelihood that you will fail, the more you are likely to experience physical manifestations of your anxiety and behave in a way that betrays your insecurity. As a result, CBT attempts to help you change physical symptoms, behavior, and cognitions.

A good cognitive behavior therapy program for social anxiety will help you learn to counter irrational thoughts that tend to be self defeating (this is called cognitive restructuring), and gradually practice with the therapist (this is called role playing) those situations that are difficult for you, beginning only with those that produce a relatively small amount of anxiety, and then try out your new skills in the real world, again beginning with relatively easy kinds of social interactions and working toward the ones that are harder for you.

And, you will discover that if you can tolerate small amounts of anxiety rather than flee them, you will “habituate” to the anxiety in much they way that your nose adapts to a foul odor by adjusting so that after a short amount of time the smell is not nearly so strong; similarly, your anxiety will weaken if you stay in the uncomfortable situation, usually within 45 minutes.

Treatment typically takes somewhere in the neighborhood of three to four months, although it can take longer if other issues also need attention. When it is successful, the patient usually finds himself less troubled by physical symptoms, more assertive, less preoccupied with other people’s opinions, more optimistic, less awkward, able to receive compliments without discomfort, able to look people in the eyes, and less avoidant.

It can feel enormously freeing and lead to much better things in life, including more and better friendships, greater vocational success, and a more satisfying romantic life.

Persistence is essential and the program takes some courage. But if you want to change your life and be less encumbered by social anxiety, CBT for Social Anxiety Disorder has much to offer.

The image above is described as Template: VER model created by Braintest. It is sourced from Wikimedia Commons.