Hope For the New Year: Old Words After a Tough Twelve Months

Its been a tough year, but not the first in human history. These old words from the great nineteenth-century Scottish writer Robert Louis Stevenson seem just right:

“Give us grace and strength to forbear and to persevere. Give us courage and gaiety and the quiet mind. Spare us to our friends and soften us to our enemies. Give us strength to encounter that which is to come, that we may be brave in peril, constant in tribulation, temperate in wrath and in all changes of fortune, and down to the gates of death loyal and loving to one another.”

Letting Go of Your Children

One of the hardest things a parent has to do for his child’s well-being is “letting go.” The attachment between a parent and child, at its best, is profoundly intense and rewarding to both parties. But, at some point, earlier than most parents think, the tie must be loosened. There are at least two reasons for this.

The first involves the danger of overprotection. While the world is a harsh place at times, children who are not seriously disabled need to begin to obtain some mastery of that world. They will not do so if the parent hovers too closely, watches every move, makes every decision, and doesn’t permit the child to get a sense of accomplishment and independence, that is, to get a sense of their own mastery of the world.

Secondly, if the child is ultimately to break-free, the parent must prepare him and encourage him. Kids will make bad decisions; they will get hurt by life. All that is a part of growing up and, in fact, a part of life as an adult, too. If they are to succeed in life, attach to others outside the family (mate), produce children, and develop a personality that is different from that of either parent, they will profit from the permission and encouragement to do so.

There is no perfect guidebook for how to disengage–how to, little-by-little, give your child more freedom, less oversight. It is easier, of course, if the young one is reasonably outgoing, a good student, and doesn’t get into much trouble with authorities. But even with kids who are having difficulty, micro-management can create resentment and rebellion, while constant criticism can be depressing and efface the child’s shaky self-esteem. A parent needs to know which children need a heavy hand, which a light touch, when to praise, when to correct, and when to punish. No one can provide¬† precise direction to this in the abstract, because each child is different and each parent is different. That said, here are a few pitfalls to watch out for:

1. Don’t try to raise each of your children the same way. While this should be obvious, it rarely is. Some parents even brag: “I treated all my kids the same.” This is preposterous, but, even if you came close, you probably shouldn’t have. All children aren’t the same and therefore require the kind of individually tailored attention that works for them. Why would it make sense to raise an active child in the same way as a passive one, or an outgoing offspring just like an introspective little person? One size doesn’t fit all.

2. Don’t “own” your child’s life. He isn’t you. He needs to have his own ideas, not some Xeroxed version of what you think he should be. He ultimately needs to “own” his direction in life, meaning that the desire to do well in school and in other things needs to be his. If he only does his school work because he is required to, even when he is in high school, somehow the transfer of responsibility from you to him hasn’t been made. You’ve got about 15 years to accomplish that hand-off; after that, demands from parents to “do better” usually generate diminishing returns.

3. Don’t set unreasonable expectations. Most middle-class folks see their children, at least a little, as a reflection of themselves; someone to carry the family banner into the future. But, you can make yourself a little crazy by wanting great fortune and fame for your kids, and letting them know you will settle for nothing less. Harvard isn’t for everyone and there is no guarantee of a good life that comes with admission to Princeton, Northwestern, Yale, etc. If your child can make a living, find love in his life, behave honorably, and experience some measure of fulfillment, that just might be quite enough.

4. Don’t make your child feel guilty over leading his own life, not providing you with grandchildren, and not being as close to you as he was when he was little. He needs to break-free and take care of himself. He should (and probably will) want to have you in his life, but don’t be an anchor around his ankle.

5. Don’t live and die with every success and failure on your son or daughter’s path. Easier said than done, by the way. Learn to accept things as they are. Get some distance. Meditate. Get a life of your own. As a famous basketball coach once said, “If every game is a matter of life and death, you’re going to have a problem. You are going to die a lot.”

6. As your kids move into adulthood, don’t preach and do be careful about giving advice, especially if it hasn’t been requested. Let your children know that you are proud of them. Not because they became captains of industry, but because they are good, decent, and loving people. Give your grown kids support and encouragement. Enjoy them, don’t manage them.

7. Remember that they aren’t you, they won’t always do what you would do, what you think wise, believe what you believe to be true. They might belong to a different political party, root for a different baseball team (God forbid!), change religion or give up religion. They might marry someone you don’t completely fit with. Remind yourself that what is important is your child’s happiness and fulfillment and decency.

8. Take good care of yourself. Find a meaning in life that is not 100% about your adult children. Try to get there gradually, not on his or her 21st birthday.

If you are lucky, your children will turn out well, and be grateful for all you did, and for your wisdom in not “doing it all” for them forever. It’s quite an adventure for the concerned parent, and you will never stop being concerned. As Sir Francis Bacon wrote, “He that hath wife and children, hath given hostages to fortune…” But, with practice, you will sleep at night even on many of the nights that your adult child is having some bumps in the road.

When you look at her, fast asleep in her crib, all of that seems impossible and impossibly far away. But it can happen.

I’ve been there.

Cigarette Smoking, Bull-Fighting, and the NFL

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What connects the words that make up the title you’ve just read? More than you might think. And they represent a dark-side to daily life in the USA and around the world.

Yet we tend not to think about them and it (that dark-side) very much.

The main link among the three is that they involve varying degrees of destructive behavior; indeed, they all risk a needless acceleration of death; an increase in the chance of an early demise for those who participate in the activities in question.

Smoke cigarettes and you roll the dice on emphysema, heart disease, cancer, and more; fight a bull and you just might not leave the stadium still breathing; play in the NFL (National Football League) and you increase your risk of dementia and a shortened life expectancy. All while the promoters of these actions and events make money.

Football, smoking, bull fighting, and (one might add) boxing have another thing in common. They are activities performed (or at least begun) when one is young; when one is in full leaf and flower, like a tree on a mid-spring day. And just as the tree cannot imagine (having no consciousness) that it will turn brown and dormant before the year ends, young people have difficulty really believing that they are mortal, and imagining a time when they could be enfeebled or worse.

Tears and strains, bumps and bruises, broken bones, and bouncing brains; bodies busted and bent.

That is what I am talking about.

According to the NFL players association, the average professional career lasts 3.5 years. No wonder that some say the letters NFL actually mean “Not For Long.” Certainly, many players are cut from the team for under-performance in an enormously competitive environment, but many leave because of injury. The average life-span of an ex-NFL player is 55 overall and only 52 for linemen. No doubt, this is partially due to factors beyond the punishment done to their bodies by the violence of contact, particularly weight and diet-related problems.

But do not dismiss the direct effect of that punishment on producing life that is diminished and shortened. A recent University of Michigan study of 1063 retired NFL players found dementia-related conditions at a rate five times higher than the national average for men 50 or older; in ex-NFL players 30 to 49, the rate of dementia-type conditions is 19 times higher than for other men in the same age group.

And what is the reaction of most of us to this? Perhaps we say, “that’s interesting, but it’s a free country and the smokers and the football players are free to take their chances.” And on Saturday or Sunday we cheer for the football teams and the young players, just as you might yell “ole'” at a bull-fight. No one does pep-rallies for smokers, of course, but we do not prevent their slow self-injury, even if we limit it to certain places and conditions.

Somehow, the bull fights seem a bit more honest to me. The injuries are plain to see. And, the bull will spill blood and die while we watch, unless it first injures the matador to the point of his own bloody and usually visible injury.

By comparison, we won’t see, for the most part, the smokers wheezing, or lying gray in ICU, holding on, if they can, to dear life; or the ex-football lineman (unless he is as famous as the boxer Muhammad Ali), rendered almost mute by the effects of repeated head injuries. We won’t be there for the knee and hip replacements; we won’t spell the over-taxed spouse who married the daring young athlete-hero in his prime, and now must change his diapers.

It’s only a short step from this to war, don’t you think? Again, it is the young who fight for us and who suffer for us, mostly out of our sight in a place far away.

Are we really so far removed from the days of gladiatorial combat in the Roman Coliseum? Dig not too far below the surface of civilization and you will find more than a little brutality. And, too often, if you look a bit more closely, there we are, the two of us, preparing a tail-gating party to witness the carnage, bundling up to sit in the stands, cheering it on.

Bull Fighter, the above image, is the work of Montyne. It was sourced from Wikimedia Commons, where it was authored by Sterling Evans, originally from http://www.montyne.com/


The Things We All Need to Learn

The things we need to learn wait for us. They are very patient.

I think you know what I mean. At least, you have seen it in others. The person who is angry, who never learns how to control his anger, or perhaps isn’t even aware of the need to control it.

Then there is the passive person, the one who cannot stand up for himself easily, who defers to others, who gets taken advantage of pretty routinely. And, despite this, doesn’t change over the years.

Some of us choose the wrong friends or wrong lovers or the wrong business associates, making the same mistakes again and again. Others continue to use failed methods in raising children. Some of us never face our fears fully (see Albert Brook’s film Defending Your Life for a funny take on this problem). And then there are the people who are impulsive, act without thinking, over and over; or the ones who are sloppy at tasks, not careful enough; or those that are too compulsive, too detail-oriented, trapped by their obsessive attention to small things.

I could go on, but instead, its time to ask you a question. What are the challenges in your life that you have yet to master, the ways of thinking or behaving that don’t work for you, but which you repeat? Most of us have a pretty easy time spotting the errors in others, but how about your own?

There is an old joke about how we learn:

A man walks down a road and falls into a hole. He didn’t see it and, because it is a deep hole, it takes some time to get out.

The next day the man walks down the same road and falls into the same hole. He still didn’t see it, but might just get out of it more rapidly this time.

The day after, the man walks down the same road, sees the hole, but falls into it anyway.

The following morning the man walks down the same road, sees the hole, and this time walks around it.

And what does our hero do after the next sun rise? He walks down a different road.

Holes, like problems unsolved, have all the time in the world. They wait for us, first to recognize them, to see the danger they pose, and then to change our behavior so as to avoid the danger. As the saying goes, “if you do what you’ve done, you’ll get what you’ve got.” Others have said that one definition of insanity is to continue to use the same failed strategy, all the while expecting different and better results.

How long will you wait to change? Your problems can last a life time. They have no train to catch, no meetings to attend; they take their time, not troubled by waiting. Or, should I say, they take your time. All of your time.

Do you really want to wait that long?

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.

To Wait, or Not to Wait: That is the Question

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I was taught a valuable lesson by a bunch of inner-city kids when I was their 20-year-old summer camp counselor. The lesson was about when and whether to take action; and when and whether to do nothing and wait. But let me tell you the story…

The job was in Cambridge, Massachusetts, the home of Harvard and MIT. Although I was attending the U of Illinois, my friend Rich Adelstein was then involved in something called the “MIT Science Camp.” I never really found out what science had to do with it, because it wasn’t much different from any other summer camp, but for a few things having nothing to do with science. First, of course, it was at MIT, one of the world’s premier institutions of higher learning; a place where only the elite young minds already proficient in science were allowed to matriculate. And because of that, it was not an “outdoor” oriented summer camp, although we did do the usual things like playing baseball. But perhaps the most important distinction between this summer camp and most of those you might have heard about or attended, was the fact that it was for underprivileged kids from troubled homes and tough neighborhoods. Most of them were in the 12 to 15-year-old range. Some were shy, some were petty criminals, some were learning disabled, some were angry, and some were lost. But, it was thought that all of them might still benefit from the camp experience.

The counselors were all about my age, and all of them were MIT undergraduates with two exceptions: myself and a Harvard student. The kids were recommended by their schools. The project was funded by money then available as part of the “Great Society” vision of LBJ, otherwise known as President Lyndon Baines Johnson. The camp itself was supervised by a psychiatrist, Dr. Warren Brody. The year was 1967.

Many of the activities of my group of six kids were done in cooperation with another counselor, Geoff Smith. Geoff was a swell fellow, smart and easy to get along with, and we worked well together. We had money for some outings with the boys (all the kids in the camp were male) and even took them on a day trip to Martha’s Vineyard and another excursion to New York City, where we watched the Rockettes in Radio City Music Hall at Rockefeller Center. As I said, we played some baseball and also put on a play under the direction of a Boston College undergraduate theater major, Betty Rose. It was “Twelve Angry Men.” We had just enough players, and these kids were thereby exposed to performance. A fun summer was had by all.

On the day in question Geoff had a morning dentist appointment, so I was in charge of both of our groups. Depending on the day, not all the kids would necessarily be there. I imagine on this particular day, there were probably 10 of them present.

I was walking with the kids through Building 7 when one of the older ones quickly instructed the others to run in different directions. We had come to a four-way intersection, so there were four possible flight paths down which each kid could escape. In a flash they were gone. As I stood at the intersection and looked in each direction not one was to be seen.

Remember, I was 20 years old and in charge of these lives. Their safety was my responsibility. But what was I to do? Even though I was rattled, I was still smart enough to know that any direction I chose would, at best, avail me the possibility of finding only two or three or four kids. For the life of me, I didn’t know what to do, so I did nothing. Not because I thought that was a clever idea, but because I couldn’t think of any good solution.

Perhaps you’ve guessed that I had stumbled upon precisely the right course: inaction. In fact, it was the only solution. If I had started running down any one of the corridors, I’d probably still be running. But because I didn’t, the kids found that the “chase” they’d hoped for hadn’t materialized, and they weren’t having any fun. In the space of 10 minutes they were all back where they started and we proceeded on to our appointed destination.

Sometimes life is like that. If you stop chasing a thing or a person, it stops running away from you. You can drive people away in your pursuit, be it romantic or angry.

Slow down. Be patient. See if you can live with uncertainty. Don’t act impulsively. Wait, wait, wait and see… Take a breath. Action for the sake of action doesn’t make sense. You can actually make things worse. Assertiveness is not always the answer. Sometimes inaction is better — much better — than action.

A lot of things in life, like those kids, are like boomerangs — they come back to you.

At least, they sometimes have for me.

The top image is called Hesitation by Alfred Garth Jones, sourced from Wikimedia Commons.

Gone in 60 Seconds: How to Lose Three Girlfriends in a Minute

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I was a dashing little boy. Resplendent in the Indian (Native American) head-dress my parents gave me and the cowboy holster and six guns that I wore around my waist. Of course, the contradictions among those elements of attire didn’t bother me. Perhaps they were an early indication of my tendency to see both sides of an argument.

I was a six-year-old. I didn’t wear my western outfit to school, but I was still pretty cute: a curly-haired, fresh-faced, sweet little boy, with large hazel eyes. And I had three girlfriends! Count ’em: three! Way more than any of the other little boys in my kindergarten class. Was it at Avondale School or Jamieson? I don’t remember that.

Little did I know that I was about to meet my Waterloo. Little did I know that the great disasters of life are largely unforeseen; and that fortune can turn in an instant.

The teacher gave us an assignment to draw something. I don’t recall just what it was. But I was good at anything having to do with art and quickly finished off my mini-Picasso masterpiece. That gave me a little time. And so I walked over to the place where two of my girlfriends were hard at work on their own artistic products.

What exactly did it mean to have three girlfriends? I was six, for God’s sake. I never saw them outside of our kindergarten class. I doubt I ever held hands with even one of them. Still, there was a sense of security, a point of pride in “having” three pretty little females each of whom also thought I was her boyfriend, and each of whom was just as clueless as I was about what that might mean.

I can still see myself standing in front of the first two charmers, who were, by the way, best friends. And I can still hear the question one of them asked me: “Gerry, whose picture do you like the best?”

Remember, I was six. Maybe even five. No life experience. A piece of unripe fruit, yet to be churned by the cruelties of the human food processor of daily life. I was pure and naive. And terribly, terribly honest.

So I answered. I chose one. I don’t remember which one. I only remember the aftermath.

The unchosen female immediately burst into tears. “You made me cry. You aren’t my boyfriend anymore!”

I was stunned. It might even have been her question that prompted the answer she was blaming me for. I considered using the Nuremberg Defense (“I was just following orders).” But before I could say anything, the next hammer dropped.

Her companion, girlfriend #2, looked at me and said: “You made my friend cry. You aren’t my boyfriend any more.”

My stock was falling like the Dow Jones Industrial Average on “Black Friday.” I was down two-thirds on my net girlfriend-worth. I was sweating. I didn’t know what to do. I must have mumbled something about being sorry. But the hard-hearted pair facing me had rendered their unchangeable verdict. The Gerry Stein Fan Club was quickly disbanding.

In my desperation I did what most anyone would do. I ran over to my one remaining girlfriend, the better to secure my position with her. God knows, if she asked me what I thought of her drawing, I was prepared to tell her that not even Rembrandt could have done half as well.

Unfortunately, in my haste I wasn’t especially careful about where my feet were going. And the hard wood floor had recently been polished, making traction tricky and braking balky. I over-ran my target and accidentally stepped on my remaining girlfriend’s foot. This damsel, now in distress, quickly began to cry. And you already know the rest: “You made me cry. You’re not my boyfriend any more.”

Dazed, stunned, disillusioned, and confused, I probably would have walked into traffic if we hadn’t been in a secure environment. Everyone else continued to busy themselves in drawing and conversation. I alone was crushed, alienated from humanity, feeling for the first time in my life the cruel indifference of a world that goes on about its business, ignoring the human road-kill still to be observed in its peripheral vision.

Little did I know my moment of lifetime peak popularity with the opposite gender had passed.

Somehow, life went on. I did, of course, have girlfriends again, although always one at a time. I eventually recovered enough to get an education, do some things of value in life, win a few awards, marry, and have children.

Over the years, my perspective on this event changed. I came to realize that I’d done something pretty remarkable. That I set a world record for most breakups within 60 seconds time. You can check it in the Guinness World Record Book.

Like Joe DiMaggio’s achievement of hitting safely in 56 consecutive games set in 1941, I’m pretty sure this mark will stand the test of time. There is a little bit of solace in that, some compensation for my kindergarten disaster, my childhood tsunami.

And now you know why I became a psychologist!

The above image is called Bath Time Smooches by Kyle Flood, sourced from Wikimedia Commons.

“The Only Thing We Have to Fear is…”

Franklin D. Roosevelt’s 1933 inaugural address, given in the terrifying midst of the Great Depression, is quite well-known for the line: “The only thing we have to fear is, fear itself.” With 25% of the work force unemployed, there was much of which to be afraid.

Less well known, but no less eloquent and telling a comment on fear came from his widow, Eleanor Roosevelt, when she was asked late in her life to give a radio audience some guidance based on her own life experience. Recall that Mrs. Roosevelt was a timid, unattractive, and lonely child, afraid of many things; left by her widowed father to be raised largely by her severe grandmother. She eventually became world famous, not only because of her husband, but because she became a champion of the rights of disadvantaged groups and a spokesperson for the United States. Eleanor Roosevelt was a public woman known for her actions and her voice when most women stood in the shadow of a husband.

The quote? “You must do the thing you think you cannot do.”

Good advice for just about everybody.

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.

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How to Choose a Therapist

Most of us are not at our best under pressure. Similarly, when depressed, anxious, or otherwise stressed and in crisis, the patience and clarity of thinking needed choose a therapist might well be in short supply. So here are a few pointers, things to consider, when you decide to consult someone for psychological assistance:

1. Ask a friend if he or she is able to recommend a therapist with enthusiasm. Also be sure to request that your acquaintance explains “how” the therapist was helpful. Not all counselors are equally adept at treating every problem, so your friend’s recommendation should be carefully considered in light of whether your issues are different from your friend’s. You might also ask your physician for a recommendation. A good way to phrase the question is, “If you needed to get a therapist for someone you loved, who would you choose?”

2. Internet searches of various kinds can help find a good person. Various organizations list therapists who perform a certain type of therapy or work with certain types of problems. An example would be the Association For Behavioral and Cognitive Therapies: www. abct.org/ The National Register of Health Care Providers in Psychology is another such group: http://www.nationalregister.org

3. Some information about the therapist is usually available on web sites such as those mentioned above. If the therapist has a web site of his own, you will usually find out a good deal more.

4. What kind of therapist are you looking for? There are many choices. Clinical Psychologists are doctoral-level professionals (Ph.D. or Psy.D) who typically have completed four years of training beyond their college Bachelors degree and had additional instruction and supervision in the form of a year-long internship, often within hospitals or clinics. In most states psychologists cannot prescribe medication, but have received more graduate training in psychological evaluation (testing) and therapy than is typical of any of the other disciplines who perform therapy.  Psychiatrists are physicians trained in medicine, who also receive specialized training during a psychiatric residency. They can and do prescribe medication and a number of them also do therapy. Clinical Social Workers generally have a Masters Degree obtained in the course of two years of post-college study, in addition to practical experience and a history of supervision. Marriage and Family Therapists usually also have a Masters Degree and may have a similar amount of training as do the social workers, although their education is not identical to that group. All of these disciplines encourage and sometimes require therapists to continue their study via post graduate course work, supervision, and reading.

4. What kind of therapy do you want? In part, that might depend on what kind of problem or problems you have. Psychodynamic psychotherapists will tend to pay much attention to early life issues including unresolved feelings toward one’s parents, and the potential impact of additional events that occur during the growing-up years in an attempt to free you from repetitive patterns of behavior that might have started at that time. Cognitive behavioral therapists use CBT to focus more on present day concerns, attempting to help you take steps to alter the automatic and self-defeating thoughts that influence your mood and fuel your depression and anxiety, as well as assisting you in changing your behavior. They spend much less time on early life events as a rule, and do not usually consider “insight” into the causes of your troubles to be crucial to assuaging your emotional pain. Marriage and family therapy aims to treat couples and family systems, usually meeting with the marital pair or family group rather than with one person at a time.

5. Try to determine how much experience your potential therapist has with a given kind of problem. Some therapists specialize, for example, in treating alcohol and drug abuse and are certified in this field (CADC or certified alcohol and drug counselor). If you have anxiety issues, on the other hand, ask your therapist how many people he has treated with this condition. Similar questions might be asked of someone who you wish to consult for the treatment of depression or schizophrenia. Don’t be afraid to ask. Any reasonable professional in the health care field will welcome your making an informed decision.

6. Other factors might be considered. How active do you want the therapist to be? Some tend to direct the therapy, while others are more comfortable listening to you and responding to just those issues that you believe are important. Some people choose therapists based on gender, believing that they will feel more comfortable with one or the other sex. Age of the therapist is important, since it tends to be correlated both with professional experience and life experience. If you believe that not everything in life is learned in a classroom, you will probably want to see someone who has a few gray hairs and who has been married with children.

7. Financial considerations often enter into the choice of a therapist. MDs are usually the most expensive people to see and Masters level professionals are the most economical. Ask your therapist about what he charges for his services and what portion, if any, of his fee is covered by insurance. Some communities have public mental health agencies that offer therapy at a heavily discounted price, although they often have long waiting-lists. A portion of therapists will discount their fees if you can make a good case for such a discount.

If you go through your insurance company, it is likely that they will steer you toward a practitioner who has a contract with them and has agreed to discount his fee to you. Understand, however, that the discount also typically benefits the insurance company, since they will have to pay less money in benefits if you choose a provider who is in their network. Therefore, their recommendation comes with a degree of self-interest.

Be aware that (as the old saying goes), sometimes “you get what you pay for.”

8. Some people choose not to use their medical insurance to pay for counseling. They make this decision because they have concerns about the impact of a mental health diagnosis on their future ability to get life or disability insurance, and the possibility that having a “pre-existing (mental health) condition” will complicate their medical coverage should they ever change jobs or go for a period without insurance and then attempt to obtain it again.

9. Remember that the most important element in obtaining a therapist is getting a person who is accomplished, talented, experienced, and a good fit for your therapeutic needs. You should also have a sense that he really cares and wants to help. While some of the other considerations mentioned previously might be important, if the therapist can’t help you, nothing else really matters. When you meet the therapist (see my blog post “What to Expect in Your First Therapy Session“) he should be able to convey expertise, compassion, and competence, as well as giving you a sense of hope. Don’t settle for less.