Monday, January 26, 2015

Why Go to Therapy?

8 More Reasons to Go to Therapy
Therapy is more than the medical model Post published by Ryan Howes PhD, ABPP on 
Mar 10, 2014 in In Therapy

Why go to therapy? The Huffington Post recently published an article titled “8 Signs You Should See a Therapist.” (link is external) Huff Po (the specific author isn’t clear) points out that “while one in five American adults suffer from some form of mental illness, only about 46-65 percent with moderate-to-severe impairment are in treatment.” They noted that some problems that don’t qualify as severe mental illness can benefit from treatment and illuminated the symptoms that may warrant psychotherapy:

  • Everything you feel is intense
  • You’ve suffered a trauma and you can’t stop thinking about it
  • You have unexplained and recurrent headaches, stomach-aches or a run down immune system
  • You’re using a substance to cope
  • You’re getting bad feedback at work
  • You feel disconnected from previously beloved activities
  • Your relationships are strained
  • Your friends have told you they’re concerned
  • I don’t have a problem with any of the above. If you’re experiencing anything on that list, therapy may be a good choice for you.

But I do have a problem with two issues raised by this post.

The first is the wording. Any time I hear someone say their friend or loved one “should” go to therapy it sounds like a condemnation, and that’s contributing to the stigma that surrounds (link is external) psychotherapy. Too many contentious arguments end with the shaming comment “You should go to therapy!” which is shorthand for “I think you’re crazy, go pay someone to fix you.” This isn’t a thoughtful recommendation of a valid path to health, it’s an insult. Many rebel against this slam as a way to save face; compliance would feel like losing the argument.

By the way, we generally don’t end up doing things we “should” do; we do things we want to. Consult anyone who ever made a New Year's Resolution for an example. You’ll have a better experience in therapy (and probably better results) if you go because you want to learn, grow, and heal, not because someone else thinks you should.

The second problem I have with this article is the focus on pathology (a.k.a. the disease model). Indeed, therapy is effective for helping painful experiences become tolerable. It’s a proven method for changing harmful thinking, relational, and behavioral patterns. But it’s also used to make good lives great.

For comparison, look at two ways you manage your physical health: a visit to your MD versus working out at the gym. You go to a physician to treat a medical problem: You feel symptoms and seek treatment to return to your “normal” state. By contrast, you go to the gym to get healthy, achieve a higher physical potential, and generally make a good life better. Two different approaches to health, one focused on illness and the other wellness. Therapy is unique in that it acts as the psychological equivalent of both the MD and the gym. We go to therapy to treat problems as well as improve an already decent life.

Would we say that people who work out must be sick or they wouldn’t need it? Hell no. But we still hold on to this antiquated idea that you must be crazy if you go to therapy. Attitudes like the one shown in the Huff Po article are only perpetuating the medical model of therapy – that you go to therapy to treat an illness. In fact, therapy is just as useful in the wellness model of getting healthy, achieving potential, and making a good life better.

In the vein of the wellness model, I present eight more reasons to try therapy:

You want to love and accept yourself – Many people have difficulty with this, and they’re not necessarily depressed or afflicted with another mental disorder. Therapy can help you explore roadblocks to self-esteem and teach you practical ways to make your happiness a priority.

You want to make a good marriage great – Many relationships are functional, but are no longer fun. Couples counseling can help improve communication and strategize ways to return passion and excitement to a marriage.

You want to be a fantastic parent – Many of us, despite our own objections, revert to parenting patterns we observed in our own childhood. Therapy can help you get out of this rut and become the parent you want to be (and your children need).

You want to thrive in your career – You say you’re unhappy where you are, why aren’t you striving for something different? Is fear, hard work, or interpersonal conflict holding you back? Therapy can be the catalyst for healthy change in your career.

You want to understand your purpose in life – Many therapists love to dive in and help you find out who you are on a deep level, helping you uncover the passions buried under the busyness of life. A desire for this time to self-reflect may mean that…

You want one hour each week to focus completely on yourself – Therapy is a course where you are the subject matter. You can explore yourself, go deeper into your current thoughts and feelings, or just sit and “be” for a while. This vital practice has become a forgotten art in our world today.

You want to reach a fitness goal – Therapists aren’t often personal trainers, but it’s commonly understood that physical fitness is as mental as it is physical. Therapy can help you overcome the roadblocks that prevent you from reaching your goals.

You want to let go and forgive – Holding a grudge isn’t a diagnosable condition, but it does have serious physical, emotional, and relational consequences. Through therapy you can learn to resolve these issues for yourself and move on.

You want a place to practice assertiveness, expressing emotion, or anything else – Therapy is a laboratory for you to explore, experiment, and practice behaviors that are scary in the rest of life. Shy people can practice confrontation. Detached people can experiment with expressing emotion. When you’ve tried this out a few times in session, you may be ready to take it out into the world. (more tips for clients in therapy here)

I’m probably forgetting a few dozen other helpful reasons, but I hope you get the point: therapy is helpful for treating serious problems, but it offers much more. If we can move past the medical model myopia that contributes to therapy stigma, perhaps many more people will come to understand therapy’s benefits first hand.


Monday, January 12, 2015

How to Win the War on Worry

How to Win the War on Worry
To tame your worry, ask yourself these two questions…
Published on January 2, 2015 by Noam Shpancer, Ph.D. in Insight Therapy

“Worrying,” quipped Mark Twain, “is like paying a debt you don't owe.” Worry features in many people’s lives. In mild form, occasional worry may serve a helpful coping function, getting us to think and plan ahead. At higher volume and frequency, worry can become annoying and distracting, and may undermine our productivity, concentration, and mood. At extremely high levels, chronic worry can derail a person’s life. Such worry also constitutes the central symptom of a common psychological disorder: Generalized Anxiety Disorder (GAD).
GAD runs in families and appears to have a substantial genetic component. It is often diagnosed together with depression and with other anxiety disorders. This is why some psychologists believe it represents an underlying constitutional vulnerability, a general ‘anxious apprehension’ process that may at times manifest itself through different specific fears, such as fear of certain objects (specific phobia), of social judgment (social phobia), of physiological arousal symptoms (panic disorder) or of troubling thoughts and images (OCD).

Worry is a devious foe for several reasons. First, people who worry a lot most often see their worries come to naught. In other words, most imagined catastrophic scenarios don’t actually materialize. One would think that a system (worry) that constantly fails at its job (predicting the future) would be abandoned. Instead, the opposite usually happens. This is because our brains tend to confuse correlation with causation. In this case, since worry is associated with things turning out OK, worriers begin to believe that it is the worry what made things turn out OK (which is in fact false; research shows that worry hinders rather than facilitates effective problem solving). Hence, worriers tend to increase their worrying in response to their failed predictions of catastrophe. Over time, worry morphs from a habit into a requirement born of superstition.

In addition, research has suggested that although worry is associated with health and coping problems in the long term, it tends to decrease physiological (fight-or-flight) arousal in the short term. In this way, worrying works somewhat like an addictive drug; it provides short term stress relief through avoidance and is hence experienced as rewarding. Since our brain is wired to privilege short term rewards, a worry cycle is easily established that is as difficult to break as drug addiction. Like a drug, worry itself over time becomes a bigger problem than whatever problems it ostensibly addresses.

Another difficulty is that for those who have developed the habit of continual worry, the experience of not worrying is novel and disconcerting. As such, it becomes a source of worry in itself: “Why am I not worried? Something must be wrong with me!” Old habits die hard, and even after they die, they often hang around as scary ghosts.

Still, when worry becomes chronic, frightening, and debilitating we may be moved to do something about it. In the past, thought suppression techniques were advanced as one solution. The evidence, however, suggests that thought suppression is an ineffective way to deal with constant worry, and may have the ironic effect of magnifying worry and its influence. Instead of suppressing, denying, or trying to avoid those nagging thoughts, it is more useful to engage them in conversation, where they may be more closely examined in the light of real world evidence.

In this context, research by David Barlow and others has identified two main cognitive distortions that characterize worry. First, worry tends to involve an “overestimation bias,” whereby the odds of the worried-about scenario materializing are invariably imagined to be high. In other words, the ‘voice of worry’ ignores actual probabilities and always predicts imminence. Second, worry involves a “catastrophizing bias,” whereby the consequences of the worried-about scenario are imagined to be negative in the extreme. The ‘voice of worry’ ignores gradations and always predicts the absolute worst.

While worried about scenarios tend to appear in our minds as both patently imminent and extremely bad, in real life not all scenarios are bad, and even bad scenarios are not always imminent and/or extreme. This distinction matters, because living necessarily requires taking on low probability risk, every single day. For example, when you step into the shower in the morning, you may slip and break your neck. But most people still take on the risk. Why? Because the odds of it actually happening are low. Accurately calculating whether the odds of something happening are high or low is crucial to our daily decision-making. In general, low probability risk scenarios are disregarded so that we can go about our daily business. High probability risk scenarios may be defended against, or avoided.

Similarly, not all negative eventualities in life are extreme. In fact, extreme catastrophes are rare. If they were common, then they would not in all likelihood be considered extreme. An event’s level of impact makes a difference in the real world. In the real world, for example, getting hit by a real bullet is different from being hit by a paint ball.

Given the distorted tendency of the ‘voice of worry’ to make all risks appear likely and catastrophic, and given the real life importance of estimating the actual likelihood and severity of risks, the internal conversation regarding worry should include two main questions:

1. How likely is it, really? This question addresses the error of overestimation. An honest consideration of the actual odds that the negative scenario will materialize will help us distinguish justified, useful concern (high odds) from unjustified, useless worry (low odds).

2. How bad is it really? This question addresses the error of catastrophizing. It helps us consider the evidence in distinguishing the extreme, real threat (a real bullet) from the non-extreme, benign threat (a paint ball).

Now, these two questions, considered in tandem, may be represented in a 2 x 2 matrix of the kind psychologists love to draw:
As seen in the table, three of the four cells constitute good news. Specifically, an event that is imminent but mundane (2) need not be terribly bothersome. Such events are not the end of the world; they are just the world. An event that is catastrophic but unlikely (3) may also be disregarded—as such events must be in the course of pursuing our most basic daily tasks, unless we’re willing to go without bathing forever… And clearly, an unlikely mundane event (4) is of no concern at all. Once your worries are fleshed out and evaluated, it becomes clear that, contrary to the distortions inherent in the voice of worry, most high likelihood events are not terrible, and most terrible events are not likely.

Now, it is important to emphasize that in engaging the inner conversation with our voice of worry, we are not looking to counter negative thoughts with positive thoughts. Instead, we are looking to counter inaccurate thoughts with accurate thoughts; to replace lies with truths. Therefore, we must accept the possibility that once in a long while we will face an imminent and catastrophic event (1). That’s life. But recognizing that life is fragile and fleeting is, if anything, a very good reason to forsake needless worrying and start living.

To paraphrase Charles Darwin, anyone who dares to waste one hour of time worrying has not discovered the value of life.

Monday, January 5, 2015

Confidence: Are You on Your Case or on Your Side?

Confidence: Are You on Your Case or on Your Side?

Is your critic controlling your self-evaluations?

Published on May 23, 2013 by Relly Nadler, Psy.D..,M.C.C. in Leading with Emotional Intelligence

Turn your Beatings into Learnings

The main question people have after they understand the value of Emotional Intelligence is: How do  I raise EI for myself and others? Here I will explore one competency called Confidence, Self-Regard or Self-Esteem and one strategy to raise it.

Andrea’s Story

Andrea was an executive in an agency and constantly felt she was behind in everything she was doing—emails went unanswered, voicemails were not returned, one-on-ones with staff were cancelled or rescheduled. Her evaluation system was harsh and unforgiving in spite of many of the positive things she was initiating at the agency. Andrea often spent her first moments with an employee apologizing for something she had failed to get around to. Her confidence was affected and her negative self-evaluation started to influence others. Perhaps she wasn’t as competent as they had thought she was?

In one of our coaching sessions, Andrea achieved a breakthrough when I pointed out that she had apologized three times in 30 minutes. It was obvious she was overly critical of herself. She became painfully aware of how automatic this evaluation system was and, more importantly, recognized that it was quite possibly inaccurate. Andrea also became aware of how pervasive this pattern was in all of her interactions and that it undermined her leadership abilities as well.

The Coach’s Corner: Strategies for Self-Confidence

Below is just one of the 10 proven strategies on Confidence in Leading with Emotional Intelligence you can use to improve your confidence. Confidence is the fuel to take risks, try new things, and make the micro-initiatives necessary to become a star. As you read through this strategy, be aware of what you are already doing and what actions you could do more of.

What Is Self-Confidence?

Confidence is knowing one’s own abilities and having enough faith in them to make sound decisions in the face of uncertainty and pressure. A confident leader exudes a strong self-presentation and expresses himself or herself in an assured, impressive, and unhesitating manner. The confident leader will take on new challenges and hold on to his or her view, even if others disagree. (Goleman, 1998)

Being on Your Case vs. Being on Your Side

Many leaders have “faulty evaluation systems.” They are rarely satisfied when successful and are overly critical of their performance even if they win and win big. This can become a rigid pattern. In the past it may have driven them to great successes, but over time it can become a burden. They tend to continually try harder and often fall short in their own eyes. These leaders will readily admit that they are hard on themselves, but they believe it is the only way to push themselves to their best performances. It is as if they have a calculator that is defective, but they do not realize it is always off one digit. When evaluating themselves, the calculator should read 1,000, but instead it reads 100. They get upset about the reading, but don’t realize their evaluation system is faulty or broken.

There are three major unintended consequences of Being on Your Case rather than Being on Your Side:

1)  These leaders are never satisfied with their performance, and their self-confidence is affected.

2)  Because everything seems to be less than they had hoped, they are miserable, tense, and unhappy.

3)  Unconsciously they treat others the same way they treat themselves—overly critical, picky, negative, and never satisfied.

They become the leader people don’t want to work for and avoid.

Most leaders who are hard on themselves are blindsided to the problems inherent in their leadership style. Sometimes they require strong language to alert them to the serious impact this kind of pattern has on their ultimate performance and well-being. If you recognize yourself in the above profile, answer a simple question: What percentage of the time are you on your case instead of on your side? Use a scale of 1-100. You can tell if you or others have a faulty evaluation system if after every performance, you establish that you should have had:

-Better effort
-Higher quality
-Faster delivery

The manifestation of this kind of attitude is typically feeling scolded by yourself for failing to live up to your abilities. It’s almost like you take out your whip and begin snapping yourself into shape. You may even say or think: “How could I be so stupid? When am I going to finally learn? What is wrong with me?” More, better, faster, more, better, faster…becomes an automatic negative self-evaluation system.

Changing our self-evaluation greatly improves how confident we feel and allows us greater awareness of how we evaluate others.

Redirecting Questions

      The best way to change from Being on Your Case to Being on Your Side is first to notice how you behave and then turn the evaluation into a learning and action plan. Below are some examples of whipping statements and statements that will help you redirect yourself to Being on Your Side.

 “On Your Case” Whipping

How could I be so lame?
Don’t I know better than this?
I’m an idiot for doing this!
Why didn’t I start this sooner?
I could have done a much better job!
What is wrong with me?
I should have known better!
“On Your Side” (Phrases that redirect your habit into a learning)

Which parts of this performance went well?
What didn’t turn out the way I wanted it to?
What exactly didn’t work out here?
Which part is under my influence?
Is there anything I could have done differently?
What will I have to do to accept this performance and not beat myself up?
What can I learn from this performance?
What will I have to improve next time?
Is there any learning, training, or help I need to improve my performance?
What will be my next step?
How will I make sure I stay on track?
Notice the quality of the statements above and their effect on you. It is important to first acknowledge what went well, in order to establish the proper perspective in your evaluation and curtail the “more, better, faster” pattern.

This chart shows the difference between the two self-evaluations.

On Your Case: Quality: Demanding, Damaging, Irrational, Over-generalized

Results: Dissatisfied, Less Confident, Overwhelmed

On Your Side: Quality: Respectful, Constructive, Rational, Realistic

Results: Encouraged, Action plan for the future, Energized

Questions and Action Applications:

Circle the terms you experienced as a result of your self-evaluation.
How accurate is your evaluation system?
On a scale of 1-100, what percentage of the time are you on your case?
How do you feel after you’ve been on your case?
What are the consequences for you and others for being on your case?
Do you treat others as harshly as you do yourself?
Is this an effective pattern for you to continue with?
If you don’t change this, what do you stand to lose or miss out on?
Keep track of the times you have stopped being on your case and then redirected to being on your side.
What is most difficult about being on your side?
What helps you to be on your side?
Keep track in your planner of the percentage of time you are on your side each day, 1-100 and track you subtle progress to being more on your side.
You won’t stop being on your case but  you will catch it sooner and redirect it faster with the result having a more accurate assessment of yourself.