Am I the right therapist for you?

How do you know if someone is the right therapist? Some people choose therapists by cost, i.e. if the person is covered by insurance. I'm not on any insurance plans, but most of my patients get out-of-plan payments and I have a sliding scale to accommodate people without insurance. But therapists are not washing machines. If you choose a therapist because he or she is on sale, you may not be getting the most experienced person or a therapist who has the ability to help you with your unhappiness. 

When people say "trust your gut," that might be a problem if your "gut" is what's been getting you in trouble and/or making you unhappy. So you cannot always trust your gut. It takes a while before you can tell if I am a good fit for you. For example, a lot of my patients have difficulties with boundaries or anger (or both). It will take a while for those issues to emerge in the treatment. I believe that what happens between the therapist and patient in the office is the key to understanding many unconscious dynamics of the patient. I am going to talk about our relationship as well as your relationship with your spouse, friends and boss. Do you want a therapist who is going to tell you when you are breaking boundaries and is not afraid of your anger?

That takes time, so how do you know within a few sessions whether I am a good fit? First and foremost, is a therapist has to be a good listener. Feeling "heard" is one of the most important things in a therapy experience. When you tell me something about yourself, it will be clear from my response that I listened carefully to what you said and can frame it in a helpful way.  That may not be evident in the first or second session because I will be listening and trying to understand what you are saying and get some idea about what is bothering you. But in a few sessions time, I will have some things to say. And from that time on, I will always be responding to you.

Temper Tantrums

Many of my patients are not able to calm and console themselves when they are frustrated or disappointed. Instead, they have temper tantrums. Adult temper tantrums may not be physical, but sometimes they are--e.g. slamming the door or walking out of a session.  The first few times I tell patients they are having a temper tantrum, they generally get insulted and angry at me. But eventually, they are able to realize it themselves and have more control over it quickly.

To understand more about adult temper tantrums CLICK HERE.

What Are Defense Mechanisms?

People have different ways of handling their anxiety and pain.  Originally conceived by Sigmund Freud, much of the development of the concept of defense mechanisms was done by his daughter, Anna Freud. Defense mechanisms can be healthy or unhealthy depending on the circumstances and how much a person uses them. They can hide many different feelings from anger to lust to guilt. Here are a list of some common defense mechanisms from:  http://www.utahpsych.org/defensemechanisms.htm:

Repression

Burying a painful feeling or thought from your awareness though it may resurface in symbolic form. 

You can't remember your father's funeral.

Denial

Not accepting reality because it is too painful.

You are arrested for drunk driving several times but don't believe you have a problem with alcohol.

Regression

Reverting to an older, less mature way of handling stresses and feelings

Projection

Attributing your own unacceptable thoughts or feelings to someone or something else

You get really mad at your husband but scream that he's the one mad at you.

Splitting

Everything in the world is seen as all good or all bad with nothing in between.

You think your best friend is absolutely worthless because he forgot a lunch date with you.

Isolation of affect

Attempting to avoid a painful thought or feeling by objectifying and emotionally detaching oneself from the feeling

Acting aloof and indifferent toward someone when you really dislike that person

Displacement

Channeling a feeling or thought from its actual source to something or someone else.

When you get mad at your sister, you break your drinking glass by throwing it against the wall.

Reaction Formation

Adopting beliefs, attitudes, and feelings contrary to what you really believe

When you say you're not angry when you really are.

Rationalization

Justifying one's behaviors and motivations by substituting "good", acceptable reasons for these real motivations

I always study hard for tests and I know a lot of people who cheat so it's not a big deal I cheated this time.

Altruism

Handling your own pain by helping others.

After your wife dies, you keep yourself busy by volunteering at your church.

Sublimation

Redirecting unacceptable, instinctual drives into personally and socially acceptable channels

Intense rage redirected in the form of participation in sports such as boxing or football

Suppression

The effort to hide and control unacceptable thoughts or feelings

You are attracted to someone but say that you really don't like the person at all

Undoing

Trying to reverse or "undo" a thought or feeling by performing an action that signifies an opposite feeling than your original thought or feeling

You have feelings of dislike for someone so you buy them a gift

Thoughts on the Oedipal Complex

Both Stormy Daniels and Karen McDougal said that before Donald Trump had sex with them, he said, "You remind me of my daughter." That made me think more about the Oedipal complex. It's one is one of Freud's most controversial concepts. While Oedipus was a male, the analogous stage for girls is known as the Electra Complex (a term coined by Carl Jung) in which girls feel desire for their fathers and jealousy of their mothers. CLICK HERE.

Am I a Freudian?

New patients often ask if I'm a Freudian. The answer is both yes and no.

For a more complete discussion of Freud and psychoanalysis CLICK HERE.

Does creativity decline with age?

In my experience, many people become more creative when they get older. One analyst friend has become a playwright; an English professor has become an artist; and I just wrote my first novel. 

For a more complete discussion of creativity and aging CLICK HERE.

Creativity involves risk taking and there are some risks you are more willing to take as you get older--i.e. the judgement of others, perhaps?

Separation

If your parents are religious and you have different views, psychological separation may be more complicated--fraught with guilt and accusations of betrayal. You may even be exiled or mourned for as if you were dead--not just by your family, but also your religious or ethnic community. Forced separation makes separation more difficult because anger and guilt can keep you entangled with the family and/or community for years--or even a lifetime. 

For a further discussion of separation CLICK HERE.

Pre-existing Conditions

Pre-existing conditions are particularly important for people in psychotherapy. Before Obamacare when a patient changed jobs, he or she was ineligible for coverage of psychotherapy for 6 months or a year. For patients who were self-employed, changing health plans was also prohibitively expensive because of being in psychotherapy. If pre-existing conditions are not covered in the health plan that replaces Obamacare, we will return to that situation. For further discussion of this topic, CLICK HERE.

Getting Old Can be Depressing

Aging involves losses—loss of friends; loss of spouse; loss of siblings; loss of status; loss of hair; loss of physical mobility; loss of hearing; loss of eyesight; and sometimes loss of financial stability. So it is not surprising that aging and depression often go together.

For further discussion of aging and depression CLICK HERE.

Sick or Not Sick?

Suzanne O'Sullivan, a neurologist specializing in epilepsy who practices in London, has recently written a book about conversion disorders--somatic symptoms caused by psychological distress--Is It All in Your Head? True Stories of Imaginary Illness (Other Press, 2016). In his review of the book, Jerome Groopman (New York Review of Books, Feb. 9, 2017) points out that Freud believed that conversion disorders had an unconscious meaning that could only be understood through psychoanalysis.

For a more complete discussion of hypochondria, CLICK HERE.

It's so hard to say you're sorry.

Intimacy, in friendships as well as romantic relationships, inevitably involves hurt feelings and disappointments. Those hurts can erode trust unless there are repairs along the way. For relationships to have the best chance of lasting, apologizing has to be part of the mix. But it is not easy. For more on saying your sorry, CLICK HERE and HERE.

Idealization

Idealization is the normal experience of a young child who puts his parents and himself on a pedestal, but in an adult it usually indicates a problem integrating good and bad aspects of self and others. My analyst had an ashtray in her office that said: "Things come in mixed packages." I haven't seen that ashtray in many years, but the message is still with me.

To read the complete article below, CLICK HERE.

Narcissistic Injury

Does your entire sense of self collapse when someone hurts you? Narcissistic injuries do not feel like your feelings are hurt, they feel like your self is being attacked.  To read the complete article below, CLICK HERE.

Was Frida Kahlo a narcissist?

Everyone craves approval and attention—that’s healthy narcissism and an important ingredient in self-esteem. Unhealthy narcissism is when other people are only used to perform a function—to mirror the specialness of the narcissist. If the other people do not perform this function, they are discarded (usually with contempt). He is incapable of reciprocity in a relationship because of his lack of concern for the other as a separate person.

To read the complete article CLICK HERE.

Intermittent Reinforcement

Growing up with an inconsistent parent can lead to bad choices in partners. For a more detailed discussion CLICK HERE.

Cancer Care

To check out the rest of this interview CLICK HERE.

Apology and Forgiveness: Essentials of Intimacy

Last week I said the session was over 15 minutes before it was actually over! The patient said: "You want to get rid of me, don't you?" The truth was I did! She had been complaining about how victimized she was for the first 30 minutes of the session and I DID want to get rid of her--for the moment. I could have tried to wiggle out of it--"I got confused about when we started" or "I didn't sleep last night so..." But I knew I needed to be honest. "You're right, I think I did want to get rid of you for now because it's tiresome listening to you blame everyone else for not treating you as if you are the most important person in the world." I was holding my breath after that--not knowing what she would say or do. Would she walk out? Would she quit? No, she didn't do either of those things. To my astonishment and delight she was able to take responsibility for expecting people to treat her as special and feeling victimized by them if they didn't. I think she was able to take responsibility for her behavior because I had been able to take responsibility for mine.

For more detailed discussions of apologizing CLICK HERE and HERE.

Schizoid phenomena

Harry Guntrip in his groundbreaking book Schizoid Phenomena, Object-Relations and the Self (International Universities Press, May 2001) discussed the schizoid personality who presents in psychotherapy as withdrawn and detached. But he also discussed schizoid phenomena which can be present in a much wider range of people. The central dynamic is the oscillation between desperate hunger for a love object and the fear of being devoured, smothered or trapped. For more discussion on this topic CLICK HERE.

Healthy Ambivalence

Llywelyn Nys/Unsplash.com

In common parlance “ambivalence” tends to have a pejorative connotation—as if it is a problem if you feel ambivalent. President Bush told the world: “You're either with us or against us in the fight against terror." President Bush’s stance allows no room for ambiguity or ambivalence. Similarly, Tom Ridge, the former homeland security secretary told Americans: “We can be afraid, or we can be ready.” Can’t we be both afraid and ready? President Reagan also had a penchant for reducing complexities to simple images of good and bad. Ambivalence isn’t American; America is the land of moral polarization. Cowboys wear white hats and black hats so that we know the good guys from the bad. And Americans love professional wrestling in which the good guy waves at the crowd and the bad guy usually has a grotesque appearance and makes threatening gestures to the crowd to elicit their booing. Yet, from a psychological point of view ambivalence is a healthy state and not being able to tolerate it is a problem. 

Setting Limits is Not Easy

If you don't want to feel angry about people taking advantage of you, you need to protect yourself by setting limits. That involves being able to say "no." 

To read the complete article CLICK HERE.