Behavior Therapists Quotes

I have come to feel that the only learning which significantly influences behavior is self-discovered, self-appropriated learning.

The conviction grows in me that we shall discover laws of personality and behavior which are as significant for human progress or human understanding as the law of gravity or the laws of thermodynamics.

Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

Someone's got to do some more research, but I would really like to know: when a CBT therapist really gets distressed, who does he go see?

It seems to me that anything that can be taught to another is relatively inconsequential, and has little or no significant influence on behavior.

The distance between your knowledge of truth and your obedience is called lack of integrity. And the amount of negative behavior--or lack of integrity--a person exhibits is directly proportional to their amount of pain." - Tara Leigh's therapist (p.118)

The borderline Queen experiences what therapists call "oral greediness". The desperate hunger of the borderline Queen is akin to the behavior of an infant who had gone too long between feelings. Starved, frustrated, and beyond the ability to calm of soothe herself, she grabs, flails, and wails until at last the nipple is planted securely and perhaps too deeply in her mouth. She coughs, gags, chokes, and spits, eyeing the elusive breast like a wolf guarding her food. Similarity, the Queen holds on to what is hers, taking more than she could use, in case it might be taken away prematurely.

I also think that human behavior is so mysterious and unpredictable that if you are not humble about it you are bound to be insensitive to a lot of the dilemmas and predicaments that people are facing.

Changes in Meaning: Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life

The concept of “cure” is entirely inappropriate, since in most of these disorders we are dealing with learned behavior, not with a disease.

If a child stays quiet in the context of extroverted friends, or even prefers time alone, a parent may worry and even send her to therapy. She might be thrilled— she’ll finally get to talk about the stuff she cares about, and without interruption! But if the therapist concludes that the child has a social phobia, the treatment of choice is to increasingly expose her to the situations she fears. This behavioral treatment is effective for treating phobias — if that is truly the problem. If it’s not the problem, and the child just likes hanging out inside better than chatting, she’ll have a problem soon. Her “illness” now will be an internalized self-reproach: “Why don’t I enjoy this like everyone else?” The otherwise carefree child learns that something is wrong with her. She not only is pulled away from her home, she is supposed to like it. Now she is anxious and unhappy, confirming the suspicion that she has a problem.

In my deepest contacts with individuals in therapy, even those whose troubles are most disturbing, whose behavior has been most anti-social, whose feelings seem most abnormal, I find this to be true. When I can sensitively understand the feelings which they are expressing, when I am able to accept them as separate persons in their own right, then I find that they tend to move in certain directions. And what are these directions in which they tend to move? The words which I believe are most truly descriptive are words such as positive, constructive, moving toward self-actualization, growing toward maturity, growing toward socialization.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

We are playwrights in that we spontaneously compose and direct dialogue, acting out various roles of a nurturer, an authority, or a character from a client's life.

Specific parts of you personality may be angry and are usually easily evoked. because these parts are dissociated, anger remains an emotion that is not integrated for you as a whole person. Even though individuals with dissociative disorder are responsible for their behavior, just like everyone else, regardless of which part may be acting, they may feel little control of these raging parts of themselves. Some dissociative parts may avoid or even be phobic of anger. They may influence you as a whole person to avoid conflict with others at any cost or to avoid setting healthy boundaries out of fear of someone else’s anger; or they may urge you to withdraw from others almost completely.

As you recover, you will feel more conscious of your surroundings. Freed from the ‘fog’ of your pain, fear, and confusion, you will awaken and see the world revealed as never before. You will begin to observe things, especially yourself. You will be aware of what you do and why you do it. You will begin to observe your own behavior and attitudes.

So many of our destructive behaviors take root in an emotional void, an emptiness that calls out for something to fill it.

Somehow the disorder hooks into all kinds of fears and insecurities in many clinicians. The flamboyance of the multiple, her intelligence and ability to conceptualize the disorder, coupled with suicidal impulses of various orders of seriousness, all seem to mask for many therapists the underlying pain, dependency, and need that are very much part of the process. In many ways, a professional dealing with a multiple in crisis is in the same position as a parent dealing with a two-year-old or with an adolescent's acting-out behavior. (236)

Too often the survivor is seen by [himself or] herself and others as "nuts," "crazy," or "weird." Unless her responses are understood within the context of trauma. A traumatic stress reaction consists of *natural* emotions and behaviors in response to a catastrophe, its immediate aftermath, or memories of it. These reactions can occur anytime after the trauma, even decades later. The coping strategies that victims use can be understood only within the context of the abuse of a child. The importance of context was made very clear many years ago when I was visiting the home of a Holocaust survivor. The woman's home was within the city limits of a large metropolitan area. Every time a police or ambulance siren sounded, she became terrified and ran and hid in a closet or under the bed. To put yourself in a closet at the sound of a far-off siren is strange behavior indeed—outside of the context of possibly being sent to a death camp. Within that context, it makes perfect sense. Unless we as therapists have a good grasp of the context of trauma, we run the risk of misunderstanding the symptoms our clients present and, hence, responding inappropriately or in damaging ways.

Time and again, I have asked myself why therapy works for some people while others remain the prisoners of their symptoms despite years of analysis or therapeutic care. In each and every case I examined, I was able to establish that when people found the kind of therapeutic care and companionship that enabled them to discover their own story and give free expression to their indignation at their parents’ behavior, they were able to liberate themselves from the maltreated child’s destructive attachment. As adults they were able to take their lives into their own hands and did not need to hate their parents. The opposite was the case with people whose therapists enjoined them to forgive and forget, actually believing that such forgiveness could have a salutary, curative effect. They remained trapped in the position of small children who believe they love their parents but in fact allow themselves to be controlled all their lives by the internalized parents and ultimately develop some kind of illness that leads to premature death. Such dependency actively fosters the hatred that, though repressed, remains active, and it drives them to direct their aggression at innocent people. We only hate as long as we feel totally powerless. I

Children make studies of their parents, decipher them, propose theories about their behavior, turn them this way and that, examining every flaw, and continue to do so long after the parents themselves are gone. In stories, at the therapist's office, at holidays--the story of the parent never ends.

Covert narcissists are likable to the outside world; they appear to be giving, humble, and kind. It is usually only the person who gets to know them intimately who sees the destructive traits. The rest of the world sees the façade, the “nice guy.” Many therapists don’t see through the mask and indeed are often impressed with how kind and aware the CN is. CNs seem to intensify their behavior around middle age; they rarely change because narcissists blame others and they usually don’t think they have a problem.

One of the survival mechanisms of children raised in alcoholic families is an awareness of parental needs and feelings and of changes in parental moods and behavior. The Adult Child often makes a full-time occupation of mind reading with partners, friends, employers, and therapists. As a consequence, they earn a Ph.D. at the age of six in observing the behavior of others and assessing parental needs—but are in elementary school at age thirty, trying to learn to assess, label, or communicate their own needs and feelings.

In projecting onto others their own moral sense, therapists sometimes make terrible errors. Child physical abusers are automatically labeled “impulsive," despite extensive evidence that they are not necessarily impulsive but more often make thinking errors that justify the assaults. Sexual and physical offenders who profess to be remorseful after they are caught are automatically assumed to be sincere. After all, the therapist would feel terrible if he or she did such a thing. It makes perfect sense that the offender would regret abusing a child. People routinely listen to their own moral sense and assume that others share it. Thus, those who are malevolent attack others as being malevolent, as engaging in dirty tricks, as being “in it for the money,“ and those who are well meaning assume others are too, and keep arguing logically, keep producing more studies, keep expecting an academic debate, all the time assuming that the issue at hand is the truth of the matter. Confessions of a Whistle-Blower: Lessons Learned Author: Anna C. Salter. Ethics & Behavior, Volume 8, Issue 2 June 1998 p122

She isn't feeling easy with any of this. She doesn't know quite what to do with Bigend's proposition, which has kicked her into one of those modes that her therapist, when she last had one, would lump under the rubric of 'old behaviors.' It consisted of saying no, but somehow not quite forcefully enough, and then continuing to listen. With the result that her 'no' could be gradually chipped away at, and turned into a 'yes' before she herself was consciously aware that this was happening. She had thought she had been getting much better around this, but now she feels it happening again.

I shake out my hands. I stretch my neck muscles. I let go of every single behavioral therapist's words. The ticks they made me suppress, the instincts they said I needed to relearn, I lean into all of them. Then I run. Full force and full speed.

When clients relinquish symptoms, succeed in achieving a personal goal, or make healthier choices for themselves, subsequently many will feel anxious, guilty, or depressed. That is, when clients make progress in treatment and get better, new therapists understandably are excited. But sometimes they will also be dismayed as they watch the client sabotage her success by gaining back unwanted weight or missing the next session after an important breakthrough and deep sharing with the therapist. Thus, loyalty and allegiance to symptoms—maladaptive behaviors originally developed to manage the “bad” or painfully frustrating aspects of parents—are not maladaptive to insecurely attached children. Such loyalty preserves “object ties,” or the connection to the “good” or loving aspects of the parent. Attachment fears of being left alone, helpless, or unwanted can be activated if clients disengage from the symptoms that represent these internalized “bad” objects (for example, if the client resolves an eating disorder or terminates a problematic relationship with a controlling/jealous partner). The goal of the interpersonal process approach is to help clients modify these early maladaptive schemas or internal working models by providing them with experiential or in vivo re-learning (that is, a “corrective emotional experience”). Through this real-life experience with the therapist, clients learn that, at least sometimes, some relationships can be different and do not have to follow the same familiar but problematic lines they have come to expect.

Learning to wear a mask (that word already embedded in the term "masculinity") is the first lesson in patriarchal masculinity a boy learns. He learns that his core feelings cannot be expressed if they do not conform to the acceptable behaviors sexism defines as male. Asked to give up the true self in order to realize the patriarchal ideal, boys learn self-betrayal early and are rewarded for these acts of soul murder. Therapist John Bradshaw explains the splitting that takes place when a child learns that the way he organically feels is not acceptable. In response to this lesson that his true self is inappropriate and wrong, the boy learns to don a false self. Bradshaw explains, "The feeling that I have done something wrong, that I really don't know what it is, that there's something terribly wrong with my very being, leads to a sense of utter hopelessness. This hopelessness is the deepest cut of the mystified state. It means there is no possibility for me as I am; there is no way I can matter or be worthy of anyone's love as long as I remain myself. I must find a way to be someone else - someone who is lovable. Someone who is not me.

Until very recently, most mental-health practitioners believed that personality disorders were incurable because unlike mood disorders, such as depression and anxiety, personality disorders consist of long-standing, pervasive patterns of behavior that are very much a part of one’s personality. In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

This is a remarkably sturdy research finding: kids are happiest when raised in a loving environment that holds their behavior to high standards, expects them to contribute meaningfully to the household, and is willing to punish when behavior falls short. And it flies in the face of virtually everything therapists and parenting books now exhort.

repeated what a cognitive behavioral therapist once told me to repeat in difficult situations: “This is the moment I find myself in.

Fortunately analysis is not the only way to resolve inner conflicts. Life itself still remains a very effective therapist. Experience of any one of a number of kinds may be sufficiently telling to bring about personality changes. It may be the inspiring example of a truly great person; it may be a common tragedy which by bringing the neurotic in close touch with others takes him out of his egocentric isolation; it may be association with persons so congenial that manipulating or avoiding them appears less necessary. In other instances the consequences of neurotic behavior may be so drastic or of such frequent occurrence that they impress themselves on the neurotic's mind and make him less fearful and less rigid.

The seduction of women - including feminists - into confusion by Dionysian boundary violation happens under a variety of circumstances. A comment element seems to be an invitation to "freedom". The feminine Dionysian male guru or therapist invites women to spiritual or sexual liberation, at the cost of loss of Self in male-dicated behavior. Male propagation of the idea that men, too are feminine - particularly through feminine behavior by males - distracts attention from the fact that femininity is a man-made construct, having essentially nothing to do with femaleness.

The drug dealer, the ducking and diving political leader, the wife beater, the chronically “crabby” boss, the “hot shot” junior executive, the unfaithful husband, the company “yes man,” the indifferent graduate school adviser, the “holier than thou” minister, the gang member, the father who can never find the time to attend his daughter’s school programs, the coach who ridicules his star athletes, the therapist who unconsciously attacks his clients’ “shining” and seeks a kind of gray normalcy for them, the yuppie—all these men have something in common. They are all boys pretending to be men. They got that way honestly, because nobody showed them what a mature man is like. Their kind of “manhood” is a pretense to manhood that goes largely undetected as such by most of us. We are continually mistaking this man’s controlling, threatening, and hostile behaviors for strength. In reality, he is showing an underlying extreme vulnerability and weakness, the vulnerability of the wounded boy.

For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)

A general principle of human behavior is that it’s easier for us to see something negative in other people than in ourselves. This mental process sometimes guides therapists when they make interpretations during treatment. Often, the traits that disturb us most in others are those that we ourselves possess. It may upset us to see these qualities in other people, but it’s completely unacceptable to acknowledge them in ourselves.

The patient rather than the therapist must decide whether or not his behavior is irresponsible and whether he should change it. [...] If a man thinks it is all right to overeat and be fat, no obesity treatment will work.

... the silent client may be experienced as withholding, oppositional, and sulking or as holding the therapist "hostage" in ways that elicit resentment and other negative responses. Because it is not unusual that relational and other forms of traumatization began when the client was preverbal, he or she may not have words. The lack of access to emotions or to words to describe them is known as alexithymia and is a common response to trauma. What the client is likely to have instead is somatosensory, behavioral, dissociative, and relational manifestations that therapists must seek to understand and translate into words, a process that involves hard work and intense focus.

Emotions are seen as crucial in motivating behavior. People generally do what they feel like doing rather than what reason or logic dictates. It follows that to achieve behavioral change, people need to change the emotions motivating their behavior. Emotion also influences thought. When people feel angry, they think angry thoughts; when they are sad, they recall sad memories. To help people change what they think, therapists must help them change what they feel.

He changes his perception of himself, becoming more realistic in his views of self. He becomes more like the person he wishes to be. He values himself more highly. He is more self-confident and self-directing. He has a better understanding of himself, becomes more open to his experience, denies or represses less of his experience. He becomes more accepting in his attitudes toward others, seeing others as more similar to himself. In his behavior he shows similar changes. He is less frustrated by stress, and recovers from stress more quickly. He becomes more mature in his everyday behavior as this is observed by friends. He is less defensive, more adaptive, more able to meet situations creatively.

It will be implied that this goal is "normal", but it may really be the goal of being like them or like the majority of people, ignoring differences in temperament. A good cognitive-behavioral therapist, however, will be attuned to individual differences...

Whereas we’d once believed that the symptoms and behavior exhibited by our clients primarily reflected their psychological defenses—a view that attributed a degree of intentionality, no matter how unconscious—now, we better understood the symptoms as manifestations of instinctive brain and bodily survival responses. We understood that sympathetic activation fuels anxiety and rage, parasympathetic dominance causes shutdown and passive-aggressive behavior, flight responses spur fleeing the therapist’s office, and fight responses lead to verbal or physical aggression or violence turned against the self. When clients self-harm, for example, these days, we understand their actions to be instinctive, rather than thought out—an effort to regulate or relieve, rather than punish.

Cognitive behavioral therapists treat trauma patients by exposing them to the things they find upsetting (at first in small ways, such as imagining them or looking at pictures), activating their fear, and helping them habituate (grow accustomed) to the stimuli.

...but if the result of my efforts and those of others is that man becomes a robot, created and controlled by a science of his own making, then I am very unhappy indeed. If the good life of the future consists in so conditioning individuals through the control of their environment, and through the control of the rewards they receive, that they will be inexorably productive, well-behaved, happy or whatever, then I want none of it. To me this is a pseudo-form of the good life which includes everything save that what makes it good.

Cognitive Therapy Instead of behavior, cognitive therapy emphasizes changing thoughts and beliefs. Cognitive therapists believe that irrational beliefs or distorted thinking patterns lead to social anxiety so they teach patients to think in more rational, constructive ways.

You are not a hot mess or hopeless cause just because you're scared or out of sorts. We cannot hang up on the call for courage that speed dials us every day. If facing the simultaneous brokenness and possibility of living were easy, we wouldn't need therapists, besties, teachers, scientists, coaches, healers, artists, and comedians nudging us to critically think, take agency, be more self-compassionate, see our humanity, and stop taking ourselves and our so-called "failures" so seriously. "Failure" is how we learn and grow. Community and solidarity are how we heal.

This work led cognitive therapists such as Aaron Beck, David D. Burns, and Albert Ellis to build treatment around the idea that our thoughts shape our emotions, not the other way around. By changing our thinking, we can alleviate depression or simply have greater control over our behavior.

Our inner experience is that which we think, feel, remember, perceive, sense, decide, plan and predict. These experiences are actually mental actions, or mental activity (Van der Hart et al., 2006). Mental activity, in which we engage all the time, may or may not be accompanied by behavioral actions. It is essential that you become aware of, learn to tolerate and regulate, and even change major mental actions that affect your current life, such as negative beliefs, and feelings or reactions to the past the interfere with the present. However, it is impossible to change inner experiences if you are avoiding them because you are afraid, ashamed or disgusted by them. Serious avoidance of you inner experiences is called experiential avoidance (Hayes, Wilson, Gifford, & Follettte, 1996), or the phobia of inner experience (Steele, Van der Hart, & Nijenhuis, 2005; Van der Hart et al., 2006).

But Wendell saw it differently. He'd given me permission to feel and also a reminder that, like so many people, I'd been mistaking feeling less for feeling better. The feelings are still there though. They come out in unconscious behaviors, in an inability to sit still, in a mind that hungers for the next distraction, in a lack of appetite or a struggle to control one's appetite, in a short-temperedness, or- in Boyfriend's case- in a foot that twitched under the covers as we sat in that heavy silence under which lay the feeling that he'd kept to himself for months: whatever he wanted, it wasn't me.

short term always leaves us in a place worse off than when we started. — To properly heal from addiction, we need a holistic approach. We need to create a life we don’t need to escape. We need to address the root causes that made us turn outside ourselves in the first place. This means getting our physical health back, finding a good therapist, ending or leaving abusive relationships, learning to reinhabit our bodies, changing our negative thought patterns, building support networks, finding meaning and connecting to something greater than ourselves, and so on. To break the cycle of addiction, we need to learn to deal with cravings, break old habits, and create new ones. To address all of this is an overwhelming task, but there is a sane, empowering, and balanced approach. But before we discuss how to implement solutions to the Two-Part Problem, we need to address one of the bigger issues that women and other historically oppressed folks need to consider, which is how patriarchal structures affect the root causes of addiction, how they dominate the recovery landscape, and what that means for how we experience recovery. If we are sick from sexism, homophobia, racism, classism, microaggressions, misogyny, ableism, American capitalism, and so on—and we are—then we need to understand how recovery frameworks that were never built with us in mind can actually work against us, further pathologizing characteristics, attributes, and behaviors that have been used to keep us out of our power for millennia. We need to examine what it means for us individually and collectively when a structure built by and for upper-class white men in the early twentieth century dominates the treatment landscape.

Behavioral Therapy Behavioral therapy differs dramatically from classical psychoanalysis. Instead of dealing with an individual’s thoughts, feelings, and past experiences, it focuses solely on the specific behaviors that are causing problems. Behavioral therapists believe that all behaviors are learned and that you can relearn and replace maladaptive behaviors with more appropriate ones.

We are offered glimpses, even deep searches, into the questions that haunt people the most. We experience a level of intimacy with our clients that few will ever know. We are exposed to levels of drama and emotional arousal that are at once terrifying and captivating. We get to play detective and help solve mysteries that have plagued people throughout their lives. We hear stories so amazing that they make television shows, novels, and movies seem tedious and predictable by comparison. We become companions to people who are on the verge of making significant changes— and we are transformed as well. We go to sleep at night knowing that, in some way, we have made a difference in people’s lives. There is almost a spiritual transcendence associated with much of the work we do.

In other words, if you don’t act as your own therapist, and interrogate your own childhood, you won’t be the best parent you can be. A parental perspective allows you to understand the challenges your parents faced that you might not have recognized as a child. A child’s perspective is myopic, and it’s impossible for us as children to understand all the factors that influence our parents’ behavior.

It is common to hear people (especially counselors or therapists) say things like “feelings are always valid.” What this usually means is that if a person feels a certain way, he or she feels that way for a reason. The feelings may be in reaction to faulty data, but the fact is that the person feels what she or he feels, wants what she or he wants, thinks what she or he thinks. It just is what it is.

Below the level of the problem situation about which the individual is complaining—behind the trouble with studies, or wife, or employer, or with his own uncontrollable or bizarre behavior, or with his frightening feelings, lies one central search. It seems to me that at bottom each person is asking, “Who am I, really? How can I get in touch with this real self, underlying all my surface behavior? How can I become myself?

This is the same stuff your parents did to you: ignoring your feelings, not recognizing what you needed, invalidating you. You grew up never being taught how to be honest about what was going on inside you. You also had to pretend.” “So now you have blame them too? It this what therapy does—teaches you to blame and hurt others to make yourself feel better?” “I don’t see why we can’t look at the facts without judging them. No one ever talked about what was really going on in our family. We were always hiding, or ignoring, or punishing when things came to the surface.” “That was years ago! If you can’t let go of the past, then I don’t think you’re making all that much progress. And you can tell your therapist that.” She’s waving frantically at the waiter to give her the check, even though our dinner is only half eaten. “Just go…” she hisses, not looking at me any more, fumbling for her purse. “Just leave.

I've put it into the world as your emotional support guide to help you in your journey toward decentering men. Just think about all the moments you've spent reeling in pent-up emotions like anger, angst, and internalized aggression-after realizing how much of your behavior that day was spent accommodating men. Like my therapist always reminds me, "When your needs are consistently not being met, you end up turning into the person you most fear you may actually be.

I resolved to come right to the point. "Hello," I said as coldly as possible, "we've got to talk." "Yes, Bob," he said quietly, "what's on your mind?" I shut my eyes for a moment, letting the raging frustration well up inside, then stared angrily at the psychiatrist. "Look, I've been religious about this recovery business. I go to AA meetings daily and to your sessions twice a week. I know it's good that I've stopped drinking. But every other aspect of my life feels the same as it did before. No, it's worse. I hate my life. I hate myself." Suddenly I felt a slight warmth in my face, blinked my eyes a bit, and then stared at him. "Bob, I'm afraid our time's up," Smith said in a matter-of-fact style. "Time's up?" I exclaimed. "I just got here." "No." He shook his head, glancing at his clock. "It's been fifty minutes. You don't remember anything?" "I remember everything. I was just telling you that these sessions don't seem to be working for me." Smith paused to choose his words very carefully. "Do you know a very angry boy named 'Tommy'?" "No," I said in bewilderment, "except for my cousin Tommy whom I haven't seen in twenty years..." "No." He stopped me short. "This Tommy's not your cousin. I spent this last fifty minutes talking with another Tommy. He's full of anger. And he's inside of you." "You're kidding?" "No, I'm not. Look. I want to take a little time to think over what happened today. And don't worry about this. I'll set up an emergency session with you tomorrow. We'll deal with it then." Robert This is Robert speaking. Today I'm the only personality who is strongly visible inside and outside. My own term for such an MPD role is dominant personality. Fifteen years ago, I rarely appeared on the outside, though I had considerable influence on the inside; back then, I was what one might call a "recessive personality." My passage from "recessive" to "dominant" is a key part of our story; be patient, you'll learn lots more about me later on. Indeed, since you will meet all eleven personalities who once roamed about, it gets a bit complex in the first half of this book; but don't worry, you don't have to remember them all, and it gets sorted out in the last half of the book. You may be wondering -- if not "Robert," who, then, was the dominant MPD personality back in the 1980s and earlier? His name was "Bob," and his dominance amounted to a long reign, from the early 1960s to the early 1990s. Since "Robert B. Oxnam" was born in 1942, you can see that "Bob" was in command from early to middle adulthood. Although he was the dominant MPD personality for thirty years, Bob did not have a clue that he was afflicted by multiple personality disorder until 1990, the very last year of his dominance. That was the fateful moment when Bob first heard that he had an "angry boy named Tommy" inside of him. How, you might ask, can someone have MPD for half a lifetime without knowing it? And even if he didn't know it, didn't others around him spot it? To outsiders, this is one of the most perplexing aspects of MPD. Multiple personality is an extreme disorder, and yet it can go undetected for decades, by the patient, by family and close friends, even by trained therapists. Part of the explanation is the very nature of the disorder itself: MPD thrives on secrecy because the dissociative individual is repressing a terrible inner secret. The MPD individual becomes so skilled in hiding from himself that he becomes a specialist, often unknowingly, in hiding from others. Part of the explanation is rooted in outside observers: MPD often manifests itself in other behaviors, frequently addiction and emotional outbursts, which are wrongly seen as the "real problem." The fact of the matter is that Bob did not see himself as the dominant personality inside Robert B. Oxnam. Instead, he saw himself as a whole person. In his mind, Bob was merely a nickname for Bob Oxnam, Robert Oxnam, Dr. Robert B. Oxnam, PhD.

Uneducated therapists often have an inability to cope with the behaviors of persecutory alters. They commonly focus on helping one side of the personality system and battling with the other side. When “Satan” or some similar part talks in a deep scary voice to you or to the client, it is easy to think this is a nasty perpetrator or a supernatural being, and to and to oppose it or fight with it or try to banish it. However, if you do this, you will engender the hostility of this part, who has probably been very badly hurt and told a lot of lies. You will foster internal splitting in this way, and get nowhere fast. Once you recognize that these alters have a protective intent, you can see that working with them involves enlisting them in the service of healing, just as they were originally enlisted in the cause of safety. You will see examples of these kinds of errors, which often result in clients leaving their therapists, in survivor LisaBri's story: When therapists make mistakes.

But another type of life review happens to all of us when we die and our consciousness leaves the physical body at the end of each lifetime. This time it is not done with a therapist, but rather with our spiritual guides or other wise beings; it is not a clinical life review but a karmic one. As we are replenished by the beautiful light, our awareness is directed to review the results of our actions while we were on the physical plane. We see the people we have harmed and we feel their emotional reactions, magnified greatly. Similarly, we feel the emotions, again enhanced, of those we have aided and loved. In this manner, we examine all our relationships, and we deeply experience all the anger, hurt, and despair that we have caused—but also all the gratitude, appreciation, love, and hope that we have elicited. This life review is not done in a spirit of punishment or guilt. By truly understanding the result of our behavior, we learn the importance of loving-kindness and compassion. As

In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are egodystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

The overarching principle of a therapeutic relationship is that therapists should be ever mindful of a variant of the Hippocratic oath and, to the degree possible, strive to "do no more harm" (Courtois, 2010). Complex trauma clients have already experienced considerable harm, much of it at the hands of other human beings. As a result of the ubiquitous processes of transference, attachment styles, and IWM [Internal working models], these clients often view the therapist's behavior and their relationship through the lens of their trauma-related negative interpersonal expectancies and unhealed emotional wounds and injuries. Therapists should not be surprised to be "guilty until proven innocent", not because clients with complex trauma histories are "unfair" or "unreasonable" but precisely the opposite - because the most realistic self-protective stance for them (given the fact that betrayal and harm have been more the rule than the exception) is to "distrust first and verify" (or to be hypervigilant) rather than to start with an expectation of safety and trustworthiness.

Freedom to be oneself is a frighteningly responsible freedom, arid an individual moves toward it cautiously, fearfully, and with almost no confidence at first... To be responsibly self-directing means that one chooses—and then learns from the consequences. So clients find this a sobering but exciting kind of experience. As one client says—“I feel frightened, and vulnerable, and cut loose from support, but I also feel a sort of surging up or force or strength in me.” This is a common kind of reaction as the client takes over the self-direction of his own life and behavior.

If all that is not confusing enough, we also use the word love to explain behavior. “I did it because I love her.” That explanation is given for all kinds of actions. A politician is involved in an adulterous relationship, and he calls it love. The preacher, on the other hand, calls it sin. The wife of an alcoholic picks up the pieces after her husband’s latest episode. She calls it love, but the psychologist calls it codependency. The parent indulges all the child’s wishes, calling it love. The family therapist would call it irresponsible parenting. What is loving behavior?

Humans never outgrow their need to connect with others, nor should they, but mature, truly individual people are not controlled by these needs. Becoming such a separate being takes the whole of a childhood, which in our times stretches to at least the end of the teenage years and perhaps beyond. We need to release a child from preoccupation with attachment so he can pursue the natural agenda of independent maturation. The secret to doing so is to make sure that the child does not need to work to get his needs met for contact and closeness, to find his bearings, to orient. Children need to have their attachment needs satiated; only then can a shift of energy occur toward individuation, the process of becoming a truly individual person. Only then is the child freed to venture forward, to grow emotionally. Attachment hunger is very much like physical hunger. The need for food never goes away, just as the child's need for attachment never ends. As parents we free the child from the pursuit of physical nurturance. We assume responsibility for feeding the child as well as providing a sense of security about the provision. No matter how much food a child has at the moment, if there is no sense of confidence in the supply, getting food will continue to be the top priority. A child is not free to proceed with his learning and his life until the food issues are taken care of, and we parents do that as a matter of course. Our duty ought to be equally transparent to us in satisfying the child's attachment hunger. In his book On Becoming a Person, the psychotherapist Carl Rogers describes a warm, caring attitude for which he adopted the phrase unconditional positive regard because, he said, “It has no conditions of worth attached to it.” This is a caring, wrote Rogers, “which is not possessive, which demands no personal gratification. It is an atmosphere which simply demonstrates I care; not I care for you if you behave thus and so.” Rogers was summing up the qualities of a good therapist in relation to her/his clients. Substitute parent for therapist and child for client, and we have an eloquent description of what is needed in a parent-child relationship. Unconditional parental love is the indispensable nutrient for the child's healthy emotional growth. The first task is to create space in the child's heart for the certainty that she is precisely the person the parents want and love. She does not have to do anything or be any different to earn that love — in fact, she cannot do anything, since that love cannot be won or lost. It is not conditional. It is just there, regardless of which side the child is acting from — “good” or “bad.” The child can be ornery, unpleasant, whiny, uncooperative, and plain rude, and the parent still lets her feel loved. Ways have to be found to convey the unacceptability of certain behaviors without making the child herself feel unaccepted. She has to be able to bring her unrest, her least likable characteristics to the parent and still receive the parent's absolutely satisfying, security-inducing unconditional love. A child needs to experience enough security, enough unconditional love, for the required shift of energy to occur. It's as if the brain says, “Thank you very much, that is what we needed, and now we can get on with the real task of development, with becoming a separate being. I don't have to keep hunting for fuel; my tank has been refilled, so now I can get on the road again.” Nothing could be more important in the developmental scheme of things.

But it's important to keep in mind that you break out of this scarcity mindset the same way that you break out of any bad habit. You need to actively change your thinking and behavior over time. Maybe that's saying affirmations in the mirror in the morning, maybe it's pounding the table and negotiating at your job for more money every single year, maybe it's forcing yourself to order something that isn't the cheapest thing on the menu. So, while yes, I highly recommend you talk to a therapist, you also need to be making active decisions to grow your wealth instead of just hoarding it or frittering it away.

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment. If we have a choice between believing one of two things, both of which we have evidence for—I’m unlovable, I’m lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations (the everyone’s-life-is-better-than-mine station, the I-can’t-trust-people station, the nothing-works-out-for-me station) instead of moving the dial up or down? Change the station. Walk around the bars. Who’s stopping us but ourselves?

Couples counseling has long been banned from the list of acceptable treatments for domestic violence . . . "an inappropriate intervention that further endangers the woman." Schechter explained: 'It encourages the abuser to blame the victim by examining her "role" in his problem. By seeing the couple together, the therapist erroneously suggests that the partner, too, is responsible for the abuser's behavior. Many women have been beaten brutally following couples counseling sessions in which they disclosed violence or coercion. The abuser alone must take responsibility for the assaults and understand that family reunification is not his treatment goal; the goal is to stop the violence.

In supportive work, the therapist cedes great control to the patient. It may seem otherwise. The therapist is setting limits, perhaps implicitly commenting on the patient's behavior or sense of self, and so forth, and on the surface it seems that the therapist is taking responsibility for the patient's progress. but all this activity leads nowhere except, if we succeed, to stability. In supportive therapy, change arises in a more or less miraculous way , through the patient's suddenly feeling secure enough to move in a certain direction, perhaps one unanticipated by the therapist. It is this pathless quality of supportive work - the degree of blind faith it requires of the therapist - that makes it most uncomfortable.

In Lost Boys therapist James Garbarino testifies that when it comes to boys, “neglect is more common than abuse: more kids are emotionally abandoned than are directly attacked, physically or emotionally.” Emotional neglect lays the groundwork for the emotional numbing that helps boys feel better about being cut off. Eruptions of rage in boys are most often deemed normal, explained by the age-old justification for adolescent patriarchal mis-behavior, “Boys will be boys.” Patriarchy both creates the rage in boys and then contains it for later use, making it a resource to exploit later on as boys become men. As a national product, this rage can be garnered to further imperialism, hatred, and oppression of women and men globally.

Dr. Louis Jolyon “Jolly” West was born in New York City on October 6, 1924. He died of cancer on January 2, 1999. Dr. West served in the U.S. Army during World War II and received his M.D. from the University of Minnesota in 1948, prior to Air Force LSD and MKULTRA contracts carried out there. He did his psychiatry residency from 1949 to 1952 at Cornell (an MKULTRA Institution and site of the MKULTRA cutout The Human Ecology Foundation). From 1948 to 1956 he was Chief, Psychiatry Service, 3700th USAF Hospital, Lackland Air Force Base, San Antonio, Texas Psychiatrist-in-Chief, University of Oklahoma Consultant in Psychiatry, Oklahoma City Veterans Administration Hospital Consultant in Psychiatry. [...] Dr. West was co-editor of a book entitled Hallucinations, Behavior, Experience, and Theory[285]. One of the contributors to this book, Theodore Sarbin, Ph.D., is a member of the Scientific and Professional Advisory Board of the False Memory Syndrome Foundation (FMSF). Other members of the FMSF Board include Dr. Martin Orne, Dr. Margaret Singer, Dr. Richard Ofshe, Dr. Paul McHugh, Dr. David Dinges, Dr. Harold Lief, Emily Carota Orne, and Dr. Michael Persinger. The connections of these individuals to the mind control network are analyzed in this and the next two chapters. Dr. Sarbin[272] (see Ross, 1997) believes that multiple personality disorder is almost always a therapist-created artifact and does not exist as a naturally-occurring disorder, a view adhered to by Dr. McHugh[188], [189], Dr. Ofshe[213] and other members of the FMSF Board[191], [243]. Dr. Ofshe is a colleague and co-author of Dr. Singer[214], who is in turn a colleague and co author of Dr. West[329]. Denial of the reality of multiple personality by these doctors in the mind control network, who are also on the FMSF Scientific and Professional Advisory Board, could be disinformation. The disinformation could be amplified by attacks on specialists in multiple personality as CIA conspiracy lunatics[3], [79], [191], [213]. The FMSF is the only organization in the world that has attacked the reality of multiple personality in an organized, systematic fashion. FMSF Professional and Advisory Board Members publish most of the articles and letters to editors of psychiatry journals hostile to multiple personality disorder.

Acceptance in the context of adult-to-adult relationships may mean simply acknowledging that the other is the way he or she is, not judging them and not corroding one’s own soul with resentment that they are not different. Acceptance does not mean saintly self-sacrifice or tolerating an eternity of broken promises and hurtful eruptions of frustration and rage. Sometimes a person remains with an addicted partner for fear of the guilt they might experience otherwise. A therapist once said to me, “When it comes to a choice between feeling guilt or resentment, choose the guilt every time.” It is wisdom I have passed on to many others since. If refusal to take on responsibility for another person’s behaviors burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for the guilt. Resentment is soul suicide.

My own odyssey of therapy, over my forty-five-year career, is as follows: a 750-hour, five-time-a-week orthodox Freudian psychoanalysis in my psychiatric residency (with a training analyst in the conservative Baltimore Washington School), a year’s analysis with Charles Rycroft (an analyst in the “middle school” of the British Psychoanalytic Institute), two years with Pat Baumgartner (a gestalt therapist), three years of psychotherapy with Rollo May (an interpersonally and existentially oriented analyst of the William Alanson White Institute), and numerous briefer stints with therapists from a variety of disciplines, including behavioral therapy, bioenergetics, Rolfing, marital-couples work, an ongoing ten-year (at this writing) leaderless support group of male therapists, and, in the 1960s, encounter groups of a whole rainbow of flavors, including a nude marathon group.

Social Skills Training Social skills training is based on the belief that socially anxious people lack certain social skills, such as how to make small talk or introduce themselves to strangers. Therapists think that anxiety would lessen for people if they knew the correct way to behave. In social skills training, you practice techniques such as rehearsal (practicing a certain skill until it becomes comfortable), modeling (imitating others in social situations until the behavior feels natural), and role playing. You also receive homework assignments, such as “This week, talk about the weather with three strangers.” A problem with this type of therapy is that even though many people know how they should act, they can’t do it because of fear, negative thoughts, and avoidance. Although practicing social skills may take away some of the uncertainty, it doesn’t address the deeper issues.

A Final Word Now that you have become familiar with social anxiety, you know that it is a common problem, especially for teenagers. You’ve learned that it affects you physically, mentally, and behaviorally, and that it can have a tremendous impact on all aspects of your life. Most important, you’ve learned ways to cope with social anxiety. Now, make the techniques presented in this book part of your daily life. With practice you will be able to calm anxious feelings and develop self-confidence in social situations. Remember that change does not happen overnight. There will be tough times mixed in with the good. It may be necessary to see a professional therapist or to take medication. There is no reason social anxiety needs to remain a part of your life. If you are committed to lessening your anxiety, you will see great results. With time and hard work, you can become the person you want to be and live a healthy, happy, and productive life.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

The therapist Terry Real described our well-worn behaviors as “our internalized family of origin. It’s our repertoire of relational themes.” People don’t have to tell you their stories with words because they always act them out for you. Often they project negative expectations onto the therapist, but if the therapist doesn’t meet those negative expectations, this “corrective emotional experience” with a reliable and benevolent person changes the patients; the world, they learn, turns out not to be their family of origin. If Charlotte works through her complicated feelings toward her parents with me, she’ll find herself increasingly attracted to a different type, one that might give her the unfamiliar experience she’s seeking with a compassionate, reliable, and mature partner. Until then, every time she meets an available guy who might love her back, her unconscious rejects his stability as “not interesting.” She still equates feeling loved not with peace or joy but with anxiety.

When a person gives attention to unresolved issues of the past, she often must work through resistance and apprehensions. To dismantle rigid defenses, interpret unconscious motives, or reflect on unexplored feelings we must sometimes push the client to the brink of her patience and endurance. She must confront parts of herself that have been deeply buried, and she must risk the consequences of relinquishing coping strategies that have worked fairly well until this point, even with their side effects and collateral damage. There is a risk (or perhaps even a certainty) that some destabilization will occur. In order to attain real growth, the client must often be willing to experience intense confusion, disorientation, and discomfort. She leaves behind an obsolete image of herself, one that was once comfortable and familiar, and she risks not liking the person she will become. She will lose a part of herself that can never be recovered. She risks all this for the possibility of a better existence, and all she has to go on is the therapist’s word.

Some addictions are clear. The homeless woman with the fresh track marks over years of scars. The man who loses his home and car to gambling debts and now is hiding from dangerous creditors. Some addictions are softer, easier to engage in and still get up and function every day. Those of us who take out a bag of chips or tray of muffins after a tough day. Or go shoe shopping for our 8th pair of black sandals that we are never going to wear. There are addictions that excuse us from society altogether, those that keep us barely afloat within it, and those that become a barrier between us and the rest of the world. It’s only a matter of degree, in the end. How do we define when we cross over into addiction territory? As a relationally-trained therapist, my answer is a simple one. When our addiction becomes our primary relationship. Maybe not in our hearts and heads. But in our behaviors, definitely. When we don’t have control over our addictions, we are spending time, resources, and energy on the addiction instead of the people we love. And instead of, let’s face it…ourselves.

I began to see that the stronger a therapy emphasized feelings, self-esteem, and self-confidence, the more dependent the therapist was upon his providing for the patient ongoing, unconditional, positive regard. The more self-esteem was the end, the more the means, in the form of the patient’s efforts, had to appear blameless in the face of failure. In this paradigm, accuracy and comparison must continually be sacrificed to acceptance and compassion; which often results in the escalation of bizarre behavior and bizarre diagnoses. The bizarre behavior results from us taking credit for everything that is positive and assigning blame elsewhere for anything negative. Because of this skewed positive-feedback loop between our judged actions and our beliefs, we systematically become more and more adapted to ourselves, our feelings, and our inaccurate solitary thinking; and less and less adapted to the environment that we share with our fellows. The resultant behavior, such as crying, depression, displays of temper, high-risk behavior, or romantic ventures, or abandonment of personal responsibilities, which seem either compulsory, necessary, or intelligent to us, will begin to appear more and more irrational to others. The bizarre diagnoses occur because, in some cases, if a ‘cause disease’ (excuse from blame) does not exist, it has to be 'discovered’ (invented). Psychiatry has expanded its diagnoses of mental disease every year to include 'illnesses’ like kleptomania and frotteurism [now frotteuristic disorder in the DSM-V]. (Do you know what frotteurism is? It is a mental disorder that causes people, usually men, to surreptitiously fondle women’s breasts or genitals in crowded situations such as elevators and subways.) The problem with the escalation of these kinds of diagnoses is that either we can become so adapted to our thinking and feelings instead of our environment that we will become dissociated from the whole idea that we have a problem at all; or at least, the more we become blameless, the more we become helpless in the face of our problems, thinking our problems need to be 'fixed’ by outside help before we can move forward on our own. For 2,000 years of Western culture our problems existed in the human power struggle constantly being waged between our principles and our primal impulses. In the last fifty years we have unprincipled ourselves and become what I call 'psychologized.’ Now the power struggle is between the 'expert’ and the 'disorder.’ Since the rise of psychiatry and psychology as the moral compass, we don’t talk about moral imperatives anymore, we talk about coping mechanisms. We are not living our lives by principles so much as we are living our lives by mental health diagnoses. This is not working because it very subtly undermines our solid sense of self.

The development of a working alliance is crucial because it addresses a psychic phobia associated with relationships that is common in complex trauma clients. As we discussed, when primary relationships are sources of profound disillusionment, betrayal, and emotional pain, any subsequent relationship with an authority figure who offers an emotional bond or other assistance might be met with a range of emotions, such as fear, suspicion, anger, or hopelessness on the negative end of the continuum and idealization, hope, overdependence, and entitlement on the positive. Therapy offers a compensatory relationship, albeit within a professional framework, that has differences from and restrictions not found in other relationships. On the one hand, the therapist works within professional and ethical boundaries and limitations in a role of higher status and education and is therefore somewhat unattainable for the client. On the other, the therapist's ethical and professional mandate is the welfare of the client, creating a perception of an obligation to meet the client's needs and solve his or her problems. Furthermore, the therapist is expected to both respect the client's privacy and accept emotional and behavioral difficulties without judgment, while simultaneously being entitled to ask the client about his or her most personal and distressing feelings, thoughts and experiences. Developing a sense of trust in the therapist, therefore, is both expected and fraught with inherent difficulties that are amplified by each client's unique history of betrayal trauma, loss, and relational distress.

Cognitive-Behavioral Therapy There are almost no pure cognitive or behavioral therapists. Instead, most therapists use a combination of both techniques. This is known as cognitive-behavioral therapy. It is generally recognized as the best therapy for social anxiety. In cognitive-behavioral therapy, a therapist helps you identity maladaptive thinking patterns and replace them with new ways of thinking. He or she also teaches you relaxation techniques and new behaviors that make you feel more comfortable in social situations. Cognitive-behavioral therapy uses many of the same techniques that we explored in the previous chapter. Although you might make great strides on your own, sometimes it is easier and faster to have someone guide you. Often it is difficult for people to explore hidden beliefs about themselves. A professional therapist is experienced in working with people who are trying to change. Often a therapist will see connections in your situation that you cannot. Carlos was terrified of speaking in class. Whenever the teacher called on him, his heart raced, he blushed, and his stomach felt upset. His therapist first had him focus on his thoughts during class. As an experiment, she had him purposely answer a question incorrectly during biology class. To his surprise, the teacher didn’t make a big deal out of it, and the other students didn’t laugh. As a result, Carlos realized that his imagined consequences for making errors were greatly exaggerated. He also realized that he held himself to a higher standard than other people, including the teacher, did. Next, his therapist showed him various relaxation techniques to lessen the physical symptoms of anxiety. Soon, he felt more comfortable and even volunteered to lead a discussion group.

Virtually every version of CBT for anxiety disorders involves working through what’s called an exposure hierarchy. The concept is simple. You make a list of all the situations and behaviors you avoid due to anxiety. You then assign a number to each item on your list based on how anxiety provoking you expect doing the avoided behavior would be. Use numbers from 0 (= not anxiety provoking at all) to 100 (= you would fear having an instant panic attack). For example, attempting to talk to a famous person in your field at a conference might be an 80 on the 0-100 scale. Sort your list in order, from least to most anxiety provoking. Aim to construct a list that has several avoided actions in each 10-point range. For example, several that fall between 20 and 30, between 30 and 40, and so on, on your anxiety scale. That way, you won’t have any jumps that are too big. Omit things that are anxiety-provoking but wouldn’t actually benefit you (such as eating a fried insect). Make a plan for how you can work through your hierarchy, starting at the bottom of the list. Where possible, repeat an avoided behavior several times before you move up to the next level. For example, if one of your items is talking to a colleague you find intimidating, do this several times (with the same or different colleagues) before moving on. When you start doing things you’d usually avoid that are low on your hierarchy, you’ll gain the confidence you need to do the things that are higher up on your list. It’s important you don’t use what are called safety behaviors. Safety behaviors are things people do as an anxiety crutch—for example, wearing their lucky undies when they approach that famous person or excessively rehearsing what they plan to say. There is a general consensus within psychology that exposure techniques like the one just described are among the most effective ways to reduce problems with anxiety. In clinical settings, people who do exposures get the most out of treatment. Some studies have even shown that just doing exposure can be as effective as therapies that also include extensive work on thoughts. If you want to turbocharge your results, try exposure. If you find it too difficult to do alone, consider working with a therapist.

Kathy’s teachers view her as a good student who always does her homework but rarely participates in class. Her close friends see her as a loyal and trustworthy person who is a lot of fun once you get to know her. The other students in school think she is shy and very quiet. None of them realize how much Kathy struggles with everyday life. When teachers call on her in class, her heart races, her face gets red and hot, and she forgets what she wants to say. Kathy believes that people think she is stupid and inadequate. She imagines that classmates and teachers talk behind her back about the silly things she says. She makes excuses not to go to social events because she is terrified she will do something awkward. Staying home while her friends are out having a good time also upsets her. “Why can’t I just act like other people?” she often thinks. Although Kathy feels isolated, she has a very common problem--social anxiety. Literally millions of people are so affected by self-consciousness that they have difficulties in social situations. For some, the anxiety occurs during very specific events, such as giving a speech or eating in public. For others, like Kathy, social anxiety is part of everyday life. Unfortunately, social anxiety is not an easily diagnosed condition. Instead, it is often viewed as the far edge of a continuum of behaviors and feelings that occur during social situations. Although you may not have as much difficulty as Kathy, shyness may still be causing you distress, affecting your relationships, or making you act in ways with which you are not happy. If this is the case, you will benefit from the advice and techniques provided in this book. The good news is that it is possible to change your thinking and behavior. However, there are no easy solutions. It takes strong motivation and time to overcome social anxiety. It might even be necessary to see a professional therapist or take medication. Eventually, becoming free of your anxiety will make the hard work well worth the effort. This book will help you understand social anxiety and the impact it can have on your life, now and in the future. You will find out how the disorder is diagnosed, you will receive information on professional guidance, and you will learn ways to cope with and manage the symptoms. Becoming an extroverted person is probably unlikely, but you can become more confident in social situations and increase your self-esteem.

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

Whenever Jane asked about his “squirrelly” behavior, Ryan accused her of being insecure, paranoid, crazy, and having major trust issues. He would flat out deny that he was hiding his phone and sending other women flirty messages, and he would tell Jane that she needed to see a therapist.

Think of him as an addict," said her new therapist in one of Selena's individual sessions. This doctor had fewer excuses for Graham. "His behavior is something outside of you that you don't control and can't fix. Don't hang your worthiness on his failings. But now you have to decide where your boundaries are, what you will and will not tolerate. Every marriage is a negotiation. Both parties have to obey the terms.

identifying his in-the-moment feelings, because feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them.

me a site visit in Seattle. Barry remembers the visit. “The committee were Hans Strupp, from Vanderbilt, who was one of the premier researchers from the psychoanalytic point of view, and Maria Kovacs, a child behavior therapist at University of Pittsburgh, very prominent.” These visitations can be quite intimidating, especially with scholars of that caliber. And for me, this was a big one. I was so nervous that I dropped a pot of coffee in my office. It went everywhere, a terrible mess. Did they want me to make another pot? I asked sheepishly. No, they did not! It was “Let’s get on with business here.” They discussed whether

He watched me grieve and he didn’t try to make things more comfortable by interrupting or analyzing the issue. He let me tell the story in whatever way I needed to say" "Of course, there are times when something just isn't right between therapists, and patient, when the therapist's countertransference is getting in the way. One sign: having negative feelings about the patient". "Our experiences with this person are important because we're probably feeling something very similar to what everyone else in these patients' life feels." "If you expect an hour of sympathetic head nodding, you've come to the wrong place. Therapist will be supportive, but our support is for your growth, not for our low opinion of your partner (our role is to understand your perspective but not necessarily endorse it)" "A therapist will hold up the mirror in the most compassionate way possible, to stare back at it and say "oh isn’t that interesting? Now what instead of turning away?" "The therapist explained that often-different parts of ourselves want different things and if we silence the parts we find unacceptable they'll find other ways to be heard." "So many of our destructive behaviors take root in an emotional void, an emptiness that calls out of something to fill it." "Whenever one person in the family system starts to make changes, even if the changes are healthy or positive, it's not unusual for other members in this family to do everything they can do to maintain the status quo and bring things back to homeostasis." "Once we know what we are feeling we can make choices about where we want to go with them. But if we push them away the second they appear, often we end up veering off in the wrong direction, getting lost yet again in the land of chaos." "I know that therapy won't make all my problems disappear, prevent new ones from coming, or ensure that Ill always act from a place of enlightenment. Therapists don’t perform personality transplants; they just help to take the sharp edges off. Therapy is about understanding the self that you are. But part of getting to know yourself is to unknown yourself- let go of the limiting stories you've told yourself about who you are, so that you aren’t trap by them, so that you can live your life and not the story you've been telling yourself about your life." "The noonday demon: "The opposite of depression isn't happiness but vitality" "We marry our unfinished business" "Babies can die from lack of touch, and so can adults (adults who are touched regularly live longer). There is even a name for this condition: skin hunger" "What most people mean by type is a sense of attraction a type of physical appearance or a type of personality turns them on. But what underlies a person's type, in fact, is a sense of familiarity, It is not coincidence that people who had angry parents, often end up choosing angry partners.

But Fiona had known even before she’d gone to a therapist or taken medications that no medical plan would work. Her behaviors had arisen purely and completely from the guilt and shame in what she’d done to Lana. After all, they hadn’t existed before Lana—not even when Lana’s teasing was at its worst.

Convinced that our lives are not our own, we become alienated from our inner sense of what is true and appropriate for us. We become experts at watching the way others live and we shape our lives accordingly. From talk show hosts, to therapists and trainers, to the countless apps and experts we consult to design our experience, everyone knows better than we do. Consequently, we have spent lifetimes trying to fit into someone else’s idea of what is right for us: assembling our bodies according to society’s formula of the perfect woman, forming our thoughts and opinions to suit the audience, limiting our feelings to what’s acceptable, and formulating our behavior and actions according to the expectations of others. We have become emotionally crippled as a result of habitually abandoning ourselves into the shapes of others. Each surrender of our feelings, truth, and originality becomes a mini-abdication of who we are.

Some of the prominent ones that have been particularly useful for many trauma survivors include dialectical behavior therapy for borderline personality (Linehan, 1993); systems training for emotional predictability and problem solving (STEPPS; Blum et al., 2008; Bos, Van Wel, Appelo, & Verbraak, 2010 also for borderline personality; short-term psychodynamic treatment of affect phobia (McCullough et al., 2003); and mindfulness and mentalization-based treatments such as acceptance and commitment therapy (ACT; Follette & Pistorello, 2007). In the past decade, manuals that specifically address the

I did it because I love her.” That explanation is given for all kinds of actions. A politician is involved in an adulterous relationship, and he calls it love. The preacher, on the other hand, calls it sin. The wife of an alcoholic picks up the pieces after her husband’s latest episode. She calls it love, but the psychologist calls it codependency. The parent indulges all the child’s wishes, calling it love. The family therapist would call it irresponsible parenting. What is loving behavior?

In the beginning of their relationships, both short term and long term, the AVP seems to welcome assistance. As time progresses, they can see these same helpers as incompetent. This could be from a spouse helper to a therapist. When this occurs, passive–aggressive displays can be apparent, subsequent to distancing from a given relationship.

Some couples therapists even postulate that 90 percent of our behavior comes from our past experiences.

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment. If we have a choice between believing one of two things, both of which we have evidence for—I’m unlovable, I’m lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations

Yet another pitfall of language is the illusion that our thinking can easily be corrected if it doesn’t “make sense.” The “cognitive” part of cognitive behavioral therapy focuses on changing such “dysfunctional thinking.” This is a top-down approach to change in which the therapist challenges or “reframes” negative cognitions, as in “Let’s compare your feelings that you are to blame for your rape with the actual facts of the matter” or “Let’s compare your terror of driving with the statistics about road safety today.” I’m reminded of the distraught woman who once came to our clinic asking for help with her two-month-old because the baby was “so selfish.” Would she have benefited from a fact sheet on child development or an explanation of the concept of altruism? Such information would be unlikely to help her until she gained access to the frightened, abandoned parts of herself—the parts expressed by her terror of dependence. There is no question traumatized people have irrational thoughts: “I was to blame for being so sexy.” “The other guys weren’t afraid—they’re real men.” “I should have known better than to walk down that street.” It’s best to treat those thoughts as cognitive flashbacks—you don’t argue with them any more than you would argue with someone who keeps having visual flashbacks of a terrible accident. They are residues of traumatic incidents: thoughts they were thinking when, or shortly after, the traumas occurred that are reactivated under stressful conditions.

Remember, we have to model the behavior we want our kids to learn. So if you refuse to ask for directions when you’re obviously lost, what does that tell them? If you refuse to admit you don’t know something, and you make up an answer to a question instead of looking it up with them, what does that show them about learning and problem-solving? Why would they be okay being vulnerable with a doctor or a therapist, with Mom and Dad, if they have been regularly shown that this is something to be ashamed of?

In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this: Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance So let’s say you want to make a change—exercise more, end a relationship, or even try therapy for the first time. Before you get to that point, you’re in the first stage, pre-contemplation, which is to say, you’re not even thinking about changing. Some therapists might liken this to denial, meaning that you don’t realize you might have a problem. When Charlotte first came to me, she presented herself as a social drinker; I realized that she was in the pre-contemplation stage as she talked about her mother’s tendency to self-medicate with alcohol but failed to see any connection to her own alcohol use. When I challenged her on this, she shut down, got irritated (“People my age go out and drink!”), or engaged in “what-aboutery,” the practice of diverting attention from the difficulty under discussion by raising a different problematic issue. (“Never mind X, what about Y?”)

He’d given me permission to feel and also a reminder that, like so many people, I’d been mistaking feeling less for feeling better. The feelings are still there, though. They come out in unconscious behaviors, in an inability to sit still, in a mind that hungers for the next distraction, in a lack of appetite or a struggle to control one’s appetite, in a short-temperedness, or—

So they sit on the therapist’s couch and look up expectantly, hoping to find some understanding and, eventually (but preferably immediately), a cure. But therapists don’t have an immediate cure because these people are complete strangers to us. We need time to acquaint ourselves with their hopes and dreams, their feelings and behavior patterns, sometimes more deeply than even they have. If it takes from birth to the day they arrive in our offices to develop whatever is troubling them or if a problem has been incubating for many months, it makes sense that they might need more than a couple of fifty-minute sessions to attain the desired relief.

like so many people, I’d been mistaking feeling less for feeling better. The feelings are still there, though. They come out in unconscious behaviors, in an inability to sit still, in a mind that hungers for the next distraction, in a lack of appetite or a struggle to control one’s appetite, in a short-temperedness, or—in Boyfriend’s case—in a foot that twitched under the covers as we sat in that heavy silence under which lay the feeling that he’d kept to himself for months: whatever he wanted, it wasn’t me.

If the eating disorder is concretized by the "not-me" ED, the patient is allowed the safety to look around comers, to follow this "other self' into the kitchen; the bathroom; yes, even the bedroom; to observe. Shame and blame are reduced; curiosity is enhanced. Conceptually this is interesting. Many patients are able to observe once allowed to look. They know well who they are at these moments. Relationally, however, they have never been entitled to look, and, as a result, self-observation and understanding have been thwarted by relational constraints and consequent immediate behavioral enactments. Ongoing, the patient is asked to consider what alternative behaviors can replace eating, purging or restricting. If the patient weren't thinking about food or weight, what else would she be thinking about? What else is needed? As the patient begins to consider concrete alternatives to symptomatic behavior, "contracts" are developed between patient and therapists.

The golden rule for supporting a family member with OCD is to remain a family member. You’re not her therapist, and it’s unlikely to benefit her if you try to be. Your family member with OCD actually relies on family support more than you might think. Though her struggle with OCD is an inwardly lonely journey—even others with OCD can’t understand exactly what it’s like for her—it shouldn’t be an outwardly lonely one. Your family member with OCD should see family and home as a place to come back to after therapy and feel close to her loved ones. If you act as though you’re her therapist, it will create distance between you. Then she may feel alone both inside and out. So be a mom, be a dad, be a brother, be a sister, be a son or daughter to your loved one with OCD.

In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are egodystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

Is pathological anxiety a medical illness, as Hippocrates and Aristotle and modern pharmacologists would have it? Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it? Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes would have it? Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? Or, finally, is it—as W. H. Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?

The most reliable sign, the most universal behavior of unscrupulous people is not directed, as one might imagine, at our fearfulness. It is, perversely, an appeal to our sympathy.” - Martha Stout, The Sociopath Next Door

My therapist helped me realize that I was more than my bad decisions or disrespectful language, and I knew that I wanted to be like her when I grew up. I

Prochaska developed the transtheoretical model of behavior change (TTM)

always working with John on identifying his in-the-moment feelings, because feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them. But if we push them away the second they appear, often we end up veering off in the wrong direction, getting lost yet again in the land of chaos.

Many parents, therapists, and teachers have said some variations of “But he already knows how to behave!” or “If he can behave at school, he can behave at home!”. We must realize that this is false. Your child’s ability to act appropriately hinges on their current state, skills, and available resources at that specific moment. If they could, they would.

Everything we therapists do or say or feel as we sit with our patients is mediated by our histories; everything I’ve experienced will influence how I am in any given session at any given hour. The text I just received, the conversation I had with a friend, the interaction I had with customer service while trying to resolve a mistake on my bill, the weather, how much sleep I’ve gotten, what I dreamed of before my first session of the day, a memory inspired by a patient’s story, will all influence my behavior with my patient.

Think of him as an addict,” said her new therapist in one of Selena’s individual sessions. This doctor had fewer excuses for Graham. “His behavior is something outside of you that you don’t control and can’t fix. Don’t hang your worthiness on his failings. But now you have to decide where your boundaries are, what you will and will not tolerate. Every marriage is a negotiation. Both parties have to obey the terms.

authentic. They are comfortable with intimacy and with engaging in behaviors that promote it, such as giving and receiving support and being vulnerable. Terry Real, a therapist and author, was right when he wrote in his book How to Get Through to You, “Sustaining relationships with others requires a good relationship to ourselves. Healthy self-esteem is an internal sense of worth that pulls one neither into ‘better than’ grandiosity nor ‘less than’ shame.

, Dr Vanessa Jones is a Clinically Certified Juvenile Sex Offender Treatment Specialist, and a Clinically Certified Juvenile Treatment Specialist. She is also a Certified Cognitive Behavioral Therapist in Youngstown, Ohio.

Your five-year-old son wanders around his kindergarten classroom distracting other kids. The teacher complains: he can’t sit through her scintillating lessons on the two sounds made by the letter e. When the teacher invites all the kids to sit with her on the rug for a song, he stares out the window, watching a squirrel dance along a branch. She’d like you to take him to be evaluated. And so you do. It’s a good school, and you want the teacher and the administration to like you. You take him to a pediatrician, who tells you it sounds like ADHD. You feel relief. At least you finally know what’s wrong. Commence the interventions, which will transform your son into the attentive student the teacher wants him to be. But obtaining a diagnosis for your kid is not a neutral act. It’s not nothing for a kid to grow up believing there’s something wrong with his brain. Even mental health professionals are more likely to interpret ordinary patient behavior as pathological if they are briefed on the patient’s diagnosis.[15] “A diagnosis is saying that a person does not only have a problem, but is sick,” Dr. Linden said. “One of the side effects that we see is that people learn how difficult their situation is. They didn’t think that before. It’s demoralization.” Nor does our noble societal quest to destigmatize mental illness inoculate an adolescent against the determinism that befalls him—the awareness of a limitation—once the diagnosis is made. Even if Mom has dressed it in happy talk, he gets the gist. He’s been pronounced learning disabled by an occupational therapist and neurodivergent by a neuropsychologist. He no longer has the option to stop being lazy. His sense of efficacy, diminished. A doctor’s official pronouncement means he cannot improve his circumstances on his own. Only science can fix him.[16] Identifying a significant problem is often the right thing to do. Friends who suffered with dyslexia for years have told me that discovering the name for their problem (and the corollary: that no, they weren’t stupid) delivered cascading relief. But I’ve also talked to parents who went diagnosis shopping—in one case, for a perfectly normal preschooler who wouldn’t listen to his mother. Sometimes, the boy would lash out or hit her. It took him forever to put on his shoes. Several neuropsychologists conducted evaluations and decided he was “within normal range.” But the parents kept searching, believing there must be some name for the child’s recalcitrance. They never suspected that, by purchasing a diagnosis, they might also be saddling their son with a new, negative understanding of himself. Bad

We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others.

Participants whose postures had been mimicked—even when they had not consciously noticed the mimicry—later reported having a more favorable impression of the person doing the imitation. Therapists know well that clients often rate their counselor more highly when the counselor has mimicked the client’s postures. And identification or a desire to affiliate with an individual increases the degree of behavioral mimicry.

Her therapist, Christian, would tell her to challenge the thought to use. To stop, take a moment, and analyze the error in it.

The British Association of Art Therapists defines art therapy as: ...a form of psychotherapy that uses art media as its primary mode of communication. It is practised by qualified, registered Art Therapists who work with children, young people, adults and the elderly.[4] Clients who can use art therapy may have a wide range of difficulties, disabilities or diagnoses. These include, for example, emotional, behavioral or mental health problems, learning or physical disabilities, life-limiting conditions, brain-injury or neurological conditions and physical illness.

Touching Like nodding, touching shows interest. Upon meeting someone, the best way to show respect and sincere interest is to shake hands. A warm, firm handshake shows that you have an open, friendly social attitude. Don’t be afraid to be the first to smile, offer your name, and extend your hand—people will appreciate your interest and willingness to connect. With whom should you shake hands? These days, it’s appropriate to shake hands man to man, woman to woman, or man to woman—in both social and business contexts while exchanging names with other people. (Of course, a man should use a slightly gentler grip when shaking a woman’s hand.) A number of clients who have come to me say that their previous therapists or their parents have advised them to take a dance class in order to gain interactive skills and desensitize themselves to social anxiety. That’s a good idea. But it’s not that simple. The ideal situation would be one in which you could progress through the various levels of intimacy at a natural pace in an actual interactive situation. Developing a keen sense of interactive chemistry will help you to understand what type of touching behavior is appropriate. As for other, more personal forms of touch, these should be undertaken more cautiously, and with keen attention to the body language of the other person. When it seems appropriate, gestures such as taking someone’s arm or offering your own as you enter or leave a room or cross the street, touching a companion’s back as you introduce him or her to an acquaintance—all of these are fairly noncommittal, but are a display of caring and interest. When you try these things, take special note of the response you get. Remember that body language involves communication between two people. Not only do you need to give signals of friendliness and approval but also to take cues from the other person involved.

Children don't learn from lessons or teaching. They learn from what we honestly have to say about our feelings, and they learn from our behavior.

I could stay bitter about all that now, or I could accept it and my behavior as that of a survivalist. That’s what my therapist in San Francisco helped me realize—that what I was doing while being subjected to my parents’ abuse was surviving. I tried to do the best for me and my sister. The best that I knew how to do in order to cope. That included lying. That included overeating. That included some mean and awful behavior toward Amy and others.

orking with serious mental illness, criminal behavior and substance addiction over the years has forced us to travel into interpersonal realms where few have gone. Over and over, we have had to face our own feelings of vulnerability, helplessness, fear and despair, only to find that, in the end, there is hope. Our experiences, although sometimes terrifying, compelled us to look deep inside ourselves, where we found an unexpected peace. It is through this upheaval and self-scrutiny that we have come to know joy. As therapists, it was a surprise to find out that so much of what we learned academically had so little to do with the reality of working with severely disturbed people. Not once during our academic careers were we ever realistically prepared for the roller-coaster nature of the professional path we were setting out on. We were not told of the horror, the helplessness or the elation we would feel in treating maladies of the human heart. So, when we launched our practice, it was trial by fire. When

orking with serious mental illness, criminal behavior and substance addiction over the years has forced us to travel into interpersonal realms where few have gone. Over and over, we have had to face our own feelings of vulnerability, helplessness, fear and despair, only to find that, in the end, there is hope. Our experiences, although sometimes terrifying, compelled us to look deep inside ourselves, where we found an unexpected peace. It is through this upheaval and self-scrutiny that we have come to know joy. As therapists, it was a surprise to find out that so much of what we learned academically had so little to do with the reality of working with severely disturbed people. Not once during our academic careers were we ever realistically prepared for the roller-coaster nature of the professional path we were setting out on. We were not told of the horror, the helplessness or the elation we would feel in treating maladies of the human heart. So, when we launched our practice, it was trial by fire. When we were finally faced with patients in the depths of despair or the throes of violence-a humbling experience-we learned we had to drop the professional persona and rely on our own intuition. There

The United States alone sports an inventive spectrum of psychotherapeutic sects and schools: Freudians, Jungians, Kleinians; narrative, interpersonal, transpersonal therapists; cognitive, behavioral, cognitive-behavioral practitioners; Kohutians Rogerians, Kernbergians; aficionados of control mastery, hypnotherapy, neurolingustic programming, eye movement desensitization- that list does not even complete the top twenty. The disparate doctrines of these proliferative, radiating divisions, often reach mutually exclusive conclusions about therapeutic propriety: talk about this, not that; answer questions, or don’t; sit facing the patient, next to the patient, behind the patient. Yet no approach has ever proven its method superior to any other. Strip away a therapist’s orientation, the journal he reads, the books on his shelves, the meetings he attends- the cognitive framework his rational mind demands – and what is left to define the psychotherapy he conducts? Himself. The person of the therapist is the converting catalyst, not his order or credo, not his spatial location in the room, not his exquisitely chosen words or denominational silences. So long as the rules of a therapeutic system do not hinder limbic transmission - a critical caveat - they remain inconsequential, neocortical distractions. The dispensable trappings of dogma may determine what a therapist thinks he is doing, what he talks about when he talks about therapy, but the agent of change is who he is.

Simon Baron-Cohen, The Science of Evil; Judith Beck, Cognitive Behavior Therapy; Louis Cozolino, The Making of a Therapist; Kevin Dutton, The Wisdom of Psychopaths; James Fallon, The Psychopath Inside; Peter and Ginger Ross Breggin, Talking Back to Prozac; Robert D. Hare, Without Conscience; Kent Kiehl, The Psychopath Whisperer; Jane McGregor and Tim McGregor, The Sociopath at the Breakfast Table; J. Reid Meloy, The Psychopathic Mind; Dinah Miller, Annette Hanson, and Steven Roy Daviss, Shrink Rap; Daniel Smith, Monkey Mind; Scott Stossel, My Age of Anxiety; Martha Stout, The Sociopath Next Door; M. E. Thomas, Confessions of a Sociopath; and Robert Whitaker, Mad in America.

Marco, remember early on when we discussed your frustration, and you determined that it was the defender part that wanted you to get back into the game of life? And that your anxiety was your fear-based defender part that was alerting you of the impending doom if you slipped and went back to your inappropriate behaviors? Or how about when the depression part stepped in, and you resolved that it was a reminder of your past actions? These are the physical symptoms of the defender parts.” I felt that if a light bulb was hanging over my head, it had now lit up. I was impressed with Keith’s memory of what I had said and the affection in his tone. At this moment, I trusted my therapist implicitly— he was the real deal. “Marco, identifying the defender part’s physical symptoms first is key to acknowledging when that part is coming in to control a situation or thought and identifying which one it is. Catching the defender part at this point is crucial to prevent it from starting to control the situation in an unhealthy manner or overwhelming your emotions with negative judgments.

general principle of human behavior is that it’s easier for us to see something negative in other people than in ourselves. This mental process sometimes guides therapists when they make interpretations during treatment. Often, the traits that disturb us most in others are those that we ourselves

The success of cognitive behavioral therapy is well known; many people consider it the most effective therapy for depression. What is not widely known, at least in the United States, is that you don’t need a therapist to do it. Scores of studies have found that online C.B.T. works as well as conventional face-to-face cognitive behavioral therapy – as long a there is occasional human support or coaching. “For common mental disorders like anxiety and depression, there is no evidence Internet-based treatment is less effective than face-to-face therapy,” said Pim Cuijpers, professor of clinical psychology at the Vrije Universiteit Amsterdam and a leading researcher on computer C.B.T.

But there is another variety of the older child that gets ugly. This is the child who is being resistant in an “eff you” kind of way. This child will look right at you while he’s peeing on the floor. You will know if you have this variety. It will feel aggressive, and you will feel hostage to your child. This behavior needs to be addressed head on. This is not funny and can lead to serious issues later on. You must deal with this as behavior and behavior only. Do whatever you would do as if he looked you right in the eyes and said, “Eff you.” ’Cause that’s kind of what he’s doing. I highly suggest contacting a family therapist if this is happening. This actually is not at all about potty training. I do think it’s serious, and I do think you should seek help and not take it lightly. Bottom line: when you have a child over three, potty training needs to be addressed in a very straightforward manner. It needs to be done, and done now, at almost any cost. The child over three is much more likely to have bigger problems. I know so many parents are fearful of seeming “hard-core”—they don’t want to traumatize their kid. I get that, totally. I never want to see a kid traumatized, either. But in my humble opinion, getting kicked out of kindergarten for potty training issues is a lot more traumatizing than having parents who are super strict now.

FEEL, THINK, ACT. Simply

Your absolute Desire to change, Your mindful Discipline to daily, consistently implementing the process and  Your ongoing total Commitment to your desired change. You will need to be totally committed to spending at least one minute a day, or more if needed, to consciously change and/or maintain your desired change(s). Change

Ready? Here you should have said, “Yes." Out loud. Here we go.  How much is 1 +1? Your answer? How much is 2+2? How much is 100-35? Do it in your head. How much us 236-137? Do this one in your head no matter how long it takes. Are you ready? Say the resulting number backwards. Now multiply it by three. And here my friends is your AHA moment. Please

The therapy thus starts by identifying negative appraisals, memories, trigger stimuli, and cognitive and behavioral factors that preserve symptoms. Then the therapist helps the client modify the excessive negative appraisals, elaborate the memories, discriminate triggers that lead to reexperiencing them, and eliminate cognitive and behavioral avoidance.

This stage is hard because the behaviors people want to modify are embedded in the fabric of their lives; people with addiction issues (whether that addiction is to a substance, drama, negativity, or self-defeating ways of being) tend to hang out with other addicts.

Borderline patients need to know that making contact is the healthy part of them; it is not their needs that make others turn away but their uncontrollable demands. In conjoint treatment, the process is to wean patients from blaming and attacking defenses and demanding behaviors (the infantile part of themselves), and slowly enable them to contain their own anxieties by facing their internal deficits. The therapist might say, “If you act like a baby then you will get treated like one and end up feeling more abandoned and left out.

When we only saw each other at weekends, we were on our best behavior, not wanting to spoil the time we had together. We didn’t really know each other. It’s only now that we’re discovering each other’s faults and weaknesses.

Deborah C Weisberg is a Marriage & Family Therapist , LMFT, LPCC, and is based out of Los Angeles, California, United States. Deborah specializes in the counseling of Grief, Relationship Issues, Anxiety, etc. The therapist has experience in handling cases of Anger Management, Behavioral Issues, Bipolar Disorder, Borderline Personality, Career Counseling, Child or Adolescent, Codependency, Depression, Divorce, Domestic Violence, Emotional Disturbance, Family Conflict, Infidelity, Marital and Premarital, Men's Issues, Narcissistic Personality, Parenting, Peer Relationships, Self Esteem, Suicidal Ideation, Transgender, Trauma and PTSD, Women's Issues, and more.

her takes a good deal of clinical experience. More importantly, the therapist needs to have worked deeply with her own early life experiences, and has to actively work with it throughout the life span. A successful therapeutic relation precipitates emotional growth not only in the patient but also in the therapist. Sieff refered to the fact that short-term cognitive behavioral therapy (CBT) is currently very popular and widely used. Can it help with healing relational trauma? Schore answered that CBT is grounded in cognitive psychology, and its research base is grounded cognitive processes such as explicit memory, rational thought, language, and effortful conscious control. Cognitively based therapy’s basic theoretical assumption is grounded in the assumption that we can change how we feel by consciously changing how we think and what we believe. This means that cognitive therapy focuses on language and thought, both of which are located in the left brain. People who have trouble regulating their emotions typically have a left brain that is already more developed than their right brain, and they may well have learned to use rational thinking and words to obscure the deeper emotional experiences and to keep them dissociated. Cognitive therapy may strengthen the very strategies that keep the affect dampening defense of dissociation in place. Even if the left brain becomes more able to control the emotions of the right brain, it can only control emotional arousal that is of low or moderate intensity. As a rule, when emotional arousal reaches a certain level of intensity the left brain goes off-line and the right brain becomes dominant. Changes made in the cognitive strategies of the left brain are unavailable when this happens. At these times, emotionally-focused therapy may enhance the neural connections between the right amygdala and the right orbifrontal cortex which allows the patient to more effectively tolerate and regulate intense emotions. Cognitive therapy which exclusively focuses on the ability of the left brain to control the right cannot directly alter changes within the right-lateralized limbic system. The

Like many people who are made different, either in the womb or because they grew up in a dysfunctional home, Helen had spent a lifetime puzzling through all the reasons she had been arbitrarily rejected by others. Therapists often identify this particular behavioral syndrome with individuals who are weak and obsessed with concerns that are of no consequence. Nothing could be further from the truth. The only reason most of these individuals become survivors and not suicides or serial killers is because they finally figure out that the world did a number on them and their rejection is undeserved and is on the world and not on them. “Run the tape backward,” Helen said. “She’s rebellious over issues nobody cares about. She

A lifetrap is a pattern or theme that starts in childhood and repeats throughout life. The theme might Abandonment or Mistrust or Emotional Deprivation or any of the others we described. The end result is that, as an adult, we manage to recreate the conditions of our childhood that were most harmful to us. A life-trap is self-destructive. This self-defeating quality is what makes lifetraps so poignant for us as therapist to watch. We see someone like Patrick get abandoned again, or someone like Madeline get abused. Patients are drawn to situations that trigger their lifetraps, like moths to flame. A lifetrap damages our sense of self, our health, our relationships with others, our work, our happiness, our moods - it touches every aspect of our lives. A lifetrap struggles hard for survival. We feel a strong push to maintain it. This is part of the human drive for consistency. the lifetrap is what we know. Although it is painful, it is comfortable and familiar. It is therefore very difficult to change. Furthermore, our lifetraps were usually developed when we were children as appropriate adaptations to the family we lived in. These patterns were realistic when we were children; the problem is that we continue to repeat them when they no longer serve a useful purpose.

Step 2: Understand the childhood origins or your lifetrap. Fee the wounded child inside of you: To feel your lifetrap, you will need to remember your childhood. We will ask you to close your eyes and let the images come. DO not force the images - just let one rise to the top of mind. Get into each one as deeply as you can. Try to picture these early memories as vividly as possible. If you do this a few times, you will begin to remember what you felt as a child. You will feel the pain or emotions connected with your lifetrap. This kind of imagery is painful. If you feel completely overwhelmed or frightened by the experience, that is a sign you need therapy. Your childhood was so painful that you should not remember it alone. You need a guide, an ally. A therapist can be this for you. Giving comfort to your inner child, offering guidance and advice, and empathizing with how the child feels are some of the things we will ask you to do. Even though these exercises may seem silly or uncomfortable to you at first, we have found that most people benefit enormously from them.

Step 2: Understand the childhood origins of your lifetrap and feel the wounded child inside of you: To feel your lifetrap, you will need to remember your childhood. We will ask you to close your eyes and let the images come. Do not force the images – just let one rise to the top of your mind. Get into each one as deeply as you can. Try to picture these early memories as vividly as possible. If you do this a few times, you will begin to remember what you felt as a child. You will feel the pain or emotions connected with your lifetrap. This kind of imagery is painful. If you feel completely overwhelmed or frightened by the experience, that is a sign you need therapy. Your childhood was so painful that you should not remember it alone. You need a guide, an ally. A therapist can be this for you. Giving comfort to your inner child, offering guidance and advice, and empathizing with how the child feels are some of the things we will ask you to do. Even though these exercises may seem silly or uncomfortable to you at first, we have found that most people benefit enormously from them.

Steps to changing your subjugation lifetrap 7. Pull back from relationships with people who are too self-centred or selfish to take your needs into account. Avoid one-sided relationships. Change or get out of relationships where you feel trapped. When we first started as therapists, our tendency was to try to preserve every relationship in the patient’s life. If the patient was married, our impulse was to try to preserve the marriage. If the patent was having a love affair, our impulse was to try to preserve the affair. But we no longer feel that relationships should be preserved at all costs. Some relationships are simply too damaging, and have too few prospects for change. There will be some people in your life who will refuse to adjust to your attempt to balance the relationships. If you are married or if they are part of your family, you can give them every opportunity to change. But if, in the final analysis, they will not change, then you have to pull back from the relationship. You may even have to end it.

I felt comfortable letting him correct my behavior, but I also felt okay pushing back on him and telling him when he was being too much. — At my second session, I brought up the fact that he was entirely different from the therapists I’d seen before. “It’s because I hated being the patient of therapists like that,” he admitted. “It terrified me. It didn’t ever make me feel safe. You have to be aware of how big a power difference there is between patient and therapist. And if you really want to work effectively with people, you have to keep surrendering your power. And that means being humble and making mistakes and fumbling and being comfortable with that.

Behavioral marital therapy is a relatively brief treatment in which the therapist meets regularly with the depressed person and his or her partner. In the first phase of treatment, the therapist tackles the biggest strains on the relationship and helps the couple have more positive interactions. The couple may be given a homework assignment to figure out what activity they have enjoyed doing together in the past and then going ahead and doing it. When this phase is successful, the depressed person is already feeling brighter and both partners are expressing positive feelings toward each other. This boost serves as the foundation for the second phase, whose aim it is to restructure the relationship—for example, to improve the way that the couple communicates, handles problems, and interacts on a daily basis. Sometimes this is done by having the couple write a behavioral “contract,” agreeing to change aspects of their behavior. When successful, this phase will leave the couple feeling more supportive and sensitive to each other’s needs, more intimate, and better able to cope with future difficulties. Finally, in the third phase, the therapist helps the two partners prepare for stressful situations that might come to pass and encourages them to attribute their improvement in therapy to their love and caring for each other. Interestingly, behavioral marital therapy has been found to be at least as effective as individual therapy at lifting depression. However, it has the additional benefit of bolstering marital satisfaction. Indeed, a number of studies have shown that the boost in marital happiness (or favorable changes in the marriage related to that boost) is in fact the reason that the marital therapy works.

Anyone who has taken an introductory psychology course has likely encountered the developmental-stage models posited by Freud, Jung, Erikson, Piaget, and Maslow. But there’s one stage model I keep in mind nearly every minute of every session—the stages of change. If therapy is about guiding people from where they are now to where they’d like to be, we must always consider: How do humans actually change? In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this: Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance

For those who are doing distance therapy, we are missing essential data and cues that were previously available to us: a client’s posture, scent, what the hands and feet are doing, where the person sits in the room, or who else is listening to the session. In addition, some of the most crucial parts of therapeutic change used to take place during the commute to and from sessions when clients would review and rehearse what they wanted to talk about, as well as the kaleidoscope of thoughts, feelings, and reactions that took place on the trip home

Some of us are at war everyday. Trying to convince other people not to do stupid things, that may results to danger, harm or death.

I’d been mistaking feeling less for feeling better. The feelings are still there, though. They come out in unconscious behaviors, in an inability to sit still, in a mind that hungers for the next distraction, in a lack of appetite or a struggle to control one’s appetite, in a short-temperedness,

As a couples therapist, I have three sources of information: what the partners report about themselves and each other, how they behave in front of me, and how I feel witnessing their behavior.

When man is less than fully man—when he denies to awareness various aspects of his experience—then indeed we have all too often reason to fear him and his behavior, as the present world situation testifies. But when he is most fully man, when he is his complete organism, when awareness of experience, that peculiarly human attribute, is most fully operating, then he is to be trusted, then his behavior is constructive. It is not always conventional. It will not always be conforming. It will be individualized. But it will also be socialized.

The machine takes all of these multitudinous pulls and forces which are fed in as data, and quickly computes the course of action which would be the most economical vector of need satisfaction in this existential situation. This is the behavior of our hypothetical person. The defects which in most of us make this process untrustworthy are the inclusion of information which does not belong to this present situation, or the exclusion of information which does. It is when memories and previous learnings are fed into the computations as if they were this reality, and not memories and learnings, that erroneous behavioral answers arise. Or when certain threatening experiences are inhibited from awareness, and hence are withheld from the computation or fed into it in distorted form, this too produces error. But our hypothetical person would find his organism thoroughly trustworthy, because all of the available data would be used, and it would be present in accurate rather than distorted form. Hence his behavior would come as close as possible to satisfying all his needs—for enhancement, for affiliation with others, and the like.

What If I Love Someone With a Serious Trauma History? This is seriously tough, isn’t it? You have someone that you care about so much that is really struggling with their trauma recovery. You want to HELP. And feeling unable to do so is the worst feeling in the world. You’re at risk of serious burnout and secondary traumatization. Because yeah, watching someone live out their trauma can be a traumatic experience in and of itself. Two things to remember, here: This is not your battle. …but people do get better in supportive relationships. This is not your battle. You don’t get to design the parameters, you don’t get to determine what makes something better, what makes something worse. No matter how well you know someone, you don’t know their inner processes. They may not even know their inner processes. If you know someone well, you may know a lot. But you aren’t the one operating that life. Telling someone what they should be doing, feeling, or thinking, won’t help. Even if you are right. Even if they do what you say…you have just taken away their power to do the work they need to do to take charge of their life. There are limits to how much better they can really be if they are continually rescued by you. …but people do get better in supportive relationships. The best thing to do is to ask your loved one how to best support them when they are struggling. This is the type of action plan you can create with a therapist (if either or both of you are seeing one) or ask them in a private conversation. Ask them. Ask if they want help grounding when they are triggered, if they need time alone, a hot bath, a mug of tea. Ask what you can do and do those things, if they are healthy things to provide. It may be helpful for them to have a formal safety plan for themselves (there are resources for sample safety plans at the end of this book), with what your specific role will be. This will help boundary your role, and keep you from setting up scenarios when you rescue or enable dangerous and/or self-sabotaging behavior. You may need to set hard limits. You may need to protect yourself. This isn’t just for your well-being, but will help you model the importance of doing so to your loved one. Love the entirety of them. Remind them that their trauma doesn’t define them. Allow them consequences of their behavior and celebrate the successes of newer, healthier ways of being. Be the relationship that helps the healing journey.

On the other hand, if the individual were in Self, he might just say, "Hmmm, that person seems very distracted today and didn't even notice me." This verbal dimension of a part is a favorite area for cognitive behavioral therapists to explore. They look for automatic irrational thoughts that arise when we interpret situations in ways that cause us to have negative emotional reactions; the cognitive behavioral therapist challenges them with rational thought.

A little secret from a therapist: The silent treatment is a form of gaslighting. It is used as a way to control you. The intention is to teach you a lesson for presenting an issue, setting a boundary, or wanting something different. It's harmful to your mental health and it diminishes trust in relationships. Repeat After Me: The silent treatment is a form of punishment that is meant to harm. When someone gives me the silent treatment, I don't have to accept bad behavior; I can speak up, refuse mistreatment or make it known that it won't become a pattern.

Anxiety is one of the most common mental health challenges faced by people in Orlando, Florida, affecting individuals of all ages, backgrounds, and lifestyles. Whether it's generalized anxiety, panic disorder, social anxiety, or specific phobias, the symptoms can be deeply distressing and disruptive—racing thoughts, constant worry, muscle tension, insomnia, and overwhelming fear that can make even everyday situations feel unmanageable. The good news is that effective anxiety treatment is available in Orlando, and many people are finding meaningful relief and support through a variety of professional, evidence-based approaches. The city is home to a diverse and growing community of mental health providers, including licensed therapists, psychiatrists, and holistic wellness practitioners, all dedicated to helping individuals understand, manage, and overcome their anxiety in ways that align with their personal needs and goals. Treatment for anxiety in Orlando typically begins with a comprehensive evaluation to understand each person’s specific symptoms, triggers, medical history, and lifestyle factors. From there, providers work closely with patients to develop a personalized treatment plan that may include psychotherapy, medication, or a combination of both. Cognitive Behavioral Therapy (CBT) is one of the most widely used and research-supported methods for treating anxiety.

Many therapists—psychiatrists, psychologists, and those in behavioral health—won’t take private insurance, exchange plans, or Medicaid plans because they don’t pay providers well, which means outpatient care is still an issue. Covered treatment becomes an emergency room issue and is reactionary rather than preventive. And, according to the National Alliance on Mental Illness, in our contemporary mental health crisis, people are more likely to encounter police than get medical help. “As a result, 2 million people with mental illness are booked into jails each year. Nearly 15 percent of men and 30 percent of women booked into jails have a serious mental health condition.

love does not require toughness for it to facilitate behavior change. People can be corrected with empathy. People can be held accountable with empathy.

The gestalt approach to therapy is also an experiential approach and focuses more on the process of therapy rather than the content. It is a way of seeing and knowing that emphasizes action and dynamic awareness rather than introspection (Perls et al., 1951). Fritz Perls is considered the founder of gestalt therapy and he believed humans are oriented toward growth and function holistically while striving to meet needs through contact with their environment. However, this environmental contact can produce anxiety as it can be painful or uncomfortable. The result may be avoidance which leads to unmet needs and even dysfunctional behavior (Passons, 1975). To assist with change the therapists place themselves as fully as possible into the experience of the client while withholding analysis, judgment or interpretation (Perls et al., 1951). At the same time, they look for ways to increase the client’s awareness of what they are doing in the present moment. Another aspect of therapy is to look at the role of unfinished business from the past that may be impacting dysfunctional behavior in the present.

As is true in many families where children create enormously upsetting diversions from core family secrets, Elana’s family fixed on her behavior as further proof that the secret should remain buried. When behavior is truly a distraction for the unspeakable, therapist after therapist may be brought in, each attempting to intervene at the wrong level, mistakenly addressing such signals at the biological, behavioral, intrapsychic, or interpersonal level, while completely missing the unimaginable maze of secrecy in which such actions are embedded.

Here are a few of the sources I used, and I heartily recommend them: Simon Baron-Cohen, The Science of Evil; Judith Beck, Cognitive Behavior Therapy; Louis Cozolino, The Making of a Therapist; Kevin Dutton, The Wisdom of Psychopaths; James Fallon, The Psychopath Inside; Peter and Ginger Ross Breggin, Talking Back to Prozac; Robert D.

Of course, not all failures in integration result in dissociation. Integrative failures are on a continuum. Dissociation involves a kind of parallel owning and disowning of experience: While one part of you owns an experience, another part of you does not. Thus, people with dissociative disorders do not feel integrated and instead feel fragmented because they have memories, thoughts, feelings, behaviors, and so forth that they experience as uncharacteristic and foreign, as though these do not belong to themselves. Their personality is not able to “shift gears” smoothly from one response pattern to another; rather, their sense of self and enduring patterns of response change from situation to situation, and they are not very effective at adopting new ways of coping. They

make them progress more smoothly. As you write, be sure that the transitions between one idea and another are clear. If you move from one idea to another too abruptly, the reader may miss the connection between them and lose your train of thought. Pay particular attention to the transitions from one paragraph to another. Often, you’ll need to write transition sentences that explicitly lead the reader from one paragraph to the next. Clarity Perhaps the fundamental requirement of scientific writing is clarity. Unlike some forms of fiction in which vagueness enhances the reader’s experience, the goal of scientific writing is to communicate information. It is essential, then, that the information is conveyed in a clear, articulate, and unclouded manner. This is a very difficult task, however. You don’t have to read many articles published in scientific journals to know that not all scientific writers express themselves clearly. Often writers find it difficult to step outside themselves and imagine how readers will interpret their words. Even so, clarity must be a writer’s first and foremost goal. Two primary factors contribute to the clarity of one’s writing: sentence construction and word choice. SENTENCE CONSTRUCTION. The best way to enhance the clarity of your writing is to pay close attention to how you construct your sentences; awkwardly constructed sentences distract and confuse the reader. First, state your ideas in the most explicit and straightforward manner possible. One way to do this is to avoid the passive voice. For example, compare the following sentences: The participants were told by the experimenter to press the button when they were finished (passive voice). The experimenter told the participants to press the button when they finished (active voice). I think you can see that the second sentence, which is written in the active voice, is the better of the two. Second, avoid overly complicated sentences. Be economical in the phrases you use. For example, the sentence, “There were several different participants who had not previously been told what their IQ scores were,” is terribly convoluted. It can be streamlined to, “Several participants did not know their IQ scores.” (In a moment, I’ll share with you one method I use to identify wordy and awkwardly constructed sentences in my own writing.) WORD CHOICE. A second way to enhance the clarity of one’s writing is to choose one’s words carefully. Choose words that convey precisely the idea you wish to express. “Say what you mean and mean what you say” is the scientific writer’s dictum. In everyday language, we often use words in ways that are discrepant from their dictionary definition. For example, we tend to use theory and hypothesis interchangeably in everyday language, but they mean different things to researchers. Similarly, people talk informally about seeing a therapist or counselor, but psychologists draw a distinction between therapists and counselors. Can you identify the problem in this

The individual struggling with overwhelming emotions and DBT therapists will benefit significantly from this workbook.

​Think about things that seem too obvious to say, and then say them. We are often so sure of our core beliefs that we think they don’t merit examination. You can ask yourself other questions to help elicit your core beliefs: What is the world like? What am I like? What are others like? What is the future like? Is there meaning? Do I view myself as a valued member of the community? Am I lovable? Am I hopeful? Can I deal with difficult situations? ​Another useful technique that therapists use is called the downward-arrow technique. Beginning with a distressing automatic thought, ask yourself, “What does this mean?” For each answer, ask the question repeatedly until you arrive at a fundamental, core belief that has no deeper meaning. For example, someone could be depressed after becoming paralyzed in a car accident. Asking “What does that mean?” might result in the following responses: I am paralyzed → I can’t take care of myself → Someone has to take care of me → I am a burden to society → I have no value. In this way, the person identifies the dysfunctional core belief “I have no value.” Once core beliefs are identified, you can challenge them and try to create healthier beliefs.

If, reading this chapter, you recognize yourself as an extreme pessimist, my advice is to find a cognitive behavioral therapist. I know how unsatisfying this recommendation might sound. Many years ago, as a teenager, I wrote to Dear Abby about a problem I was having. “Go see a therapist,” she wrote back. I recall tearing up her letter, angry she didn’t propose a neater, faster, more straightforward solution. Nevertheless, suggesting that reading twenty pages about the science of hope is enough to remove an ingrained pessimistic bias would be naive. There’s much more to say about cognitive behavioral therapy and resilience training than I can summarize here.

This particular form of relationship is best represented by the mother-child relationship. In our research into this particular relationship, we found out how important it can be for the child's future development. Many scientists and therapists consider the mother-child relationship to be the working model for all subsequent relationships that the child will develop. A stable and healthy love affair with the primary caregiver appears to be associated with a high probability of healthy relationships, while a weak love affair with the mother or primary caregiver appears to be associated with numerous emotional and behavioral problems later in life.

While getting treatment for compulsive sexual behavior, it’s important to know about the details of coping and support plans. Here’s what we have curated for you today about Porn Addiction Therapist Grapevine.

The primacy of cognition over affect was a cornerstone of the theoretical framework that organized the work of early cognitive behavioral therapists

Let me tell you the story of Alice in Wonderland,” said John. “Alice sees this very unusual rabbit go down a hole, and she jumps in with two feet. She has no idea what this journey is going to be and Wonderland isn’t really all that great a place—there’re scary things, challenging things, and things that are also interesting and fascinating. It’s an adventure, and Alice doesn’t know what’s in store for her, but she jumps in anyway. Alice doesn’t hesitate or think maybe a better rabbit will come along tomorrow. She feels in her heart that she’s embarking on a profound journey and that, despite the difficulties, it’s still magical and amazing. Alice doesn’t look back and doesn’t question the adventure she’s chosen. That’s commitment. You two never did that. You have the trappings of commitment and loyalty, but you go to a party and think someone else can meet your needs better. You don’t like each other’s behavior and think that means they’re not the one for you. When you negotiate with each other, it’s always from a point of self-interest, not mutual benefit. You haven’t built trust, or commitment, or a foundation of loyalty to each other because you’re not really in this relationship. That’s why no therapist can help you. You’re both still looking over your shoulder thinking the grass would be greener if you had followed some other rabbit down some other rabbit hole, into some different wonderland.

A great deal of understanding is shown for an unemployed father who beats his children. There is no problem understanding an overburdened executive who does the same thing, especially when he is irritated by his wife. The wife also meets with understanding when she can’t help beating her child after the milk boils over. This parental behavior is understood because the therapists have probably been victims of such situations countless times and are invariably ready to understand the parents rather than face the repressed truth about their own lives. They have been trained for this, and at the same time they have been taught that it is dangerous to become aware of the situation of the child.

A general principle of human behavior is that it’s easier for us to see something negative in other people than in ourselves. This mental process sometimes guides therapists when they make interpretations during treatment. Often, the traits that disturb us most in others are those that we ourselves possess. It may upset us to see these qualities in other people, but it’s completely unacceptable to acknowledge them in ourselves. Richard’s complaints about Brenda probably

Replace Behaviors That Make Your Rumination and Worry Worse There’s not much point in using strategies to decrease rumination and worry if you’re concurrently adding fuel to those fires. Self-criticism is one kind of fuel. Other types of fuel include things like excessive reassurance seeking, spending hours looking up health information online, or compulsively looking at your ex’s Facebook page. Look out for behaviors that seem to provide a temporary reprieve from anxiety but, in fact, make you feel like you need to go back and repeat them. Look into seeing a cognitive behavioral therapist if you can’t stop those behaviors on your own.

I’ll never forget a story I heard years ago about a whirling dervish of a girl with ADHD, nine years old. Her teacher proposed a deal, a reward for meeting a behavioral goal. If the girl could “be good” for three weeks, the teacher would buy her an ice cream cone. The girl reported to her therapist: “Is she kidding? I can’t ‘be good’ for three hours, let alone three weeks. And besides, I don’t like ice cream.

It is important to note that though the process of habit change is easily described, it does not necessarily follow that it is easily accomplished. It is facile to imply that smoking, alcoholism, overeating, or other ingrained patterns can be upended without real effort. Genuine change requires work and self-understanding of the cravings driving behaviors. Changing any habit requires determination. No one will quit smoking cigarettes simply because they sketch a habit loop. However, by understanding habits’ mechanisms, we gain insights that make new behaviors easier to grasp. Anyone struggling with addiction or destructive behaviors can benefit from help from many quarters, including trained therapists, physicians, social workers, and clergy. Even professionals in those fields, though, agree that most alcoholics, smokers, and other people struggling with problematic behaviors quit on their own, away from formal treatment settings. Much of the time, those changes are accomplished because people examine the cues, cravings, and rewards that drive their behaviors and then find ways to replace their self-destructive routines with healthier alternatives, even if they aren’t fully aware of what they are doing at the time. Understanding the cues and cravings driving your habits won’t make them suddenly disappear—but it will give you a way to plan how to change the pattern.

This stage [relapse] is hard because the behaviors people want to modify are embedded in the fabric of their lives; people with addiction issues (whether that addiction is to a substance, drama, negativity, or self-defeating ways of being) tend to hang out with other addicts.

I will add a piece of advice that my therapist Jason gave me when I was debating whether I'd endured true abuse. He told me that he couldn't travel back into the past and prove that anything I'd endured was abuse, but he could see that my behavior patterns were those commonly found in a person who had been repeatedly treated like their emotions didn't matter. Just as a surgeon can recognize a fracture that is consistent with a physical struggle, Jason could look at my behavior and fears and recognize the lingering effects of being emotionally invalidated, neglected, and used by adults for comfort.

Mental health is an essential part of overall well-being, and in a thriving, fast-growing city like Raleigh, North Carolina, more individuals and families are recognizing the importance of prioritizing their emotional and psychological health. Whether facing stress from work or school, navigating life transitions, managing anxiety or depression, coping with grief, or living with more complex conditions like PTSD, OCD, or bipolar disorder, people throughout Raleigh are seeking mental health support—and finding it in a diverse and dedicated network of providers.Yet with the pace of life, population growth, and everyday pressures, it’s no surprise that mental health has become a vital topic of concern and conversation. Fortunately, the city offers a robust range of services and resources designed to support individuals at every stage of their mental wellness journey. Mental health care in Raleigh encompasses a wide spectrum of options—from traditional therapy and psychiatric medication management to holistic and community-based approaches. Licensed therapists, psychologists, and counselors are available in private practices, group clinics, and nonprofit organizations across the city and surrounding areas like Cary, Garner, and Wake Forest. These professionals offer evidence-based therapy approaches such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), trauma-informed care, EMDR, and mindfulness-based therapies. Whether someone is seeking help for a specific issue like panic attacks or relationship difficulties, or is simply feeling overwhelmed and in need of someone to talk to, there is a provider in Raleigh who can help. Many practices specialize in working with particular populations—such as children and adolescents, veterans, BIPOC communities, LGBTQ+ individuals, or survivors of trauma—ensuring that people receive culturally sensitive, identity-affirming care that meets them where they are.

As a self-appointed spokesperson for the importance of feelings, I feel like a pariah among my peers. My poor colleagues are in the thrall of Cognitive Behavioral Therapy. Scientifically hamstrung CBT barely recognizes the legitimacy of feelings! They are phenomena that must be subjected to affect regulation via processes that can turn people into emotional eunuchs.

feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them. But if we push them away the second they appear, often we end up veering off in the wrong direction,

Trying to get the patient to consider their past and how it went wrong, and what could have gone better and how should it be different, what can happen, what’s the most likely outcome and so on—a lot of these different interventions are actually worry- and rumination-increasing interventions,” he told me over Zoom. Instead, when patients present with depression or generalized anxiety disorder, therapists “should be doing worry and rumination discontinuing interventions.”[5] Meaning, a good therapist should do what cognitive behavioral therapists do: prove to a patient that rumination is an unproductive mode of thought and train them to stop.

One clue that you might have a case of engineered rather than organic DID on your hands could be the intense feelings of being deskilled and inadequate that arise in you as you are treating one of these clients. They puzzle and confuse even the most experienced of therapists until their multiplicity is recognized as engineered. Another sign might be the sudden appearance of self-harm, compulsions, or 'crazy' behavior after patient disclosures. These people have trip wires layered into their programming that are set to 'go off' whenever a therapist gets too close to a hidden truth or when the client remembers something new. These booby trap programs can look like: • sudden suicidal impulses out of nowhere, especially ones that are 'supposed to look like an accident'. as one client told me • scrambled words or word salad in a client that has no history of schizophrenia • an abrupt nonnegotiable firing of the therapist when the client is making progress • pseudoseizures—episodes that look like grand mal seizures or dropping into a semi-conscious state with no EEC evidence of seizure activity • feelings of being electrically 'shocked' at different places on the body • recurrent and constant migraines • an unexplained compulsion to return to a previously abusive environment that they have successfully left, such as an abusive family of origin or spouse, especially at certain times of the year such as Halloween.

And once he was gone, I filled the void by Google-stalking him when I should have been writing. So many of our destructive behaviors take root in an emotional void, an emptiness that calls out for something to fill

People who come to therapy present snapshots of themselves, and from these snapshots, a therapist has to extrapolate. Patients arrive, if not at their worst, then certainly not at their best. They might be despairing or defensive, confused or chaotic. Generally, they’re in very bad moods. So they sit on the therapist’s couch and look up expectantly, hoping to find some understanding and, eventually (but preferably immediately), a cure. But therapists don’t have an immediate cure because these people are complete strangers to us. We need time to acquaint ourselves with their hopes and dreams, their feelings and behavior patterns, sometimes more deeply than even they have.

In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this: Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment. If we have a choice between believing one of two things, both of which we have evidence for—I’m unlovable, I’m lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations (the everyone’s-life-is-better-than-mine station, the I-can’t-trust-people station, the nothing-works-out-for-me station) instead of moving the dial up or down? Change the station. Walk around the bars. Who’s stopping us but ourselves? There is a way out—as long as we’re willing to see it. A cartoon, of all things, has taught me the secret of life.

History is the best yardstick for judging the ability to modify behavior. It tells us just how long we may expect the learning curve to be. The longer a behavior has been effective for an individual, the more resistant she will be to changing this pattern in the future. This is why nobody—human or dog—escapes a therapist’s office without digging into family history; how far back a habit goes really makes a difference in potential outcomes.

A little-discussed fact: Therapists go to therapists. We’re required, in fact, to go during training as part of our hours for licensure so that we know firsthand what our future patients will experience. We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others.

At some point in the recovery process, the addicted gambler will learn that they have an addiction, that their brain has been compromised by their gambling behavior, and that it is now preventing them from stopping that behavior. That knowledge will help a little to reduce the shame. The problem that still exists is that your friends and family likely don't know you have an addiction, or they don't really understand what that means. You know that they are judging you, you still feel the helplessness of that judgment, and yet you still don't really understand why you can't stop. It gets even worse. In order to justify your new reality that you can't quit, that you have an addiction, the thing that will irrefutably prove your inability to quit, and that will show to others that you do, in fact, have an addiction, is to continue to gamble. You can then say with confidence to your therapist or family, I have an addiction! I went to the casino again, I can't stop. Because if I do simply stop, I wouldn't have this inability to stop. My addiction excuse would disappear, and I would have to go back to knowing that I'm stupid and weak and immoral for all the gambling I have done. So, in order to not feel weak, stupid and immoral, I'll run with that addiction idea and just keep on gambling! This is where Dr. Linehan's concept of Radical Acceptance can be very powerful for addicted gamblers. It is a way out of the negative spiral described in the previous paragraphs. Don't get stuck in the guilt and shame cycle. Accept that those things are in your past, cannot be changed, and need to be understood simply as what you've done, not who you are. Then you can move on to finding solutions for your goal of changing future behavior, for your goal of living a gambling free life.

because feelings lead to behaviors. Once we know what we’re feeling, we can make choices about where we want to go with them.

So many of our destructive behaviors take root in an emotional void