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Thu Dec 13, 2007

Blessed Teresa of Calcutta and Divine Providence

I recently read a book by Blessed Teresa of Calcutta in which she talked about how she lived her life according to Divine Providence. It seems that she had no desires or aspirations of her own except to do exactly what she felt God wanted her to do. She then carried out what she believed was God's will with complete trust. She founded a religious order relying completely on God to raise the money necessary for construction and other logistics. There was mention of a time when a U.S. bishop told Teresa that she would never be able to raise funds necessary for a certain project and she asked him why he thought God's providence did not extend to New York.

This way of living seems so radical and flies in the face of many American values. I think of all of the psychological pain could be avoided by getting rid of all desires and behaviors that do not directly relate to serving God. So much self destructive behavior and relationship chaos would be out the window. Teresa's radical surrender, then, is really radical simplicity.

I often tell my clients that my job is to help them have boring lives. We work to put out fires and eliminate everything that is unwanted, and then they are free to fill their lives with all the things that they truly want.

Teresa had it right.

posted at: 20:30 | path: /saints | link

On Existentialism and Psychotherapy

The atrocities of World War II brought with them an unshakable preoccupation with the meaning of life and the seeming absurdity of human suffering. Philosophers in Europe cut deeper than Freud in their descriptions of the human condition and theorized that the essence of one's self was defined by one's solutions to the core problems of human existence: namely, how does a person live a life that he himself finds meaningful when (a) there are infinite possible worlds that he could create for himself, (b) the responsibility for the course of his life ultimately rests on no other person but him, and (c) he is faced with constant reminders of the reality that his life in this world will one day end.

When existentialism is applied in psychotherapy, then, the focus is on the person's responsibility for the situation in which he finds himself and for exploring the deepest meaning of psychological symptoms in order to creatively resolve them. Many of these symptoms, both individually and culturally, are boiled down to the fear of annihilation, and it is the task of the individual to ease this fear by choosing to embrace mortality and live life as fully as possible.

posted at: 19:36 | path: /existential | link

Religious Scrupulosity in OCD

One type of compulsion that I tend to see quite a bit is religious scrupulosity, in which the person is compelled to pray repeatedly or to worry about whether they have prayed as correctly or completely as possible. There is often an obsessive fear that fuels the compulsion, perhaps of going to hell or about being punished by God.

With these symptoms, I often find myself in the ironic position of trying to help someone to pray less. This is a great example of the yin-yang of therapy: Where someone is too extreme, the goal is to decrease; where they are too lax, the goal is too increase. Similar strategies that are used to combat other obsessions and compulsions, such as turning light switches on and off, remain extremely useful here. A typical bottom line is to help the person experience the fear and not run from it.

However, an important addition is usually helpful. This is to address the person's image of God. If the person is constantly fearing being smited by the Almighty for forgetting one Hail Mary in their 20 rosaries, then there is an image of an extremely harsh, punishing God at the root. It can be helpful to explore where this comes from, and why there is such an underemphasis on the idea of God's mercy, particulary if there is a prayer specifically appealing to God's mercy being said by the person after each of their Rosary decates.

I believe that the ability to meet the client deep within their own Christian framework and discuss the cognitive distortions within that context is critical in addressing scrupulosity, and this is one case where Christian psychology has an edge over a secular approach.

posted at: 17:43 | path: /ocd | link

The Purpose of Addiction

An addiction is a strategy for accomplishing something. Smoking can be a strategy for managing anxiety; alcohol abuse can be a strategy for literally swallowing pain; sex addiction can be a strategy for connecting. These strategies are often the best the person has been able to come up with on their own. In a sense, there is a need to give the person credit for creatively devising the strategy - for doing something instead of nothing.

The problem is, it's the wrong solution. Not only does the addiction not accomplish the intended goal, but it creates entirely new (and often more chaotic) problems that then dictate the devising of additional solutions. And so the drama spirals on.

To me the solution is not moralism but pragmatism. If there is a problem with anxiety, then address the anxiety. If there is a problem with underlying pain, grab it by throat and feel it. If there is a lack of connection, then connect at the deepest level instead of the emptiest.

In this sense, the addiction is the symptom and not the root of the problem. If we go after the true problem itself, the addiction then becomes pointless - purposeless. This is the way out of the spiral. "The truth shall set you free" (John 8:32).

posted at: 17:14 | path: /addiction | link

The Importance of "Team" in the Relationship

I believe that one of the most critical concepts for improving a relationship is that of "team." Consider the idea of a team working cooperatively to achieve common goals and then think about how much or how little that applies to your current relationship. If you feel that you and partner are light years from being a team, there is likely faulty communication and general dysfunction close at hand.

So the first step is to recognize how much you operate as separate, opposing entities rather than as a unified whole. For what areas of your relationship is this true? What are the triggers and topics that put the two of you into debating club mode? When your need to win the debate is your priority, there is no team to be found. Dr. Phil always says that every relationship needs a hero, and I agree. "Heroically" allowing yourself to lose the argument or admit that you were wrong can strengthen the relationship. Sometimes you need to take one for the team.

In what ways can you build more team focus into your relationship and how might that resolve dysfunctional patterns? Also, how might your faith inform a this process of team-building? How might a more Christ-like stance be an improved focus for each of you, and how might incorporating habits such as praying together be a concrete part of the solution?

posted at: 15:10 | path: /couples | link

Imagery Rescripting with Christian Content

Imagery rescripting, an established technique from cognitive-behavioral therapy, involves recalling a distressing memory, feeling the feelings associated with it, and then modifying the image in your mind so that it is less aversive and feeling the feelings associated with the modified image. Imagery rescripting has been found to be effective for minimizing negative symptoms associated with traumatic events.

For example, if you are bothered by a painful memory about being singled out and embarrassed by someone, I might help you to experience those feelings and then encourage you to alter the image to be less aversive, perhaps by picturing the person shrinking down to miniature size. By using this less intimidating image, we might be able to activate in you other emotions that you need to express (such as anger) in order to gain closure here.

One particular imagery rescripting technique that I use incorporates Christian content. In this technique, I might encourage you to modify the image by imagining Jesus entering into it and then processing what you experience. Clients will often report imagining Jesus hugging them or consoling them, which allows them to release significant emotion and restructure their perception of the original event. Many clients have said that they have found this technique effective, and some have even said that they believe something occurred on a spiritual level, which is wonderful.

This is an example of how Christian imagery can be used to develop a powerful image of resolution that can be associated with a previously unresolved memory in order to break its hold.

posted at: 14:34 | path: /imagery | link

Getting Specific About Symptoms

One of the most important ways of combating anxiety is to get specific. Anxiety is inherently vague. Clients often say that they don't know what exactly they are anxious about but that worries are always present. Half of the battle here is becoming your own detective and monitoring your thoughts.

What are the specific thoughts that are constantly running through your mind? Does it tend to be the same thought over and over, or are there a series of different thoughts? If they are different, are they related by a similar theme? We need to be able to study and name the enemy in order to get our arms around it and neutralize it.

This tactic may seem obvious and straightforward but often to be able to slow the mind down enough to jump in and put words to each issue one by one can very difficult. Some people find it useful to monitor their thoughts by writing them down. Some therapy techniques even go so far as having clients carry around devices that beep and require them to record their specific thoughts at the time of the beep.

The important thing is to be able to accomplish this important first step of treatment by moving from vague to specific.

posted at: 14:05 | path: /anxiety | link

Wed Oct 03, 2007

Embracing The Shadow Side

One of the most interesting concepts put forth by Carl Jung is that of the shadow. Jung posits that prominent personality traits tend to exist alongside their opposites. So, if I possess a certain trait to a great extent, then I also possess the opposite trait at some level, though I may be unaware of it. For example, if I am generally a very polite person, I am also likely to have a side of myself that is very impolite or even aggressive. However, to say that I am a polite person is to say that I generally do not bring the impolite side into reality, relegating it to my inner life, which I may glimpse through fantasy and dreams. This "unrealized" aspect of myself which generally contains material that I censor or stifle is known as the "shadow" side of my personality.

Like Jung, I beileve that it is important to acknowledge the existence of the shadow and to have some way of honoring it. I am not suggesting that we move through life constantly expressing every forbidden impulse or, pointing to the example, that we devise some schedule for venting our hidden impoliteness. However, an important element of fulfilling my potential as a human being is recognizing that I am complex and multifaceted. It is fine for me to be a polite person, but it must be acceptable for me to harbor fantasies of impoliteness, to laugh heartily at comedy that is impolite, and even to sometimes be impolite in situations that call for sternness. Otherwise, I do a disservice to myself by failing to be authentic and by ignoring -- and indeed blockading -- a potentially important aspect of myself.

To embrace the shadow is to live more completely. It is an extension of "The truth shall set you free" (John 8:32). To have sides of ourselves that are ugly is unavoidable; the task is to submit them, as with all other sides, to the will of God: "We are taking every thought captive to the obedience of Christ" (2 Corinthians 10). And this is no small task.

posted at: 10:49 | path: /theories | link

The Need for a Balanced View of Psychotropic Medication

Psychotropic medication can be an invaluable component to the treament of depression and most psychological issues. However, it is important to have a balanced perspective about these medications. First, it is important to recognize that as Americans we are conditioned to want to "fix" or "get rid of" symptoms as quickly as possible. This view of alleviating suffering is certainly understandable, but is often incompatible with issues such as bereavement, where a sometimes lengthy healing process is needed.

Furthermore, the depressive symptoms that we wish to remove may be indicative of larger issues that need to be addressed. Very often, people come to me asking how they can continue to behave in ways that are beyond their emotional capabilities without feeling the negative psychological effects of doing so. For example, if someone starts a new job and finds themselves depressed after two months, the typical question is "What can I do to not feel this way?" instead of "Is this the right job for me?" My approach is simply to be as efficient as possible: If you have your hand on a hot stove and are feeling pain, then take your hand off of the stove instead of asking what I can do to help you numb the pain.

The psychological suffering at hand may in fact be a mechanism for telling us that we are not on the right track -- either something is missing and we need to seek it, or something is present and we need to eliminate it. By removing the depressive symptom with medication, we may lose the critical information needed to address a core issue in our lives. Because I am a Christian psychologist, I believe that many symptoms that arise for people in fact have their roots in deep, spiritual issues. If someone's depression is present due to a fear of a punishing God, then, as a staunch pragmatist, I would advocate grabbing that issue by the horns and addressing it, instead of effectively ignoring it by eliminating the depressive symptoms with pills.

Finally, it is important to be aware of the chicken-and-egg game associated with brain chemistry in mental illness. In American culture, issues such as depression are often seen as caused by a chemical imbalance in the brain. Although there is significant research evidence that demonstrates that chemical imbalances are indeed associated with psychological issues, this does not necessarily mean that they are the cause of them. If you slapped me in the face repeatedly for an hour and then measured my brain activity, it would likely exhibit a chemical imbalance associated with depression. But in this situation I am not depressed because of the chemical imbalance but because someone is slapping me. The cause of internal emotional imbalance is frequently external.

Please note that I am not recommending that people taking medication for depression or any other condition should stop doing so (and I would never recommend stopping any medication without consulting with the prescriber). I work with many clients that are dramatically helped by medication and I stand in awe of these improvements. Also, there are degrees of severity with depression and in many cases, particularly the more severe ones, I will absolutely recommend the use of medication. However, it is important to remember that the biological is only one of the many aspects of our complicated human issues, and medication is only one of the potential solutions for them.

posted at: 10:46 | path: /depression | link