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Overview:
The purpose of pain in our life is to promote healing and growth. The
psychological pain of sadness, grief, fear, depression, or anger serves the same
purpose that physical pain does. Both physical and psychological distress warn
us that something is wrong and we need to do something different. I once read a
newspaper story about a young girl who suffered from a rare neurological
disorder which made it impossible for her to feel physical pain. Her health was
always in danger because she would do risky things which would cause her serious
injury but she wouldn’t know it. She had broken nearly every bone in her body
through reckless behavior because she did not know she was hurting herself.
When you are in pain psychologically, it is a
message to you that you need to make some changes in your life to alleviate the
pain and keep you from generating more pain. Your pain is a gift to you (yeah,
some gift!) to push you to make a better life for yourself and to stop injuring
yourself. Therapy can help guide you not just to feel better, but to understand
how you can change things so that your life will not generate so much pain. The
problems you bring to therapy present you with opportunities to grow and make
positive changes in your life.
Depression:
Depression is often said to be caused by a chemical imbalance in the brain and
that is a partial truth in most cases. Depression is also caused by a
pessimistic way of thinking about one’s self and one’s life which keeps the
depressed person feeling bad about themselves, inferior to others, unassertive
with others and helpless to make any changes. Anti-depressants have helped
millions of people and have been a lifesaver for many but therapies that focus
on changing the way you think and the way you relate to others have been shown
to be highly effective at getting people out of depression and helping
them to stay out. These therapies, called “cognitive-behavioral”, can be very
helpful by themselves or in conjunction with anti-depressant medication.
Many times, depressed people are in vicious
circles in which their negative thinking leads to ways of relating to others
which strengthen their negative beliefs. Here’s a common vicious circle:
· I believe that I am inferior to others so I don’t stand up for myself.
· Because I don’t stand up for myself, I get taken advantage of by others.
· When I get taken advantage of, I feel inferior to others.
· When I feel inferior, I don’t stand up for myself. And so on.
Breaking this kind of self-reinforcing cycle can be a very important part of
effective treatment of depression. If you learn to think more positively about
yourself and you learn to be more assertive with others, you will be stronger
and more in charge of your life and therefore less depressed.
Anxiety Disorders:
Like depression, anxiety disorders (these include obsessive-compulsive disorder,
generalized anxiety disorder, social anxiety disorder and phobias) are seen by
many as primarily a problem with brain chemistry, another partial truth. While
medications can be helpful for many, there are powerful
psychological therapies which focus on changing how you think and what you do in
the present. They use principles from cognitive and behavioral psychology to
help you gain control over your fears.
For many types of problems other than anxiety disorders, the specific techniques
used by your therapist are not particularly important to the outcome of therapy.
Many different techniques are effective with many different types of problems.
However, research seems to support the idea that with anxiety problems, specific
techniques matter a great deal. If your therapist is using a general, unfocused
talking therapy and is not using specific techniques to help you relax, combat
your fears with alternative thoughts, and gradually expose you to what you fear
in order to overcome that fear, you may not be getting the most effective
treatment for your problems.
I have found that when people have reduced their
anxiety problems enough so that their symptoms are not interfering with their
life, they may need to work on problems that were fueling their anxiety or were
covered up by their anxiety. For example, a couple’s marriage may be focused on
one of the partners’ anxiety problems, keeping them from having a fully
satisfying and mutual relationship.
The partner without the anxiety may be spending a great deal of energy taking
care of their mate and can become very frustrated. The person with the anxiety
may feel inferior and dependent. When the anxiety is not long present, the
couple may need some help to have a relationship without the anxiety.
Problems in marriages and other intimate
partnerships:
Most marital problems are not caused by lack of communication, but by lack of
maturity. Most couples come for help because one or both of them are trying to
change their partner and their partner is not changing. This leads to
frustration, blame, and anger. Often the member(s) of the couple who want
their partner to change try to get the therapist to make their partner “better”.
If the therapist does take one partner’s side and tries to make the other
change, therapy will not be successful.
What makes change possible in an intimate partnership is if at least one of the
partners is willing to change themselves so that they are different with their
partner. They often need to give up on their efforts to change the other. It is
not necessary that both partners want to work on themselves but it is easier
when both are willing to make changes in themselves and give up on their
efforts to change the other.
For partners willing to change themselves, they
usually need to work on two difficult projects at once: (1) emotionally letting
go of and accepting that their partner is the way he or she is and (2) learning
to communicate clearly and without blame to their partner about their own
thoughts, beliefs, values, feelings, and hopes for the relationship. This can be
very difficult work, particularly if the partner doing the work is in the habit
of trying to change the other and has spent little or energy working on
themselves.
Divorce or Other Breakups of Intimate
Partnerships:
Breakups of intimate partnerships are some of the most painful events that we
humans experience. People going through them roughly fall in to two categories:
(1) those who are initiating the divorce and (2) those who do not want to end
the relationship. Those who want to end the relationship often
seek help thinking through whether or not they are dong the right thing. They
have doubts about getting out and need a relatively neutral party to help them
think through whether they are doing the right thing or not. Generally, they do
not have as much distress as those whom they are leaving.
Those who are being left often come for treatment feeling an intense combination
of anger, guilt, betrayal, and fear. Often they need to work through their pain
as someone mourning the death of a loved one. Although no one has died, a
relationship and the hopes and dreams surrounding it have
died and they need to mourn. When their pain subsides to some degree, they also
can be helped by looking at how they got into the relationship in the first
place, how they might have contributed to the problems, and what they can work
on so that they will choose a healthier partner in future relationships.
Post-Traumatic Stress Disorder:
People can get traumatized by many things and can have a hard time “getting
over” those traumas. People can be hurt by being in combat, being in a bad car
accident, being sexually assaulted, or being physically assaulted. For years
after these events, people can continue to have fears of situations which are
similar to the situations in which they were traumatized. They can have
intrusive flashbacks and nightmares about them and avoid places or relationships
which would bring back the memories of these incidents. This is post-traumatic
stress disorder.
To be helped in therapy requires a willingness to gradually face these past
events and reduce the fear that is so closely tied to those events. Change comes
when the client emotionally knows that these are past events which do not need
to exert their power over their present lives. It helps to have a
compassionate and patient therapist who can guide you through talking about the
past trauma, feeling some of the feelings again in the context of a safe
relationship, and losing some of the fear. It also helps to have supportive
family and friends who can accept your pain and encourage you because you
are valuable to them.
Abusive Partnerships:
Being hurt physically, sexually or verbally by someone you love is a very
confusing and wrenching experience. On one hand, you are bonded in love (or what
you thought was love) with this person. You may have been with them many years
and you may hope for many more years together. On the other
hand, they repeatedly hurt you, control you and demean you. As you succumb to
the control of an abusive partner, you can come to completely disrespect
yourself.
Getting help is usually a process of regaining your sense of self, realizing
that it is not good for you to be controlled by your partner, learning to not
need their “love” and learning to move on with your life. This is such a
difficult process because you have been bonded to them, perhaps for many years,
and
you are drawn towards them at the same time you are trying to move away from
them. It is a heart-rending experience.
A therapist who appreciates both that you are emotionally tied to your partner
and that you are trying to protect yourself can be very helpful. Too often
therapists are so frightened themselves by what you have been through that they
push too hard for you to get away and are not able to appreciate the forces that
draw you towards them. It is up to you (not your therapist) to sort out when,
how and if you move away from your lover/abuser.
Child Behavioral Problems:
Bringing your child or adolescent for help is made difficult by the fact that
your child usually does not want to go for help—it is usually your idea. You are
concerned about some behavioral or emotional problem that your child has and you
may want your child to want to get over it. But young children are not (with
rare exceptions) motivated to get help for their problems. As a result,
the change that will come has to come from your efforts, not those of your
child.
It is important to go to a therapist who understands children and their problems
and can carefully evaluate your child and give you some accurate and helpful
information. Your child is not going to do the work to make the changes you’d
like to see, even if they want those changes, too. You will need
to work towards making the changes, whether that means changes in the way the
child is dealt with at school, a need for medication, or changes in the way you
parent your child. You may need to learn to be more consistent, firm, and
authoritative (not authoritarian!) with your child. You may need to learn to
listen better, pay more attention, or be more encouraging to your child. You may
need to work on changing yourself and dealing with your own problems before you
can be more helpful to your child. When you’re on an airplane, the flight
attendant will tell you that when the oxygen masks drop down in front of you and
you are traveling with a child “put your own mask on first and then assist your
child with their mask”. If you’re not getting any oxygen, you’re of no help to
them.
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