Curious, Healing » psychology

“The Gift of Therapy” by Irvin Yalom, MD

Sonia Connolly — Sun, 15 Apr 2012 00:59:36 +0000

Subtitle: An Open Letter to a New Generation of Therapists and Their Patients

Recommended by: Rachel Manija

This is a collection of short tips about psychotherapy from a longtime practitioner. I loved his tips about creating a warm, safe, positive relationship with the client and processing the here-and-now of the relationship for clues about how to help the client with external relationships. I loved that he starts with the assumption that he is helping to remove obstacles, because everyone naturally grows and develops given the chance. I loved that he sees himself as a fellow traveler with his clients.

This quote early in the book of German philosopher Arthur Schopenhauer expresses our common expectations that life should go well, and that we’ve done something wrong if it doesn’t, and yet it so often doesn’t.

In early youth, as we contemplate our coming life, we are like children in a theater before the curtain is raised, sitting there in high spirits and eagerly waiting for the play to begin. It is a blessing that we do not know what is really going to happen. Could we foresee it, there are times when children might seem like condemned prisoners, condemned, not to death, but to life, and as yet all uncounscious of what their sentence means.

I found the stated assumption that clients are causing their own problems frustrating and condescending. He overtly says he makes that assumption because that is how he can be effective in helping the client. Reminds me of someone looking for lost keys under the streetlight because they can see better there.

Of course it’s true in many cases, and looking at one’s role in a recurring problem can be a fruitful exploration. He seems to say that it is universally true, and does not acknowledge the work a client may already have done in that arena. Some clients need help to stop blaming themselves. I hear an underlying assumption that clients are broken, despite his starting assertion that growth simply requires the removal of blocks.

I think as a white male doctor he has a lot more experience of agency in his life than a lot of his clients, and he would also naturally discuss in his book the clients who benefited most from his approach. It makes me angry that the book made me question myself again on the topic, and I imagine he had that effect on some clients as well.

He repeatedly brings up the damaging effect on psychotherapy of insurance, “managed care,” lower compensation, less training, and “evidence-based” treatments. This book is a defense of long-term therapy toward profound change.

The book is a quick read. I recommend it as a tool to learn about psychotherapy, although I would not personally benefit from a therapist who followed all these practices.

Available at Powell’s Books.

“Self-Compassion” by Kristin Neff, Ph.D.

Sonia Connolly — Tue, 10 Apr 2012 05:51:39 +0000

Subtitle: Stop beating yourself up and leave insecurity behind

Kristin Neff is a psychology professor who focuses on self-compassion. Her book has a lot of helpful information – and also pushed my buttons. I think I’m not in her target audience.

While Kristin Neff talks about some emotional trauma in her life, there is an “us vs. them” feeling when she talks about trauma and mental illness, and an element of blame for self-defeating behaviors that arise from anxiety and self-criticism. It’s hard to read about compassion while feeling the raw edge of judgment.

I think she intentionally simplifies the discussion and examples for her intended audience, and “proves” her ideas by referring to small research studies where she gave questionnaires to college students.

I set the book aside in frustration, but I’m glad I went back to it.

Self-compassion is first compared with self-esteem. Self-esteem is an evaluation of our self-image, where self-compassion is a response to feeling fear, shame, or other painful emotions. Self-esteem depends on comparison and competition with others, where self-compassion reminds us of our common humanity.

To err is human. Better to be human than perfect. Moments of shame and inadequacy feel isolating, but all humans have them. Where do you excel? Where are you average? Where are you less than average?

She suggests gentle caresses, and kind words of acceptance. “Poor darling. This is really hard right now.”

Remember that our actions arise from an interconnected web of genetics, environment, past events, and current resources. Causality and blame are ambiguous. “Judgment defines people as bad vs. good. Discriminating wisdom recognizes complexity and ambiguity.”

Mindfulness helps us notice moments of suffering before (or while) dropping into blame and problem-solving. It helps us respond rather than react. Suffering = pain x resistance.

“One thing we have little power to change is what goes on inside our own heads. [...] Thoughts and emotions arise unbidden and often overstay their welcome.”

Notice the experience of painful feelings in the body, and send yourself compassion for feeling that way. “Soften, soothe, allow.”

Three doorways into self-compassion: mindfulness, common humanity, kindness.

“This is a moment of suffering.
Suffering is part of life.
May I be kind to myself in this moment.
May I give myself the compassion I need.”

Self-compassion can be hard for survivors of childhood abuse because it is sometimes associated with the cycle of alternating kindness and abuse.

Self-compassion doesn’t magically make the negative thoughts and feelings go away.

Self-compassion motivates better than self-criticism, despite what many parents and teachers enact. Love, not fear. “What’s good for you?” instead of “Are you good enough?” Intrinsic vs. extrinsic motivation.

Sympathetic joy – appreciating others’ success and good qualities allows us to appreciate our own as well, and helps us stay aware of the positive in general. Celebrate achievements, which also come from a mix of genetics, environment, etc.

Through the book, Neff talks about how helpful self-compassion has been with her husband Rupert and son Rowan, especially when Rowan was diagnosed with autism. At the end of the book she describes their adventure in Mongolia, combining horseback riding with shamanism to help Rowan, chronicled in the documentary and book, “The Horse Boy.”

Available at Powell’s Books.

“The Myth of Sanity” by Martha Stout, Ph.D.

Sonia Connolly — Tue, 03 Apr 2012 22:00:14 +0000

Subtitle: Divided Consciousness and the Promise of Awareness; Tales of Multiple Personality in Everyday Life

This book contains a therapist’s compassionate, engaging views on people who have Dissociative Identity Disorder (previously known as Multiple Personality Disorder) and how they can heal. Martha Stout discusses both specific cases and general themes of survival, courage, integrity, and the process of healing.

After trauma, she says the core question is, “Shall I choose to die, or shall I choose to live?” Those who choose to live, live fully, passionately. Anything less would not be worth the struggle and pain of healing.

Healing requires going back and revisiting traumatic memories while the whole nervous system shouts, “No! Danger!” They don’t all have to be revisited, and perfect recall is not required, but at least a few frozen traumatic memories have to be transformed into narrative memory.

The key predictor of healing is a sense of responsibility for one’s actions. Conversely, prioritizing self-protection above responsibility acts to keep dissociative mechanisms in place. A sense of integrity, or the lack of it, shines through all the dissociative fragments of a person.

We see dramatic portrayals of Dissociative Identity Disorder in books and movies and believe it to be very rare, but most people with DID switch quietly, unnoticed, in higher numbers than we believe. Martha Stout says it is because most people aren’t such good actors, and I think people also try to camouflage switching as much as possible. She validates the anger, frustration, and bewilderment of coping with someone’s quicksilver changes and lack of memory for their own recent words and actions.

She also says that we all dissociate to some extent, whether arriving at a destination without remembering the drive, or being absorbed in a movie, or suppressing “inconvenient” emotions.

For trauma survivors she recommends:

Find help, a steady witness, whether a therapist or a friend.
Be as safe as possible in the present. Provide your nervous system with a calm environment.
Buy comforts, keep a pet, fall in love with silence.
Separate yourself from difficult, crisis-addicted, rageful, and violent people.
Have routines. Make them sacred. Sleep every night.
Meditate.
Keep a journal. Note your dreams.

This book is unreservedly recommended!

Available at Powell’s Books.

“Embracing Your Subconscious” by Jenny Davidow

Sonia Connolly — Sat, 11 Feb 2012 22:12:45 +0000

Subtitle: Bringing All Parts of You Into Creative Partnership: Conscious & Subconscious, Head & Heart, Masculine & Feminine, Adult & Child, Waking & Dreaming

Recommended by: Jenny Davidow

Jenny Davidow’s clear, practical, non-judgmental book covers a surprising array of techniques to make friends with your subconscious. Learn to decode your dream symbols, negotiate inner alliances, create positive endings, take fantasy vacations, transform outdated beliefs, heal your inner child, dream lucidly, connect with your creativity, and widen your choices in your waking life. Vivid examples and detailed exercises encourage you to make these techniques your own.

As seen in the parallel paired contrasts in the subtitle, the book emphasizes stereotypical, Jungian ideas about masculine and feminine attributes. In addition to being passive and receptive, femininity is paired with childhood and innocence. In several examples, women resolve relationship issues, while men resolve career issues.

Both outer relationships and the “inner marriage” between (stereotypical) masculine and feminine aspects are heterosexual, with no discussion of other possibilities.

This book safely skirts the realm of “you control external reality with your thoughts” while offering practical tools to negotiate improvements in your internal reality. Recommended, with the noted caveats.

Available at Jenny Davidow’s website.

“Forgive for Love” by Dr. Fred Luskin

Sonia Connolly — Fri, 27 Jan 2012 01:40:57 +0000

Subtitle: The Missing Ingredient for a Healthy and Lasting Relationship

Recommended by: my sister

There are some good ideas in this book, delivered in a patronizing, lecturing tone with a lot of repetition. Yes, people choose each other for a reason, and it’s useful to remember that when times get hard. No, staying with someone when pregnant and later having more children with them is not always an uncomplicated free choice in our misogynist society.

One of the recommended techniques is deep breathing to calm the nervous system. I liked the explicit tie from nervous system activation (stress) to continued struggles, and from nervous system calming to forgiveness. The more we can calm our nervous systems, the better we feel, regardless of how others behave.

I also liked the repeated statement that forgiveness and acceptance are two different things. One can forgive someone for behaving badly, and still get out of range of their bad behavior.

Being forgiving means understanding that you can’t force your lover to change just because you are uncomfortable, inconvenienced, or disturbed. It is up to you to manage your emotional reactions, not the responsibility of your partner. Once you are able to forgive, you can deal with the [original] problem with dignity and openness, not blame.”

Other good advice: Notice what does work, since our attention is often drawn to what doesn’t work. Be grateful for the blessing of being loved. Change “You must …” to “I wish…” and drop unenforceable rules. Grieve the losses when you don’t get what you want. Both recognize that you are flawed, and give yourself a break. Forgive yourself.

Sadly, the example couples are all heterosexual and all painfully adherent to their stereotypical gender roles, except in two examples where the roles are still stereotypical but it looks like the names have been swapped.

Race, ethnicity, and income are not mentioned, but all the names and stories read as white, European-American, and middle class.

There was one great example where, early in Dr. Luskin’s couple’s therapy career, a man came in with a long list of complaints about his wife. The therapist sat stunned, thinking that the wife deserved combat pay for putting up with this, and finally responded, “If she met your standards, why would this superwoman hang out with you?” His main point was that the wife forgave the husband for being critical. To me, that highlights the difficult line between forgiving people for having human failings, and tolerating abuse.

Recommended as a first book about forgiveness for heterosexual gender-role compliant white people in monogamous couples, or for anyone else who can be forgiving of the book’s weak points.

Available at Powell’s Books.

“Transition and Beyond” by Reid Vanderburgh

Sonia Connolly — Tue, 17 Jan 2012 04:57:42 +0000

Transition and Beyond

Subtitle: Observations on Gender Identity

Recommended by: Reid Vanderburgh, MA, LMFT

Speaking as both a trans man and a psychotherapist, Vanderburgh provides a compassionate, detailed tour through all the aspects of gender transition, from contemplation to completion. Client vignettes provide real-world examples.

The book candidly addresses every question I had about gender transition as well as many I had never considered. It does leave lingering differences to grow up socialized as one gender and transition to another. Conscious resocialization is needed. People transitioning male to female learn about losing male privilege and taking up less conversational and physical space to fit in with other women.

People with DID (multiple personalities) can be transgender, and at the same time a history of abuse is a complicating factor. In abusive families, children may desire to be a different gender to feel less vulnerable or identify with a less abusive parent.

Throughout, the book emphasizes the physically dissonant aspects of having the wrong hormones for one’s gender identity.

If a person is capable of developing truly intimate, honest, fulfilling adult relationships in the gender assigned to them at birth—they’re probably not trans. Part of what it means to be trans is an inability to truly mature into adulthood in one’s birth gender assignment.

Vanderburgh advocates a slow, self-observant approach to hormone therapy to help adult clients confirm that they are on the right path. Some transgender children are certain of their identity from toddlerhood and should be fully supported in social and physical transition when they are ready.

Recommended for anyone who is interested in learning in more depth about what it means to be transgender and how to help make transition easier.

Vanderburgh recently announced the closure of his therapeutic practice to pursue teaching and writing opportunities.

Available at Vanderburgh’s website.

“The Mother’s Voice” by Kathy Weingarten

Sonia Connolly — Sun, 13 Nov 2011 04:05:51 +0000

Subtitle: Strengthening Intimacy in Families

I read this by coincidence, and it fits perfectly with themes I’ve been thinking about lately. Kathy Weingarten, a family therapist, addresses double binds that society creates for women around acceptable roles and definitions of success. She talks about dominating behaviors in men and how to address them. She weaves her personal story of motherhood, illness, and family together with societal trends. Throughout, she maintains awareness of intersectional issues of race, class, sexual orientation, and gender.

When she was diagnosed with breast cancer, she realized that her need to focus on her health conflicted directly with her need to be a “good mother” by focusing wholly on her pre-adolescent children. This contrast brought to light the invisible constraints society placed on her thoughts about mothering. She includes thoughts about the roles of wives and fathers as well.

At age 7, her son bullied her daughter, then 3 years old. She withdrew from his dominating behavior, and had to consciously reconnect with him. As she connects with him as “like her” rather than disconnecting as “alien, unlike her,” she has leverage to change the roles society prescribes for boys, sons, and men, as well as for mothers.

When she shares her true feelings and thoughts with her children in age-appropriate ways rather than maintaining a perfectly serene front, she builds real connections with them and allows them to see her as a separate person.

I appreciate how much consciousness and intention Weingarten brings to her mothering.

Some passages become repetitive, perhaps in an attempt to convince the reader, but that is a minor flaw. Overall, this is a beautifully written, carefully thought out, intimate gift of a book. Highly recommended.

Available at Guilford Press.

“I Thought We’d Never Speak Again” by Laura Davis

Sonia Connolly — Sat, 05 Nov 2011 00:48:35 +0000

Subtitle: The Road from Estrangement to Reconciliation

Recommended by: Laura Davis’s website

Laura Davis is co-author of the classic book about healing from incest, “The Courage to Heal.”

This book is written with compassionate awareness that not all stories have happy endings and not all estrangements can be reconciled. Nevertheless, I cried while reading it, for all the estrangements I have been unable to reconcile, and for all the reconciliations that turned out to be grave mistakes, and for all the fears that I should have been able to do it all better.

It has concrete suggestions for how to evaluate the possibility of reconciliation and take steps toward it, as well as a variety of gritty, beautiful stories about others’ attempts and successes. Davis’ reconciliation with her mother is woven through the book.

Recommended, if you have the time and energy to work through the feelings it might bring up.

Available at Powell’s Books.

“In an Unspoken Voice” by Peter A. Levine, PhD

Sonia Connolly — Sun, 02 Oct 2011 05:46:00 +0000

Subtitle: How the Body Releases Trauma and Restores Goodness

This book is billed as a “culmination of his life’s work” on the back cover. It recapitulates material from Peter Levine’s earlier book “Waking the Tiger” about trauma and the nervous system, and uses many of the same case studies covered in the Somatic Experiencing curriculum. Somatic Experiencing is Levine’s protocol for healing trauma, taught through the Foundation for Human Enrichment.

I liked his emphasis on the need for therapists to be present, flexible, and cooperative, rather than distant, rigid, and controlling. I liked his quote from an (unidentified) soldier returned from Iraq: “I have a Post-Traumatic Stress Injury, not Disorder.”

I liked his distinction between awareness and introspection: awareness is experiencing the inner glow of an ember, while introspection is examining it with an external flashlight. Awareness allows; introspection dissects. He also distinguishes between feelings (bodily sensations), and emotions (fear, anger, etc.) which arise when impulses are interrupted.

There are some annoying aspects to the book, starting with overuse of italics for emphasis. When discussing the history of scientific discoveries about trauma, emotions, and the nervous system, he repeatedly uses the words “prescience” or “prescient” regarding earlier researchers, even though they clearly did actual science. When talking about the calming effect of being near a peaceful person, he names three specific famous men and the generic “loving mother peacefully nursing her infant.”

This book would make a good textbook for Somatic Experiencing classes (aside from the annoying bits). It is too dense for a layperson to enjoy, and yet doesn’t cover the healing process in enough detail to be a technical reference on its own.

Available at Powell’s Books.

“I Thought It Was Just Me (but it isn’t)” by Brene Brown

Sonia Connolly — Sun, 28 Aug 2011 04:03:19 +0000

Subtitle: Telling the Trust About Perfectionism, Inadequacy, and Power

Recommended by: Pam Lyons

Brene Brown researches shame by listening to people’s stories. This book focuses on women for the most part, although she mentions how men’s experience of shame differs at the end of the book. The content overlaps with The Gifts of Imperfection quite a bit.

She describes shame as a “full-contact” emotion because it includes visceral and physical responses. Yes, emotions are physical. All of them. I became suddenly wary of an author who seems to live primarily in her head.

The writing tone is breezy and casual, overlaying the formal language of research. I can see the effort she put into structuring the anecdotes and creating the ideas of the shame web (people who engender shame) and connection network (people who support shame resilience) complete with cute iconic drawings.

On page 9 she puts in an “early call for compassion,” acknowledging that stories about shame are difficult to read, so we often leap to judgment rather than compassion to distance ourselves. I wonder how much of my reactions to the book fall in that category.

I appreciated her explicit inclusion of diverse women across race, class, sexual orientation, age, and religious identity. She includes a lot of her own stories, so there is a pronounced tilt toward mid/upper class white educated heterosexual married mothers of young children, but other voices are represented as well. She specifically mentions hair texture and skin tone as issues for women of color, for example.

One helpful bit for me was the typical responses to shame: moving toward, moving away, or moving against. I seem to have a lot of the moving toward response, and I hadn’t seen that reflected before. It’s not just me!

I’ve done a lot of personal work with shame and authenticity over the years. I suspect this book would be more useful for someone who has not thought about the subject as much. As I think about the fairly basic material and its presentation as earth-shaking new discoveries, I continue to get a sense that the author is disconnected from ongoing work about shame and community. Maybe no one else is pursuing that work in an academic context.

Edited to add: I thought a lot about the sense of distancing I got from the book, and the early disclaimer about shame being distancing. I decided my experience was valid (imagine that!) and the early disclaimer was the equivalent of “I don’t mean to be offensive, but [something offensive].” “I don’t mean to be distancing, but [distancing book].” I find it interesting that it took so much thought to validate my own experience.

Available at Powell’s Books.